Maggie: Pancreatitis and DKA recovery

[karen24]

Hi everyone,

Our schnoodle Maggie is about 11 years old and was diagnosed with diabetes in the fall of 2012. We had her quite well regulated at 8 units of insulin twice a day for over a year.

Last weekend we went away and boarded her at the vet's. When we picked her up on Sunday afternoon she seemed fine, but after dinner she began vomiting, was very restless, and was up all night, obviously not herself. She also developed diarrhea. We took her to the vet on Monday. After a day of observation and tests the vet told us she had "mild" DKA and as she also seemed to be in some pain she recommended an abdominal ultrasound. We had to take Maggie to the emergency vet/animal hospital for that. The ultrasound showed what we were told was "mild" pancreatitis; no other serious issues.

The vet at the hospital recommended that she be admitted there as she could get 24 hour care there. She was there from Tuesday through Friday as they tried to get her glucose regulated and the ketones down to negative. She was eating well after the first day or so and the vomiting and diarrhea stopped.

She was finally able to come home yesterday after her glucose got back down into a normal range and the test for ketones was negative. Now she's back on 9 units of Humulin-N twice a day.

We know now that we were not managing her diabetes as well as we should have. We were feeding her too often and giving her treats that weren't good for her (Milk Bones, baby carrots, etc.)

Of course, this was a huge scare for us and I am trying to do whatever I can to ensure it doesn't happen again. But I have so many concerns:

--She seems so thin. Her normal weight is 18-20 lbs and she's down to about 15. I know now that she should only get 2 meals a day, with her insulin. But I'm worried that she won't gain any weight on this regime. She also seems very hungry, but I'm afraid to give her an extra meal or too many snacks, even healthy ones. Do any of you feed more than 2 meals a day? What about snacks? This morning she devoured her meal and was genuinely hungry again an hour later. I gave her some green beans and half a hard-boiled egg, which she gobbled down. Bad?

--The doctor sent us home with medication for the pancreatitis and said it could be given "as necessary," but I honestly can't tell if she needs it or not. She SEEMS OK and not in pain, but how can I tell? Is it better to err on the side of caution and just give it to her? It does seem to knock her out a bit.

--Testing - the vet gave us some test strips but said that after the first couple of days at home, he didn't recommend at-home testing because the results are too erratic and hard to interpret - that we should only test if we suspect something is wrong. I know a lot of people here disagree; is there any consensus?

Thanks so much for any advice/shared experience!

Karen

[jesse girl]

Re: Maggie: Pancreatitis and DKA recovery

with the pancreatitis and once a dog has had it is prone to it in the future so you dont want to put to much pressure on the digestive system so feeding all the time may put the body in constant digestion

you would like to feed something that is easily digested low in fat of coarse because that is the toughest thing to digest for the body but as we all talk here every diabetic dog has to take there own path and ones persons triumph can be very unproductive for another dog

my jesse appetite completely changed after the start of this process being more aggressive for food. she stayed thin for a long time because the balancing act we had to take after the pancreattis she actually gets less calories then recommended . there was a limit on how much she could consume

many do prescribed to giving more smaller meals but if blood sugar is not adequately controlled than i believe can affect the pancreas so it can be a double edge sword in these situations. you do want to home monitor blood sugar if possible just because off the inconsistency in digestion from the pancreatic problems . you may not see the regulation that you are accustomed to

id say dont worry to much about the weight if it is semi stable it can be a slow process putting it back on you may have to ignore the demands for more food. i know its hard but the body needs a break and over time a dogs behavior may change when they see there is no more opportunity for extra food which may have caused the pancreatitis. diabetics digestive system can become delicate and sensitive they are not like normal dogs but appear to be normal on the outside which at time leads us into complacency. i am guilt of that with my jesse . if i stray just a bit which leads to problems with my jesse

[Rubytuesday]

Re: Maggie: Pancreatitis and DKA recovery

Welcome! Not sure if the vet sent you with urine strips or blood testing strips. The best, most accurate way to track the bgs is through blood tests and only that will give you answers to the questions you are asking about feeding and weight gain.

If you are open to trying blood testing we can recommend meters and get you started.

There are just so many variables that there is no way to tell how they will all affect her without seeing the bg numbers. Composition of the diet and insulin are the biggest variables, but others such as exercise, stress, certain treats, ect. all can have different reactions in different dogs.

My recommendation would be:
*buy a one touch ultra meter and strips on ebay (be sure the srips aren't close to expiration)
*keep everything the same for a week
--feeding times & amounts
--feed only twice a day and no treats
--injection times & amounts

Until the food and insulin are well balanced it doesn't matter if you let her eat the whole bag of food she still won't gain weight. The intake of calories needs to be balanced with insulin. The proper amount of insulin allows the cells to absorb the nutrients. As soon as you add more food you throw off that balance. Therefore your animal cannot only not absorb the extra nutrients, but also the baseline amount before the extra.

