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Old 09-30-2012, 04:37 AM
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zk067 zk067 is offline
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Default Diabetic Labrador Keeps losing weight. Please Help....

Hello All,

Our lovely, bouncy labrador was diagnosed with Diabetes nearly a year ago. He was in ketoacidosis when he was diagnosed and was overweight at 48kg. He was placed on caninsulin and W/D dry food twice a day and steadily lost weight and seemed to greatly improve health wise. In the past year we've had a couple of scares with him, he gets UTIs sometimes and has been on oral and IV antibiotics for them a few times.

In the past few months, without any changes to his exercise or food regime, he's gone hypo twice. The first time he went into shock with a blood glucose low of 20. When the vet stabilised him we reduced his insulin and increased his food. A month later he went hypo again (thankfully not in shock this time). We decreased his insulin and increased his food a little more.

Something we've noticed seems to be that in the past few months he has been steadily losing more and more weight and his coat seems incredibly dull. He also seems very tired all the time, though always in a mood for walks. The vet says all that could be from the diabetes, but I'm not so sure he doesn't need more/different food and/or some vitamins or...?

His curve has always been "weird" to quote the vet. Somigyi has been mentioned a number of times as has insulinoma. We did a curve on him a few days after we last decreased his caninsulin and it was:

9am: 97.2 (food & insulin given)
11am: 109.8
1pm: 388.8
3pm: 129.6
5pm: 239.4
7pm: 615.6
9pm: 399.6 (food & insulin given)
11pm: 604.8
1am: 446.4
3am: 72
5am: 604.8
7am: 406.8
9am: 428.4 (food & insulin given)
11am: 388.8
1pm: 536
3pm: 275
5pm: 126
7pm: 322
9pm: 180

So a bit

We use an alphatrak meter and strips and regularly monitor his urine for ketones etc. He's positive for glucose, but negative for ketones, protein, blood etc

The poor dog seems more and more exhausted each day and with his weight loss and numbers I'm not surprised really. The issue being if we increase his insulin even by one unit to get some of the highs down some he seems to go hypo at one or two readings through the day at least...

He was on 10 IU caninsulin in the morning and 11 IU at night before his last hypo. He's now on 7IU in the morning and 8IU in the evening. He gets 180gr W/D in the morning and 180 in the evening with 1/4 of a cauliflower at each meal for extra fiber as per the vet's instructions...

Any ideas for our lovely boy? Any ideas/thoughts would be greatly appreciated!

Zoe
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Old 09-30-2012, 08:21 AM
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CraigM CraigM is offline
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Default Re: Diabetic Labrador Keeps losing weight. Please Help....

Welcome to the forum! I'm on the way out the door, but wanted to say hello.

I've just briefly looked at your curve readings, and I agree they do appear "weird", the numbers really jump around! Just wondering, do you give any between meal treats that might be causing the jumps in glucose? Is he currently on any medications?

I'm sure others will ask more questions. Gotta run.
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Annie is a 18 pound Lhasa Apso, eats Blue Buffalo Healthy Weight with added black beans and Benefiber for additional fiber, uses Walmart's ReliOn branded Novolin (mix of R and N)
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Old 09-30-2012, 08:46 AM
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Default Re: Diabetic Labrador Keeps losing weight. Please Help....

Pancreatitis? Cushings? Cancer? Thyroid? Have you discussed any of these with your vet? Thyroid in particular may be what's going on. Take a look at Decker's thread. His thyroid was an undiagnosed problem for a while.
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Zoe: 9 yr old Black Lab/shepherd mix. Diagnosed 6/1/11. Currently on 15 units Novolin NPH 2x day, and hopefully as close to regulated as possible. Feeding Hill's Science Diet Ideal Balance Grain Free Salmon and Potato. Weight 69lbs.
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Old 09-30-2012, 08:48 AM
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Default Re: Diabetic Labrador Keeps losing weight. Please Help....

hi and welcome i would recommend reading hollis deckers thread

decker had some very unusual readings also kept raising and lowering the dose for months on end

changed insulin big improvement determined i believe there was a thyroid issue and had to take medication

its very understandable he doesn't feel well with big swings in blood sugar .

there maybe an underlying problem that is not identified the symptoms that you identified maybe something besides diabetes and the numbers in this curve is concerning

we base dose adjustments on the lowest number not the highest or the average anything under a 100 with fairly big swings in blood sugar maybe to low and the dose should be reduced now if you start raising the dose back up after higher numbers and then seeing lows again you just cant raise them back up

we used fast acting insulin for sometime with jesse while we tried to come up with an answer to her instability we still use it on occasion as a correction we try not to raise or lower her basal insulin (nph) and any adjustments we use as a correction to higher numbers .

i think if you have done something for a period of time it maybe time for a change maybe another insulin and to check deeper into an underlying problem that maybe causing this instability

i think even the most problematic diabetic can have reasonable numbers its just locating that solution my jesse was very difficult for years till we found a solution that did work for her its not perfect but acceptable
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Old 09-30-2012, 01:22 PM
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Default Re: Diabetic Labrador Keeps losing weight. Please Help....

