Remy Newly diagnosed Diabetes

[jesse girl]

A challenging road you and Remy have been on . So much contamination in our world it's almost impossible to escape and for our much smaller fury friends they are more vulnerable.

I think your doing all you can . Even having any control with glucose with all that on the plate is a miracle in itself . I used fast acting with Jesse early in her diagnosis to treat high numbers to make her more comfortable but it was never a strategy for regulation

It's to a point you can't judge reasons for inconsistent blood sugar control . It could be one of many . I probably would not make any changes and keep Remy comfortable as you have been doing a fine job of .

I had no clue of dog dementia until Jesse came up with it . No different than a human as the brain just evaporates . It was hard to let her go as she always remembered who I was but struggled just to remember how to eat . Some say I kept her to long but I always thought not long enough . I think many can't understand the attachment you feel being a caretaker for a loved one . Take time to enjoy the moment with Remy . It can get a bit foggy . Me and Jesse had a beautiful camping moment and let her go soon after . She floated in the river and laid by the waters edge as I looked at her and just said wow what a moment to remember . I never saw her as defective and she felt the same . It was all good start to finish .

[Riliey and Mo]

i was just hoing to say it might be easier to turn your phone sideways take a screenshot but this is not a priorty

also i was thinking breeders are breeding dogs with this cancer gene knowingingly or not maybe in your area just a thought. not your falt Claire

Remy is fortunate to have the experience and love you have for him

[RemysMom]

Hello everyone and I thank ou from the bottom of my heart for the support. It’s been such a difficult road and now to learn Remy has bladder cancer has me feeling gutted. How on earth do I get three dogs with bladder cancer? The other two were females, toy poodles. No relation to each other. I did see an article suggesting that high glucose in the urine might predispose to transitional cell carcinoma. We have always been so very careful of pesticides, herbicides, chemicals, anything that might cause it. Since last night the insulin seems ineffective again. I checked in a bit ago with the AlphaTrak and he was 699 ! But he’s not drinking or fussing so I gave him 2.5 units and will wait until his dinner and give him the rest of his dose. I have an appointment with his primary care Wednesday and will see if he can give me some fast acting. I realize it isn’t easy to measure 1U but I think I can manage until we can come up with a pen with U100 Novolin R. I spoke with one of the oncology nurses at the University Vet school. We made an appointment there (April 1, soonest) and she suggested given Remy’s high stress levels that perhaps we would be better off going to a private oncologist which is definitely on the table. Even with a longer drive and traffic we would likely come out ahead if they can schedule him to move through his appointment without delay. In the University system you have to get in line and wait your turn for the lab, radiology, etc. It’s a good six hour day. It would be very hard on him. Knowing when to let go is so difficult. I’ve always pulled out all the stops but maybe that’s more for me than for them. Remy is a strange little guy. Not a cuddler at all. He was a back y and breeder’s stud dog and when the man died his family had to rehome the dogs. We got Remy from a rescue. His teeth were totally rotten, he was skinny and had never been properly socialized. He does’t fight back. If other dogs push him around he just backs off. He’s afraid of everything but he bonded with my husband. It has taken me years to get him to accept me. Now that he has we are near the end. The hardest part is knowing when to back off and let them go in peace. Sometimes I think I don’t know how to do that. Right now I just need to keep him from being high glucose and uncomfortable at night. I’m afraid of making mistakes when I don’t get to sleep much. So I am so thankful for all the help and moral support here. I have screen grabs of Remy’s Libre records but for some reason they seem to be very small when I try to print them. I think iti’s time to try something besides Vetsulin.

[jesse girl]

I did use humalog with Jesse and R . Humalog worked very fast and had a very short duration . About an hour . R was a bit slower and the duration was much longer . Close to 4 hours for jesse

The problem is if you have a sharp drop you could see a response of a spike back up . Drops and spikes may not feel comfortable.

Just to give some perspective some dogs never did much better than the 400s . Maybe dip into the 300s and maybe pop over 500 and physically did ok without and comfort issues .

It can't hurt to try n but don't get your hopes that it will be a game changer

If you are not seeing mass drinking and urination your probably ok. Dogs just seem to be more tolerant of high numbers . Not sure why . Once Jesse started insulin she never had diabetic symptoms again even with her spiking into the 500s . My thoughts is the meters don't do that well at high levels with dogs and I have some evidence of that comparing with a lab analyzer . Meter read 500 and the analyzer was 350 early in Jesse's diabetic life .

