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Old 02-22-2013, 04:42 PM
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clownshoes clownshoes is offline
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Default New at this and so confused- LONG post

Hi! I have been reading these posts and browsing the site for a few weeks now since our dog, Drake, was dx with diabetes. We called him "clownshoes" when he was a pup, because his paws were so big for his lanky body, and he tripped over them ALL the time-- like he was trying to maneuver those big red shoes you see clowns wear Anyway, he was a rescue pup, so we aren't exactly sure of his birthdate, but we assume he is approximately 8 yrs old. He is a 70 lb. baby with a huge heart and a gruff bark-- and completely laid back and gentle with our 3 yr old daughter.

So... all of this started in the fall-- probably late October. He got a rash on his belly that never seemed to heal. We took him to a vet nearby, and they gave him steroids and antibiotic cream and sent us on our way. The rash returned as soon as the steroids ran their course, and we also noticed at this time that he was just acting very lethargic and seemed like he was really bloated. We thought, "steroids." Well, the rash continued to get worse, fatigue got worse, and we had a new symptom-- his hair started falling out! Bald spots all down his back (especially the rump area) and tail. Back to the vet (a new one, recommended by friends). He thought maybe flea or food allergy, so we changed his frontline to activyl, switched foods, steam cleaned carpets with hypoallergenic solution, got special shampoo... and nothing.

Back to the vet. This time, more steroids and an antibiotic for infection. Soon after the steroids course was finished, the drinking water started... and more drinking and more drinking... you all know the story here. He would urinate in the house during the night and basically just sleep and drink and pee. We thought it was a side effect from the steroids (the drinking water), so a few more weeks went by. It was now the end of January, rash was no better, hair still falling out, eyes pink all the time, couldn't even take him for a walk without him dragging and stopping. It was so sad. Now a new symptom appeared-- he stopped wanting his food. This dog LOVES to eat, and between he and our other dog (12 yr old terrier mix, Marley), it was like a competition to see who could eat the fastest. Suddenly, he wouldn't eat a thing, though, and his bloated appearance disappeared, and he was losing a lot of weight.

Back to the vet. This time, they kept him for evaluation, and he was diagnosed with diabetes on Feb 2, 2013. He stayed there for 8 nights, because they could not get him regulated. The problem there was he would not eat, so they couldn't administer the insulin properly. He refused the W/D canned food. A few times while he was there, they were able to coax him to eat and got his blood glucose levels down (still in 300's, though, I think? We don't have a copy of those records) for a short time-- but never a full 24 hours. At one point, he did bottom out due to low blood sugar, after being administered Humulin R (again, not sure how much-- don't have copy of that info). At any rate, they sent him home on Feb. 12, and we were instructed to administer 12 units Humulin N after his meals, 12 hrs apart.

We bought a human glucose monitor and have been trying to test regularly ever since (thanks to this site, I learned to test on his inner lip!), and he is doing fine handling the shots (again, a huge thanks to this site-- I had never given a shot before in my life!). In the beginning, he would not eat, and we didn't know what to do. I know this is not good, and I have since changed this, but I was desperate-- I would feed him 1 cup of Nutro (the chicken, brown rice, and oatmeal formula), add 3 boiled chicken tenderloins, mix in some broth, and a tad of cottage cheese. He finally ate, and we were able to do insulin. The first day, our notes look like this (took him 2 hours to eat his food the first day-- this has since improved, and the schedule is much more regular):
Feb. 13th:
7:30 A: morning reading, before food: 575
9:30 A: FINALLY ate, then 12 units Humulin N
11:20 A: 559
2:45 P: 528
4:35 P: 448 (the LOWEST it has been since)
ate at 7, then 13 units Humulin N
9:15 P: 525

This goes on, with the 448 being the lowest number we have ever been able to get. The vet instructed us to try Humulin R at 16 units on the 14th. The numbers were 553 and 528, at 11:30 A and 1:30 P, and the rest of the time "hi." After reading on this site, I realized that that was a pretty low amount of insulin for his 70 lbs, and we were instructed to go up a little each day until his blood sugar came down. I calculated that 1/4 of his body weight would be 17.5 units per dose, so I felt ok raising the insulin. (N)

