Desperately need help....Quinn being tested for Cushings

[Quinnsmom]

First, I want to thank those of you who suggested I check into the Blue Dog Lift Em Harness. Quinn can now walk with little assistance. Fantastic product for those who have difficulty with their hind legs and those who take care of them.

Now...I need lots of advice. We are having difficulty regulating Quinn's insulin. When she was dx on 1/7/12 she started on 10 units of Humulin N 2x day. Her blood glucose was 586. We test urine 2X day. She eventually went up to 57 units 2X day. Her Vet began to lower insulin thinking she would regulate. But when glucose tested neg four consecutive times, Vet stopped shots for two days and then started at 37 units 2X day. She is now up to 47 units and still showing 2% on urine testing. She appears to be ok mentally and physically. She has come a long way since diagnosis and per Vet's orders, we are keeping very close watch on her so she does not have blood sugar drop. (I have been sleeping on the couch so I can keep eye on her during the night.) I am exhausted and very worried that we won't get her regulated. The day before Quinn was dx, our 10 year old lab died suddenly due to a large mass on his spleen. We haven't even had time to mourn for our lab because we are emotionally and physically exhausted and frightened for Quinn. Any advice or suggestions would be appreciated and welcomed. Thanks, Jackie

[k9diabetes]

Re: Regulating large dogs??? Help

That's a lot of insulin changes in a month.... has the vet done curves to evaluate these doses?

If so, please get the results of those curves from the vet and post them here so we can see how things look.

I'm hoping the 57 units is a typo...

Are you interested in learning to test blood sugar at home?

Natalie

[Quinnsmom]

Re: Regulating large dogs??? Help

Thanks for responding. As you can see, I am so confused and overwhelmed. No, 57 units of insulin was not a typo. I too am concerned about the dosage but that's only my gut and not knowledge speaking. I feel like we are all over the place with these numbers. I am working closely with the vet. Speaking with him at least 3X a day. I have decided that I will purchase an Alpha Track monitor. However, I will not be able to do so for another week or so. The Vet suggested it but also said I was doing well with urine testing so it wasn't necessary at this time. Quinn's last blood glucose was 110 last week (down from 586 in early January) so Vet felt I was doing well with testing and shots. I have read about curves but I do not understand what they mean or how to read them. Should I be going more often to Vet so he can do the curves? How can I learn how to do this?

[k9diabetes]

Re: Regulating large dogs??? Help

You are right to be concerned... I don't think any dog should ever be put on that much insulin so soon after diagnosis and especially the kind of jumps in dose that seem to have been made rather quickly.

So is the vet not doing curves? Rather, just doing spot checks?

If the vet is only doing spot checks, then my head truly is going to explode over the 57-unit dose...

Someone needs to be doing curves - you or the vet. You can get started learning to test blood sugar at home with an inexpensive meter for people that will be much cheaper to buy and use than the AlphaTrak. Better to waste inexpensive strips while you're getting good at it.

And you can often get a decent meter for little or no cost.

I like the OneTouch Ultra the best but even if you started with an inexpensive meter like a Relion you could get going and then be really ready to do a curve when you get the AlphaTrak.

I had an AlphaTrak but almost never used it. I used the OneTouch Ultra almost exclusively and it has a very good reputation with canine blood.

I worry that she's actually going through a very large swing in blood sugar, from 500s down to 100s and back up. Something that looks, in urine testing, just like blood sugar somewhere in the middle all day long.

Natalie

[CarolW]

Re: Regulating large dogs??? Help

Wow Jackie - you have REALLY been through the mill. First, my deepest condolences on the loss of your Lab. It's truly heart-breaking - then to have this diagnosis on Quinn the very next day is also very difficult.

Like Natalie, my head is going to explode on that 57 units - from 10 to 57 to 37 - since 7 January. To me that makes no sense at all.

I very much hope your vet has done some curves. That is, testing blood glucose levels, first, at fasting in the morning (before feeding), then every two hours through the day, to fasting just before the evening meal.

Blood glucose levels vary naturally throughout the day, and until you and your vet have data on these fluctuations, it's not possible to determine a really useful dose of insulin for your dog.

The only time insulin is (properly, in my opinion) given without having a curve first is when insulin is just being started for the first time - it's called a starting dose, and apparently, your vet started Quinn on that 10 units, which is just a bit low for a 100-pound dog, but not drastically low.