It's just going to be difficult to get consistency . You have done amazingly getting decent control with the Cushing's . Not an easy task .

Another thing that was successful for Jesse was just feeding her one meal a day and she got 3 shots of N and a snack . She had a spit dose . Half at dinner the other half a couple hours later . Then a reduced dose 10 hours later with a milk bone snack . So there is allot of flexibility and the 12 and 12 is not set in stone Jesse had very good regulation with this method. My thought removing food from the equation for half the day could be beneficial . This could be beneficial for remy who may not have great appetite . That wasn't a problem for Jesse it was the only method that worked to get her regulated and it made it easier to as she neared the back end of life .

[RemysMom]

I give you all the credit in the world for managing Jesse’s diabetes! Some dogs are so easy and then there are the very difficult ones. Years ago I had a diabetic Pomeranian who got her two injections of Humulin and it was never a problem.Remy is all over the place. When he’s high (usually over 400) he can be extremely uncomfortable to the point we need to take him for a dose of fast acting. Then there are other times when even as high as 600 he seems perfectly fine. The past couple of days the insulin just hasn’t seemed very effective. I know he has some scar tissue built up and he also doesn’t have lots of loose skin to pull up but I feel pretty confident my injections are good, definitely SQ, not fur sticks or going thru. Our AlphaTrak 3 is new since they discontinued the test strips for the 2. I felt comfortable with that meter, not so sure about the new one. Then there is the Libre 3 sensor without which I could never manage Remy. We started with the 14 day Libre which had to be manually scanned. We could use the reader or my iphone as long as we started it with the reader. That reader read up into the 500s which I much preferred. When we got the Libre 3 there was no reader for it. I know they have a reader now but have had mixed information on whether or not we can use the reader and the smart phone. The smart phone scans every minute or so and honestly, at times it’s like too much information. We sit staring at it watching his glucose numbers going up and down and I’m ready to panic when it starts to drop like a rock.The good thing though is the alarms do work and where ever I am I’ll know how he’s doing. I don’t go far from home so I can get back fast if he goes low. I also have a FURBO which can toss treats to him if I need to start getting some sugar into him while I’m rushing home. We can watch him on the camera and talk with him which is reassuring. And so far he has never had clinical signs of hypoglycemia. So with all that you would think I could have a little fast acting on hand for those times when he is obviously high and miserable. I would always check first with the AlphaTrak to confirm before treatment. The internist is concerned about being able to draw up such a tiny amount as 1 unit. The pen would be nice (provided they are accurate as far as dosing) but they don’t make it in Humulin R anymore. There was at one time a junior version that could measure 1/2 unit. I am trying to find out about the Novolin R which would be very similar. I can’t remember why he didn’t want us to use Humalog. Endocrinologist wanted us to try Degludec but none of the other vets are familiar with it and have concerns that no one would know how to treat it if we had issues on an emergency basis. I’ve thought about adding an interim dose for Remy. He does get hungry even though we have to feed him with a demitasse spoon. Remy has always been a very picky eater and would rather graze. This way he gets his entire meal while it’s fresh and helps maintain consistency. Of course we found out yesterday they are discontinuing all but 3 flavors of the food we have been using. He has no teeth and eats a canned food.It takes about 40 minutes to feed him, do his meds, etc. Vetsulin just doesn’t last very long with him and it often takes six hours or more to kick in. His Cushings was controlled but around Christmas we found out his adrenals had stopped functioning and his cortisol was very low. They recovered and we went to 5 mg Vetoryl every other day but he dropped way down again and so far we have not restarted although I suspect his cortisol is climbing back above normal and that’s one reason for the lack of response to his insulin. And now with the bladder cancer it seems I’m back to having to figure that into the equation and the results will unfortunately not be good. How do I put him thru chemo with all these other issues? I will have to get an opinion and options from the oncologists and go from there. Years ago my little heart dog Rose was slipping way from both bladder cancer, kidney failure and heart failure. She loved to go for a walk in her stroller and her last day was a beautiful sunny day. We propped her up with pillows and took her for a last walk. She got to feel the sun and the breeze and smell the flowers and hear the birds singing and she was at peace just as your Jesse was. What a beautiful memory you have. I do think sometimes they hang on for us until we are ready to say good by. It really is the worst kind of pain! It’s hard knowing Remy is my last. There won’t be another fur kid at home to help comfort me. And it will be so difficult. But I also know I am getting too old to provide the level of care that I do and the anxiety has taken such a toll. My life which for the most part has revolved around the dogs will change dramatically but it’s time to let Remy be the last one.

