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-   -   Elderly long-term diabetic having weird episodes (http://k9diabetes.com/forum/showthread.php?t=8150)

juicy 06-03-2020 03:38 AM

Elderly long-term diabetic having weird episodes
Hi there. I am hoping for some advice for my 14-year-old lab/kelpie, Juicy, who has been diabetic for six years now. She is everything to me.

Shortly after she was diagnosed, I posted about her on this forum. I can't log in via my old user name now , but here's a link to that old thread if anyone would like to see it.

Just briefly before going into her history, our current problem is that she is having episodes where she seems very confused, disoriented, wobbly. It has been difficult to link these episodes to a specific trigger, but each episode seems to follow her blood sugar spiking very high (above 30) without clear cause. This has been going on for about four weeks. We have been back and forth to the vet - she has a very caring vet team, but still not sure what's going on.

The first episode - I came home to find she'd urinated twice in the house, which is not like her. Her BG was above 34 - too high for the meter to read. She had eaten breakfast well that morning and seemed herself. That night, she seemed groggy and did not attempt to eat dinner. I noticed she was limping a lot on her right shoulder - she has bad arthritis, so wondered if the pain was discouraging her from eating. I gave her 100mg of Neurontin, which had been prescribed on an as-needed basis. Normally, she sleeps for a bit after Neurontin, then wakes more comfortable - and also usually very hungry. On this occasion, I could not properly rouse her for several hours. When she did get up, she was so unsteady and groggy that I had to carry her back to bed so she wouldn't fall and hurt herself. She slept right through the night without moving, despite not going out for her evening toilet break.

Since then, she still hasn't been herself. The episodes have not been as severe, but they have continued. Her vet suggested she may have had a stroke, and I have to admit that was my first thought too. She hasn't had any imaging because she seems too frail to cope with any kind of sedation. She has had episodes of confusion before, but never as severe and the last significant one was linked to a UTI.

She has had 2 x urine tests for UTI, a FBC, and full kidney/liver/pancreatic profile, and a test for EPI. Apparently there was nothing dramatic in any of the results, just progressive changes in line with her age and previous results. She did test positive for pancreatitis, however, she has tested positive for pancreatitis in every blood test for the past three or four years, regardless of her symptoms, so difficult to know if this is accurate. Fructosamine was also fine, which surprised both me and the vet.

I've noticed that her blood is very difficult to draw into the test strip each time she is having one of these episodes - sometimes it seems too thick, other times, like just now, it seems very watery and thin. It also seems very dark when this happens.

She is not eating well and has lost about 1kg that she couldn't afford to lose - she is currently down to 16.4kg. To give an idea, she was a good 27kg at diagnosis six years ago. She has been around 20-22kg for the past couple of years. Over the past 12 months, she had crept down to 17.5k. Even allowing for aged-related muscle loss, she is now very thin and I am very worried about her.

Her diabetes has been fairly unpredictable in recent years, but since these episodes started, she's constantly bouncing from too high to too low. I've noticed that as soon as her BG starts to come down into a good range - say, below 8 - she becomes extremely sluggish, groggy, and unsteady when walking, as if she were having a hypo.

We seem to have two modes at the moment - hungry and eating a lot, which results in massive blood sugar spikes, or lethargic and not eating, where I'm struggling to keep her away from a hypo. It's been very difficult to judge insulin safely. Whenever I am able to get her to eat a decent amount, her blood sugar spikes, despite her insulin - she'll drop down to 5, say, for a brief time and then climb right back up to 30. Additional insulin drops the lowest point but does not stop the climb.

I know that Juicy is a senior dog, and has been diabetic for a long time. She's had more than her fair share of health issues over the years, and of course, has been steadily declining as she ages. She has a long history of being an inconsistent meal eater, which is probably why she's been such an unpredictable diabetic. She has also had previous periods of anorexia, which have eventually resolved through persistence, but no definite cause has ever been attached, despite extensive testing each time. Each time she has one of these periods of anorexia, however, she loses weight, and she's just got nothing left now.

She's lost her vision due to cataracts and retinopathy. She acquired Horner's syndrome about three years ago, which causes her eyes to be very sunken in her face, and also has chronic dry eyes. The combination of the Horner's and the dry eyes means she is very prone to eye infections. We follow a very careful eye care regime to try to prevent these as much as possible.

I've noticed since this started that she's been having a lot of facial twitching. This is not new - I believe the Horner's syndrome is due to facial nerve dysfunction - but seems much more marked. She''ll often drop food out of her mouth a couple of times before she goes to eat it- again, not new, but seems to be happening more.

