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Old 04-21-2016, 10:03 AM
nyjenniferc nyjenniferc is offline
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Default Cookie and Impatient Jenn, RN!

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
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  #2  
Old 04-21-2016, 11:22 AM
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jesse girl jesse girl is offline
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Default 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 .
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Jesse-26 lbs - 16 years old ,10.5 years diabetic, one meal a day homemade and a vitabone snack . 3 shots of Novolin a day . Total insulin for a 24 hour period is 6.5 units of NPH insulin .
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  #3  
Old 04-21-2016, 11:23 AM
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CraigM CraigM is offline
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Default Re: New diagnosis, help!

Quote:
Originally Posted by nyjenniferc View Post
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
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Annie was an 18 pound Lhasa Apso that crossed the rainbow bridge on 10-5-17. She was nearly 17 years old and diabetic for 9 years.

Last edited by CraigM; 04-21-2016 at 11:26 AM.
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Old 04-21-2016, 03:23 PM
nyjenniferc nyjenniferc is offline
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Default 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...
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Old 04-21-2016, 07:49 PM
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amydunn19 amydunn19 is offline
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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.
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Maggie - 15 1/2 y/o JRT diagnosed 9/2007, Angel status on 6/20/16. Her mantra was never give up but her body couldn't keep up with her spirit. Someday, baby.......
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Old 04-22-2016, 03:25 AM
nyjenniferc nyjenniferc is offline
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Default 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?
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Old 04-22-2016, 03:58 AM
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amydunn19 amydunn19 is offline
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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.
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Maggie - 15 1/2 y/o JRT diagnosed 9/2007, Angel status on 6/20/16. Her mantra was never give up but her body couldn't keep up with her spirit. Someday, baby.......
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Old 04-22-2016, 08:34 AM
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peony peony is offline
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Default Re: New diagnosis, help!

Quote:
Originally Posted by nyjenniferc View Post
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.
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Old 04-22-2016, 02:01 PM
nyjenniferc nyjenniferc is offline
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Default 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!!!!!
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Old 04-23-2016, 05:08 AM
nyjenniferc nyjenniferc is offline
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Default 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
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