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  #11  
Old 03-03-2016, 09:46 PM
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amydunn19 amydunn19 is offline
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Default Re: Need help with Ben

Maggie had DKA and pancreatitis originally so it could be both or either. Pancreatitis diagnosis is an easy blood test. The SPEC cPL will tell you if that is it. I would think the level of ketones and certain levels in the CBC would be indicative of DKA - the elevated BUN (urea) indicates a toxin is present, high liver enzymes, high cholesterol, low levels of phosphorus, potassium and sodium. Elevated white blood cells may also be present. So, blood tests can give a pretty clear picture.

I would ask for that SPEC cPL test. It shouldn't cost much and would explain vomiting.

Glad that your Ben is better - take it slow. Fluids are great so glad you can give them at home.

Cushings is a very common MISdiagnosis in unregulated diabetics. There are specific Cushings tests that would have to be performed and many are false positives or inconclusive so I would be leery. IMO, Cushings is what vets go to when a dog doesn't respond to insulin. If Ben wasn't trying to eat you out of your house and home, then I would have another reason to doubt Cushings. Sometimes, there are many other reasons for dogs not responding to insulin and can be an easy fix. If you want great Cushings information, check out out sister site, k9cushings.com. The people there are great - super knowledgeable. It will ease your mind.
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  #12  
Old 03-09-2016, 12:35 PM
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Default Re: Need help with Ben

I thought I'd give you an update on Ben.

After a very long week Ben is now out of the thicket and doing well. He recovered from severe ketoacidosis thanks to a five-day long intravenous fluid treatment.

We switched to Royal canin which he loves and eats heartily. The only problem is that, while the food is giving him all the nutrients he needs, he still asks for more when he is fed. We are being very disciplined with food and feeding and insulin times.

We are also using Insulatard now, and he is on a 5iu dose twice daily, every 12 hrs. Glucose levels fell immediately as soon as we started using it, but we are still trying to find the right dose, and sugar levels are still going up and down. They are sometimes in the 20s (evenings) and I hope this will not lead to another ketoacidosis episode. Peeing and thrist abated.

Still waiting for test results. Being tested for pancreatitis too and already have pancreatic enzymes on reserve. Still not convinced it is Cushing's.

I also ordered a glucometre from the US (the brand suggested on this forum) to start home testing and plot a more exact curve and understand how Ben's body is reacting to insulin throughout the day. I am carefully reading the case study on this website to hopefully make informed decisions.

Many thanks for all your suggestions and help. It meant a lot to me, especially last week when we were really on thin ice.
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  #13  
Old 03-10-2016, 06:11 AM
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Default Re: Need help with Ben

That's a nice update. It sounds as if things are gradually improving for you and Ben. Testing at home will help as well so it's great that you plan to do that.

I haven't heard of that brand of insulin being used for a dog before - interesting that he seems to need so much less of it than he needed of the Caninsulin.

Hope things carry on getting better!
Antonia
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  #14  
Old 03-10-2016, 08:33 AM
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Default Re: Need help with Ben

Good to hear he's doing better. You'll get to the bottom of it.
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  #15  
Old 03-10-2016, 10:20 AM
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Default Re: Need help with Ben

Thank you for your well wishes.

Insulatard is insulin intended for human use, but as Caninsulin was not working we had to find something else. I think it is stronger than Caninsulin, and we immediately saw a drop in glucose levels. Today they are hovering between 15 and 17. We still have some way to go, but we can see some light at the end of the tunnel now!
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  #16  
Old 03-10-2016, 11:14 AM
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Default Re: Need help with Ben

i believe its an intermediate type of insulin as nph which many in the states use for there dogs

now dosing as far as measurement on the specific syringe usually adds up to be about the same with caninesulin. so i am wondering what type of syringe your using . in the states we would use u-40 for pet insulin and u-100 for humane

did you change syringes when you switched insulin's ?
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  #17  
Old 03-11-2016, 05:25 AM
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Default Re: Need help with Ben

No, we kept the same syringes. They have an orange cap. The needle is very fine. There is no indication on the packaging if they are 40 or 100. I will ask my pharmacist, as it will be good for me to know too.
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  #18  
Old 03-14-2016, 08:34 PM
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Default Re: Need help with Ben

I am so happy to hear that Ben is doing better!

