Multiple Medical Issues and Food - Help!

[Jaye]

Hi, Folks...

I'm new here, although not new to canine diabetes (or feline diabetes either). My Robbie will be 15 this month. He's a mix of poodle and ?, approximate 21 lbs, which is his normal weight, although he's always been slim. He's been on 9.5 units of Vetsulin since April of 2009. I thought he was doing fairly well, although, after initial BG curves at the vet, we've been using the Keto-Diastix for general...and I realize it's VERY general...glucose readings.

For food we do a bowl of Royal Canin OS canned 2x daily. He's had bouts with urinary crystals in the past and the vet decided not to take him off the prescription food. He gets several supplements a day (arthroflex, forti-flora, vetasyl).

As many of you have been doing, we've switched to NPH over the last week or so. Started at 7.5 units and I tried, for the first time with him, to do actual BG readings. I've been doing them with my cat for months, but Robbie is a bit of a...shall we say, "drama queen." The poor boy screams when the vet even shows him a needle. He fights, wimpers, yelps..the whole nine yards. It took months to get him used to his 2X daily shots.

His first readings weren't bad. 177 at 4.5 hours and then 128 at 5 hours post injection. Then the other day they dipped to 94 at approx. 4.5 hours. I know that's not that low, but I freaked a bit and gave him some of his normal food. Later the BG was quite high...rebound from the low BG or the result of the food I don't know.

Vet had me drop to 7 units, although on the U100 syringes the difference between the two is really difficult for this old gal with bifocals to see. Here's the "I'm feeling guilty" part. Today I was told to test him at 4 hours and at 8. It was a disaster. Not only would he NOT bleed, even with a warm compress, but he got very tense (seems his recent blindness exacerbates his nerves as well). Then my sweet little boy started showing his teeth and biting at me! Didn't matter where I tried...ears, base of tale (I can't do his mouth...he's always been very sensitive there). I was almost in tears when I called the vet, because I've fought very hard to be able to handle this diabetes stuff (first with Robbie, then with my cat, Chester). Forgot to mention that I'm highly needlephobic.

Vet (who I trust completely) said not to stress him out any more and to bring him in Monday for a full BG curve. I know it's a good idea when switching the insulin...and it's been a decent amount of time since the switch, but DRAT! I've failed and I'm not happy about it.

I've noticed more peeing in the house, which I assumed was a separation anxiety issue (which we sometimes struggle with) but now I'm thinking it's because he wasn't as regulated as we thought. Not sure, though, because the peeing is only when we're not home or when we, for lack of a good reason, ignore his barking. Caught him lifting his leg today for that reason. He easily makes it through the night with no problems.

Behaviorally, he seems to be doing okay. Doesn't like steps (up is worse than down) and flinches when things move too close to him, but on our 2X daily walks with his "sister," Callie, he usually doesn't walk, but jogs, and I have to step it up to keep up with him. I keep reminding him that he's 15, blind and diabetic, but he doesn't seem to notice my huffing and puffing in my attempt to follow.

Sorry for the long post. I'm just venting but it's nice to have found a place to vent!

Here he is...my sweetheart.

[k9diabetes]

Re: New and Feeling Guilty

What a cute boy! Sorry to hear that everyone feels so upset right now...

I agree with the vet that there's no point of continuing trying to test blood glucose when it's just upsetting everyone and everything. So I too would have said just to stop for now.

Have you continued to urine test?

If so, what kind of readings have you been getting?

Do you use syringes with half-unit marks?

With the readings you had and the drop in dose, he should be in pretty good shape. So it seems to me that there's no panic in needing to test. You could try once or twice in a day and then set it aside.

Tell us about your testing materials... what gauge are the lancets and do you use a clicker or lance by hand?

Natalie

[CarolW]

Re: New and Feeling Guilty

Hi! - and a big, fat welcome to you and Robbie!

Glad you joined us. I can't be too coherent at this hour - up in the wee hours, but will be watching your reports, and cheering you on, and maybe have some comments and suggestions later.

Just wanted to welcome you and Robbie.

What a gorgeous guy Robbie is! Thanks for the picture!

Sun, 11 Jul 2010 02:23:17 (PDT)

[BestBuddy]

Re: New and Feeling Guilty

Robbie is definitley a sweetheart.