Here we are, and here is an example of that it looked like on the 20th, now that we're on a better schedule:
7:30 A: Hi
Eat at 7:35 (had weaned away chicken/cottage cheese; was on 1 1/4 c. Nutro with some chicken broth (home made-- not store bought) mixed in so he would eat it)
Insulin at 7:45: 18.5 units N
11:30 A: 598
3:10 P: Hi.
Ck after walk (short walk-- he can't do more than 10 min at a time right now, so we're doing that a few times a day) at 5:10 P: 588
Ck at 7:15 P: Hi
Eat at 7:30 P (same as morning meal)
Insulin at 7:45 P: 19 units N
Ck at 9:00 P: Hi
... and so on. We cannot even seem to get it to register on the meter! The average, according to the meter, is 600. We know this is very dangerous for him and are so confused. Please help us help him! Our vet is stumped. We are stumped.

The only things I can think of are to change his food (which we did, just this evening). We are doing the Wellness Core Reduced Fat Adult dog food and giving him 1 1/2 c. AM and 1 1/2 c PM (we have to normally watch him so he doesn't become overweight, and that's the recommendation on the back of the bag).

We continue to try 10 min. walks, even though this morning's broke my heart-- I had to carry him through the yard, poor guy. He couldn't do it.

Keep upping insulin? But how much? How often should I increase? N or R? Or both? Does it sound like there is anything else going on with him that would prevent regulation? At one point, I thought Cushings (because of the hair falling out, etc., in the beginning), but the vet seems to just think diabetes. I am still not sure, though. Any suggestions are welcome. I am trying so hard to remain positive and upbeat, but deep down I am very scared. He is just such a big part of our family-- we want to do everything we can to help him.

If you made it through this post, thank you I am so glad to have found this forum. I'm not sure how it works, as far as communication, etc. Will I know if the thread has replies? In case, my email is j_leigh_j18@yahoo.com.
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  #2  
Old 02-22-2013, 05:01 PM
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k9diabetes k9diabetes is offline
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Default Re: New at this and so confused- LONG post

Since he responded at the hospital to Regular insulin, I'm not worried that he's resistant to the NPH. That's good.

For now, I would feed him whatever diet he will regularly eat. That gives you a starting point for seeing whether his blood sugar can be regulated or whether there might be something else going on, such as Cushing's disease.

It could be, in part, that he's getting a lot of food relative to his insulin... do you have an idea of how many calories he used to consume prior to his diabetes diagnosis?

Most of the food manufacturers list calorie counts (kCal) per cup on the bag and/or on their websites. If you could estimate how much food he used to eat every day and determine how many calories that was, you could give him a similar number of calories of his current diet.

And I see nothing wrong with sticking with his current diet. WD isn't a requirement. And pointless if he won't eat it.

You can actually give insulin without food. Approximately half of a dog's insulin need comes from the baseline blood sugar level that needs to be maintained when there is no food being digested. So you usually can safely give 1/4 of the dose of the dog refuses to eat at all and maybe half the dose if they eat part of the meal... kind of sliding scale based on how much they eat.

That way, you don't hold up regulation. But, as I said, I wouldn't try to force him to eat the WD anyway.

I also think you probably need a more skillful vet to deal with the skin issues and the diabetes - do you have some options?

Skin issues are associated with allergies, thyroid deficiencies, other endocrine problems like Cushing's disease... it sounds like - and I may be way off base here - a solid diagnosis wasn't necessarily made.

If you can get settled on a consistent diet with a consistent, likely appropriate amount of food and then see what the blood sugar does with that, you will have a path to follow to decide what to do next.

The skin problems also may be elevating the blood sugar... so they need to be sorted out.

It's possible he just needs more insulin. But the fastest way to figure that out is to settle into a predictable, consistent diet.

Natalie
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Old 02-22-2013, 05:02 PM
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k9diabetes k9diabetes is offline
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Default Re: New at this and so confused- LONG post

Oh, by the way... what a handsome guy!!!! Looks to have some shepherd in him. I love big mutts. Our diabetic dog Chris was, as far as we could tell, a crazy mix of about eight breeds!

