Update, and what do you think?

[nyjenniferc]

Hello! Love the support I see on this board!

My 7 year old, 30 lb cockapoo, Cookie, was panting and peeing and suddenly incontinent. Took her to the vet, no big surprise that she's diabetic. I'm a nurse and worked for a time as a diabetes educator, so I thought I'd be pretty comfortable with this.

They started her on a 5 u dose of Novolin N twice a day, but did not suggest a diet change. She's eating Science Diet for sensitive stomachs. I wasn't thrilled with her numbers after a couple days, so I upped her insulin dose to 6 u. I did a curve on her over the weekend, and her blood glucose was all over the place in the 200-low 300's with no actual CURVE, no rhyme or reason. No peak, no trough, no nadir, just random screwy numbers.

I upped her dose to 7 u yesterday, 6:30 am and 6:30 pm, with her injections immediately after she eats.

She's been consistently high first thing in the morning- around 300 on 5 and 6 U, but this morning after 7 u last night she was 382! What's up with that?

I get home from work at 2:30, and her sugar is always around 300. By dinner at 6:30, though, where you'd think the Novolin H would be wearing off, she's got the lowest blood sugar readings at 176-135.

To complicate the issue, she also MIGHT have Cushing's.

Any thoughts? Is the food too carby? It's only been a week, am I being impatient?

I'm used to hanging a bag of IV fluid and insulin and adjusting the rate every hour. I'm used to kids with insulin pumps and continuous blood glucose montitors! I'm used to dosing type 2 diabetics with a long acting and then covering them with fast acting insulins at meals. This has thrown me for such a loop!
HELP!
Jenn

[jesse girl]

Re: New diagnosis, help!

hi and welcome

you might have to throw out what you know with human diabetes and how its treated

A dogs metabolism is quite different than humans

First and foremost it can take a week to sometimes 2 weeks for a dose adjustment to settle ,so raising a dose after a day or 2 because the numbers are not adequate may not be prudent

It appears with dogs it takes quite a bit of patience and it can take 3 to 6 months to get a dog properly regulated

One of the biggest problems is going past a dose that's needed . this can actually lead to higher numbers and more unstable and it can be difficult finding your way back to the proper dose . Thata why slow and steady wins the race

6 units would be a normal starting dose for your pup but some pups need less than what a normal starting dose my jesse was one of them which created a problem for her receiving to much insulin which put her at risk and slowed down the process of regulation

dont expect to see regulation that looks like normal blood sugar . not many attain that and actually prefer regulation a bit higher because of the variables to cause a dogs blood sugar to drop and it can be quite dramatic like with exercise and excitement .

[CraigM]

Re: New diagnosis, help!

Hello! Love the support I see on this board!

My 7 year old, 30 lb cockapoo, Cookie, was panting and peeing and suddenly incontinent. Took her to the vet, no big surprise that she's diabetic. I'm a nurse and worked for a time as a diabetes educator, so I thought I'd be pretty comfortable with this.

They started her on a 5 u dose of Novolin N twice a day, but did not suggest a diet change. She's eating Science Diet for sensitive stomachs. I wasn't thrilled with her numbers after a couple days, so I upped her insulin dose to 6 u. I did a curve on her over the weekend, and her blood glucose was all over the place in the 200-low 300's with no actual CURVE, no rhyme or reason. No peak, no trough, no nadir, just random screwy numbers.

I upped her dose to 7 u yesterday, 6:30 am and 6:30 pm, with her injections immediately after she eats.

She's been consistently high first thing in the morning- around 300 on 5 and 6 U, but this morning after 7 u last night she was 382! What's up with that?

I get home from work at 2:30, and her sugar is always around 300. By dinner at 6:30, though, where you'd think the Novolin H would be wearing off, she's got the lowest blood sugar readings at 176-135.

To complicate the issue, she also MIGHT have Cushing's.

Any thoughts? Is the food too carby? It's only been a week, am I being impatient?

I'm used to hanging a bag of IV fluid and insulin and adjusting the rate every hour. I'm used to kids with insulin pumps and continuous blood glucose montitors! I'm used to dosing type 2 diabetics with a long acting and then covering them with fast acting insulins at meals. This has thrown me for such a loop!
HELP!
Jenn

Welcome to the forum!
6 units was a pretty normal starting dosage for a 30 pounder. A VERY general starting dose is 0.2 units per pound, although that is usually a conservative amount and would likely be raised over the coming weeks. just as an example my 19 pound dog is on 9 units of Novolin-N and 3 units of Novolin-R per meal/injection. You might not need the "R", the future curves will be your guide.

