From Jan (Dazzle's owner)

[janspack]

Hi all,

I've just been given the link to this forum by Niki's Mum so thank you for letting me join.

My 10 yr old Border Collie bitch, Dazzle, was diagnosed with Diabetes on 6th Feb 09 - so just a week ago now. This is complicated by the fact that she suffers from chronic pancreatitis which has damaged the organ so much that she has both EPI and now diabetes. I'm told by the vet this could make it much more difficult to stabilise her.

She's on 5 units of Caninsulin twice a day after food. I have ordered an AccuTrak animal glucose meter which should arrive early next week. At the moment, my vets tend to only monitor once a week or so, despite the fact that she's not yet stable which I'm not too happy about. I think they do this as many owners find home monitoring too difficult/time consuming or whatever. However, I'm the sort of person who needs to be more hands on in my animals' treatment and want to be able to monitor and adjust her insulin at home (with the vet's blessing of course).

Anyway, at diagnosis, her blood glucose was 25 (455 USA). On Thursday, after almost a week on insulin, her bg was still at 17 (309) even when the blood was taken 8 hours post injection when I understand it is at it's peak effect. I feel this is still far too high but the vet seems quite happy with it and didn't think she needed testing again for another 2 weeks or that she needed any more insulin. From what I've learnt, I'm concerned about such things as kidney damage etc.

She's still extremely hungry, thirsty, and peeing alot which isn't really surprising in the circumstances.

I'm here to learn so I can have at least a little knowledge however small when I speak to the vet about this again. The vet we saw on Thursday isn't the one who diagnosed her and although I've been very happy with this practice for over 30 years, I'm not too happy about this situation.

Thanks in advance for any advise that anyone can offer.

Jan & Dazzle (Border Collie 10yrs)

[eileen]

Re: New Member Jan with Dazzle

Jan....welcome to you and Dazzle, my Mildred is a Border Collie mx, was dx at the age of 5, she is now going on 10. If you haven't already you may want to read the action profile of Vetsulin, you'll see that it has 2 peaks, the first about 4 hours after injection and then the other 8 or so hours later. Periodic 'spot' checking can not tell you anything other than where they are at that moment in time, it takes many other readings thru out a day to make sense of each reading. I actually use a human meter, the Accu Chek Aviva which has been found to be very reliable with consistent readings, many pet owners choose this meter (along with others) because of the ongoing expense and availability of the test strips. Your main concern with wanting to keep the bgs in a lower end range is to avoid the formation of cataracts which seem to develop sometimes overnight. Our diabetic dogs do not have the lifespan as human diabetics so for the most part do not develop other diabetes related health issues that humans do over time. Eileen

[We Hope]

Re: New Member Jan with Dazzle

Welcome, Jan!

What's Dazzle's weight? The usual starting insulin dose is between 0.25- 0.50 units per kilo of body weight.

http://www.intervet.com.au/binaries/82_103335.pdf

Intervet--Caninsulin-Australia--Page 6--Twice daily Caninsulin Regimen

Are you feeding any special "prescription type" food, such as W/D, R/D, Purina DCO--something you'd need to buy from your vet? What is she eating?

There are times when it's suggested with pancreatitis having been a problem that instead of serving two large meals, 12 hours apart, one should be serving 3-4 smaller meals. What type of feeding routine do you have for Dazzle?

Sometimes the need to serve more than the usual breakfast and dinner followed by the insulin shot can affect the action of the insulin. If this is happening with Dazzle, we'll try to help you work with the insulin and the possible "extra" meals to smooth things out.

It can take anywhere from 2-7 days for you to see some results from increasing the insulin, depending on the individual dog:

http://www.childrenwithdiabetes.com/...as_insulin.pdf

Page 10

"the size of the insulin depot makes it necessary to allow 2-5 days of adjustment before achieving a new equilibrium."

http://www.vetsulin.com/vet/DosingAdjustment.aspx

Vetsulin (this is the trade name for Caninsulin in the US)

"Following adjustment, wait to reevaluate until the new dose has been given for at least 5 to 7 days, unless evidence of hypoglycemia appears."

