Cara earned her wings last nite

[Cara's Mom]

I am new at this...so here goes:
2 weeks ago my 8 yr old English Setter, Cara, was diagnosed with diabetes and the world came tumbling down. The vet put her on new diet, new schedule and insulin, after a very traumatic 2 1/2 days in hospital. Cara was very, very upset and barked for hours!!! They let her go home and I started her insulin (Caninsulin, same as Vetsulin) 4 units twice/day. No problem there.
Her problem is she refuses to eat, mainly her first meal of the day. There is a trace of ketonen in her urine. Her glucose per yesterday at noon was 20.4 (we are measuring in mmol/l in Canada) Sorry, don't know what it is in mg/dl!
Have to go to vet for BG reading, so bought glucose meter yesterday (AlphaTrak for animals) and will do it myself Ofcourse I am little nervous drawing the blood(while it's just a little lancet!) and that makes Cara jumpy too. Have had no luck this morning, but will try again this afternoon. Any suggestions how to make this easier on the both of us?
Because of her refusal to eat, I can now start a store selling petfood !
But I always have Polly, (Cara's real mom) who will eat anything!
Would like some input from you, who have had to deal with this for awhile.

Thanks for listening!
Marion

[We Hope]

Re: Need a shoulder!

Hello, Marion!

First of all, what does Cara weigh? She's a full-grown English Setter and this seems to be a VERY small amount of insulin for her, even for starting insulin therapy. The old Intervet suggestions were for 1 unit (IU) per kg of body weight plus an extra unit. The new starting dosage is now for 0.5 unit (IU) per kg of body weight-- one-half unit of insulin for every 2.2 lb of body weight.

http://www.vetsulin.com/PDF/Vetsulin...tor_Letter.pdf

The daily dose of insulin Cara is getting now was the daily dose for my 4.5kg/9.9 lb Lucky; you can see from his photo he was not a big fellow. This kept his bg's at 4.7222 mmol/85 mg/dl 8-10 hours after breakfast and the first 4 units of insulin.

http://www.childrenwithdiabetes.com/bs_conv.htm

Here we have a handy bg converter which converts mmol to mg.dl and vice-versa. Measuring as we do here (and we seem to be the ONLY ones still doing it this way! ), Cara is at 367.2 mg/dl.

When you are seeing glucose in the urine, it means that she's over the renal threshold and staying there for periods of time:

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

"Urine only tests positive for glucose if the blood glucose concentration remains above the renal threshold for a substantial period of time. This occurs when glycemia reaches 180−220 mg/dL (10−12.2 mmol/L) in the dog."

Since she's not eating well, we don't have a lot of food going in which might account for yesterday's glucose reading. I do think Cara needs to get more insulin than she's presently receiving; when you post her weight, we can calculate what might be a proper starting dose so you have an idea.

I'd like to ask you to notify your vet about the trace of ketones in her urine if you haven't already. What we want to do here is to make sure Cara is receiving enough insulin so that they don't become worse, thus an emergency, and that they will disappear entirely.

Quite a bit of the time when they are running high, it's hard to get them to eat. What is Cara supposed to be eating and not? It's a problem because when they're not eating right, you can't give the full dose of insulin because there's no food there to handle it.

What was Cara eating before she was diagnosed and is she willing to eat that now? If so, you might be able to go with that in lesser proportion and start "sneaking" the prescribed food into that mix--a little more every day until it's all new food.

Some dogs will eat if you add low-salt, no fat chicken or beef broth to their food. Some will eat their food with a little low-carb, low fat baby food added to it; most of them like chicken. For others, it's chicken breast, and so on. You can heat up the broth or baby food; dogs eat with their noses and you want to make the meals smell as appealing as possible. Heating them up adds to the tempting aroma.

Please tell us more so that we can try to give you more help with Cara!

Kathy

[Cara's Mom]

Re: Need a shoulder!