Some things take time and I wouldn't be getting upset about BG testing just yet. If you are all getting stressed it is time to take a step back and leave the testing for a bit. Maybe when things settle down you can try again because it really is a valuable tool. Although the urine sticks are not very accurate you can still keep an eye on things so I would continue those.

Dogs can pick up on our stress and it makes them nervous and upset so it is important for you to take a few deep breaths and relax. I know it is hard but you can learn to pretend and hopefully soon you won't have to pretend because it will be easy for both you and Robbie.

Good luck.

Jenny

[Tikobird]

Re: New and Feeling Guilty

Welcome Jaye & Robbie! What a cutie he is - never would have guessed him to be 15 from that picture! Don't beat yourself up too bad - everything takes time to accomplish and the fact that you are willing to try & learn is 1/2 the battle! Good luck with the home testing - post his curve results when you can so everyone here who can help with advise has the info. This is also the best place to "vent" as we all understand what it is you're going through and many have great suggestions to beat just about anything you run across.

[Jaye]

Re: New and Feeling Guilty

What a cute boy! Sorry to hear that everyone feels so upset right now...

Thanks! It's a pretty constant theme in my house. I have cats with feluk, FIV, kidney failure, diabetes, pancreatitus..you name it, we have it!

Have you continued to urine test?

Yes, we (hubby and I) were always pretty diligent about the urine tests and they were never hugely consistent. We'd get tons of negatives, then, for no apparent reason, he would zoom over 1000. My vet keeps reminding me that urine test strips are only able to give us a general view of his blood sugar since the last time we tested and that (this surprised me) they will show negative until the blood sugar reached around 200, when the blood spills into the urine. (My fault totally if this isn't accurate...I was a bit stressed when she told me and might not have gotten it right).

If so, what kind of readings have you been getting?

Last night: 7.0 units. Checked at 3.25 hrs post injection. He was over 1000
This morning: Checked before breakfast (5:15 a.m.) Again, he was over 1000 so I upped him to 7.5 units.

Checked again at 3.75 hrs post injection...still over 1000.

Although vet said to put him at 7.0, she predicted that we would end up higher and I think tonight and tomorrow morning (before his BG curve starts at 7:30 a.m.) I'm going to do 7.5 if his urine numbers are still high.

Do you use syringes with half-unit marks?

Yes, which are REALLY challenging when my cat needs 1.75 units!

Tell us about your testing materials... what gauge are the lancets and do you use a clicker or lance by hand?

I alternate between Keto-Diastix and Diastix. We've never had an issue with ketoacidocis yet. I used the Freestyle Lite meter that I use for my cat and the accompanying lancets set on 4 (highest level). If he would have bled the first prick I think we would have been okay. It was the subsequent unsuccessful attempts that freaked him out. Not to mention the sound of the plunger and the beep (Robbie hates beeps...Drama Queen!)

As far as using a regular lancet, frankly, I'd have a hard time. I mentioned being a needlephobe...I still have heart flutters when I give his shots and I've been doing that for well over a year! It's a very situational thing. I give his shots yet need to look away when the vet gives his vaccines. My husband has to administer the cat's B12 shot...and he's not around during the week to help with Robbie.

Thanks again for your fast responses, everyone!

[k9diabetes]

Re: New and Feeling Guilty

You got the information from the vet about blood versus urine glucose right. There is a "threshold" above which high glucose in the blood starts to spill into the urine and that threshold is around 180.

So any time the blood sugar stays below that threshold, no glucose goes into the urine.

As you know, then, urine tests don't tell you anything about low blood sugar.

Since you had some low readings, I would not want to up his insulin until a curve can be done.

I know what you mean about the lancing by hand! I was very lucky that Chris was a champ with the lip so I could always use the clicker. I did NOT want to have to stick my directly! I also liked that he had enough fur that I did not have to actually see the injection go into his skin either. I have a tendency to pass out at the sight of needles going into skin, especially my own! So I was glad he wasn't a hairless breed!

