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-   -   Introducing Luna (http://k9diabetes.com/forum/showthread.php?t=7600)

Halloweenqueen 03-29-2018 08:25 AM

Introducing Luna-tough weekend
I first want to mention how grateful I am to have found this community. I've been a lurker for weeks, but decided to come out of the shadows for some advice.

Luna is a 9 year old chi mix. She was an active and anxious dog until 7. We started to see little things that made us believe she was losing her eyesight.

We took her to the vet and they thought she might have a brain tumor. We live in an isolated community with two vet clinics. We decided to take Luna to the big city, four hours away to the University vet hospital. After lots of tests it was determined that Luna had PRA, progressive retinal atrophy. A hereditary disease that would leave her completely blind. They determined she had 80% sight loss during the exam.

We brought her home, sad from the news, but happy to hear she didn't have a tumor. With the help of some supplements we were able to prolong her sight until about 6 months ago when she went blind.

About 14 months ago she was having blood work before a dental cleaning when we found out her liver numbers were through the roof. Vet 2 (we had switched clinics after the PRA diagnosis) thought cancer again. She had lots of tests, including an ultrasound and concluded that she she had liver disease and possible Cushings. Since she didn't have any symptoms of Cushings we decided to tackle the liver disease and she was put on prescription liver diet and supplements (Denamarin). Her numbers went down significantly and we were told to keep her on the diet.

About a month ago she started to have accidents. I took her in and they determined she had diabetes. (this is Vet 3 because Vet 2 moved away) We were given the option of putting her down or treatment. ? We started on Novalin, 3 units, twice a day. Level was 758.

This was on a Friday.

Week 1- Monday 462, increased to 5 units, twice a day
Friday 399, increased to 6 units, twice a day

Week 2- Monday 376, increased to 7 units, twice a day
Thursday 366, increased to 8 units, twice a day

I received a promotion that required me to have evening training. I trained my husband to give the evening injections for the following week.

Week 3 Tuesday, 477, 8 units, twice a day
(explained to the vet that husband thought he might not have injected correctly, was told to stay on the same dose)

Friday 404

Friday the vet calls us and says she believes Luna is insulin resistant. She wants to redo all the previous tests since they were administered by the previous vet and are over 14 months old. She thinks she has Cushings and wants to start treatment. (again given the option just to put her down)

Vet upped dose to 10 units, twice a day

I ask if I could meet with her to discuss Luna's treatment next week. Going in today. Yesterday, while rolling the insulin bottle I noticed a crack and a hole at the bottom of the vial. My hand started to fill with insulin. I had to rush to Walmart for a replacement. Her dose was late. I felt horrible. I now have a spare bottle in the cupboard.

From what I've researched, we need to concentrate on the Diabetes number first. I do not want to burn any bridges since I am running out of vets. My husband wants us to go to the Vet University, but this isn't really practical in the long term.

I have brought up the home testing route and haven't received any response.

Luna hides her issues so well. We were surprised by the liver disease diagnosis. She is pretty much symptom free...happy.

I'm worried about straining my relationship with the vet. I am not against more testing, but I don't think we have given the diabetes treatment enough time.

Am I on the right track?

jesse girl 03-29-2018 08:46 AM

Re: Introducing Luna
Hi and welcome

the big problem I see with your post that it appears that you raised the dose of insulin based on one number

If thats what is occurring the problem with that is just one number is just one moment in time . Blood sugar can be quite different anytime in a 24 hour period

My jesse early in her diagnosis could start out at 500 at 7 am . 5 hours later she could be at 70 and 5 hours later she could be back up to 500

Now you vet may say the standard is blood sugar is lowest say at 6 hours . thats not true all the time and i would not be surprised you may only see it half the time . another problem one day it could be lowest at that 6 hour mark and the next day it could be lowest at the 12 hour mark

Thats why you need to do complete curves ( test before shot and food and every 2 hours after till next food and shot some do 24 hour curves

Now if your vet is not doing this you could run into big problems . You cant base a diagnosis of resistance on one number

I had a similar problem having a rural vet . What i ended up doing was get my own meter to test jesse at home and i ended up managing the disease on my own . It was a scary decision but i knew i wasnt getting good info from jesses vet at the time that was 8 years ago so i think i made the correct decision

Now you dont need to disconnect completely from the vet as i did with jesse but at a minimum you have to do complete curves once a week some take up to 2 weeks for a dose to settle and make a decision on dosing up down or stay the same . Now a dose is determined by the lowest number in a curve

Its really not complicated

Lolo 03-29-2018 09:12 AM

Re: Introducing Luna
Like Jesse girl I’m wondering when those single day numbers are being taken. My Lucy isn’t regulated yet, but her fasting numbers are always over 400. This is obviously not good and I’m working to correct it, but different dose levels (in my case) aren’t budging her fasting numbers but do make a huge difference when insulin is at its peak. In my case this can be anywhere from hour 3 to hour 6. You can’t really make adjustments based on just one number especially if that number is a fasting number. When my Lucy was at too high a dose she dropped to 50s-70s at peak. If I was just looking at her numbers before meal time I would have mistakenly thought she needed a higher dose.
Also, if you’re afraid of upsetting your vet and burning bridges you can Home test to start and just not tell him. Just so you have more info to work with. I don’t mean you should hide it indefinitely and you have to resist making any snap decisions based on a number, but more info to work with will help both you and the vet.