I think Dazzle could have an increase considered before two weeks are up, but there's something you need to be aware of and watchful for because she has the exocrine pancreatic insufficiency (EPI):

http://www.intervet.com.au/binaries/82_103335.pdf

Intervet--Australia--Caninsulin--Page 15--Concurrent Disease

"Concurrent disease that increases the risk of hypoglycemia includes exocrine pancreatic insufficiency (EPI), hepatic [liver] insufficiency, and any disease that may cause inappetance."

Basically, they're saying that any problem which might cause an animal not to eat or not to eat a full meal can carry with it the risk of low blood glucose. Following along, down the page:

"If the diabetic patient is unwilling or unable to eat due to illness, administer a lower dose of insulin (approximately 30% of the normal dose) until appetite is restored."

People whose dogs don't have other medical problems sometimes refuse to eat also, and the answer for them all is that they receive much less of an insulin dose when they either don't eat or eat only a portion of their meal.

Caninsulin/Vetsulin is a combination of two Lente-type insulins--it's 30% semilente (a fast acting insulin) and 70% ultralente (a long-acting insulin). The two are put into combination to make Lente an intermediate or "medium" acting insulin, just as isophane insulin is.

Isophane insulin can also be had in combination with neutral (R) insulin--they call it 30/70, which is 30% neutral insulin combined with 70% isophane insulin, and there are other various combinations of neutral and isophane insulin on the market. These are still considered to be "medium" length insulins.

Any time you are using more than one insulin at a time, whether it's manufactured that way (Caninsulin, 30/70), or you're giving a shot of fast (neutral, semilente) or rapid (NovoRapid, Humalog, Apidra) and also giving a shot of a medium (isophane) or long (ultralente, Lantus), each of those insulins will have its own peak, regardless of how you're using them.

I think the meter you have on order is known as the AlphaTrak in North America. We have some links for videos on that here:

http://k9diabetes.com/forum/showpost...89&postcount=5

All those under Abbott Animal Health.

Again, welcome to you both!

Kathy

[Debbie & Apollo]

Re: New Member Jan with Dazzle

Hi and a warm welcome from us also!
Happy Valentines Day too!

Apollo also has had bouts of pancreatitis --- not fun!

I would ask what food you are using...
also are you using SAM e (Denosyl) and Milk Thistle yet.

since we made the switch to W/D and started the supplements -- we have been pulling A ++++ !

you are in an excellent place to support and help!

Debbie and Apollo

[Soaphie & Sydney's Mom]

Re: New Member Jan with Dazzle

Welcome!

My Soaphie is a border collie mix using Vetsulin as well. We are on 10.5 units twice a day and are "fairly" regulated (it's taken quite a bit of time). There is some thoughts that the working dogs may be more difficult to regulate (?).

Be patient and if there is one piece of advice that I could give you is to not increase the dosage too quickly....our old vet was increasing Soaphie every 4 days or so and it turns out that Soaphie needed longer to "regulate" to a particular dose and it was causing her to rebound and go even higher and then the vet would increase her again and again and eventually it lead to a hypo incident with a seizure.

You have come to the right place!

Tami

[Cara's Mom]

Re: New Member Jan with Dazzle

Hi Jan, welcome to you and Dazzle (cute name).
You wil find a lot of information and advise on this board and this bunch of very nice people is always ready to share experiences! So you came to the right place

[peggy0]

Re: New Member Jan with Dazzle

Welcome Jan!

I also have a border collie/lab mix. He's a big boy 80 pounds. I agree with Tami, you can't make changes too quickly. Forbin was diagnosed in December and we are still at it. Each time he was changed by too much or too quickly, we had at least a 3 to 4 day set back. Be patient and come to this board. It's a God Send for all of us in this situation.

[Fishslayer]

Re: New Member Jan with Dazzle

Hi Jan,

Welcome to K9diabetes. You've come to the right place for info.

