Sidney has passed December 21, 2014

[Monsters Momma]

Re: Newly Diagnosed, still not Controlled

How much is the Vetsulin?

petfooddirect.com has it for $40 a vial plus shipping. I just received a shipment of 4 vials for $188.98.

I wish I could say it was helping Vinny at that price. Truth be told, we've been discussing changing to NPH to try it. We've been at this for 10 months though and have tried lots of different alternatives.

My advice to you would be not to give up. You've only be at this for about 4 weeks and have a long way to go before deciding that another route is more viable. If you don't give NPH a fighting chance, you'll never know if it could have worked.

I know it's hard to be patient and try not to hurry. This diabetes thing asks of us, not only to give our best to our pups, but to do so in a slow methodical way. We don't have a problem with the first part of that...it's the second part that gets us every time!

Hang in there.
Mel

[amydunn19]

Re: Newly Diagnosed, still not Controlled

Wow, those are some very comprehensive spreadsheets. That is a ton of info! Great job.

My opinion, for what it is worth, is that sydney hasn't been on nph long enough to decide whether it is working or not. It does bring her down and finding the balance of food and insulin just takes time. Vetsulin won't be a magic bullet. It will take the same process. You have been at 16 units for four days counting today and the numbers today are lower than yesterday. I would give 16 units a couple more days then go up one unit again if still high, then leave her there 6 or 7 days, curve and reevaluate. The insulin takes time to work at a new dosage. I think she just isn't at her dose yet. But, you have to go slow. It is a balancing act.

I know how difficult it is but it is very very rare to just land on the correct dose so quickly. Yep - four weeks is quick. I have seen it take months and some dogs never get magical numbers. Natalie always says every dog has their own "book" and it will take some time to really get your dog's book written. You can't skip to the juicy parts without enduring the slow parts.

You are doing a great job doing all you are doing. Wear your patience hat - it pays off in the end. Also, if you can, I would love to see a real 12 hour curve, testing every 2 hours from fasting to evening dose before moving up. It is good to do those curves by testing at the same times so you can compare apples to apples.

Dr. Peterson is a great source but always keep in mind that every dog is different. He may take a grouping of dogs in research and 8 out of 10 may react a certain way but your dog might be in the minority. It is always good to have these different options put back in your mind for later. Changing now might be premature.

[SidneyDog]

Re: Newly Diagnosed, still not Controlled

Thanks again for all the input. It helps me tremendously. I guess I would just think he'd have much lower numbers by now. I'm scared for him when he hits 690 and stays in the high 500's. I will give the 16 a few more days. Then bring it to 17 and see if there's better progress.
Question on doing the curve.
I'd start next Saturday (when I'm home) and when we wake up take his BG. Do I need to wait 2 hours to feed him & give him insulin?
Or do you basically test him every 2 hours from when you wake up?

He is still lying around having a hard time getting up on his own, drinking a ton of water.

[amydunn19]

Re: Newly Diagnosed, still not Controlled

You would test him before food and insulin, feed/give insulin, then test every two hours. No reason to wait. You want it to be a typical day. Don't do it on a day when you are having company or plans that will skew the results.

If you can't do it before next Saturday, see how he finishes out today and early tomorrow. Test as much as you can and move him up if needed tomorrow night with no other changes this week. I don't think based on your numbers he is having lows. That way, the curve will mean something. He will have about five days at the new dose.

Thats what I would do.

[Fishslayer]

Re: Newly Diagnosed, still not Controlled

Just checking in. Thinking good thoughts for Sidney.

Kind of wondering. Is there any chance that Sidney may be sneaking food on the sly? My little Heeler Monster will scarf the cat food any chance he gets.

Lucy was the same way.

[SidneyDog]

Re: Newly Diagnosed, still not Controlled

Hello!
Yesterday his low was 413 5 hours after insulin & an hour 15 later he was up to 560.
He dropped to 497 before bed and this morning at 7 am he was up to 649.
I'm home for lunch now 5 hours after insulin and he is at 479, but he is very sluggish. Didn't even lift his head when I got home. His gums are a bit sticky so I'm going to try and take him for fluids after work. I think all the highs have drained his hydration.
I feed the other two dogs same time as him & whenever they finish I pick up bowls. Last night he was hungry and was looking around for food, but I am trying to keep him controlled with that.