Insulatard is the European name for Novolin NPH.

http://diabetesindogs.wikia.com/wiki/Insulatard

It sounds like you were already using U100 syringes, which is the right type for Insulatard. If you were using U100 syringes with Caninsulin, you were giving him less units than shown on the barrel of the syringe.

But all that matters is what you are doing now, since it's working fairly well!

It is a good idea to determine for certain what type of syringes you are using. I think the color coding is the same in the UK and Europe but I am not certain of that.

Natalie
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  #19  
Old 03-19-2016, 03:25 PM
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Default Re: Need help with Ben

Yes, we were using u-100 syringe all along. This might explain why Caninsulin was not having any effect on Ben.

Test results have come out.

TLI is + 50 Ig/l - vet said that this point to pancreatitis or renal insufficiency. Having blood tests in Monday to check on the latter, though previous blood tests showed that everything was working properly.


Urea normal. Creatinine slightly below normal.

Urine cortisol: creatinine ratio 80 - vet said above 25 points to Cushing's

LDDT 126.7, 121.9, 15.3 (hope I got the last number right as this information was communicated to me over the phone)

I am not sure if I am to take these tests at face value.

They were taken while Ben was undergoing a severe DKA episode and receiving intravenous fluids - therefore, a period of huge stress. With all our good will, we were the ones to cause it as we stopped giving him insulin if he did not eat. He was not eating his kibbles from another brand, we gave him boiled chicken, and were just happy to see him eat again. All this while Ben was on Caninsulin.

What puzzles me in all this is that Ben shows none of the physical symptoms associated with Cushing's - no fur problems, no skin infections, no pot belly, drinking and peeing returned to normal.

The only thing is that he is always hungry, but he is getting only 120 gr of kibbles for diabetics per day (accurately measured and strictly timed), whereas before he used to graze all day long. Other than that he is happy, lively, and energetic (read flashes away when we take him out).

Ben is still on 5 iu of Insulatard x 2 daily, 12 hours apart. We haven't measured sugar levels for past 4 days or so, as vet said no changes were being observed. The last reading we had was 26 in the morning, 14 in the afternoon, and 20 in the evening. I am still not doing home testing as glucometre is taking ages to be delivered. However, in my limited knowledge, these figures seem to indicate that the insulin is not lasting for the whole 12 hours, and not necessarily that there is an underlying cause for Ben's unregulated sugar levels. The more I read the case study in this website, the more I see similarities between that case and Ben's and it might just be that he is metabolising his insulin too quickly.

Vet is proposing that we stop the insulin, and start treatment for adrenal Cushing's. I am not so much ikeen on this:
A) we do not know if it is adrenal or pituitary-based
B) Ben will have to go without his insulin during treatment, and if his Cushing's (if indeed he has it) is pituitary, then I have no idea if this could lead to another DKA

Now that Ben is less stressed I have a good mind to ask vet to start tests from scratch. What worries me is that to do LDDs we have to stop giving Ben insulin for two days, and again I fear DKA. Vet said we could do the high- dose test. Cannot do ultrasound as there are no specialists on it where I live.

I really do not know what is the best decision here.
If waiting another 2 weeks will not be dangerous for Ben, I would really like to have the time to do a proper curve for him, to see if we can stabilise his sugsr levels.

I am also concerned about the side-effects of the treatment for Cushing's, especially if it is a false positive.

Any ideas or advice please?
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  #20  
Old 03-19-2016, 04:10 PM
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Default Re: Need help with Ben

Ben's conditions are way over my knowledge level, but 5 units of NPH isn't an overly high dosage for a 8kg / 18 pound dog. All dogs / situations are different, by my Annie is also about 18-19 pounds and is getting 8 to 8 1/4 units of NPH.

I understand you have a meter on order. Is it the AlphaTrak, or a human meter? You might think about getting a human meter from a local pharmacy if they are available and not too expensive. Staying in the 20s mmol/L (300s mg/dL) can't be good for him.

Craig
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