Who took their dog to a specialist? Advice?

[anotherk9lover]

Re: Who took their dog to a specialist? Advice?

my Jenny died a few years ago. I stick around the boards to try to help with cushings/diabetes and keep up with some of the people who helped us.

We only saw the specialist the one time. He was in conjunction with our regular vet. I think the biggest expense was the ultrasound that he insisted on doing and in our case it was good. My regular vet was wrong about the type of cushings Jenny had.

Everyone advised me to see a specialist because the 2 diseases can be tricky to regulate together. I balked and we almost killed off Jenny's cortisol. The specialists see these conditions more often.

In December Jenny's ACTH was perfect for her cortisol and her blood sugar was pretty well controlled. over the next few months her insulin need decreased rapidly (at one point her blood sugar was 40!)

I'm a CPA so I just thought we were doing a great job and kept reducing her insulin till after April 15th.

Once we went to the vet after the 15th we found out her cortisol was barely registering.

That is when we went to the specialist.

We went to Blue Pearl and their goal was just to advise and work with our regular vet.

We never needed to go with them and Jenny managed with both diseases for 3 1/2 years. We let her go when she was getting dementia, walking in circles, and really not enjoying her life anymore. She was 14 1/2 and I don't think it was cushings or diabetes related.

So, I think seeing the specialist is an excellent idea and another resource for you and your vet. Getting their advice on the treatment for both diseases is beneficial because they see things so often. Jenny was a 7 pound poodle so we were doing crazy things like giving her cushings meds every 3 days or twice a week. We had to keep a calendar in the kitchen just for her medicine schedule.

I just wanted to warn you about the cost because I had the ultrasound my regular vet had done but the specialist felt he would be more accurate if he did his own.

hang in there. I tried to not sweat the small stuff and focus on if my dog was enjoying her life. There are ups and downs managing both of these at once but if I can do it anyone can. After Jenny's sugar went scary low I did learn how to test blood sugar at home. It took me 3 horrible days but it was worth it.

Judi

So did you constantly take her in for bloodwork to manage the cushings? How were you keeping her on irregular doses? and what made her sugar go so low?
Daisy has been on 5mg/day vetoryl for a few months, and the last blood work showed that her pre cortisol level was pretty low, 0.9, so my vet said to take her off the vetoryl for now, which is why i'm taking her to the specialist.

I'm sure they will push for more ultrasounds and labs bc that's how they make the money, but I'm not doing another ultrasound. When she had it done in July I paid $400 just for the u/s and it didn't show anything significant other than fatty looking liver. I'm sure nothing has changed since then, since she was at her sickest at that time in July.

[Judi]

Re: Who took their dog to a specialist? Advice?

So did you constantly take her in for bloodwork to manage the cushings? How were you keeping her on irregular doses? and what made her sugar go so low?
Daisy has been on 5mg/day vetoryl for a few months, and the last blood work showed that her pre cortisol level was pretty low, 0.9, so my vet said to take her off the vetoryl for now, which is why i'm taking her to the specialist.

I'm sure they will push for more ultrasounds and labs bc that's how they make the money, but I'm not doing another ultrasound. When she had it done in July I paid $400 just for the u/s and it didn't show anything significant other than fatty looking liver. I'm sure nothing has changed since then, since she was at her sickest at that time in July.

My specialist wanted the ultrasound to see the adrenal glands. As my dog's cortisol went too low, the insulin needs went low. Because Jenny's cortisol went so incredibly low we were able to do the first part of the ACTH a couple of times which was cheaper and didn't take 3 1/2 hours just to see where she was at. I tested her blood sugar at home twice a day before I fed her.

I think the specialist's advice on how to treat the cushings will be invaluable. Hopefully after this one visit you can work with your regular vet.

I think over the 3 1/2 years we probably had 3 ACTH tests done and the cheaper first part of it done twice. Of course we accidentally killed Jenny's cortisol to the point that she didn't take any cushings meds for the last year of her life. It was kind of a relief

Knowledge is good. The specialist I met with was just a huge dog lover and very helpful. My other vet was good too and we worked with the regular one until she died.

You do the best you can and you keep your dog enjoying life. hang in there! Judi

[anotherk9lover]

Re: Who took their dog to a specialist? Advice?

