Marianne's Pebbles - In Hospital TA&M 10/20 [Archive] - Diabetes in Dogs: The k9diabetes.com Forum

k9diabetes

03-23-2008, 01:14 PM

I am not sure about control solution for the AlphaTrak since it is adjusted for dogs. I don't know if they make an adjusted control solution.

Do you have the meter coded for dogs? Just want to make sure as AlphaTrak has one code for cats and one for dogs.

What I don't like about the AlphaTrak and all of the animal-adjusted meters is that they do not read the glucose level more accurately. They rely on an artificial adjustment that is based on an average of some number of tests in a group of dogs, I forget how many they used... and then they take an average of the difference in the meter's readings and the lab analyzer values from those tests and they "adjust" the meter to raise the reading to the average amount difference.

So say you have the following group of dogs tested on the meter that will become the AlphaTrak and on a lab analyzer:

Dog 1 - Meter 85 - Lab - 85 - difference = meter 0 low
Dog 2 - Meter 100 - Lab 130 - difference = meter 30 low
Dog 3 - Meter 115 - Lab 165 - difference = meter 50 low
Dog 4 - Meter 120 - Lab 190 - difference = meter 70 low

The average difference is 37.5 so they would adjust readings in that range on the meter to be 38 points higher. Not so bad for Dog 2 but not so great for Dogs 1 and 4 especially.

The adjustment has no bearing on actual blood sugar.

In addition, they tested very few diabetic dogs so most of their tests were done mostly on normal blood sugar ranges with only a few dogs giving BGs in higher ranges.

Let me see if their test data is still available... it is: http://www.abbottanimalhealth.com/docs/ALPHA-033_Valid_Study.pdf

Of the 239 dogs they tested, only 53 were diabetic.

Also, if you take a look at their own chart, all those red dots high above the mean line are AlphaTrak readings that were higher than lab values.

http://www.randomfierce.com/canines/alphatrakdogsm.jpg

This all came from http://www.abbottanimalhealth.com/vetProfessionals/products/DiabetesMonitoring/index.shtml. Click on Download Clinical Trial to get the study date.

That said, I've found the AlphaTrak to be pretty consistent for Chris. I ran a long comparison, which showed that AlphaTrak was pretty consistently 30-40 points higher than my OneTouch Ultra, which is the same as the numerous OneTouch Ultra to Lab Analyzer comparisons I've done.

http://www.k9diabetes.com/metercompare.jpg

Long story short, I still prefer, no matter what meter you use, that you have some comparisons done of the meter versus a lab analyzer as that is really the only way to know how far off your meter might be, even if it's an AlphaTrak.

I have noted, also, that it seems like Freestyle works better with small dogs. I'm not sure why that is but I've seen it be very close to right on with some small dogs. It did not work as well for us. Was off by more like 60 points as I recall.

As far as cost, if your vet will sell you the strips at cost, that's probably the cheapest. There are other sites where they can be purchased.

Medi-Vet... I think this is where I bought them.
http://www.medi-vet.com/SearchResult.aspx?KeyWords=alphatrak

The price was better than the one offered by my vet... wasn't impressed with her wanting to take a huge cut on that cost.

Hope that helps!

Natalie

rhodesian46

03-23-2008, 02:40 PM

Natalie,
I know that they have a control solution I checked and I am coded for dogs(7)
I just don't understand the large point difference even when she was 117 Bg on freestyle she was 196 dog meter, Could the strips be bad? Maybe the meter got thrown around by UPS in route? If Pebbles was in fact 446 an hour after she ate on dog meter than I would of noticed a big increase in water intake. Do you advise me not using this meter until I get some control solution? I hate to waste the strips I was thinking if Texas A & M can get me her dogfood cheaper they probably can get me the strips and solution cheaper as well Will call tomorrow for sure.Her Bgs are higher than normal today even using the freestyle. I took her off the Cephalexin as it is not helping her bacteria skin infection ( on Fri eve)I wonder if stopping the Cephalexin that that could of made her Bgs go up? She has been on that for 5 weeks or more.I guess I am having a hard time (if the dog meter is correct) accepting that her Bgs are really that high if correct.I wish we knew of someone who has a freestyle freedom and a dog meter Her third eyelid has not retracted back yet She has only been on med for 2 days Does it take time?

k9diabetes

03-23-2008, 04:42 PM

I really can't say what may be causing the difference - Yes, the test strips and/or the meter could be bad. It could also be that the AlphaTrak adjustment is not appropriate for Pebbles.

If your Freestyle is reading her BG pretty accurately, then the adjustment made in the AlphaTrak could be artificially raising the readings.

If you have urine test strips, you could test the urine and see which reading it confirms. That works best when the blood sugar is down in lower numbers, so if the AlphaTrak said 250 and the Freestyle said 160, the urine test could confirm which was correct based on whether there was glucose in the urine. Positive for glucose would confirm the AlphaTrak and negative would confirm the Freestyle.

I don't know what Pebbles is like. Chris' drinking doesn't increase noticeably until his blood sugar is well over 400, closer to 500. That's why we could never use pure observation to monitor his regulation. Pebbles may be the same but I can't recall if this has been sorted out since you need to be doing testing and noting the BG when the increased drinking occurs.

See what you can confirm with urine strips and then the best thing to do is to take both meters to the local vet and have him/her run a blood sample and test both of them against the lab analyzer. If you're lucky, they have an in-house analyzer and could test just her glucose right there on the premises rather than having to send it out.

Last time I did this I tested Chris with my meter myself just before the blood draw and just after. Then they ran the sample they drew in-house. My two tests both came within 35 points of their test.

If the eye isn't better by Monday or Tuesday, I do think the ophthalmologist is indicated. I've just seen too many conditions that have gone undiagnosed by general vets. There are other possibilities for the eyelid being up besides infection and the ophth. can test her eye pressures and see if they are low, suggesting the possibility of noninfectious inflammation.

It does seem like antibiotics can affect blood glucose. I can't give you any objective information on that; it's just something I've observed in Chris.

Refresh my memory on the skin infection - what symptoms does she have?

Natalie

I just don't understand the large point difference even when she was 117 Bg on freestyle she was 196 dog meter, Could the strips be bad? Maybe the meter got thrown around by UPS in route? If Pebbles was in fact 446 an hour after she ate on dog meter than I would of noticed a big increase in water intake. Do you advise me not using this meter until I get some control solution? I hate to waste the strips I was thinking if Texas A & M can get me her dogfood cheaper they probably can get me the strips and solution cheaper as well Will call tomorrow for sure.Her Bgs are higher than normal today even using the freestyle. I took her off the Cephalexin as it is not helping her bacteria skin infection ( on Fri eve)I wonder if stopping the Cephalexin that that could of made her Bgs go up? She has been on that for 5 weeks or more.I guess I am having a hard time (if the dog meter is correct) accepting that her Bgs are really that high if correct.I wish we knew of someone who has a freestyle freedom and a dog meter Her third eyelid has not retracted back yet She has only been on med for 2 days Does it take time?

rhodesian46

03-23-2008, 06:01 PM

here is her curve for today Not as good as last week.
5:30 AM-fasting 234 Freestyle 350 Alphatrak-fed,gave meds-new bottle of insulin
6:30 Am- 330 freestyle 446 alphatrak then walked 15 mns gave 2 baby milk bones
8:30 AM-239 Freestyle new bottle of strips
10:30 AM- 272 freestyle
12:30 PM- 266 freestyle
2:30 PM-201 freestyle
4:30 PM- 199 freestyle 280 alphatrak 100mg/dl(diastix)
So here is a prime example of the urine strips reading really low but Alphatrac said 280.
Pebbles skin infection is that I can pull her hair off her like skinning an animal The baldness has a yellow crust around the diameter Dr Stone looked at it in Dec and said it was a bacterial skin infection She doesn't have a lot of bald patches but what she has they haven't gotten any better Her eye is not bothering her a bit. I am hoping it can wait till I go to the appointment on 4/16 If the eye pressure is low what could it be? I mean what could a noninfectious inflammation be?

k9diabetes

03-23-2008, 08:29 PM

I don't know what all might cause eye inflammation.

Mature cataracts is one source. Pretty much any time a diabetic has fully developed cataracts they will have inflammation - the lens breaking down generates it. Chris is given daily eye drops (diclofenac or Voltaren) to control that, which has worked well for him. He must use them for the rest of his life.

From Veterinary Partner.com (http://www.veterinarypartner.com/Content.plx?P=A&C=&A=1945&SourceID= (http://www.veterinarypartner.com/Content.plx?P=A&C=&A=1945&SourceID))

When a cataract is ?hypermature,? it is starting to actually liquefy and dissolve. While this can actually lead to the restoration of vision which sounds like a positive turn of events but the dissolution process is quite inflammatory.

Uveitis is inflammation of the uveal tract of the eye, which consists of the vascular tissues of the eye. In simpler terms, uveitis is the inflammation that results when the hypermature cataract begins to liquefy.

Did the vet do a tear test where they put a little strip of filter paper between the eyeball and the lid to check the amount of tears she can produce?

Dry eye is pretty common in diabetics and usually easy enough to manage with a lubricating ointment.

As for the skin infection, did they scrape and culture it to see what kind of bacteria it is and whether it is susceptible to cephalexin?

I would think, if it is in limited patches, that they would perhaps have you apply an ointment directly to the patches.

How big are the bald areas?

Kiska'smom

03-24-2008, 08:50 PM

Hi Marianne,

I'm so glad that Pebbles is doing better! With everything else that you do, eye-drops should be a snap!

Jeanne and Kiska

eyelostit

03-25-2008, 12:07 AM

Always good to hear good news!!!, I know you are happy!!

ladysmom06

03-25-2008, 11:43 AM

Hi Marianne,

Just checking to see how Pebbles eye is doing. Hoping everything is going well. Hugs to you and the gang.

rhodesian46

03-25-2008, 04:00 PM

Hi everybody,
Couldn't get on this site last night! Pebbles eye has not gotten any better. She does care that it looks the way it does. I think the other eye is starting to do the same but not as bad. Her IMS Dr Stone e mailed me today and said that he would check her eye out in April So I think he doesn't feel that it is a dire emergency But I have been a lttle ditsy Remember when I told ya'll thatthe Alphatrak was way off WELL I called the tech at Alphatrak today We used the control solution meter and strips were fine. BUT I WAS GETTING THE BLOOD INCORRECTLY!!! WITH A HUMAN METER I HOLD IT TO THE SIDE With the dog meter you are supposed to let the blood go on the side of the strip. yes it did give me incorrect results. Tonight at fasting she was 137 freestyle 187 Alphatrak Will compare this Sun for her curve. Meanwhile I sent the curve to Dr stone He replied that they may do a curve in April since the differences in meter were so great. I e mailed him just now an said I feel real stupid. I was doing it wrong! NatALIE THE VET LAST WEEK DIDN'T DO A TEAR TEST ON PEBBLES! Just a yellow dye in her eye.The bacteria skin infection is about quarter sizes. Dr Stone said today thatI should take her off the Cephalexin he will do a skin culture in April. he doesn't want me to increase insulin as he says that we may see a reduction. So she is at 49 u BID now.
Marianne and Pebbles

k9diabetes

03-25-2008, 04:15 PM

One thing I dislike about the AlphaTrak is the channel that takes up the blood not being visible.

And one thing I always liked about the OneTouch Ultra is the entire channel you fill with blood is visible and the meter errors out rather than gives a bad reading if it's not filled properly. If there's even a tiny bit too little blood, it gives an error reading.

...

I just realized... 137 and 187!!! Those are great readings!!!!!!!

Natalie

Ricksma

03-25-2008, 05:54 PM

Yay Marianne....don't feel bad about not doing it right...that is my one complaint about the Alpha Trak....the strips don't have the capillary action, and won't "sip" the blood onto the strip. It is a little difficult to get the blood in just the right spot, so you aren't the only one who has ever had this trouble. Just glad you got it worked out....
TERRIFIC NUMBERS!!!!!:D

Love and hugs, Teresa and Ricky

We Hope

03-25-2008, 05:58 PM

Marianne,

Not sure if this is helpful or not, but here's a link to AlphaTrak's quick users' guide. They have illustrations of how the sample should be applied to the strip.

http://www.abbottanimalhealth.com/docs/ALPHA_Trak_Quick_User's_Guide.pdf

Can tell you that when first using an Accu-Chek Advantage for my mother, I promptly "killed off" all of the 10 strips included with the meter on the first test. :) That also--if you don't get enough blood on it, you get an error reading and you get one also if there's too much.

BTW--Abbott does sell control solution for this meter--here's their Animal Health Product Catalog--

http://www.aahcatalog.com/catalog_files/AAH-255_R2_2007_September_Catalog.pdf

Meters and supplies are on Sec 1:3 (5 of 26)

rhodesian46

03-25-2008, 08:00 PM

Actually there is a site that Alphatrak does a video on how to use their producthttp://www.alphatrakmeter.com/images/products/AlphaTRAK_Video_Imagemap.gif The tech had me go online Thanks for the info though. Any place where I could get the strips less than $59?
Marianne and pebbles

k9diabetes

03-25-2008, 09:23 PM

http://www.alphatrakmeter.com/vetprofessionals/seminars/videos/AlphaTRAK/index.shtml

rhodesian46

04-01-2008, 06:13 PM

]

Here is Pebbles Bg for the week She is currently on 49 units BID. The left numbers are the alphatrak THe right the freestyle
Mon 3/24
ALPHATRAK FREESTYLE
5:30 AM- 235 123 neg
4:30 Pm- 125
Tues 3/25
5:30 AM- 138
4:30 PM- 187 137 50 pt difference
Wed 3/26
5:30 AM- 264 169 95 pt diff
Thurs 3/27
5:30 AM- 184
12:00PM- 220
2:30 PM- 241 164 77 pt diff
4:30 PM- 211 145 66 pt diff
Fri 3/28
5:30 AM 245
2:30 PM- 238
4:30 PM- 252 176 76 pt diff
Sat 3/29
5:30 AM- 304
2:30 PM- 245
4:30 PM- 291 249 51 pt diff
Sun 3/30
5:30 AM- 494 353 141 pt diff
6:30 AM- HI 464
8:30 AM- 471 344 124 pt diff
10:30 AM- HI 383
12:30 PM- 390 267 123 pt diff
2:30 PM- 355 266 89 pt diff
4:30 PM- 354 243 101 pt diff
Mon 3/31
5:30 AM- 487 347 140 pt diff
12:30 PM 312
2:30 PM 246
4:30 PM-
Sat eve I injected Pebs in the scruff She yelped I pulled needle out and injected again in different part of scruff AM sure that I didn't lose any insulin Maybe I injected into a muscle? Thats why Bgs are high? Her bacteria skin infection is worse She is getting so thin in the hips and her tail is getting more rat tailed Today she was 220 on Freestyle meter at fastings. THen my day went to heck!!!!!!!!!!Husband is in the flippin dog house! He failed to put 40 lb weights on the cat litter box cover ANd guess who had litter out of her nostrils and on her flippin chin!! If you haven't guessed IT IS PEBBLES! High Bgs now. Then the day doesn't end from here I have been injecting her for 8 months now I have forgotten 2 x to give her insulin and never had this happen!!! I PUT THE NEEDLE IN AND WONDERED WHY SOMETHING WAS DRIPPING ON THE TILE. IT WAS HER FRIGGIN INSULIN!I had 40 units left so to be on the safe side in gave her 4 more units Now she will be high in bgs for a couple of days. I just want to go start the day all over. If my foot could reach i'd kick my butt!!!!! Maybe something else is going on with her BGS They were perfect 2 weeks ago.Can't wait for her IMS appointment. E mailed Dr Stone as to whether or not to increase 1 unit I think I will increase tomorrow What do do you think?She is no longer on Cephalexin as it wasn't working. Have to wait till 4/16 That is her appointment with the IMS Dr Stone. Question if she had any infection such as a UTI (never had one before) Would her Bgs stay elevated or would you see variations?

Brandy mom

04-01-2008, 07:17 PM

Marianne

Don't kick yourself. That would hurt.:p

You know Pebble just can't help it. She loves cat poop.:eek:

The number in the week don't look to bad. I would be on the moon. Singing and dancing. They just got higher over the week. It could be the cushing. I glad she go for a check-up. Might just need the med adjusted.

I was looking at the picture you sent me awhile back of Pebble skin infection. Is it worse? This could cause the higher BG too. Heck if I know. Brandy had a skin infection too. I had a culture done for the right antiabotics. Brandy skin infection was cause by too high of thyroid medication. But with Pebble cushing this could be causing it too. He body has gone through a lot of changes in the last few months. I know I know I want it now.:)

Dawn and the girls

k9diabetes

04-01-2008, 09:50 PM

Marianne,

You are so hard on yourself!! No self-abuse now - I won't have it! :)

As for Pebbles... well, I'm sure she looked quite lovely in her cat litter goatee. Chris is more of a dirt surfer and comes in with mud on his old man chin!

I wouldn't worry about that one day of high numbers. The scruff can build up scar tissue that makes it slow to absorb insulin or perhaps it was injected into the skin itself rather than subq... I think intramuscular actually works faster than subq.... (not sure).

Or she's just having one of those days. As long as it's a blip, no big deal.

Everything you've been saying about Pebble's skin and bony hips and rat tails sounds like Cushings... I apologize that I haven't kept up well on her Cushings treatment. Is it possible that the Cushings is what's currently not well controlled? Interesting too what Dawn said about the thyroid medication. Both tend to cause skin problems. I hope all will get sorted out on the 16th.

Could be the antibiotics didn't help because it's not an infection. That was the case with Chris' eyelid ulcerations. Antibiotics improved them by getting rid of the secondary bacterial infection but were not getting at the cause.

What did work for Chris' eyelids was immune-suppression ointment - tacrolimus. Just a tiny bit and things cleared up immediately. We had tried benedryl to treat allergies, antibiotics, and steroid ointment to no avail. Finally all that was left to try was tacrolimus and that did the trick.

With an ongoing infection, I think you would see constantly higher BG. I'd let the cat litter clear her system and see where she's at. After all those days of good numbers, I wouldn't get too worried about one day of higher ones. Look for trends more than one day at a time.

My guess is that it's a hormone problem of some kind... thyroid, cortisol... something along those lines.

Natalie and dirt-surfer Chris

E mailed Dr Stone as to whether or not to increase 1 unit. I think I will increase tomorrow. What do do you think? She is no longer on Cephalexin as it wasn't working. Have to wait till 4/16 That is her appointment with the IMS Dr Stone. Question if she had any infection such as a UTI (never had one before) Would her Bgs stay elevated or would you see variations?

rhodesian46

04-02-2008, 05:32 PM

Dr Stone replied back He says
"I wouldn't hesitate to add a little fiber to her diet, as long as she
drinks adequately. I am concerned that her skin may be causing some of
the insulin resistance we are now seeing. I wouldn't adjust her insulin
dose until she is rechecked here - we may need to check a serum
fructosamine level to see what her true level of control has been over
the last month. As previously mentioned, we will likely investigate her
other causes of insulin resistance at the same time (recheck ACTH stim,
etc.). If the stool is still bad and getting worse (loose, blood
visualized, etc) that will definitely require further investigation
(physical exam, fecal, etc.). You can have the fecal done earlier if
you can - I have no problem with that, or even just empirically
deworming her to be safe."
I am going to wait to do the fecal as it is the same No major blood I think she is strining Whatabout giving her Miralax as fiber? Her eye hasn't gotten worse/ Why do a fructosamine test when I know whather BGs are It is mazing to me thatthe Alphatrac is much higher than the freestyle So in fact she was always in the 200-300 range when the human meter read 130. Her stim test post was good in Feb Doesn't mean that things could change

k9diabetes

04-02-2008, 06:29 PM

Hey Marianne,

Do you have a timeline in your head or in your records for when the skin problem started and what changes, if any occurred at the same time? Including new or discontinued medications, dosages of existing medications, diet changes?

Chris went through a jag of panting like a fiend last year and I could NOT figure out what was causing it. Then he had an irritated bowel and I took him off of every nonessential supplement and medication. When I started adding them back in, the panting started as soon as I added his DermCap back in. Which was weird because he had taken DermCaps for years without a problem to control his allergies. But a few days of testing showed very quickly that it was in fact the DermCap oil that was the cause. Every time I took it out of his meal, the panting stopped and as soon as I put it back in it started up again.

Same thing with Clavamox. The vet at the time chided me for thinking it was the antibiotic that made him throw up because he didn't throw up right after taking it. He threw up about 5 hours later. Like clockwork. Same test. On antibiotic... threw up. No antibiotic... no throwing up.

Sometimes detective work is the only way to figure it out.

Allergies and endocrine and autoimmune disorders all tend to affect the skin so it's hard to know what's going on. The dermatologist Chris saw felt the only way to know for certain the cause of his eyelid ulcerations was to biopsy them. But that required anesthesia and a big chunk of tissue removed and an e-collar. So he also understood why we didn't want to do it. We tried one treatment at a time. First antibiotics, then steroid ointment... no go. So we tried the autoimmune problem treatment - tacrolimus - and that's the one that worked. Hence our diagnosis was resolved! :)

Inflammation of any kind can raise blood sugar so regardless of the cause the skin problem could be upping her need for insulin. Chris' arthritis made his BG harder to control and more erratic. Putting him on an NSAID helped his blood sugar plus his bad back. And seasonal allergies will raise blood sugar too.

Did you put her on a bland diet? I can't remember.

Natalie

rhodesian46

04-02-2008, 07:22 PM

Natalie the skin infection occurred first in Nov 07 She was on Soloxine for a couple of months prior and Dx with DM in Aug 07 No other meds were given She has always been on the same food as well It must be something with her immune system being haywired, Cephalexin never worked to correct this,So the saga goes on!! All of this Bgs,rat tailed,etc are making me think thtmayybe her post stim results have gotten higher.I guess I will have to wait 2 weeks.

Kiska'smom

04-03-2008, 09:08 AM

Hi Marianne,

I sure can relate to your concerns about Pebbles. Kiska looks just the way you describe your beautiful girl. Kiska'a tail has an almost bare spot about mid-way, and most of the rest is very sparse with little fur on top. Her hips are so bony, and she's very thin. We are up to 34 U per injection, and her BG numbers are still in the 400's with a One Touch Ultra2 meter. Good Lord, I hope that her actual numbers aren't even higher! Kiss has been on Cephalexin for weeks. First for the elbow infection, and then for a UTI. I read somewhere that Cephalexin can interfere with insulin. I'll have to look back in my information journal and see if I can find that for you (and for me). How long has Pebbles been off of that antibiotic? Maybe other antibiotics also react badly with insulin too. Don't you just hate all of the trial and error? I know how frustrating it is. Just know that we understand what you are dealing with, and are here to support you. (Then for a few of us, add the Cushing's or Atypical Cushing's diagnosis, and the stress level rockets out of sight. Boy, do I know!) I think that you are doing a wonderful job with Pebbles. Those cat pan incidents happen to me, too! I don't see the attraction! Ha! Anyway, it is just one of those things that you try to control, and sometimes it doesn't work. Kiska got into the cat's food and pan and her BG shot up past 600!!!! That was scary. Not to mention, I didn't want any kisses from her for a while! Hang in there. I'll check back on you soon.

