New Here - Olive the Pug, struggling to get regulated

[OlivesMom]

At the end of November of 2013 we noticed our pug Olive guzzling water and peeing all the time. Over the course of a week we monitored and decided to take her in to the vet, where they ran bloodwork an urinalysis to then diagnose Diabetes. We took her in for 4 glucose curves to the vet where they seemed to have little luck with lowering her levels which made them think that something else was going on. They did further bloodwork and an ultrasound, which then revealed that she had pancreatitis, an enlarged liver (moth eaten appearance), and her gallbladder was blocked from the other swollen organs. She was put on Ursodiol 250mg (one quarter once a day), Colchicine 0.3 ml once a day, and 150mg of SAMe once a day for 3 months (which we started her on Mid-January 2014). After we realized that we could do home curves, we've been doing one pretty much every weekend since the beginning of January 2014. Her blood glucose levels rise VERY hi (our meter actually says HI, so we're not sure what the cap out of what what it will read is) from the time she eats and gets her insulin for up to 3-4 hours and then start to come down.Our vets seem to be stumped with this. I've been doing a lot of reading, and research on the internet of other underlying conditions, and with her rapid weight loss, high readings that last way too long with the food + insulin, my gut is telling me that she could possibly have EPI. We're taking her in tomorrow after work to get the blood test done to see if this is the case. Does anyone have any suggestions as to how to help her?


~ 5 1/2 yr. old Pug Weight: 12 lbs (down from 16) Diabetes Diagnosis November 24, 2013 Diet: Recently switched from Hills Prescription Diet w/d to Hills Prescription Diet i/dŽ Low Fat GI Restore Insulin: Started out with Caninsulin, but didn't respond. Currently on Levemir 1.5 units with breakfast, 1 unit with supper, her treats are the dry dog food kibble Meter: Accu-Chek Aviva BG Range: Our meter reads in mmol/l, so the highest she goes is 33(594), lowest we've gotten her to is 14(252), average low has been 22(396)

[Olesia]

Re: New Here - Olive the Pug, struggling to get regulated

Hi Olive's mom....so glad to see you here.... i just responded to you on the EPI forum.... the folks here are AWESOME and do poke around on the website....the information...is beyond anything you will get in the vets' office...
If you can....upload your pup's BG charts and post here in your thread ..... the knowledgeable folks here will review them and give you some suggestions....i know they helped me a lot!

[jesse girl]

Re: New Here - Olive the Pug, struggling to get regulated

hi and welcome

could you provide a bit more history of events with the starting dose of caninsulin how long and record of dosing and the same for levemir and any curves that may go along with it with any pertinent medical situations including medications .

my thought on pancreatitis is to feed something that is easy to digest nutrient enriched foods so the volume of food needed to be digest is reduced . some of these fiber latent foods requires the body to digest more volume of food to maintain weight putting more pressure on digestion.

with my jesse i take it a step further and only give her one meal a day and its as small a meal i can give and maintain weight l . now generally the consensus is giving more smaller meals but i feel with this method you are keeping the body in constant digestion not giving the pancreas a much needed break . which is usually the initial way its treated at onset with no food and drink for 48 hours or longer with the use of IV so my thought is to continue that mind set as lifetime routine for jesse . i think i maybe the only person with this mindset but we have had good success with jesse without any major flareup of the pancreas but we do have to keep a watchful eye because her system is delicate .

levemir usually doesn't have a good track record with smaller dogs . the largest problem is dosing. its 4 times more potent than caninsulin and NPH insulin's. fine tuning the dosing can be difficult . levemir has had good success for larger dogs on a larger dose of the other type of insulin's and helps maybe with big swings in blood sugar. mostly big drops at onset flattening out blood sugar and making it more stable .

yes the blood sugar needs to be reduced at these levels especially with the other challenges. most healthy dogs can handle the higher blood sugar for a longer period of time . you may have to be a bit more proactive and may have to incorporate a fast acting insulin on a temporary bases. if like you said you are seeing big rises after shot this maybe an appropriate way to go . this may just be temporary solution until you can figure this out and buy some more time .

doing curves at home and spot testing blood sugar every day will be helpful .

just some thoughts and hope you pup improves soon

[OlivesMom]

