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For people who are new to canine diabetes, it's important to read Joan's story of Bella's road to regulation all the way to the end and to know that a dog would not be started on this kind of plan when first diagnosed. You start with the basic standard regimen of two shots and meals a day and see how that works. When it doesn't work well for a dog, though, Bella's story demonstrates what can be accomplished with a flexible schedule and home blood glucose testing! 
Natalie
Natalie
Bella
We had 2 pugs, Faith and Samson for nearly 6 yrs, before our rescuing experience began. One day at the vets office, we were informed the SPCA had brought in a pug that had been thrown out of a car, and left for dead by the highway. He had fleas, worms, urine scalds…….and a broken back. I went to the SPCA to arrange adoption, and was told he was un-adoptable. A heated discussion ensued on the meaning of that word, and the end result was that a few days later we returned home with a third pug, and that was how it all began. We named him Solomon, and though we were told his days would be measured in weeks or possibly months, we will be celebrating his 5th birthday with us in a few months.
Shortly thereafter we sold our business, and “retired” to seriously look after the pugs we began to acquire. We only take the ones that have run out of options, and were specializing in handicapped pugs as we had some experience in this area by then. Two more handicapped pugs were added in short order, one more that was considered unadoptable, and then online one day I ran into a blind pug that had been left at rescue, and no-one wanted. What was one more at that point? Not much work involved, a 10 yr old pug, blindness was the only problem right? Seven is a lucky number! And so the saga of Bella began.
June 11/08 I drove 6 hrs to pick her up, and after 6 hrs in the car with her coming back, I was in love. She was the most determined, independent little pug I had ever come across, and that is saying something. She had been with the same owner (and I use that term lightly) since being a puppy, but when she went blind, he dumped her at the nearest rescue.
Integrating her into the household of 6 other pugs went pretty smoothly. When I took her in to the vet clinic for her check up 2 wks later, she passed with flying colors, but while we were there someone brought in a pug for euthanasia, that had been hit by a car. Fate? You guessed it, broken back, leg and jaw. We named her Sarah, and she is like the gift that keeps on giving. Now we were 8.
Back to our little blind girl. We had named her Bella, as she was so beautiful to us. In mid September/08 her eating was getting sporadic, and after blood tests revealed elevated liver enzymes, we had an ultrasound and biopsy which confirmed a diagnosis of chronic active hepatitis , CAH. With a few meds, she rallied a few days later and seemed very healthy till early Jan/09
She stopped eating once again, and after more blood work, found she had blood glucose levels of just over 400, and ketoacidosis. Her liver enzymes are now 300 times the upper parameter. She was put on IV fluids, and I brought her home, pump and all. I had nursing training earlier in life so the IV was no biggie, and really the diabetes diagnosis did not phase me that much. The liver problems were my main concern. She never exhibited the excessive drinking/peeing symptoms that most diabetic dogs show. Really I was sure that it was the liver again.
After several days on IV fluids, we had to go to Spokane to pick up our next rescue who was flown in from Florida. It had already been arranged before Bella fell ill. So I unhooked her for the 5 hrs the round trip would take, and took her with us. Now we are 9!
So the vet gave me the protocol after the IV of giving 5 units Caninsulin twice daily and feed w/d. She sold me urine strips, and said to check for glucose/ketones every pee. On the way home, I checked the ingredients of the w/d, and nearly threw it out the window. I had home cooked for the herd for a long time, and would continue to do so. For 2 days the routine seemed to go well. Bella ate her meals, and I gave the 5 units b.i.d. Did I mention she weighs 16 lbs? I tested her urine every outing, and on the third day, it showed negative. I phoned the vet and asked what insulin dose I should give, and she said to continue with the 5 units. Sat down and thought about that for a bit, and went downtown and bought a glucometer. Checked her fasting bg a few hrs later and she was 100. Called the vet and she still said to give the 5 units (I didn’t), but she would like me to come in the next day and show her how a glucometer worked. Now I am not a nervous person, but this is starting to get to me. I did go in and give her, and the “techs”, a demonstration…….
Now we really started the fun. I realized my vet was not up to speed and to compound that problem, I live in a very small town with no choices, plus Bellas eating is now so erratic that I just have no way to turn. I called my vet one more time to ask how I could possibly get all her meds into her, if she absolutely would not eat. Her answer, “most people don’t want to spend their last days with their pet shoving meds down their throat”!!! I replied that I didn’t think these were her last days. So talk about feeling alone! I found a canine liver forum online, and tried to get some help there. Meanwhile Bellas bgs are up and down like a yo-yo. She has no curve, it is a series of peaks which would put Mt Everest to shame. After more than 3 days with no food, I posted on the liver site that I was scared I did not have enough time left with Bella to learn what I needed to save her life. If you knew me, you would realize how hard that was for me. I never ask for help, I have always been the helper! Anyway by a true miracle, a very kind knowledgeable lady started helping me one on one, and for me that was perfect.
For nearly 6 wks she emailed daily with info on interaction between food and insulin, and gave me moral support when it was so desperately needed. Bella was laying by me one morning looked mildly interested in the whole wheat pancakes we were having, so I gave her some knowing at this point any food was better than the direction we were headed. She ate it!! And that was the beginning of my infamous pancakes. After a few days I added cod to the pancakes, and then oatmeal, then eggs, then green beans etc till she was actually eating a good balanced diet, and from that point on, she has never missed a meal in over a year. During this period I learned to adjust her insulin, not only from dose to dose, but in between as well. When you have to feed what a dog will eat, as opposed to what they should eat, the insulin dose began as a hit and miss situation. With tons of testing, 1000s of strips I never let her get above 400, and she never dropped below 70. But it was a struggle.
