Diabetic Australian Cattle Dog

[jesse girl]

Re: Diabetic Australian Cattle Dog

Routine and consistency is key to success . It can take months to get a dog regulated . For my Jesse she was difficult and took 6 months to stabilize and close to a year when I settled on her routine .
It can be a bit crazy in the beginning trying to get your bearings . Almost all figure out their dogs unique type of regulation
Must remember meters are not perfect and can be off especially at higher levels but as they get lower they become more accurate . Now that's ok . What you look for is patterns . Say you test at 500 and in reality it's 400 . Either way if it's 500 or 400 it's still high
Taking medication for Cushing's is going to make your dog a bit more challenging to regulate
Your managing 2 diseases at the same time and the body is still trying to adapt
Your off to a good start . Need to settle in a structured routine . This is important early on . Once regulated you maybe able to be a bit more flexible

[labblab]

Re: Diabetic Australian Cattle Dog

You all are doing an awesome job of working together to get Bear settled into this new routine. Just wanted to let you know that I’m still following along in the background and will continue to do so.

I’m going to go ahead and make a couple of Cushing’s-related comments that you don’t need to focus on right now — you’ve got your hands full, as is! But I’ll just put these things in writing for your future reference. You already know that I’m nervous about the accuracy of the Cushing’s diagnosis when the testing was done when Bear was overtly ill with uncontrolled diabetes. But for the moment, assuming the diagnosis is accurate and you do proceed, here are some treatment guidelines. I wish I knew what dose of Vetoryl (trilostane) your vet is ordering. In the past, dosing was higher. But current recommendations are not to exceed a daily total of 1 mg. per pound when starting off. Ideally, diabetic dogs who are receiving insulin twice daily will receive their trilostane in two split doses, as well. However, if your vet is ordering brandname Vetoryl, the dosing can become complicated since the med is only produced in certain discrete capsule sizes that can’t be opened and divided.

Many non diabetic dogs are started with one dose daily in the morning along with breakfast. And depending on what your vet has ordered for Bear, that just may be the easier way for you to start out, too. If so, and if he’s ordered brandname Vetoryl, I’m hoping he has ordered capsules no larger than 30 mg. for Bear. Vetoryl is marketed in capsule sizes of 5, 10, 30, and 60 mg. It is much safer to start off lower rather than higher in order to stave off possible side effects from overdosing. So given Bear’s weight, 30 mg. definitely would be preferred over 60 mg. Your vet may actually be ordering a compounded version of trilostane, though, and if so, that dosage can be customized for each dog in the form of capsules, tablets, or a liquid suspension. So we’ll just have to wait and see what he’s ordered. But I just wanted to get this dosage info down in writing for you to refer to if and when the time comes. I know you’ve already had challenges with the vet, and I’m surely hoping that the trilostane dosage won’t become another issue.

OK, back to focusing on the diabetes once again! I’ll slip back into lurking mode but I’m always here rooting for you guys.

Marianne

[Zoology1603]

Re: Diabetic Australian Cattle Dog

the Freshpet website, feed guide has weight from 21 to 40 pounds to feed 1/2 to 1 1/8 lbs per day. yes pounds. tonight i looked again its changed to 21 to 35 lbs feed 2 1/4 to 3 1/4 cups. yes its cups not lbs. confusing.

Here is the exact product I have:
https://freshpet.com/dog/freshpet-se...-egg-recipe/#/
The back of the bag says dogs 21lbs - 35lbs: Serve 1 1/2 - 2 1/4 Cups per day. So I divided 2 cups in half. 1 cup in the morning and 1 in the evening.

I went with the hills prescription this morning. She took 2 more poops last night and another one this morning. Brown, solid but soft inside. Very smelly.

does Bear have any medical issues?

Nope. She's wormed every year but never had any. She had an ear hematoma last year about this time.

is there anything outside that she eats? poop?

She's been searching for chicken poop like she's on a mission when she goes out now. I assumed because of the lack of food she had been consuming that she's trying to get some nutrients that she was lacking. In the past she liked to dig in the dirt and lick it, again I thought she was after nutrients but her diet was good so I didn't know what she would have been after.

has the bleeding stopped?

I'm not seeing any red in the water bowls any more. That doesn't mean it's cured but I'll keep an eye on it from time to time and see if I see it bleeding again. It was hard to see as it wasn't always bleeding when I looked inside her mouth.

do you have a human glucose meter? i.d like to double check the alphatrack high readings. or take her to the vet for a glucose reading.

I do have one. I will check it later today when I have access to it. We have a OneTouch Ultra 2 but unfortunately no strips for it.