Natalie
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Old 02-22-2013, 05:18 PM
Linda1 Linda1 is offline
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Default Re: New at this and so confused- LONG post

Welcome to the forum. With the high bg have you checked for ketones?
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13 years old, diagnosed Sept. 24, 2012
At the rainbow bridge, Nov. 12, 2016
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  #5  
Old 02-22-2013, 05:19 PM
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momofdecker momofdecker is offline
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Default Re: New at this and so confused- LONG post

Welcome to you both. Wondering if a complete blood count and full chemistry panel have been run since the diabetes diagnosis? If not, it may be worth requesting as the results may be able to offer more insight as to whether or not something else may be going on. Has your vet mentioned checking for ketones while blood glucose (bg) is elevated?
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Holli & Decker // diagnosed November 5th, 2011 // Journeyed to the bridge January 26th, 2013, surrounded by his family at home // 9 years old // Levemir insulin // Hypothyroid // C1-C5 cervical spinal lesion // weight 87 lbs // Run with the wind my sweet boy. Run pain free. Holding you close in my heart till we meet again!
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Old 02-22-2013, 05:44 PM
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clownshoes clownshoes is offline
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Default Re: New at this and so confused- LONG post

Thank you for your responses! I checked the bag, and it says 360 calories per cup, so if he eats 3 cups a day, that would be about 1,080 cals. He was a bit overweight before he got sick, so I am trying to keep him at around 70 lbs.

So far, he loves his new food and ate it all with no coaxing or added broth, etc. i will keep this consistent and see what his readings are. I checked him an hour and a half after I administered 23 units of Humulin N, and it is still registering "Hi." .

I have been using the sticks to check for ketones. So far, so good. It looked like today there MAY have been a trace amount, but it's so hard to tell by those color charts.

I agree that we may need a vet that is more experienced with diabetes. I'm sure you all know how hard it is to manage all of this financially. Our current vet worked with us during Drake's 8-day stay there, and allowed us to basically pay what we could afford. For now, we are VERY tight, financially, and just feel somewhat stuck.

A complete blood panel was done, but I don't have a copy of it. I am going to write that on my list to do first thing Monday morning-- call the vets office and get all the records from his stay. I think that might help us to know what path to take next.

Thanks, again. I'm sure I'm going to have plenty more questions! So glad to know I have somewhere to take them
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Old 02-22-2013, 05:53 PM
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Rubytuesday Rubytuesday is offline
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Default Re: New at this and so confused- LONG post

hello and welcome. I agree with everything offered already.
You can get Ketostix at the pharmacy and test his urine. Anything over a trace needs to be addressed with the vet. Ketones can turn very serious quickly.

I am wondering if hypothyroid or cushings could be in play. To test the thyroid I would recommend doing testing with Dr. Jean Dodds. Here is her website:

http://hemopet.org/

Cushings can be pretty difficult to definitively diagnose. There is an inexpensive test that can rule it out though. It is a UC/CR (urine cortisol/creatinine ratio). That might be a good place to start with regards to cushings.

The hair loss, pot belly and not a lot of reaction to insulin makes me think of these two diseases. Now the pot belly has gone but that may be due to the disease process has just progressed enough that the weight loss from the diabetes may be changing things.

Keep your chin up.

Tara
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She was a courageous Boston Terrier who marched right on through diabetes, megaesophagus, and EPI until 14.
Lucky for both of us we found each other. I'd do it all again girly.
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Old 02-22-2013, 06:08 PM
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BogiesMom BogiesMom is offline
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Default Re: New at this and so confused- LONG post

Hello,
I want to give you and clownshoes a warm welcome and tell you that you have come to a great forum... Everyone here is so welcoming and supportive and in my oppinion some of the people here have more knowledge than some vets when it comes to diabetes.
I am new to this as well, my dog Bogie was diagnosed about 6 months ago and I still learn everyday. It is very scary when this all starts and there will be days down the road when things just make your hair turn grey, but were here for you.
Hang in there...
Best of Luck,
Dawn & Bogie
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Bogie is a 8 year old 24 pound Miniture Schnauzer, Dx on 08/24/12. Home cooked diet formulated by Just Food For Dogs, Switching from Levemir to Vetsulin.
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Old 02-22-2013, 08:03 PM
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momofdecker momofdecker is offline
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Default Re: New at this and so confused- LONG post

