We had to say goodbye to Foster

[oahu]

Sorry in advance if this post is long...Our dog Foster is a 11.5 lb min pin mix, about 13-14 years old. (We rescued him 7 yrs ago.) He had the usual thirst & urinating last fall, was diagnosed with diabetes & pancreatitis, was put on Royal Canin Digestive Low Fat (L/F) dry food, & ended up on Vetsulin when humulin didn't work at all. The Vetsulin (6 units 2x/day) worked great & he was very well regulated. Now that we've had to switch to humulin (in early July), we're back to square one, & I'm hoping for some advice about his food. Right now, he's getting 5 units of Relion N 2x/day. Other than the diabetes, he's really quite healthy for an older dog. His appetite is always good, & even when he was diagnosed with pancreatitis, he never had stomach problems.

His two vet performed curves with the Relion (first at 3 units, then at 5 units, a couple weeks apart) have been:
8am 478 / 8am 446
Fed at 8:05.
9am 519 / 9am 465
10am 400 / 10am 336
11am 301 / 11am 275
12pm 425 / 1pm 488
3pm over 600 (too high to register)

So, about 3 hours after eating, his bg gets lowest. The vet said he may need more protein or fat to last longer in his system. I think I understand the basics of how diet and insulin interact, & I'm wondering what dietary additions/switches have worked for others. The vet recommended adding a little Hill's prescription diet i/d (which is supposed to be bland for his pancreas) to his meal, & we're trying that tonight. I've also read that cottage cheese might help, so we tried some of that, but it was low fat cottage cheese, & it didn't change his bg curve. Oh, we bought a Relion Micro bg meter, which reads slightly low, but gives us a general idea.

If I understand correctly, we need to flatten out his bg curve, then increase his insulin dose to get the curve closer to under 200 at all times.

Sadly, the vet has been kind of disappointing lately, overwhelming me with lots of "you could try this or that," including trying 3 shots of 5 units per day (which we can not logistically do), but no definitive direction. But I digress...

As the Vetsulin to humulin switch has taken place, his cataracts have gotten worse, he's gotten LIU (which we've treated pretty well with prednisone), and he's gone nearly blind, which is painful to watch happen. He's back to drinking and urinating like crazy.

Any advice is appreciated! Thanks.

[Noodle]

Re: New & need diet advice

Hello Oahu & Foster and welcome.

I can think of a few points and then I'm sure others will be along tomorrow to offer more helpful information. It's a little slower on the weekends.

A food that has been found to be very successful for many of us on the board has been Blue Buffalo. It's available at places like Petsmart and is available in dry and canned. For my own dog, Noodle, it has made his curve amazingly flat. I give him the dry "Healthy Weight" formula along with a small amount of the canned Wilderness in the turkey & chicken flavor. The Wilderness comes in dry also, but it is higher in fat so probably best to avoid that one since he has had pancreatitis. But the Healthy Weight is lower in fat and might be worth a try if you have it available in your area. You can get a $5 off coupon sent to you by visiting their website. If you have Petsmarts in your area, you can sign up for their "PetPerks" card which also gets you discounts and special offers.

I don't know much about LIU, but the prednisone can increase blood glucose and make it difficult to obtain good regulation. If there are other treatment options available, that would be worth investigating.

If all else fails, (diet changes, insulin increases, eye medication changes, etc) and he was doing well on Vetsulin, the makers introduced a critical need program in May. You can read more about it in the Vetsulin sticky - it is in post #19. That might be another option if nothing else works.

Often a dogs blood glucose is effected by stress and/or excitement at the vet and it can effect the numbers significantly. Testing him at home will give you a more accurate picture of the interaction of his food/insulin/activity during his normal routine at home. The information it provides can be priceless. We have lots of information on how to test on the main page of this site, including videos of different places to test. I use the inner, upper lip on Noodle and he doesn't mind it a bit. On smaller dogs, many use places like the base of the tail or a toe pad.

Welcome again and I'm glad you found your way to the board.

[k9diabetes]

Re: New & need diet advice

Hi and welcome!

Although it certainly would be helpful to flatten out his curve, he also could benefit from an increase in the insulin.

Is that planned soon?

You got 175 points that lowest blood sugar could drop so more insulin should be able to be given and bring all of his levels down. Some vets put a limit on units per pound that is lower than what I see as common. Foster's dose remains on the average side at the moment and certainly has room to go up.