---

test before food at fasting,
test half hour after 3/4 cup food and 8 u insulin
test at 12pm
do the same at supper

9/18

6:00am :: 591
6:08am :: Hills prescription a/d, small can. No feeding directions.
6:15am :: 8 Units of Vetsulin
6:47am :: 651
12:22pm :: 324

[Zoology1603]

Re: Diabetic Australian Cattle Dog

Your off to a good start . Need to settle in a structured routine . This is important early on . Once regulated you maybe able to be a bit more flexible

Currently I'm still trying to figure out what she is going to be eating from now on. I only have a little bit of each thing (freshpet, canned, hills) as I just needed to get her something to eat and stay alive. Now I need to figure out what to switch to on the regular so I can go get some more and keep her regular. I'm hoping to switch back to dry someday but I'll concede to giving the freshpet for a while longer while she heals and gets back to her normal weight of 38lbs.

The issue with dry is she never ate in the morning but in the afternoon or evenings. This morning I offered her a piece of dry and she didn't want it as I expected. So her routine may be fresh in the morning and dry in the evening, if she even wants to go back to dry at all.

[Zoology1603]

Re: Diabetic Australian Cattle Dog

You all are doing an awesome job of working together to get Bear settled into this new routine. Just wanted to let you know that I’m still following along in the background and will continue to do so.

Thanks. I'm going to print out a spreadsheet of my daily routine with all the testing and take it into the vet when I go back. We'll see if that helps me in any way.
The funny thing is, my sister used the same vet with her diabetic dog. I'm learning that they kept her dog and did a blood curve on him. She also got the over the counter insulin and was giving it to him twice a day the way I am doing now. I never got any blood curves or special treatment in any way. Diabetes took a back seat to cushings and I had to keep pushing to get the insulin. The nurse even asked what dose of insulin are you on now, as did the other doctor.
I am wondering when I will get a copy of those test results too. I'm afraid of giving her the cushings meds because if she doesn't have it then that's going to be hard on her body for no reason. I also would hate to have to do another test.

[labblab]

Re: Diabetic Australian Cattle Dog

Yeah, it seems so odd they said they didn’t have the LDDS test results to give you yet — if they don’t have the results, then how did they already make the diagnosis? Just doesn’t make sense.

Here’s one other thing for you to know in advance in the event you do start trilostane. Unfortunately, in-office blood draws will be necessary to monitor Bear’s cortisol level. Here in the U.S., the ACTH stimulation test is still used most commonly for that. However, since your vet says he can’t perform that test, your other option is to have her resting cortisol level checked in the morning, one hour before getting her breakfast and her trilostane. That form of monitoring has now become the norm in the U.K. and a lot of Europe, so it is acceptable. But it does have to be done frequently to begin with. At the two-week mark to start, and then monthly until the dose is stabilized.

So the Cushing’s treatment does involve a whole additional level of care and monitoring (and expense!) that is sobering. It’s for this reason that I’ve been hopeful that her glucose levels can be managed successfully with insulin alone, and that Cushing’s isn’t actually a reality for her. But there are indeed dogs who suffer from both disorders, and we’ll deal with that if we have to. But going full circle, where the heck are those LDDS results?

[labblab]

Re: Diabetic Australian Cattle Dog

Just wanted to add one more thing. Insulin resistance is one of the main symptoms that does trigger speculation that Cushing’s is present in a diabetic dog. However, I’ll highlight a quote that Natalie linked to earlier. Dr. Peterson is an endocrinology specialist who has written extensively about the challenges of differentiating between the two disorders. Bear does indeed exhibit observable symptoms that are consistent with Cushing’s, but at this early stage and insulin level, it doesn’t seem to me that we can say that she’s insulin resistant. Per Dr. Peterson’s definition below, if my math is correct, it would take nearly 40 units before she’d meet that threshold.

This blog entry is on diagnosing Cushing's in a diabetic dog. It includes Dr. Peterson's definition of insulin resistance, which is the same one I have followed.

https://www.vetco.org/51-content/kci...betes-mellitus

Quote:
We define insulin resistance as doses greater than 2.2 U/kg/injection to control hyperglycemia (4), so we aren't even close to the doses required to diagnose resistance.

And yes, diabetic dogs can get marked hepatomegaly secondary to fat accumulation in the liver. That can lead to a mild-moderate "pot bellied" appearance.

Because it can be very difficult to make a diagnosis of Cushing's syndrome in dogs with diabetes, observation and monitoring is the best course in many of these patients. If Cushing's disease is present, it will be progressive and other signs will develop to make the diagnosis easier to confirm.

