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Elderly long-term diabetic having weird episodes
Hi there. I am hoping for some advice for my 14-year-old lab/kelpie, Juicy, who has been diabetic for six years now. She is everything to me.
Shortly after she was diagnosed, I posted about her on this forum. I can't log in via my old user name now , but here's a link to that old thread if anyone would like to see it.
Just briefly before going into her history, our current problem is that she is having episodes where she seems very confused, disoriented, wobbly. It has been difficult to link these episodes to a specific trigger, but each episode seems to follow her blood sugar spiking very high (above 30) without clear cause. This has been going on for about four weeks. We have been back and forth to the vet - she has a very caring vet team, but still not sure what's going on.
The first episode - I came home to find she'd urinated twice in the house, which is not like her. Her BG was above 34 - too high for the meter to read. She had eaten breakfast well that morning and seemed herself. That night, she seemed groggy and did not attempt to eat dinner. I noticed she was limping a lot on her right shoulder - she has bad arthritis, so wondered if the pain was discouraging her from eating. I gave her 100mg of Neurontin, which had been prescribed on an as-needed basis. Normally, she sleeps for a bit after Neurontin, then wakes more comfortable - and also usually very hungry. On this occasion, I could not properly rouse her for several hours. When she did get up, she was so unsteady and groggy that I had to carry her back to bed so she wouldn't fall and hurt herself. She slept right through the night without moving, despite not going out for her evening toilet break.
Since then, she still hasn't been herself. The episodes have not been as severe, but they have continued. Her vet suggested she may have had a stroke, and I have to admit that was my first thought too. She hasn't had any imaging because she seems too frail to cope with any kind of sedation. She has had episodes of confusion before, but never as severe and the last significant one was linked to a UTI.
She has had 2 x urine tests for UTI, a FBC, and full kidney/liver/pancreatic profile, and a test for EPI. Apparently there was nothing dramatic in any of the results, just progressive changes in line with her age and previous results. She did test positive for pancreatitis, however, she has tested positive for pancreatitis in every blood test for the past three or four years, regardless of her symptoms, so difficult to know if this is accurate. Fructosamine was also fine, which surprised both me and the vet.
I've noticed that her blood is very difficult to draw into the test strip each time she is having one of these episodes - sometimes it seems too thick, other times, like just now, it seems very watery and thin. It also seems very dark when this happens.
She is not eating well and has lost about 1kg that she couldn't afford to lose - she is currently down to 16.4kg. To give an idea, she was a good 27kg at diagnosis six years ago. She has been around 20-22kg for the past couple of years. Over the past 12 months, she had crept down to 17.5k. Even allowing for aged-related muscle loss, she is now very thin and I am very worried about her.
Her diabetes has been fairly unpredictable in recent years, but since these episodes started, she's constantly bouncing from too high to too low. I've noticed that as soon as her BG starts to come down into a good range - say, below 8 - she becomes extremely sluggish, groggy, and unsteady when walking, as if she were having a hypo.
We seem to have two modes at the moment - hungry and eating a lot, which results in massive blood sugar spikes, or lethargic and not eating, where I'm struggling to keep her away from a hypo. It's been very difficult to judge insulin safely. Whenever I am able to get her to eat a decent amount, her blood sugar spikes, despite her insulin - she'll drop down to 5, say, for a brief time and then climb right back up to 30. Additional insulin drops the lowest point but does not stop the climb.
I know that Juicy is a senior dog, and has been diabetic for a long time. She's had more than her fair share of health issues over the years, and of course, has been steadily declining as she ages. She has a long history of being an inconsistent meal eater, which is probably why she's been such an unpredictable diabetic. She has also had previous periods of anorexia, which have eventually resolved through persistence, but no definite cause has ever been attached, despite extensive testing each time. Each time she has one of these periods of anorexia, however, she loses weight, and she's just got nothing left now.
She's lost her vision due to cataracts and retinopathy. She acquired Horner's syndrome about three years ago, which causes her eyes to be very sunken in her face, and also has chronic dry eyes. The combination of the Horner's and the dry eyes means she is very prone to eye infections. We follow a very careful eye care regime to try to prevent these as much as possible.
I've noticed since this started that she's been having a lot of facial twitching. This is not new - I believe the Horner's syndrome is due to facial nerve dysfunction - but seems much more marked. She''ll often drop food out of her mouth a couple of times before she goes to eat it- again, not new, but seems to be happening more.
She takes daily 500mg paracetamol, 20mg Cerenia (1/8 160mg Cerenia tablet), 2 x Antinol Rapid capsule, 50mg Carprieve. Her normal insulin dose is 20 units AM/PM. Until recently, she was also taking 4 x Rosehip powder capsules per day for arthritis. I am currently cooking a turkey sort of mix with a little bit of low-carb potato for her, which she is generally eating. Prior to this episode, she was eating a variety of low-fat wet foods served with tuna AM/poached chicken PM. Her diet is obviously far from ideal, but the goal has just become to get anything edible into her that won't harm her.
She has always been a very anxious dog. In the last 18 months, she has lost both of her lifetime companions - one very recently, however, I have to say that this problem did not start at that time.