Hi Kathy!
Thanks for your reply.
Cara is 22.4 kg. Lost 2 kg since diagnosed. She is supposed to be on high fibre, low protien diet. Before she became ill, she was on mainly fresh veggies, cooked chicken and chicken broth, with a 1/4 cup of Science diet adult. Snacks were carrots, halve apple. I have her back on Science diet and do bribe her with the chicken and veggies. Have no problem with her at night, it is only the mornings she is such a problem baby. Her morning meal is at her normal time, but evening meal is 2 hrs past her normal time. Vet is not in favour of mixing food...wants het to eat only high fibre with maybe little broth. No change!!!
Phoned vet Re: insulin......will be raised to-nite to 5 units. However, that is still very low, is not it? Looking for new vet?

Marion

[k9diabetes]

Re: Need a shoulder!

Hi Marion,

Welcome! I know you'd rather not have to have all these questions but we all can assure you that this "first part" is the hardest part. Once things get sorted out and Cara's feeling better, you will be able to look back on this time and smile, knowing that it was just a little bumpy transition!

Insulin

22.4 kg puts Cara at about 50 pounds, so yes, that is an extremely small dose of insulin for her size. Do you know if there is a reason why the vet started it so low?

A very general guideline (our dog did not fit the guideline, needing a lot less insulin) is 1/2 unit per pound, or about 1 unit per kilogram. That's average... some dogs need more, some less. That would put Cara as potentially needing 25 units of insulin per injection.

There can be a very wide variation. I know of 25 pound dogs who need 25 units of insulin per injection and our 60 pound dog, who needed about 12 units.

So perhaps the vet is acting from an abundance of caution but I wouldn't want Cara to be strung along for weeks on such a small amount of insulin. Your test readings should be a good argument for her needing more.

Food

The high-fiber lowfat diet was the mainstay of diets for diabetic dogs for years but we have seen that it is (1) often not necessary as insulin and food can be well balanced on many types of diets, and (2) it is not necessarily a diet that works well with Caninsulin.

Caninsulin can have a pretty potent effect during the first couple of hours, apparently because the insulin, which is an exact match molecularly to a dog's own insulin, can be metabolized fairly quickly. The lowfat, high fiber diet was designed to delay the absorption of the glucose from the food. And sometimes it's delayed so long that there's no food there when the Vetsulin needs it.

So...

When it comes to diet, I don't like to see vets be rigid about going to the lowfat high fiber, ESPECIALLY if they won't eat it! Sure doesn't do any good that way. The diet you were using with Cara might work just fine. Time and testing will tell. And if it doesn't, there are many many other diet choices available. I did a poll once before... guess I should do it again. It will give you a chance to see the wide variety of diets the diabetic dogs here are being fed.

Vet

It's not uncommon to need a new vet when it comes to diabetes. We had to change not too long after Chris was diagnosed because the first vet was unwilling to be flexible on the type of insulin used. The one we started with just wasn't working for Chris.

Primarily, you need a vet who is open to new approaches and human-based approaches to treating Cara, who listens to you and takes your concerns and desires for Cara to heart, and who is willing to go out and consult/research problems.

Then, the more you can understand all this yourself, the better off Cara will be. Eventually, we no longer needed the vet at all to manage Chris' diabetes, thanks to a long time learning and testing. That's not for everybody but it sometimes is needed, especially if your veterinary resources are limited. I'll go back, too, and see where you are in Canada and see if we know anyone who might be able to refer you to someone they like.

Hope you've had a chance to peruse the information pages...

www.k9diabetes.com

They will help you get through the basics of managing Cara's food and insulin and there are many links there as well.

This time really is scary but Cara can have a normal healthy happy life and lifespan with good management.

So try not to worry! We are happy to help you any way we can.

Best,

Natalie

[rhodesian46]

Re: Need a shoulder!