Hugs,

Jeanne and Kiska

rhodesian46

04-03-2008, 10:49 AM

Hi Jeanne,
Your meter is probably lower than what Kiskas Bg really is That is why I posted the freestyle meter and the Alphatrak. I will use the dog meter when I am suspicious of really high Bgs The strips are a$1 a piece!!!!.Pebbles will be weighed by the same scale that weighed her in Dec.I think she has lost weight as her spine shows right through her skin and her hips compared to her sis Husky is so tiny She is all skeleton head When she was on Cephalexin her Bgs were good No set pattern though( By the way you can get Ceph at Walmart for $4) Her tail has lost all of her hair since DX with Cushings in Dec 07. I am supposed to take her off her High blood pressure 3 days prior to her appointment to see if she needs those meds any more. I can't wait to see Dr Stone as I really want some answers And yes I am saving for this expensive visit!! I would rather travel 1 1/2 hours to A & M then having a vet here look at her They also have a 24 hr emergency hospital Hopfully I get good news and at least an explanation as to why she is insulin resistanr She is on 49 u BID That is a lot of insulin Don't forget I have been dealing with DM since Aug It has been a really hard road for me Stress and worry. You know!!!

ladysmom06

04-03-2008, 11:09 AM

Hi Marianne,

Your doing a really awesome job with Pebbles. I know how frustrating all this is for you. Remember I told you Lady kept losing weight even after we had the diabetes under control. I was convinced she was going to just keep losing weight. It wasn't until this past winter that she finally gained some weight. Her tail was also a mess. She hardly any fur left on it but after a few months on the trilo it started growing back - not a lot at first - it was really hard to see it but I had shaved her on the tail in February to hometest her and I could see a little fuzz starting there - today it looks like she has more fur all over than she ever had:). I'm hoping Dr. Stone will have some answers for you. Hang in there - things will get better. Hugs to you and Pebbles.

rhodesian46

04-03-2008, 12:03 PM

Thanks Lynne Hope today is a nooo stress day Will not test Pebbles till tomorrow We need to take a break me and her!!!!!Can't wait for my appointment with Dr Stone Can't wait to spend all that money I saved!( Ha)

Dollydog

04-03-2008, 12:56 PM

Hi Marianne,
At our house we just kept going one day at a time and hanging in there, and things did get better. And re--spending all that money--someone on the diabetes or cushings board posted that that was what Visa cards were for!!
Hope you have a stress-free day and weekend, take care,
Jo-Ann & Lady :)

rhodesian46

04-03-2008, 01:22 PM

Thanks Jo-Ann,
I ripped my cards up it's cash!!! Thats hard to do Pebbles is my million dollar old lady!!!!

Kiska'smom

04-03-2008, 03:30 PM

Hi Marianne,

I just had to write back and let you know that it isn't Cephalexin that interferes with insulin. In fact, it messes up the ketodiastix glucose reading. Sorry about that. I had a migraine headache coming on, and shouldn't have tried to think or give advice. Since you already knew that Pebbles' BG's were good while on the antibiotic, I guess you already knew better . I'm glad. I'll be careful not to do that again!!! I feel like an idiot! So sorry!

Wow, I didn't know that Cephalexin was a $4 prescription at Walmart!!! Really? I have been paying the vet between $35 and $60 for Kiska's pills. Ouch!! I'll have to request a prescription next time! Thank you for that information! Any penny saved is wonderful. Our bank account just keeps going lower and lower. I know what you mean about our "million dollar" ladies. It wouldn't be so bad, if better results were being seen. Hope that Pebbles' next doctor visit gives you some good news.

Jeanne and Kiska

rhodesian46

04-03-2008, 03:46 PM

Hi Jeanne,
it the $4.00 prescription that walmart advertises You get 30 pills for $4.00 Now Pebbles took 500 mg 3 x a day so it cost me like $12. Why give the vet a chance to make a profit!!I have to search for ways to cut back I have 6 dogs,2 cats and a bird. They get real expensive when they become geriactric 2 of my dogs are 2 yrs and less. The rest are between 8-10 yrs old.

We Hope

04-03-2008, 05:38 PM

Not sure if this will help or not. We did this page because there are a lot of drugs which both people and pets use--the human forms of the drugs often carry advisories for those who have diabetes. Many of the same drugs given to pets say nothing about any possible conflicts with diabetes.

http://petdiabetes.wikia.com/wiki/Medication_warnings

Kiska'smom

04-03-2008, 10:41 PM

Hi Johanna and We Hope!

I will definitely be getting my next Cephalexin prescription at WalMart! My last 14-day supply (56 pills, 500 mg) cost $48. For 60 at WalMart, that would have cost $8. That's quite a savings!

We Hope, I thought the link that you provided was fantastic. I've printed it out to use as a reference! Thank you! It's a little scary to think that there are no warnings on some pet medications regarding conflicts with diabetes. There is so much to learn. Thank goodness for you and this site. I'm learning everyday!

Jeanne and Kiska

We Hope

04-04-2008, 12:04 AM

Hi Jeanne!

I think the list started out of frustration, initially. We'd had people posting on the other board for quite a while that their dogs' bg's went up substantially after being given their heartworm med; some reported the same thing if they used flea and tick products.

I took Lucky in for a blood test the day after he'd taken his monthly heartworm pill. He was off the charts with his bg's--the only time since getting him regulated. He'd taken the pill within 24 hours of the blood test. We looked back on all of his previous tests and none of them had been taken that close to when the heartworm pill was given.

Brought him back within 2-3 days after to have another test and he was getting back to normal--2-3 days after that, he was at normal.

We caught it "in the act" and in checking all of the package inserts and online information for every brand of heartworm med on the market, we found that none of them carried a warning that this could happen if it was given to a diabetic animal.

We made the personal decision to stop giving the heartworm medication--Lucky was more at risk from the 500+ bg's every month the pill was given than for heartworm.

All diabetic dogs taking heartworm meds don't have this, and the decision to continue or discontinue the pills has to be made individually--based on which situation seems riskier for that particular dog.

Just never forgot going over all the literature for all heartworm medications and found none contained a word about this possibility. When we did the page, comparisons between what a human prescription for the medication advises re: diabetes against the information and literature given for the veterinary forms of them were done. Not a lot has been done about getting this information included in the veterinary literature for the same drugs, unfortunately--so all we have is "the list".

Kiska'smom

04-04-2008, 08:29 PM

Hi We Hope,

...and a great list it is! Kiska used to be on heartworm medicine, but we haven't even thought about starting it again this Spring because of everything else. I don't think that I'll be risking it at this point.

Hi Marianne!

How are you and Pebbles today? Kiska is holding her own. I didn't get to the vet to weigh her this week. I'm almost scared to do it. If she has lost more weight, I'm going to cry!

Were you able to get Pebbles' eye problem under control?

Hugs,

Jeanne and Kiska

rhodesian46

04-05-2008, 05:12 AM

Pebbles eye is still the same. No change Her skin infection is getting worse. I haven't checked her Bgs for about 3 days as we need a break Will check a fating at 4:30 PM today Sun I will need to do a 12 hour curve for Dr Stone I am keeping Pebbles on heartworm meds as in Texas it gets hot with lots of mosquitos, Can't risk her getting heartworm with her immune being messed up. I am literally counting the days to see Dt Stone at A & M. I have added 1/2 teaspoon of Metamucil to her food(sugar free) to see if in fact she is straining and that is the cause of a little red blood in her stool. Dr Stone instructed me for the amount to use.I hope Kiska hasn't lost any more weight!!!I know how u feel. Pebbles spine is really boney. Have to walk Pebbles soon(her 15 mn trot down the street) She also gets 2 baby milkbones as she walks Good incentive. Keep me updated on Kiska and thanks for checking in on Pebbles!!

Ricksma

04-05-2008, 07:04 AM

Marianne, Just checking in on Pebbles...how is it going? I keep intending to mention that my daughters both live in Austin...and they love it. Let us know how Pebbles' eye is...hope it is better.

Love and hugs, Teresa and Ricky

rhodesian46

04-05-2008, 07:23 AM

Hi Teresa,
Pebbles eye is the same Third eyelid hasn't retracted back.Will have Dr Stone look at it on 4/16 He wasn't alarmed when I sent him pics of it. I took a break from testing pebbles. I get so worried when the bgs rise.Dr Stone says that the bacteria skin infection may be causing the rise in Bgs. I need to write all these issues down as I will be meeting with the student at A & M then Dr Stone, A & M is a teaching school . So it will be tedious to repeat everything from 2 yrs on forward I do need to ask if they are doing a urine specific gravity test on her as the Dr Stone didn't think Pebbles had Diabetes Insipitus
from 2 1./2 years ago He said he thinks that she had Cushings all along If her urine is concentrated then she didn't in fact have this disease. Where do your daughters live in Austin. Wouldn't that be funny if they lived down the Street from me I am (if you know) in S Austin near the intersection of Manchaca Rd and Slaughter Lane Thanks for asking about Pebbles Will do a curve tomorrow

rhodesian46

04-07-2008, 03:54 PM

Mon 4/7
5:30 am-255 fed 2 1/2 c dco gave meds and metamucil and injeted
6:30 am-338 then walked 15 mns gave her the usual 2 tiny biscuits
8:30 am-300
10:30 am-323
12:30 pm 280
2:30 pm-244
4:30 pm 223 then fed 2 1/2 c if dco with metamucil gave meds and injected her at 5 pm
bathed her again in Melesab shampoo this weekend Bacteria skin infection causing havoc Bald spots are the size of a dime. Still real hungry Pu/pd not bad Third eyelid protrusion the same Doesn't seem to bother her. Can't wait for her appointment I really think that her skin infection is causing the bgs to rise And who know she may need more cush medicine.

forscooter

04-07-2008, 06:17 PM

Marianne,
I've not a single clue what to say to be of any help whatsoever! But I am following you and "over there" and wishing things turn around soon for Pebbles!
You know, though, one thing....Scooter has a lot of skin issues and when he was infected, I was using Keto-Chlor shampoo, it's supposed to help with skin infections...I swore it made it worse! It was most likely my overactive imagination, but I started to use Selsun Blue and it seemed to help. Maybe it's just all the bad hair needing to fall out like when the Cushing's finally gets regulated?:confused:
I think you are right about the infection and BG issue relation too!
Wishing you the best....and sending you lots of hugs!!!!
Beth, Scooter and Bailey

Brandy mom

04-07-2008, 06:31 PM

Marianne

It is not that bad of a curve. Don't you remember the 400 and 500. It has been a long time since you have seen those numbers. Unless Pebble eats cat poop.

It could be the skin infection causing the higher BG. I bet the 16th can't come fast enough for you and Pebbles.

Dawn and the girls

Kiska'smom

04-07-2008, 10:07 PM

Hi Marianne,

I'll trade curve numbers with you!!! I'm going to do hand-springs when Kiss is in the 200's!

Hugs,

Jeanne

ladysmom06

04-08-2008, 05:40 AM

Hi Marianne,

Those numbers are a lot better than before you started the trilo. I'm with Dawn and Beth in thinking the skin infection is what is causing those high numbers. I know how anxious you are for the 16th to get here. Hoping Dr. Stone will be able to give you some answers. Hang in there. Hugs to you and the gang.

rhodesian46

04-08-2008, 04:46 PM

Thanks Lynne Hugs to Lady Jeanne keep in mind I have been doing Bgs since beginning of Sept 07!!! It is nerveracking!

Dollydog

04-09-2008, 05:39 PM

Hi,
When we had numbers like that we were happy and they do get better!! So we got even happier!!
I was glad to read about the heartworm discussion...I guess that we'll skip that this year unless I find something that won't affect Lady's bgs. Didn't have to worry about mosquitoes in Northeastern Nevada--didn't get the full explanation from our vet but another friend with a diabetic dog did so didn't worry about it. There are mosquitoes here but she only gets a few bites a year.
By my count you have 7 more sleeps to go before your visit with Dr. Stone!!
Take care,
Jo-Ann & Lady :)

rhodesian46

04-09-2008, 05:51 PM

Hi Jo-Ann,
I can't skip the heartworm meds as we have loads of mosquitos in Texas! Yes 7 more sleeps Then a couple of more waiting for the tests Hope I don't have to wait to the following week Oh Dear More stress!!!!!

k9diabetes

04-09-2008, 09:10 PM

Hey Beth,

If the Keto-Chlor has chlorhexadine in it, it could be making things worse. Chris' skin turns read when using anything with chlorhexadine or neomycin.

I'm anxious for Pebbles' appointment. Hope they will culture a skin scraping and check susceptibility of any bacteria to various antibiotics. Chris' eyelids, when they were inflamed, had a fairly resistant staph infection but it was fortunately susceptible to cephalexin. For ointments, we have used vancomycin and erythromycin but the staph were resistant to erythromycin.

Could be it's not primarily an infection. After trying everything while avoiding a biospy, we finally discovered that his eyelid ulcerations responded to tacrolimus. One little swipe and they go away for weeks.

Natalie

ladysmom06

04-10-2008, 06:09 PM

Hi Marianne,

Lady takes the heartworm meds once a month and it doesn't mess up her bg's. I was really afraid to use it when she was first dx but she has never had any problem with it. Hugs to you and Pebbles.

k9diabetes

04-10-2008, 06:24 PM

Chris takes Sentinel monthly. I sometimes think he gets a little higher blood sugar the day he takes it but not enough even to be sure that's the case.

Chris' cardiologist really wanted him to stay on the heartworm preventive as they are a problem in this area. It's mosquito season most of the year here.

rhodesian46

04-13-2008, 04:15 PM

Sun 4/13 curve
5:30 Am-260 fed 2 1/2 c DCO.gave meds except no Norvasc,injected 49 u
6:30 AM- 354 then walked and gave 2 small biscuits
8:30 Am-273
10:30 AM- 335
12:30 PM-312
2:30 PM-277
4:30 PM-257 1000mg/dl injected 5:00 PM-49 u gave meds no norvasc
Gave Melesab bathe again.skin infection dime size not any better. Sent this to Dr Stone today My appointment with him is this Wed( Pebbles 10th B day) Had me take her off her Norvasc(high blood pressure med 3 days before. he wants to see if she still need this med.Something is wrong that her Bgs are high Can't wait for the appointment If you can think of any more questions to ask him feel free to advise me. Hope and pray that all turns out well for Pebbles

Kiska'smom

04-13-2008, 10:38 PM

Hi Marianne,

Just wanted to say that you and Pebbles are in my thoughts and prayers. I can't think of anything to ask the vet, but happy early birthday to Pebbles! Give her ten love pats for me!

Hugs,

Jeanne and Kiska

Ricksma

04-14-2008, 06:18 AM

Marianne...keeping our fingers crossed here for Pebbles. Maybe they can tell you something this week...gosh, we sure hope so. Sending good thoughts.

Love and hugs, Teresa and Ricky

ladysmom06

04-16-2008, 05:51 AM

Hi Marianne,

HAPPY 10TH BIRTHDAY PEBBLES & JASMINE!!!!!!:D:D:D:D

Just wanted to wish you luck today with your visit with Dr. Stone. We'll be thinking of you guys and hoping that all goes well and you get some answers. Have a safe trip - please let us know when you can how everything went. Hugs to you and the gang.

rhodesian46

04-16-2008, 06:18 PM

Hi everybody,
Just got back from A& M to see Dr Stone All went well. her third eyelid protrusion is called Horners Eye Syndrome. It could occur say if pebbles had a ear infection as it all connects he checked her ears they are fine So you can either do MRI and more testing to determine if their is a growth somewhere deeper in or you leave it alone( he called it idiopathic meaning unexplained cause) it will not get worse yet it will not retract back.Another symptom was her pupil is smaller on that side too. So we will accept the fact that she can't see as well but isn't in any pain Her blood pressure was 195,.200 and 205 in Dec 07 it is now 130. Normal is 120. They do doppler readings 3 of them Pebbles no longer needs Norvasc for the high blood pressure. Yeah saved me $7 a month!he did an electrolyte panel,T4, a direct and fecal flotation. complete CBC,urine culture and routine urinalysis and Stim test. he also did a check in her rectum to see if there were any polyps There weren't any. The fecal came out great. he wants to keep her on the metamucil. Said sometimes if there were a polyop that would cause a line of red blood in her poop I haven't seen much red blood since she was put on Metamucil 2 weeks ago. She has lost 5 more lbs since Dec 07. It is not abnormal for this to happen. The spiney appearance is seen alot in older dogs. he thinks she is a good weight. if she comes back hyperthyroid that of course we will back down on the Soloxine Her stim test may come back that we have to increase the trilo. Won't know any more until all tests come back He thinks that we are at the tweeking stage and it may be that Pebbles is the type of dog that needs 49 u BID of Novolin He cultured the skin infection and showed me that her skin in places are dry and scaley. They felt her lymph nodes and found one on left hand side a little swollen. its the lymph node by her jaw he seems to think that it is a bit swollen because of her teeth needing cleaning. Doesn't want to clean them at this ti me.he was able to palpitate the liver but cannot say for sure if the 3 spots on her liver have grown. if she had liver cancer she would have clinical signs and one would be that she wouldn't be hungry. he can't see doing another ultrasound if there aren't any signs. He seems to think that these spots were there a while Forgot what he called them Gosh darn my brain is in override today.So it is a waiting game now probably will have results in on al ltests Fri or Monday.Walked in the door and my daughter calls me She got a Maltese pup 5 mos ago Just found out that it had giardia and coccidia ( AN intestinal parasite) my dogs have been with her as I babysit my hairy Maltese "Bella" So off to the vet one dog goes as he has had soft stoolls Of course I freaked Called Dr Stone Suggests that I bring Harley for a fecal flotation. or if want we can treat with Panacure and deworm them Pebbles tested OK. What a flippin day I have had Need to kick back and relax!!!

We Hope

04-16-2008, 07:03 PM

http://artfiles.art.com/images/-/Nancy-Overton/Margarita-Print-C10141644.jpeg

Cyber Refreshment :)

rhodesian46

04-16-2008, 07:29 PM

Send it to me

k9diabetes

04-16-2008, 10:26 PM

Hello!

Sounds like it was a very productive and worthwhile visit!

I know of another dog with Horners Syndrome. Margaret's Storm, a labrador, developed it several years ago and he's still going strong well into old age. His eye just looks a bit droopy.

I was talking with Montana's mom - not sure if you have been reading her thread on the Cushings board. Montana's vet seemed to think that 28 units of insulin in a 100 pound dog was a massive dose of insulin!! I was explaining to her that the dose that's freaking out the vet is really just a starting dose for most dogs. Guess Montana's vet needs to meet Pebbles! :)

Will be anxiously awaiting her other test results! Glad to know the eye problem is settled and not a big deal.

Natalie

Just got back from A& M to see Dr Stone All went well. her third eyelid protrusion is called Horners Eye Syndrome. It could occur say if pebbles had a ear infection as it all connects he checked her ears they are fine So you can either do MRI and more testing to determine if their is a growth somewhere deeper in or you leave it alone( he called it idiopathic meaning unexplained cause) it will not get worse yet it will not retract back.Another symptom was her pupil is smaller on that side too. So we will accept the fact that she can't see as well but isn't in any pain Her blood pressure was 195,.200 and 205 in Dec 07 it is now 130. Normal is 120. They do doppler readings 3 of them Pebbles no longer needs Norvasc for the high blood pressure. Yeah saved me $7 a month!he did an electrolyte panel,T4, a direct and fecal flotation. complete CBC,urine culture and routine urinalysis and Stim test. he also did a check in her rectum to see if there were any polyps There weren't any. The fecal came out great. he wants to keep her on the metamucil. Said sometimes if there were a polyop that would cause a line of red blood in her poop I haven't seen much red blood since she was put on Metamucil 2 weeks ago. She has lost 5 more lbs since Dec 07. It is not abnormal for this to happen. The spiney appearance is seen alot in older dogs. he thinks she is a good weight. if she comes back hyperthyroid that of course we will back down on the Soloxine Her stim test may come back that we have to increase the trilo. Won't know any more until all tests come back He thinks that we are at the tweeking stage and it may be that Pebbles is the type of dog that needs 49 u BID of Novolin He cultured the skin infection and showed me that her skin in places are dry and scaley. They felt her lymph nodes and found one on left hand side a little swollen. its the lymph node by her jaw he seems to think that it is a bit swollen because of her teeth needing cleaning. Doesn't want to clean them at this ti me.he was able to palpitate the liver but cannot say for sure if the 3 spots on her liver have grown. if she had liver cancer she would have clinical signs and one would be that she wouldn't be hungry. he can't see doing another ultrasound if there aren't any signs. He seems to think that these spots were there a while Forgot what he called them Gosh darn my brain is in override today.So it is a waiting game now probably will have results in on al ltests Fri or Monday.Walked in the door and my daughter calls me She got a Maltese pup 5 mos ago Just found out that it had giardia and coccidia ( AN intestinal parasite) my dogs have been with her as I babysit my hairy Maltese "Bella" So off to the vet one dog goes as he has had soft stoolls Of course I freaked Called Dr Stone Suggests that I bring Harley for a fecal flotation. or if want we can treat with Panacure and deworm them Pebbles tested OK. What a flippin day I have had Need to kick back and relax!!!

rhodesian46

04-22-2008, 12:34 PM

All results are in except for the skin culture as to what drug to use I guess I will post some of the results She weighed in at 58.2 lbs Has lost 5 lbs since Dec visit Dr Stone says that her body condition is excellent( said 5 out of 9 whatever that means) I thought she was too skinny as she has lost alot of muscle mass her urinalysis is normal No UTI her ALKP ( liver enzyme ) went from 557 in 2/08 to 310 on this test.Now this is where its confusing me They did a fructosamine test Result was 428.2 test interpretation says good disbetic control over the last 3 weeks. I kinda figured that she was high according to me meters. Can someone explain?Pebbles is now on 49 u bid of novolin n, Dr stone typed 51 u. That is incorrect There is no adjustment to her Soloxine(for hypothryoidism) he has taken her off the high blood pressure meds as her pressure is now normal She does have osteroarthritis on the right joint(coxofemoral)her Cushings is controlled!!!Of course I have more questions to ask him Will call him Fri as the skin culture should be back by then. I am going to post the instructions to me from Dr Stone as it may help other people that have worries of their dogs having symptoms etc.Pebbles is on a lot of insulin More than a dog at 58 lbs should be on She is not by the textbook by any means Also didn't know that taking blood pressure on an animal is so important. Was told if high it could damage their body organs So ya'll need to ask your Dr to take their blood This is what my instructions are Please read Hope it helps someone!!!!
Please do not adjust the medications that Pebbles is currently taking until further notice. We will advise you on adjustments to her Insulin and her Trilostane once we have all the results of the diagnostics that we have performed today. We will determine which antibiotic would be most beneficial to treat Pebble's skin infection once we have the culture result.

Because Pebble's blood pressure was normal today, you may discontinue giving the Norvasc that she has been taking.

Many times when patients do not respond adequately to insulin therapy we recommend a change in the type of insulin that we are using. In Pebbles' case it is difficult to commit as to whether or not she would benefit from a change in insulin because of her other concurrent problems (most specifically her skin infection and her Cushing's disease). We do recommend that you consider switching her therapy to Vetsulin in an attempt to decrease the overall amount that she receives each day. We understand that the cost differential between NPH and vetsulin is considerable, but we also feel that Pebble's might greatly benefit from seeing another, different, drug. If we do try this medication, and Pebble's diabetes is controlled, you may end up discontinuing Pebble's weekly glucose curves. If controlled, we would only require curve checks every 3-4 months, or if you notice clinical signs of hypoglycemia (inactivity, seizures) or hyperglycemia (increased urination, increased drinking) at home.

Exercise:
No changes in Pebbles' activity level are required at this time. You know best when Pebbles has reached her limit for activity. Please regulate her as you see fit. If you notice any signs of rapidly progressive pain or weakness associated with any joints in her limbs or back, please call us so that we may perform a full orthopedic examination in order to isolate any problems.

Diet:
No changes in Pebbles' diet are required at this time. Her body condition looks excellent. If you notice that she continues to lose weight or body condition, please let us know so that we can make any adjustments that are necessary with regards to diet or medication.

Call If:
If Pebbles becomes acutely lethargic or weak please call us. If she shows any signs of inappetence, vomiting, or diarrhea, please call us so that we can better assess her status. If you find that her glucose levels are inadequately controlled, please call us to make an appointment so that we may examine her and make any adjustments in her therapy that are necessary.

If you notice advancement of the abnormality associated with Pebble's left eye, please call us so that we can assess the status of her disease. If you notice a head tilt, loss of balance, or seizure activity (a large amount of salivation, urinary and fecal incontinence, loss of muscular control) please call us or bring Pebble's in as soon as possible.