In essence, by giving extra food you may actually be making things worse, making the outcome like you were feeding less.

What medication did they give for the pancreatitis?

Tara

[amydunn19]

Re: Maggie: Pancreatitis and DKA recovery

Hi, Karen and Maggie! I have a Maggie, also.

My Maggie also has had pancreatitis. Did your vet or emer vet do the Spec cPL blood test for pancreatitis? Just curious why they opted for the ultrasound rather than the blood test? Perhaps they weren't sure if it wasn't something else. Regardless, her pancreas needs a little rest so the less stress on it the better.

You will find that better control of her blood sugar will lead to weight gain in due time. I disagree with the common vet mentality of not testing at home - testing at the vet clinic is far more erratic and unreliable. Many dogs are quite anxious at the vet and that may yield false results. You will feel better if you know where she is at blood sugar wise. I use a human meter - the one touch ultra.

As Jesse Girl mentioned, some feed only once a day, some twice, and others with pancreatitis issues split the two meals into four meals so there is not so much food at one time. I would try very hard to stick with two meals for now and try to get the blood sugar under control. When she has better control, then the hunger will subside and the weight will be able to come back.

What medication did they give her? My Maggie took a pepcid twice a day for a short period of time and that seemed to settle her quite alot. If it was cerenia, that is for vomiting and I would only use that if she is vomiting or if she seems like she is uneasy(Maggie had really loud gurgling noises from her belly and she would be shaky- that told me she had a flareup coming on)

[karen24]

Re: Maggie: Pancreatitis and DKA recovery

Hi,
Thanks everyone for your replies! I will try to answer your questions :-)

-I have a huge list of services on the bill from the vet :-( But I don't see the Spec PcL test listed. I think our vet actually requested the ultrasound because Maggie's liver enzymes were also elevated, and then while her liver turned out to be OK, the pancreas had this one area that looked different.

-The medication we got for the pancreatitis is Tramadol, 50 mg tabs, and we are supposed to give her 1/2 tab every 8-12 hours.

-We also got a medication called Metronidazole and we're supposed to give her 1/2 tab of that every 12 hours as well - that was for the diarrhea. She hasn't had that since about her second day in the hospital but I guess continuing to give it to her is a precaution.

I appreciate your advice about the blood testing. They sent us home with urine testing strips (for ketones and glucose.) I know they are not terribly accurate and I also have a really hard time using them. I'm not very coordinated and Maggie is small! I'll have to think about doing the blood testing at home. In the meantime I will take your advice and really try to stick to the two meals a day. Hopefully she will adjust and start to do well.

Last night I was a bit concerned because she got restless at bedtime again and couldn't settle down. I remembered that I hadn't given her the pain medication so I did that, and she finally did sleep. Not sure if this behavior was related to the diabetes or possibly to discomfort from the pancreatitis. It's so hard when they can't tell you!

Karen

[Monsters Momma]

Re: Maggie: Pancreatitis and DKA recovery

Hi Karen and Maggie!

I'm so sorry that you are having to deal with multiple issues! One can be overwhelming enough!

I personally have not had to deal with pancreatitis (knocking on wood), but others have. I would encourage you to take a look at the video's for home testing though. I share Amy's thoughts...our vet told us that home testing wasn't necessary. We do it anyway, because we disagreed. Now our vet uses our numbers!

Good luck with everything...give Maggie a scratch from us!
Mel and Vinny

[momofdecker]

Re: Maggie: Pancreatitis and DKA recovery

I know the ideal food schedule for a diabetic is every 12 hours. But sometimes the pancreatic diabetic dog is an exception to that rule. Dogs with pancreatitis seem to respond better to smaller, more frequent meals. Perhaps four feedings per day. As long as that schedule is consistent from day to day, it may help Maggie heal. Not ideal for a diabetic, but having a diabetic that will not eat consistently is not ideal either. If you find she is not eating or not feeling well after two meals per day it may be worth asking your vet about temporarily going to four meals until you feel she's had time to recover from the pancreatitis.

[amydunn19]

Re: Maggie: Pancreatitis and DKA recovery

I agree with Holli - if two meals is a problem in getting her to eat, then by all means go to four. Or if it appears two meals are too much for her system. My Maggie gets three a day but she tends to go low without the extra meal.

It is just tough to get her numbers stable on two meals but since she was stable at one time then hopefully those numbers will start to improve and go back to where she was. I think the biggest key is to not aggravate her pancreas.