New member looking for advice

[Bellandanny]

Hi there, I'm Danny, and my dog Bella was recently diagnosed and we're looking for some advice.

-Bella is 11.5 years old
-Cattle dog mix
-38 lbs

-Took her to the vet a little over a month ago; she was drinking a lot more than usual, started being very lethargic, and I noticed some cataracts forming in her eyes
-She was diagnosed with diabetes, based on blood glucose of 450, and +++ glucose in urine. Also in her blood work her ALT, ASP and ALP were slightly high, her cholesterol was moderately high, and her lipase was very high.
-She was started on Vetsulin 4 units twice a day. After one week her blood glucose curve was 550 at 8:00am to 400 at 3:00pm to 550 at 8pm. That same week she had numbers as low as 378 in the afternoon when I did spot checks.
-A week later at 6 units she was over 600 (monitor just says Hi over 600) all day
-A week after that at 8 units she went from 595 to 550 to 558
-A week after that at 9 units she went from over 600 to 478 to over 600

So as you can see, numbers wise it's kinda confusing, as it doesn't see to indicate progress after a month. (Using Healthy Tracks Test Buddy, and it checks out good with control test)

However, besides that she does seem to be doing better overall. Some rear end neuropathy has cleared up, she has more energy, her body composition looks better, and she has a good appetite. She is however still drinking a lot, especially 1.5 hours after meals when she'll drink about 500ml at once.

It has been a challenge finding a diet she'll eat all at once, but for the most part she's had some variation of chicken dry food mixed with chicken wet. Currently mixing Ketona Chicken dry food with Crave Turkey pate wet. 8am and 8pm.

The only other data point to mention is that in the first week after diagnosis she was showing trace ketones, and ++ to +++ glucose in her urinalysis, and now she's at no ketones and + to ++ glucose.

Does this all seem to amount to a normal case of diabetes on the right track towards regulation? Is increasing dosage in 1 unit increments from here and testing after a week a good plan? Should we consider any other potential issues?

Thanks so so much! -Bella and Danny

[jesse girl]

Re: New member looking for advice

Hi and welcome

The priority is to make sure your doing complete curves before adjusting the dose . My Jesse had Numbers similar to your dog except she had a steep drop for a short period in the day . She went from 500 to 80 and back up to 500 in a few hours . If we did not test at that time we would have just considered high and kept raising the dose but it was quite the opposite and the dose was to much .

Its positive the physical symptoms have subsided and showing Insulin is having an affect even when glucose is still high .

Its a patient game doing a curve every week and adjusting the dose based on the lowest number in a complete curve .

Food is speculative on what works and doesnt work . Most consider having lower fat is important and carbs are necessary to work with the strength of insulin

Seems like you are off to a good start testing at home and weekly dose adjustments . With the minimal numbers posted you maybe seeing some resistance to insulin . We cant be sure what is causing the resistance which could be as simple as not enough insulin or on the other spectrum to much passing the dose that was needed

Just be sure to do complete curves before making any adjustments to the dose and letting that adjustment settle for a week .

[Bellandanny]

Re: New member looking for advice

Thanks! We have been doing full curves actually, here's what they've looked like:

08:00am: 437 (after meal, before Vetsulin 4units)
10:00am: 551
12:00pm: 455
02:00pm: 438
03:00pm: 406
04:00pm: 435
06:00pm: 465
08:00pm: 447 (after meal, before Vetsulin 4units)
10:00pm: 543

08:00am: 488 (after meal, before Vetsulin 6units)
10:00am: High
12:00pm: High
02:00pm: High
03:00pm: High
04:00pm: High
06:00pm: High
08:00pm: High (after meal, before Vetsulin 6units)

08:00am: High (after meal, before Vetsulin 8units)
10:00am: High
12:00pm: High
02:00pm: 595
03:00pm: 550
04:00pm: 557
06:00pm: High

08:00am: High (after meal, before Vetsulin 9units)
10:00am: High
12:00pm: High
02:00pm: 575
03:00pm: 507
04:00pm: 478
06:00pm: High

I'm glad you think that improvement in physical symptoms is a good sign, as the blood glucose readings are confusing. I had considered that possibly we overshot the insulin needs, but there haven't been any really low readings at any time. My uneducated guess is that perhaps that first week on 4 units with the lowest readings, she was adjusting to her new diet and possibly not getting as many calories, and certainly not as many carbs as compared to her old diet?