[Riliey and Mo]

Re: Diabetic Australian Cattle Dog

i thought a food change would lower her numbers. also reducing her food will

its imperative that she stops eating poop,

feeding the recommended amount of the wet hills is important. or whatever food you feed. food takes effect in half an hour shows up.in the blood. i know it seems far out there. but the right amount of food meets up with the insulin lower her blood suger

that 641 after she ate shows the food is too much

i would raise her insulin up one unit tonight to 9, and expect raising it more tomorrow.

you.ll.know if you have the right amount if food when the blood glucise doesnt rise after half an hour of food.

your doing great

[Zoology1603]

Re: Diabetic Australian Cattle Dog

I've been browsing through the material I have from David Bruyette, this one in particular > https://www.veterinarydiagnosticinve...10fcfcee95.pdf

With insulin given once a day, feed three meals a day (of
equal calories) at six-hour internals. Give the first meal at the time of the insulin injection. For animals receiving insulin twice a day, feed four meals a day. Schedule them to coincide with the insulin injections and feed mid-afternoon and late evening.

So, if giving 2 shots a day, would it be better to cut the size of each meal down considerably (the total would be the exact amount for the day) split out over 4 meals in the day? She would have less food and might lower those spikes I'm seeing as you have said from too much food. I'm deferring to your thoughts.

[Zoology1603]

Re: Diabetic Australian Cattle Dog

Her 12:22pm reading for 9/18 is 324.
I tried the human meter we have (TrueMetrix) and it wanted more blood than I had so I had to stick her again and when it was finally happy it gave an error. I didn't want to use up all of the test sticks as they are only allowed so many by insurance so I didn't try again.


Do you want me to do any testing before the next feeding cycle where I will repeat what I did this morning?

[Zoology1603]

Re: Diabetic Australian Cattle Dog

[Riliey and Mo]

Re: Diabetic Australian Cattle Dog

i.d stick to feeding twice a day. feed the 32 lb amount for hills wd. wd works good with vetinsulin.

yes the graph shows a bowl curve, too much food. the blood shows it. a change in food will raise bg also.

check the amount of food feed tonight please

the hills is working better than the freshpet. shes 50 points lower than yesterday @ 12 noon.

were making progress, i dont see signs of insulin resistance. hold off on cushings meds. we.ll know more in a few days sticking adamently to this schedule. doing a curve in 3 days

raise the insulin one unit tonight to 9.


rotate the injection site

test at fasting
test 1/2 hour later, 30 minutes instead of 40 minutes
test before you go to bed

test in am
fasting, half hour later, 2 hourmark and at 6 hours

[Zoology1603]

Re: Diabetic Australian Cattle Dog

I was hoping she would eat some dry food tonight. I've only got a few more canned foods and don't know when I'll be going to town and don't want to be without in the morning. She may not eat it but I did want to try. The Holistic is 199 grams for 30lbs, split in half would be 99 grams for the night. I do have a scale and will let you know how many grams she eats if she chooses to eat that. The Hills was 156 grams this morning. The Freshpet was 280 grams for the whole day. But I will give her another Hills a/d if you want me to. I have 2 left.

As for the Hill's Prescription Diet w/d Digestive/Weight/Glucose Management All Life Stage Dog Food, I'm not sure how much of that I can afford but I'll look into it; very expensive stuff.
I looked into the Freestyle strips but they are higher priced than the AlphaTrak oem's.

rotate the injection site

I've been rotating which side I give it to her on each time but I am still doing it behind the shoulders.

yes the graph shows a bowl curve, too much food. the blood shows it.

So, she isn't eating between noon and 6pm but her glucose still goes up (from 373 at 12 to 541 at 2 yesterday). The insulin isn't lasting very long I guess and the food is still having an effect even that far out?

[Riliey and Mo]

Re: Diabetic Australian Cattle Dog

whats her bg now please?

places like kijiji might have the freestyle strips. there is other cheaper pet meters and strip but not as accurate

200 grams a day okay inject 9 units right after food
might as well change food now

if she wont eat this dry feed the wet right away okay we dont want to wait to give insulin.

after this food change, no more changes till after the curve okay

you.ll need to test more often especially before food, 30 minutes after food, at the 2 and 6 hour.

do you have the syrup on hand?

[Zoology1603]

Re: Diabetic Australian Cattle Dog

whats her bg now please?

350 @ 2:44pm

after this food change, no more changes till after the curve okay

Yes, I am hoping she will eat it because if I keep up the hills and freshpet, I'll be out before we can do the curve and I know she won't eat the dry in the mornings.

do you have the syrup on hand?

Yes