Shih tzu recently diagnosed plus Cushings

[k9diabetes]

Re: Shih tzu recently diagnosed plus Cushings

You don't have to make a tent to inject - as long as the insulin gets where it needs to go, any technique is fine.

I used to just barely pull Chris' skin away and insert the needle into the side of that.

There are also auto injectors you can use.

Check out various tips in the Answers forum of saved posts on injections.

https://www.k9diabetes.com/forum/forumdisplay.php?f=14

[k9diabetes]

Re: Shih tzu recently diagnosed plus Cushings

I will be sure to check back in tomorrow. My schedule's not so hectic at the moment so I can spend some time here.

But do take advantage of the Answers forum and the main website for tricks and tips.

Now get some sleep!!!

Natalie

[PaddysPerson]

Re: Shih tzu recently diagnosed plus Cushings

Paddy's at his regular vet now. They did the bloodwork that was scheduled & checked his urine for ketones (none). His glucose with glucometer was over 600 (maybe 680? can't remember) and bloodwork 585. So they gave him insulin - no food- and iv fluids. His doctor is concerned about his weight loss. He's getting a curve done. After I pick him up, he has to spend the night at the er and get more fluids and have his glucose monitored. Then tomorrow,he'll see the IMS who works there.

[k9diabetes]

Re: Shih tzu recently diagnosed plus Cushings

That's good that he's seeing an IMS - Hope he or she is a good one!

With such high blood sugar, he's bound not to be hungry or to feel well. But do keep in mind when talking with the IMS that diabetes can be a symptom of other things. Less likely if the blood work is all good. It's just important not to chalk everything up to blood sugar.

Our non diabetic dog, who passed away at the end of February, seemed a little slow moving but was 14 years old and the vet didn't feel anything that she felt warranted x-rays. But after some white blood cells showed up in his urinalysis, she did radiographs and found a huge mass (noninvasive - not what killed him) the size of a loaf of bread in his chest, pushing his heart and other organs to one side. You'd never know it to look at him and it it took the vet completely by surprise.

I was planning to have the radiographs done even though she didn't think they were necessary because I felt like something was going on with him. Subtle but not just age, which is another thing problems can be dismissed as.

So whatever noninvasive diagnostics the IMS can do can give you peace of mind if nothing else. Good news would be to find that it's "only" high blood sugar.

From the curve you posted: Base - 504. Then 422, 303, 242, 215, and 143

I'm assuming that's 8-10 hours since at the vet? Was that after he had breakfast? And insulin? If so, how long after?

His blood sugar took a long deep dive so the insulin certainly is having an effect but is not well balanced with his sugar supply. Changing diet and/or injection time can help with that.

Urinalysis strips will help you by sorting out first thing in the morning whether his blood sugar has gone high.

If he's amenable and biddable (cooperative!), let him out to pee early in the morning, say an hour before you feed him, and do whatever you can to get him to empty his bladder, not parcel out just a bit.

You can test that urine if you want to have a comparison but it's been collecting overnight so could have a lot more sugar in it than his blood.

Then right before you feed him, again if he's willing (our dog pretty much peed upon request, which was handy), test the urine he generated over the preceding hour or so and see how much glucose is in it.

You might be able to test from pee pads directly. And if you're brave... stickiness will give you an idea how sugary it is.

Let us know what you find out! I'm glad he's getting some fluids - that should make him feel better.

Natalie

[k9diabetes]

Re: Shih tzu recently diagnosed plus Cushings

Does that make sense about how to use the urinalysis strips?

[MomtoMax]

Re: Shih tzu recently diagnosed plus Cushings

Paddy's at his regular vet now. They did the bloodwork that was scheduled & checked his urine for ketones (none). His glucose with glucometer was over 600 (maybe 680? can't remember) and bloodwork 585. So they gave him insulin - no food- and iv fluids. His doctor is concerned about his weight loss. He's getting a curve done. After I pick him up, he has to spend the night at the er and get more fluids and have his glucose monitored. Then tomorrow,he'll see the IMS who works there.

So sorry you are gong thru this with Paddy… Healing vibes are headed your way for you both! Hoping the IMS gets some answers for you! If Max didn’t eat even a single meal I’d be in panic mode as he’s a typical Corgi and worships food!