Additional Instructions:

As you know, Pebbles has a complex combination of illnesses that make working out one specific disease both confusing and frustrating. The most difficult complication of her set of diseases is that they all have the potential to exacerbate her diabetes. The fact that 51 units of NPH are required to control her Diabetes indicates to us that these other afflictions are working against us with respect to her therapy. If we can control her hyperadrenocorticism, hypothyroidism, skin infection, and dental disease, we may eventually be able to safely decrease the dose of insulin that she is receiving.

The abnormalities that are associated with Pebbles' left eye are most certainly the result of a dysfunction of the sympathetic innervation of that eye. There are many causes of this dysfunction, and this nerve can be damaged anywhere along its long path from the brain, down the spinal cord to the thoracic vertebrae, and back up to the eye. Because Pebble's ear canal appears relatively normal and healthy today, we believe that the cause of the Horner's disease is more than likely idiopathic. If you notice a progression of the clinical signs, or if you become more concerned with this problem, we will be more than happy to perform a full neurologic work-up, which would more than likely include advanced imaging.

The occasional blood you notice in her stool does not appear to be due to parasites at this time. It is possible that dietary changes or treats can contribute to colitis. However, if she shows any signs of lethargy, diarrhea, or inappetence we would be concerned that the blood in her stool may be related to oversuppression of the adrenal glands. In that scenario, we would have to start prednisone immediately (you have an emergency supply) and stop the trilostane temporarily. Currently her stimulation test is low, but acceptable as long as she doesn't show signs of weakness, intestinal upset, or decreased appetite/ vomiting. Just monitor closely for any such signs and call immediately if they occur. As we discussed, you can empirically deworm her with fenbendazole to cover for any undetectable parasites.

We are still awaiting culture results on Pebble's skin infection. Once we have those results we will prescribe an antibiotic that is appropriate for her specific infection.
Thank you for bringing Pebbles in to see us today, she sure is a sweetheart. It is clear that you care a great deal about her and she is truly lucky to have such a passionate owner as yourself. Please do not hesitate to call or e-mail with any questions or concerns that you may have.

P.S Dr Stone is transferring to Michigan University this July Boy we he be missed by Pebbles and I Hope I get an IMS thatis good with e mails!!!!
*

Marianne and Pebbles PEBBLES- Siberian Husky DOB 4/16/98. DX diabetes 8/07 Also is hypothyroid,high blood pressure and cushings(DX 12/07) Eats 2 1/2 c Purina DCO BID,gets 49 u Novolin N BIDweight 60 lbs

BestBuddy

04-22-2008, 03:06 PM

Hi,
I don't know anything about the fructosamine test as Buddy has never had one. I originally thought the result would be an average of the last few weeks BG but that obviously isn't the case. I would be interested in the result interpretations if anyone has them.
Most of the testing sounds like it is good and has improved and I wonder if there is another insulin (not that I have a problem with Vetsulin) that would be cheaper and worth a try. I am only thinking of the cost for a big dog.
Jenny & Buddy

We Hope

04-22-2008, 03:09 PM

Hi Marianne,

I know you will miss Dr. Stone--he sounds great! (And when the doctor is happy, so is everyone else! :) )

A fructosamine test is sort of like a grade point average--it tells you how you did during that given period of time but not how you were doing day to day.

http://petdiabetes.wikia.com/wiki/Fructosamine_test

http://www.vetsulin.com/vet/Monitoring_Glycated.aspx

This page contains a table of the fructosamine values.

HBP can be a problem for people with diabetes, so it's good to hear that it's getting to be more of a "must check" for our pets.

Pebbles gets an A for her great report, that's for sure!

rhodesian46

04-22-2008, 04:28 PM

There isn't any other insulin besides Vetsulin. pebbles would need 4-6 bottles a month Got the company thatI get my trilo from to ( if I need to) to sell me Vetsulin at $25 a bottle Still expensive It a wait game Hopefully Pebbles will get her Bgs lower They aren't that bad Always flat which is good!:D momma is still nervous about pebbles WIll do a curve this Sun

forscooter

04-22-2008, 07:38 PM

Hi Marianne,

Just had to say YAY!!! So glad Pebbles got a good report from the doctor! And I hope you are both doing something relaxing now!
Beth and the boys

rhodesian46

04-22-2008, 07:47 PM

I never relax. I am always worrying about something. I will start testing Bgs on Pebbles maybe 1 x a week and do curves weekly as Dr Stone wants to see them until Pebbles Bgs are within range. I don't see the point testing her 2-3x a day every day it stresses me and Pebs:(

k9diabetes

04-22-2008, 09:27 PM

When I first read this, I thought she weighed more. Yeah, 50 units of insulin in a 58 pound dog is a lot. Montana (from the Cushings board) weighs 100 pounds and her vet thinks 28 units is a TON of insulin, which tells me that vet isn't real skillful with diabetes.

Still, it is controlling her blood sugar and you would have to give a lot of fluid to give Pebbles 40 units of Vetsulin. So that's something to consider also.

You might have them give the reference ranges for the fructosamine so you can see where exactly she fell on that scale. There are a couple of different tests and the scales are very different.

Last time Chris had one, which has been a while, it was IDEXX:
350-400 Excellent
400-450 Good
450-500 Fair
>500 Poor

Somewhere there's a link that makes an approximate translation of fructosamine to blood sugar levels... will look for it if someone else doesn't post it first. I suspect that they would consider that good for a diabetic as they expect that the blood sugar will run higher than normal. Chris' test results showed a reference range for Normal (nondiabetic) as 260-378.

I appreciate how detailed their instructions are!

Sorry to hear that Dr. Stone is transferring to Michigan - good news for the folks in Michigan! I tend to feel like good facilities create good doctors, that it all kind of succeeds or rots from the top of the administration down. So chances are they will have lots of good docs there.

Natalie

k9diabetes

04-22-2008, 09:49 PM

Here's the one I was thinking of, from SugarCats: http://www.sugarcats.com/infirmary/fructosamine.asp

Based on normal=250-400
Fructosamine -- Average BG
250 -- 120 BG
300 -- 150 BG
325 -- 180 BG
350 -- 210 BG
400 -- 240 BG
450 -- 270 BG
475 -- 300 BG
500 -- 330 BG

I'm not familiar with this site or its accuracy but it sounds like it's in the ballpark and similar to the sugarcats list.

From: http://www.healthyinfo.com/clinical/endo/dm/hga1c.test.shtml

Fructosamine (glycated albumin) measures short term control of blood sugar for the past 1-3 weeks. Each 75 µmol change equals a change of approximately 60 mg/dl blood sugar or 2% HbA1c.
Approximate Comparison of Blood Glucose,

Glucose (mg/dl) -- Fructosamine (µmol)
90 BG -- 212.5
120 BG -- 250
150 BG -- 287.5
180 BG -- 325
210 BG -- 362.5
240 BG -- 400
270 BG -- 437.5
300 BG -- 475
330 BG -- 512.5
360 BG -- 550
390 BG -- 587.5

They show the same numbers!

ladysmom06

04-23-2008, 05:33 AM

Hi Marianne,

The report sounds good. Sorry:( to hear that Dr. Stone is leaving - I know how much you like him. I don't have any advise on the insulin - Lady was on Vetsulin for a short time - it didn't help her with the high bg's but she was on it before she started treatment for the cushing's. Maybe it would of worked once we had the cushing's under control. You said the post was 2.0 on the stim test. That is a really good number:):). Lady's last one at the beginning of March was 2.5. In January it was 1.2 - then she was on 60 mgs of trilo and we reduced it to 30 mgs. The IMS wants her between a 1 and 2 b/c of the diabetes. She hasn't had a fructosamine test since March of 2007. If I remember right she only had about a total of three. I told the vet I didn't want to do anymore once I started home testing. I'm trying to remember when Pebbles started the trilo - I think it was at the end of December - correct me if I'm wrong. If that's when she started then she's been on it for 3 1/2 months so there's still a chance her bg's will come down and you will be able to reduce the insulin. If I'm not mistaken I think it took JoAnn's Lady awhile before her bg's came down after being on trilo. Check with her. Hugs to you and the gang.

rhodesian46

04-23-2008, 10:13 AM

yes you are correct lynne to say Pebs strted trilo Dec 31,2007 to be exact. They put her on 60 mg trilo then 10 days later upped her to 90mg.I hope that Pebbles is the dog that gets a reduction of insulin. It sounds to me that Dr Stone wants to control the skin infection first then possibly switching. I am not switching till I reach 58 units as after that she would be considered insulin resistant I think thats whatI got out of his directions and advice

Kiska'smom

04-24-2008, 08:42 AM

Hi Marianne,

I was just reading through this thread. Poor Pebbles and poor you. I am sure that the high doses of insulin are causing you a great deal of concern; however, your curves look good to me! I know that they are not ideal, but with all of the other factors going on I think that you are doing great!

I'm a worry-wort, too; so I completely understand! Your report from the vet sounded good! Things are improving, so take heart in those little victories!

Hugs,

Jeanne and Kiska

rhodesian46

04-26-2008, 07:14 AM

hi ya'll,
Spoke to Pebbles IMS Dr Stone yesterday. The skin culture came back Yes it is a bacterial infection. He is prescribing Clavamox bid for 1 month.Don't give on n empty stomach. Wants be to bathe her weekly in Malesab shampoo. God this Dr uses too big words i asked him where did he learn them he chuckled He is so pleased with all her blood work her alt is within normal range and her ALKP has gone done in the low 300's he said it is normal for her to have that number as she has 3 regenerative nodules on her liver. The serum fructosamine test wasn't excellent control but good control. He is pleased with that and wants me to start doing curves every 2 weeks instead of every week and spot check if PU/PD goes up The balding tail that has become worse in 4 months is part of the skin infection as he said is real crusty.He agrees before we switch insulins to clear this infection up He suggests that I put her on 1000 mg of fish oil to help her arthritis. SAMe is fine as well. Forgot to ask him how much Said he will do an addendum stating that he does not believe Pebbles has diabetes insipitus as she is concentrating her urine now(1.035) and not on DDAVP since 12/07 Ihave been waiting for that statement as I am reporting the butt face vet that put her on DDAVP drops for 2 1/2 years!!! THat is $40 a month when she didn't need it I also wanted to wait till Pebbles was stable.Dr Stone wants me to bring her back in 4 months as we will repeat ACTH stim test and Chem profile.I let him know that some people on both forums think he is great and a good communicator Evidently he is going out of state to do his residency like he did here before.He assured me that the next Dr on Pebbles case will be in contact with me as Pebbles is a complicated case and needs addressing.I said can I e mail you? he replied yes I don't know what my e mail address will be but your Dr at A& M would know your dog in case of emergency rather then someone else reading your file In other words he would answer my questions but wants me to still be in contact with my new Dr.I feel better talking with him for a 1/2 hour. I didn't understand all his med terms but am relieved that test results are good

k9diabetes

04-26-2008, 05:35 PM

Did he say what kind of bacteria? (just curious, doesn't really matter)

Chris' eyelid ulcerations had a Staphylococcus bacteria and they were resistant to several different varieties of antibiotics. One of the eye ointments we were using, it turned out, contained an antibiotic that didn't work so we had to switch.

The shampoo should help too - it probably makes a big contribution by directly killing what's on the skin.

If after the round of Clavamox the skin infection persists, they might want to consider some other cause for it.

Chris' eyelid ulcerations get infected with bacteria because the ulcers are a comfy place for them but the ulcers actually start with an auto-immune disorder. Antibiotics improved his eyelids but didn't get rid of the ulcers. Only after we tried tacrolimus, which quiets the immune system, (we gave just a tiny bit topically) were we able to get rid of the ulcers altogether.

After months of trying things and several rounds of antibiotics, we tried the tacrolimus cuz it was all we had left to try. One swipe over his eyelids and they improved dramatically.

The docs don't feel it's pemphigus, which is an auto-immune attack on the skin... I don't think they have a label for it really. That's okay as long as we finally found something that works.

Perhaps with the Cushings controlled, the diabetes fairly well controlled, and a slap of antibiotics, you'll be able to get rid of her scaly skin once and for all! :) I hope so!!

Chris sends Pebbles a nuzzle to get healed up!

Natalie

rhodesian46

04-26-2008, 06:53 PM

Natalie,
Yes he told me but he is always using the big words They go over my head. Hopefully he will put it in the addendum he is doing for Pebbles. He is giving his opinion that Pebbles never had DI 3 yrs ago as her urine is concentrated(1.035) Maybe we start with this drug and if doesn't work try another. Does the skin culture name the drugs to use besides the type of infection?

k9diabetes

04-26-2008, 11:37 PM

Depends on if they did a sensitivity test. They can either just grow what is in the scraping to find out what bacteria it is or they can put discs that contain various antibiotics on the plate and see which antibiotics are effective. Hope they went ahead and sensitivity tested it and are giving you the antibiotic based on that.

Chris had a coagulase positive staphylococcus, which is a common skin bacteria that can invade inflamed tissue.

They tested...
Augmentin - amoxicillin
ampicillin - resistant
ceftiofur = a cephalosporin
cephalothin
chloramphenicol
clindamycin - resistant = Antirobe
enrofloxacin - resistant = Baytril
erythromycin - resistant
gentamicin
oxacillin
penicillin g - resistant
tetracycline- resistant
tribrissen - resistant
vancomycin

Clavamox, like Augmentin, is amoxicillin.

Chris was given Simplicef, which is a cephalosporin and has worked well for him.

Clavamox made Chris throw up but I've seen other dogs have no problem with it. Chris didn't throw up when it was given but when his stomach was empty, usually just before he was due for another meal. Threw up like clockwork.

I should go back and see what they were using before. Since it wasn't getting rid of it, they probably did check to see what antibiotics would be effective... was it Baytril? Chris' bug was resistant to Baytril.

Natalie

k9diabetes

04-26-2008, 11:40 PM

I LOVE one dog, one thread... I see it was Cephalexin so they have changed antibiotics, which seems like a good thing. I hope it's cuz they tested to see what the bug was susceptible too.

Natalie

rhodesian46

04-27-2008, 04:55 AM

Natalie,
The IMS told me that the Clavamox needs to be given right after she eats because of possible gastrointestinal problem. She will be on 375 mg bid so I can feed her first. I believe they know the bug AM doing a curve on Pebbles Tues as I am off. I ended up injecting her last night and must of gone outside of the scruff and insulin came out on my hand This is the second time I have done this since August 07. So I gave her 2 u more. Can't do the curve now! Am going to ask Dr Stone to tell me exactly whae bacteria it was Will e mail him Tues eve.

Dollydog

04-27-2008, 01:38 PM

Hi Marianne,
Glad that you got to see Dr. Stone and get all the reports back...I'm just getting caught up today!! He will be about 10-11 hours away from us when he gets to Michigan State and I hope he likes winter!! Although they don't get as much as us, it will be more winter than Texas has.
Lady was up to as much as 14iu's of Vetsulin twice a day. She came down to around 9 or 10 for a little while but has been at 12.5 in am and 13.5 in pm for 5 months now. She has stayed pretty consistent at 15-15.3lbs from the beginning of her diabetes diagnosis. Every dog is so different and things get complicated with dogs like Pebbles and Lady and some of the others with multiple issues. It didn't help Lady that she was on Anipryl for a year and then received trilo. What would our lives have been like if she'd gotten the trilo from the beginning?
Keep up the good work and a special hug for Pebbles for getting such a good report card! :D
Jo-Ann & Lady :)

rhodesian46

04-27-2008, 02:13 PM

Thanks Jo-Ann, I have noticed that Pebbles isn't as hungry as before. She will walk away from her food then go back to eating again I guess its scaring me as she has had a ravenous appetite for such a long time Dr Stone did tell me if I see her not wanting to eat as much to back off the trilo for one day I think he sais give her pred the lower mg I would need to do another stim in 3 weeks instead of the 4 months he originally said. THat post # 2 is pretty low I have the fear that she will become Addisonion I had a dog that had Addisons disease. Maybe that is the normal for Pebbles before the dx of Cushings I don't remember. ANy advice you can give on this subject is aopreciated!!!

rhodesian46

05-02-2008, 04:52 PM

Talked to Dr Stone this morning Pebbles refused to eat today Walked away till my other 5 dogs came in the house She ate slowly Took 15 mns to eat compared to the normal 2 mns This inappetence has been occurring for almost 2 weeks now but this is the first time she walked away. He told me to give her her prednilosone and to stop the trilo till Sun Then reduce to 60 mg instead of 90 If she is feeling crappy tomorrow give pred again and on Sun if still not eating well and then if I have to skip trilo. he said it isn't going to hurt her not to have trilo Hopefully I can start Sun again with trilo. I really can't remember what was normal for Pebbles eating as she has been hungry for years She is freaking me out Yes I am a worry wart I never thought there would be a day that she wouldn't be hungry

And maybe Pebbles needs the 90 mg and her not eating all of her food is normal for her If I don't see a change in her eating habit on 60 mg then he wants me to either way call him Monday. Pebbles may only need 60 mgs We will see What does the prednisolone do for a dog?Does it prevent an Addisonian crisis?:confused:

k9diabetes

05-02-2008, 05:10 PM

Hi Marianne,

Pred is essentially cortisol given in pill form.

So if they worry that the adrenal gland has been oversuppressed and her cortisol is low, which is Addison's, prednisolone gives her a boost of cortisol to get her levels back to normal. Which should perk up her appetite if low cortisol is the cause.

I agree that it's best to avoid an Addisonian crisis - those are very dangerous - so to stop giving the trilostane for a few days. Being Cushinoid for a few days from stopping trilostane is much safer than being Addisonian.

It's a tricky balance, huh? But I think it helps to remember that Cushings, even more than diabetes, isn't going to do major damage with high levels for a few days. At worst, it will be uncomfortable.

Natalie

We Hope

05-02-2008, 05:21 PM

Marianne,

Prednisone can also be used to stimulate the appetite:

http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/190302.htm

"Drugs used as appetite stimulants in monogastrics include B vitamins, glucocorticoids, anabolic steroids, benzodiazepines, and cyproheptadine."

http://www.merckvetmanual.com/mvm/htm/bc/tphm02.htm

"Drug Dosage
Prednisone 1 mg/kg, PO, every other day"

BestBuddy

05-02-2008, 05:28 PM

Hi Marianne,
I would stop the trilo until Pebbles is eating well again. Buddy went through several stops because his ACTH numbers were non stimulatory (post no higher than the pre) and we stopped for 7 days one time and it was 10 days the next each time lowering the dose. He was not eating well either and I had seven or eight food option I would offer each meal to try and get him to eat, usually he did but his BG's suffered as the meals were not consistently the same but it was the only option at the time. We didn't use the pred at that time as he was not in a crisis.
Jenny & Buddy

rhodesian46

05-02-2008, 06:35 PM

Pebbles did eat tonight Added a tbl cottage cheese. I won't give the pred if she is eating tomorrow You know Pebbles has never been text book dog. Maybe she just needs 60 mg?I Am supposed to call the IMS Mon r stimulatory Question if Pebbles results were non stimulatory on last stim then why didn't the Dr lower her dose of Trilo?This is so confusing.I guess whats normal eating for one dog is not normal for others?

k9diabetes

05-02-2008, 06:54 PM

Chris is so far from "normal" that I don't even bother with figuring out what's "normal" anymore!

Chris has never been a counter surfer or major chowhound. He will usually eat with little or no coaxing though. Any time I have to coax him to eat, I know he's not feeling well.

When his kidneys values were off because of having taken lasix, it was nearly impossible to get him to eat. A food would work for a day or two and then he'd refuse it. When he started refusing hamburger, I KNEW he was sick...

One of the great things about Chris' cardiologist is that she got that about him right away - his complete lack of interest in what he's supposed to do or how much medication it is supposed to take. She makes no assumptions with him and we start every med at half to three quarters of the "normal" dose.

Ricksma

05-03-2008, 06:15 AM

Marianne, Just wanted to touch base with you and say, "Whew!" Wow...I don't know how you do it....I'm not sure I could keep it all straight. I know how motivated you are, though, and the people here are SO knowledgable. Keep up the good work!!

Love and hugs, Teresa and Ricky

rhodesian46

05-03-2008, 07:42 AM

Teresa,
I don't know how I do it either I love these guys All 6 dogs,2 catts and a cockatiel that wants to do nothing but stay on my shoulder and poop!!!!. I think I was brought in this world to take care of animals. Must of ben a dog in previous life:DI pretty much don't give up on anything and stay focused. Pebbles did eat this morning, yeah No pred will be given. Tomorrow if she eats tonight I will start with 60 mg of Trilo and see how she eats. She is real alert and walked like a walking fool this morning Bought her thatleash that extens to 16 ft She loves it. Also walk my fat chihuahua with Pebs. Pebs is not vomiting or showing any signs of Addisonian. Had a dog with Addisons disease as well Can't seem to get ahead as Pebbles if staying on 60 mg of Trilo will need another stim test in 3-4 weeks At least Dr Stone can examine her again and answer anymore questions that I may think of I think he is leaving sometime in June:(

rhodesian46

05-03-2008, 05:05 PM

Just an update pebbles ate her dinner tonight as well as this morning Was told not to check her BG for a couple of days cuz with pred it would be elevated. Well do you think I listened NO ! It was 178 Thats great Am starting 60 mg of trilo. Hope this is the majic number number. Haven't gotten her Clavamox from Pet Meds yet Should come at the end of next week Had to mail them the original script. Hope that this med doesn't mess up her appetite Know thatI have to give it to her with her meal. Hey ya'll where do you buy SAMe? I didn't see it at Wally Mart Wanted to Put Pebbles on 400 mg.

rhodesian46

05-05-2008, 04:34 PM

Hey ya'll,
we are on track with Pebbles Her appetite is back Not overly hungry but eating normally.I guess the 60 mg of trilo that I started Sunday helped Haven"t talked to Dr Stone as of yet He wanted me to call him today Instead I emailed him She is alert , no lethargy,stool firm and PU/PD is OK. I tested her Bg at 2:30 PM today That is 9 hours after her shot It was 166. GOOO GIRL!!! Should be getting her clavamox this week. Hopefully her Bgs will come down Am going to keep a sharp eye on them. Most cush pups have a reduction in insulin Not Pebbles. She wrote the book on what the rules shouldn't be!!!I think that Lady( Lynnes dog) called Pebbles and they laughed at stressing their MomsBoth dogs are not textbook ruled!!!!

We Hope

05-05-2008, 04:41 PM

Marianne,

See you asked about SAMe:

http://www.veterinarypartner.com/Content.plx?P=A&C=31&A=1319&S=0

S-Adenosylmethionine (SAMe, Denosyl, Zentonil)

BRAND NAME: Denosyl, Zentonil

AVAILABLE IN
90 mg tablets, 225 mg tablets, and an assortment of sizes and doses for human consumption

"SAMe is considered by the FDA to be a nutritional supplement rather than a drug, which means it does not have to undergo the same rigid testing for efficacy as a licensed drug. There is a definite problem with lack of quality control in regard to nutritional supplements for human consumption thus products for human consumption do not undergo standardized production and may not be of the same quality as the Nutramax® product (Denosyl)."

https://www.vetamerica.com/index.asp?PageAction=PRODSEARCH&txtSearch=s-adenosyl&gclid=CK-sje60kJMCFQ58PAod03zJGA

And here you see it under the Denosyl trade name and as a generic by Vitality Systems.

I think that people whose dogs went "by the book" never posted here or at any other MB I know of! :)

rhodesian46

05-06-2008, 05:06 PM

Ok I feel like an idiot Not the first time of course I spoke to to Dr Stone today Of course he called while I was driving Told him Pebbles is doing good ;eating an as of Sun on 60 mg of trilo. he was talking about watching her as far as bottoming out which I understand as going Addisonian. he wants to redo the stim in one month if all goes well till then He said:confused: maybe in a week Pebbles may start to drink more water to watch that Why would she start drinking more water because she may not be on enough Trilo? Does it take that long to lower the cortisol or not?I couldn't understand him as I friggin didn't know how to make my cell phone louder as I was driving. new phone I could kick myself in the butt for not saying why?Can ya'll explain cuz I don't feel like e mailing him He is going to think I didn't listen.I know if she doesn't eat or is weak to call him immediately Maybe Pebbles will do OK on 60 mg of Trilo. I thought the cortisol either lowers or gets higher right away.:confused:

k9diabetes

05-06-2008, 08:24 PM

As I understand it, trilostane washes out of the system fairly quickly. It doesn't destroy actual adrenal gland tissue, so without it they can revert to a Cushings state faster than with lysodren.