Came back from the specialist apt today. They did an adrenal scan for free for me because their sister hospital seems to have missed it when Daisy was hospitalized. That was nice of them. And the scan showed normal adrenal glands, which she said means she's unlikely to have cushing's, but doesn't totally rule it out so confused, since her low dex test was positive. sigh.. this is frustrating. Was Jenny's adrenal scan abnormal?
We're going to take Daisy off of vetoryl for now.

As far as Diabetes, she wasn't all that thelpful, didn't explain too much to me, she just said she wants Daisy to go on one unit less from 6 to 5un, because it seems like she's on a high dose for her size and may be overcompensating or something. But on 5 units Daisy had a pretty high curve. This specialist says she also doesn't discuss curves over the phone, that I would have to take her in each time which is kind of BS, I can't do that. So it looks like from now on will just have to go back to my regular vet. But I am thankful that they did that adrenal scan bc it's an important piece of info to have.

[Judi]

Re: Who took their dog to a specialist? Advice?

Came back from the specialist apt today. They did an adrenal scan for free for me because their sister hospital seems to have missed it when Daisy was hospitalized. That was nice of them. And the scan showed normal adrenal glands, which she said means she's unlikely to have cushing's, but doesn't totally rule it out so confused, since her low dex test was positive. sigh.. this is frustrating. Was Jenny's adrenal scan abnormal?
We're going to take Daisy off of vetoryl for now.

As far as Diabetes, she wasn't all that thelpful, didn't explain too much to me, she just said she wants Daisy to go on one unit less from 6 to 5un, because it seems like she's on a high dose for her size and may be overcompensating or something. But on 5 units Daisy had a pretty high curve. This specialist says she also doesn't discuss curves over the phone, that I would have to take her in each time which is kind of BS, I can't do that. So it looks like from now on will just have to go back to my regular vet. But I am thankful that they did that adrenal scan bc it's an important piece of info to have.

Good news on the adrenal glands. My Jenny's adrenals were very irregular. My vets did say that cushings is misdiagnosed often and the medicine really only treats the symptoms. So if Daisy isn't horribly thirsty, starving, going bald or getting a big belly, laying off the Trilostane is probably the right thing to do.

With your baby coming soon I know you want to get a handle on this. So maybe you need to simplify. Lots of our vets didn't want to work with information from us and most of us either convinced our vet or found one who would work with us. So I vote dispensing with the specialist for now.

You had questioned diet and carbs in the past. For whatever reason, some fiber and some carbs helps the insulin last for 12 hours with the dogs. I obsessed over the icky ingredients in the prescription dog food for months. My dogs eye doctor swore by the Purina because it tasted better.

Finally, I just went with it. It looked hideous but for the time that Jenny was willing to eat it, it worked. You really can't argue with results, it works for a lot of dogs.

The insulin changes, as you know, take a while to kick in. If Daisy has some dental infection that could be causing her blood sugar to be a little high. Dogs can handle blood sugar that is a little high, it is the lows that are worrisome.

hang in there. Judi

[jesse girl]

Re: Who took their dog to a specialist? Advice?

you have eliminate from the equation . the cushings . medicating for something not present can be big deal . now you know what you are dealing with . it sounds like the specialist wants to start over as far as dosing . its to bad they wont allow you doing the tests but i guess i understand that as they are putting there reputation on the line based on their test

actually this is something you can do without a vets help . i have done it for almost 10 years

[anotherk9lover]

Re: Who took their dog to a specialist? Advice?

Do what exactly? The curves? I felt like the specialist gave me very little info on diabetes in general. All she said is to just lower her to 5 units and recheck curve in 3-4 weeks before bringing her in for a follow up. I'm not going to do that, bring her back in that is. What kind of insulin did you guys use? She seemed to think that 6 units for Daisy who is 4.9kg is too high, but she also mentioned that NPH N from Walmart that we use is a weaker insulin, so maybe that's why daisy needs a bit more of it. How did you guys go about dosing, and what type of insulin?

[Judi]

Re: Who took their dog to a specialist? Advice?

we used nph from walmart because of the cost. most people around here use that.

in US terms my dog weighed 7 lbs. We started at 1 unit twice a day. Did a curve every week to 10 days. It. Took. Forever.

What was Daisy's last curve at 6?

[anotherk9lover]

Re: Who took their dog to a specialist? Advice?