She takes daily 500mg paracetamol, 20mg Cerenia (1/8 160mg Cerenia tablet), 2 x Antinol Rapid capsule, 50mg Carprieve. Her normal insulin dose is 20 units AM/PM. Until recently, she was also taking 4 x Rosehip powder capsules per day for arthritis. I am currently cooking a turkey sort of mix with a little bit of low-carb potato for her, which she is generally eating. Prior to this episode, she was eating a variety of low-fat wet foods served with tuna AM/poached chicken PM. Her diet is obviously far from ideal, but the goal has just become to get anything edible into her that won't harm her.

She has always been a very anxious dog. In the last 18 months, she has lost both of her lifetime companions - one very recently, however, I have to say that this problem did not start at that time.

Thank you very much if you have read this far. If you have any advice, or have been through something similar, or anything at all, I'd be very grateful. :)

jesse girl 06-03-2020 10:25 AM

Re: Elderly long-term diabetic having weird episodes
Hi and welcome back . Wish it was on a better reason but most dont post if everything is going well .

My jesse is now 15.5 years old and been diabetic for over 10 years . Six years is impressive especially with the other challenges . Its sounds like you dogs blood sugar has been difficult to regulate and probably has and is contributing to the symptoms you are seeing with with high appetite and none at all with periods of anorexia . Big swings in blood sugar can point to to much insulin and or an imbalance between insulin and food . Also arthritis which is inflammatory and medications like steroids can affect blood sugar . So a reduction in the dose and it could be substantial and do curves to see if the big swings in sugar reduces

The episodes could be low blood sugar events and hypoglycemia due to the sugar going to low

Now my jesse only eats one meal a day and it was the only way to get a handle on her blood sugar so thats an option

Jess also has a homemade diet with canned Mackerel ,chicken vegetables beans and sweet potato yams and she has yet to get cataracts . She also has no problems with arthritis . She can get confused and pee and poops in the house on occasion . She also can be unsteady but all that is understandable at her age and having epilepsy for most of that but mysteriously that went away 4 years ago . Her hearing isnt very good and her eyesight is declining but her nose works very well

I know for jesse we are on the backside of life . She is at the top end of a beagles life span and having all the other challenges I think that is quite amazing. Same for your pup . I do believe her human grade homemade diet was pivotal in her health and quality of life . For the most part she is happy and I enjoy her but sometimes I can loose my patience as we all can do with the old but I am glad she decided to stay for this long . At 5.5 years old her chances of living 6 months wasn't very good

So if you want any help trying somethings I can be more specific what i did with jesse but its hard to say if it can improve the symptoms you are seeing . What works for one dog may not for another For jesse we needed a more unconventional method to make it to this mark

Riliey and Mo 06-03-2020 10:59 AM

Re: Elderly long-term diabetic having weird episodes

16 kg is 35lbs
for a 35lb dog 20 units seems alot
starting dose would be 8 units x 2
without eating properly and the high insulin
and along with other meds not eating well can bring on other problems like dopy and not wanting to eat
my dog was 20lbs and on 5 1/2 units at 17
his dose didnt change over the years

was her insulin dropped when she lost weight? 20 units would be good for a 27kg dog.

might just be reducing insulin for a quick fix this means testing frequently

can u post a recent curve?

are you testing at home?


juicy 06-07-2020 04:03 AM

Re: Elderly long-term diabetic having weird episodes
Thank you both so much for taking the time to reply. It was so heartening to find your responses and suggestions - I'm sorry that it's taken me a few days to find time to reply. :)

Mo and Jesse Girl, the insulin dose is definitely something that I have been concerned about as well - I have wondered if it is too high, or out of balance with her food, and making her bounce around all over the place. I think the fact that she's been so inconsistent with her food isn't helping the food-insulin balance. I really appreciate you both flagging that - it's made it clear to me there is an issue there.