I would ask for his last blood panel and ask how his liver looked, his thyroid like Jesse Girl and Cebe mentioned

My Jenny has both Cushings and Diabetes. It's hard to diagnose cushings in a diabetic dog. You really need a specialist. But most Cush dogs gain weight and have pot bellies. they have crappy coats but I'd lean more toward thyroid.

Plus, your dog may just have a higher metabolism than other dogs. He may need more food. I know a breeder who has 2 adult dogs, mother and daughter. Eating the same food, one gains weight and the other loses.

Your lows worry me though. But if he's had a lot of infections, he has probably needed more insulin until the infection cleared up. So that might be it.

Welcome to the forum. I'll be watching your thread to see what you find out. Hang in there! Judi
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Jenny: 13 years, May 2011, 8 pounds. Cushings June 2011, Blind from cataracts Sept 2011
Hills WD twice a day/over medicated for Cushings, cortisol low but slowly rising. switched to Novolin N Oct 2012, gets 4.5u twice a day
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Old 09-30-2012, 01:45 PM
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Default Re: Diabetic Labrador Keeps losing weight. Please Help....

Ask your vet about Addison's disease. Sammie had 2 hypo attacks in the 2 weeks following her diabetes diagnosis. Hypos are common in untreated Addisonians until there's an adrenal crisis, which is exactly what happened to Sammie just 3 weeks after her diabetes diagnosis. She also was very lethargic along with some gross discharge from her very dry nose. She had lost a ton of weight by that time (65 lbs to 42 lbs!) Once diagnosed it's very easy to treat... just a little expensive.

Addison's is often not diagnosed as the disease waxes and wanes over weeks, months or even years and mimics many other medical problems. The vet needs to look closely at the potassium/sodium ratios to suspect the Addison's and then there's a specific, more expensive, test to diagnose for sure.
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Karen & Sammie 77 lb Female Golden Retriever/Collie 9 years old. Addisons and diabetes diagnosed June, 2011. 21 U am/ 11 U pm Novolin N & 2 mg of Prednisone/day. 3 cups Nature's Variety Limited Ingredient Lamb split into 4x a day feedings.
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Old 09-30-2012, 02:29 PM
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Default Re: Diabetic Labrador Keeps losing weight. Please Help....

Welcome. You have already gotten a lot of great input already.

After a hypo incident the numbers can jump around for 3-5 days so it is possible he didn't have quite enough time to settle down before this curve was done. Here is a good link to read:

http://diabetesindogs.wikia.com/wiki/Somogyi_rebound

The 72 on this curve indicates that he may need another reduction.

How long has he been on this reduced dose?

While there may be other things going on I think he may still be getting too much insulin and that could be causing the weight loss. I would want to do another 12 hr curve to start with and probably doing it hourly in his case.

I wonder if because of the severe hypo if his liver panics and shots out glucose as all of these lower numbers are followed by a sharp rise. Then possibly the insulin clears the glucose at which point the cycle repeats.

This may be one of those cases where reducing the dose and allowing the dog to run a bit higher will even things out.
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She was a courageous Boston Terrier who marched right on through diabetes, megaesophagus, and EPI until 14.
Lucky for both of us we found each other. I'd do it all again girly.
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Old 09-30-2012, 04:02 PM
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zk067 zk067 is offline
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Default Re: Diabetic Labrador Keeps losing weight. Please Help....

Hello and thank you all for the very helpful and informative replies and the warm welcome!!!!!

Craig: Our boy doesn't receive any treats or foods outside of his two meals a day. We were much less strict about that when he was first diagnosed, but it's so much easier to monitor his blood glucose without treats so he's been going without... No other meds except the caninsulin

Cebe: Pancreatitis has been tested for and excluded by the vet a number of times. His thyroid was checked when he was first diagnosed (almost a year ago) and it was ok at the time, but to my knowledge hasn't been re-checked since. Cushings and cancer have been discussed by the vet as possibilities, especially an insulinoma that would cause the weird blood sugar readings. The issue with that is that our, lovely and helpful, vet referred us to a specialist hospital for cancer testing and they quoted us 4000 pounds (almost 5000 dollars I think) just for blood tests and scans while saying that if he does have an insulinoma nothing can be done anyway so why bother testing him at all... It's left us a bit perplexed and reluctant to put him through any cancer related tests, if nothing can be done.... Our regular vet is very helpful, but thinks cancer is very rare and we should exclude other things first. I'll take a look at the thread you mentioned, thanks! Thyroid sounds like an intriguing possibility!

Jesse: This thyroid business sounds very interesting indeed; I'll read the thread asap! Yes, his numbers are concerning and so is his weight loss really... Fast acting insulin? In place of his regular insulin or whenever his blood sugar spiked really high to get it under control? Sorry, that might be a silly question; I really don't know much about the different kinds of insulin to be honest...