I can see from the curve where three shots of insulin a day could work well for him (recognizing you can't do that, just thinking about this in generalities) as his lowest blood sugar is just 3 hours after his injection.

If you don't have any other pets, one thing you can do is give a snack using a timed-release feeder. If he could get a snack around 10am, that could flatten out his curve and put the insulin to better use.

I'm afraid it is hard to be definitive because all dogs digest food and process insulin in their own way. A food that works great for one dog will be awful for another. Cottage cheese worked well for our dog, for example.

Some potential sources of fiber that you could add include pumpkin. Some dogs do well with oatmeal but others have blood sugar that soars from it. You could also add some protein, like white meat chicken. Protein is typically slow to digest. You also can add fiber directly by sprinkling on a little benefiber or metamucil.

It most likely will wind up being a matter of experimentation... and if the insulin has a late kick, you may not be able to make any food last long enough.

I'm afraid I don't know what LIU is...

Natalie

[oahu]

Re: New & need diet advice

Thanks for the reply, Noodle. I'll put Blue Buffalo on my list of things to try. We have been testing Foster's bg at home, and it's been really easy (thank goodness!) using his hind foot pads.

We tried some Hill's prescription diet i/d (wet) tonight with his dry Royal Canin L/F, & so far (it's been 4 hours), his bg has remained high (in the 400s) longer than it did without the Hill's.

I had read that prednisone may increase bg, so I asked the vet & he told me the effect from eye drops is minimal, unlike oral prednisone. I hope he's right. Then again, we don't have to use the prednisone unless his eyes get cloudy again, so hopefully that's a minor issue.

I've been reading a lot of the threads here and learning alot. Thanks!

[oahu]

Re: New & need diet advice

Thanks, k9diabetes, for the advice. Yes, we're definitely going to increase his insulin tomorrow.

LIU is "lens induced uveitis," an inflammation in the eye caused by cataracts. I'm told it can come and go, but it needs to be treated whenever it appears.

I'm curious about what you mean by a "late kick" of the insulin...is that a second "kick" after the first effect, or just that the insulin doesn't start working until all the food has been digested?

Thanks again!

[k9diabetes]

Re: New & need diet advice

Insulin can be absorbed long after it's injected - however long it takes the dog's body to break it out of the protamine "packaging" that they add to extend the duration of pure insulin.

Our dog started out on Humulin L (since discontinued), which is essentially Vetsulin but made with the human insulin molecule instead of the pork one, and it too him about 7 hours to get access to the insulin! His blood sugar started low at meal time and then went up, up, up for 7 hours. Then abruptly plunged down. It's like it sat around doing nothing and then all came loose at once!

Foster seems to be breaking most of the insulin out all at once at 2-4 hours. Before and after that, he doesn't have access to much of it.

When you have a burst of insulin metabolism like that, you also often see short duration.

Yup, the cataracts are highly inflammatory and they should be treated with drops. Has he seen an opthalmologist?

Our dog was on horrendoulsy expensive Voltaren - worked great for him and probably worth it as he had other serious eye issues. But Flurbiprofen seems to work pretty well.

Natalie

[claire81]

Re: New & need diet advice

Hello and Welcome

We tend to find that our staffy x ridgeback bg's drop to acceptable range when we mix her dry perscription with some lean protein like chicken.

We don't get Blue Buffalo here in Australia (that I know of) but if we did i'd certainly give it a go!

I hope you and foster get ontop of things soon.

Claire

[CarolW]

Re: New & need diet advice

This is merely a welcome to the forum - glad to see you've been reading! I read through entire threads when I joined here; learned a lot that way.

Wishing you well with Foster - I'm not very good with food, so I'll let others help you with that!

So, here's your big, fat welcome!

Mon, 16 Aug 2010 05:04:56 (PDT)

[oahu]

Re: New & need diet advice

Just a quick update on Foster... we've increased his RelinOn N to 6 units 2x/day, and we've been replacing 1/3 of his dry Royal Canin with canned Hill's i/d, and he's doing better. His thirst is reduced, he's not pacing around and he has much more "good" energy, i.e. playing with toys. I don't have the exact numbers in front of me, but last night's curve was something like this:
7pm 99
Fed at 7:05.
8pm 146
9pm 199
10pm 240
Went to bed.
7am 214

I'll have to wait until this weekend to get a full day's curve, but it seems something is going right since he doesn't have the bg drop at the 3 hr mark. I guess we need to play around with the food; I want to try the blue buffalo as I'd rather feed him dry non-prescription food. I also forgot to mention that he's dropped from 13.2 lbs to 11.2 lbs during the insulin switch and is looking a little thin.

