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**BestBuddy** · 02-16-2009, 06:35 PM

Re: Tehya, 10 y/o labx, cushings and now Diabetic Ketoacidosis

Hi,
So glad you made it over here. Diabetes is a steep learning curve (bit like cushings) but one step at a time is all you need. Tehya will need to get stabilized at the vet and started on a regime of insulin at home. Usually it will be injections twice a day 12 hours apart with meals. Food will be very important as it needs to match what she needs and also the insulin. I have to go back to work so I won't try to confuse you anymore but please come back when you have more info on how she is going.
Jenny

**We Hope** · 02-16-2009, 07:11 PM

Re: Tehya, 10 y/o labx, cushings and now Diabetic Ketoacidosis

Hi Alison,

The good news is that she did so well with the short-acting insulin cutting her bg's almost in half. I would also believe that it was good news that Tehya was able to come home tonight and go back to continue treatment in the morning; many with ketoacidosis are so ill they need to stay in the hospital.

If Tehya has Addison's, you would need to be giving her cortisol and possibly mineralcorticoids to make up for what her adrenal gland no longer produces.

http://petdiabetes.wikia.com/wiki/Addison%27s_disease

As Jenny told you, you'll need to learn how to give Tehya insulin injections. For now, you can check both for ketones (they are what causes the diabetic ketoacidosis) and her blood glucose by buying Ketodiastix, which test for both. Later on, when you feel more comfortable with all of this, you can get a blood glucose meter like people with diabetes use to check their blood glucose and test Tehya like that.

At times, the liver values are off when diabetes is initially diagnosed and once the dog is regulated on insulin, they go back to being normal ones.

The UTI is probably adding to Tehya's high blood glucose levels, as infections usually mean for higher blood glucose.

Jenny also said, "one step at a time" and right now that's to get Tehya stabilized on insulin by the vet and for you to learn how to give her the insulin shots at home. We'll be here for you, so feel free to ask any questions you like--all of us have "been there" with diabetes before.

Kathy

**allygatt** · 02-16-2009, 07:21 PM

Re: Tehya, 10 y/o labx, cushings and now Diabetic Ketoacidosis

Originally posted by We Hope View Post

Hi Alison,

The good news is that she did so well with the short-acting insulin cutting her bg's almost in half. I would also believe that it was good news that Tehya was able to come home tonight and go back to continue treatment in the morning; many with ketoacidosis are so ill they need to stay in the hospital.

I hope so, I really insisted she come home because the vet didn't have anyone to monitor her during the night and I felt she would be better at home where I could. There is an emergency clinic about 25 minutes away in case she gets worse.

I have a question too, can the diabetes make her feet knuckle over when she walks? She just started doing this on Saturday, then when she got a cortisone shot it stopped....it's back again tonight. (They didn't do any testing on sat, we found out today about the diabetes...)

**We Hope** · 02-16-2009, 07:46 PM

Re: Tehya, 10 y/o labx, cushings and now Diabetic Ketoacidosis

Both out of control diabetes and yet to be managed Addison's disease can cause a condition called neuropathy, where the muscles and nerves can't communicate properly.

http://petdiabetes.wikia.com/wiki/Neuropathy

http://petdiabetes.wikia.com/wiki/Addison%27s_disease

"Also like diabetes, Addison's is an endocrine disease, and its sufferers are at risk of developing neuropathy."

Since you say this stopped when Tehya got a cortisone shot, but is back again, I think it might be a sign that there is Addison's, because Addison's is the opposite of Cushing's. Cushing's is basically too much cortisol and Addison's is not enough.

If the neuropathy is caused by the diabetes, when that's being treated and controlled properly, it normally puts an end to the neuropathy. If the cause of it is Addison's, getting that under control should mean the end of the neuropathy. Right now, with the diabetes not yet controlled and there being the possibility of Addison's, I would say that she might be having problems from either or both of these.

http://petdiabetes.wikia.com/wiki/DKA

The signs of DKA are at this link, so you can tell if Tehya is having problems while at home.

Please do keep asking any questions you have--we'll try our best to answer them, and keep us current on how you both are doing!