But I suspect it still might take a while to build up to a Cushings type level as it would have to go past too low, through normal, and into a high range before the thirst would kick in.

I'm only guessing. I'm sure the Cushings folks gave you a better answer.

Natalie

Kiska'smom

05-07-2008, 10:58 AM

Hi Marianne,

I wish that I knew more about Trilostane. I can't advise you about that one. However, I don't think that your vet would mind a call from you! Just tell him that you had a new phone and missed part of what he said because you couldn't find the volume button! I bet that he would laugh! I'm sure that he wouldn't think that you didn't listen on purpose! Give it a try. You will feel much better when you have all of the information that you need!

Hugs,

Jeanne and Kiska

rhodesian46

05-07-2008, 05:25 PM

Well I didn't call dr Stone I e mailed him and told him that I remembered more questons when he hung up About the possibility of Pebbles drinking more I asked that if the 60 mg isn't enough then her cortisol would be higher therefore her bgs would rise and then she would drink more water See what he says.Will have to make a trip to A & M in 4 weeks if all goes well with Pebs for another stim test.Since we decreased dosage he wants to see where she is at.More money!!!!This will be the last time I see Dr Stone so I will have my ducks in order and questions written down I am sure thatthe replacing IMS will be just a good

Kiska'smom

05-08-2008, 07:46 AM

Hi Marianne,

I am so glad that you contacted Dr. Stone, even if it was by email! I hope that you get all the answers that you need to help Pebbles. I know what you mean about the money! Boy, vets and tests are so expensive! Yikes!

I know that you will miss Dr. Stone. Good luck with your last visit with him, and I will be hoping that his replacement is just as good!

I just want to say that I am so impressed with you. You are such a good mom, and always have Pebbles' best interest at heart. Who could ask for more?

Hugs,

Jeanne and Kiska

rhodesian46

05-08-2008, 10:48 AM

Thanks for the compliment Jeanne You know I Just want to have Pebbles lead a good quality life I don't want to say(if anything were to happen to her)that I didn't do enough for her. When she goes I will be at peace. Hopefully she will be around for a while Now the vet bills are expensive It costs me & $ 123 for the stim and $60 as I have to see Dr Stone and his pupil. I am hoping that 60 mg of trilo is enough for her because if the stim test comes out that she needs an increase she will then need another stim in a month again Dr Stone hasn't answered my email yet. pebbles Clavamox will be here tomorrow So I hope we can kick her bacterial skin infection as it probably has caused higher Bgs than normal:D

rhodesian46

05-09-2008, 12:41 PM

Finally Pebbles Clavamox has come in via mail from pet meds Will start her this evening with food of course Don't want any tummy upset . Am hoping her Bgs will come down better than they are that is when this bacterial skin infection gets under control.

forscooter

05-09-2008, 06:31 PM

Fingers, paws and everything crossed for you and Pebbles, Marianne!!!:D
I am so very much hoping this works for you!!!!
Beth and the boys

rhodesian46

05-10-2008, 08:03 AM

For the past couple of days Pebs has been drinking more water I think the 60 mg of trilo is too low for her I am wondering whether Dr Stone will increase a bit or wait till her next stim in June Think I will do a curve tomorrow to see how her Bgs are I wish Pebbles wouldn't be such a difficult dog :mad:to tweek!!!

k9diabetes

05-10-2008, 05:03 PM

Maybe she can take one 60 and one 90... alternating days or some other schedule if 60 is not enough but 90 is too much.

What sizes do they come in?

How's the Clavamox going?

Natalie

We Hope

05-10-2008, 05:30 PM

NOAH UK has them listed in the following sizes:

http://www.noahcompendium.co.uk/Compendium-datasheets_by_AI/Active_Ingredients/-24874.html

Trilostane
>> Vetoryl 10 mg Hard Capsules
>> Vetoryl 30 mg Hard Capsules
>> Vetoryl 60 mg Hard Capsules
>> Vetoryl 120 mg Hard Capsules

While putting the Cushing's Page together on the wiki, I came across this great resource for it:

https://listserv.tamu.edu/cgi-bin/wa?A0=CUSHINGS-PETS&D=0&H=0&I=-3&O=T&T=0

Archives of CUSHINGS-PETS@LISTSERV.TAMU.EDU
Cushing's Syndrome and Cushing's Disease in Animals
Texas A & M

Did quite a bit of reading there for the wiki page and remembered reading that what some people do whose dog doesn't use one of the "ready made" size trilostane capsules do is to have a compounding pharmacy "re-package" them. The compounding pharmacy opens the capsules and re-distributes the trilostane powder in them into capsules to fit that particular dog's dosage pattern. I also see that some have the trilostane powder made into liquid medicine:

https://listserv.tamu.edu/cgi-bin/wa?A2=ind0309&L=CUSHINGS-PETS&P=R6495&D=0&H=0&I=-3&O=T&T=0

"After they ran the tests, the specialist at Auburn recommended that her Lysodren be increased from 250mg per week to 300mg per week. However, they recommended that we give it to her twice a week instead of the full dose once per week so she has been taking 150mg on Tuesdays and 150mg on Fridays (given in two doses - 75mg in a.m., 75mg in p.m.). The pharmacist made up a liquid compound for her so that we could get the correct amount measured out instead of trying to quarter pills."

https://listserv.tamu.edu/cgi-bin/wa?A2=ind0409&L=CUSHINGS-PETS&P=R196&D=0&H=0&I=-3&O=T&T=0

"We're giving her 20 mg/day to start, and my vet made it really easy to measure doses by having a pharmacist compound (mix) the trilostane with a liquid that dogs like. So each day I just give Stephanie one ml of the liquid. If we need to increase the dose to 30 or 40 mg/day, then I'll just give her 1.5 or 2 ml.

"I just wanted to mention this because Silvia recently wrote about
dividing the trilostane powder by hand, which is what a lot of people do.
Compounding it into a liquid (or a pill) seems a lot easier, and the dose
is more accurate (as long as you shake the bottle well!)."

https://listserv.tamu.edu/cgi-bin/wa?A2=ind0406&L=CUSHINGS-PETS&P=R10869&D=0&H=0&I=-3&O=T&T=0

"I don't think it's a good idea to be dividing the capsules into smaller
(uneven) doses by yourself. I think that a Compounding Pharmacist could
divide the capsules quite accurately into smaller doses for you."

Marianne, this might be something for you to think about if the 60 mg capsules aren't quite enough for Pebbles.

k9diabetes

05-10-2008, 05:52 PM

70 mg might work well.

rhodesian46

05-11-2008, 01:20 PM

hi Natalie,
I believe that Diamondback Pharmacy (where I get her trilo) can do any size capsule. The good thing is that I always order 120 30 mg's just in case their is an adjustment Pebbles is on day 3 of the Clavamox. No tummy upset.Not drinking alot of water today. OMG wait till you see this curve:D I am happy dancing already !!! I bathed her in her Melasab shampoo as I do weekly. She will be on Clavamox for a month Just in time for Dr Stone to see her for her next stim June 3. It will be the last time I deal with him:mad: He is so thorough! Will post her curve when she is done at 4:30!

rhodesian46

05-11-2008, 04:17 PM

Here is Pebbles curve that I do every 2 weeks. I used the freestyle meter.
5:30 am-215 fed,gave meds and gave 49 u Novolin N
6:30 am-229 then walked 15 mns gave 2 baby biscuits
8:30 am-175
10:30 am-151
12:30 pm-152
2:30 am-172
4:30 am 212 fed,gave meds and 49 u of Novolin N 100 mg/dl
She stayed flat as usual Not bad. You know she drank alot of water yesterday Did a spot check yesterday at 2:30 It was 186. Hasn't drank a lot today Now Pebbles you need to do this every curve. Hopefully the Clavamox will kick in in a few more days.Will spot check her this week. She is nice and clean as she had her weekly Melesab bath!:D

k9diabetes

05-11-2008, 11:41 PM

Just passing through very quickly... hope to have a chance to write more tomorrow... but wanted to say what a lovely curve that is!! :cool:

She responds really nicely to the insulin!!

Re the Trilostaine, with the 10 mg capsules added in, you could do some pretty fine adjusting on your own, allowing you to give 70 or 80 mg without having to compound it. That's cool.

Natalie

k9diabetes

05-12-2008, 09:44 PM

Chris really NEEDS a bath but he hates them so much... I haven't had the heart to do it.

rhodesian46

05-13-2008, 12:11 PM

pebbles bacterial culture for her skin was a Bacillus soecies ans was sensitive to Amoxillin-Clavulanate( Clavamox) whatever that means She is on Clavamox now of course

k9diabetes

05-13-2008, 02:15 PM

Hope she tolerates it okay and it finally gets things cleared up. Are they gonna give it for quite a while? Chris' most recent runs of antibiotics for his eyelid ulcers were for 30 days.

rhodesian46

05-13-2008, 03:41 PM

Hi Natalie,
She is on 375 mg bid for 30 days. I make sure I give it to her with food. As a matter of fact I give her a thin piece of chicken culcut with 6 or seven pllls in it. She doesn't even chew it! She thinks this is a treat. So by the time I take her for her next stim(June 3rd) she would be on the Clavamox for almost a month. Hopefully we can get it cleared up How is Chris doing?

Kiska'smom

05-14-2008, 01:44 PM

Hi Marianne,

I just wanted to peek in and see that curve! It's a thing of beauty!!! I'm so glad to hear that Pebbles is doing well. Hope that her infection clears up quickly. I'm with Natalie, regarding the bath. Neither of my girls like water unless it's in a river. Then they are up to their heads swimming. Wish I had one nearby. They are both needing a bath after a long winter!!!

Hugs,

Jeanne

rhodesian46

05-14-2008, 01:56 PM

You know I bought this long hose that you hook up to the top of the showerhead It has its own showerhead thatyou can turn on or off. It Saves my back Also have the old fashioned tub that has sliding glass doors so I close them and Pebbles and I wait for 10 mns to let the shampoo stay on her skin. She doesn't have much choice as she can't get out. It was well worth $30 at Pets Mart

k9diabetes

05-15-2008, 03:06 PM

After Chris had his belly shaved for the ultrasound, I gave a moment's thought to just shaving his whole body for the summer! His skin is so cute and he would be easy to wipe down with just peach fuzz! ;)

Chris loved rivers, lakes... he doesn't have the energy for it anymore but really loved wading and a little swimming. For a while in deep water we put a life vest on him and he thought that was great!! His stamina was never good after the PDA, so we worried he'd wear himself out swimming. He'd get his neon green life vest on and it made swimming so much easier for him.

But NO water that comes at you on its own!! No waves fromthe ocean or splashes from sprinklers and especially no baths. He's always hated them. Shakes and looks pathetic. Since we've been trying to keep his stress to a minimum, he's only had one in the last 9 months or so. He really needs another but I just don't have the heart.

He's been having a rough few days. Lots of wheezing and coughing. I think as much from lung disease as heart disease. I finally broke down and gave him a little Lasix as it really helps his breathing even though it's a very small dose. Also gave him a little Zantac last night. He's clearly uncomfortable but we don't really know why... maybe a combination of a bunch of small things. I feel bad for him. I'm considering some changes to diet and meds to see if I can get him to feel a little better. The Tylenol didn't seem to hurt him but didn't seem to help him either.

Natalie

rhodesian46

05-16-2008, 01:09 PM

That Lasix makes them urinate more frequently. Glad it helped though I thought you weren't supposed to give dogs Tylenol just aspirin? You may want to try Ascriptin OTC that is an aspirin that is coated to help tummy upset

rhodesian46

05-25-2008, 09:17 AM

hi ya'll,
Hows kitty Gus and Chris doing? Pebbles is doing fine. Have to give another melesab bath today it has been almost 100 degrees in Austin texas. Of course none of the dogs want to go outside A/c is better.Pebbles and Jasmine(my other husky) pee and cry to come in Gosh darn That is all I do is vacuum Anyway am doing a curve on Pebbles today. She is still on her Clavamox for her skin infection. I think (unless I am crazy) that her sides are coming in hair that is brown Very little but coming in:D:D Her chest hair has completely come in. her Where they shaved her 12/07 for her ultrasound is still bald. Can't wait to take a pic of Pebbles when she looks normal. Next week I will do another curve and water measurement test so that I have info to give Dr Stone I am taking pebs 6/3 for her stim test After this I will get another IMS Dr that replaces him:( You know I swear that Pebbles is faking me Last night I injected her in the scruff I didn't even put the needle in and she balked. Then I did and she screamed again freaked me so I pulled it out and injected again in a different spot. So I think she is faking me sometimes and because of 2 injection in different spots my fasting curve is a little higher than usual. Will post later.

k9diabetes

05-25-2008, 05:45 PM

Hi Marianne,

It's nice to hear from you, especially with such good news about Pebbles!! :) I hope the Clavamox has been the fix she's needed.

Good luck with the curve!

I always feel sorry for the northern breeds around here. We had a few 100 degree days recently... I don't know how they can stand it!

I'll update Chris and Gus's posts so I don't hijack yours with their news,

Natalie

eyelostit

05-25-2008, 10:34 PM

Nice Curve:)

ladysmom06

05-26-2008, 06:25 AM

Hi Marianne,

Happy to hear that Pebbles is doing fine. How was the curve you did yesterday? Hugs to you and the gang.

Luv,
Lynne and Lady

rhodesian46

05-26-2008, 10:56 AM

it was Ok She started out mid 200's and stayed flat for the entire day Ended at 203.Will do another next weekend for Dr Stone The skin infection is not cleared yet Some spots are cleared up. She has a couple of weeks to go on Clavamox.Have to go for another stim on 6/3 Right now she is still on 60 mg of Trilostane Will be seeing for the last time Dr Stone. i hope to get a good replacement.It has been really hot here Pebbles doesn't want to stay outside for long All 6 dogs pee and run back in The texas heat is horrible Humid as well. How is Lady doing?

rhodesian46

05-28-2008, 06:05 PM

Well I did it again I injected Pebbles tonight and apparently some leaked out. About an hour after injecting I went to go kiss pebs on the snout and that is when I smelled the insulin.Wonderful!!! I gave her another unit just in case. Now I feel guilty!!! She will run high tomorrow for sure. If foot could reach I would kick my butt. Have done this 4 times in almost a year. She has been faking me when I inject in the scruff. Yelping even before I inject. My bad!!! Not my day Husband had surgery on his wrist this morning. Put all dogs in kitchen and my 1 yr old Pup chewed my oak table bottom. i even thought to remove 4 chairs as he chewed those as well One of those dogs that chews everything in site and who is used to peroxide down his throat to throw up!!!! Can't leave Sabastion outside when we go out as it is 100 degrees here Hope for a better day tomorrow Am digging out the metal cage!!!!

k9diabetes

05-28-2008, 07:11 PM

Insulin smells so bad too! I hate that.

No wonder you're having a hard time with injections with Pebbles faking you out like that!! She can tell she's got your nerves on edge now and she's playing you! :p

Sorry you had a bad day. Hope your husband is doing okay and things settle down a bit.

Natalie

rhodesian46

05-28-2008, 07:27 PM

Thanks Natalie pebbles has her IMS appointment next Tues for her stim test. Pray things go well for her. Dogs can sure tell when their masters are stressed Thats for sure:D

eyelostit

05-31-2008, 01:57 AM

Just checked in to see about you and peebles, seems things got better since the first post. :)

Take Care ;)

rhodesian46

05-31-2008, 11:20 AM

Pebbles is doing OK. I am still bathing her weekly with the Melasab shampoo and she has been on Clavamox for the bacterial skin infection for 3 weeks now About 3/4 of has cleared She still has a few spots that haven't gone away. She has a week left on her med though Dr Stone may want to do another month of this pricey antibiotic($84 for the month) Tomorrow I will do a curve and measure her water consumption as I know that the Dr will want it Hopefully the Stim test turns out that she is on enough Trilostane For her weight she should be on 120 mg She is on 60 mg as we had to drop her down a couple of weeks backThe hunger issue is gone She eats quite slowly. Will post her curve tomorrow Thanks for asking about her!:D

BestBuddy

05-31-2008, 02:42 PM

Hi Marianne,
Good news that the infection is clearing, but not that those last few spots are being difficult. Maybe another month of the antibiotics will completely fix it. I hope Pebbles gives you a good curve, I will be waiting to hear. Don't worry that Pebbles isn't on enough trilo for her weight as all dogs are different in their needs just like insulin so fingers crossed for a good ACTH.
Jenny & Buddy

k9diabetes

05-31-2008, 04:42 PM

I too am anxious to hear how the curve and the Tuesday appointment and tests go! Glad to hear the new antibiotic and baths seem to be finally helping clear up some of the skin problems. It seems like skin infections are really hard to beat.

Natalie

rhodesian46

05-31-2008, 05:43 PM

I guess I thought it would be all cleared up by now.She has had this infection since 11/07. The old butt head vet of mine said it was a fungal infection No culture was ever done till 4/08 as we tried Cephalexin for months. I spot checked Pebbles today She was in the low 200's. Would like Bgs better than that. She is still having blood in her stools Not a lot Vet said probably colitis How do they treat that.? Will ask Dr Stone Tues if I can up her Metamucil. She is on 1/2 tsp bid. That Clavamox 375 mg is $84 for the month Holy cow that is expensive! But if we need to I will buy another month. I hope that Pebbles hasn't lost any more weight She was I think 58 lbs in April(her last visit to A& M)Am always nervous when I go to her appointments Need to write down my questions as this will be the last time I see Dr Stone Will post curve tomorrow

rhodesian46

06-01-2008, 05:19 PM

Have finished Pebbles curve Water consumption test will end at 9 pm. We started at 5:30 am
5:30am-155 fed,gave meds,49u
6:30am-156 then walked for 15mns and gave 2 baby milk bones
8:30 am-142
10:30am-154
12:30pm-139
2:30pm-111
4:30pm-109
Way to go Pebbles!!! This is the best curve since 8/07!!! Hope the dr is pleased. Gave Pebs here Melesab bath and made sure I got those bald spots that just showed up. I think that her post # is going to be high as even though she as been inside most of the day(It is high 90"s here) she still has drank a lot of water I would estimate 70 ounces already and we aren't done measuring yet. If it is highere than before than we will have to return 4 weeks laster instead of 4 months for another stim. Pebbles needs a job to pay for this!!!

We Hope

06-01-2008, 06:45 PM

http://bestsmileys.com/party/5.gif

Sounds like party numbers to me!

ladysmom06

06-02-2008, 04:47 AM

Hi Marianne,

WOW:D:D:D!!!!!!! That's a GREAT CURVE. I can imagine how pleased you must be. Sounds like the antibiotic and baths are working for the infection. Good luck with the ACTH test tomorrow. Hugs to you and the gang.

BestBuddy

06-02-2008, 01:46 PM

Marianne,
What great numbers. Yay Pebbles!
Jenny & Buddy

rhodesian46

06-02-2008, 02:42 PM

Wish me luck tomorrow it is Pebs stim test at A& M She had drank from 5 :30 am to 9pm 84 oz of water.She is 58 lbs. here is a formula that the IMS uses They consider Dm and Cushings disease into that formulaAnd she was inside most of the day It was 97 degrees here!. I think that we will have to increase the trilo We will see from the test. Off we go tomorrow Will post when I get home Stim test won't be back for a few days. Thanks everyone Pebbles sends hugs

ladysmom06

06-02-2008, 04:05 PM

Hi Marianne,

Good luck with the IMS visit tomorrow. Have a safe trip and please let us know how everything goes. Hugs to you and the gang.

rhodesian46

06-02-2008, 07:29 PM

Natalie,
What is the protocal for the starting dosage of Vetsulin Was reviewing Pebbles record from when she was first dx with Dm. Pebbles was on Vetsulin for the first 2 weeks. he started her out at 8 units bid Isn't that too low She was 60 lbs or 27.3 kg

We Hope

06-02-2008, 09:47 PM

Marianne,

The old starting protocol depended on if you were trying to use Vetsulin once daily or twice daily.

http://www.vetsulin.com/vet/DosingOverview.aspx

For once a day, they were going with 1 IU insulin per every kg (2.2 lb) of the dog's body weight with a supplemental dose ranging from 1-4 IU which depended on the weight of the dog.

"If twice-daily treatment is initiated, each of the two doses should be 25% less than the once-daily dose of Vetsulin required to attain an acceptable nadir.

"For example, a 10 kg dog would receive 12 IU of Vetsulin once daily or 9 IU of Vetsulin administered twice daily. See product label for more information."

We had quite a few people on the other board who were outside of the US and were trying to initially use the once-daily method. In order to achieve regulation, all of them had to go to the twice-daily method.

Here's the new beginning protocol for Vetsulin:

http://www.vetsulin.com/PDF/Vetsulin_Dear_Doctor_Letter.pdf

1 (1 of 4)

"The dosing guidelines for the use of Vetsulin in dogs have changed. The revised starting dose for dogs (0.5 IU insulin/kg body weight) is based on a review of the average required to maintain adequate control in the original approval as well as current recommendations in current literature. Please see the DOSING AND ADMINISTRATION section of the new PI (Package Insert) for complete dosing information."

These changes are beginning to also be made on the Caninsulin (outside of US) pages too:

http://www.caninsulin.com/managing-diabetic-dogs-insulin-dosage.asp

"Many specialists recommend that intermediate acting insulins be administered twice daily to dogs.

"Starting dose in the range of:

0.4-0.7 IU/kg twice daily is usually used, with larger bodyweight dogs started at the lower end of the range.

(Ref: Broussard JD, Wallace, MS. Insulin treatment of diabetes mellitus in the dog and cat. In Kirk's Current Veterinary Therapy XII Small Animal Practice. Bonagura J ed. Saunders, Philadelphia, 1995. p. 393-8.)

0.25-0.5 IU/kg twice daily

(Ref: Fleeman LM, Rand JS. (2001) Management of canine diabetes. Veterinary Clinics of North America: Small Animal Practice 31, 855-80.)

"The starting insulin dose range is thus taken as:

0.25-0.7 IU/kg twice daily - larger bodyweight dogs started at the lower end of the range.
Dose is also dependent on initial blood glucose concentrations. See table below.

Remember to round the dog’s bodyweight down to the nearest whole kilogram and the calculated dose down to the nearest whole unit.

Blood glucose concentration Starting insulin dose

<20mmol/l (360mg/dl) 0.25IU/kg
>20mmol/l (360mg/dl) 0.5IU/kg"

I'd have to say that 8 IU bid for a 60 pound dog is much too low. Lucky weighed 9.5 lb and when we changed him to Caninsulin/Vetsulin from Lilly Iletin (pork) insulin, his daily dose was 4 IU bid. He was using Iletin II Lente twice a day and when we switched him, we stayed with twice daily because both of them are intermediate-acting Lente insulins, with the difference in strength--Caninsulin/Vetsulin being U 40 and Iletin being U 100. He was steady at about 100 with two shots a day of Iletin II Lente, but we were able to take advantage of the more dilute Caninsulin/Vetsulin and tweak so that 8-10 hours after breakfast and morning insulin, he'd be at 85.

Lucky's initial Iletin dose was calculated based on body weight and we continued with that as a basis for calculating how much Caninsulin/Vetsulin he needed.

When I work it out with Pebbles being 27.3 kg saying for the sake of example that she was to receive 0.25 IU/kg, I get 6.825. Going with 0.50 IU/kg, we get 13.65, so she wasn't even receiving what's now their guideline for beginning insulin dosage--0.50 IU/kg, as the letter link indicates.

HTH!

Brandy mom

06-03-2008, 04:17 AM

Marianne and Pebbles

Just want to wish you luck today. I will be thinking of you.