Raysaint 03-29-2018 10:28 AM

Re: Introducing Luna
You should read some of the information on this forum and educate yourself, because your initial approach is not good, no offense.

Basing an insulin dose on one number is dangerous, not to mention opposite of any standard diabetes procedure.
Regulating your dog will take time, and you must be consistent, methodical, and patient. Radical and quick changes in dose or food or anything will start a rollercoaster of reacting, which doesn't work.

As jessegirl mentioned, get a meter so you can test and do curves at home. Only a full curve can show you what, and where, her low point is. That tells you if you have room for an insulin increase.
Basing a dose on one number at some point in the day could make you overdose the dog, causing her too go too low, which could kill her.
And you need to wait at least a week for a new insulin dose to settle in and allow the body to adjust. Then do another curve and check the lowest point.
Don't worry about fasting numbers right now, worry about getting on a steady and consistent routine.
If your vet wants to change insulin dose based on one number, they are inexperienced.

Your dog should be on a lower fat food, with moderate fiber and protein.

amydunn19 03-29-2018 09:13 PM

Re: Introducing Luna
When we started with Maggie, her vet only tested her once a week. And kept increasing the dose. And completely overdosed her. I completely trusted my vet and had no reason to question her decisions. She was on 9 units twice a day at one point, and her dose(once we got her straightened out later) was only 2.5 units twice a day. She had a hypoglycemic seizure at about five in the morning on a weekend. Her body had been releasing glucose to counteract the insulin dose (which is why we were getting the high numbers when they tested her) and eventually that just failed. So, an inexperienced vet almost killed her.

I just decided to take over after that, learned all I could and started testing her at home. I found a new vet but told him we were doing this my way and if he wasn’t going to cooperate with testing, that I would find someone else. I was just angry at that point and felt betrayed by the first vet. Luckily, he was on board and his one stipulation was that I consult him before I changed anything. We worked great together and after a while, he told me I could manage it myself so he had no problem with me adjusting. It is all a matter of learning the basics of diabetes and home testing enough to understand your dog’s tendencies. There is not a vet on earth that will be able to understand your dog like you can. You just need one who understands that basing dosing off a single test is not a safe decision. A twelve hour curve is the way to set your dose. It involves you testing before the first meal/shot, and testing every two hours until the last meal/shot. Is that doable for you?

How much does your dog weigh?

Halloweenqueen 03-30-2018 07:24 AM

Re: Introducing Luna
Thanks to all for your replies.

The meeting did not go well. She says there really isn't a point moving forward if we don't exam the Cushings and treat it first. No curve until Cushings is ruled out. :(

She now has us at 11 units twice a day for a 22 lb dog. I know that ranges vary, but I think she just ups the dose if the number is over 300. (Luna was at 319 yesterday). These tests are always done at 4 hours after morning dose.

Ironically there was three other families in the waiting room. Two waiting for their twice weekly blood sugar test. The third person there was with her cat, but when she heard why we were there she boldly said the vet was doing it all wrong and we should home test.

I'm going to make it my mission to read and educate myself this weekend. I've purchased a monitor from Amazon and it should be here tomorrow. Luckily I work from home, so testing and dosing are not a problem.

It amazes me that with so many diabetic pets a more regulated and trusted protocol is not in place. Why so many bad approaches? How many pets suffer/die/put down because of vet error?

So grateful to find this community. Thank you!

Halloweenqueen 03-30-2018 07:31 AM

Re: Introducing Luna
I forgot to ask...diet.

She is on Royal Cain Hepatic dog food because of the previous liver disease diagnosis.

I've asked the vet several times about changing to a different food, but never get a real answer.

Any advice?

Raysaint 03-30-2018 07:34 AM

Re: Introducing Luna
11 units for a 23 lb dog is a lot. And based on one test 4 hours after eating? Scary.
A starting dose for a 23 lb dog should be about 4.5 - 5.0 units.

When you get your meter, make sure you compare a reading with the vet's so that you can equate the meter. Others on here have experience with meters other than the AlphaTrak. They can tell you the math that equates your meter.

Lolo 03-30-2018 07:58 AM

Re: Introducing Luna
Do not change food right now. I changed mine because some allergy tests revealed she had sensitivities to the main protein and I’m wishing I had waited. I’m still dealing with the problems caused by attempting a food change before I had her insulin figured out. Learn from my mistake!
Just focus on testing glucose right now and figuring out if it’s Cushing or if you just need to start over at a smaller dose. I agree that 11 units sounds like a lot for a 23 lb dog, but there’s no one rule that works for all dogs unfortunately. You can see high numbers across the board if they’re being overdosed... but that can also be the case with Cushings. Why are they so sure it’s cushings? What tests did they run?

momofdecker 03-30-2018 09:31 AM

Re: Introducing Luna
If they are insistent on ruling out cushings, you could ask them to do a UC:CR urine test (urine cortisol/creatinine ratio test). You collect the first urine sample of the day and take it in for them to check. If it's negative - that will rule out cushings. If it's positive - it will not confirm cushings - it will only indicate that further testing is warranted. The UC:CR is much less expensive and much less stressful for your dog. The main consideration is that if it is positive - it will be an added cost. If negative - it will save you money.

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