Donna and Max the Corgi

[PaddysPerson]

Re: Shih tzu recently diagnosed plus Cushings

Not exactly sure where to start.
Paddy's home now - he spent 2 nights at the hospital/er and the IMS took x-rays and urinalysis. Paddy didn't have ketones at his regular vet on Tuesday, but did later that night & on Wednesday. Results from urinalysis not in yet.
He wouldn't eat much while he was there (on curve days, his regular vet has to syringe feed him). His glucose levels were high to start but several readings were below 100. I can post some of those later, as well as more detailed info.
The IMS has also discontinued the vetoryl that Paddy takes for his Cushings (possibly switching to lysodren later) and gave him an rx for antibiotic and a different probiotic than the Fortiflora that I've been giving.
The major thing is his prostate and bladder. Back in May, I guess, I had posted the results of Paddy's ultrasound & cytology on the k9cushings board, but never posted them here (also the results of his acth stim test that was sent to UTK for his cushing's). His liver and prostate were both enlarged (Paddy is neutered). The cytology from his prostate showed "probable carcinoma and abundant necrosis". That IMS (different from the one at ER location. We've been to the first one several times and had at least 3 ultrasounds done by him) that IMS suggested, as first course of action, starting Paddy on Proscar to try to shrink his prostate. We had another UTK stim test first to check Paddy's hormones - it took a month to get those results from UTK. And right after we got those, he was diagnosed with diabetes and Proscar was put on hold until better regulated. (I'm an idiot)
Now, results from x-rays done by IMS #2 show an enlarged bladder and possible obstruction. He referred us to two universities, one of which suggested other specialists - oncologists - to call due to their long wait time. I have more info I can share later, with specific medical terms.
Also IMS #2 has lowered Paddy's insulin to 2u of vetsulin.
I feel really.....stupid? I've messed up things for Paddy by not being proactive and by, I guess trusting people because of their education. I've felt in over my head just dealing with the diabetes.
Natalie, thank you for the info regarding the test strips - i'm going to read your post better later. And thanks to everyone else for your kind words and help.
If anyone has any experience with prostate cancer to share or can recommend an oncologist, we would appreciate it.

[k9diabetes]

Please don't beat yourself up. You are always doing the best you can for your pup.

Our dog was seen by the guy who literally wrote the book on diabetes from which your IMSs learned - it shouldn't get any more knowledgeable than that! And frankly, he was lousy at managing diabetes. He was the reason we first switched general practice veterinarians and then started managing our dog's diabetes ourselves. And the horror stories about Cushings... the truth is that there are very good, very bad, and lots of mediocre IMSs out there.

My understanding of Proscar is that it reduces inflammation so if cancer is present it wouldn't have done anything for that. Don't know that it would have made any difference. And regulation is must a lot more difficult when you have a dog who doesn't cooperate with injections, let alone testing. It is harder. You have to rely on curves at the vet where he doesn't have his regular schedule, meals, environment and it's stressful.

We were extremely fortunate to have had an incredibly tolerant diabetic dog - he was difficult to regulate well with home testing. Had our last dog Jack become diabetic, it would have been a very different story.

I like what this second IMS has done in general - very thorough. It is tough to get into oncologists these days as the pandemic was not kind to the availability of specialists.

Many vets are now using continuous glucose monitors with dogs - that might be an option for Paddy to get a better picture of what's going on at home. But probably no point until he's off the Vetoryl and on Lysodren if he goes on it.

Everything affects blood sugar - including probiotics because they change how food is digested and antibiotics can strongly affect how insulin is processed. And inflammation tends to increase blood sugar So you're in for some challenging times and working hard for your buddy, and it's the working hard and learning and asking questions that make the difference.

The multi-test urine strips can also help you monitor bladder issues so I they could be very helpful to you.

Hang in there... it's tough with dogs with multiple health problems. For most of our dog's last four years, diabetes was his smallest problem.

Sending you a hug,

Natalie

[k9diabetes]

This forum exists because the guy who wrote the book was so bad at managing diabetes. We joined an earlier version after meeting with him.

[PaddysPerson]

I'm dropping in to give an update and for some advice, of course.
I did get the test strips and have been using them. When I test Paddy's morning urine, it always seem to be between 250 & 500 for the glucose (never sure about color & timing) lightest pink for ketones. I decided to try switching to the IMS that we saw recently to help with Paddy's diabetes. He's going to put a Freestyle sensor on Paddy this week. Is it pretty accurate? Issues?
I'm also going to ask him about Paddy's diet as well as make sure I've been giving injections in right place.
Regarding Paddy's prostate, we saw an oncologist last monthand they did another ultrasound. His prostate measured about 2cm in April & now is 2.5 but hasn't spread to lymph nodes. Paddy's bladder was also smaller than when x-rays were done a few weeks before .The oncologist prescribed an nsaid (piroxicam) and discussed treatment options. Radiation doesn't seem...possible? It's very expensive and Paddy would have to be sedated daily, for 5 days, staying at their hospital. The other option is chemo. My concern with that is... it makes him more prone to infection, right? His diabetes would make it worse? Does anyone here have experience with chemo and diabetes?
I was also wondering about some foods and supplements that were recommended by a cancer support group - turkey tail mushroom, Zesty Paws cranberry chews. The food is Dr. Harvey's paradigm. I plan to ask the internist about them, but wanted to hear from you all first. I mentioned Dr. Harvey's to the GP the other day (not Paddy's regular gp) and she kind of discouraged me from trying anything that's not rx food.