There is a K9 cushings site, a sister site to this one. You can browse through the site and will find information on both symptoms of cushings and hypothyroidism on the site. Some of the links give detailed information which may be helpful when you get the results of the CBC.

http://www.k9cushings.com/forum/forumdisplay.php?f=10

Cushings symptoms:
http://web.archive.org/web/200806171...clinical_signs

Hypothyroidism symptoms:
http://www.lbah.com/word/hypothyroidism/


What your pup is experiencing may be a simple need for more insulin but it never hurts to take a closer look between blood work and other symptoms in addition to established curve patterns.
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Holli & Decker // diagnosed November 5th, 2011 // Journeyed to the bridge January 26th, 2013, surrounded by his family at home // 9 years old // Levemir insulin // Hypothyroid // C1-C5 cervical spinal lesion // weight 87 lbs // Run with the wind my sweet boy. Run pain free. Holding you close in my heart till we meet again!
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Old 02-22-2013, 08:49 PM
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Default Re: New at this and so confused- LONG post

Approximately 1,000 calories per day sounds like a good place to start. Our dog was not very active and weighed about 65 pounds and he maintained his weight on 900 calories a day.

It is a great practice to always get a copy of lab results. There might be some clues in the blood work regarding any potential sign of Cushing's disease, for example, which usually causes significantly elevated liver enzymes. The liver enzymes in an unregulated diabetic can be high also, but usually aren't sky high.

I would not want to keep upping his insulin every day or few days.

It takes time for the body to adjust to having insulin again and, when the blood sugar has been very high for a while, the body is not very responsive to the insulin being given. That resistance to the effects of insulin "breaks" eventually and an amount of insulin that wasn't enough last week could be too much next week. So it's important to move slowly.

With the caveat that the development of ketones calls for an aggressive effort to get the blood sugar down.

He's not currently on a massive dose of insulin for his weight but it is a fairly high dose for the short amount of time he's been treated with insulin. And it is possible that he's actually on too much insulin and is "rebounding"...

http://www.caninediabetes.org/pdorg/somogyi.htm

This is where additional notes from the vet might be helpful. If you knew how much insulin the vet gave and whether it was with food, you could take the drop in blood sugar that resulted (like when the Regular was given) to suggest how many units he might need per dose with food.

NPH is a like a timed-release medication. It will take more units of NPH to drop the blood sugar the same amount as Regular would because it gets absorbed more slowly over time.

So, for example, our dog needed about 10-11 units of NPH given twice a day but needed only about 7 units when given Regular insulin (for a long time he was on Regular insulin only, four times a day).

So gather as much information as you can and share it and we will see what we can figure out!

If you want help interpreting the bloodwork, you can email it or fax it to me. My email is k9diabetes@gmail.com and I can send you my fax number by Personal Message if you need it.

Natalie



Quote:
Originally Posted by clownshoes View Post
Thank you for your responses! I checked the bag, and it says 360 calories per cup, so if he eats 3 cups a day, that would be about 1,080 cals. He was a bit overweight before he got sick, so I am trying to keep him at around 70 lbs.

So far, he loves his new food and ate it all with no coaxing or added broth, etc. i will keep this consistent and see what his readings are. I checked him an hour and a half after I administered 23 units of Humulin N, and it is still registering "Hi." .

I have been using the sticks to check for ketones. So far, so good. It looked like today there MAY have been a trace amount, but it's so hard to tell by those color charts.

I agree that we may need a vet that is more experienced with diabetes. I'm sure you all know how hard it is to manage all of this financially. Our current vet worked with us during Drake's 8-day stay there, and allowed us to basically pay what we could afford. For now, we are VERY tight, financially, and just feel somewhat stuck.

A complete blood panel was done, but I don't have a copy of it. I am going to write that on my list to do first thing Monday morning-- call the vets office and get all the records from his stay. I think that might help us to know what path to take next.

Thanks, again. I'm sure I'm going to have plenty more questions! So glad to know I have somewhere to take them
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