Of course there isn't really much difference between 300ish and 382. Could be normal variation (do you weigh out the food, or use a measuring cup?) My Annie is frequently higher first thing in the morning, so I often give a tiny more insulin at dinner (9iu in the morning and 9.25iu in the evening). My wife, Linda, and I are both type-2 diabetics and our morning readings are usually the highest of the day also.

The "experts" here usually warn not to jump to Cushings right away. I'll let them explain why Cushings is often a false diagnosis.

As you suggested, a week or two isn't very long and it might (likely) will take several months before you get things the way you would like them. Can't really rush diabetes

Craig

[nyjenniferc]

Re: New diagnosis, help!

Thanks! You guys rock! I'll proceed with more caution, I guess...I'll wait a while before I think about changing the dosage again.

I do measure out her food and try to keep things really consistent now...exercise and food times and amounts.

They were thinking Cushing's because her liver enzymes were wacky high. I'm actually giving her some dandelion extract to help her liver (I took classes in herbal medicine). I guess it's hard, the Cushing's can lead to the diabetes, and the symptoms are similar and all that. We haven't thought about further testing, they wanted to get her regulated on the insulin first, so we'll see...

I know they don't keep the dogs under tight control like humans, but the vet did say she'd like her to be under 180. I find when she's over 300 she starts with the drinking and urinating...but I'm happy with any number around 200, personally!

Thanks, will check back and let you all know how it goes...

[amydunn19]

If she can get down to 135, she likely isn't a cushings dog. Also, unless her appearance isn't cushings(pot belly, balding) then she probably isn't cushings. Unregulated diabetics will test false positive for cushings and you can do damage with cushings treatment if she doesn't have it.

It is very early and you don't want to rush the process. The food may not be a good balance but time will tell you that.

Are you testing at home? That will get you to regulation quicker. Also, go easy with herbs at first. I am not against them but sometimes it muddles things up and may not be helping. There are some helpful supplements but sometimes in the beginning, it might be best not to add them. I use denamarin with Maggie and it has changed her blood results for the better. I also use d mannose and when she is consistently taking it, she hasn't had UTI's.

[nyjenniferc]

Re: New diagnosis, help!

Thanks, amydunn19! Cookie doesn't really have a potbelly, but she doesn't have great definition either. I guess between that and the incessant panting and the bloodwork, the vet was saying it was a possibility. Her hair is pretty good, no thinning, and other than some skin tags, no dermatological issues either. But I'm glad to hear someone say she's probably not Cushings!

I'm going to be a little more patient with the process. I'm not a patient person by nature, so it's hard!

I was looking at slowly transitioning her to a kibble with a lower carb content. I see the Nutrisca is available at WalMart and one of the supermarkets near us, and it seemed to get a good rating. Does your Maggie like it?

[amydunn19]

It was all she would eat. I prop it up a bit. Low glycemic food can have its challenges but Maggie eats some meals plus snacks. I have found she has digestive problems with just two meals a day. The best thing to do is try it and see if it works.

Patience is the hardest part. In the earlier years, some forum friends would ask me if I was wearing my patience hat. Diabetes will force it on you, it seems.

[peony]

Re: New diagnosis, help!

Thanks, amydunn19! Cookie doesn't really have a potbelly, but she doesn't have great definition either. I guess between that and the incessant panting and the bloodwork, the vet was saying it was a possibility. Her hair is pretty good, no thinning, and other than some skin tags, no dermatological issues either. But I'm glad to hear someone say she's probably not Cushings!

I'm going to be a little more patient with the process. I'm not a patient person by nature, so it's hard!

I was looking at slowly transitioning her to a kibble with a lower carb content. I see the Nutrisca is available at WalMart and one of the supermarkets near us, and it seemed to get a good rating. Does your Maggie like it?

My OLD vet diagnosed my dog Kirby with Cushings and even though his blood work showed very high blood glucose (over 600) never gave a script for insulin. His weight went from 31 to 17 pounds over about six months. The vet kept wanting another test before he would treat Kirby. After spending over $1,100 he said he still needed more tests. Kirby ended up with high ketones and was very ill. He was peeing all over, lost almost all muscle, his hair quit growing and was thinning. He couldn't climb the stairs or get on the couch without help. He struggled to walk.

Thankfully I found the K-9 Cushings site and they recommended I come here. The wonderful people here helped me save Kirby's life. It was a holiday weekend (New Year's 2015) my vet never called me back and then closed for three days. With people here holding my hand I started Kirby on Novolin N. I started at three units twice a day, found a new vet and have gradually increased his insulin. The new vet has me give him the increased dose for at least two weeks before I do a curve. Kirby is on 7 units a day now and weighs 21 pounds. She also lets me test at home and email her with his curve results (I called around until I found a vet that would.) We are doing a curve today and his first reading was 241.