Re: New Here - Olive the Pug, struggling to get regulated

Hello,

From the initial diagnosis at the end of November, our vet started her on 1 unit of Caninsulin twice a day, and by mid-January before the diagnosis of the pancreatitis, she was up to 4 units of Caninsulin twice a day. After the pancreatitis diagnosis is when they switched her to Levemir. That started out at .5 units twice a day, which wasn't working still, then in was bumped to 1 unit twice a day, still not working, they tried bumping her to 2 units twice a day, but we think she actually had one of those somogyi effect happen to her. I hadn't been keeping the greats curve results until recently. The Sunday Feb 9 curve was the day after we thought she had the somogyi effect happen and we told the vet that we thought that the insulin dosage was too high. I've also been reading about the faster acting insulins as well. We just had her at the vet on friday as they wanted to make sure we were injecting the insulin properly, which we are, and that's when they just seemed concerned about her rapid weight loss. I've been very concerned about it, which is why I have been researching the EPI, and we've got her booked in tomorrow to get the test done.

Sun. Feb. 9

Before meal - 6:00 -- 12.4

8:45 - 32.0

10:40 - 24.5

12:40 - 15.5

14:40 - 10.8

16:40 - 11.9

Fed supper around 17:15

18:30 - 28.0

10:20 - 18.9



Feb 14 –
7:20 –HI
4:20 – 16.9
Feb 15 -
8:30 – HI
2:35 – 24.4
Feb 16 -
Before meal – 20.3
11:10 – 25.4
15:15 – 15.7
Feb 17
15:50 – HI
19:00 – HI
22:00 – 28.4
Feb 18
Before breakfast – 29.6
16:50 – 13.5
Here is the complete curve from Sat. Feb 22
Before breakfast – HI
Ate and had insulin @ 6:15
7:20 – HI
8:20 – HI
9:20 – 33.2
10:20 – 27.4
11:20 – 23.3
12:20 – 23.7
14:20 – 19.0
16:30 – 16.4
18:30 – 30.1
10:35 – 31.6
Feb 23
Before breakfast – 32.5
Ate and had insulin @ 6:10
7:05 – HI
9:05 – HI
11:55 – 25.2
14:30 – 21.3

[jesse girl]

Re: New Here - Olive the Pug, struggling to get regulated

insulin is working just getting some big swings in blood sugar . that be a clue of to much insulin

the big problem with the curve on feb 9th is that big rise after food and shot now the numbers come down slowly after that spike

so you could use a fast acting insulin like r at shot time with food and leveimir . your goal would initially not remove the spike all together just slow it down and see how the numbers react the rest of the day with levemir your long acting insulin

things i have seen with my jesse if i remove a spike at one time it can show itself at another time

i think before you use a fast acting insulin like r you would like to see some more information if this occurs day in day out . you want to be sure

i think its maybe a good idea to change insulin's just because of the difficulty of dosing for it. just being a bit off on the syringe can be a big difference in dosing

you could move to nph it would be a reset period maybe try to get better info and set routine and start with that. add maybe a fast acting insulin if you continue to see those big rises at onset

food can also improve things but that can be a bit more time consuming because you just cant keep changing foods all the time but with pancreatitis you want that food to be easily digested

[OlivesMom]

Re: New Here - Olive the Pug, struggling to get regulated

Yes every meal + insulin her levels sky rocket, usually taking between 3-4 hours to come down.
Is it possible to use 2 types of insulin do you know?

[jesse girl]

Re: New Here - Olive the Pug, struggling to get regulated

yes i do for jesse. actually i use 2 different types of fast acting insulin r and novolog . this in conjunction with her normal insulin nph

r starts (onset ) at about a half hour and lasts about 4 hours . novolog starts in 15 minutes and maybe lasts a couple hours. now this is what i found for jesse it maybe a bit different for others

for nph which is jesse normal insulin it starts about 1.5 hours after shot and last from 10 to 12 hours

so we use r to prevent a spike and use novolog as a correction to already high blood sugar

[amydunn19]

Re: New Here - Olive the Pug, struggling to get regulated

I am a bit confused with the insulin change from caninsulin to levemir so quickly. If you only got up to four units, Olive wasn't close to resistance and levemir is so powerful for a small dog. I suspect Olive could be overdosed on levemir. This doesn't probably make sense but overdosing can lead to really high numbers because the liver can freak out and dump stored insulin into the system as a defense mechanism. I don't know if that is the case but it could be a possibility.

Did your vet consider nph insulin as a possibility? I would think that would be a consideration before levemir.

[Riliey and Mo]

Re: New Here - Olive the Pug, struggling to get regulated

Hello and welcome

Just wanted to ask if Olive has been spayed?

Mo

[Eddie]

Re: New Here - Olive the Pug, struggling to get regulated

Hello and welcome
You'll probably know more about whether she has EPI after you've had her tested - but I would just say that the weight loss might easily be attributable just to the diabetes.

