Need Advice - Dog Sick / Diabetes Now Unregulated

[amydunn19]

I have found when Maggie has had a pancreatitis attack, all of her values rise but with recovery, they do come back down. For liver support, I give Maggie a supplement called Denamarin. The vet offices usually sell it but you don't need a prescription. You can order it online as well. It doesn't do anything harmful and no side effects that I have seen or heard about.

I know it is hard but try to take those results in context, and worry about one day at a time. Sounds like your vet is on top of this and so are you!

[jaycapz]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

Lily has been diabetic for 3 years. We think she was hypothyroid prior to that. She went blind with cataracts 5 months after being diagnosed with diabetes and has had successful cataract surgery. We're certain the cataracts formed because her BG levels were > 400 for at least 5 months. Her vision is great now. I give her eye drops daily and she visits the opthalmologist every 6 months. You may not have to worry about that because Jude's BG levels have been good up until recently

Her thyroid symptoms were hair loss, dry skin, dark belly skin pigmentation, high cholesterol, high triglycerides and insulin resistance. She also had weakness in her hind legs and was very lethargic, but that could have been diabetes related.

When she was insulin resistant she was up to 30 units of Novolin N. Once diagnosed with hypothyroidism and on soloxine, her IMS backed her off to 15 units and she settled in at around 18 units. She is currently on a mix of 16 units Novolin N and 4 units Novolin R.

Mike

Hi Mike,

In terms of medication and timing of shot/food, are you giving the thyroid meds at the same time? I am trying to find the best way to manage this in terms of time of day, as is I struggled due to time I leave/get home from work. I am hearing the meds must be given a half hour to 1 hour before food and shot? Have you had success doing all at the same time? Trying to see what someone elses routine and experience has been. It would be preferable to give all at once, just not sure how that will affect BG control and effectiveness of the medication.

Appreciate all your input! anyone with experience greatly appreciate your input as well.

[MikeMurphy]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

Hi Mike,

In terms of medication and timing of shot/food, are you giving the thyroid meds at the same time? I am trying to find the best way to manage this in terms of time of day, as is I struggled due to time I leave/get home from work. I am hearing the meds must be given a half hour to 1 hour before food and shot? Have you had success doing all at the same time? Trying to see what someone elses routine and experience has been. It would be preferable to give all at once, just not sure how that will affect BG control and effectiveness of the medication.

Appreciate all your input! anyone with experience greatly appreciate your input as well.

Hi Jason,

Dr. Jean Dodds, who has done a lot of research on hypothyroidism in dogs, recommends giving the meds 1 hour before or 3 hours after eating...

http://drjeandoddspethealthresource....n#.V2RQtZD3aK1

However, I give Lily her thyroxine right before eating and it seems to work just fine. I put the thyroxine tablet on a small dab of low fat peanut butter and she licks it off my finger

Mike

[jaycapz]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

Thanks Mike.

The internist/specialist just called me, so apparently Jude is just inside the threshold but still wants to treat him for hypothyroid. In terms of thresholds, .8 and higher is ok. He came back .9, but because of his symptoms he would still treat him. I am not sure I agree with this, I am going to ask my direct vet about it. The incident he suffered supposedly a mild pancreatitis attack, and had a slightly inflamed liver and pancreas. Yes hes a few pounds over weight, he does sleep often, but don't see any other symptoms. I guess left untreated and the thyroid continues to dip he will have issues eventually, I guess I am very conflicted.

Anyway, thank you for the advice. Regardless of what the vet says, I may just try giving it to him with the food. I don't think I can manage that much of a diet on my schedule. I guess we will see when he goes back for his check up, and how his Bg levels manage.

My concern is more about how much to lower his insulin, which my vet I worry is a bit old school and will down play it. I am hesitant to go back to the specialist, because to pick up the pills and then go back in 2-3 weeks for follow up will probably run me over $300. I just came out of pocket almost a $1k. My normal vet helps me out, I may pay for a simple visit.

I feel so at the end of my rope trying to do the right thing. My patience is at absolute 0 at this point. I know many have it way worse, but my personal tolerance ... just trying to keep my cool.

[Rubytuesday]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

It might help to look over Holli and Decker's thread. Not sure what page she talks about the thyroid, but I know his insulin needs dropped significantly.

http://www.k9diabetes.com/forum/showthread.php?t=3282

[stylynjm]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

My Sissy is on .1mg levothyroxine. Has been for about 6 months now. I give her her pills when i test her,right before her breakfast or supper. Her insulin needs went down slightly ( she is on a different insulin, stronger than NPH) about 1/2 unit.however,i only decreased when her numbers got lower,not before.she is doing well and actually some of her hair is growing back,lol.