I apologize for this being so long but Kirby is doing great now. Now only did he gain some weight back but he runs and jumps like a puppy (he's 8.) His hair his growing, no more accidents, he's getting muscle back. All of his Cushings symptoms have disappeared.

[nyjenniferc]

Re: New diagnosis, help!

Peony, I'm so glad Kirby is doing so well! Stories like this give me hope! And I'm VERY glad you found another vet, OMG.

Cookie seems symptom free now- not panting nearly as much, not drinking or peeing constantly. I don't know why her liver enzymes were so high...I guess I'll have to get it rechecked at some point. But if the insulin is fixing the symptoms, it's good enough for me right now! I hate to say it, but I don't have a lot of $$$ right now for doggie diagnostics and surgeries and what not. Thank God for WalMart and a vet who suggested it as a lower cost alternative!

Just had a nice walk and a bath, and her sugar was 169. Pretty good!!!!!

[nyjenniferc]

Re: New diagnosis, help!

And, just like that, she's back up to 348 this morning. Oy vey.

Curious, though, does anyone know if injection site changes absorption rates? I know in the (human) hospital we were instructed to inject insulin into the fatty abdominal tissue for best absorption. I've been injecting Cookie in the scruff of her neck...

And in humans we were instructed to rotate testing and injection sites due to the build up of scar tissue. Any thoughts about dogs?

Thanks!
Jenn

[MikeMurphy]

Re: New diagnosis, help!

And, just like that, she's back up to 348 this morning. Oy vey.

Curious, though, does anyone know if injection site changes absorption rates? I know in the (human) hospital we were instructed to inject insulin into the fatty abdominal tissue for best absorption. I've been injecting Cookie in the scruff of her neck...

And in humans we were instructed to rotate testing and injection sites due to the build up of scar tissue. Any thoughts about dogs?

Thanks!
Jenn

I've been injecting Lily in the scruff of her neck for almost 3 years now, but I do try to rotate as much as possible around the scruff.

I wouldn't be too concerned about the 348. It's just one number and we are looking for trends. Future curves will give you a better idea of how she reacts to insulin, food and exercise. One thing you know at this point is that the insulin is working and this is good news!

[Auddog]

When my dog Bazzle was first diagnosed we injected him in the scruff of his neck, but after a while not only did scar tissue build up, but he became hyper sensitive too! At first it was just a bit of a whine, which progressed to a yelp, then full on crying and carrying on!
So after talking to some people here in the forum, we decided to try out changing his injection site from the scruff to his sides. I noticed it didn't bother him at all to have the shot in his side (though it did take us a few tries because he was rather ticklish). We also noticed that the absorption rate if the insulin was much faster, and because we switch back and forth from his right side and left side we've had minimal scar tissue build up

Don't forget that changes to diet, just like changes to insulin will take a while to settle in their system. I can't tell you how many times I've read "make a change, wait at least a week, run a curve, and repeat if necessary". I know it can be frustrating, but you and Cookie will get there ; patience, patience, patience.

Best of luck with everything!!

Audrey & Bazzle

[amydunn19]

Re: New diagnosis, help!

I have never been a fan of the scruff - it isn't best for absorption(although many vets instruct patients to use it). I use the sides of the top of the back but not over the spine. I don't tent - just pull up loose skin and inject at the bottom point. I work my way up and down the sides and yes please vary the site as scar tissue will build up. After a long period of time, Maggie has scar tissue, but after more than 6,200 injections, I guess that is to be expected

[CraigM]

Re: New diagnosis, help!

Just adding my 2 cents about injection sites. I also found scar tissue(?) after injecting into the same area for an extended length of time. So we now inject from the scuff and all along her right side. We avoid her left side because it just feels awkward to both of us and she might twitch if I try the left side, I'm sure we would eventually get over the awkwardness.

BTW, now that you're a regular, would you like the title of your thread changed to something more personal? Something like "Cookie's adventure"? Just post what you would like and a moderator can change it for you.

Craig

[MomofGus]

Re: New diagnosis, help!

My vet did not agree with scruff of the neck and advised against it. She advised the best place is to do each side of the back, alternating locations, starting just about the hip and working upwards (but not over the spine). She also advised we could do abominably, but to me, that seem like it would be harder for me to do and for the dog as well and not enough skin to pull up. I know with my schnauzer, he does not absorb well when done in the scruff of the neck. When my husband gives the shot when I'm not home, that's where he seems to do it. I always make a notation in my daily journal of shot location and after awhile was able to see where he had been given the injection on days with higher readings and to see if there was a pattern there. What I have found that sometimes I wasn't injecting under the skin and that would cause a higher BG level. It happens still, unintentionally, and I can tell I'm not in the right spot when he flinches and how the insulin plunger feels when injecting.