A BC named "Dazzle" rings a really loud bell. Do I know you from somewhere, YouTube maybe?

Besides my diabetic foster Cattle Dog Lucy, I also have another ACD named Dingo & a GSD named Fauna.

Love the herding breeds!


Rick

[janspack]

Re: New Member Jan with Dazzle

[QUOTE=Fishslayer;6732]Hi Jan,

Welcome to K9diabetes. You've come to the right place for info.

A BC named "Dazzle" rings a really loud bell. Do I know you from somewhere, YouTube maybe?


Hi Rick,

thanks for the welcome.

Don't think you would know us - not sure what part of the world you are in but I'm in the UK. Dazzle hasn't appeared on YouTube (well at least not yet!)

I had a Australian Kelpie x Border Collie until two years ago . Lost her age 13 to cancer. She most certainly was a handful!

Jan & Dazzle

[janspack]

Re: New Member Jan with Dazzle

Welcome!

My Soaphie is a border collie mix using Vetsulin as well. We are on 10.5 units twice a day and are "fairly" regulated (it's taken quite a bit of time). There is some thoughts that the working dogs may be more difficult to regulate (?).

Be patient and if there is one piece of advice that I could give you is to not increase the dosage too quickly
Tami

Hi Tami,

I'm prepared for it to take time - the vets have said all along that because of her EPI and other pancreas problems, she is likely to be more difficult to stabilise.

I was worried because the her blood glucose has been increasing rather than decreasing on the 5 units twice a day. Spoken to the vet this morning because she has had me awake most of the night drinking and then having to go out to pee! He has suggested an increase to 6 units bid. He didn't like the BG results we got on Thursday either. He knows I am going to be monitoring her very closely at home (I'm disabled and don't work so with her and my 4 other dogs 24/7). They worry about keeping them too close to the edge if the owners are at work etc but with me at home and knowing that I will be into the surgery at the slightest sign of trouble he is happy to let me try to keep her sugar levels a bit lower. I won't be making any changes to her dose without it being approved by the vets I can assure you.

I know I have a huge amount to learn - that's why I'm here - and I appreciate each and everyone of you for the advice you are giving me.

Jan & Dazzle.

[janspack]

Re: New Member Jan with Dazzle

Hi and a warm welcome from us also!

Apollo also has had bouts of pancreatitis --- not fun!

I would ask what food you are using...
also are you using SAM e (Denosyl) and Milk Thistle yet.
you are in an excellent place to support and help!

Debbie and Apollo

Hi Debbie,

Pancreatitis is horrible isn't it? I feel so sorry for them when they are in such pain. Dazzle had open surgery last November because of her weight loss and other problems and had intestine and pancreas biopsies taken. They showed she has borderline IBD and that her pancreas was just about non-existent due to the chronic inflammation.

I haven't thought about giving her either of those - they're liver protectants are'nt they? I'll certainly look into doing that.

I feed Dazzle and all my animals (I also breed pedigree cats) on raw food. Dazzle is just getting wholemeal biscuit and tripe or lean chicken. The vets have all said that it is best to stick with the diet as she has been doing well on it with regards the pancreatitis/EPI. I want to avoid putting her on a kibble/tinned food if I can avoid it but if it is essential, I'll have to see if I can afford it. The price of prescription diets here in the UK is astronomical!

Looking forward to learning a lot from everyone here.

Jan & Dazzle.

[janspack]

Re: New Member Jan with Dazzle

Hi Kathy,

Thanks for such a detailed reply. I'll take a good look at all those links as soon as I've finished going through the posts!

I'll try to answer all your questions. I know you need to ask to be able to advise.

The vet this morning has said that Dazzle should have 6 units bid instead of 5 as her levels have continued to increase on the lower dose over the past week. Last Sunday, her fasting level was 11 (200) but by Thursday it was 17.9 (325) when taken 8 hours post injection.