Natalie

[Patty]

Re: New and Feeling Guilty

I'm a bit late in getting to this thread but just wanted to say welcome to you! What a great picture of your guy
Patty

[BestBuddy]

Re: New and Feeling Guilty

Guilt and failure were something I dealt with for a long time with my Buddy. I cried for 2 weeks when he was dx with diabetes blaming myself and feeling like I was going to vomit when it was time for the injections. My hubby did them until I discovered the BD inject ease. I have recommended it many times but not sure that anyone ever used it. Once adjusted to my needles it was magic and I used it for 4 years before it finally wore out from the dropping and use but I loved it so much I got another and continued to use it for another couple of years until Buddy passed away. I didn't have to worry about how hard to push the needle because the inject ease did it for me.

I also didn't home BG test for the first 4 (yes four) years and I wish I had started earlier. Buddy was also a drama king and squealed like a girl whenever we tried to BG test so I just didn't. We used the ketodiastix which worked ok until other health issues popped up and we really had to start the BG testing. I would never have believed that I could use Buddy's lip because he hated his mouth being touched but it was the easiest place to get blood and he was a real trooper about it. It was actually much easier than I thought. We used the softclix because it didn't make much of a noise and I really wish I had persevered at the start.

So I suppose this is my confession but we got through it all and so will you.

Jenny

[Jaye]

Re: New and Feeling Guilty

Thanks, Jenny and everyone else...

I had high hopes for testing Robbie in the lip, but those were crushed the first (and only) time I tried. Had I not removed my hand in time, there would have been holes in it, no doubt in my mind. And, even though I know that it would have been my fault, if they would have had to be treated by a doctor (who are required to report dog bites) Robbie would have been put in quarantine.

That happened to a friend of mine who had an injured dog that bit her daughter who hugged her on the wound when the dog was sleeping. The police came, the dog wasn't allowed to leave the yard (even for walks) and had to be kept on a chain while outside for 10 days.

I would never have thought that Robbie would bite, but as my father always told me "All dogs bite, all horses kick."

Tomorrow is the BG curve. I'm going to give him 7 units even though he was high tonight on the test strips. At about 2:30 today he just stopped and stared very strangly...almost thought he was having a small seizure (although there's NO history of that with him). Hubby couldn't tell, but I knew he wasn't feeling right. I thought about the Karo syrup, but opted for a piece of bread instead. His test strip not long before this happened showed negative and I was concerned that he got low since I had given him 7.5 in the morning.

This diabetes is all encompassing, isn't it? With Robbie, and my cat who is FAR from regulated, I'm pretty doggone stressed out!

[k9diabetes]

Re: New and Feeling Guilty

I'm really anxious to see the curve as it sounds like he may be going through some wide swings in blood sugar. Tweaking the diet can often help if that's the case.

You have a lot on your plate so I can imagine how stressed you are!

Robbie's diabetes should eventually get settled into a routine and won't require thinking about it too much. In some ways, I think I'd rather deal with canine than feline diabetes, both because I've never had a cat that would allow me to test blood sugar and because with dogs they just lose their ability to produce insulin and you move forward with injections whereas cats can go into remission.

I had a cat with diabetes but it was before they knew much about how feline and canine are different. She didn't respond to the insulins available at the time so lived about 18 months with very poor blood sugar... I know she would have done a lot better if she had developed it a few years later when more was known.

Natalie

[Jaye]

Re: New and Feeling Guilty

Ugh! What a horrible and stressful day.

I took Robbie in for his BG curve (and stayed with him the entire time. We need softer seats at the vet for the humans!)

He got 7 units of NPH at 5:30 a.m. I didn't have a BG (because of his testing issues discussed above) but his urine glucose was NEG.

I took along my Freestyle Lite meter to compare with their Accu-check. We didn't get both on the first reading, but did on all subsequent readings. Part of the surprise was that the numbers were SO different. The next part of the surprise you can see in this basically non-existent curve...more like a sliding board!

5:30 - Breakfast and 7 units NPH

Accu-Check / Freestyle
7:50 - 430 / No Reading
9:40 - 417 / 307
11:30 - 367 / 267
1:30 - 316 / 227
3:30 - 229 / 171
5:00 - 229 / 159

He never came back up!

We had to leave at 5:00 to get home and feed and give insulin to the cat. Robbie normally eats at 5:30 and gets his shot but we were kind of at a loss what to do. My vet is VERY good and even she was scratching her head.