[jesse girl]

I understand reaching an age and have to manage taking care of a fur buddy . My worry is out living me . Jesse was my only big medical adventure and I gave everything I had to be an expert of her condition as you have with Remy and your previous pups . It is stressful and time intensive but we are more than happy to do it .

I believe Jesse got diabetes to change my health practices . I followed her lead to become a more healthy human and maybe I may not be here today if not for Jesse . I am very grateful to her.

At one point I was a insulin pump for Jesse trying to keep her numbers out of high levels . I would give r or humalog every 4 hours and that included sleeping times but that ended when I discovered what worked and it was fairly routine for her for 10 years with blood sugar not a problem even up to the end . We had all the hard work in the first 6 months and on easy street at about a year .

I had no problem giving mico doses of humalog as low as a quarter unit . I just be above the line or below . One unit was not a problem on dosing but I do need some strong readers .

My brother's dog who had cancer they elected to do steroid treatment and got a quality year of life . Not sure if that's a alternative. Of course that can affect insulin and maybe counter productive with Cushing's but maybe there may be a middle ground . The wonderful thing we have is the gift to let them go not to reach a level of suffering that's not pleasant which we mostly don't have as humans .

I have only had Jesse as my only dog I was truly responsible for so it was all new from start to finish . I have grandkids and a grandpuppy (polo) so that's where I place my energy . My days of raising kids and pups in home is done for me and I am ok with that . I do think back but for me that life is over and have entered a new one . Dogs give a look at how are lives will progress . They are so much shorter it lets us get a vision of our lives and what to expect as we age and hopefully be ok with .

[labblab]

Claire, I'm so grateful for the feedback you're getting from the K9D folks, and I know you are, too. Since the Cushing's treatment is currently on hold, I'm afraid I don't have medical advice to offer right now, myself. But my heart absolutely goes out to you as you struggle to find your footing on the path ahead. Especially because I'm facing some of the same uncertainty. My Cushpup, Barkis, was lost to my husband and me almost 20 years ago due to the effects of his pituitary tumor enlarging. Our next precious Lab, Peg, graced our lives until she passed in 2016. And then, our last Lab girl, Luna, passed away December 2022. During his last couple of years, Barkis was quite ill and needed a lot of care. Peg had severe allergies her whole life, and also developed epilepsy and chronic intestinal problems. Luna was the healthiest of our furbabies, but she had recurrent bouts of orthopedic problems that also required a fair amount of attention. Like for you, the rhythm of my own life was so deeply intertwined with that of our dogs. After Luna died last year, I knew it was best for me to take some time off. But at the same time, I didn't know what to do with myself. How to fill the emptiness. And I'm still struggling with that. My husband and I talk about getting another dog, but I don't know whether that will really come to pass. We don't seem to be ready, yet, and perhaps not ever again. Oh my. That's a hard thing to even write down. But I don't mean to go on about myself. I just really wanted you to know that you're not alone. Please continue to update us with your thoughts and questions, no matter what decisions you end up making.

Sending you and Remy continuing healing thoughts and hugs,
Marianne

[Riliey and Mo]

just want to remind everyone that these sensors are helpful but when the dogs number go low or high the sensor give a false reading as it reads liquid not blood glucose.

Remy could read high at 600 sensor and feel just fine but in actuality the hand held meter would read 450. same same same as low of say 65 would actually be 90

[jesse girl]

Just to let you know if you are not treating the Cushing's it's going to be difficult to lower blood sugar. It could possibly require a much higher dose

[RemysMom]

Well today Remy is not responding well to his insulin It only kicks in for about 4 hrs. I have to think his cortisol is on the rise. It’s been about a month now since he had any Vetoryl. The private internist said he didn’t think he would treat him until he tests high or has Cushings symptoms. I think we need to do an ACTH and find out. IF there is ay truth to glucose in the urine ‘feeding’ bladder cancer then I desperately need to get the glucose back under some control. I have an appointment at Medvet next Monday but the distance concerns me during an emergency situation and also the lack of ‘connection’ between the university doctors and private practice doctors that are here in the same city. I don’t want to get ‘too many cooks in the kitchen’. If we could find a way to keep Remy calm I’d just as soon keep him at the university vet school even if my husband and I go and sit with him there all day on treatment days. Or maybe we would opt for an oral treatment we could give at home. With Angel (she also had elevated liver enzymes like Remy) we did 10 IV treatments of vinblastine first and that was pretty much an all day deal. It did help stabilize the tumor for several months and then we went with metronomic chemo at home. But she didn’t have Cushings or diabetes and she was calm while she was there for the day.