Hi Marion,
Welcome I also have a dog with diabetes but also has cushings and is hypothyroidI would try to keep her meals 12 hours a part or close to that Carrots are a little high on the glycemic index I would limit those What about some green beans You could try puree frozen green beans with say 1 c and 1 c of water and put some in her food And be consistent with your food. Pebbles was on Purina DCO(script food) It worked well for her until about 3 weeks ago she had a bout with pancreatitis and was switched to Purina OM She is ona human insulin that I get from Wal Mart for $21.96 It is Relion Novolin N I get 2.5 more insulin than the Vetsulin so it lasts longer A lot of dogs do really well on this No script needed Different syringes than the Vetsulin U 40. A box of syringes at Wal MArt is $13 compared to the U 40 Vetsulin at $30. You may want to check into that Also please make sure that you are comfortable with your vet and he is knowledgeable in Diabetes. I made the mistake and thought mine was and OMG I learned the hard way Keep a file on your dog with all tests and notes just in case you need this for an emergency If Cara has elbow callous you can get blood from there The Alpha trak's strips are real expensive ( I have one) I only use that if I am suspicious but generally use a human meter called One touch ultraYou can bring the human meter to the vets and compare bgs from his lab and yours This way you kinda know what her Bgs are throughout the day At first Dx a year ago I was testing at fastings and did weekly curves at home An increase will take about 3-5 days to work I know too much info I was overwhelmed at first All will chime in shortly You will get it. Bit if you have a bad feeing about your vet Run and find another one Don't be afraid to ask a new vet how many cases he has treated and if he has used human insulin. For me the cost of Vetsulin would be astronomical!

[Dollydog]

Re: Need a shoulder!

Hi Marion,
We're in Marathon, ON, just 3 hours east of Thunder Bay. My Lady became diabetic while we were living in Nevada...she had been diagnosed with Cushings just a year before the diabetes. We've had quite the journey to get both diseases regulated and it can be quite a struggle at first. Diabetes is definitely a challenge and can be very frustrating.
Lady had no problem eating her meals when she first became diabetic but did after a couple of months. I had tried to introduce some high fiber food in with her other food and she liked it at first. But somewhere along the line she caught on that I was desperate for her to eat in the morning and would do anything to coax her to eat. She would sit back and wait and watch while I would spend 45 minutes putting different things with her food to tempt her to eat it. There was never a problem with her evening meal and it was the same food!! We eventually came up with something that she would eat every morning and the problem went away. I also have discovered that if she's not that keen on her breakfast at injection time she will eventually eat a couple of hours later. But it rarely happens now and if it does I just give her some of the dog food that she will always eat no matter what! I understand about having enough food on hand to start a petfood store!!

I can't add anything to what Natalie and Kathy have already told you, except that I've been reading Natalie's posts for 18 months and if there's anything that she doesn't know about diabetes...it's not important. She should be teaching mandatory courses on diabetes for vets. Her care for her dog Chris (who just passed away at the beginning of August) is absolutely awe-inspiring.
As for changing vets, members here can give you a good idea if you need to do that. The Nevada vet and his clinic were awesome and we were very spoiled. I like the vet in Thunder Bay but the clinic is too big and we don't fit them very well! But they're learning

Lady is 15.5lbs and is currently on 13iu's of Caninsulin in am and 13.5 in pm. She eats a mixture of food, some canned, some dry and some human. She takes Trilostane for the Cushings, plus Metacam, Milk Thistle, fish oil and Cosequin. She is a 12 year old Australian Terrier, with emphasis on the terrier part!
I'll check back later to see how you're doing, take care,
Jo-Ann & Lady

[Cara's Mom]

Re: Need a shoulder!

Thanks Natalie, your way of thinking and mine are rather simular. But me being so new at this, I was not sure that my thinking was right!!! My vet is very rigid. There is only one way of treating Cara and that is her way. Have already contacted other vet, will see him on Monday. In the meantime going in to my vet in next half hour to have a talk.
Thanks again,
Marion

[Dollydog]

Re: Need a shoulder!