Kathy

**k9diabetes** · 02-16-2009, 07:53 PM

Re: Tehya, 10 y/o labx, cushings and now Diabetic Ketoacidosis

Hi Allison!

I'm sorry Tehya is having such a time! I just went over and read through your thread at the Cushings board.

I have to tell you... I've never seen blood sugar that high! It's no wonder Tehya feels miserable.

The hind leg weakness you're seeing in her is most likely diabetic neuropathy from the high blood sugar and it will most likely resolve once the blood sugar is down into a better range for a while. It's very similar to the neuropathy humans can get. It doesn't happen all that often in dogs... guess I should put something on the website about it. But it's not surprising with such high blood sugar.

http://www.merckvetmanual.com/mvm/in.../bc/100604.htm

Diabetic neuropathy is an uncommon complication of diabetes mellitus ( Diabetes Mellitus) in cats and rarely dogs. Signs include weakness, ataxia, and muscle atrophy. There are several proposed pathophysiologic mechanisms, but prolonged hyperglycemia seems to be the important underlying factor. Pathologic findings in nerves consist of demyelination with remyelination, axonal degeneration, or both. Diagnosis is based on clinical findings, laboratory evidence of diabetes mellitus, and nerve biopsy. The prognosis is guarded, but partial or complete recovery can occur with insulin therapy.

Did she have some prednisone in the last few days?

That would drive her blood sugar sky high on top of the diabetes.

If she seems to get worse - throws up, gets very lethargic - please do take her to the 24-hour hospital. Ketoacidosis can kill.

As others have said, the most important thing right now is to get her blood sugar down and get her out of ketoacidosis as soon as possible.

http://www.merckvetmanual.com/mvm/in...d=ketoacidosis

Ketoacidosis is a serious complication of diabetes mellitus and should be regarded as a medical emergency. Therapy includes correcting dehydration by administration of IV fluids, such as 0.9% NaCl or lactated Ringer’s solution; reducing hyperglycemia and ketosis by administration of crystalline zinc (regular) insulin; maintaining serum electrolyte levels, especially potassium, through supplemental administration of appropriate electrolyte solutions; and identifying and treating underlying and complicating diseases, such as acute pancreatitis or infections. Numerous insulin regimens have been used in treatment of ketoacidotic diabetes mellitus. In the intermittent insulin regimen, regular insulin at 0.2 U/kg IM is the initial dose, followed by hourly administration of 0.1 U/kg. Once the serum glucose is <250 mg/dL, the insulin is administered SC at 0.25-0.5 U/kg, every 4-6 hr, with careful monitoring of the serum glucose at 1- to 2-hr intervals. During aggressive treatment with insulin, blood glucose levels may fall rapidly, and the addition of 2.5-5% dextrose to the IV fluids may be required. When insulin therapy has been instituted, the blood glucose should be checked frequently until an adequate maintenance dose has been determined. Once the animal is on maintenance therapy and its condition is stable, it should be reassessed every 4-6 mo.

It's very fortunate that you took her in right away and got treatment started. If you have any doubts about how she's doing, please contact the ER.

Her reactions to the lysodren are a concern so I'm anxious to find out what her cortisol levels were. With this kind of stress, they may be very high also. But I'd be cautious about giving any more lysodren as she just does not seem to tolerate it well.

I will be looking for news about your girl. Hang in there...

Natalie

**eyelostit** · 02-17-2009, 03:28 AM

Re: Tehya, 10 y/o labx, cushings and now Diabetic Ketoacidosis

I just wanted to welcome you to the board, hang in there, I think Tehya is a strong little cookie and things will work out for you two.

Dolly

**dctexan** · 02-17-2009, 08:58 AM

Re: Tehya, 10 y/o labx, cushings and now Diabetic Ketoacidosis

Gah! What a scary ride you are on right now. My dog Dixon was diagnosed with diabetes recently and also had ketoacidosis (complete with the hospital stay). Hugs to you and your puppers! This board has been an excellent source of support and information for me. Just give a shout when you have a question or need a shoulder!

