Sudden, Random Hypoglycemia?

[nick_138]

Hi,

My dog Maggie has been diagnosed diabetic for just over a year now. She was doing so well, she had finally become stable on 15iu of caninsulin. According to a fructosamine she had done the control was bordering on excellent.

All of a sudden on morning we woke to her having a hypoglycemic episode. Rushed her to the vets and got her bg tested, she was super low. And we started again trying to stabalise. Its happened twice more since, that was about 6 months ago. All the while the vets have been focusing on getting her back stable. They have not looked into the causes. Every time its happened we have asked for bloods but they say they arent too concerned to do them at the moment or that they will do them when we get her more stable.

So just wondering if this has happened to anyone? Does anyone know why this may be happening now?

If you need more info, just ask

Thanks

[Patty]

Re: Sudden, Random Hypoglycemia?

Hi Nick and welcome to you and Maggie!

So sorry to hear about the hypo incidents. They can be very scary. Do you have honey, karo syrup or regular pancake syrup you can give or rub on her gums if needed to bring up her blood sugar?

I would insist on having a curve done. This is where they test blood sugar before food/insulin then every 2 hours after until next shot time. This will allow you to see where the high and low points of the day are. Insulin needs can change over time as the body fluctuates. It's not uncommon to go through periods of needing more/less insulin, especially if exercise or routines change.

A fructosamine just gives an average of blood sugar over the last few weeks. So you could have a high of 400 and a low of 40 and come out to a decent average that is around 180 but blood sugar is swinging quite a bit and dangerously so.

Would love to hear more about Maggie...what does she eat? How much does she weigh, etc?

Again, welcome to you!
Patty

[k9diabetes]

Re: Sudden, Random Hypoglycemia?

Other health problems can cause blood sugar to go low. Among them are Addison's disease, which is a lack of cortisol, and problems with the liver, which is responsible for maintaining blood sugar between meals (the basal blood sugar).

But insulin needs can also change, and vials of insulin can be somewhat different from previous batches.

Since it sounds like her regulation was pretty tight, she may simply be needing a smaller dose of insulin.

Also, those low blood sugar events can destabilize the blood sugar for several days afterward and they may be looking for stabilization and tight regulation too soon.

Under the circumstances, I would reduce her insulin dose until the low blood sugar events completely disappear. Ignore high blood sugar for the moment because it could be a result of the lows.

See this information on rebound hyperglycemia: http://www.caninediabetes.org/pdorg/somogyi.htm

It, and other useful links on the main website Links page:
http://www.k9diabetes.com/complinks.html

Once you find a dose where the blood sugar never goes too low, preferably never under about 5.5 (100 in U.S. measurements), I would keep her on that dose of insulin for a week and give her body time to settle in and stabilize on that dose.

Then have a full blood glucose curve done to assess her blood sugar throughout the day.

The curve can help identify problems such as sharply dropping blood sugar or strong insulin action when she has no food to generate sugar to go with it.

Based on the curve, you can figure out what next step is needed.

The curve could also help suggest whether her blood sugar is constantly erratic even after she has been given a week with no low blood sugar.

. . .

As far as bloodwork goes, I don't think it ever hurts to have it done now. More information is pretty much always better. You might find everything looks great, in which case you can focus on the insulin, or you might find something like elevated liver values that point toward the liver not doing its job to support stable blood sugar.

I very much prefer a vet who will do the bloodwork if I ask them for it. If I'm willing to pay for a noninvasive test, I don't see much reason to refuse.

The main thing is to get the insulin dose down to a point where the low blood sugar goes away. And if the low blood sugar continues even as the insulin quantity goes down almost to zero, then I think you know there's some other problem going on that's not diabetes related.

Natalie

[jesse girl]

Re: Sudden, Random Hypoglycemia?

do you test blood sugar at home i believe its a good idea even for stable diabetics because one thing about this disease it can change on a dime and lots of causes from just a mild walk to weather illness medication which most things are stress related and of coarse just getting older

excellent blood sugar would get me nervous just because there is not much room to enter a point of low blood sugar and if you do have such tight regulation i would not dare do that without testing blood sugar at home and really know your dogs trends blind regulation for me gets me nervous

just to put things in perspective many dogs on this forum do quite well with numbers ranging from 8.3 to13.8

for most of us on the forum we base our dose adjustment on the lowest number in a curve not the highest or the average and that lowest number is what we are comfortable with some might like it lower some higher but as natalie said most dont like going below that 5.5 and as patty said an average to me has little value and can be dangerous giving a false sense of security

so if you do want to take control home testing is the best way to do that the forum has lots of info and youtube videos has visuals on how to do or just ask if you have questions

do you understand how to intervene in a low blood sugar event as patty suggested something that is very important that with home testing can get a dog out of this event and into safety within minutes

welcome to both of you and hope you never see this happen again but with diabetes its always a possibility for every diabetic you have taken a fist step searching out knowledge to help your pup and thats great

[amholmesy]

Re: Sudden, Random Hypoglycemia?

