Newly diagnosed need help with other health complications

[Linda G.]

My Westie female age 11 was diagnosed diabetic 10/19/15. She started on Vetsulin but we are now on Novolin since 11/25/15. I've been on another FB forum for diabetic dogs but it was suggested I post on your forum for her more complicated health issue. Katie was found to have high ALKP levels in 2010, other liver values were normal and have remained so. I've been to specialists and had u/s 4 times over these last years and have been keeping her GI issues mostly stable until recently with diet and supplements. She has to eat 4 small meals a day and this I know is not recommended with diabetic dogs. We tried to get her to 3 meals but all the juggling of food amounts and timing has reactivated her GI problems causing morning inappetance, bile, and noisy stomach sounds now all day today, won't eat. We went to Emergency Clinic 12/3, had abdominal u/s, cerenia shot, and fluids. She was okay these last few days but had the same problem this morning again. Shortage of internal med vets in my city but have appt. with one Dec. 16. I am monitoring her BG as I have been all along. My primary question or goal here is to find a resource for a dog who has primary health issue of GI trouble and diabetes secondary. Is there anyone here who has experience with a dog with GI issues, mainly liver and IBD related? Thank you.

[jesse girl]

hi and welcome

my jesse had issues we did something very out of the ordinary and switched her to one meal a day and a very nutritious homemade diet without fillers so the meal doesn't have to be that large . my theory is one meal relieves the body of constant digestion as with more meals but some diabetic dogs here have done good on more than 2 meals so you can make just about anything work for a diabetic pup but you will have to do most of the work

jesse had acute pancreatitis bloody diarrhea stools loosing weight . she has done well for the last 5 years with this method . havent heard a stomach gurgle since those difficult days

now i doubt you will find any professional to agree with this method and jess maybe the only diabetic of any kind doing this. for me as you that was the priority and diabetes was second but the funny thing her blood sugar numbers improved also

now i cant be sure this method is the key to jesses success all i can say is what we have done and still doing and her issues maybe unrelated to your pup

sometimes thinking outside the box and using some common sense. start small if you see some progress continue if not move onto something else

[Linda G.]

Hi and thanks for the welcome. I certainly understand thinking outside the box and having to do things differently. The thing with my Katie is she requires more and smaller meals. Her GI trouble has been called Bilious vomiting meaning empty stomach syndrome causing bile, air licking, nausea. We've tried various meds at night with her like Pepcid, Zantac, small meal before bed. Even setting an alarm for 2am to give her a few pieces of food. My concern is the diabetes may be causing her more liver distress. This is tough just getting her stable again. Also this GI thing is very common in Westies from my experience.

[eileen]

Welcome, Linda!
So glad to see you here. I know this community has a lot of very helpful and knowledgeable members that will offer input for your Katie's extra special needs.

[k9diabetes]

You can make four small meals a day work. If you are finding it difficult to use an intermediate insulin such as NPH and Vetsulin, you can go with something like Regular, which lasts a much shorter time and might be able to be given with each meal. Our dog was on Regular insulin only, four times a day (every six hours).

I actually preferred a four times a day schedule to three, which we tried at one point. I fed and injected at 10am, 4pm, 10pm. and 4am. That allowed me to take care of things during the day (I work from home), including lunch and dinner out if need be, while still not having to get up too terribly early. I was very good at going back to sleep after the 4am meal and injection.

So if your meals a day works well for her, I would look for a food/insulin combination that works with that, and fast (Humalog, Novalog) or faster (Regular) insulin could be helpful.

I have also known a few diabetic dogs with quite bad allergies who spent their entire diabetic lives also taking prednisone (steroid). They needed somewhat large doses of insulin but they managed quite well for a number of years and without it, they would not have survived. So if your girl needs steroids to control the IBD, it is doable with the diabetes.

Liver issues can make the blood sugar somewhat unpredictable / erratic, but again, this is something you can work with. Some folks have used a sliding scale for the insulin dose, for example 4 units per injection when the blood sugar is 250 or less at meal/injection time and 5 units if it is 350 or more... that sort of thing. Because some dogs don't do stable. And the shorter the duration of the insulin you are using, the easier it is to adjust the dose as needed. You want to start with a small change, test, and see how it goes.

In your shoes, I would work out the med / meal routine that is best for her and then adjust the insulin type / dosing / frequency to match.

How long is NPH generally lasting for her?

Natalie

Originally Posted by Linda G.

My Westie female age 11 was diagnosed diabetic 10/19/15. She started on Vetsulin but we are now on Novolin since 11/25/15. I've been on another FB forum for diabetic dogs but it was suggested I post on your forum for her more complicated health issue. Katie was found to have high ALKP levels in 2010, other liver values were normal and have remained so. I've been to specialists and had u/s 4 times over these last years and have been keeping her GI issues mostly stable until recently with diet and supplements. She has to eat 4 small meals a day and this I know is not recommended with diabetic dogs. We tried to get her to 3 meals but all the juggling of food amounts and timing has reactivated her GI problems causing morning inappetance, bile, and noisy stomach sounds now all day today, won't eat. We went to Emergency Clinic 12/3, had abdominal u/s, cerenia shot, and fluids. She was okay these last few days but had the same problem this morning again. Shortage of internal med vets in my city but have appt. with one Dec. 16. I am monitoring her BG as I have been all along. My primary question or goal here is to find a resource for a dog who has primary health issue of GI trouble and diabetes secondary. Is there anyone here who has experience with a dog with GI issues, mainly liver and IBD related? Thank you.

[Linda G.]