It's normal to start low, and raise the dose slowly over several weeks at least - and before each raise in insulin, it's normal to do a blood glucose (BG) curve test.

I'm glad you're here, because that could start on really saving Quinn's life. Your dedication to Quinn is very clear. I'm sure you'll get the assistance you need, here on the forum.

So, a Big, Fat Welcome to you and Quinn. I'll be watching.

Thu, 9 Feb 2012 21:55:08 (PST)

[Quinnsmom]

Re: Regulating large dogs??? Help

You are all so helpful. I am so relieved to have found this site and know that I am not alone out here. I tested Quinn with strips this morning and at 2%. I spoke to Vet this morning and he said to stay at 49 units of insulin. Went over her diet which he said was fine and didn't need to go to prescription diet yet. We spoke about curve testing and he suggested it would be less expensive for me to do the blood monitoring at home for curve instead of his office which I agreed. I have been pretty much keeping Quinn to her eating schedule of 10 hours which Vet said was OK. I told him I would now switch to 12 hours and see if that made a difference. I don't know about the numbers but to see the difference between Quinn when she was diagnosed and today you see a miracle. One day after her diagnosis, her hind legs gave out and she couldn't walk without use of a sling. Trying to get a 105lb dog out the door to do her business was exhausting for us and painful for her. Since she started on insulin and we purchased the Blue Dog harness she can get up herself and is walking around the house and yard with only a little assistance. I keep thinking that it will be a very long road and will go very slowly to get to regulation. Do you think I am rushing her recovery or expecting too much?

[jim maceri]

Re: Regulating large dogs??? Help

First, welcome. You have definaty come to the right place for advice and moral support. I too have a giant breed, Newfie, who is 125 pounds. Regulation takes time and patience. My boy is currently on 12 units 2x per day 12 hours apart and most of the time has BG readings between 100-220 but that was only achieved by balancing food, exercise AND most importantly doing testing and curves at home.

If I might suggest work on one thing at a time meaning don't make changes to food, insulin and exercise all at the same time. You need to see how these changes affect your pup on their own to come up with a plan and routine that works for you and your dog. For instance, once I got to a reasonable dose of insulin, I focused on his food for the next week. Went to 2 meals per day, 12 hours apart with no snacks. Again, the home testing is critical to see how it affected his BG. I found the change in his diet allowed me to reduce the amount of insulin. The next week I did pre and post walk/exercise testing.... Again that info let me further reduce his insulin.

When spirit went to the vet after being diagnosed, he was started on 50 units. I rang the alarm bells with my vet from the wonderful input from members here. His dosing went like this....

First day at vet 50 units, second dose was 25 units and when I brought him home I was told to give 16 units 2 x per day. Now he is on 12 units in the a.m. Or less based on his morning reading, and 12.5 units in the evening since he is less active. You WILL find the right bance with patience.

Every dog is different thus this is a bit of "art" and science mixed together. Remember that our dogs will also throw us curve balls and have readings on some days that just don't make sense both hi and low. Always remember to focus on those low numbers when making dose changes and share your thoughts here and you will get great insight.

I test my guy on the elbow callus and he doesn't mind at all even when I poke him 6-7-8 times per day. Get him focused on testing = a treat. When I pull out the meter he comes right to me and sits waiting for his treat. This is alot of info so research the site, read, read, read and don't forget to take care of yourself in the process. I assure you things will get better in a short period of time and this will all become routine. BTW.... Don't tell your dog he has diabetes and he will never know. Take a breath, relax and don't hesitate to use this forum for advice, info or just to vent. These folks are truly angels.

[CarolW]

Re: Regulating large dogs??? Help

I'm so glad Quinn is doing better - good for you!

Right now, what I'd do, in your place, is concentrate on learning to test Quinn's blood glucose levels. Then, as soon as you can, I would do a full curve; that is, testing first in the morning just before feeding (morning fasting), thereafter, every two hours, through at least the evening fasting (just before feeding in the evening).

I REALLY like your idea of feeding 12 hours apart, rather than 10 hours, as that will help greatly with consistency, and help avoid very confusing overlap of insulin doses, or going 14 hours without insulin.

Consistency is key in helping get a dog regulated and comfortable.