Her last curve 12/23/19 at 6 units was: 386 (fasting 6am), 458, 178, 198, 221, 320, 445. That's from 0600 to 6pm every 2h. And then I checked again at 11pm just to see what the peak was, and it was 94, which the specialist seemed to not like that it's pretty low, so that was part of the reason why she lowered it to 5. But the previous curve on 5 units was higher: 446, 450, 391, 367, 416, 410, 502. It never even went lower than 300's at the peak which is really weird. The curve 2 weeks before that looked better, on 6 units, but it went low at one point which is why my vet wanted her back on 5: 94 (fasting), 157, 59 (at peak 11am), 198, 405, 539. As you can see her curves are just all over the place.

The best curve we had was back in end of sept, it was on 5 units: 349, 415, 190, 161, 200, 189, 133 (before 6pm feed). I'm not sure how to interpret these really, and the specialist didn't tell me anything in depth about it either, she mentioned that maybe increasing the dose makes her compensate by creating higher sugar, not sure how that works. Anyone experience that?

[anotherk9lover]

Re: Who took their dog to a specialist? Advice?

Did any of your pets suffer with uti's or skin infections? Daisy gets yeast infections around her urethra because she has folds there that collect moisture and turn into infections. Have you found any helpful products for it? I imagine now with diabetes things will get even more aggressive, although strangely this has ben her longest stretch without an infection yet.

Maybe there's already a thread on that here, i'm not too sure how to navigate it still.

[jesse girl]

Re: Who took their dog to a specialist? Advice?

cushing meds could have caused the instability .

people do curves every one to two weeks until the dog is regulated and that can mean different types of regulation . i am happy for jesse to be from 100 to 250 . she has had very good sugar and at times not so much in her almost 10 year career in diabetes

usually a starting dose is multiplying weight by .2 now my jesse need less than a starting dose so nothing is perfect . all dogs have a unique way of processing injected insulin . my jesse is on nph from walmart

[k9diabetes]

Re: Please help me regulate her sugar??

[QUOTE=anotherk9lover;167938]

I don't know, i'm genuinely confused because I was under the impression that low carb and high protein is what's recommended for diabetic dogs.

Pet store owners in particular, pushed by pet food manufacturers, are always trying to sell low-carb high-protein food for diabetic dogs and freak out if you tell them you need your dog a food with corn in it.

But here's the thing.

Most of what the people selling the food know about diabetes they know about human diabetes and, in particular, Type 2 diabetes, which is heavily influenced by diet.

Canine diabetes is basically always similar to Type 1 in humans but there are important species differences in how they process these insulins.

Dogs typically process NPH faster than humans do. And process Vetsulin fairly quickly as well. So we have seen over the years - I've been involved in this and a preceding forum since 2004 - is that dogs need some carbs to go with the fairly quick effect they get from their insulin. And that high protein and mostly meat diets generally have not worked well for diabetic dogs.

Every dog is different - in the end, I think the best advice is to feed the food that gives your dog the most level blood sugar.

The flatter the blood sugar, the better you can regulate their diabetes. Because you have to base the insulin dose on their LOWEST blood sugar, not their highest. All levels drop if you increase the insulin so you can only increase it so long as the LOWEST blood sugar isn't too low.

Some dogs who really get a quick response to the insulin have actually had to have really carby food and/or a delay in injecting the insulin so that the insulin and sugar from food got delivered together. Like crackers carby!!

I know you posted your curve and when I have a bit more time I will take a look at it.

But if the blood sugar never goes below 300 or 250, that's indicates that more insulin is needed.

Natalie

[k9diabetes]

Re: Who took their dog to a specialist? Advice?

Do what exactly? The curves? I felt like the specialist gave me very little info on diabetes in general. All she said is to just lower her to 5 units and recheck curve in 3-4 weeks before bringing her in for a follow up. I'm not going to do that, bring her back in that is. What kind of insulin did you guys use? She seemed to think that 6 units for Daisy who is 4.9kg is too high, but she also mentioned that NPH N from Walmart that we use is a weaker insulin, so maybe that's why daisy needs a bit more of it. How did you guys go about dosing, and what type of insulin?

Hope you mistunderstood the vet about NPH being a "weaker" insulin as there is no such thing. There are "weaker" solutions that deliver less insulin molecules than other solutions. But NPH isn't even that!