Dazzle is fed on raw food - tripe or lean chicken and wholemeal biscuit. She doesn't get the fatty or meaty bones the other dogs get though. She is getting two meals a day and her insulin injection straight afterwards.

Her pancreas is now so atrophied that the specialist she saw doesn't think she will get more bouts of pancreatitis - she is now just coping with the EPI and borderline IBD. Was doing very well with that having increased her weight by 1 Kg despite the fact that she had at that point, undiagnosed diabetes. She has Lypex capsules for this. She has also been put back on metronidazole to help prevent SIBO as apparently dogs with concurrent EPI & diabetes are more prone to this. She had recently completed a two month course but is now back on it for another month at least.

One thing Dazzle doesn't seem to have is problems with her appetite!! LOL. Even when she had acute pancreatitis she was still trying to eat. However, just in case, I always feed her before I give her insulin injection. As the vet said, you can't suck it back out again if they don't eat!

I won't rush things. I want Dazzle to be as well as possible for as long as possible and if it takes time to get her there, then so be it. I know you will all rein me in though if I get impatient!

It is the AlphaTrak I've ordered - did I call it the AccuTrak? I've got a bad memory I'm afraid - goes with kidney problems (my own) and having strong pain killers for my spinal problems - in other words, I'm a physical wreck! LOL It is the same meter my vets use so it seemed sensible so we can be sure we are on a level playingfield.

I know the EPI is going to cause complications with her stabilisation - the vets warned me of that straightaway. It's lucky I can be home with her 24/7as this will make monitoring her much easier than for someone who has to go out to work every day. Has to be some advantages to being disabled doesn't there?

Jan & Dazzle.

[janspack]

Re: New Member Jan with Dazzle

Thanks to everyone else who has welcomed us to the forum as well.

Whatever did we do before the Internet? I would be feeling very isolated and worried without it that I'm sure of.

Jan & Dazzle.

[k9diabetes]

Re: New Member Jan with Dazzle

Hi Jan! Welcome to you and Dazzle!

Okay... so I had to look! ;0

http://en.wikipedia.org/wiki/Exocrine_pancreatic_insufficiency

Exocrine pancreatic insufficiency (EPI) is the inability to properly digest food due to a lack of digestive enzymes made by the pancreas. This disease is found frequently in dogs. EPI is also found in humans afflicted with cystic fibrosis and Shwachman-Diamond Syndrome. EPI is caused by a progressive loss of the pancreatic cells that make digestive enzymes. Most commonly in dogs, this is caused by pancreatic acinar atrophy. The atrophy in turn can be caused by previous infections, a blocked pancreatic duct, or genetics. Chronic pancreatitis is the most common cause of EPI in humans and cats, but it is an uncommon cause in dogs.[1] Loss of digestive enzymes leads to maldigestion and malabsorption of nutrients.

From: http://www.vetmed.wsu.edu/courses_vm546/content_links/DfDx/Dog%20Case%203/small_intestinal_bacterial_overg.htm

Small intestinal bacterial overgrowth (SIBO) is characterized by an uncontrolled increase in the number of bacteria (105 colonies/ml intestinal fluid) in the upper small intestine. It is considered by some to be an important cause of diarrhea in small animals. SIBO may occur secondary to a number of other intestinal disorders, or be idiopathic.

I'm glad you're working toward home testing. I would not want to leave her blood sugar at a level that is still causing so much thirst and urination for weeks!

How much does she weigh?

Natalie

[We Hope]

Re: New Member Jan with Dazzle

Jan,

Sometimes these companies play "tricks" on us with different names for the same product. You and most of the rest of the world know the insulin you use for Dazzle as Caninsulin; that same insulin is called Vetsulin in the US.

Abbott markets a blood glucose meter for people which tests blood for glucose and also for ketones with the use of the respective proper strips for each. They call this meter the Precision Xtra in North America, whether it's measuring glucose by mmol or by mg/dl. In Australia, the same darn meter with the same features is called the Optima.

Kathy