[momofdecker]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

Given the insulin resistance Decker had experienced, and for the length of time he experienced it (approx. six months), combined with how low his thyroid values were, my instincts told me that when I started him on the thyroid meds I needed to be around so I could test him frequently to keep him safe.

Decker was overdosed pretty badly at the hands of his original (diagnosing) vet. I'd learned enough (from the great folks on here) to do my own research so I waited until I was on vacation for a week to start his thyroid meds. I'm glad I did because I was feeding him extra food and liquid sugar to keep him in a safe range that first day. Reduced his insulin and followed the same pattern for a total of five days.

Because we were testing his bg at home, once his insulin needs stabilized I did a few tests where he got his thyroid meds an hour before his meals and then tested again where he got his meds with his meals. With Decker there was a notable difference with giving him his meds an hour before his meals. The timing worked fine with my schedule so we just opted to follow that schedule. There were a few others on here at the time that gave their dogs thyroid meds with their meals and didn't note any problems. And honestly, if it had not worked with my schedule, I would have done the same and not worried much about it.

[jaycapz]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

Thanks guys, all good info.

Yea, to be honest, I don't know if i have a choice in when i can give him the pill. As it is I have moved allot around just to make sure his shots are taken care of.

Thankfully, my regular vet is in and just called to say bring him in now. Wants to discuss the specialists recommendations. So I will see in an hour or so what he says, doubt he will over turn the specialists instruction.

When I start him, and being here is going to be a concern. I'm going to try and plan it out that I can take a couple of days around the 4th of july, maybe I can be home a couple of days. How quickly did the insulin requirements drop? Should I expect that in the first couple of days I will notice anything at all? Not sure of how quickly his insulin requirements will change. The worst case scenario is I guess, I could just cut his insulin by a couple of units. I can't work from home or take off for a week, so hopefully a couple of days of monitoring will work.

If it wasnt for the fact his cholestorol came back 1500 after the mild pancreatic attack, and the slightly elevated liver, pancreas results. I would honestly follow my gut and say no medication, and chalk it up to a diabetic related episode. Oh, and after the attack results showed mild anemia. Lets add that to the mix. All of which the specialist states was a result of thyroid (with diabetes playing a role in the background).


UPDATE: Instead of replying with another thread, i'll update todays post. I saw my regular vet, he was in agreement with the specialists recommendation to start treatment. He said, he may have even started him a little higher. He said even though the range is 8-40 and he is 9, that his T3 levels were still very low and he has mild/beginning symptoms and to be ahead of it. They prescribed .2mg of soloxine twice daily. Vet said you can just give it with the food, and we will see how the results look in 3 weeks. He wants to retest him in 3 weeks to check his levels. In terms of monitoring, he said dont change the insulin levels just monitor. That the changes wouldn't be sudden enough to worry. He also said that I should watch for side effects, make sure he is not drinking allot more than usual, no change in stool and if there is diarrhea that I should stop the meds immediately. Hopefully this all sounds accurate.

[momofdecker]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

Here is my take on what happened with Decker - and it's simply my perception as I have no medical degree. When all was said and done - Decker had high chol and trig values. He tested positive for pancreatitis. He was suffering from insulin resistance.

My suspicion is that he was suffering from hypothyroidism long before it was ever diagnosed (like possibly five years before it was dx). I suspect that the undiagnosed disease led to Decker having high chol and trig values. I suspect those high values led to mild pancreatic attacks and that over time they scared his pancreas to the point he no longer produced insulin - and thus was dx. diabetic. His original vet was terrible and unfortunately I had no idea at the time. I blindly trusted him and Decker suffered great consequences as a result.

The toll the undiagnosed/untreated hypothyroidism took on Decker's health was a much greater toll than the diabetes ever took on him.

If your pup is dealing with true hypothyroidism - the meds will start to get his metabolic system back in check. Meaning that his lipid levels (chol & trigs) will likely lower and if he was suffering from pancreatitis - that may resolve as the lipid levels lower. Anemia is another sign of hypothyroidism in dogs - and that value may resolve as treatment is initiated as well. If the lipid levels and pancreatitis and hypothyroidism were all causing insulin resistance - you may see a quick need to lower the insulin as those may all start to resolve at once. I hope this is making sense.