Dawn and the girls

rhodesian46

06-03-2008, 03:02 PM

hey ya'll,
Just got back from A & M with Pebbles.She had her stim test and electrlytes. All will be back in a few days. Pebbles was howling and talking while we waited and I was told thatthey put her in a cage in between blood draws and she was howling again The student had to sit with her in a room( Ha) Dr Stone put her on 20 more days of Clavamox as she still has some spots still. She had lost 1 lb 2 oz (since 4/08) He is not concerned with that along as it isn't alot of weight She still had good muscle tone. If of course she losses a lot than an ultrasound would be in order. I had mentioned that the mucousy blood is still in her fecal and that it has gotten a little worse than in April( they had done a fecal and exam on her butt ) and since being on the Clavamox He wants me to give her a 1tbl os plain yogurt a day till we finish the Clavamox.Clavamox or the last antibiotic could cause colitis) What do they do for colitis? He was happy about the last curve and wants me to repeat in 2 weeks If better than then once a month is fine he doesn't feel comfortable with having her post stim at 2 like before he would rather have it higher I guess for fear of Addisonian. If we increase trilo then I will have to go back in 4 weeks for another stim. If not it will be 3-4 months. I told him he needs to give pebbles a kiss goodbye He blushed and patted her on the head. he will be leaving in 1 month SO thatall I have for now Will post when I get the results and his summary. Pebbles meanwhile is tired staying in the truck for almost 2 hours one way We ended up bringing Sabastion(the pup that eats everything in site) and Puma my chihuahua. Sabastion ended clawing and making a hole in one of my DCO food for Pebs that I had bought there. Never a dull moment here. Need to get going as I have to feed 8 animals and the cat next door Oh yeah I forgot I asked Dr Stone how much insulin( Vetsulin) thathe would of put Pebbles on in the beginning of dx He said 15 units bid My stupid vet put Pebble on 8 units bid. A week later I switched Pebbles to Novolin. Makes me so mad!!!!

BestBuddy

06-03-2008, 03:40 PM

Hi Marianne,
I agree that some vets are stupid and I think they have caused a lot of people to be wary of vetsulin. A lot of people won't try it or even give it a chance but sometimes the starting dose is so low that it never had a chance. I do understand that different insulins work for different dogs but I wonder if vetsulin was used correctly whether it would have a better reputation. I used caninsulin for 4 years with Buddy and it was great.
Jenny & Buddy

rhodesian46

06-03-2008, 04:18 PM

The reason I never tried it again is that Pebbles would need so much a month I spent also on Trilo and script dogfood.It is astronomical now! WeHope you were right That figures to almost 15 u bid like Dr Stone said I think it is like 1./4 per lb on small dogs? This just adds more to the vet board when i finish getting all my info and ducks in order. Pet meds said to me today "Go girl "Too many people don't do anything about their vets misdiagnosing and tend to forget as one they just don't have time to compile their thoughts and two they j just forget to do it I am the type that crap on my once I will look the other way crap on me twice then beware I am coming at you full force! I will win this for Pebbles. I hope that the vet board maKes this vet responsible for Pebbles health and if he gets a slap on his hand then oh well I tried! Looking at pebbles whom I adore and seeing that all of the health problems she has just makes me livid. Just think of how many other pets were done wrong and have died due to negligence

We Hope

06-03-2008, 04:31 PM

OK, Marianne--here's colitis from the Merck Veterinary Manual:

http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/23302.htm&word=colitis

Treatment and Control:

"If possible, the inciting cause should be identified and eliminated. Food should be withheld for an initial 24-48 hr in animals with acute colitis in an effort to “rest” the bowel. The addition of soluble fiber to a highly digestible commercial diet results in a very good to excellent clinical response in most dogs with chronic idiopathic large-bowel diarrhea; over time, the fiber dose can be reduced or eliminated in some dogs and a standard dog food substituted without causing a return of the diarrhea. When feeding is begun, the protein source used should be one to which the animal has not previously been exposed, ie, a “novel protein.” In one study, clinical signs associated with lymphocytic-plasmacytic colitis resolved in all dogs within ~2 wk after feeding of a low-residue, digestible, hypoallergenic diet (1 part low-fat cottage cheese and 2 parts boiled white rice). Thereafter, most dogs were maintained without recurrence of clinical signs on commercially available prescription diets they had not been previously fed. Currently, there are a number of commercially available diets that contain rice with mutton or lamb, venison, or rabbit. If feeding a high fiber or novel protein diet is not beneficial, a commercial low residue diet may be tried, especially a low residue diet that contains FOS. Cats with lymphocytic-plasmacytic colitis may respond to dietary management alone (eg, lamb and rice, horsemeat, or a commercially available diet). In another study, cats were initially treated with dietary fiber, or dietary fiber and pharmacologic intervention (prednisone, tylosin, or sulfasalazine). Most cats were eventually maintained on high-fiber diets or a highly digestible diet.

"Supplementation of the diet with fiber (1-6 tsp psyllium hydrophilic mucilloid or 1-4 tbsp of coarse wheat bran per feeding) improves diarrhea in many animals. Dietary fiber reduces free fecal water, prolongs luminal transit time (increasing the opportunity to absorb water), absorbs toxins, increases fecal bulk and stretches the colonic smooth muscle, and improves contractility. However, the addition of fiber alone rarely results in complete resolution of clinical signs of large-intestinal diarrhea in dogs, and beneficial effects may take as long as 6 wk to become evident.

"Clinical signs resolve more rapidly when concurrent anti-inflammatory medication is added to the change in diet. Those drugs most commonly used in the management of colitis include sulfasalazine, prednisone or prednisolone, and azathioprine. Sulfasalazine (dogs: 12.5 mg/kg, qid for 14 days, then 12.5 mg/kg, bid for 28 days; cats: 10-20 mg/kg/day for 14 days) is the drug most often used to treat lymphocytic-plasmacytic colitis, the most common form of idiopathic colitis. Longterm use is discouraged because it predisposes to keratoconjunctivitis sicca. Prednisone is reportedly not as effective as sulfasalazine in the management of lymphocytic-plasmacytic colitis but may be considered. In some cases, prednisone is used in conjunction with sulfasalazine in cases unresponsive to more conventional therapy. Azathioprine (1 mg/kg, sid for 2 wk), alone or in combination with prednisone, has been used to control clinical signs associated with lymphocytic-plasmacytic colitis. Azathioprine may be considered in cases poorly responsive to prednisone or to prednisone with sulfasalazine. Eosinophilic colitis generally responds to prednisone (2-4 mg/kg/day for 2 wk and then tapered over 6-10 wk). Histiocytic colitis of Boxers is treated with a combination of controlled diet, sulfasalazine, and prednisone.
Some animals require additional short-term use of motility modifiers until inflammation is brought under control. Loperamide (0.1-0.2 mg/kg, bid-qid) stimulates segmental activity and slows passage of fecal contents. Loperamide also decreases colonic secretion, enhances salt and water absorption, and increases anal sphincter tone."

This was the only problem Lucky had after his diabetes diagnosis--a one-time minor problem with colitis. He got some sulfa drugs we knew he tolerated, and a course of Pepto-Bismol, which was a LOT tougher to give than insulin because he HATED it. I had pink all over the house and we were calling him the Pink Panther! :)

He was getting adequate fiber because he was eating W/D canned; W/D and similar prescription foods are quite bland, so there wasn't a problem with him staying on that.

For Pebbles, you may be better off that you are using Novolin. First of all, there's the difference in the strength of the insulin. Novolin is U 100, where Caninsulin/Vetsulin is U 40. Stronger insulin starts working slower, but lasts longer. Then there's the human/pork/dog difference. Caninsulin/Vetsulin is a pork insulin and pork insulin is 100% identical to a dog's own insulin. Human insulin differs from pork (and dog) insulin by 1 amino acid--position #30 in the B insulin chain.

What this may mean for you both is that the Novolin lasts longer because there's more resistance when you give a dog human insulin than when you use pork. Every dog isn't like Lucky, who was resistant to all but an insulin 100% like his own. When resistance isn't extreme, as it was with Lucky, it can mean that the insulin doesn't leave the body as quickly as it would if there was little or no resistance there.

We had someone in the UK on the other board whose dog was started on Insuvet Lente (100% beef Lente insulin--made by Schering-Plough and only sold in the UK). Beef insulin differs from pork (and dog) insulin in positions # 8 and #10 on the A insulin chain.

http://images.wikia.com/petdiabetes/images/f/fb/Canineinsulin8.png

He was not using the Insuvet beef quickly enough for it to be of help in controlling his diabetes, because of the amino acid difference/resistance. So he was switched to Caninsulin, and because this is a perfect match to a dog's own, there is little resistance there. He was using the Caninsulin too quickly because of that.

Transferring him to human NPH/isophane insulin (Insulatard by Novo--we know it as Novolin N or Humulin N) gave him just the right amount of resistance to make the insulin last long enough but not too long.

Basically, I don't think many vets knew how to use pork insulin before Vetsulin was approved, even though there was pork insulin from both Novo and Lilly available in the US for many years. Gonna go further here and say that I don't believe it was taught in a lot of med schools. I once was forced to take Lucky to another hospital when both John and his son were out of town. The vet, one year out of med school, looked at the vial of Iletin II Lente like it came from Mars; it was obvious she'd never seen a vial of pork insulin until now. Thank goodness the problem wasn't diabetes-related because I realized she knew less about it than me.

We used Caninsulin/Vetsulin just as we did Iletin II Lente--because they're both pork Lente, intermediate-acting insulins--differing only in manufacturer and strength. Personally have only praise for Intervet and its insulin because they were the other half of the team who saved Lucky's life when he couldn't tolerate the suspension and preservatives of Iletin II NPH. We could have thought it all we liked, but without being able to HAVE it, all of our thoughts wouldn't have done Lucky any good.

Marianne,

We were immensely interested in Caninsulin from the start; read everything Intervet had available on the internet in any languages we could understand. Had it been available here at the time, we would never have gone to Lilly's Iletin II Lente. We read far enough to get to the Horn-Mitten study and Dr. Church's work, where he equated Caninsulin with Novo's Pork Monotard and that equalled Lilly's Iletin II Lente. So we were ready when Lucky had issues with the pork NPH/isophane--knew what we had to have, and where to go to try to get it.

rhodesian46

06-03-2008, 04:43 PM

Send you a pm We Hope. I asked Dr Stone what they do for colitis He said they switch to Purina DCO That is what Pebbles is on. Her stools are firm always have been Pred isn't a choice as she is a cushings dog She is also on 1/2 tsp of Metamucil 2 x a dayWill watch and make sure it doesn't get worse

We Hope

06-03-2008, 04:51 PM

Pred wasn't an option with Lucky and diabetes either! :D Most of the prescription diabetes foods and those for weight loss like R/D are quite bland. I've seen people using the W/D for diabetes, for keeping weight off and some have had it prescribed for irritable bowel, also because it's so bland.

We found that Lucky had a problem with turkey, thus he had the colitis bout. We stayed away from any turkey after that and had no more problems with colitis.

rhodesian46

06-05-2008, 11:34 AM

Heard from Dr Stone via e mail He says:
"I just received the results on Pebbles' ACTH stimulation test and
electrolyte levels. The Stim was improved from last time, now with a
pre cortisol of 2.8 and a post of 3.75 (previously 2 and 2.9). I am
more comfortable with these numbers (ideal for trilostane). The
electrolytes showed a very mild artifactual increase in potassium, but
the sodium levels were good (I wanted to be sure sodium levels weren't
dropping due to over-suppression of the adrenal glands).

One of the senior faculty members here on our medicine service
mentioned that in some diabetic patients, we can try to lessen the
amount of thirst by dividing the dosage of trilostane into 30 mg every
12 hours instead of 60 mg every 24 hours. At the higher dosages I
wouldn't have considered this due to fear of too much adrenal
suppression. However, at the low dose we currently have Pebbles on, we
can consider this split regimen if her thirst begins to get out of
control again OR if her diabetic control worsens. The last curve we
looked at suggested we don't need to change anything right now.

I am happy with these results, and none of this would explain the
periodic blood tinge to her stools. I haven't been able to detect any
masses or any other lesions during physical examination, but if the
bloody stool worsens we may need to investigate further.

For now, keep up the good work! We can consider trilo dosage splitting
if the next curve suggests we need to - I will just wait for the next
curve to come back! No need to buy 10 mg trilo at this point.

Thanks, and let me know if you have any questions."

Richard Stone DVM

k9diabetes

06-05-2008, 02:45 PM

Hi Marianne,

I congratulated you in more detail over at the Cush board but just wanted to say it again here... Way to Go!! :cool:

Natalie

rhodesian46

06-05-2008, 04:19 PM

Thanks Natalie I thanked you on the cushings forum as well. Now 60 mgs of trilo will last 2 months. I told Pebbles that she doesn't have to get a job Mama will take care of her:D

BestBuddy

06-05-2008, 08:50 PM

Hi Marianne,
Tell Pebbles I think she is just perfect.:D
Jenny & Buddy

rhodesian46

06-06-2008, 05:05 AM

Jenny I will tell her!

rhodesian46

06-29-2008, 06:48 PM

Hey everybody Haven't posted in a while Yes we are still here!!Have finished Pebbles curve today Not as good as last 2 weeks but I expected it to be worse. Because I laprsed on her Clavamox(started back up on 6/14) her skin infection has gotten worse. She will be on that till 7/24 If the skin infection doesn't get beeter than I will may have to take her back to A & M to see a derm or talk to my new IMS about Yes Dr Stoens last day is tomorrow:(: He says"I would say if it is
not improving after the clavamox, I would let dermatology reevaluate the
skin before another drug is started. The lesions may have changed
slightly in character, indicating another problem. I would say the only
thing she may be on indefinitely for the skin at this point would be the
medicated shampoo. We can let dermatology decide, that is if she is not
most of the way better at the end of this round of clavamox. If she
starts having MORE breakthrough PU/PD or a worsening of her curve, we
can try switching her to 30 mg every 12 hours rather than 60 mg every 24
hours. I will await this weekend's glucose curve! I also noticed that since have her on 1 tbl of yogurt with her meal that her Bgs are higher or it may be the infection. I have stopped the yogurt as of last night and will talk to Dr Stone tomorrow. Am trying to think of all the questions I have as I asked him to call me, I am doing a water consumption test today as well Do you know how hard it is to watch when Pebbles wakes up and goes to th ewater bowl? She usually sleeps and goes outside only to pee and poop!!! It has been 100 degrees here in Austin All of the 6 dogs are in 24/7. ANyway here is her curve: Tell me what you think.
5:30 am- -229 fed,gave 60 mg trilo and meds and 49 u Novolin N
6:30am-223 walked gave 2 baby biscuits
8:30 am-255
10:30am-254
12:30pm-219
2:30pm-182
4:30 pm- 183 fed,gave meds,49 u Novolin
Pebbles says hi to everybodt Will post water intake as we will end it today at 9 pm. Yes I go to bed early Get up every day at 5:30 am to take care of my zoo and then go to work!

k9diabetes

06-29-2008, 11:24 PM

That's a nice curve!! Yes, it's a little higher than you'd like but not much and it's so incredibly flat!! Chris has never been able to get that flat of a curve.

Over the years I've seen people say that significant changes in temperature also affect their dog's blood sugar levels so the heat wave may be part of it too.

I'd only worry about the yogurt if it significantly changed the shape of the curve. If it just raises everything a little, you're probably just adding some calories and if you really want to keep it you could up the insulin a little or cut the other food a little.

It's when you add something and your nice flat curve turns into a nose dive or a screaming spike upward that would concern me.

Glad to hear that you're all surviving the heat wave and sorry to hear that Dr. Stone's moving along. Do you know where exactly he's going? I'd like to keep track of him so he could be recommended where he winds up.

Natalie

Brandy mom

06-30-2008, 06:04 AM

It is still a good curve. I would be dancing over the moom.:D With that much heat you wouldn't get me outside to go pottie. When Brandy had the skin infection she was on Clavamox for 3 weeks and had to have a bath 3-4 times a week. Hang in there it will get better.

Dawn and the girls

rhodesian46

07-02-2008, 04:10 PM

Hey Ya'll.
Dr Stone is going to the University of Georgia Near Atlanta? He will be there a year. Spoke to him yesterday for the last time. He has personally selected a woman Dr named Dr Bostrum. He said that she has great bed side manner and that he has filled her in on everything about Pebbles I will continue to do curves every 2 weeks. and send them to her.He said that I am doing a great job with Pebbles and most clients wouldn't of been able to handle 3 endocrine disease He said that he will e mail me in a couple of months to check on her. I asked him about Pebbles blood in feces, He said that in June that they did a really good exam on her rectum No polypsHis thinking is colitus and doesn't think that the Clavamox is causing this. If it continues or gets worse then I should bring her in , His thinking is that Pebbles is a risk to be put under and that because of her age that we may not want to put her through an endoscopy if bleeding is bad. He is actually surprised that Pebbles is doing as good as she is I don't know whether he meant that she is old and surprised that she is still alive He wants me to start bathing her 2 x a week with the Melesab shampoo and to make sure I leave it on her skin for at least 10 mns. If the infection doesn't get any better by the time I am finished the Clavamox he wants me to set up an appointment for Derm A& M He said it doesn't pay to waste money on a different antibiotic if the lesion have changes,Her Bgs are a little higher than he would want but not bad. I asked him if I could increase her to 50 u He said if she remains with low 300's during my spot checks this week then I could increase but watch her Bgs as they may go lower when the skin infection is cleared, up. I asked him if Pebbles pendulous belly will go back to normal and if her muscle wasting will reverse. He said no it will remain the same ( It would of changed by now being on Trilo. He wants me to continue to walk her as this will keep the muscle that she has He has admitted that Pebbles is not a text book doggie and that she followed non of the rules with Cushings or Diabetes I asked if she was a learning experience He laughed and said yes So my eyes are peeled with poop checks and Melesab shampoos I just bathed Pebbles again this week She had a fit and opened the sliding glass door herself, She was howling and talking up a storm It was a horrble 10 mns, Will bathe again Sun He also said that the yogurt or green beans may increase her Bgs up to 50 pts, I have cut the green beans a tbl She was getting 2 tbl She may be having higher Bgs because of this as well I guess I will have to experiment

k9diabetes

07-02-2008, 04:43 PM

Marianne,

UGA (Athens) is one of the most incredible vet hospitals. My friend Patti has taken her very complex diabetic/atypical Cush dog there for several years and I've been so impressed with them. I'll bet Dr. Stone will LOVE it there!! They are on my Top Five list of vet schools, along with A&M.

What is Dr. Stone's specialty? Is it endocrinology?

Natalie

rhodesian46

07-02-2008, 04:53 PM

I believe he is just specializing in Internal Med. I guess tha tmeans he will handle everything Tell your girlfriend to see him He will be there next week God this guy is sharp I hope he hand picked a good Dr for me!!!!

ladysmom06

07-03-2008, 07:40 AM

Hi Marianne,

I know how upset you are about Dr. Stone - hoping you like the new IMS. If Dr. Stone personally selected her - I'm sure she'll be great with Pebbles. Hugs to you and the gang.

Luv,
Lynne and Lady

rhodesian46

07-13-2008, 08:00 AM

Hey, ya'll.
Am doing a curve today Looks good so far Will post later. Meant ttell you that Pebbles Horner Eye syndrome has gone away. No third eyelid retraction!!!!

rhodesian46

07-13-2008, 06:03 PM

heres Pebbles curve Am using freestyle freedom meter.
5:30am- fasting 148 then fed,gave meds and approx 49 u Novilin N
6:30 am-162 then walked 15mns gave 2 baby milk bones
8:30am-130
10:30 am-158
12:30 pm-146
2:30 pm- 99 tested again with ALpha trak-149
4:30 pm-115 then fed,meds and approx 49 u Novolin N
Again she stays nice and flat!THe skin infecion has gotten a wee better She has 10 more days left of the clavamox left. Noticed that her skin is dry like dandruff Maybe it is cushings related? Shoot I don't knowWill see what my new dr at A & M says Her name is Dr Bostrom. Now if we can kick this bacterial skin infection I would be sooo happy!!!

k9diabetes

07-14-2008, 01:25 AM

Very nice numbers Marianne!!! I know there are a lot of skin changes with the Cushings and as I recall those things take a while to sort out once the treatment is in place, that they're not usually the first thing to resolve but the last.

I'm anxious to hear how things go with the new vet! :)

Natalie

Brandy mom

07-14-2008, 05:24 AM

Marianne

Ok I am dancing on the moon for Pebbles.LOL Great curve and third eye retracted that is all great news. The dry skin got me thinking so I went back to Brandy records on skin infection. Yep there it was a few weeks later I took her back for dry skin. The vet gave Derma caps. I coat got very pretty and dry skin went away. But she started to pant a lot. So off to the vet again. He couldn't find any reason for the panting. The only thing that changed was giving the Derma caps so I stopped them and the panting went away. I think Natalie's Chris had the same problem. I not sure if the Derma caps cause the problem or it was something else.

Dawn and the girls

rhodesian46

07-14-2008, 11:44 AM

Hi Dawn and Natalie,
E mailed the new Dr Bostrom. She e mailed me back early this morning and wanted to know if tomorrow would be good to call me as she needs to review Pebbles records( pretty lengthly indeed) Pebbles will finish her 40th day on Clavamox in 9 days. my concern was that I didn't want to stop any antibiotic as her skin infection would come back worse like when I skipped 10 days in June. I don't know if the Derm at A & M is booked weeks ahead or what. So when she calls me I will question her. I think I read that Cush pups have this dandruffy coat or maybe pebbles is shedding her skin and getting new( Like a snake!!!)Dr Stone had said that to put her on another antibiotic may be a waste as the lesions could of changed. So I will be anxious to talk to Dr Bostrom Will let ya'll know what happens tomorrow

ladysmom06

07-15-2008, 12:42 PM

Hi Marianne,

GREAT CURVE!!!!!!!!!!!

I think I read that Cush pups have this dandruffy coat or maybe pebbles is shedding her skin and getting new( Like a snake!!!)

Lady had the dandruff and dry,flaky skin - I used a shampoo from the vet for it. I know you already use a special shampoo for Pebbles now - not sure what kind your using. Let us know what the IMS has to say. Hugs to you and the gang.

Luv,
Lynne and Lady

rhodesian46

07-15-2008, 04:11 PM

So far I haven't heard from the new Dr . Maybe something came up or maybe pebbles file is way too long!( Ha) I hate watching my cell phone I am afraid that I will miss her call. Will keep you posted!:D
Marianne and Pebbles

eyelostit

07-21-2008, 11:42 PM

Good news her eyelid retracted, and nice curve, glad things are going better:)

rhodesian46

07-22-2008, 03:27 PM

Thanks I have never used the relion meter I have a freestyle and Alpha trak. But getting back to Pebbles I wondered why she hadn't been too interested in eating I have been giving her Tylan powder in her food Got it compounded for her blood in stools It is an antibiotic. Finally figured out that it must taste bad Sure enough it tastes like crap!!! Kinda like pred. Poor Pebbles I should of gotten pill form. Will do a curve this Sunday Hope its good!!! The bacteria skin infection is getting better We are on day 40 of Clavamox and have 2 more weeks to go.Hopefully we can kick butt on this infection.
MArianne and Pebbles

k9diabetes

07-22-2008, 08:16 PM

I tasted Chris' heart med the other day after he bit into a capsule and started drooling. It's very sour and he doesn't care for the taste.

Glad you figured out where the lack of interest in eating may be coming from and that it's something simple.

Also, congrats on the Horner Syndrome resolving - that's very cool.

Natalie

BestBuddy

07-23-2008, 01:33 AM

I've got my fingers crossed for a good curve. The skin infection sounds like it is finally disappearing so I hope you can finally get rid of it. It's a shame about the bad tasting pet meds out there, Buddy turns his nose up at quite a few too.
Jenny & Buddy

ladysmom06

07-25-2008, 06:51 AM

Natalie & We Hope,

Marianne called me this morning and said Pebbles is in the hospital ( Texas A&M) with Pancreatitis. She wanted me to let the two of you know. I didn't talk to her long - she was leaving for work. Said she would update us later after she talked to the vet.