Hi Nick and Maggie
Welcome to the best place for help for your diabetic dog and you! The people here are fantastic and have so much knowledge. Natalie and Patty have already been on advising you. I had a problem with the vets that diagnosed cj so I ended up changing vets and it was the best thing I could have done for cj.

I don't understand why they won't do the blood tests on Maggie. Just wanted to let you know it's sometimes necessary to change even if you have been with the same vets for a long time.
Maggie is the most important thing and getting her well.

Hope they do the tests so you can see what is going on .

[Rubytuesday]

Re: Sudden, Random Hypoglycemia?

Lots of good advice already that I would second.

Those hypo incidents can be so scary. I do home testing on Ruby to always know where we are. After doing it for so long I really know her trends and can't imagine being without it. It can be hard with some dogs, but luckily mine is a gem about it.

Other then that a curve at the vet's would let you know how she is doing though out the day and how to make adjustments.

Welcome!

[Cebe]

Re: Sudden, Random Hypoglycemia?

Was the excellent control backed only by a fructosamine test? If so, I have to wonder if she wasn't having low episodes all along?

This is a little like what happened with my dog when she was first diagnosed. They gave her a starting does of 15 units based on her weight and I had a fructosamine test done 2 weeks later, and they increase her dose based on that test. Then she went hypo. It wasn't until I was doing curves on her that I was able to see that she actually needed a lower dose.

So, if fructosamine testing is your only vehicle for determining how your pup is doing, I highly recommend having a curve done. Also, home testing may be important, if you can swing it.

After that hypo incident, I started home testing.

[nick_138]

Re: Sudden, Random Hypoglycemia?

hey everyone, thanks for the responses!

yeh, i forgot to say we have been home testing a while now. she's so patient with us blees her!

the most recent drop was saturday we gave her some honey we have on standby but it took a while to start getting the blood glucose up, she went to 5 but stayed there quite a while so we gave her some food... how much would you recommend roughly? so we had her in with the vets monday for a curve. vet said it was a pretty good curve (sort of low to mid teens). we were told again, not too concerned for a blood test...

natalie, i am slightly concerned there may be underlying problems such addisons, originally i suspected hypothyroidism but the vet sort of shrugged that off as its difficult to test for? (false positives and such) but now she has a swollen gland on the side of her neck/jaw, i have read this may be linked addisons?

i suppose my question is what should the vet be doing in these instances?

thanks for now, i'll try figure how to put maggies details in one of these footer things most of you have

[eastolberg]

Re: Sudden, Random Hypoglycemia?

Shelby had Addison's prior to Diabetes, but we also experienced sudden low blood glucose back in May after almost a year of her diabetes diagnosis. We had also done only fructosamine up until that point, and those tests showed good control. Of course since it is an average I always wondered if she could be having highs and lows that just averaged to a good number.

As far as testing for Addison's, I was under the impression that it is a pretty clear cut test. It was just hard to get anyone to test Shelby for that 3 years ago because all the specialists had their own ideas of what was wrong.

Anyway, we had blood work done in May after the hypo episodes; I insisted on it and they didnt question it. She had an elevated ALP level, which is related to the liver function, but her other levels related to the liver were good. Our vet suggested an ultrasound, but after blood work a few weeks later came back showing the ALP had decreased by half, I decided to wait and see what happened. The ALP never got extremely high again until last week. It was over 6200, which is probably 62 times what it should be, and for the first time her ALT was extremely elevated.

We had the ultrasound and she has gallbladder sludge. I'm not sure what comes first in this case (the gallbladder or the liver problem), but I know it is all associated. She is now on medication and her blood work results improved in just a week - not perfect by any means but an improvement. Coincidentally, or maybe not, she seems to be needing more insulin to maintain good blood glucose.

Sorry I tend to ramble, but my point is, I would totally insist on blood work. Even though we had it, I could kick myself for not having the ultrasound 3 months ago. Maybe something would have been different now. I don't understand why they would put it off if you asked. But I also dont understand why my vet still doesnt agree with home BG testing...

Hope everything is going better for you now!

[diggydog]

Re: Sudden, Random Hypoglycemia?

natalie, i am slightly concerned there may be underlying problems such addisons, originally i suspected hypothyroidism but the vet sort of shrugged that off as its difficult to test for? (false positives and such) but now she has a swollen gland on the side of her neck/jaw, i have read this may be linked addisons?

i suppose my question is what should the vet be doing in these instances?