Thank you Natalie. We've only been using Novolin a short time and up until 12/3/15 we were trying to give her more calories and increasing meals and changing times of feeding. Her GI trouble became worse because she doesn't handle a lot of food or changes to her diet well at all. It was recommended at the emergency clinic on Dec. 3 we return to 4 small meals as we had been doing in the past. So, we've only had 3 good days back on her meal schedule. Her BG numbers were a bit higher as expected but I knew it would take a few days to settle a bit after her very bad day at the emergency clinic. To explain further, she started on Vetsulin 10/19 but had very weird and erratic numbers when I opened a new vial so we went to Novolin and I think it was a better fit for her. In the 3 days time back on her 4 meal schedule her highest BG was 347 and her lowest was 109. My main and most concerning problem right now is her current GI problem (since she woke up this morning) because today she has eaten NOTHING due to her gastric upset. We gave her a cerenia tablet about 90 min ago.

[Linda G.]

Hi Eileen and thank you again for recommending this group

[Joan]

My first diabetic pug Bella, had very very high liver values, after biopsy diagnosed as Chronic Active Hepatitis,,,CAH. She was not expected to live, but she did!!
She became diabetic about 3 months later, and lived more than 3 yrs after that. As Natalie has already laid out the 4 meals, that is what we did for her most of the time. I was pretty new to diabetics at the time, and used 4 meals, and 4 injections of Novolin N. It would have been better no doubt to have used Novolin R, but had no experience with it at that time.
The timing can be up to you as long as you are somewhat close to the 6 hour spread, we did 6 -12- 6 -12. But what ever goes with the schedule you can maintain.
At the time I was told I was going to kill my pug by injecting and feeding 4 times per day, but sometimes you just have to do what you think is right. Now it is much more widely accepted and recommended to go outside recommended protocols. You can trust Natalie's opinions over any vet that I know of.

On the liver/digestion issues, what diet are you on? We fed a modified Dodds Liver diet, low fat cod, cottage cheese, oatmeal, small amt of chicken and small amt of rice. By home cooking you can adjust a lot easier to match up with the insulin. As you know the most important thing with these liver dogs is to keep them eating, so whatever it takes.

Are you giving SamE, milk thistle etc.? This diet plus supplements got our little Bellas bile acids down from 10X normal to 2X, and she was comfortable there.

[Linda G.]

Originally Posted by Joan

My first diabetic pug Bella, had very very high liver values, after biopsy diagnosed as Chronic Active Hepatitis,,,CAH. She was not expected to live, but she did!!
She became diabetic about 3 months later, and lived more than 3 yrs after that. As Natalie has already laid out the 4 meals, that is what we did for her most of the time. I was pretty new to diabetics at the time, and used 4 meals, and 4 injections of Novolin N. It would have been better no doubt to have used Novolin R, but had no experience with it at that time.
The timing can be up to you as long as you are somewhat close to the 6 hour spread, we did 6 -12- 6 -12. But what ever goes with the schedule you can maintain.
At the time I was told I was going to kill my pug by injecting and feeding 4 times per day, but sometimes you just have to do what you think is right. Now it is much more widely accepted and recommended to go outside recommended protocols. You can trust Natalie's opinions over any vet that I know of.

On the liver/digestion issues, what diet are you on? We fed a modified Dodds Liver diet, low fat cod, cottage cheese, oatmeal, small amt of chicken and small amt of rice. By home cooking you can adjust a lot easier to match up with the insulin. As you know the most important thing with these liver dogs is to keep them eating, so whatever it takes.

Are you giving SamE, milk thistle etc.? This diet plus supplements got our little Bellas bile acids down from 10X normal to 2X, and she was comfortable there.

Joan,

I'm relieved to hear feeding 4 small meals is doable with diabetes and also, that there are options as far as injecting more than the normal two times a day or even using a different type of insulin. That gives me some hope. We've tried Katie on different diets including chicken breast with and without rice also various vets and specialists have suggested different diets but she's done the best on Hills ZD due to the hydrolyzed protein. She's been on it 3 years I believe. I soak it in warm water to soften. She also gets some yogurt, unseasoned pumpkin, and can handle finely chopped steamed green beans, broccoli, zucchini sometimes. Last year at this same time we lost her brother to jaw cancer at almost 16 yrs of age. He too had IBD and skin allergies. SOOO common in Westies. He could only eat RC potato rabbit and Katie has eaten that food at times and does pretty well with it. Recently I tried her on some egg whites, cottage cheese, lean turkey. She had a very bad reaction to one of those foods, I think it was likely cottage cheese. We really have to be super careful with food. She's been on a liver support that contains milk thistle, a digestive enzyme, and a couple probiotics. I put her on these things 5 years ago when a liver group I joined recommended them. We have an appointment to meet an internal med vet here on Dec. 22. Katie had an abdominal ultrasound Dec. 3 with a vet in the ER clinic and from what I understand on the report the are liver changes. Her pancreas looked okay. The Internal med vet will no doubt have other tests or ideas.

[Linda G.]

I'm still finding my way around your site, hope I'm doing this the right way. Joan/Natalie, Katie's bile acid test done a couple of times, was non fasting and may not have been done the 'recommended way' I learned when I was on the liver site group, but her BA was 24 those 2 times, 4 and 5 years ago. Her liver values are okay except for her ALKP which has ranged up and down from 1259 in 2010 down to 503 a year ago and up to 1407 in Oct. Several vets have told me they see this in many dogs and often never know why. I've wondered about Cushings but she doesn't have most of the tell tail signs like pot belly, over drinking, over urinating. The vets she's seen absolutely do not think she's a Cushings dog. She had a slightly high than normal UC:CR test in 2010 but we didn't proceed with the LDDS test.