That said, some people here have schedules that vary from the standard "feed and give insulin every 12 hours." They do a LOT of BG (blood glucose) testing, to support oddball schedules.

Wishing you a lot of luck with Quinn. Hope you can get a meter soon, and learn to test. I still shiver at the thought of 49 units for Quinn, without any suggestion the dose has been based on a curve of any kind.

Fri, 10 Feb 2012 06:57:04 (PST)

[Cebe]

Re: Regulating large dogs??? Help

I would imagine with insulin doses like that, you might run into rebound, which, as I understand it, is when a large dose of insulin makes the blood sugar drop so much that the body compensates by releasing glucose, and that causes readings to be higher, and then we treat the higher reading with more insulin and it becomes a vicious cycle.

Home testing will help a great deal. I have an alpha trak meter, and I like it, but I also have a Nova Max that I think works pretty well (got that one for free, and you can get the strips for 1/3 as much as the alpha on ebay). I trust the alpha the most, however.

It has taken a very long time to regulate my dog. Frankly, she's not fully regulated either, as she's been throwing me some bigger numbers recently, and I'm going to have to do a curve and evaluate.

Curves are testing every 2 hours, beginning with a test right before morning feeding and shot. That's called the "Fasting" number. From there, you test every two hours through the evening Fasting. This gives you an idea of how your dog is processing the insulin throughout the day. Keep track of the time of each test and the number results. I plot mine on an Word/Excel chart, so I can see the shape, but the folks here are so proficient that they only need to see the numbers to evaluate the curve.

I test my dog on her carpal pad (unused foot pad above the paw). She just lies on her side, and I free hand poke her with a lancet. I don't use a lancet device. They scare me.

Once you get the hang of testing, EVERYTHING will click. I promise. I was really scared before, but now it's almost boring.

[momofdecker]

Re: Regulating large dogs??? Help

Jackie -

Hello and welcome. I'm so sorry to hear about your lab - my thoughts and prayers are with your family.

I wanted to chime in on the concern over the large dose of insulin your Quinn is receiving. I'll apologize in advance as I feel quite strongly about this and have a lot of my own story to share with you.

My Decker was diagnosed in early November. At the time he was diagnosed he was 98lbs. After a two day vet stay to get him 'regulated' he was sent home with instructions to give him 40u of humulin N twice a day. Thankfully we tested his bg at home! In the first week alone we skipped seven shots because of his low numbers. On two occasions we had to give him karo syrup and food to prevent a hypo incident because his numbers were so low. By December we started seeing crazy numbers...like 500-600 in the evening and under 50 in the morning...20 in the evening 500-600+ in the morning.

Consulted the vet after the first three days (only because they were closed on the second day). Never was it mentioned to lower his dose nor was in mentioned that it was very bad to skip shots. The only advice we received was that he could be 'honeymooning' and that it could last a few weeks, months or up to a year. Not sure if he was ever honeymooning but he indeed was rebounding:
http://www.caninediabetes.org/pdorg/somogyi.htm

Joined this Forum in December and the folks here are the ones who were able to help identify what was going on with him. Per their recommendation his dosage was lowered to 20u, and then to 15u.

Had we not been home testing we would have blindly given him 40u twice a day and it would have been only a matter of time before it was met with fatal results.

I don't mean to frighten you, however, it was explained to me that if a dog is rebounding there are some dogs who have a reserve of glucose which will kick in to prevent them from going hypo, however, if the rebounding happens long enough the body's reserve of glucose may eventually run out. This could be met with tragic results.

Because of what Decker went through we've had a difficult time trying to get him regulated. Three months into this journey his bg still runs in the 300-600 range. He is sensitive to quick and fast changes as well as large and fast drops. Going from 500 to 300, even though still a high bg range, will potentially start him rebounding. I believe that his body used that approach to keep him alive during the four weeks we were unintentionally overdosing him.

We have been working him up from 15u, one unit at a time. We try to give five to seven days in between dosage changes. He has currently passed 20u, which we had tried twice before (once with the drop from 40u to 20u and once from 16u to 20u). Both times we saw immediate rebounding. Having patience and taking things slow has allowed him to pass the 20u mark with no problems.

He is currently at 21u which seems to be too low for him. Sunday will be evaluation day but there is a good chance he'll move to 22u soon. I honestly believe that had our vet started him at 15u to begin with he would never have experienced all of the bouncing around he did and that he would be very close to being regulated at this time.