At 4.9 kg, she weighs about 10.75 pounds. So 6 units is within the normal range but on the high side of normal.

To be honest, I wouldn't put much stock in a specialist's knowledge of regulating your dog's diabetes... we took our dog to the guy who literally wrote the book on canine endocrinology used to teach up and coming vets and he was an idiot. We wound up regulating our dog ourselves using home testing. And we never used a high protein diet.

You can learn a bit about our dog's journey at www.k9diabetes.com/k9diabetes.pdf

Whether she should be on 6 units depends on how long she's been on insulin. I will go check.

[k9diabetes]

Re: Who took their dog to a specialist? Advice?

Her last curve 12/23/19 at 6 units was: 386 (fasting 6am), 458, 178, 198, 221, 320, 445. That's from 0600 to 6pm every 2h. And then I checked again at 11pm just to see what the peak was, and it was 94, which the specialist seemed to not like that it's pretty low, so that was part of the reason why she lowered it to 5. But the previous curve on 5 units was higher: 446, 450, 391, 367, 416, 410, 502. It never even went lower than 300's at the peak which is really weird. The curve 2 weeks before that looked better, on 6 units, but it went low at one point which is why my vet wanted her back on 5: 94 (fasting), 157, 59 (at peak 11am), 198, 405, 539. As you can see her curves are just all over the place.

The best curve we had was back in end of sept, it was on 5 units: 349, 415, 190, 161, 200, 189, 133 (before 6pm feed). I'm not sure how to interpret these really, and the specialist didn't tell me anything in depth about it either, she mentioned that maybe increasing the dose makes her compensate by creating higher sugar, not sure how that works. Anyone experience that?

I would be concerned about a 94 reading at night because it could have been lower before or after that.

The answer could be to give less insulin at night than in the daytime.

Also, keep in mind that going up or down between 5 and 6 units is a pretty large change. A 20% increase by adding 1 unit when giving five units.

So 5 could be not enough and 6 too much. You can eyeball half units on the syringe or get syringes with half unit marks - that's what we used.

.......

My advice: Do 5.0 units for five days, do a curve at home from morning until bedtime and see what you get. Post the numbers here and we can help you interpret them and decide what would likely improve the curve.

Natalie

[k9diabetes]

Re: Who took their dog to a specialist? Advice?

Take a look at the main website for general information on regulating, testing, effects of things like Cushings, etc.

In particular, look at honeymooning, which can mean that a dose of insulin that was too high six months ago is too low now.

http://www.k9diabetes.com

http://www.k9diabetes.com/dogdiabeteshoneymoon.html

http://www.k9diabetes.com/insulinfood.html

Natalie

[Raysaint]

Re: Who took their dog to a specialist? Advice?

Studies show that curves are usually slightly different even one day apart. It can depend on what the fasting is, as sometimes bodies compensate differently as the day wears on.
If my dog starts high, his nadir can be 8 points lower than fasting. If he starts good, he might only be 2 points lower. (a point Canadian is about 20 points U.S.)
My vet always tells me that any reading is one point in time and may be different other times, so myself, I wouldn't worry about a 94 unless they were consistent. That's why when playing with doses, might be good to do more than one curve once you settle in to one dose. And changing doses often is going to affect curves.
Looks like 5.5 units might be the dose to try for a couple weeks. Half unit increases are normal for small dogs.

As for yeast, our chihuahua also gets them, and had them bad when we got her. So my vet prescribed me some Surolan, but now it's Otizole. I keep a small bottle handy for the odd time she gets a bit yeasty (she licks more and the skin gets blackish.) I clean the area with hydrogen peroxide, then apply the ointment every 12 hours for a few days.

Your specialist didn't help much because there is no magic bullet to regulation. The people on here have learned that it's methodical and consistent. Same dose for at least a week, curve, adjust, repeat. Stick with the same food while doing that. If that seems to not produce results, a food change may be tried, but then you should start back at a smaller dose just in case. Then curve, adjust repeat.
And most agree that high protein is not the norm for any diabetic. You need carbs to balance and work with the insulin pattern.

It can take a while. Just when things start to look promising, something will surprise you and you think thru what might be happening.

It took me 2 years to get my dog where he is now. Don't panic, stay the course.