Hi again,
I've just read Marianne's post after sending mine. Some of the rules regarding the buying of insulin and syringes are different in Canada than in the US. Some things are easier to get and some are harder and I can't remember which ones are which. I know where to get supplies for Lady but our situation gets complicated because we live 200 miles(300km) from a vet clinic and a pet food store and we have to pick up her trilo in the US.
TTYL

[k9diabetes]

Re: Need a shoulder!

I don't know anyone in Calgary but with such a large metro area I imagine you have quite a few choices.

There are some pretty good manuals on treating diabetes in dogs. One is put out by the makers of Caninsulin and I have only a few quibbles with it. It's for vets but is not jargon heavy and I find it very useful, plus your vet(s) should view it as authoritative :

http://www.vetsulin.com/PDF/20585.pdf

Next is also a good article on treating diabetes. I've opened it at the page where it describes how to start treatment on a nonketoacidotic dog. Presumably Cara either is not or is over being ketoacidotic... it is an interesting little software set up that let's you page through the article like a magazine and you can download it as an exe file to save as well:

http://www.nxtbook.com/nxtbooks/adva...hp?startid=608

On page 612, it discusses diet and how prescription high fiber diets are not necessary.

http://www.nxtbook.com/nxtbooks/adva...hp?startid=612

You may have better experience with diabetes working with an internal medicine specialist... although they are more expensive and not always better.

Good luck with the new vet! Persevere until you find someone you can work with who will treat you as a partner in Cara's care. NO ONE will know Cara the way you do and with diabetes that's an essential point of view that the vet should never overlook.

Would love to see a picture...

Natalie

[Debbie & Apollo]

Re: Need a shoulder!

Hi Marion and Cara!

Just wanted to say hello -- I really can't add much except to say that when we first started this journey with Apollo eating was tough!
and yes the AM feeding was the hardest!! -- I believe the memory of the good old days was stronger than the hunger urge.

We spent a lot of time on the floor coaxing! No problem now

It gets easier!

Debbie and Apollo

[Cara's Mom]

Re: Need a shoulder!

Thanks Natalie!
Boy you guys are a "God sent"! You have no idea how much better I feel with all your info and advice!
Would love to post a picture, however do not know how yet. Will find out in near future!

[Cara's Mom]

Re: Need a shoulder!

Hi Debbie and Apollo,
Good to hear someone has had the same problems as we do right now! It is so nice to know you're not alone in this, with all you beautiful people and your problem babies sharing your experiences.

Marion

[Cara's Mom]

Re: Need a shoulder!

Hello everyone! If I missed anyone with a reply, I am sorry...I was overwhelmed by your support and advice! Cara says Thanks and so do I!!

Had a vet appointment this afternoon....we had a good talk...and we said "Goodbye" but not after she did BG reading...23.1.

Stopped at pharmacy on way home and found a nifty device to prick for blood..bought it and used it at home and it worked! Same reading as vet. It works almost like an eppy pen. You must know it, it's made in USA!!! Called "one touch Penlet Plus."

Went back to Cara's old food. Raw green beans, broccolli, chicken and 3/4 cup of dry. You should have seen her eat!! It was a joy to watch. Nose went down in her food and did not come up until bowl was empty. After that she got 5 units Cansulin. Phoned new vet about her dose. He told me she should be on 5 for 3-4 days and after that she could go up 6 or only 10%(that would make it 5.5.units)depending on her BG.
I have a bit more fait in everything now, thanks to you all!
Now I am going to look at all those websites you all mentioned.

Will keep you informed!

Marion and Cara Mia

[Debbie & Apollo]

Re: Need a shoulder!

I quote :

" Stopped at pharmacy on way home and found a nifty device to prick for blood..bought it and used it at home and it worked! Same reading as vet. It works almost like an eppy pen. You must know it, it's made in USA!!! Called "one touch Penlet Plus."

but here's the funny part -- if it's made in the USA we probably dont' have them in the stores!
all of our things are made in China

I will look for it however -- thanks for the suggestion.

Debbie and Apollo

[Cara's Mom]

Re: Need a shoulder!

Debbie,can always sent you one!!!