Ugh. Another bad day. I faxed my vet the spreadsheet so hopefully I'll hear back from her soon.
Thank you for thinking of me.
I hope today brings better results.

Talk soon!
Brooke

[Riliey and Mo]

Re: Newly Diagnosed, still not Controlled

The nph is working he just needs an increase.

Diddo

Up him now to 17 iu, do the planned saturday curve to c if he needs another increase then.

Your doing great

[SidneyDog]

Re: Newly Diagnosed, still not Controlled

Has anyone given their dog pedialyte for dehydration? Or is there too much sugar. I feel like he needs fluids but taking him to vet is going to raise his sugar. He has been 550 first thing in the am, then 580 5 hours after 18 units of Novolin (as per my vet we increased it) and 519 9 hours after insulin & breakfast.
He looks dehydrated again.
Please, any advice is welcome. I don't want him to feel so ill. I have an appointment tomorrow at 11:40 (4 hours after insulin).
Should I wait it out?

[SidneyDog]

Re: Newly Diagnosed, still not Controlled

Or should I just boil some chicken and have him drink as much as I can?

[jesse girl]

Re: Newly Diagnosed, still not Controlled

you could add some tuna water or broth to get him to drink more . the pedialyte i think has some electrolytes which can be helpful . i thought they did have a sugar free type .

you would think he would automatically want to drink if hes dehydrated but dogs can sometimes do the opposite of what you would think

[SidneyDog]

Re: Newly Diagnosed, still not Controlled

I think when he gets really dehydrated he doesn't want to drink. I put some chicken in his water bowl & he drank the whole thing. I'm boiling chicken now for him to have the water.
The problem is he is still not able to get up on his own because he is weak in his back legs from the diabetes so I think he's not getting up to get himself water. Or he's a smart cattle dog & has tricked me into doing everything for him & no longer leaving the house except for work! Smart little doggie!

[amydunn19]

Re: Newly Diagnosed, still not Controlled

If you do pedialyte sugar free, make sure it doesn't have artificial sweeteners in it. Those are very dangerous.

[SidneyDog]

Re: Newly Diagnosed, still not Controlled

So today I took Sidney for his 11:40 am appointment. My vet and I decided to test his sugar with both of our machines and to test the blood from his vein vs. his elbow.
First she took the blood from the vein, and then put one drop on her AlphaTrak2 and then another drop on my AlphaTrak2.
Her read 419 and mine read 470.

Then I used the lancet on his elbow callous as I have been and hers read 490 and mine read 518.

So, that's disturbing.

She took some blood to run it through the in-house machine and got a 430 reading (I think)
Since I went on my lunch break I asked if she could keep him there and give him the fast acting insulin and some IV fluids so he could have some relief.
When I returned to get him at 6 she told me she wanted to keep him because his Amylase was over 3000. She showed me the last time he was here it was 1800 and before that it was 1600 and before that it was 1200. She said she did a quick ultrasound and said his pancreas looked inflamed.
She feels this is why his blood sugar levels have been so high. He's remained in the 600's and 500's for weeks.
She is keeping him for a couple days to give him antibiotics, IV and the fast acting insulin. She said we caught it early because he was still eating, did not have a temperature and isnt vomiting.


I called Dr. Mark Peterson's office today, because he is 20 minutes away from me in Manhattan, but he is no longer taking patients. His secretary did say he always recommends to try Vetsulin first. My Vet feels very hesitant to change him to a different insulin at this point.

Does all of this seem reasonable or could there be other issues? Should they have red flagged those amylase readings prior to today? I feel like if I'm not a pain in the butt and keep calling and bringing him in and saying he's dehydrated, his sugars still SO SO high then I'd be here with a sick dog worrying out of my mind. I like my vet a lot, but I am wondering if I should go see an internist. I was reading about Pancreatitis and it says there is a PLI test that better determines if it is Pancreatitis.

Does anyone have any experience with this? What questions should I be asking, could it be something that appears to be pancreatitis but is another underlying issue?

[momofdecker]

Re: Newly Diagnosed, still not Controlled

Since I went on my lunch break I asked if she could keep him there and give him the fast acting insulin and some IV fluids so he could have some relief. When I returned to get him at 6 she told me she wanted to keep him because his Amylase was over 3000. She showed me the last time he was here it was 1800 and before that it was 1600 and before that it was 1200. She said she did a quick ultrasound and said his pancreas looked inflamed.