By mid Feb we took her down to an internist at WSU. No-one there could believe her liver enzymes, they were so high that most dogs would not be alive. He told me to take her off all the meds, give 5 units daily Caninsulin and feed w/d. Heard that somewhere before! The ultrasound he did showed some abnormality with the liver, but not enough to warrant a biopsy, and this seemed better than the one we had 6 months previously. So to me the extreme liver readings seemed more a side effect of the diabetes… they were worse, her liver looked better, and the only change was the diabetes. Flawed thinking? Maybe!
On the caninsulin, Bella could not be kept with in reasonable levels. The added problem is trying to compromise a good diabetic diet along with 2 meals 12 hrs apart, and the liver diet with multiple small meals, and trying to control the ammonia levels which perpetuate the liver troubles. If Bella was 300 at fasting, 1 unit of caninsulin could sometimes drop her to 100 within the hour. Waiting for a rise from her food and then giving insulin seemed to make it worse. She really seemed to do the exact opposite of what you would expect. I was scared to sleep as I would miss testing and knowing and/or anticipating what she needed next.
Six weeks in, I changed her to Humulin N. Luckily here,in Canada I did not need a prescription, and I did not let my vet know till weeks later. Now we at least could track what she was doing. The huge and sudden drops and spikes levelled out somewhat. For the first time I got a few hrs sleep at a time. But right about the time I thought maybe we had it figured out, or at least we were on the right track, she began to produce insulin on her own. My vet disagreed, but I knew differently. When your dog is eating well, not losing weight (thru this entire year, Bella stayed at 16-17 lbs), and is acting normally, and I did not need to give insulin for more than 3 days at a time….there is no other explanation. This continued for nearly another 4 months. Some days she needed 1 Unit, somedays 3, somedays none. One thing this teaches you is to be reactive. Through much trial and error, multiple shots per day we got through it. I never felt safe at this point to give her more than 1-2 units at a time, as somedays she needed 5 units bid and other days absolutely no insulin.
Finally by July/09 Bella seemed to be finished the honeymooning. She consistently needed insulin at every meal, and what a relief that was. The next problem I ran into was duration. Did not matter what I fed, how much I fed, or how much insulin I gave, she would skyrocket up the last 3-4 hours. After reading up on the dawn effect, I discounted this on her, as it happened on every fasting. Now keeping in mind her liver issues warranted multiple feedings, and the insulin did not seem to last with or with out carbs, so I came up with what is now her permanent regime. Lots of research went into this, realizing that I was going against any and all advice available for canine diabetics, I began to give 4 meals and 4 insulin shots per day. The Humulin does give me the dreaded overlap, but that very overlap has become our best friend. Without getting back into faster acting insulins, which never suited Bella, I can keep her within 100 points all day. Every day! And she gets her 4 meals per day, eats everything in front of her, and if she gets a treat with the other dogs at times (she loves popcorn) occasionally, it is not enough to throw her off kilter now.
I did not come to this easily or quickly. I have been known to do 24 hr curves every hour for a week at a time. I did not lightly add insulin doses, knowing I am not a vet, not a medical professional, but using common sense, extreme caution, and extreme testing, we have pulled it off. Her schedule now along with her range of bgs is:
6am 200-220 5 ounces food 4 units Humulin N
9am 180-200 2 ounces food 1 unit
12pm 120-140
3pm 140-160
6pm 200-220 5 ounces food 4 units
10pm 180-200 2 ounces food 1 unit
Some of the timing is to accommodate the fact that I have 8 other dogs, and they get fed at 9am and 6pm. Everyone gets a treat at bedtime, and Bella gets her 4th meal. She is thriving on this. My new vet who is an excellent surgeon and clinician, though she is 150 miles away, calls for an update on Bella if she doesn’t hear from me regularly on any of my herd. Her liver enzymes are still through the roof, but the only meds she is on are samE and metronidazole (flagyl). The really funny thing is that as I got her “curve” flatter and flatter so I could move the whole thing down to a lower level, I found she did not want to be any lower. Any lower than 120, or too fast a drop, and she will begin whining. If you do not get the message that she is in need of more food immediately, she will begin to howl like a mini-wolf. As if that is not enough she can get all other 8 pugs doing the same. So now I leave her at these levels, and the whole household is happier.
With all these special needs pugs, one thing I deal with on a daily basis is quality of life. Bella has a great life!! She is happy, healthy, her coat is shiny, and she loves life. Anyone seeing her come in from her morning walk, seeing her whirl and rear and bark for her breakfast would never guess she was a 12 year old blind diabetic with liver disease.
Every once in a while we get a reminder of how fragile she is. In November /09 she was scheduled for dental surgery. She was given the pre-op med while still in my arms, and within minutes her heart stopped. Both surgeons and 2 techs worked furiously on her, and me still clinging to her. She revived, and for a while I thought we had cured her diabetes. She ate 4 hrs later (no surgery of course, and never will have any), and never needed insulin for more than 2 days. But that’s my Bella.
What will be next? We don’t know, we take it one day at a time here. But today all 9 pugs are happy, and snoring beside me. What more could you ask for?
Joan
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