Thank you very much if you have read this far. If you have any advice, or have been through something similar, or anything at all, I'd be very grateful.
Shortly after she was diagnosed, I posted about her on this forum. I can't log in via my old user name now , but here's a link to that old thread if anyone would like to see it.
Just briefly before going into her history, our current problem is that she is having episodes where she seems very confused, disoriented, wobbly. It has been difficult to link these episodes to a specific trigger, but each episode seems to follow her blood sugar spiking very high (above 30) without clear cause. This has been going on for about four weeks. We have been back and forth to the vet - she has a very caring vet team, but still not sure what's going on.
The first episode - I came home to find she'd urinated twice in the house, which is not like her. Her BG was above 34 - too high for the meter to read. She had eaten breakfast well that morning and seemed herself. That night, she seemed groggy and did not attempt to eat dinner. I noticed she was limping a lot on her right shoulder - she has bad arthritis, so wondered if the pain was discouraging her from eating. I gave her 100mg of Neurontin, which had been prescribed on an as-needed basis. Normally, she sleeps for a bit after Neurontin, then wakes more comfortable - and also usually very hungry. On this occasion, I could not properly rouse her for several hours. When she did get up, she was so unsteady and groggy that I had to carry her back to bed so she wouldn't fall and hurt herself. She slept right through the night without moving, despite not going out for her evening toilet break.
Since then, she still hasn't been herself. The episodes have not been as severe, but they have continued. Her vet suggested she may have had a stroke, and I have to admit that was my first thought too. She hasn't had any imaging because she seems too frail to cope with any kind of sedation. She has had episodes of confusion before, but never as severe and the last significant one was linked to a UTI.
She has had 2 x urine tests for UTI, a FBC, and full kidney/liver/pancreatic profile, and a test for EPI. Apparently there was nothing dramatic in any of the results, just progressive changes in line with her age and previous results. She did test positive for pancreatitis, however, she has tested positive for pancreatitis in every blood test for the past three or four years, regardless of her symptoms, so difficult to know if this is accurate. Fructosamine was also fine, which surprised both me and the vet.
I've noticed that her blood is very difficult to draw into the test strip each time she is having one of these episodes - sometimes it seems too thick, other times, like just now, it seems very watery and thin. It also seems very dark when this happens.
She is not eating well and has lost about 1kg that she couldn't afford to lose - she is currently down to 16.4kg. To give an idea, she was a good 27kg at diagnosis six years ago. She has been around 20-22kg for the past couple of years. Over the past 12 months, she had crept down to 17.5k. Even allowing for aged-related muscle loss, she is now very thin and I am very worried about her.
Her diabetes has been fairly unpredictable in recent years, but since these episodes started, she's constantly bouncing from too high to too low. I've noticed that as soon as her BG starts to come down into a good range - say, below 8 - she becomes extremely sluggish, groggy, and unsteady when walking, as if she were having a hypo.
We seem to have two modes at the moment - hungry and eating a lot, which results in massive blood sugar spikes, or lethargic and not eating, where I'm struggling to keep her away from a hypo. It's been very difficult to judge insulin safely. Whenever I am able to get her to eat a decent amount, her blood sugar spikes, despite her insulin - she'll drop down to 5, say, for a brief time and then climb right back up to 30. Additional insulin drops the lowest point but does not stop the climb.
I know that Juicy is a senior dog, and has been diabetic for a long time. She's had more than her fair share of health issues over the years, and of course, has been steadily declining as she ages. She has a long history of being an inconsistent meal eater, which is probably why she's been such an unpredictable diabetic. She has also had previous periods of anorexia, which have eventually resolved through persistence, but no definite cause has ever been attached, despite extensive testing each time. Each time she has one of these periods of anorexia, however, she loses weight, and she's just got nothing left now.
She's lost her vision due to cataracts and retinopathy. She acquired Horner's syndrome about three years ago, which causes her eyes to be very sunken in her face, and also has chronic dry eyes. The combination of the Horner's and the dry eyes means she is very prone to eye infections. We follow a very careful eye care regime to try to prevent these as much as possible.
I've noticed since this started that she's been having a lot of facial twitching. This is not new - I believe the Horner's syndrome is due to facial nerve dysfunction - but seems much more marked. She''ll often drop food out of her mouth a couple of times before she goes to eat it- again, not new, but seems to be happening more.
She takes daily 500mg paracetamol, 20mg Cerenia (1/8 160mg Cerenia tablet), 2 x Antinol Rapid capsule, 50mg Carprieve. Her normal insulin dose is 20 units AM/PM. Until recently, she was also taking 4 x Rosehip powder capsules per day for arthritis. I am currently cooking a turkey sort of mix with a little bit of low-carb potato for her, which she is generally eating. Prior to this episode, she was eating a variety of low-fat wet foods served with tuna AM/poached chicken PM. Her diet is obviously far from ideal, but the goal has just become to get anything edible into her that won't harm her.
She has always been a very anxious dog. In the last 18 months, she has lost both of her lifetime companions - one very recently, however, I have to say that this problem did not start at that time.
Thank you very much if you have read this far. If you have any advice, or have been through something similar, or anything at all, I'd be very grateful.
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