Hi Nick,

You could get the vet to do a basal cortisol level - if thats low then you could pursue Addisons testing. If its in the normal reference range then I am pretty sure it rules out Addisons with out having to do a full ACTH test.

With regards the the thyroid testing - I insisted they test Alfie last year. I wanted to rule out hyperthyroid with him. I think as long as they test T3, free T4 and TSH then it helps to eliminate false negatives.
Dogs with chronic illnesses such as diabetes normally have a low T4 value so its important to not to rely on that alone and get the free T4 value.

If you feel strongly that something else is going on then you should insist that they do the testing or move to another vet that will do it.

As a side note - when I used to get the fructosamine test done with Alfie and he was near excellent control his blood sugar was actually dropping dangerously low. IMHO i think fructosamine testing a waste of time, even more so if your home testing. The testing you are doing will tell you so much more than a fructosamine ever will.

Allison

[diggydog]

Re: Sudden, Random Hypoglycemia?

thanks for now, i'll try figure how to put maggies details in one of these footer things most of you have

If you click on User CP, along the top left handside in blue.
The down the left hands side click edit signature, it will bring up a text box so you can write about maggie and it will put it as a footer whenever you post anything

[Rubytuesday]

Re: Sudden, Random Hypoglycemia?

Hi Nick, You may want to check out Dr Jean Dodds' website:
http://www.hemopet.org/

She is the doctor a lot of folks here turn to for thyroid issues. Your vet can send the results to her lab instead of another lab that doesn't take as many things into account. It talks you through how to submit the bloodwork on the website.

Holli's Decker was recently diagnosed with Hypothyroid after really struggling and now is doing much better.

Tara

[momofdecker]

Re: Sudden, Random Hypoglycemia?

Nick,
I'm not sure what symptoms Maggie may have/had that made you suspect hypothyroidism. But I wanted to pass along a list of symptoms from Dr. Dodds:

http://siriusdog.com/hypothyroid-dog-signs.htm

If she did have a complete blood panel and had low white or red blood cell counts, was anemic or if she had high cholesterol - those may give you reason to ask to have her thyroid evaluated.

Decker's diagnosing vet never ran a full CBC on him. His bg was only 330 when diagnosed on a Friday. The following Monday we took him to the original vets 'to be regulated.' We fed him around 7a and dropped him off at 8a. At 8:30a-ish his bg was only 263 (after eating) and he was started at 35u of NPH. Given that his bg was under 300 after eating, I'm pretty confident we caught his diabetes early on. Had a CBC been run at diagnosis of the diabetes I'm willing to bet his cholesterol would have been off the charts high at that time.

After switching vets in December, the new vet ran a CBC on him. His cholesterol in mid-December was >520mg. Because his diabetes had been uncontrolled the high cholesterol was attributed to the uncontrolled diabetes. Thought was that once the diabetes got controlled the cholesterol would come into normal range.

He had another CBC run at the end of Febuary and his cholesterol was again >520mg and his white blood cell count was low this time. He had a UTI (dx. via urinalysis) - and the low white cell count was attributed to that. We'd taken him to the vets in February because he would yelp immediately after barking and had stopped barking. He has an obsessive love of barking so for him not to bark signaled something wrong to my husband and I. Never found an explination regarding the barking but it did return full force after he was started on thyroid treatment.

When we finally talked the current vet into running a fasting test on him in June his cholesterol reading was dangerously high at 1055. His triglycerides were also high - over 300. His hypothyroidism was diagnosed a week later. Turns out the high cholesterol and low white blood cell readings were likely from the low thyroid. But because we had no starting reference point it was easy to link the readings to other causes. I'm not trying to imply Maggie may have hypothyroidism, only trying to say that if you do have a history of blood work it may be worth taking a closer look to see if any signs are there that may have been overlooked or attributed other causes.

And I agree with you, if you feel testing or blood work should be done I'd find a vet that is willing to accommodate your request. Having a history of blood work and other tests might prove to be very helpful in understanding what may be going on with Maggie. Wishing you the best in getting things figured out! Holli

Just came across this where Dr. Peterson is quoted in a Dog Fancy Article on Addison's Disease:
http://endocrinevet.blogspot.com/201...edium=facebook

[k9diabetes]

Re: Sudden, Random Hypoglycemia?

Hi Nick.

My apologies for not responding sooner. I was out of town when you posted last and have been running behind ever since.

The std blood panel isn't very useful for checking the thuroid as it can give false low values when other diseases like diabetes are present. But a full thyroid panel would be helpful.

Personally I'm a big fan of more information and will go for blood testing any time I can afford it. A relatively small price to pay for reassurance.

I'm assuming her insulin dose was dropped. How is the blood sugar now?