Mo, we do home test, and we more or less do a mini curve most days nowadays. Here are her basic numbers from the last few days:

Thursday, 4 June - Alert and eating very well.
7am - 25
7am - 19 units insulin, breakfast
11am - 12
6:30pm - HIGH (above 34)
6:30pm - 20 units insulin, dinner
8pm - 13.1
11:30pm - 13.8

Friday, 5 June - Extremely lethargic and eating poorly.
7am - 21.5
7am - 15 units insulin, breakfast (ate almost nothing)
9am - 14.6
11am - 10
1:30pm - 11.5
3:30pm - 16.4
6:30pm - 22.5
6:30pm - 16 units insulin, dinner (ate almost nothing)
9pm - 16.9
11:30pm - 14

Saturday, 6 June - Lethargic and ate small amounts.
7am - HIGH (above 34)
7am - 20 units insulin, breakfast
11am - 15.4
2:30pm - 7.3
6:30pm - 12.4 pre dinner
7pm - 23 after dinner (small amount)
7pm - 12 units
9:30pm - 11.1
12:30am - 28.6
12:30am - 5 units insulin

Sunday, 7 June - Tired but increasing alertness and eating well.
7am - 23
7am - 15 units insulin, breakfast
9am - 10.8
12pm - 10.5
6:30pm - HIGH
6:30pm - 20 units insulin, dinner

As you can see, we've tried lower insulin over the past couple of days where appropriate, but it's probably too early to tell? After the lower insulin yesterday, I ended up having to give the rest of the dose before bed because her BG was very high and she was very lethargic and disoriented. She did perk up and become more alert within about 15 minutes of having the extra insulin.

What you say about the inflammatory response also sounds like it could be a factor for her, Jesse Girl - with the arthritis and the eye issues, as well as her anxiety. I know whenever she's anxious about anything, her BG just goes through the roof.

Jesse Girl, can I ask you a bit more about the one meal a day feeding?

Funnily enough, before Juicy was diagnosed, she and her sister used to have one raw food meal a day (I was worried about bloat, basically), but when she was diagnosed, the vet said she would need to eat twice a day. I definitely see the advantage, but my main worry would be her anxiety around changing her routine - nowadays, the slightest change in routine unsettles her for the rest of the day, which has a knock-on effect on her appetite and blood sugar. Did you find the transition hard? How do you manage insulin?
If you have time, I would love to hear a bit more. :)

I am planning to take her to the vet tomorrow for another check-up - I am concerned that she might still have some underlying infection that we haven't picked up somehow.

Thank you so much again, both of you, for taking the time to reply and offer your insights - I really do appreciate it very much. :)

jesse girl 06-07-2020 07:11 AM

Re: Elderly long-term diabetic having weird episodes
Jesse was a free feeder before she was diabetic . I would give her a bowl of food and she would come back to it during the day to eat . Kind of like a cat . She became more food motivated after she became diabetic . She briefly went on prescription food but I wanted something a bit more healthy but those diets seem to do well with blood sugar . I was willing to give up some blood sugar control over a more healthy diet . My first try wasn't very good going with a raw diet . That was my first mistake and I have made a few more . Dogs like humans need balanced diets to be healthy and diabetics especially and carbs are part of that equation to get injected insulin to work

We struggled with regulation and was at my wits end and maybe nearing the end of this battle . I discussed on the forum about going to one meal a day . I had support from some and not a good idea by others but I already new you could give insulin without food .

I new by her stools I needed to get off the raw diet . It was a process adding and removing until I found what her body liked . The final key was pinto beans which a forum member suggested . I give her vegetables grind up in a food processor ,canned mackerel , skinless chicken , sweet potato yams ,pinto beans , hard boiled eggs and I sprinkle yeast flakes on top . I use egg shells for calcium and giver her milk thistle ( liver support ) and B-12 .

You also could use a fast acting insulin like R in response to higher levels and try to keep the everyday insulin you are using the same amount . Constantly adjusting that can limit the body to adapt .I have used it and also novolog when jesse had more difficult times with blood sugar . When she had epilepsy seizures her blood sugar would skyrocket so I found it useful at times but I haven't used it in a while as her epilepsy mysteriously disappeared with all her anxiety . Maybe the diet helped I dont know and she is not telling

Change is difficult especially at an older age ( jesse was 5.5 years old ) . So you have to look at the risk reward and quality of life and only the caretaker would know that . Even veterinarians can only give some guidance but they dont spend everyday with a pup. Once again if you need specifics on a specific thought let me know .

Riliey and Mo 06-07-2020 04:07 PM

Re: Elderly long-term diabetic having weird episodes

back in 2014 u started at 7 units. in a week you got up to 14 units. thats a big jump.

changes in insulin take 7 days to take affect

your changing insulin twice a day.

her dose is way too high. i.d be dropping the dose and testing frequently.

ask your vet about her insulin dose

your doing great

juicy 06-16-2020 07:24 AM

Re: Elderly long-term diabetic having weird episodes
Thank you both again so much for taking the time to reply and give your advice and encouragement. Again, I'm sorry for not being able to respond sooner. I really am so appreciative of your time and kindness. :)

Things have been very up and down with Juicy over the last few days. Both of you flagging the high insulin dose was so helpful; it really highlighted that as an issue that needed to be addressed. With her ongoing poor eating, we ended up at 12 units AM/PM, and that was giving a more predictable curve.