Marianne,

So glad you went with your gut instinct and took Pebbles to the hospital right away. Keeping that sweet little girl in my prayers. Give her tons of hugs and kisses when you see her from Lady and me. Hugs to you and the gang.

Luv,
Lynne and Lady

Dollydog

07-25-2008, 03:20 PM

Hi,
Hope everything is going well for Pebbles today....was sorry to hear about the pancreatitis attack. That poor dog just can't get a break! :(
Will check back later...take care,
Jo-Ann & Lady

k9diabetes

07-25-2008, 03:49 PM

Copied this news from Marianne from CDMB...

Have 3 hours sleep last night and have decided to go back to A & M Pebbles still hasn't eaten. There is a trace of ketones so this may get dangerous in the next 24 hours or she may eat and ketones will disappear. Spoke to Dr Bostrom and she said that Pebbles has a lot of issues(cushings,dm and hypothyroid) If things do get to being bad then they will switch to regular insulin and she will be in crisis. I am worried so I want to see her just in case she doesn't make it and she must be really scared. I am leaving to travel; 2 1/2 hours MAybe she will eat for me She did drink a whole bowl of water at 10 am Don't know whether she kept it down Her Bgs have been in the 300's but she hasn't eaten this morning They are trying to feed her every 4 hours Gave her 1/2 insulin dose. Will post later I am literally exhausted and have been crying so I need to see her!!! Thanks guys for all of your concern Be back later!!!
Marianne

We Hope

07-25-2008, 03:54 PM

Sending thoughts and prayers to Marianne and Pebbles that we'll hear some good news from A & M!

Kathy

rhodesian46

07-25-2008, 07:14 PM

Ok just got in the door Living on no sleep. Work went horrible today Ran out to travel to Tx A & M. I had come home and burst into tears thinking Pebbles could not makeit and that I wanted to see her or I would never fogive myself My poor husband has been driving all these trips and agreed that maybe she would eat for me and that I should see her.When we arrived Pebbles was brought in the room. The students said that I can spend as much time with her as I wish . They are feeding her I think Waltham canned food? I believe I heard right. They said she is on anti nausia iv meds.pain meds and whatever else. She kept the water down and ate a bit for the students. Novomiting. They brought food in for her I asked Pebbles if ( we say to her) she was hunggy???? She howled and ate it all!! She is real alert and quite vocal as she thought she thought she was going home We went outside a bit. Didn't get a chance to meet Dr Bostrom as she was in a meeting The students said that Pebbles has a trace of ketones and a lot of protein in her urine What does that mean??? And of course their is glucose in her urine. They are feeding her every four hours and testing her BGs When I left they were to decide at 6 pm whether to 1/2 her insulin or increase That is up to Dr Bostrom. She is in ICU There is someone with her 24 /7 which makes me feel better. The definite diagnosis of pancreatitis was confirmed at 6 pm today They left me a message on the way back to Austin. So they know for sure They did a test last night in emergency I think a quick snap. Today they sent the test downstairs This guy there is the one who invented this test.I am not familiar with all this so bear with me Anyone who can explain further please do!! I mean I think the good thing is that she has eaten The protein I have no idea what that means??? I realize that she could take a turn for the worse but I can't think that way. The fact that Pebbles is alert and responsive is good!!! If she continues maybe she will come home tomorrow( Positive thinking) It broke my heart to kiss her goodbye as she turned her head numerous times looking at me. I am glad I went. Of course A & M stopped me to get a deposit! Her bill so far is $650 a I am totally tapped giving them $800. Now I know how Johanna felt with Killian. No charge cards!!!UGGGGHHH!!! Oh yeah I forgot her USG is 1.040 Her BUN normal and amalyse??? THe students don't know whether Pebbles will be on DCO anymore That is up to Dr Bostrom. I told them that I wouldn't mind home cooking for Pebbles if that is what it takes to regulate her and keep her from getting sick again. Now I still am a bit confused about her blood being lipemic that this is normal for DM and cush pups Any explanation would help me I asked but I didn't absorb that answer. Too much info for me now. My brain hurts,my heart aches and I am plain old plum tired. PLease say a prayer for my little Pebbles. If I must drive back tomorrow I will They said that no news is good news and also I can call anytime to check on her. My dumb move this evening was to get a coke with caffeine. Time to take a sleeping pill as I am wound and wired Thanks to all that are concerned. Natalie sorry to call you and put more on your plate that you can handle. You are a great person Lynne thanks for answering the phone and hearing me cry and just being there!!!All of you are great!!
Marianne and that fighter of a Pebbles!!!

We Hope

07-25-2008, 08:09 PM

Marianne,

Here's what they were talking about with the SNAP test in ER:

http://www.idexx.com/animalhealth/testkits/snapcpl/index.jsp

"Diagnose or help rule out pancreatitis in a SNAP.

"Use the most accurate pet-side pancreatitis test for clearer direction and added confidence in your diagnostic workup.
Provide answers and a treatment plan to your clients during the patient visit.
Monitor your treatment and the long-term health of your canine pancreatitis patients with the Spec cPL® Test."

SNAP is an Idexx brand name; when you go to the link you'll see SNAP tests for both dogs and cats and for things other than pancreatitis. I've had SNAP tests for heartworm for the dogs for years--they are able to give you results in a very short period of time.

http://www.idexx.com/animalhealth/laboratory/speccpl/compchart.htm

This talks about the doctor at A & M who developed the test.

Right now, it's very hard to say why the protein is in the urine. This page shows it could be a lot of things.

http://en.wikipedia.org/wiki/Proteinuria#Conditions_with_proteinuria_as_a_sign

Take a look at this link's Table #3:

http://www.vet.uga.edu/vpp/clerk/Zwicker/index.php

"Lipemia and high cholesterol concentration"

That's noted for both diabetes and Cushing's patients.

It sounds like Pebbles is making a good recovery--eating and being able to go out for a bit sounds very encouraging. While I don't necessarily know if she's gonna be able to go home tomorrow, I DO believe she is doing well on the road to going home.

Hang in there! While you might want to send Pebbles door to door to take up a collection for her med bills when she gets home, I do believe she's going to do just that. :)

Kathy

k9diabetes

07-25-2008, 10:51 PM

Marianne,

No apology is needed! And I'm thrilled to hear that you got to spend some time with Pebbles and that she's eating and keeping things down. Sounds like she's much improved already.

Texas A&M has a GI lab that runs a whole series of tests - the four different tests that our cat Gus had to sort out pancreatic and IBD issues... Cobolamin, Folate, Pancreatic Lipase Immunoreactivity (PLi), and Trypsin-like Immunoreactivity (TLi)... were all done at the Texas A&M GI lab.

Chris has had the Spec cPL™ test also.

http://www.cvm.tamu.edu/gilab/assays/cPLI.shtml

Hope you are sound asleep right now and that Pebbles gets to come home tomorrow!

Natalie
http://www.k9diabetes.com/forum/images/misc/progress.gif

BestBuddy

07-25-2008, 11:59 PM

Marianne,
Great news. Hope you can take a much improved Pebbles home soon.
Jenny & Buddy

Debbie & Apollo

07-26-2008, 04:46 AM

HI Marianne,

I saw where you were wondering about the protine in the urine.

Since we test Apollo with the urine strips we have on occassion found elevated protien. Our Vet has noted this also -- BUT it is not a major worry...when they feel bad, from whatever - especially infection etc.., you will can a change in the protien -- also since they are not eating like we would like them too... It will get back to normal as Pebbles get better.

If the ketones are elevated -- that is the one I have been alerted to watch for on the strips!

good luck --
I know what you mean about caffine - sometimes I forget too:eek:

Debbie and Apollo

ladysmom06

07-26-2008, 05:21 AM

Hi Marianne,

Just checking in - hoping Miss Pebbles will be able to come home today. Hugs to you and the gang.

Luv,
Lynne and Lady.

Dollydog

07-26-2008, 06:26 AM

Hi Marianne,
So glad you got to visit Pebbles and you have good news about her! :D Hope she's able to come home very soon,
Jo-Ann & Lady :)

rhodesian46

07-26-2008, 11:09 AM

: I spoke to A & M this morning. My heart jumped out of my skin when the unavailable call came in. The 4th year student;Isla said that Pebbles is doing the thing that you told me she would do . I replied "Is she howling with a high shrieking noise that goes right through you?" She said yes I warned her if Pebbles feels better that is the first thing she will do. Many vets have covered her cage because it sound like she is trying to talk!!! probably saying get me the heck out of there! She is eating and drinking They are now taking her off the IVs and giving her pill form of different meds including some sort of pain pill They expect her to be released tomorrow morning if all goes well. She also has been given her 49 u of Novolin N instead of 1/2. Good sign. She is now eating Royal Canin Anyone know what kind ?prescription.? It is of course the lowfat kind. At this time they are comparing this to the DCO to see if she can switch and as far as calorie intake, This is of course up to Dr Bostrom Pebbles weighed in at 55 lbs Has lost 2 lbs since June 3rd. They are not worried or concerned I have reminded them that Pebbles has the fecal blood still so to please make sure that the fiber is sufficient. Also Pebbles has never had anything but DCO for a year now. I wonder how she would do on a different food? Maybe the DCO is part of the reason of insulin resistance And maybe I could give her less insulin if another food worked better.She wrote everything down to ask the Dr as far as my concerns go Also said that if I need to home cook for her just tell me how much of what so I can do this. I have checked Pebbles cholesterol reading from April and she was within range Don't see triglycerides amount. Want to understand the fatty blood isssue. Ya'll have gone through this horrible ordeal please comment as to what questions that you feel I should ask ,what food are you using etc. This has been a hard time for me! Say a prayer that she comes home. I really think that I helped her in being with her yesterday. What the total bill will be I don't want to know!!! They estimated $1200 to $1800. I guess I won't be getting that crown anytime soon!!! I will post later and if I don't that means that all is well And of course I will post tomorrow when she arrives!I want to thank ya'll for all of your info,concern and love for Pebbles. Shesays Ruff Ruff and I say thanks for being there to help me deal with this.

Marianne and Pebbles!!!! Pebbles- 10 yrs old DOB 4/16/98 58 lbs Siberian Husky Has diabetes,hypothyroidism and cushings.Takes Soloxine,Trilostane,Milk Thistle, and is on 49 units of Novolin N BID.Was misdiagnosed with Diabetes Insipitus 3 yrs ago. Also Jasmine-Pebbles sister-husky,Puma (8yrs old)my chubby 12 1b chihuahua,Kahlua-my 6 yr old boxer and survivor of mast call cancer,Harley-2 yr old lab-pit,and Sabastian-1 yr old demon dog eats everything,Sabrina -7 yr old cat ,Yoda 8yr old cat and Baby Boy-my spoiled rotten cockatiel
<< Previous Topic Next Topic >>

Forum Jump

ladysmom06

07-26-2008, 12:54 PM

Hi Marianne,

YEAH PEBBLES - So happy:D:D:D:D she's coming home tomorrow. Give her tons of hugs and kisses from Lady and me when you see her.

Luv,
Lynne and Lady

BestBuddy

07-26-2008, 01:56 PM

Great news. What a good mum you are, you picked up on the problem so early. I hope the new food works well.
Jenny & Buddy

We Hope

07-26-2008, 04:44 PM

Marianne,

You might not be getting the crown, but your Jewel will probably be home tomorrow! :D

I would ask which Royal Canin Veterinary Diet Pebbles is on now because I see one for diabetes and one for pancreatic problems:

http://www.walthamusa.com/Learning%20Center/HF18.html

http://www.walthamusa.com/Learning%20Center/pdf/HF18.pdf

RC Vet-Diabetes HF-18

http://www.walthamusa.com/Learning%20Center/LF20.html

http://www.walthamusa.com/Learning%20Center/pdf/LF20.pdf

RC Vet-Low Fat LF

The Diabetes diet says it has elevated levels of fiber and low fat content, while the Low Fat diet says that it's low fat but with a low fiber content.

OK--fats in the blood-AKA hyperlipidemia:

http://petdiabetes.wikia.com/wiki/Hyperlipidemia

"Hyperlipidemia is associated with diabetes, pancreatitis, Cushing's Disease, and hypothyroidism, among others."

"This 2004 ACVIM Abstract (#216) suggests a strong association between hyperlipidemia and hypothyroidism in dogs."

http://www.acvim.org/uploadedFiles/Forum/abstracts/AbstractsWeb.pdf

Abstract # 216--pages 81 & 82; this is one large pdf file.

http://petdiabetes.wikia.com/wiki/Triglycerides

Triglycerides and how they contribute to insulin resistance.

Let us know as soon as you get that girl where she belongs! ;)

Kathy

rhodesian46

07-26-2008, 07:04 PM

Thanks Kathy
Called A & M this evening Pebbles is doing great No ketones,trace of protein. her Bgs ( lab ) is 132!!! Yeah Thats better than home Dr Bostrom has decided to take her off Purina DCO and was going to put her on Royal Canin None of there fod would work with Pebbles issues She wants low fat,more fiber and I guess more protein She has decided on Purina OM It has 5% more protein than DCO,6% less fat and 4% more fiber. The only thing is that it is $20 more than a 35 lb bag of DCO. Pricey for a 55 lb dog. You know we never tried anything but DCO for Pebbles Maybe a switch is needed not only for her health issues but for her Bg's. I would like to home cook for Pebbles and will address that with Dr Bostrom Don't know how many calories are needed and what the percentage of all is needed. She may not think that it is wise. They are going to call me early tomorrow so that I can begin our 2 1/2 hour journey there. Pebbles is resting comfortably in her cage the student says. Why can't they say that she is chillin!! I will get all copies of their tests and reports and post some info. I am thinking of throwing Dr Stone an email He is now at the University of Georgia for 3 years doing his residency. Like to see what he thinks of this food as well
I am soo happy Pebbles is coming home Thanks ya'll for all of your support

We Hope

07-26-2008, 07:15 PM

Thanks Kathy
Pebbles is resting comfortably in her cage the student says. Why can't they say that she is chillin!!

Call the people hospital and ask about somebody and if they're doing well, they tell you the same thing--minus "cage". :)

They also make a sort of polite announcement on the PA when visiting hours are over. I used to say that I'd like to hear them say--just ONCE--"If you're not working here or sleeping here, you're OUTA here!" :D

Get a good night's rest because you'll be on the way to A & M before you know it!

Kathy

rhodesian46

07-27-2008, 02:55 PM

Got a chance to meet Dr Bostrom today. I liked her but you know noone can compare to Dr Stone!!!She wants me to feed Pebbles 4x a day a total of 5 cups of Prina OM They warned me that Pebbles bg was 99 Don't know if that was before her 8:00am meal or She wants me to monitor her Bgs closely. Doesn't want her to lose any more weight as well. She mentioned that she has never seen a dog recover so quickly and be released. I said Pebbles is a fighter for sure,THey sent her home with Tramadol for pain as needed and Maropitant ( I think this is for anti nausea) We got home at 12:30 pm I immediately tested her with my Alpha trak dog meter, She was 49!!!! I freaked as usual as Pebbles never ever went this low. I grabbed pancake syrup and gave her 1tbl on her gums I tried to give her her 1 c of om and they gave me 2 cans of moist om. She just laid her face in the bowl like she was tired and stoned. I had some white chicken breast in the frig and cut some up was hand feeding her the moist food I took her Bg a 1/2 later it was 77 then an hour after that it was 128.I called A & MTHe student said that Karo syrup is the best thing to give them Is that so? She wants me to check Bgs every 2 hours and when shot time is do to call Dr Bostrom. We may have to skip her shot or 1/2 it tonight. I asked the Dr today if this could be low because of her food change She said yes Also she isn't eating her normal amount. So any advice of going hypo is appreciated I think I will stay up late and test her every 4 hours thereafter till morning They put her on 6 am 6 pm shot and food so I guess I will stick to that schedule instead of 5:30 am and 5:00 pm. I don't know for how long I will have to monitor Pebbles She may just have to have a decrease in insulin!!! It has been a very scarey day for me I am glad she is home but atthe same time I am freaking!!!!
marianne and Pebbles
Also her stool is really soft Has blood in it I am wondering whether it is from the switch of food I will ask how her poop was today when I call Dr Bostrom Ran to the store and bought Pebbles some chicken breasts($1.99 a lb good deal) corn syrup and no fat beef and chicken broth just in case she gets fussy on her dry new food. I am ready!!!

BestBuddy

07-27-2008, 03:00 PM

Hi Marianne,
You always wanted Pebbles to reduce her insulin needs but I guess this wasn't the way you would have liked. You are watching her closely so you are on top of it. I found that the couple of times Bud had a hypo the syrup worked in a few minutes and I could always get him to eat chicken breast to top him up after that. I think the syrup is a "quick fix" but it doesn't hold long so it is important to get some food into them as soon as they will eat.
Good luck and let us know how it goes today.
Jenny & Buddy

We Hope

07-27-2008, 03:50 PM

Marianne,

Jenny's right re: syrup, sugar, etc. being a quick fix and that you need to follow that up with food.

There are two kinds or carbs--simple and complex:

http://petdiabetes.wikia.com/wiki/Carbohydrates

"They are sorted into two basic categories--simple carbohydrates and complex carbohydrates. The difference between the two is this: simple carbs have much shorter chains than complex ones This means they are broken down by the body's digestion easier, making them quickly absorbed. Complex ones have longer chains, which take longer for the body to break down by digestion. They take longer to be absorbed because the breaking down process for them is more complex.

Simple Carbs-

"What this means for someone with diabetes is that in eating simple carbs, such as sugar, products containing sugar, milk, fruit, etc., the rise in blood glucose levels will begin quite soon after the food has been eaten. It will also not last for an extended period of time.

When dealing with hypoglycemia, the simple carbs (like sugar and corn syrup) are desirable, because they are able to work rapidly to raise blood glucose levels. Since they work quickly, they are also expended quickly, with possibly little or nothing left to keep blood glucose levels from dropping again. Eating or feeding something with complex carbs in it shortly after the start of recovery from the hypoglycemia makes certain that there will be longer-lasting carbohydrates available to keep blood glucose levels up, after the sugar or corn syrup has worn off."

http://www.carbs-information.com/simple-carbohydrates.htm

So you see here that yes, they do raise the bg's rapidly to get you out of hypo, but they are in and out of the system rather quickly. They will raise it, but since they don't stick around very long, you need something more substantial to "hold them up" after you've raised them with syrup or sugar.

They usually advise people to have a sandwich about 30 minutes after they've had a hypo problem and needed to use something syrupy or sugary. The bread for the sandwich is a complex carb.

Complex Carbs-

"Eating complex carbs such as potatoes and grains, means that the rise in blood glucose levels from them will begin later than with the simple carbs. The rise from complex carbs is also longer lasting."

http://www.weightlossforall.com/complex-carbs.htm

We had a situation some time ago on the other board where a dog threw up his dinner and went hypo very soon after getting his evening insulin shot. The person was very new to diabetes. She knew how to give the syrup or sugar, but not what to do about the evening's dose of insulin he'd just been given.

We had her feeding him peanut butter and jelly sandwiches--something he loved but couldn't have any more. What we wanted to do is offer him something he loved so much he wouldn't refuse that was carby. She had one hand on the phone to her vet and the other on the computer keyboard. We fed enough PB & J in advance of the NPH's peak (when it works the hardest). Since she was so new to this, we had to use the insulin activity profile for NPH to estimate about what time that evening NPH would be peaking for him.

His vet didn't need to do an emergency that night--good old PB & J "fed" the insulin and he had no more hypos from this.

Lucky had only one very low incident when we were first getting him regulated on Iletin II Lente. He was at 35 with no physical hypo signs. He got 2 cc's of Mrs. Butterworth's in a 3 cc syringe barrel under his tongue and a Happy Meal cheeseburger--something he loved but couldn't have after diabetes. He had no pancreatitis problems so we went with something he'd eat up quickly.

I think doing a bit of reading on the simple and complex carbs when you have a chance would be good for any future problems.

It might help to compare simple carbs to fast-acting R insulin--works fast, fades fast too, and then to compare complex carbs to intermediate acting insulin like NPH--starts slower, lasts longer.

HTH!

Kathy

forscooter

07-27-2008, 04:21 PM

Marianne,

If it helps, I am so sorry you are going through this....I can say that after I have a hypo episode, I do need to eat within the hour or I rollercoaster right back down again. In addition to the more complex carbs, you can also serve a simple carb along with a protein or fat (but I know fat isn't good with pancreatitis...).....by adding protein or fat along with the carb, it creates a longer rise and fall of the glucose.

The simple carb will get it up quickly, the complex or simple carb along with the protein or fat will keep it there on more of a curve you want so you can avoid the yo-yo of up/down/up/down....

Hugs to you and Pebbles! Beth, Scooter and Bailey

rhodesian46

07-27-2008, 05:19 PM

Pebbles has stayed in the 130's on the dog meter have been checking her every hour at first now every 2. Got a chance to talk to Dr Bostrom this evening as I had to know how much insulin to give her She said that this morning at fasting Pebbles was 99 and that the students should of called her before they injected her with 49 u(her regular amount) If they would of called her she said that they would of been told to 1/2 the insulin At least I was warned at pick up that this could occur and I checked her as soon as I walked into the door She was 130 at fasting this evening so Dr said to only give her 20 u after she eats She ended up eating her 1 1/4 c of OM food put some chicken breast in it and no fat beef broth She gobbled it Pebbles stool was pretty loose today SHe said that this is probably from the change of food and should get better It also had more blood in it than usual She replied that it is probably stress colitis I will need to feed her again a 9 pm ( her small 4 mini meals) until the Dr tells me otherwise.I suggested that I test her again before I feed then around 12:00 am If lower than 130 give a snack. I will set my alarm to get up at 4 am as well, She said if her bgs are lower than 130 at fasting then to skip the insulin in the morning If higher than 130 then 1/2 the insulin. I guess she wants Pebbles to be safe Better high than low.She will retrieve her e mail at noon( SHe is off tomorrow)and will will discuss furtherPebbles otherwise is her lazy self laying down in the kitchen on the tile floor. She has been through a lot and I am emoitionally and physically tired It has been a horrible 3 days!!! I will need to put Pebbles to work as her bill was $1200. Holy crap!!!!! SHe better give me 5 more years!!!If you see a lady with a husky on the side of the road beggin for money it is Marianne and Pebbles( HA):D:D

k9diabetes

07-27-2008, 11:34 PM

Yay!! Pebbles is home!!!!

With low BGs I always start with syrup or frosting (we use pancake syrup rather than karo cuz Chris would never take the karo). These days I mostly use frosting - less messy. But if he lost consciousness, I would use syrup.

That's going to get into the system immediately and stop any continuing downslide of the blood sugar. It doesn't have to be digested - it gets absorbed directly through the gums and from the digestive tract into the bloodstream so it works faster than anything else you can give.

Since sugar syrup gets in fast, it gets out fast too. So it won't hold the blood sugar for very long.

So most of the time I follow up with something readily digestible like kibble or crackers and finally with something longer lasting like protein.

So I always give sugar first.

Whether I follow up with anything else depends on where we are in the insulin injection's life span. If there's likely more insulin to come, I definitely give longer lasting food. If it happens shortly before the next meal when his insulin is basically used up, I will usually use sugar only to prop the blood sugar up to a normal level and then do his meal and insulin.

Thank goodness for home testing.

Natalie

We Hope

07-29-2008, 07:38 AM

Well, Pebbles has been home for 2 days. So, Marianne, how are things going with one of the most expensive dogs in Texas? :D:D:D:D

Kathy

k9diabetes

07-29-2008, 10:32 PM

Hi Marianne,

Also checking on Pebbles. I hate to see insulin doses cut in half... that always seems awfully drastic to me. Am anxious to hear how things are going.