[MomtoMax]

In my experience, and from the mouth of my wise, old, now retired veterinarian, they are not nutritionist. There is a chapter on nutrition they are required to read and that’s it! Their advice on nutrition comes straight from the representatives who sell them products, such as Hills, Royal Canin, etc. These reps are often times are in fact veterinarians who have had their tuitions compensated by the large food companies, so are obviously biased.
Some one once stated on another board that a person should feed the best food they can afford, with fresh food always at the top, but also the most expensive. Years ago, I bought a book by Monica Segal (who is a true K9 nutritionist BTW) on preparing my dog’s fresh food diet, but I got overwhelmed with the requirements (organ meats, bone meal, oh my!) and gave up… I think she may still formulate diets for dogs with specific needs for a fee, so if you’re inclined to check it out, her website is www.monicasegal.com I’ve known several people who have had used her diets with multiple conditions on their dogs had and are very satisfied.
When first diagnosed, my former vet, whom I fired, insisted on prescription food. My current vet, who is holistic, embraced me feeding The Honest Kitchen, which is dehydrated, human grade food that I add meat to and Max does well on it, but he is just one diabetic dog…
I can’t help with the urine testing as I uses strips that are simply color coded and while Max continues to show trace Ketones, my vet isn’t concerned about it as she said even non-diabetic dogs can have them. I do test him weekly though to make sure they’re not climbing up the color chart!
I can’t help with the cancer questions as thankfully I’ve not dealt with that. Hopefully someone else can.

Donna and Max the Corgi

[k9diabetes]

I am relieved to hear from you and to hear that Paddy is doing okay. In my experience, dogs with diabetes resist infection and heal up fine. They can get bladder infections but that’s more related to the sugar in their urine, which the bacteria thrive on.
Piroxicam often greatly improves bladder cancer.
It is a difficult decision to make… our dog, who was not diabetic, developed a noninvasive mass in his chest and we opted to treat it with three days of highly focused radiation. Which greatly reduced the mass. But within two months, a separate mass invaded his spinal cord. Knowing now about outcomes of radiation, I am not sure I would do the radiation. But not doing it meant letting him die. All you can do is use the vet’s information and your knowledge about and love for your dog to make the best decision… there aren’t right and wrong decisions in these cases. I know how hard it is.

[PaddysPerson]

So Paddy has had the libre since beginning of January. When they put the first one on, his fructosamine was 463. The IMS wanted to increase his insulin from 4u to 6u, which I wasn't sure about so we agreed on 5u (which was the dose before Paddy was at ER in Dec.) His readings were high the majority of time so on next visit 2 wks later to get sensor changed, Dr. said to increase to 7u. I didn't exactly do that. I had to leave Paddy alone a few times that week, afraid his BG would get too low, so I worked up to 6.5 ( a few times gave 7u). But it wasn't until about 5 days before his appointment on Monday that I consistently gave 7u. I told the vet tech this before seeing the dr.so he should've known.. He said that Paddy should see an ophthalmologist since that could be one reason his glucose is so high (we go next week). Also, he discussed switching inulins, which makes me nervous. He wants to switch to prozinc but waiting til I finish the vetsulin (still have 1/2 bottle) He said Paddy's eyes may be more of an issue right now rather than his cushing's.

Prozinc... that's not usually prescribed for dogs? IMS wants to switch to that one because it's also 40u. Other insulins are 100? He said it would be really difficult to only give 5u (or was it .5?). I tried to search posts here.. it would be only once a day but with more chance of hypoglycemia, right? I really don't like the idea of changing insulins....

Also, later on Monday night - after appmt with IMS and before next insulin dose - Paddy's gluose was slightly better and got down to 84 (vet has normal range set to 70 - 150 on reader) That was from 7u, 11-ish hours earlier. And since then it has been "better" - not so many "HI" and 350+ readings. Last night, it got down to 72 - made me very uneasy.Today it's ranged from 94 (before a.m food), 218 (20 minutes after eating, right before injection), 400+ ("HI" on reader, 1 1/2 hour later). down to 84 around 5 hours after that.(I did check every hour) Last few times it was mid to low 100's. (when it gets in 100s...i start checking every 30 minutes or so because I'm skeered) And I have yet to go up to 8u..
I'm really apprehensive about going up to 8u since Paddy's BG did get below 100 on 7u. Not sure how this sounds, but with everything else he has going on - prostate and now needing an ophthalmologist - i really want to avoid the er. ER expense could be spent on other things (oncology, eyes, a holistic vet..) But we would go if necessary.
Do I follow dr. instructions & go up to 8u? Also how can I get Paddy's BG to stay in a good range - 100-250?