I have looked into other possibilities that could factor into insulin resistance - infection, pancreatitis, cushings, etc., but she really doesn't have any symptoms beyond the polyuria/polydypsia and lethargy (which has improved in recent weeks, but she's still much slower than a few months ago). Her vet suggested an ultrasound could be useful for more info, so we'll probably do that if her numbers don't start coming down soon.

Thanks again, this is an awesome community!

[jesse girl]

Re: New member looking for advice

I think a normal starting dose is about 7.5 units so your still in the back end of dosing . Now some dogs like my jesse receives a dose smaller than a normal starting dose so nothing is a guarantee as each dog kind of follows its own path

Medical conditions can cause resistance as you sugested but from what you have said it doesn't sound like that so It may just take more insulin for it to crack

Its a foreign substance to the body so it takes time to adjust

[Bellandanny]

Re: New member looking for advice

Thanks again. Yes, that's the hope that the increased insulin starts bringing her numbers down. While she does seem to be doing better physically, it's concerning when we get the High readings (over 600) which most things I've read say is an emergency situation and to rush her to the vet. I can tell she's somewhat uncomfortable for an hour or two after meals - she mostly just wants to sleep, her breathing is shallow, and at times will wake up panting.

For now we'll continue on the current path as her vet has advised, it seems to make the most sense.

Another question, I noticed a lot of dogs here are on different types of insulin. Should I consider switching from Vetsulin to something else, especially if she continues to not make much progress on it?

[jesse girl]

Re: New member looking for advice

My jesse started on vetsulin 11 years ago as that was the primary insulin for dogs at that time . It was taken off the market around that time so we switched her to NPH

Now she was not on vetsulin very long so I can't give my opinion on that insulin and I am still not exactly sure why it was removed from the market and what justified it coming back but it has become more widely used by vets in recent years

Nph became the primary insulin for dogs after vetsulin was not available and during that time it had a good proven track record with K9 diabetes . My jesse has been on it for 11 years. Now from what I have seen both insulins have good success and the action as far as it affects blood sugar is similar and the dose is actually about the same but you do use more liquid with vetsulin and a larger volume syringe and why dosing in terms of units is usually about the same .

So then what would be the advantage of NPH over vetsulin ? First usually you dont need a prescription and you can purchase from walmart for about $ 25 . You can also buy the syringes at walmart for about $ 12 for a 100 without a prescription . The syringes for Nph have more choice on size and increment of units including half unit markings which gives a more exact adjustments and not just one unit adjustments that is usually found with vetsulin . Some dogs need smaller incremental adjustments as going to much may cause some resistance and sensitivity to injected insulin.

Now if you are getting good regulation on a specific insulin it maybe good just to stick with it but if your dog is not regulated and early in the process with little relief a change may be an opportunity to make but it could set back the regulation process depending how long you are into the process but usually the dose amount like I said is about the same but its always a good idea to start with a bit less to begin with . That amount depends on you

The other factor that vets are not thrilled with since you dont need a prescription in most cases you dont really need a vet as the process is not complicated once you are home testing . My jesse has not has a vet involvement with her diabetes for almost 11 years . My thought is a vet could not provide the time that I could . Little scary at the beginning but eventually I became jesses foremost expert on her diabetes . I believe no one has a better understanding because I am in it everyday

[MisterAlan]