Decker had a pretty steady curve pattern and if he continued to lower past 2p I knew he'd go too low. The first day we started his thyroid meds that happened. He got liquid sugar and extra food before his dinner meal and his evening insulin was reduced.

I don't think you have to reduce the insulin before you start - but it may be worth doing some extra testing and to see if you note anything outside of his regular curve pattern. Every dog is different - so home testing will be the single best tool to let you know how your pup will handle the introduction of the thyroid meds.

Sounds like you are doing a great job thus far - keep up the good work!

[jaycapz]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

Here is my take on what happened with Decker - and it's simply my perception as I have no medical degree. When all was said and done - Decker had high chol and trig values. He tested positive for pancreatitis. He was suffering from insulin resistance.

My suspicion is that he was suffering from hypothyroidism long before it was ever diagnosed (like possibly five years before it was dx). I suspect that the undiagnosed disease led to Decker having high chol and trig values. I suspect those high values led to mild pancreatic attacks and that over time they scared his pancreas to the point he no longer produced insulin - and thus was dx. diabetic. His original vet was terrible and unfortunately I had no idea at the time. I blindly trusted him and Decker suffered great consequences as a result.

The toll the undiagnosed/untreated hypothyroidism took on Decker's health was a much greater toll than the diabetes ever took on him.

If your pup is dealing with true hypothyroidism - the meds will start to get his metabolic system back in check. Meaning that his lipid levels (chol & trigs) will likely lower and if he was suffering from pancreatitis - that may resolve as the lipid levels lower. Anemia is another sign of hypothyroidism in dogs - and that value may resolve as treatment is initiated as well. If the lipid levels and pancreatitis and hypothyroidism were all causing insulin resistance - you may see a quick need to lower the insulin as those may all start to resolve at once. I hope this is making sense.

Decker had a pretty steady curve pattern and if he continued to lower past 2p I knew he'd go too low. The first day we started his thyroid meds that happened. He got liquid sugar and extra food before his dinner meal and his evening insulin was reduced.

I don't think you have to reduce the insulin before you start - but it may be worth doing some extra testing and to see if you note anything outside of his regular curve pattern. Every dog is different - so home testing will be the single best tool to let you know how your pup will handle the introduction of the thyroid meds.

Sounds like you are doing a great job thus far - keep up the good work!

Thank you for that. So I am basically trying to figure out a couple of things right now, I got the medication so its about when I can start the medication. Doc said its ok to wait 2 weeks if I really want to be home, cause as I said I will be taking a very extended 4th of july weekend. I'd like to be able to monitor him for first 72 hours. Do you think this is good idea? I mean, is what I see in the first 72 hours what I should expect? So basically, if I see that I need to drop him a unit in the first 24-48 hours... then I should expect that this is where he will settle out? What I fear is that sudden decline in insulin needs leads to a hypo attack, and I am not home to catch it. I guess what I am trying to figure out, is how long before I can say ... OK, if meds are right (perfect world), I can assume its safe to start re-regulating him? I would hate it if his insulin requirements stay in flux for a week.

I am probably over thinking all of this, but I have put in a great deal of time and effort to keep him in check. Those high BG's affecting his eye site and more, I want to keep this as controlled (best effort) as possible. To add more madness to the mix, the doc made a recommendation for changing his diet. Hes a little over weight, so he wants to adjust the caloric intake as well. So many variables .

[stylynjm]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

Hi,
I would definitely not worry about the food change right now. First of all,if he's going to be taking thyroud,he will lose weight... (if his thyroid is under active), second,never change more than one thing at a time.
As far as thyroid,every pup is different. It is impossible to know how long before his insulin needs change,or even,if they will change. My Sissy needed a little less insulin,but for her,it took 2 to 3 weeks.
If your pups numbers start going lower,i would adjust insulin to try to keep him not lower than 100.that way you will have a little wiggle room ...
I personally would wait until you can be home for a few days

[momofdecker]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

Thank you for that. So I am basically trying to figure out a couple of things right now, I got the medication so its about when I can start the medication. Doc said its ok to wait 2 weeks if I really want to be home, cause as I said I will be taking a very extended 4th of july weekend. I'd like to be able to monitor him for first 72 hours. Do you think this is good idea? I mean, is what I see in the first 72 hours what I should expect? So basically, if I see that I need to drop him a unit in the first 24-48 hours... then I should expect that this is where he will settle out? What I fear is that sudden decline in insulin needs leads to a hypo attack, and I am not home to catch it. I guess what I am trying to figure out, is how long before I can say ... OK, if meds are right (perfect world), I can assume its safe to start re-regulating him? I would hate it if his insulin requirements stay in flux for a week.