[jesse girl]

So Paddy has had the libre since beginning of January. When they put the first one on, his fructosamine was 463. The IMS wanted to increase his insulin from 4u to 6u, which I wasn't sure about so we agreed on 5u (which was the dose before Paddy was at ER in Dec.) His readings were high the majority of time so on next visit 2 wks later to get sensor changed, Dr. said to increase to 7u. I didn't exactly do that. I had to leave Paddy alone a few times that week, afraid his BG would get too low, so I worked up to 6.5 ( a few times gave 7u). But it wasn't until about 5 days before his appointment on Monday that I consistently gave 7u. I told the vet tech this before seeing the dr.so he should've known.. He said that Paddy should see an ophthalmologist since that could be one reason his glucose is so high (we go next week). Also, he discussed switching inulins, which makes me nervous. He wants to switch to prozinc but waiting til I finish the vetsulin (still have 1/2 bottle) He said Paddy's eyes may be more of an issue right now rather than his cushing's.

Prozinc... that's not usually prescribed for dogs? IMS wants to switch to that one because it's also 40u. Other insulins are 100? He said it would be really difficult to only give 5u (or was it .5?). I tried to search posts here.. it would be only once a day but with more chance of hypoglycemia, right? I really don't like the idea of changing insulins....

Also, later on Monday night - after appmt with IMS and before next insulin dose - Paddy's gluose was slightly better and got down to 84 (vet has normal range set to 70 - 150 on reader) That was from 7u, 11-ish hours earlier. And since then it has been "better" - not so many "HI" and 350+ readings. Last night, it got down to 72 - made me very uneasy.Today it's ranged from 94 (before a.m food), 218 (20 minutes after eating, right before injection), 400+ ("HI" on reader, 1 1/2 hour later). down to 84 around 5 hours after that.(I did check every hour) Last few times it was mid to low 100's. (when it gets in 100s...i start checking every 30 minutes or so because I'm skeered) And I have yet to go up to 8u..
I'm really apprehensive about going up to 8u since Paddy's BG did get below 100 on 7u. Not sure how this sounds, but with everything else he has going on - prostate and now needing an ophthalmologist - i really want to avoid the er. ER expense could be spent on other things (oncology, eyes, a holistic vet..) But we would go if necessary.
Do I follow dr. instructions & go up to 8u? Also how can I get Paddy's BG to stay in a good range - 100-250?

To be below a 100 and suggesting to raise the dose is not a good idea . Also giving nph insulin is the go to choice switching from vetsulin . Yes you use u-100 syringes but the dose usually will compare with the dose with vetsulin u-40 syringes .The other insulin suggested doesn't have much success in dogs and have not herd of any dogs regulated ion that insulin . The vet seems to be not well versed in the disease .

[PaddysPerson]

Sorry to have taken so long to reply...
After I posted last time, that same night Paddy's glucose was down to 61 on the reader. I was worried it would get lower so I gave him some treats (actually rx low fat kibble). He wasn't acting unusual or anything, napping like he normally does. I called the internist the next day.They said as long as Paddy wasn't showing symptoms of hypoglycemia, no reason to be concerned because the libre gives false readings in lower ranges. They quoted this info in an email:
"The Freestyle Libre device may inaccurately indicate hypoglycemia. The results of studies in people showed that 40% of the time when the device indicated that user sensor glucose values were at or below 60 mg/dL, user glucose values were actually in the range of 81-160 mg/dL. Studies on animals have likewise shown low reading are inaccurate. Therefore, interpretation of the Freestyle Libre Pro Flash Glucose Monitoring System readings should only be based on the trends and patterns analyzed through time."
But the IMS also said I could continue with just 7u instead of 8u until next appointment (next week).
The funny thing is, ever since that night, Paddy's readings have been high again the majority of the time Last night, maybe the past several nights, they finally got down to mid 100's. I haven't been giving him treats or anything, so not sure what happened....?

We went to the opthalmologist on Monday. They said Paddy is a good candidate for cataract surgery, however it's $4000 -$5000. I don't have insurance and with everything else Paddy has going on... I mentioned to the Dr. that Paddy's teeth extractions were never completed - just the one side. She said his teeth could be affecting his glucose more than his eyes. So I need to find out if the other teeth can be extracted. In the meantime, he got an rx for eye drops (already gets optimmune for dry eyes). I do wish he could have the surgery and be able to see again

Regarding changing insulin - I should put my foot down, so to speak, over the prozinc? If the dr wants to switch, it should be to NPH? He's a specialist and I think he said vetsulin wouldn't have been his first choice - can't remember why. Paddy is only about 13.5 lbs now. How many units might he be started on, if we switched to NPH?