Our dog lost loads of weight with EPI and then a few years later he lost just as much with diabetes. Each time he got very thin indeed, but put it back once we got on top of the condition.

You probably know that EPI almost always comes with a characteristic smelly, oily, runny poop which results from the food not being properly digested. Unless you are seeing that sort of poop then I'd suspect that the weight loss is more likely to be due to the diabetes.

Our dog lost weight and kept losing it for many weeks after we started on insulin, then eventually he stopped losing and very slowly (over months) started to put it back on as we got his dose more accurate.

(Just to add to the confusion I think the test for EPI is not always conclusive. Our dog's result came back inconclusive but I was convinced from my reading that he had EPI so we got the vet to give us enzymes anyway and they worked like magic).

Hope the vet can sort things out for you
Antonia

[OlivesMom]

Re: New Here - Olive the Pug, struggling to get regulated

Yes, We had olive spayed as soon as we could when she was a puppy.

[OlivesMom]

Re: New Here - Olive the Pug, struggling to get regulated

We took Olive in to the vet last night to get the bloodwork done for the EPI test, just awaiting results now.
Our vet also changed up some things on us. They switched her back to Caninsulin, 1 unit, twice a day. Feedings will now be 6am, noon, 6pm, 10pm, with the insulin given at 6am & 6pm. I don't think this enough as she's guzzling the water again, but I know that it sometimes takes a couple of days for the insulin to start working.

[jesse girl]

Re: New Here - Olive the Pug, struggling to get regulated

it is possible to add additional shots if the extra meals keep him elevated

sounds like a pretty low dose but having those smaller meals may have a bit of a problem at the onset(insulin taking affect ) of insulin

if comparing the dose your pup was on levemir it could be as much as 6 units for caninsulin

hope things improve soon

[Monsters Momma]

Re: New Here - Olive the Pug, struggling to get regulated

They did further bloodwork and an ultrasound, which then revealed that she had pancreatitis, an enlarged liver (moth eaten appearance), and her gallbladder was blocked from the other swollen organs. She was put on Ursodiol 250mg (one quarter once a day), Colchicine 0.3 ml once a day, and 150mg of SAMe once a day for 3 months (which we started her on Mid-January 2014).

~ 5 1/2 yr. old Pug Weight: 12 lbs (down from 16) Diabetes Diagnosis November 24, 2013 Diet: Recently switched from Hills Prescription Diet w/d to Hills Prescription Diet i/dŽ Low Fat GI Restore Insulin: Started out with Caninsulin, but didn't respond. Currently on Levemir 1.5 units with breakfast, 1 unit with supper, her treats are the dry dog food kibble Meter: Accu-Chek Aviva BG Range: Our meter reads in mmol/l, so the highest she goes is 33(594), lowest we've gotten her to is 14(252), average low has been 22(396)

Wow, you and Olive have really been through it since November...and now testing for EPI! We've had a couple of dogs with diabetes and EPI so hopefully between them and the rest of us, we can help.

I'm not familiar with the medicines mention above, but other med's do sometimes affect our pup's bg...not to mention the reason for taking those med's to begin with. Has your vet addressed how these other issues might be affecting the diabetes one?

The other thing I noticed with Vinny that when I put him on the diet the vet wanted, he was not only losing weight because he wasn't regulated, but also because of the low glucose, weight control food. I had to switch Vinny to another food which means I'm back to messing around with his insulin! Such is life. I would question whether he really needs to be on the food he's on.

That's all I have except good wishes for you all!
Mel

[Olesia]

Re: New Here - Olive the Pug, struggling to get regulated

Hi Olive's mom.... sent you a very long private email and i did some charts for you too ... if your dog is now struggling with Pancreatitis and Diabetes..... you might want to look at Annamaet Lean / Low fat food.... i recently switched to it because we are battling EPI (need low fiber and low carb) Diabetes (lower carb food?/ and for us, with Izzy's diabetes i do have to monitor the fat content) and high cholesterol (again need low fat)..... anyway... i am guessing with Pancreatitis your vet will probably want your dog on low fat food..and then if your dog has concurrent EPI (in other words the remaining viable cells have not all transitioned to EPI but rather the remaining viable ones have developed pancreatitis) you will need to find a low fiber, low fat, low carb food....and a lot of those prescription diets just simply don't work..... At least this Annamaet food has healthy ingredients while adhering to the "low" criteria. The fat content is anywhere between 7-9%