Thanks for the welcomes and advice!

[k9diabetes]

Re: New & need diet advice

Wow! That's looking great!

I hope after the dose has had time to settle in that you will have found the answer.

Natalie

[lab lover]

Re: New & need diet advice

Hi Natalie,

Just wondered about something I was reading the post regarding bg's and how they dropped so low within 2-3 hrs after injecting that happens a lot too Baby she also has been running high in the evening and am too and then I will checked one day and she drops from 350 to 150 in 2-3 hrs. Is Buffalo Blue a better dog food for her and which one should I get since she has been on Orijen she her bgs haven't been good also do yu know of a metamucil without sugar my vet said she needs more fiber when I tried metamucil it has a little sugar she went higher - feel liked I am back to square one again. Also, I noticed are they not going to be selling Novolin NPH from Walmart anymore and changing the insulin - I couldn't really read the whole article is it going to be the same but, under th e Lilly brand. Thanks, Ida

[oahu]

Adjusting to blindness?

I'm pretty sure Foster is completely blind now because he's having a pretty bad day. He's lost in the house, lost in the yard, barking at the windows, not finding his doggy door... He's being very careful about where he walks, but he's just confused.

For those of you with pups who gradually went blind, did their adjustment period last long? I'm worried because Foster doesn't have the best sense of smell (for a dog anyway), and while his hearing is OK, he always thinks sounds are coming from the opposite direction, so I'm having no luck guiding him with my voice.

I'm reading these great stories of blind dogs swimming, running, etc. and I'm wondering if those dogs had a time of less confidence.

I realize this is a diabetes web site, not a blind dog site, but you've all been so helpful so far. Thanks!

[claire81]

Re: Adjusting to blindness?

Blindess is definately a diabeties thing, so it's all welcome here.

Some dogs do go blind quickly with sustained high levels, but fortunately we haven't had to deal with this yet.

While I dont know first hand, I've heard plenty about dog who adjust quite well given that their environment is stable.. i.e. don't move the furniture around too much!

[k9diabetes]

Re: Adjusting to blindness?

Most likely Foster has been adjusting to diminishing sight for a while now and it has just finally reached the point where he can't compensate anymore.

And yes they very definitely do go through an adjustment period, usually a few weeks to a month, where they are tentative and spend a lot of time bumping into things.

I sometimes wonder if they don't kind of wait around at first for the fog to clear! And then at some point they think okay, I guess this is how it is. And then they start figuring things out.

In six years involved with dogs with diabetes, still the best example is a little tiny Yorkie, Sandy, who went blind in the wintertime while living in the east on a few acres of land. She had to navigate a couple of steps before she got to the snow that was deeper than she was tall. Her person was, to put it politely, "doubtful" that she would adjust and she suggested that a couple of us who said it would be okay ought to try walking a mile in her shoes first!!

And she had a point... I had a dog who was 30 inches tall, two-thirds legs, no snow, and no steps!

But after a few weeks, Sandy just got over it. She figured it out and moved on and no one was more relieved that we were! LOL

Foster will do the same. Some dogs take longer than others but a few weeks is pretty typical I think.

It's also good to remember that a dog's brain approaches the challenge differently. Dogs don't wring their hands and fuss over Why Me? Why Did I Have to Lose MY sight!!! We do that but they don't. My sense with Chris was more like, Well, That's Different. So almost without exception, blindness is far more traumatic for the people watching than for the dogs.

You might want to try scents to get his attention. Some people scent paths through the house and doorways to help them navigate and that would be good for Foster too but you might consider a strong scent to get his attention. Maybe not food but something that would kind of grab his attention but not be unpleasant like a flower oil or tree oil.

(I just got back from an intro to nose work class and spent a few hours watching dogs follow their noses.)

You all will figure out what works for him.

Natalie

[eileen]

Re: Adjusting to blindness?

I can't add much as Natalie's post really sums it all up wonderfully.

My Mildred was blind for 10 months before I could give her cataract surgery.
She adjusted to her blindness quickly and quite well.

I really think it was me who had the difficulty, not so much her.

In the 6 years I've been around diabetes and dogs losing their sight I have only seen 1 that did not adjust well, she basically gave up.

Countless others really do well, in their own time.