Natalie

rhodesian46

07-30-2008, 02:11 PM

Hi Natalie,
Yesterday Pebbles was 369 at morning fastThat was at 5:30 am AT 2:30 she was 332 E mailed the Dr SHe said to increase to 40 units Last night and this morningShe was 314 this morning at 5:30 am My husband was home with her at 11:30 and took herBg It was 150 then gave her meal She picked out all of the chicken out of her Om dry So he called me freaking I had him give a little less than 1/2 can of moist Om At 2:30 pm it was 144 BTW am using my alpha trak as I want to watch these bgs. I guess I am confused and will e mail Dr. Bostrom. I mean how can we even think of regulating Pebbles on 4 meals a day I think her plan is to keep her Bg's in range so she doesn't go high? She is not eating the exact amount as I scramble for Om canned when she gets picky.I know how chicken breasts(no rib) in the crock pot for the rest of the week Will add some of the juice to her foodI need to ask the Dr her game plan Don't want to rush things but 40 u yesterday and this morning will not show it is working right for a couple of days? Will let you know what the Dr says as I need to email her Bgs today
Marianne and Pebbles

rhodesian46

07-30-2008, 03:34 PM

Hi KAthy,
Please read post to Natalie above. And tell me what youthink.:D
Still waiting for the Dr to email me as far as the amount of insulin to do tonight. Yes Pebbles is an expensive doggy Can't afford for anything else go wrong as I still have a balance at A & M! I really don't want to figure on how much I spent on herIt is more than $5000 in a year that is for sure if you add meds,insulin,testing strips,stim tests and all of the A & M visits and before that. Oh god I am getting ill. (Ha) Pebbles will have to go find a job or I need to get 2!!!!
Marianne and Pebbles

k9diabetes

07-30-2008, 06:17 PM

Hi Marianne,

The four meals a day is to try to avoid another bout of pancreatitis by avoiding overloading the pancreas with a few big meals. Johanna's Killian was put on the same plan after his pancreatitis attack. So it definitely is worth trying, if only to save agony and money.

There are ways to make it work if it doesn't work with the current regimen if they want you to keep this as a permanent thing....

Is this something they expect to be permanent for Pebbles or just for a while to settle things and then see if the diet change is enough?

Sometimes it is necessary to give a little boost of something like Regular insulin with the intervening meals. It can also be possible to overlap smaller injections of insulin if the meals are given something like every six hours.

Are you feeding every 6 hours on a 24-hour schedule or feeding 4 meals in 12 hours with a 12-hour mealless stretch at night?

I'm sure it can be made to work reasonably well if that's the way it has to be. Much better than another pancreatitis incident.

Talk to her about her willingness to eat the food too. That is certainly an issue with a diabetic - she needs to be fed something she will eat!

Natalie

Hi Natalie,
Yesterday Pebbles was 369 at morning fastThat was at 5:30 am AT 2:30 she was 332 E mailed the Dr SHe said to increase to 40 units Last night and this morningShe was 314 this morning at 5:30 am My husband was home with her at 11:30 and took herBg It was 150 then gave her meal She picked out all of the chicken out of her Om dry So he called me freaking I had him give a little less than 1/2 can of moist Om At 2:30 pm it was 144 BTW am using my alpha trak as I want to watch these bgs. I guess I am confused and will e mail Dr. Bostrom. I mean how can we even think of regulating Pebbles on 4 meals a day I think her plan is to keep her Bg's in range so she doesn't go high? She is not eating the exact amount as I scramble for Om canned when she gets picky.I know how chicken breasts(no rib) in the crock pot for the rest of the week Will add some of the juice to her foodI need to ask the Dr her game plan Don't want to rush things but 40 u yesterday and this morning will not show it is working right for a couple of days? Will let you know what the Dr says as I need to email her Bgs today
Marianne and Pebbles

rhodesian46

07-30-2008, 06:57 PM

PEBBLES IS on a 15 hr schedule Eats at 5:30 am ,11:30 am,5 pm,and 9 pm. Of course we split the 5c Purina OM plus addded chicken and om canned if she doesn't finish Dr Bostrom e mailed me Pebbles stayed at 150 from 11:30 to about 144 a fasting at 5 PM.She wants Pebbles to be on 40 u for 2 days and try to wean her off of 4 meals a day to 3 then 2 meals. I am going to call her fri as I am off and have time to talk to her. I am not comfortable in reducing her to 2 meals a day. Will wean her tomorrow to 3 for at least a week What do you think? I wouldn't mind feeding her 3 x a day. I wonder if that would be better. Also isn't the 40 units going to kick in in a couple Just increased her to 40 last night. You know this dr is assuming that I will keep an eye on her and her Bgs. I think I will do 5:45 am.12:00 pm and then her normal time that I inject a second time at 5 pm. Would it be smart if I did a bg every time? I feed at fasting then before I go to bed at 9 pm. Like to see how this 40 u works for her She wants Pebbles to be fed 2 x a day. I don't agree for now or maybe never!PLease give me your feedback on this She hasn't mentioned R insulin at all I wonder why? Shoot I am confused I mean what is the majic number for Pebbles Maybe the 40 u bid is too much. I will keep an eye?

We Hope

07-31-2008, 07:50 AM

Hi Marianne,

Looking at what you've posted since Pebbles came home, I see that you do have a high morning fasting. It might be caused by the fact that you feed and give insulin at 5PM, then feed once more at 9 PM--possibly the timing of that 9 PM meal against the 5 PM meal and insulin.

I can see where your vet is trying to go here, with the thought of taking Pebbles back to the 2 meals a day she was on before. If you're not comfortable with going back to 2, 3 seems to be workable because you can use some R if need be, as Natalie has told you. Giving the food in thirds instead of half, would still mean that you are giving the pancreas less to digest at each feeding.

You could think about something like this:

5 AM--breakfast and NPH

11AM-Noon--"lunch"--possibly giving some R with it

5 PM--dinner and NPH

That would remove the 9 PM meal and most likely mean that her morning fasting would be lower, since she would be going 12 hours--from 5 PM to 5 AM without any food. I know you'll check her before going to bed and will give her a snack if she seems to be dropping too low.

I would be testing more than usual because this is a new "pattern" for both of you and this is the only way you're going to be able to see how Pebbles is handling it, bg-wise. It will show you how much the additional meal(s) have made her bg's change.

When you talk with the doctor tomorrow, why not initiate the discussion about using R? The possible use of the R may mean that Pebbles doesn't need so much NPH because you would have that working as well as any R that might be added. This is a good time to discuss something like this with her, along with Pebbles not caring to eat the new food too much.

Don't be afraid to tell her what's worrying you--the thought of another pancreatitis attack--if you go back to 2 meals a day. Again, I see where she's trying to go--to get the meals back to the point where they were--along with the insulin. Then the two of you can talk this issue out; she can tell you her thoughts and you can give her yours.

Both of you want what's best for Pebbles; sometimes talking it out can be good medicine. It's too bad we didn't record the "sessions" John and I had when helping Lucky. If we did, you would have heard two people doing a lot of bouncing thoughts and ideas back and forth. (It was also marvelous therapy for me! :D ) This was how we were able to take someone who didn't fit any pattern and was the toughest diabetes case John had ever seen in 35 years of practice and make him the easiest to control and most stable diabetes patient. We both did a LOT of research and a lot of observing his reactions--large and small--sharing and discussing it in terms of what this might mean to Lucky.

I'm sure the doctor will say what she thinks, and you need to do the same. You're both "players" on Pebbles' team, so give and take can only help. :)

Kathy

rhodesian46

07-31-2008, 12:10 PM

Hi Kathy
I don't think Pebbles is ready for 3 meals a day yet. I am off Fri St and Sun and would really like to see how she eats for me. g( the last time she had eaten was 9 pm( her Bg then at fasting was 196) the night before Her Bg at 5:45 am today was 240 on my dog meter Not bad.She ate all of her om dry with chicken,I wasn't home to feed her at 11:30 am today ZShe gave my husband a hard time and left all of her kibble:picked out the chicken!SO maybe she ate 1/2c Was supposed get 1 1/4 c . I got home at 12 pm and she still didn't eat. My husband mixed the canned om(1/3) with her kibble) She wouldn't eat it I picked through her kibbles and got the canned OM out of the food Took her Bg was 146 and then fed her the rest of the canned OmWas worried that she will drop later today as her Bg is usually lowest around 2:30 pm THe brat ate that. SO we really don't have consistency with her food yet and she is not eating everything at one meal Maybe it is because it is 5-6 hours in between each meal or maybe she isn't healed yet. Any ideas that I can do with her kibble?SHe needs to eat this as it has a lot of fiber in it and is low fat SOme meals she eats it allAs far as giving R around 11. She hasn't been real high at that time I feel like I am playing with her Bgs My main concern is to make sure she eats and enough I think I will place a call tomorrow to the Dr Bostrom

We Hope

07-31-2008, 12:43 PM

Marianne,

First of all the doctor needs to know that Pebbles is not eating all of her meals and is grabbing the "good stuff" at times, leaving what's important to her. Can you get hold of some fat free, low salt chicken broth and run this by the doctor as a possible incentive to eating the OM? Using that with either the canned or dry might make the OM more edible in Pebbles' eyes. The broth has very few calories in it, so that content shouldn't be a problem. Look for the labels that say Fat Free and Low Salt or Low Sodium as there are cans of chicken broth on the market which are not.

If you heat it a bit before you put it in the food, you'll get the chicken aroma going even more. Dogs eat with their noses and you want to make these meals smell as temping as possible without any chance of bothering the pancreatitis.

I agree with you that right now you need 4 "chances" to get the proper amount of food into Pebbles until you can find something that won't contend with the pancreatitis that will make her want to eat the OM on a regular basis.

When I brought this up with the doctor, I would also get into the insulin question because what's going on right now is that she is not eating her full daily portion, and this is probably what's keeping her bg's down. I'd mention this and then ask her where we're going when we find a way to get a full day's OM into Pebbles and we may run into some "bumps" with the bg's.

Have you tried getting the chicken to the point where it's chopped very fine, then mixed so that it would be almost impossible for her to go through the bowl and pick the chicken out without getting some of the OM in the process?

Again--agree with you that you need to contact the doctor and see what her prescription for a "picky patient" is. I think she's having some fun with all of you and hoping that you might decide to serve only the chicken. :)

The little girl we had before Lucky had a bout with some minor GI problems and she was put on the bland boiled beef and rice diet for about a week to settle things down for her. She'd gotten over the GI problem just fine, but oh, the headaches we had trying to get her back onto her "fat dog" R/D once again! She wanted the boiled beef and rice to keep coming.

The tough part of having a dog with diabetes and having that dog decide not to eat is that he/she has all of the "cards", "winning" the game by refusing things. Even tougher is that you're dealing with pancreatitis here and can't go with the idea of just getting something they'll eat--diabetic diet-friendly or not--into them.

Hang in there!

Kathy

rhodesian46

07-31-2008, 01:59 PM

I have added low fat chicken broth and no fat beef broth Somethimes it works SOmetimes it doesn't. I bought some white chicken tenders and put them in the crock pot with some water Used the juices for the feeding today at 11:30am. Thats the same meal that she put her nose up on I will break that chicken upmore fine What about taking the dry Om putting it in the blender and making it like bread crumbs then adding the chicken and some broth MAy be I can trick her.This is so hard. WILL KEEP YOU POSTEDThanks
MArianne

We Hope

07-31-2008, 02:17 PM

Marianne,

You can only take a shot at blending some OM as you said and see if she will eat it. If you put the chicken in the blender too and make it about as fine as sawdust, this should be impossible for her to pick out.

It's not easy, but it would be somewhat less difficult if we weren't looking at the pancreatitis and have to be SOO careful about the fat. At times like these, those who aren't dealing with pancreatitis can try a little baby food, but I wouldn't think about that unless I asked the doctor for some idea of how much fat, if any, might be permissible. Then if you need to resort to baby food, you can do that with an eye on the label's fat content.

I had Lucky refuse his food once, due to a bad anxiety attack. Got him back to eating with some baby food, with my eye being on the label's carbs, sugars and fats. Gave him some straight first, then a bit of it mixed with the W/D canned. By dinner time, he was back to eating the W/D without my needing to add anything to it, but we weren't dealing with pancreatitis.

John and his son were both out of town when it happened, but I knew John would tell me to get him eating again, even if it's not what we want him to eat--that we would deal with that one once he was eating. When he got back, he said that I'd read his mind once again. :)

Maybe Pebbles thinks Dad might give in to her more than Mom does. :D

Keep on keepin' on!

Kathy

rhodesian46

07-31-2008, 02:33 PM

I looked back the past days on her records It is definitely the 2 nd meal that she is the fussiest Put an e mail to Dr Bostrom to call me Meanwhile out comes the blender!!!!Chop Chop!!! I hink the baby food has too much fat as I had brught 2 can to A & M and the Dr wouldn't let me feed Pebbles that.
MArianne

We Hope

07-31-2008, 02:43 PM

Sometimes the things you come up with out of sheer frustration that can't do any harm are the biggest successes! ;)

Could it be that she's not really that hungry by the time Meal #2 shows up and she can "afford" to pick at it because she's already had her breakfast?

Hoping that Meal #3 will be better and that Pebbles will appreciate all your effort in the kitchen by eating it ALL! :)

Kathy

Debbie & Apollo

07-31-2008, 03:13 PM

Dear Marianne and Pebbles,

Apollo gets 5 mini meals beacause of the pancreatitis and (if he's feeling ok) he also seems to be hungry! HE comes looking for me! and I mean ME!

Anyhow -- Pebbles tummy might not be geared to that extra meal schedule and that may have her confused.
As for all the extras you are doing to get her to eat - trial and error -
Yes - she could could looking for something better.
It also sounds like she eats better for you :D (that happens here too ;)

My mother in law says -- "If he's hungry he'll eat!" I want to ^%$#% :(

Until later -- have fun with that blender!

Debbie and Apollo

We Hope

07-31-2008, 03:27 PM

When Pebbles is done with the blender, and she's eating on schedule again, clean it out good and use it to reward the kitchen help:

http://artfiles.art.com/images/-/Nancy-Overton/Margarita-Print-C10141644.jpeg

This includes DH as he's part of the "crew". :)

rhodesian46

07-31-2008, 03:29 PM

Heard from Dr Bostrom. I told her my concerns and she replied "I think you are stressing too much about the food issue and should be enjoying Pebbles good quality of life!! OMG I was flabbergasted-She is not an advocate of r insulin and only uses it in a dog that is ketoacidosis. She feels that Pebbles will do well on a 2x a day regimen and being on a lowfat diet like hers will help in not having a recurring problem with pancreatitis She does agree that Pebbles is probably not hungry noontime Duh I could of figured that out!.She wants her on 40 u today and tomorrow and if she runs low at fasting( under 120) then call her I questioned how much of the canned OM should I give Pebbles if she doesn't eat well. She replied Didn't the students calculate that on her discharge papers? I said no I have read it twice they calculated calories on the dry She will e mail the calorie content I think I will send her an email as I am pretty aggravated at her Of course I am stressing I am new at this problem

We Hope

07-31-2008, 03:40 PM

Marianne,

I have no idea how things work when one goes to a teaching hospital like A & M, but if you're not pleased with this doctor, is it possible for you to choose another one?

We've had the same family of vets for 50 years without any disagreements, so all of this is new to me. Know how it works re: changing MD's in and out of hospital, but again, no idea of how the A & M system works with respect to this.

Kathy

Brandy mom

07-31-2008, 08:13 PM

Marianne

Brandy the brat would do the same thing. Eat all the chicken and leave the dry. So I tricked her. I ground up the dry and added chicken broth and cooked ground turkey. Heated it up in the mirco. I also add fiber powder to make it thicker. She couldn't pick out the ground turkey like chicken.

Then I started to ground the dry less and less. So she would eat the kibble with broth and ground turkey and fiber. Next I started to add more water and less broth. Now she eats the dry with ground turkey and fiber and warm water. It took about 2 months to get her to eat this.

Ask the vet. If you want to keep Pebbles on 3-4 meals a day. If you could feed less food each meal. Then increase the amount each day. If you added a few tablespoons each meal. Not sure if the vet would agree with this because of Pebble weight.

Dawn and the girls

rhodesian46

08-01-2008, 06:55 AM

Have switched to 3 meals a day. She ate last night but gave me a hard time this morningShe is eating 1 3/4 c of kibble each meal I also add probably 1/2 c of chicken and chicked broth. Her weight needs to stay at 55 lbs so adding chicken is not going to hurt her I will be home these next 3 days and I will monitor her bgs Once I see that she is eating well I will go to 2 and then do curves. I may have to give her a snack lunchtime or in the evening as she is not getting anything after 5 pm or so,Will see what her bgs look like I really haven't decided for on 2 meals a day Lets see if her appetite improves I am wondering too if this make a difference in appetite. Pebbles is on a pain bill Tramadol(human med) Today is her last day of it I wonder if this could be causing some of her inappentance

We Hope

08-01-2008, 07:25 AM

Marianne,

BINGO!

http://www.drugs.com/tramadol.html

"Less serious side effects may include:

"nausea, vomiting, constipation, loss of appetite;"

Agree with you--you're not gonna see too much that you want to know until Pebbles quits the pills which may be affecting her appetite.

Kathy

rhodesian46

08-01-2008, 11:18 AM

KAthy,
Shehas one more dose tonight I really don't have to give it to her as the script says as needed every 8-12 hours. I am going to skip it and see what tomorrow brings. Sorry I forgot to mention tramadol to you So far so good she has eaten well last night and her 2 meals today She has one meal left(a total of 3 now) which will be at 5-5:30 tonight, Her Bgs before her luch meal was 222 Not bad
MArianne and Pebbles

We Hope

08-01-2008, 11:28 AM

GREAT!!! It was Meal #2 that was giving you fits, so we've had a move in the right direction there.

You're right--even the bg's aren't running too badly.

Don't know about you, but it seems like we've come a long way from yesterday--gotta love that kitchen crew and their determination! :D:D:D

BTW, Marianne, what did you do differently than what you were serving yesterday? If you'd be kind enough to post it, it might help others who could be going through something like this--might give them some ideas to try.

Kathy

Dollydog

08-01-2008, 12:19 PM

Hi Marianne,
Glad to hear that things may be getting better in the food department. Lady became difficult about eating her breakfast a few months after becoming diabetic. This was a dog who always ate her meals without a problem and loved trying new food.
Aussie Terriers like to make a game out of everything and when Lady discovered that Mom was desperate for her to eat and would do anything to get her to eat, she would wait to see what I would do to her food so that she would eat enough to use up the insulin. Lunch and supper were the same foods but she wouldn't have a problem eating them. Her lunch meal is smaller than the ones at shot time.
But her breakfast could take up to 45 minutes to get eaten while she waited for something to tempt her pallet!! That was in April/07 and I had changed some of her diet to include the high fiber food from Royal Canin. I finally found a combination that she would eat up right away but I was getting pretty stressed about the whole thing. Our Nevada vet never tells me I'm stressing, but I pick up on his voice and facial expression when he thinks I'm going too far and I definitely know I'm trying his patience when he puts my name in the middle of a sentence!
Lady takes Cephelexin pills for 7 days out of the month and it has affected her appetite at breakfast and lunch. If that happens at a breakfast meal now I give her 1/4-1/3 cup of the dry food that she likes and it gets eaten up right away. Plus I know that she's getting enough food to match the insulin and I don't worry that the fiber isn't quite as high for that meal. PLUS the pills that come from the pharmacy are smaller than the capsules from the vet AND came with instructions on when to give them and that is helping with the eating of breakfast during that time. :D
Lady is getting Metacam daily and I was giving it at night with pumpkin. Then I read a post of Beth's and she always gives it with meals so I changed that too. Those little changes seem to be agreeing with her and making her more comfortable. ;)
Will check back to see how you're making out,
Jo-Ann & Lady :)

rhodesian46

08-01-2008, 06:48 PM

Ok this is where the Italian in me came in handy I measured 1 3/4 c of her OM kibbles and put it in a blender Made it look bread crumbs.Then I put the white meat chicken in a blender It too looks like bread crumbs I added about 1/2 c of the chicken water (leftover from me cooking her chicken in the crock pot) and about 1/2 cup of chicken and made meatballs. She can't eat the chicken out of this! She has eaten last night and all of her 3 meals today SO here is the problem now Remember when I posted the other that her bg's were good in the afternoon because she didn't eat all of her meals. Tell me what you think. At 5:45 am her fasting on the Alpha trak was 187(not bad) fed At 11:30 am it was 222 then I fed At 5:45 this evening she registered high on my meter : then I fed She has been on 40 u bid as well as the Dr wants her on this amount till Sun morning. My thinking is that she is now eating therefore I will see higher readings for now. I would like to do 3 meals a day for another day or 2 but I am not sure as if I went to 2 meals a day On sunday. Her bg's probably would be better doing 2 meals Didn't giver her her pain pills tonight as she has one more dosage left. She doesn't have to finish them.Kathy and everyone please giveme your feedback on Pebs high Bgs.
Marianne and the Italian Pebbles
P.S. Kathy break out the margharitas

We Hope

08-01-2008, 08:01 PM

OK, Marianne, "pay" before "play". :)

First of all, yes, HURRAY!, she's back to eating her full portion of food, which wasn't going on when you were having the lower bg's.

Second, that lunch is a "speedbump" to the action of the NPH you normally have when Pebbles is eating only 2 meals a day, just before her insulin. By the time Pebbles starts to digest lunch (this begins about 2 hours after eating--this is why you see people with diabetes checking their bg's then), the NPH isn't working hard enough to be able to handle the second shot of glucose from the food that's coming at it.

This doesn't mean there's anything wrong with the insulin or Pebbles--it means that the insulin just is not formulated to handle this. A person with diabetes in this situation would use some fast (R) or rapid (Humalog, Novolog or Apidra) acting insulin to cover the food eaten at lunchtime. That would prevent the high bg's from showing up before dinner.

When Lucky had the bout with colitis, we had him on 3 meals a day for a short time--the "middle" meal was throwing his bg's off too, which we expected it would.

http://www.k9diabetes.com/insulinfood.html

"So insulin and food are an issue of balance. Kind of like a race... a relay race really, because there is constant processing of the food and the insulin throughout the period of time between meals and injections. The finish line is the bloodstream. Sometimes the food team is ahead, sometimes the insulin.

"If the insulin gets ahead of the food being digested and turned into glucose, your dog’s blood sugar can drop too far too fast. If the food gets ahead of the insulin, your dog’s blood sugar can rise too far too fast. A dead heat is what you want - food and insulin being delivered in balance, giving your dog a steady supply of glucose in a good range throughout the day."

So if we want to go Olympic a bit, it's something like putting more hurdles on the track when the runners get started. They can be world-class athletes, but they're only going to be able to jump X number of hurdles without either exhausting themselves or falling short of those bars.

This is what's happening to poor NPH with the middle meal--more "hurdles" than it can jump. Bringing in some R, as people would do, would help the situation, but I understand your vet is against that idea, period, so until Pebbles can get back to two meals a day, I think she will have some higher bg's.

I don't believe you should be increasing the NPH because it has a much longer time of activity then R does--increasing the NPH could mean borrowing other kinds of trouble such as lows or even rebound. When Pebbles gets back on two meals a day and she's higher than she should be, it may be time to talk about that.

I think you could sort of "sneak" your way back to two meals a day--as Dawn mentioned here about feeding less at each meal, but in reverse--taking some from the lunch and adding that to the breakfast and dinner meals. It would be gradual and our end point would be that lunch is discontinued. You might feel more comfortable about doing it like that, and that would mean the lunch bg "speedbump" would be getting smaller all the time, just like lunch. :D

Good thing Pebbles doesn't need to save up for this for you at Christmas:

http://www.seenontvproducts.net/meatballmagic/Meatball%20Magic.jpg

And now--if the blender is ready----

http://artfiles.art.com/images/-/Nancy-Overton/Margarita-Print-C10141644.jpeg
GUSTARE!!!!

