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-   -   New member looking for advice (http://k9diabetes.com/forum/showthread.php?t=8201)

sibhus 04-03-2021 09:05 PM

Re: New member looking for advice
Given you have high liver values, I would try to get your dog the right amount of insulin sooner than later too help mitigate the formation of cataracts. You can up the insulin every few days by a few units.

Also assuming your injecting your dog correctly if the numbers dont come down with insulin increases, over the next month or so, you should follow up with a vet and have a biochem blood test just to rule out any other concurrent diseases and make sure the liver values stabilize or get better with regulation.

My dog had elevated alp and cholesterol at the onset of diabetes and have now found im dealing with a Cushing and diabetic dog which requires much more insulin than the average diabetic dog.

Bellandanny 04-26-2021 03:12 PM

Re: New member looking for advice
Just an update, and again thanks for all the replies!

Unfortunately things aren't going great but Bella is hanging in there. We have been upping the insulin 1 unit per week and she's now at 13 units of Vetsulin.

She had some smaller cataracts already, but last week in the span of 2 days they got bigger and she pretty much went blind, then her right eye became inflamed and clearly painful. We went to the vet and she prescribed Prednisone Mild .12% eye drops and Atropine. After a couple days Bella is at least opening that eye again, and seems to have very slight vision - she will somewhat follow me waving a toy around, but hardly. She was referred to an ophthalmologist, but won't be able to get in there for another couple weeks. Of note - out vet doesn't have the ability to test for glaucoma, so that is a concern of mine, and I'm not sure if it can wait 2 weeks.

While we were at the vet for that, we did another full bloodwork and Fructosamine test. Since the bloodwork 2 months ago, she has become anemic, her kidney levels have risen, and her blood glucose is the same. The Fructosamine level was 685, indicating poor blood glucose control.

So, the next step is to do an ACTH test for Cushings.

Let me know if anyone has any advice in regards to any of this. Keeping hope alive for something to work out somehow. And thanks again so much!

Riliey and Mo 04-26-2021 03:38 PM

Re: New member looking for advice

Can you post the recent curve done ?

38 lbs

Bellandanny 04-26-2021 03:58 PM

Re: New member looking for advice
Sure! Here it is, from last week:

08:00am: 599
10:00am: High
12:00pm: High
02:00pm: 546
03:00pm: 490
04:00pm: 453
05:00pm: 449
06:00pm: 499

jesse girl 04-26-2021 05:03 PM

Re: New member looking for advice
Yes you are seeing resistance to insulin and it could be as simple as not enough insulin and as long as you started with a normal starting dose and raised the dose conservatively in response to the higher numbers maybe once a week than that maybe the reason .Other things can cause resistance like some medical conditions

Riliey and Mo 04-26-2021 05:06 PM

Re: New member looking for advice
Maybe you coulld phone around for an ophthamologist?

You.ll probably know more after the cushings test and her eye healing.
Both will raise blood sugar and i would not raise the insulin anymore. Changng to novolin nph insulin could be considered.

Please post any updates.

Symogi? Testing after a meal before giving insulin and waiting till bg is over 200.

Consider home testing if your not already ...doing a nighttime curve?

Bellandanny 04-26-2021 08:40 PM

Re: New member looking for advice
Agreed, will wait to see how her eye recovers and what the Cushings test shows.

We have been testing blood glucose at home, and at this point I feel confident raising the dosage quicker than the vet has suggested. I do wish I'd listened to the suggestions here to be less conservative early on.

If the Cushings test is positive, it sounds like she'll be put on Trilostane. I'll give an update on how that all goes.

Also, there is also a potentially safer and simpler treatment for Cushingss, using Melatonin and Lignans, which seems to have some promise: https://www.amazon.com/gp/product/B0...84158FP9&psc=1

As for her blindness, a chat with the ophthalmologist brought up cataract surgery. I don't think we'll consider that unless there's a turnaround in her overall health, but I would be curious to hear if anyone has had that done with their diabetic pup.

Thanks again everyone!

jesse girl 04-26-2021 09:30 PM

Re: New member looking for advice
You may want to talk to our sister site k9 cushings just to make sure your going in the correct direction on that subject . Sometimes vets go to that with higher numbers as a reason with blood work than can be skewed by unregulated diabetes . you just want to make sure your on the right page .

I agree I would not worry about cataract surgery until things look a bit clearer

Bellandanny 04-30-2021 01:20 PM

Re: New member looking for advice
Just an update re: cushings. Bella tested negative with the ACTH test. I'm still suspicious of it though, since her bloodwork looks like cushings, and the test can give false negatives. There is an "atypical" cushings also that there's no good test for; the recommendation for that is a simple and safe supplement of lignans and melatonin, so I figure I'll start her on that since it can't hurt.

Otherwise, she's currently up to 14 units of Vetsulin twice a day, and weighing in at 35 lbs. Her vet says if she gets up to 16 units and is still over 300 blood glucose, she is then considered insulin resistant, and that could mean any number of things at his point. The vet suggested an ultrasound and a visit to the ophthalmologist, with the caveat that returns may be diminishing at this point. Since shes almost 12, now blind, and has declined quite a bit and been through a lot recently, I'm thinking it may be time to focus on comfort and good spirits and not continue with further medical intervention beyond what we're doing now.

I'll report back with her next blood glucose curve tomorrow, we've gone from 11 units to 14 in the past 2 weeks so I'm hoping to see some improvement there.

On the upside, she's eating great, and adjusting to being blind.

Thanks again everyone!

Bellandanny 05-02-2021 09:03 PM

Re: New member looking for advice
Here's Bella's latest blood glucose curve, at 14 units Vetsulin (up from 11 units 2 weeks ago, the curve for which posted here five posts back):

08:00am: 445 (before meal)
10:00am: 576
12:00pm: 477
02:00pm: 371
04:00pm: 442
06:00pm: 432
08:00pm: 411 (before meal)

So, showing improvement finally? She's definitely drinking less water now around mealtime, and drinking about the same or a little less an hour or so after eating.

We'll go up to 16 units from here. She weighs 16kg, so I gather this is getting close to the indicator level of insulin resistance, of 2.2 units/kg? However I'm unsure if that 2.2 units means for the whole day, or per dose?

Has anyone here had to go much over 1.1 units/kg per dose twice daily?

Either way, increasing the insulin seems to be the only trick left. The cushings test was negative (tho it sounds like it can be iffy), seemingly no infection (per blood work and urinalysis), pancreatitis is unlikely (never any vomiting, diarrhea) - so we're kinda at a loss as to what could be going on, besides the diabetes and insulin resistance for some unknown reason.

Thanks again, and if anyone has further input or advice, please let us know!

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