Judi: Thank you. I'll ask for his latest blood panel tomorrow morning and check his liver tests. I think it was ok, but he had so many tests done when he was last at the vet's I may be wrong... More food is a bit problematic, as it makes his blood sugar spike even higher than where it is now but with this amount of weight loss we really won't have much of a choice other than more food soon... Could adding something to his meals that doesn't have a lot of complex carbs, like a hardboiled egg or..., help him gain weight a little without messing up his blood sugar readings too much? I'm sorry to hear your Jenny has both cushings and diabetes; I hope she's doing well

Heinzle: Addison's disease! Aha! I'll ask the vet tomorrow morning if he can check his recent potassium/sodium ratios and I'll try and discuss the possibility with him over the phone... Diseases that mimic other diseases and issues sound frighteningly difficult to diagnose! Ah, the weight loss sounds very similar. I hope your Sammie gained some of the weight she lost back with the proper treatment for her Addison's

Ruby: Thank you for the welcome and the information! The info on the Somogyi is very interesting. The curve was done a good 7-10 days ater his latest hypo, but perhaps he needed a bit more time for his blood glucose to settle completely? Yes, that's what we feared as well, that he may need another reduction with the 72 and with those high numbers the possibility of him going into ketoacidosis is a bit scary, especially if we reduce again. He's been on this dose now for 20 days and he's continued losing weight slowly but steadily on it. I was going to do another curve this week; hourly sounds like a really good idea to get a better handle on what's going on with his numbers!

Thank you so very much for the replies and help! I'll talk to the vet, get more information re his blood tests, do another curve, read up on thyroid issues and update; a plan of attack!

Zoe
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Old 09-30-2012, 04:11 PM
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heinzle heinzle is offline
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Default Re: Diabetic Labrador Keeps losing weight. Please Help....

Quote:
Originally Posted by zk067 View Post
Heinzle: Addison's disease! Aha! I'll ask the vet tomorrow morning if he can check his recent potassium/sodium ratios and I'll try and discuss the possibility with him over the phone... Diseases that mimic other diseases and issues sound frighteningly difficult to diagnose! Ah, the weight loss sounds very similar. I hope your Sammie gained some of the weight she lost back with the proper treatment for her Addison's
Sammie is now a hefty 73 lbs and she's doing great. Thanks for asking! I hope the puzzle is solved for your baby very, very soon.
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Karen & Sammie 77 lb Female Golden Retriever/Collie 9 years old. Addisons and diabetes diagnosed June, 2011. 21 U am/ 11 U pm Novolin N & 2 mg of Prednisone/day. 3 cups Nature's Variety Limited Ingredient Lamb split into 4x a day feedings.
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Old 09-30-2012, 05:26 PM
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momofdecker momofdecker is offline
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Wink Re: Diabetic Labrador Keeps losing weight. Please Help....

Hello and welcome to you and your boy! From looking at his curve it does seem he gets some large fluctuations in bg. Decker got similar swings on NPH with the big difference being that he typically didn't have any lows. His range was more of a 300-600+ range. The swings left Decker curled up in the corner as he did not tolerate the fluctuations well.

He was diagnosed in November 2011 and his diabetes went uncontrolled until May 2012. We switched him from NPH to levemir in May and it worked wonders for him. The potency of levemir is four times stronger than NPH but the action is much more steady and not nearly as strong as the NPH. Exactly what Decker needed to stop the bouncing around. In June he had a bunch of additional testing done which revealed a fasting cholesterol reading of 1055, triglyceride reading ofr 383, pancreatitis and hypothyroidism. His insulin needs dropped from 10u of levemir to 5u. His regulation is still not perfect but he does on average range from 100 - 320. Much better than 300-600+.

I will say that out of all his testing - the only reading that was not surprising was his triglyceride reading. We knew his cholesterol was >520mg from previous blood panels, but had no idea how dangerously high it was. Pancreatitis was chronic (likely from the high chol and tri's) and he did not exhibit any symptoms of it. Would have had no idea had the blood work not told the story. Hypothyroidism was also a surprise. His main symptoms we saw at the time were the high cholesterol and in May he became very lethargic and had exercise intolerance. Symptoms could also be attributed to his uncontrolled diabetes. Looking back he also had some eye issues in May, had cold intolerance (or more appropriately heat seeking behavior) and despite his bg being uncontrolled for so long his weight held steady at 98 pounds.

Sounds like your boy has been losing weight and hitting some lows. Hypothyroidism can present in many different ways so if you are open to having the test done I would encourage you to do so. But it seems Karen might be on to something with the Addisions as well and the sypmtoms you describe seem to fit with what she has described. Wishing you the best of luck in getting things figured out! Holli
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Holli & Decker // diagnosed November 5th, 2011 // Journeyed to the bridge January 26th, 2013, surrounded by his family at home // 9 years old // Levemir insulin // Hypothyroid // C1-C5 cervical spinal lesion // weight 87 lbs // Run with the wind my sweet boy. Run pain free. Holding you close in my heart till we meet again!

Last edited by momofdecker; 09-30-2012 at 05:28 PM.
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