I do want to clarify as far as the Libre sensor readings, they stop at 401. On the smart phone that’s the highest reading shown. So if he’s seeming not to be responding then we check with the AlphaTrak 3 which will read the blood glucose rather than interstitial fluid. But last night I got 699 on the AlphaTrak even though he seemed comfortable. That’s the most accurate way I can test hi and the vet uses the same AlphaTrak although the 3 is new to us. I was pretty comfortable using the AlphaTrak 2 but test strips are no longer available for it. The Libre sensor can be pretty close but it can also be totally whacky so it’s imperative to check with the AlphaTrak. The crazy part is how he can read that high and not be panting and pacing and drinking. Usually over. 450 and he’s uncomfortable.

Marianne I feel where you’re at. It is a huge decision to go back into the world of being a dog mom again. I’ll be 75 in the fall so I think it’s time for me to stop with Remy. I’ve adopted senior rescue dogs for years and that usually meant almost immediately having to deal with medical problems. That’s been my life for the last 25 years sometimes with multiple senior fur kids wth multiple problems. I haven’t had a vacation or gone anywhere really in over 20 years unless the dogs could go too.The anxiety is the worst part. Laying awake at night listening to them breathe and counting respirations to every little tummy noise. I don’t mind doing it. I’ve never minded caring for them and I love them dearly and I”m happy to do it but I feel I’m at the end of being able to provide that level of care and get by on three or four hours of sleep and not make mistakes. Plus I have to look ahead a few years and ask if I’ll be able to care for myself let alone another dog. So it’s time for Remy to be the last. And I don’t know what I’ll do with the time. Like you said, you hve all this time now and what to do with it? We don’t have grand kids or even grand dogs anymore so I suppose I will have to figure out what to do with myself. LOL!

I think I can measure up a unit of Novolin or Humulin R. I had cataract surgery ac purple off years ago and have those fancy multifocal lenses and I still can add readers so I can see the markings clearly. I have never used an insulin pen so I’m not sure how trust worthy they are as far as dosing. But right now I think the change in responsiveness to the insulin has to be the cortisol level. He’s never been regulated nearly as well as I would like but this week has been crazy. I have so many decisions to make, it’s all I think about.

And I am so thankful for the advice, the compassion and the moral support I find here! You all are so kind and helpful. You make it easier to navigate this oh so difficult road!! And I can’t thank you all enough!!

Claire

[RemysMom]

Update from last night. NOT a fun night! No action from his insulin last night. Now at 7AM he’s finally down to 329. His regular 5.5 U at dinner time didn’t help. I even gave it about 30 minutes early to help it start to kick in. We checked via AlphaTrak at one point and he was 481 but he was headed up I think not down. Pacing, whining, fussy, wanting to drink until around 2:30 AM when he finally settled down a bit. I’m thinking his cortisol levels are high enough to effect the insulin so he needs to go back on it but on a very small dose since he has become so sensitive. 5 mg every other day was too much so maybe every3-4 days? This is what the private Internist would do. He’s not a fan of compounded meds. What do my resident expert ladies think??

[labblab]

I’m so sorry things are going poorly again. But if Remy were mine, I would not start back with the trilostane until you’ve had an ACTH that confirms abnormally elevated cortisol once again. There may be other causes for his lack of response to the insulin, and adding trilostane back into the mix if it’s not called for can just make things worse. If an ACTH is abnormally elevated once again, then I’d strongly advocate for a small compounded daily dose. As I’ve written above, I do understand why your vet prefers Vetoryl, as do I when it’s feasible. But giving Remy a dose of Vetoryl that’s too large on a spaced out basis does not seem like a workable solution to me. In essence, you’d be overdosing him part of the time and underdosing him most of the time. It seems to me that would only add to the rollercoaster effect. But step one would be to start with the ACTH. Once we have those results, the path forward may be clearer.