Re: New member looking for advice

My dog was at the same point as yours at 7 units a day but he was 90lbs and the readings were always 500-HIGH for about a month. Now as frustrating as it was for a month and increasing it a unit a week not seeing movements for it to go down to the 100s i started seeing it lower by the 50-70s when i got to around 10 units. I finally got him to 13 units at some decent numbers : 9AM-120Bgs / 2PM - 80Bgs / 9PM - 120Bgs. Since i work and wasn't able to check on him during the day i thought 80 was cutting it too close to low BGS so i took some advice from Jesse to lower the dosage so i moved it to 12 units and the curve went to 115-95 surprisingly, but yeah i had to increase his units to 12 for the initial month and a half this was from May till Dec. Now during December last year he went Low Bgs and had me running for food and corn syrup haha. At this point i lowered his weight from 90 to 70lbs his ideal weight for a few months now so i think his weight lose reduced the amount of insulin he needed. During that entire month i was dropping his units by 1.5 unit a week and every time i checked him before his meals he was at 70-80s Bgs no matter how low i went it stays there till this day through out the 12 hour period for 4 months now. So i figured his pancreas got some use back so i left his insulin at 4.5 units right now and the numbers are still 70-80s surprisingly, odds are i wont decrease his insulin so his pancreas doesn't overwork itself. But yeah you seem to be doing good just requires patience the most which is very hard in the initial months because looking at those numbers causes so much anxiety. The physical symptom i look for the most if his BGs are going high is an increase in water drinking and urinating. As for his eyes, his cataracts formed during those high times but after regulating him we stopped the formation in its tracks. Good luck to you, you're doing great!

[Bellandanny]

Re: New member looking for advice

Thanks for all the info and support! Sounds like sticking with our current plan and Vetsulin is the way for now. And it helps to hear the patience angle.

As added confirmation that the insulin is working despite the high bg numbers, last night I made my first mistake with the insulin injections - stuck the needle into the skin tent, and back out the other side, leaving a wet spot on her fur. Don't think any went in, but I didn't give her any more as I couldn't be sure. She drank at least double the water she has been and had to go out a couple more times than usual, and clearly didn't feel great in the morning, with no interest in the food she has been loving for the past couple weeks. Managed to get her to eat enough chicken breast, and once she got her shot she started doing much better.

As for cataracts, she does have what the vet called immature cataracts. I noticed there's some eye drops on Amazon called LuminPro which contain Lanesterol, and claim to reduce or slow cataract formation. Do you know if anyone has tried these, and had any luck?

[jesse girl]

Re: New member looking for advice

There is nothing that is proven to help with cataracts except for better blood sugar . If it does no harm it can't hurt to try . I dont really do the tenting method as prescribed . I just grab the skin with my thumb and index finger . Pull up and give the shot in a downward directory . We have all had a shot coming out the other side . You made a good choice not giving more insulin .

It is possible the sugar your reading may not be as high as what you see on the meter . From what I have seen with higher numbers the meter read higher than what it actually was . I remember I compared with the vets analyzer(most exact way to read blood sugar ) many moons ago that jesse read about 500 on her meter but the lab came back at around 350 and that would make more sense from the lack of high blood sugar symptoms you are seeing .So blood sugar still maybe high but not that high

Now when you get to lower levels that seems to change a bit . Some actually say the hand held meters read lower . As you can see its not an exact science but it gives you an idea on how to move forward .Years ago physical symptoms were the only way to gage blood sugar levels . Using the 2 ,symptoms an testing sugar in conjunction with each other is helpful

[Riliey and Mo]

Re: New member looking for advice

hi Dan and Bella

looks like Bella was started on a low dose of insulin.

also finding the right amount of a quality food is equally important. same food every 12 hours

injecting mid back above the leg .

double check when you get a high. use the dog meter for curves.

if bg is under 200 after food wait till its over 200 to inject.

consider changing to novolin nph insulin. you will need different syringes and you need to drop back 1 unit.

i think the main problem is the food isnt meeting up with the insulin.

[sibhus]

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]

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]

Re: New member looking for advice

Hi

Can you post the recent curve done ?
Thanks

38 lbs

[Bellandanny]

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]

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