Emily

**allygatt** · 02-17-2009, 10:34 AM

Re: Tehya, 10 y/o labx, cushings and now Diabetic Ketoacidosis

Thank you everyone. She did okay during the night, ate a little of canned SD W/D at dinner time. Basically layed down throughout the night, but this morning she was really bad. She had peed during the night while laying down, (which I kind of expected since she had been on fluids and was still drinking a lot) but this morning she could barely even raise her head off the ground. I took her back to the vet, her glucose level (or is it sugar level?) was 490 something, which actually was good because it meant that it hadn't spiked back up overnight. I had to bring her in on a sled though, I couldn't even pick her up she was so lethargic. I called around 11:30 and she was down to 390, and able to get up with towel assistance. I'm supposed to call the vet this afternoon and she'll give me another update. Should she start to feel more peppy and closer to normal as the levels decrease? Oh, she also has a UTI, so antibiotics were started as well. Thanks again for the support.

**allygatt** · 02-17-2009, 10:37 AM

Re: Tehya, 10 y/o labx, cushings and now Diabetic Ketoacidosis

Originally posted by k9diabetes View Post

Hi Allison!

Did she have some prednisone in the last few days?

Her reactions to the lysodren are a concern so I'm anxious to find out what her cortisol levels were. With this kind of stress, they may be very high also. But I'd be cautious about giving any more lysodren as she just does not seem to tolerate it well.

Natalie

She was given an injection of cortisone on Saturday, but no other tests were done. She had been having trouble walking, and was walking on her knuckles.

I'm not doing the lysodren any time soon. They are waiting to test the cortisol levels till after this crisis is done I think.

Alison

**allygatt** · 02-17-2009, 10:39 AM

Re: Tehya, 10 y/o labx, cushings and now Diabetic Ketoacidosis

Originally posted by dctexan View Post

Gah! What a scary ride you are on right now. My dog Dixon was diagnosed with diabetes recently and also had ketoacidosis (complete with the hospital stay). Hugs to you and your puppers! This board has been an excellent source of support and information for me. Just give a shout when you have a question or need a shoulder!

Emily

How long did it take to resolve and how high was the glucose level? I'm glad things worked out:-)

Alison

**Cara's Mom** · 02-17-2009, 12:18 PM

Re: Tehya, 10 y/o labx, cushings and now Diabetic Ketoacidosis

Hi Allission and Tehya! Welcome! Sorry to hear you and Tehya are having all these problems. But you came to the right place and will find the answers to you questions here with the help of Natalie and Kathy

, I sure did!!

Hugs to you and Tehya

**ladysmom06** · 02-17-2009, 02:40 PM

Re: Tehya, 10 y/o labx, cushings and now Diabetic Ketoacidosis

Hi Alison,

Welcome to you and Tehya. I also have a pup with diabetes and cushing's. She was first dx with cushing's in Sept. 06 but was also diabetic at that time. The vet that was treating her missed the diabetes. She had been on lysodren and became really sick after being on it for 2 1/2 days. When we took her back to the vet she was seen by someone else who dx the diabetes. We didn't think she was going to make it. Her bg was in the 400's and she also had ketones. We stopped the lysodren and just worked on getting the diabetes under control. We had to keep increasing her insulin - she was on a high dose for her size. We retested for cushing's and she started on trilostane in March 07. Since then she has been doing really well

. Her diabetes and cushing's are both under control. She is now on 5 1/2 units of insulin twice a day and 30 mgs of trilostane. She had an ACTH test yesterday and the #'s were great.

I know how scary all this is for you but please know you are at the right place for help. The people here are so kind and caring and full of information. Good luck with Tehya. Hugs to the two of you.

Luv,
Lynne and Lady

**eyelostit** · 02-17-2009, 09:03 PM

Re: Tehya, 10 y/o labx, cushings and now Diabetic Ketoacidosis

Just checking in on you and Tehya, glad you went to the vet, sometimes when different things flare up it makes both our doggies and us feel better to go to the vet, even tho it costs.........

**k9diabetes** · 02-17-2009, 09:35 PM

Re: Tehya, 10 y/o labx, cushings and now Diabetic Ketoacidosis

Just checking on Tehya... hope she is okay.

Natalie

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Tehya, 10 y/o labx, cushings and now Diabetic Ketoacidosis

Tehya, 10 y/o labx, cushings and now Diabetic Ketoacidosis

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