I am probably over thinking all of this, but I have put in a great deal of time and effort to keep him in check. Those high BG's affecting his eye site and more, I want to keep this as controlled (best effort) as possible. To add more madness to the mix, the doc made a recommendation for changing his diet. Hes a little over weight, so he wants to adjust the caloric intake as well. So many variables .

I agree with Jackie on waiting on changing anything with the food (calories or type of food). Hypothyroid dogs also tend to be overweight (it's one of the hallmark signs - one Decker's original vet completely missed). You may see your pup naturally start to shed pounds with the introduction of the thyroid meds (my guy lost 10 pounds).

The other thought - and this is more diabetes related - is that I tried to keep the rule of thumb of only changing one variable at a time. If you change food - that alone could change the curve pattern and/or the insulin needs. Then if you add in the thyroid meds - that could also impact curve pattern / insulin needs. If you introduce both at the same time - it may leave you second guessing if something doesn't work as planned.

Many folks on here will recommend to feed a dog who is prone to pancreatitis a diet low in fat. However, given that your pup has high lipid values and is also hypothyroid, you may note that once those are lowered (which they probably will do once starting the thryoid meds), the pancreatitis will resolve on it's own. I didn't note any re-occurring pancreatitis attacks for Decker once he started his thyroid meds. I'd still encourage you to keep a close eye on your pup - just in case - but his pancreatitis may be secondary to the hypothyroidism. So again - there may not be an urgency to make a food change.

I think you are wise to wait until the fourth of July week - where you have a few days to be home with your pup. Every dog is different - so it's difficult to predict insulin changes - but since you will be home testing, you will likely have a good sense after a day or two how much impact the start of the thyroid meds will have on insulin needs. Worst case - if you've reduced for two or three days and are still unsure - you could reduce to a standard 'start over' amount of insulin and work your way back up. Better to run higher for a little bit than to have a hypo when nobody is home to intervene.

Once you are able to stabilize the insulin amount - I'd still keep a close eye on things. If he does lose weight that could also impact insulin needs. Once you feel the weight and insulin are stabilized - if you still feel that a food change would be best - you could start to slowly introduce a new food at that point in time.

[MikeMurphy]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

Jason... I agree with everything Jackie and Hollie have said. And I would probably wait to introduce the thyroid meds until you can monitor more closely.

The thyroid meds had a big (positive) effect on Lily. Her resistance to insulin went away within a couple of days. In Lily's case, we reduced her insulin from 30 units to 15 units before adjusting to 18 units in addition to starting the thyroid meds. But remember that her BG level was > 400 for almost 6 months, so the rule of changing one thing at a time was bypassed.

Mike

[jaycapz]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

Thanks guys. No, I agree. I didn't want to make too many changes, that was part of the struggle. Changing food before or after the thyroid meds. Because if I wait, it could be weeks-months depending on if the meds are good and no adjustments needed.

The reason I am itching to change the food, is because its higher in fat content. I only have him on it now is because in the past it was the only food (evo ancestrial diet) that would help keep tight regulation, and he went off the rails during the incident. It was guesswork for a stop gap measure, now hes normal I want to put him back on the dry food. Well, hes getting 1/4 dry glycobalance, 1/4 can evo wet. Keep in mind, I had him on this diet when I realized it was too high in fat and switched to dry. 2 months later he had his first pancreatic attack, strange it would happen when I move him to a food much lower in fat. Go figure.

I could see this weekend, if I can quickly get him back on an older regime (insulin/glyco dry only) and if he takes to it quickly. Then maybe the following week (4th weekend) I start the meds. I fear leaving him on the higher fat diet for a month or so while the meds are evaluated, that it may trigger something. I could be over thinking it.

Regardless, I can see that he will need 2-3 adjustments due to hypo meds, associated weight loss and diet changes.

This process is not for the weak of heart, I tell you that.

[stylynjm]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

I found with Sissy,that dry food (even though i wet it) was much harder on her pancreas and since i changed her to canned (much easier on digestion ) we have not had any trouble with pancreatitis. ..just what worked for us.