If that's not right, blame Google, as it said that's Italian for ENJOY!!! :D

Kathy

rhodesian46

08-01-2008, 08:32 PM

MAybe I can decrease her mid meal to 1 1/4 c( instead of 1 3/4 c)then add a 1/4 cu to morning and evening Then Sunday go to 1 c midday and add the rest to morning and evening I test before each meal and at 9 pm when I go to bed Do you feel I should test more than that?Pebbles need to get a friggin job!!! Not look for a meatball maker!!! I wonder if I can add some garlic powder to her meatball!! Gotta make Pebbles have bad breath not that she doesn't have it from bad teeth!!! Seriously would garlic hurt her!!! I should amrket these meatballs Call them Pebbles Mangia meatballs Maybe then I can pay off my debt to A & M ALso could get Pebbles a dog condo and a masseuse to make her back better, Ok Marianne taking this a little too far!!!!Just want to be a little rich so I don't have to worry about dog and cat health problems. Cheers!
Marianne and Pebbles:D:D:D

We Hope

08-01-2008, 08:57 PM

Marianne,

I think your plan to make lunch disappear sounds good. You'll gradually be putting the major food load onto the morning and evening NPH--it was able to handle it before and it should handle it again. It also means that with the pancreatitis, you are easing Pebbles' way back to the two meals a day and you can see how she handles things with that too.

I think they way you're testing now is just fine too. If we were looking at a situation where we were afraid that Pebbles might be going too low at night, that would be a different story.

Just had a look at one of Toodles' dog "junk foods"--the Puparoni Lean I use for his pills says it has garlic powder in it, but I think as long as she's eating the "not-so-old family recipe" happily now, I wouldn't mess with success. :)

Maybe we could put out a k9diabetes cookbook--we already have two recipes--Pebbles' Mangia Meatballs and Ricky's Baked W/D. :D

If I won the lottery, I'd get Toodles a Dog Nanny who would pick up the things he throws on the floor and then barks until The Maid (guess who :) ) "retrieves" them.

Kathy

rhodesian46

08-02-2008, 01:50 PM

Hi Kathy,
So far so good Her BG at 5:45 am at fasting was 239.pebbles ate 2 cups in the morning along with her chicken and broth, At 11:30 am her bg was146 fed her 1 c of kibble with her chicken and broth Total is going to be 5 cups You know if Pebbles bgs look good at 1 c or 1/2 c lunchtime then I may keep her on 3 meals a day It doesn't have to exactly divided into 3's?. I guess it will be trial and error and many curves will be done Her pu/pd is fine Her bg at 2:45 pm was 289 Will take another one at fasting for dinner and feed her 2 c of ki bble ,chicken and broth
Marianne and Pebbles

We Hope

08-02-2008, 02:14 PM

You bet, Marianne, so far, so good! :)

What we see here is that the insulin after breakfast is doing its job when you tested her before lunch, and then you see lunch beginning to make them go up again. As we talked about before, you're getting the "climb" after lunch because that meal messes up the NPH action somewhat. We're giving food when the NPH is at a point where it just isn't able to bring down the bg's from lunch. I would expect that you will see they're higher than you'd like when you test her before dinner because of the middle meal.

No, you don't have to divide them evenly into thirds--if her bg's work out with keeping lunch, you'll want to make sure lunch is the lightest meal you serve because there's no insulin given to cover it. I'd try, though, to keep breakfast and dinner exactly even portion-wise, because this is when Pebbles is getting her insulin. So if you were going to cut the cup of lunch down to a half cup, it leaves you with a half cup to divide in quarters--1/4 more to breakfast and 1/4 more to dinner.

If you give that a try, her post-meal bg's should be even better than what you've seen today after lunch--because there's less food there to be dealt with without insulin being given.

Isn't it great that we're able to sit here and talk about this, compared to what was happening with Pebbles last week at this time?

Pebbles, You GO, Girl!!! :):D

Kathy

rhodesian46

08-02-2008, 08:09 PM

Yes it was a pretty stressful weekend for both of us last week.I think we put over 650 miles traveling to A & M back and forth *Her bg at fasting this evening 5:30 am was 196 Not bad And at 9 pm it was 240. I am hoping that 1/2 c lunchtime will make her Bgs better WIll keep her at 2 1/4 c both other meals. I just wish that Pebbles hair would grow back instead of clumps!! Pebbles says thanks Kathy Actually she said "who's Kathy? I thought she was We Hope"!!!:D:D:D
Marianne and Pebbles

We Hope

08-02-2008, 09:12 PM

That girl is gonna shock the socks off us yet! :) As long as Pebbles went from 289 at 2:45 to 196 before dinner at 5:30, I think you're going to be able to pull this one off, Marianne, by leaving the 1/2 cup at lunchtime. Our lunch "speedbump" seems to be smaller and the NPH is able to handle it.

My thought would be that when you go down to 1/2 cup for lunch, it probably won't have much of an effect on the bg's at all--if any.

There are people whose dogs tend to go quite low when the insulin "peaks"--working at its hardest--and it's a must that they get either a snack or a small meal around that time. I'll be waiting to see how Miss Pebbles handles things tomorrow with only the 1/2 cup for lunch--something tells me I should put my money on her. :D

Again, I think it's great that she's doing so well this weekend after spending last weekend at A & M. Last weekend we were all worrying fiercely about her and now, thank goodness, we're able to talk about how much for lunch without making a bad impact on her bg's.

I think the wish you made about Pebbles' hair isn't covered by the Diabetes Genie. Let's hope that the Genie who grants those kinds of wishes stops by to read this board! :D

That was my name on another board also. I chose that when we were still looking for Lucky's answer. John and I (We) had Hope of finding whatever it took to help Lucky. At the time that was all we had--hope--the answers were yet to come.

When I went into writing for the Pet Diabetes Wiki, I kept the name there too. But you get into one heck of a bad habit because you sign mostly with your user name. Everybody has the habit; there are people who are paid employees of Wikia and that's what you know them by--their user name only. There's one guy there who was a super troubleshooter--you needed help, he was right there. I have no idea what this man's true name is--just know him by his wiki user name. ;)

Kathy

rhodesian46

08-03-2008, 06:53 PM

Kathy,
We went down to 1/2 c of Om for lunch Her Bgs were terrible! At 5:30 am at fasting she was 190 fed 2 1/4 c om plus chicken and broth 40 u
11:30 am fed 1/2 c om pinch of chicken and broth
2:30 pm-315
5:30 pm-324 fed 40 u
What the heck is going on ?Her bgs were better Sat being on more food at 11:30 am. Am planning on going to 2 meals a day so the Dr can tweak her insulin Then I may give her say a 1/4 c of om lunch time, Pebbles ate fine today Did catch her licking my dishes in the dishwasher. She smelled my homemade spaghettis sauce Didn't have much So she is definitely feeing better. Will post tomorrow on her 2 meal She may do better on that, One thing I did notice is that the blood in the dttol has gotten better, Probably from more fiber in her food and the tylan powder.
Marianne and Pebbles

We Hope

08-03-2008, 08:43 PM

Marianne,

I thought she'd do very well with what you did today. Maybe Pebbles cleaned more plates than you think she did. :) Still, it's good to see that she feels good enough to get into mischief.

I know you're not going to get any insulin adjustments if needed out of your doctor unless you're back on the 2 meals a day; she made that pretty clear. So I think you do need to go back onto this and see how things go along. Then if you see that they're not going as they should, you can get insulin adjustments from her.

Can also see that the fiber is helping with the stool problems. When Pebbles was avoiding the OM, she wasn't getting enough of that.

Tomorrow I need to send my system back to the shop--it still has issues. They tell me I'll get it back the same day, but we'll need to see about that.

Kathy

rhodesian46

08-06-2008, 11:14 AM

Ok here it goes Thought that Pebbles would have better Bgs being on 2 meals a day She is on 40 u bid instead of her usual 49 u.Started 2 meals a day Monday I am still using the Alphatrak
At fasting 5:45 am-113 fed gave trilo and meds
At fasting 5:15 pm- 163
Tuesday
5:45am-315
11:30 am-178
5:15pm- 302
Wed
5:45 am-382
11:30 am-257 177 on my freestyle
5:15 pm-185 143 on freestyle
There has been the same time and duration of exercise at 6:30 am
Same food amount Tuesday I reduced the chicken to 1/4 c
I am probably looking at an increase soon. Will send all info to the Dr at the end of the week Can't figure this out New bottle of insulin was opened last night before shot. Her bacteria skin infection is still there Not as bad. She isn't on an antibiotic as Dr Bostrom wants to if bad switch drugs. Gonna go give her her Malesab bath/ Please tell me what you think.Am curious as to what her Bgs are at nighttime?
MArianne and Pebbles

We Hope

08-13-2008, 09:38 AM

Marianne,

Finally got the system back this morning!!

You will sometimes find lower than usual bg's once you open a new vial of insulin; I always made a note of when I did that so that we all were aware if we happened to see Lucky's bg's slightly lower than usual for that time of day. It was never to the point that we needed to lower his insulin dose when we opened a new vial, but just something to be aware of and to take note of.

Would like to see how Pebbles is doing during the day now that you started a new vial of insulin recently.

Kathy

rhodesian46

08-13-2008, 07:47 PM

Pebbles did horrible on th new bottle ofinsulin Noticed that her bacterian skin infection had gotten worse We have been battling this since Nov 07 She was high 300's then on 8/8 high 300's both at fastingson 8/9 She was Hi on meter Have switched to the one touch ultra The dog meter is too expensive as far as strips go I was real concerned that day as she never dipped below 450 E mailed Dr Bostrom at A & M She wanted me to do a curve and remain on 40 u till the curve was done Here is Sundays curve
5:30 am 441 fed ,gave meds 40 u
6:30 am-450
8:30 am-360
10:30am-378
12:30 pm-338
2:30pm-243
4:30 pm-224 fed at 5:15 pm gave meds 40 u
The doctor replies
"let's increase her insulin to 42U every 12 hours and recurve her in one
week. Have you weighed her recently? It would be good to know if she
is maintaining her weight at this juncture as well too. Sounds like you
are doing a great job keeping her diet low fat, great!

Let's try clindamycin (Antirobe) for her skin. I would prescribe her
300mg capsules every 12 hours for 3-4 weeks. It would be a good idea to
consult with a veterinary dermatologist, especially if this course of
antibiotics doesn't work. We do not have dermatologist right now at
TAMU, not sure how long it will take to find a new one. You may want
to do a search for the nearest one around you.

Have we tried the tylosin for at least 4-6 weeks? If so then we can
discontinue, it's not working"

So I have upped as far as mon 8/11 to 42 units and have gotten her started on Clindimaycin( Costco had a great price).Tues Pebbles was weighed at another vet yesterday Her weight remains at 55.6 even gained a little Dr B is happy with that As far as the blood in stool some days are more than others I am going to continue the Tylostin powder for a month more as Pebbles never follows protocol. She is eating 2 meals a day fine Her Bg this morning was 187 not bad. I think the reason she was running high was that she needed an increase and her skin infection is back at full force. Am real happy she hasn't lost any more weight as the Dr doesn't want her to I will weigh her at that vets office monthly This way I know what is going on If not Pebbles needs to go for her ACTH stim in the beginning :D:D:Dof Oct. Welcome back Kathy!!!
"

We Hope

08-13-2008, 09:06 PM

Marianne,

That's one of the "down" sides of the animal only meters--both the meters themselves and the strips for them are a LOT more expensive than the human ones. I'd hate to see anyone think that they can't take good care of their pet with diabetes because they can't afford these types of meters and strips! BTW--most of those posting at FDMB (feline diabetes message board) do NOT use animal-based meters and I don't think I've seen more "Help! Hypo!" posts there than are to be expected with taking care of diabetic pets.

Before there were any animal-based meters, I was on another MB and those who did testing obviously had to use the human meters, since that's all there were. We didn't have rashes of hypos, etc. going then. We surely did have some, but when you'd look at why or how it happened, the hypos were never a result of anything to do with the meter.

I think what you've said about Pebbles is on target.

Infections can either raise or lower bg's--we most commonly see them get raised from them, but this doesn't mean that the opposite can't also be true, depending on the patient and the circumstances.

And--if we look back a bit--before Pebbles spent that weekend at A & M, she was getting 49 units twice a day; when she came home, they dropped her to 40. She's also gained a bit of weight, and that also points toward the idea of needing an insulin increase or a need to lose the weight, depending on the patient's needs.

Those with diabetes can tend to pick up weight when their diabetes is in good control-

http://www.mayoclinic.com/health/insulin-and-weight-gain/DA00139

"What's the connection between insulin and weight gain?

"Weight gain is a common side effect for people who take insulin. The more insulin you use to control your blood sugar level, the more glucose that gets into your cells and the less glucose that's wasted in your urine. Glucose that your cells don't use accumulates as fat. If you continue to eat as you did before, you'll likely gain weight when you start taking insulin.

"Think about it this way: Before you start taking insulin, you may be able to eat more food than you need without gaining weight because your body doesn't use the food properly. But when you start taking insulin, all bets are off. When your body uses food properly, you may need less food than you think.

"And the concern about insulin and weight gain goes beyond what you see in the mirror. Excess weight can make your body resistant to the action of insulin — which means that you may need to take even more insulin to get sugar into your cells."

Because of this, you hear a lot of "horror" stories, especially about young girls who need to use insulin. What they do to either try to keep themselves thin or lose weight is to start skipping their insulin.

It sounds to me like the plan for Pebbles is a good one--to give her the 2 units increase and go to work on treating the skin infection, then seeing how everything is in a week. You're not doing an increase that's too much for her nor are you rapidly increasing it, thus opening the door for rebound.

Now, you've lived with Pebbles long enough to know by now that protocol, like DCO kibble, is made to be broken! :D

Kathy

rhodesian46

08-14-2008, 11:32 AM

Ok tell me what I am doing wrong I pre fill Pebbles syringes When filling I always get an uneven line Is this an air bubble? If this happens While the needle is in the bottle I say (for example)back it up to 60 u then push the plunger back to 42 Sometimes this works sometimes not THen when I use a pre fill syringe I gently roll the syringe till mixed Know that it wasn't uneven when I put in the frig but becomes uneven again. I end up having to put that back in the bottle and fill again I have tried to put 42 u of air in first then fill but this still happens What am I doing wrong?PLease advise. I injected Pebs last night She yipped during injection so I pulled out and tried again yipped again the 3rd time she didn't This happens every one in a while. I inject in the scruff Left and middle of her neck She yipped when I do the right. So I stay away Would like to inject somewhere else but I am afraid to She picks up on my nervousness Is it Ok for me to continue on the scruff ?I have been injecting there for a year now. her Bg this morning was Injection went well this morning but her Bg 6 hours later was 463! Go figure Was this because of my poor injection last night?:confused:
Marianne

We Hope

08-14-2008, 12:32 PM

Marianne,

There's no reason you can't inject other than in the scruff. Some contend that the scruff is not such a good area because there's not much blood circulation there, and it's circulation that means insulin absorption:

http://petdiabetes.wikia.com/wiki/Injecting_insulin#Injection_tips

"Injecting any insulin at the same site repeatedly over time or blunting a needle with re-use can cause a lipodystrophy: either lipoatrophy or lipohypertrophy. Either makes absorption unreliable. But varying the injection site can cause variability in action profile, too. This page illustrates illustrates the most common areas humans with diabetes inject insulin and explains how absorption differs in various areas of the human body. This is true for ALL insulins. The new shot area needn't be very far from where the last shot was given--the distance of the width of 2 fingers will do fine as a measure. Most of us dealing with pet diabetes vary the side we give the injections in--right side mornings and left side evenings, for example. This is another help in avoiding giving shots in the same areas.

"Many people give insulin shots in the scruff of the pet's neck, which is now considered to be a less than optimum choice. The neck area provides poor insulin Absorption, due to it not having many capillaries, veins. etc. (vascularization). Other sites suggested by Dr. Greco include the flank and armpit. Intervet recommends giving injections from just back of the shoulder blades to just in front of the hipbone on either side, from 1 to 2 inches from the middle of the back."

Citation links for this are on the wiki page, BTW.

I never used the scruff for Lucky again after we went to Caninsulin/Vetsulin--went according to what they recommend:

http://www.vetsulin.com/dog-owner/HowTo.aspx

"Giving the injection

"Injections should be given just under the skin (subcutaneously) 2−5 cm (1 to 2 inches) from the midline of the back (middle of your dog's back running from tail to head), varying from just behind the shoulder blade to slightly in front of the hipbone."

As you see above, you can build up a type of scar tissue where you repeatedly give insulin shots; that also interferes with the insulin's absorption. Insulin isn't absorbed well from areas of thickened tissue--it would be like giving shots where someone has a callus. I understand they sometimes have problems with kids who are able to give their own shots because many times this is where they choose to do it because you can't feel it. But doing it like this doesn't allow the insulin to work as it should.

So it may not have anything to do with your technique at all.

OK--now bubbles. The problem with them is while they're not harmful per se, the bubbles take the place of insulin when they're in the syringe; you're not getting the full amount of units when the syringe has any in it.

http://petdiabetes.wikia.com/wiki/Syringe#Drawing_Insulin

"To eliminate bubbles: If drawing insulin from a vial, set the syringe plunger to the dosage you want to draw, put the needle into the top of the vial while the vial is still upright, and push all the air out of the syringe. This will maintain air pressure equilibrium in the vial once you draw the dose and, because the vial is upright, will not cause air bubbles to mix with the solution. Turn the vial upside down and draw the insulin slowly.

"If you do get air bubbles into the syringe, it's ok with most insulins to re-inject the insulin into the vial and draw again until the air is gone. Check that this is ok with your insulin. See also injecting insulin. Slower draw is less likely to draw bubbles.

"Another way to get rid of syringe air bubbles is to hold the syringe upright and give it a tap or two with your finger. The problem with having air bubbles in the injection is that you will not be getting the full dose of insulin; the bubbles take the place of it.

"Some people prefer to gently jiggle their vials to make any air bubbles rise to the top, away from where the needle will draw.

"Some caregivers find that certain syringe brands are less susceptible to air bubbles than others because they have a smoother push and pull motion. If you consistently have problems with air bubbles, consider trying other syringe brands."

Again, the citation links for this are on the wiki page. I can tell you that if I had any bubbles, I was able to re-inject the insulin back into the vial and re-draw, as I didn't remove the needle from the vial until I'd "inspected" the insulin in the syringe for any air bubbles. I don't think this would be a problem to do with NPH insulin either.

This board is really taking on an international flavor. We have Pebbles representing Italy with her Mangia Meatballs, and now we have her Mom thinking Hawaii--with those "Tiny Bubbles"--that should stay in the wine! :D

Kathy

Adding some prefilled tips info as a PS. :)

http://petdiabetes.wikia.com/wiki/Syringe#Prefilling_tips

"Store the recapped needle point-up to avoid clogging the needle.

"If the insulin needs refrigeration normally, so do the prefilled syringes.

"The "cloudy" insulins (NPH, Lente/Ultralente, PZI, Mixes) need to be re-suspended before use. Gently roll the syringe back and forth in your hands as with the vial. Improperly suspended insulin may lose some or all of its effectiveness."

rhodesian46

08-17-2008, 06:32 PM

42 u Have done some
random bg testing on my One Touch Ultra at fastings and some mid morning
Tues 8/11 started Clindamycin for 30 days
5:30 am- 371
Thurs 8/14
5:30 am-445
5:15 pm-426
Fri 8/15
5:30 am-333
11:30 am-284
4:30 pm-237
Sat 8/16
5:30 am-258
4:30 pm-396
SUNDAYS CURVE 8/17/08
5:30 am-240 fed, gave meds and 42 u
6:30 am-254 walked 15 mn gave a baby milkbone
8:30 am-217
10:30 am-244
12:30 pm-248
2:30 pm- 128 did second reading was 150
4:45 pm- 182
THe Dr wants Pebbles to stay on 42 u and redo curve in 2 weeks. I think I will redo in one week. Wants me to try canned pumpkin Have some her but it is the stuff you use to make pumpkin pie with 4 g of sugar per 1/2 c What is the stuff I need to buy?I told the Dr that I am going to weigh Pebbles monthly at the vets in Austin. Need to continue with the Melesab baths weekly as well Not a bad curve WOuld like to see her with better but I think that the skin infectionhas something to do with this.

We Hope

08-17-2008, 07:52 PM

OK, Marianne, from meatballs to melons, here we go! :D

There are two ways you see pumpkin in the can. One is pumpkin pie filling mix (the one you don't want to buy), and the other is plain, pure, pumpkin. You also see it referred to as solid pack pumpkin.

http://www.goodhousekeeping.com/cm/goodhousekeeping/images/libbys-canned-pumpkin-de.jpg

Some people make their pies with this one--adding their own sugar and spices:

http://busycooks.about.com/od/sweetpierecipes/r/canpumpkinpie.htm

http://www.amazon.com/Farmers-Market-Foods-Organic-15-Ounce/dp/B000HDI5OS

http://ecx.images-amazon.com/images/I/51816NRF61L._SL500_AA280_PIbundle-12,TopRight,0,0_AA280_SH20_.jpg

Farmer's Market Recipe, certified organic sugar and spices already added

And here you see that the mix has had spices and sugar added to it, where there's nothing added to the pumpkin in the pure or solid pack cans.

Here's how it looks to me--you started meds on Tuesday and they don't work instantly--it takes time for them to take hold and start fighting an infection.

Here's where a lot of people taking antibiotics mess up. After taking them for a few days, they start feeling better and believe they don't need to finish the course of the treatment by taking all the pills their doctor prescribed for this. Truth is, if you don't take all the meds for the number of days you were told to, you may not get rid of the infection 100% and it can come right back.

Sure looks to me like we're seeing the oral meds, the medicated baths and the increase from 40 units to 42 units take hold here. :)

Kathy

PS--Even though Thanksgiving is a while off, we'll all pass the cyber plates for some pumpkin pie--whether you make it with solid pack or with pie filling mix. :D

rhodesian46

08-19-2008, 07:07 PM

This is the emailI sent to Nurse Ratchet( Dr Bostrom)

Hi Dr Bostrom,
Her skin is looking better for sure I don't mind bathing Pebbles as
much as she needs. Would like to take her off the Metamucil sugar free.
It is something about the globbing effect that worries me as in humans
we are supposed to drink water with it. So what are my alternatives? If
I do canned pumpkin( not the kind they use for baking with sugar) how
much should I give her every feeding? What about Konosyl? It is a
natural psyllium fiber:no sugar or gluten Wal Mart sells it. Or maybe
Benefiber? What do you think? How much would I give? About the curve
You know I am not going to be able to wait 2 weeks If it is ok with
you I would like possibly do one this Sunday just to see where she is
at Then another the following week. I am going to give her a few days
off from spot checking She told me that she feel like a pin cushion !
:). I guess I would like to spot check this week and if she is
throwing me curve balls then do a curve If not and her bgs
are good then I won't She is usually at her lowest around 2:30 pm.I
will keep in touch with you for for sure. Also I have been following her
outside to check the poop. She is straining. Some days there is more
more blood then others I really think that adding more fiber would
really help her Please let me know what you think Thanks for the quick
reply

She replies

"Yep, make sure the canned pumpkin doesn't have anything added. I would
give about 2-3 tablespoons per day divided up into her meals. The other
fiber supplements benefiber etc need water as well too. Water is
important for any source of fiber or else the patient gets constipated
from the fiber. Just let me know what her 2 week BG curve is, what you
do inbetween is up to you... ;)
good luck.
Brier Bostrom, DVM
It seems to me that all she wants is a 2 week curve Thats not going to happen on my end I tested Pebbles at noon today She was in the high 400's Don't have a clue Curve was good 2 days ago.I am going to do a curve this Sunday as I think she needs an increase. Don't understand her logic Want t give her more fiber Can't find the canned pumpkin Looked in 2 grocery stores Why was Pebbles on Metamucil if she wasn't getting the water? No wonder why she is straining I don't want to change the variables too quick. What if I did the metamucil and added 1 full cup of water to her food Would this make up for the 8 ox of water that you would need to drink with Metamucil? Any suggestions would be helpful. You must applaud me I injected Pebbles on her side instead of her scruff First time in over a year I changed sites Always did the scruff. Was real nervous Grabbed whateve fatshe had to the right of her top of her leg,tented and didn't stick myself:D Did this while she was laying down.