She put in a call to the vet internist who, of course, had left for the day to see if he had suggestions. We didn't want to not give him any insulin after eating for fear of ketoacidosis, but don't want him too low, either.

She told me to give him 3 units with dinner, and tomorrow morning up his units to 8 since he obviously was too high in the morning (He was previously on 9.5 with Vetsulin). I'm beginning to wonder if we really had him regulated on that or not...this is beginning to make me think probably not.

I just got a urine glucose on him at 8:00 p.m. and made sure to check the keytones as well. Both were NEG, which means, if I'm not mistaken, that his BG is probably below 180. Of course, how far below who knows?

Vet says that it seems like the higher numbers show a greater discrepancy between meters than lower ones and that proved to be true. Even if I could get him to allow me to test, right now I wouldn't trust the results.

We may have to switch insulins again. She's thinking maybe PZI, although my cat dropped low quickly on that, so I'm a little tense.

Anyone have any suggestions?

[Patty]

Re: New and Feeling Guilty

I don't have a lot of time right now to go back and look, but are you home during the afternoon? An afternoon snack maybe around 1pm could be a solution to evening out the curve.

I wouldn't look at switching insulins. I think you should be able to "tweak" the food to change the shape of his curve.

If you aren't home in the afternoon, another option might be adding a food to his current meal that is slower to digest and will be converted to glucose later in the day, such as brown rice.

It would be interesting to know what is happening with his numbers at night.

One other question, has the vet run a comparison test with her meter against the lab machine to know how far it's off?

Patty

[Jaye]

Re: New and Feeling Guilty

Thanks for responding!

I'm only home during the day for the summer, I'm a teacher. I do have someone who comes daily to let Robbie (and Callie) out, but he can only come around 11:30.

The brown rice sounds like an interesting idea. I'll run it past my vet. Would that, I wonder, interfere with his prescription diet for urinary crystals?

I'm pretty frightened of his numbers, both day and night!

She said that their meter reads very close to the lab's meter...within 10 I believe she said.

I'm just going out to see if he'll pee for me again...we're all pretty exhausted after the day we just had (only to come home to tornado warnings!)

[k9diabetes]

Re: New and Feeling Guilty

I wouldn't rush to change insulins either. He is getting a considerable effect from the NPH. It's just taking some time for him to unlock the insulin and put it to work while his food is being digested very quickly.

So the food and insulin are not balanced.

One thing you should rule out is whether he goes low in that first hour or two after a meal and so is actually getting a little rebound.

I suspect he's not and that it's just his meal kicking in fast and early.

With a negative urine test this morning, presumably his blood sugar then was and had been under 180 for a while. So perhaps very similar to his dinnertime blood sugar.

Which would make his curve a mountain instead of a valley.

Which isn't bad in and of itself. Some dogs have mountains for curves and I'm actually a big fan of them because however low the blood sugar is at meal time is as low as it's going to go.

What I would want to change about his curve is the difference between highest and lowest blood sugar.

There are several ways to do that.

-- You could give some Regular or Novolog faster acting insulin with his injection, either by mixing two insulins in one syringe or, given his steep mountain curve, by trying 70/30, which is a preprepared miixture of 70% NPH and 30% Regular.

To do this, I would cut his dose a couple of units when starting him on some faster acting insulin. See if it levels out his curve and then increase the dose to get good numbers. If you premix it yourself, you could start with a small percentage and slowly increase if needed.

-- You could arrange for him to have a lunchtime meal, either from the person who visits him or through a timed feeder.

-- You could add protein and fiber to his diet and see if that slows digestion down enough to hold some glucose from his food until later in the day.

The dip in the curve is late enough that I don't know if a tweaking of the diet will be enough to delay the food conversion that long. If you can do a mid-day meal, I'd try that first and try the faster acting insulin if you can't do a mid-day meal.

I'd trying "adding" the mid-day meal first, not taking it from his other meals. Then whether you keep in the extra or adjust portions would depend on whether he needs to gain some weight.

In both cases, the aim would be to flatten the curve. Not to worry about how high or low the blood sugar is, only on how much difference there is between highest and lowest. If you manage to flatten the curve, then you can adjust the insulin to bring all levels down into a good range.

Does that make sense?

Natalie