Marianne

[jesse girl]

It's maybe time for a reset and make the switch to N . If getting at Walmart purchase under the relion name at a discount . Should not need a script . Same for the u100 syringes that you will need which is also under the relion name .Pick up some r insulin under the relion label as standby . I would call to see if available I might start with half the dose you were giving with vetsulin . If after a few days if no improvement and maybe a decline in action than go back up to the same dose that Remy was taking on vetsulin . Remember physical diabetic symptoms are a important gauge also . The reason for such a lower start is to make sure that the dose given was not to much . Jesse was very sensitive to the amount of insulin given as one shot . That's why I had to give her a split dose at meal time . If the Cushing's had abated you may have needed to reduce the dose . Elevated sugar can also point to to much insulin . A battle I had with jesses sugar early on always responding to higher numbers with more insulting which was the opposite of what I should have been doing .

If no stabilization and maybe an increase in diabetic systems go back up to the same dose amount remey was on vetsulin . Go 5 days if no improvement go up a unit and continue that process if no improvement. If you reached double the amount with no improvement then come up and take a breath and maybe time to add some R .

Probably time to get more aggressive with insulin . If you can avoid going down the Cushing's rode that would be helpful . Giving insulin is the simplest thing to do . With Jesse I felt we had nothing to loose being more aggressive and I was extremely aggressive. Maybe to much . I thought she may have a few months to live for how sick she was . She proved me very wrong and lived longer than any diabetic dog I have heard of

Cancer is a strange thing . It can take off at fast growth rates and can be quite slow . You have to balance the time left with treatment and how it affects quality of life .

[Riliey and Mo]

yes changing to nph and starting at a lower dose as this insulin is more concentrated. its worth a try but adding anything else into the mix will throw off the insulin change

have you tried Abbotts Freedom lite strips they work with the alpha track

we dont have any data to go on no blood tests, lab reports, curve, no oncology exam yet

also when was the sensor changed
is it making him uncomfortable
does he need a new one

[RemysMom]

To answer a couple of question, Remy’s Libre 3 sensor was changed yesterday. It isn’t bothering him at all. He hated the 14 day Libre but doesn’t pay any attention to the Libre 3. We’ve only been using the AlphaTrak 3 a short time. The AlphaTrak 2 we had for several years until they stopped making the test strips for it. Remy has regular blood work performed. I will schedule him for an ACTH as soon as possible. Then we will have a better idea of his cortisol level. There is some history going back to just before Christmas when we learned his cortisol had tested very low. He has been on Vetoryl for over four years which is quite a long time and in some rare cases the adrenals can be affected. A few weeks off Vetoryl and his adrenals recovered and he was back up around 135. We dropped to the lowest dose of 5 mg every other day but that put him back down in the 20s. And since then his glucose hs been even more difficult to regulate. Remy has been off Vetoryl 30+ days. He spends most of his time with his glucose at or above 400 now. We have a constant curve because of the Libre. We have found it averages within 10 points or so of a blood stick. I cancelled the oncology appointment for Monday after today’s visit to Remy’s PCV. Given his level of stress just going to his PCV this morning I think it is unfair to put him through all the fear and stress of traveling over an hour way. We will keep our oncology at the local university vet school on April 2 and see what they think. His PCV and his PC Internist both feel if he were theirs they would go with NSAID therapy and keep the procedures and time involved to a minimum. He is exhausted from his visit today but his ears were treated, his hips were lasered and his PCV has done an ultrasound of his bladder so now he is familiar with the location, dimensions, etc. He gave me a Rx for Humulin R but it has to be ordered and hopefully will come in tomorrow. I only plan to use it in emergency situations when he is hyperglycemic and uncomfortable. My gut is telling me his cortisol is high and affecting his glucose. That said, his glucose has never been as regular as we would like and I”m not adverse to changing from Vetsulin. But I also feel it is very important that we get the cortisol stabilized so it doesn’t keep affecting the glucose. PCV is going to discuss pros and cons of compounded trilostane and every few days dosing with Vetoryl. Hopefully I can get the Humulin R tomorrow. For tonight we are doing a split dose to try to keep him in a more comfortable range. Hopefully I can get some sleep tonight and kind of regroup my thoughts for tomorrow. I’m at that stage where my head is spinning with information and I really need that ACTH to make an informed decision. How’s that sound? UGH, I’m just worn out and so is Remy! IMG_4611.jpg