Again, I apologize for interjecting such as strong opinion on this matter but I see many similarities between your vet's approach and the approach our initial vet took.

I would recommend reading through a lot of the threads on this forum and then following up with a long and serious conversation with your vet on the approach you wish to take to manage Quinn's diabetes. She is your baby and you should have ultimate control over how you wish to treat her.

In the mean time, please don't hesitate to post questions, concerns or anything in-between here on this board. The folks here are full of encouragement and can offer lots of great tips. Best of luck in this journey. Holli

[Quinnsmom]

Re: Regulating large dogs??? Help

Thanks for your input. I have already purchased Alpha Track. Unfortunately, it won't be delivered til next week. I will do curves as you all suggested. Quinn still on 49 units of insulin. I have spoken with Vet twice today and he feels we are close to regulating. I don't know if I mentioned in previous threads, but Quinns Keytones were high when she was diagnosed but has been neg soon after starting insulin. Would this make a difference in why we can't get her regulated? You are all helping but I still feel overwhelmed. I feel like I don't want to leave her out of my sight which is exhausting to me. On the other hand she is doing so well now she wants to be outside in the cool weather all the time. I do let her outside for hours at a time but check on her ever 30 mins because I am afraid she will have a hypo episode. I truly feel like an overprotective mother.

[momofdecker]

Re: Regulating large dogs??? Help

Just checking in to see if you got your meter in the mail and to see how things are going. Hope all is well with Quinn. Holli

[MaryLea]

Re: Regulating large dogs??? Help

Thanks for your input. I have already purchased Alpha Track. Unfortunately, it won't be delivered til next week. I will do curves as you all suggested. Quinn still on 49 units of insulin. I have spoken with Vet twice today and he feels we are close to regulating. I don't know if I mentioned in previous threads, but Quinns Keytones were high when she was diagnosed but has been neg soon after starting insulin. Would this make a difference in why we can't get her regulated? You are all helping but I still feel overwhelmed. I feel like I don't want to leave her out of my sight which is exhausting to me. On the other hand she is doing so well now she wants to be outside in the cool weather all the time. I do let her outside for hours at a time but check on her ever 30 mins because I am afraid she will have a hypo episode. I truly feel like an overprotective mother.

IMO: the "early" keytones would not have an effect on getting her regulated, but are a result of high BGs, which means it may take longer to get to the correct dose. So it's not a direct relationship, but a related factor. Since she is feeling better and keytones are negative, you are doing a good job and she's improving!

We understand about feeling overwhelmed since we've all been there to one degree or another. You are probably being unnecessarily overprotective, though, since she is acting so much better and keytones are negative. Do you know the effect exercise (being outside, etc.) has on her BGs? If she's never had a hypo incident and exercise has not taken her too low, you can probably relax somewhat. Yeah, I know; easier said than done! (I don't recall her latest curve results.)

Your vet is probably right: you are close to having her regulated.

Mary

[Quinnsmom]

Re: Regulating large dogs??? Help

Well, I ordered Alpha Track last week and it was supposed to be delivered today. Now tracking message says the 22nd. The up-side is that I saved $100 purchasing it from Amazon. I am very excited to start testing. Quinn was up and down in units and is now at 46. Her glucose has been negative since Tues night. She was up to 52 prior to that and we have been decreasing slowly. She is much more active and now that she can walk, we have been taking 15-30 min walks every day. I notice she gets tired on the longer walks. She usually stays on my covered porch most of the days or sometimes in the back yard. She is now even barking to go out there. I feel more comfortable with leaving her alone for longer periods of time. She appears to be healthy and looks so much better than last month. I forgot to mention that she gets Reiki therapy once a week for her hind legs. If anyone is thinking about it as an alternative therapy, give it a try. I am still confused by the numbers and really don't understand why we haven't regulated yet. I will let you know when I start with the Alpha Track so you can help me figure out the numbers.

[jesse girl]

Re: Regulating large dogs??? Help

be careful with exercise dogs blood sugar can drop dramatically during

always carry liquid sugar with you being such a large dog you wont be able to carry him home so if you do have symptoms of low blood sugar use your karo honey or syrup dont try to force him to walk until he is up to it

on the walks stay close to home for now

home testing will help greatly with this to see how your baby reacts to exercise by testing before and after to see the affect