Mo, your advice about giving her time to adjust to the insulin dose has made a big difference - I think it has been key to getting a more reliable curve. I really can't thank you enough.

Jesse Girl, the way you have managed your Jesse through ten years of diabetes is amazing. I am so grateful for the information about her meals and insulin management. You mentioned that rapid insulin might be helpful on an intermittent basis, which is something I have heard about from human diabetics, but it has never been discussed for Juicy by either her regular vet or specialists she's seen. I think that would be ideal for her, but I'm not sure how to go about that without some vet input - the first step will be talking to her vet tomorrow. Her insulin is Mixtard 30/70, which is the usual 12-hour action insulin, I believe.

The care you put into Jesse's diet is obviously a huge part of her wellbeing; Juicy has been through a lot of different diets over the years, and leading up to this, she was having a combination of cooked meals and prescription diet; after all this started, I started cooking her a simple casserole of potato and turkey or chicken, but the cycle has continued - she would eat well, then have severe symptoms the next day and poor appetite for a couple of days, then start to feel better, eat well again, and repeat.

She had a couple of very bad days over the weekend, and has lost almost another kilogram. She was very weak and lethargic. While we were back at the vet, I picked up some of the Hills ID tinned food and she has been eating that in small but regular amounts so far. With the return of regular meals, her blood sugar curve has started to rise and 12 units does not seem to be enough. We are currently back at 15 units AM/PM with the lowest point in the BG curve about 13. As she began to eat these small meals, she started having more energy to get up and move around, and there was a big improvement in her energy level after 48 hours, but with the rise in the BG, the lethargy has returned. I feel very cautious about increasing her insulin, but am also very keen to avoid these prolonged periods of high blood sugar because she seems very affected afterwards

Another thing I'm concerned may be causing an issue is delayed stomach emptying; from what I've read, she seems to have many the symptoms. She's had GI issues for a couple of years now that come and go and are part of that set of things that are never really resolved. Once she's eaten a small plate of food, she starts to cough and although she tries to eat more, she can't seem to manage it. Then, a couple of hours later, she'll go back searching around her food bowl, wanting to finish the rest. One of the strategies for dealing with that seems to be smaller meals more frequently, dosing insulin more frequently.

However, I don't actually know if that's what's going on. I believe the delayed emptying can be caused by cranial nerve dysfunction, and I know that some of her other cranial nerves have already been affected with the Horner's syndrome, etc. She has also been sneezing a lot during this time - the vet has checked, and there's no sign of anything, but it hasn't stopped and over the weekend, she almost had a couple of episodes of reverse sneezing, wheezing with it.

She often seems confused and disoriented at the moment. I am so thankful that she is up and moving around again, but she still seems very far from where she was six weeks ago.

I'm planning to speak to her vet again tomorrow. At the moment, it really feels like we are operating without a compass, so to speak.

My apologies for the long and I'm sure very muddled post - at the moment, everything seems relevant, even when it's probably not.

Thank you so much again for all your encouragement and kind words. I really am incredibly grateful for all your insights and advice - it means a lot. :)

jesse girl 06-16-2020 10:01 AM

Re: Elderly long-term diabetic having weird episodes
My jesse is a wanderer and paces back and forth throughout the house and she has done that for a couple years without any additional decline ( kind of maintaining ) . She doesnt jump up onto the couch anymore . At first i thought is was diminished eyesight but I think its her depth perception and tied more to a brain dysfunction which makes complete sense as she had epilepsy most of her life but the last 4 years it disappeared for some reason

You do what the circumstances give you . There were members who gave more smaller meals and worked well for them . As you know I give one meal . The key is keeping it consistent whatever you may do to manage the disease

There will be challenges with an older dog but it sounds like you have discovered solutions that work . Solutions are only limited by our imagination .

Raysaint 06-20-2020 04:36 AM

Re: Elderly long-term diabetic having weird episodes
you really need to stick with one dose. Her body will be confused and it won't be able to get used to how to metabolize the insulin. And her numbers will be erratic and unpredictable; that can be dangerous.
Using different doses of insulin is really only done with fast acting insulin, for us human diabetics. Our long acting stays the same.
Consistency is paramount to regulating a dog.

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