She feels this is why his blood sugar levels have been so high. He's remained in the 600's and 500's for weeks.

She is keeping him for a couple days to give him antibiotics, IV and the fast acting insulin. She said we caught it early because he was still eating, did not have a temperature and isnt vomiting.

Does all of this seem reasonable or could there be other issues? Should they have red flagged those amylase readings prior to today? I feel like if I'm not a pain in the butt and keep calling and bringing him in and saying he's dehydrated, his sugars still SO SO high then I'd be here with a sick dog worrying out of my mind. I like my vet a lot, but I am wondering if I should go see an internist. I was reading about Pancreatitis and it says there is a PLI test that better determines if it is Pancreatitis.

Does anyone have any experience with this? What questions should I be asking, could it be something that appears to be pancreatitis but is another underlying issue?

I think there is a fine line with ill pets. Vets often have the education and licensing but owners often know their pets best and instinct can tell them when something is 'off' even if they can't explain why. The good news is that your vet is willing to entertain your questions/concerns and is searching to find answers for you.

My understanding of pancreatitis is that it can be subclinical for some dogs - meaning they can test positive for it without showing any of the obvious symptoms. A high AMYL value and an ultrasound would be supportive of pancreatitis. There is also a SPEC cPL blood test that could confirm it. Any reading above 400 would confirm pancreatitis. Pancreatitis is known to cause insulin resistance in diabetic dogs during periods of flare up so that certainly could be contributing to the higher numbers your pup has been showing.

My boy was one who I think was either atypical in his symptoms or sub-clinical all together. Every now and then he'd get a cough/gag after eating but it was well before his diabetes was diagnosed and it was after we'd feed him people food. And then there came a time where he ate a lot of grass - that was after the diabetes was diagnosed. He'd also have periods of being gassy. But he also ate his dog food every day with gusto and would eat his canine brother's food if I didn't stand guard. He was also a master of finding a way to sneak into the basement to eat the cat food. He never vomited. He never ran a temp. He had regular, solid bm's - no diarrhea. He had five CBC's in a one year period and his AMYL was low on all five of them. But he was tested via the SPEC cPL and was over 400.

In his case I suspect the pancreatitis was secondary to high lipids. His fasting cholesterol value was over three times higher than it should have been and his fasting triglyceride value was more than twice what it should have been. He was also found to be hypothyroid. Hypothyroid dogs can't clear lipids from their systems. My best guess for him.... he suffered from hypothyroidism long before he was diagnosed with it. I suspect he developed high lipids as a result of the undiagnosed hypothyroidism. Then he developed pancreatitis from the high lipids - but he never vomited, ran a temp or had diarrhea. Over time the (subclinical) pancratitis scarred his pancreas to the point he could no longer produce insulin. Then he was dx. diabetic. But his dx. came reversed. Diabetes, then high lipids, then pancreatitis then hypothyroidism. Once we treated his hypothyroidism his high lipids return to normal ranges and his pancratitis cleared (went from a 404 to a 57 in an eight week period).

I share this with you because with him I believe the pancreatitis was secondary to the hypothyroidism. Eight weeks after he started his thyroid meds we retested everything and the pancreatitis cleared. There was a two week period where we did feed him a low fat diet to reduce his chol value as it was in such a high range it put him at risk of having a stroke. But after that we returned to feeding him wellness core reduced fat food twice daily. We also never treated him with antibiotics or pain killers.

Did your vet give any pain relief pills to treat the pancreatitis? Was there any discussion of what may have caused it? It seems dogs with primary pancreatitis might need low fat diets and possibly need to be fed several small meals through out the day to avoid inflaming the pancreas.

If your vet has run blood work I'd ask for copies and check to see if there are other values that are either high or low (out of normal range) and ask the vet to explain what might be causing them as well.

Hope your pup is on the mend soon!

ps - here is a good link with information about canine pancreatitis (you can select different tabs - the related documentation tab has lots of good info):
http://www.idexx.com//view/xhtml/en_...jsf?SSOTOKEN=0

[amydunn19]

Re: Newly Diagnosed, still not Controlled

As far as the meters being off, that is pretty common and the numbers are still in the same range. You are looking for ranges and patterns not numbers. A 490 and 518 are essentially in the same range and the 419 and 470 are further apart but still in the same range. You would treat them the same. Dog's numbers change minute by minute and it is best to not look at that number but what range it is and how your dog is reacting.