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Diabetes and Regulation in General The big picture of managing and regulating a dog's diabetes

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Old 07-27-2008, 04:46 PM
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Default Hero - Juvenile diabetic now thriving at 2 years old

Hi Everyone, I am a new member here. I am owned by an 8 month old English Springer Spaniel puppy who was diagnosed at 8 weeks old. His name is Hero.

I have been fighting this puppy and his eating habits for too long about 4 months. He used to eat like a cow at every meal and about 4 months ago he quit eating for about 2 weeks staright. Now Some days he eats with a vengence other days he won't eat at all, and I mean I have tried everything short of force feeding him. I can not get him to consistently eat for a few days in a row to be able to do a curve. I have had all blood work done and nothing is wrong there. I have also had his stools checked as he seems to be on and off metronidazole he is getting blood in his poop at times about twice in 3 weeks now for a few days each time. We had a bout of giardia last winter and nothing since, but it has been checked 3 times and treated anyway twice. No other dogs here are having stool issues either.

Now for the pondering questions.... I am afraid Hero is in need of a dose adjustment. His numbers aren't coming and staying in the 100's anymore. I am wondering if I am dealing with rebound, and could have been for a while how do I know and what do I do? I dismissed the rebound issue before after talking to my vet, since Hero is never gone too low on me. Hero is always too high. I increased him to 8 units the other day, but when I had to use both N and R I backed off the 8 units and went back to his usual 7. His insulin doesn't last for twelve hours and I find myself feeding him and injecting around supper time when he really shouldn't be due until about 9pm before he spikes up again. As his insulin wears off he gets too high. Plus I use the competition of the other dogs eating at dinner time to make him interested in food period. It is almost impossible to get him to eat alone at a time other than the other dogs eat and I can't feed all of the others so late at night 9pm.
I don't know whether to increase his insulin (which I suspect he needs) or decrease it hoping for signs of rebound. Is there someone who is an expert on here? We aren't getting numbers in the 100's anymore, and the lowest I have seen in a while is 260.. I know you will ask for his curve but there just isn't one to offer on a day where he ate both meals and I didn't need to give any R that day. We use R intermittantly because of the high numbers.

Lisa & Hero
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Lisa & Hero DOB 11/25/2007-June 21st, 2013
DX Jan 2008
  #2  
Old 07-27-2008, 05:47 PM
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Default Re: Hero

Welcome, Lisa!

Sounds like you have a juvenile diabetic there. We see very few of them, as diabetes in dogs and cats is mainly a "middle age" problem. We had one some time ago on another board I was on; he was a little terrier. His insulin needs changed as he grew, just as children with diabetes have their insulin requirements needing adjustment as they grow up.

We had another person with a young Great Dane who had diabetes write a case study for the Pet Diabetes Wiki. Quila was diagnosed at 5 months old.

http://petdiabetes.wikia.com/wiki/Case:Quila

You haven't posted Hero's weight--dosing of insulin is based on how much the patient weighs.

As long as you're not able to attempt a curve at this time, what about trying to do some regular monitoring with urine testing strips? Used three times a day, they can help point out where Somogyi rebound may be a factor, whether the dose of insulin is too low and some idea of how long the insulin is lasting. While they can't tell you as much as doing a curve would, testing urine like this could help identify what's going on with Hero.

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.

"Have pet owner test urine three times a day: before the first meal (test 1), before the second meal (test 2), and late in the evening (test 3)."

This page then provides a table for you to check your positive or negative results against.

If this is rebound, the answer is always less insulin, rather than more.

Another problem with diabetes is being prone to infections and some of those can be occult or hidden ones:

http://petdiabetes.wikia.com/wiki/Hidden_infection

Hidden infections in diabetic cats or dogs may have no outward signs at all except unexplained hyperglycemia. Infections can also be the cause of hypoglycemia. Therefore when facing persistent obstacles to regulation, it's a good idea to ask a vet to check blood counts for the possibility of a hidden infection. Hidden infections may be anywhere in the body, including dental, urinary tract, or elsewhere.

Infections and diseases can also be referred to as 'subclinical'; this means the condition is present but there are no easily discerned signs or symptoms of it. Using urinary tract infections as an example, it is possible for one to be present, but not evoke the traditional signs which tell us it's there. A traditional urinanalysis might not turn it up, but doing futher testing and performing urine culture tests may be the only way to spot it.

http://petdiabetes.wikia.com/wiki/Category:Infections

http://petdiabetes.wikia.com/wiki/Ob..._to_regulation

If you haven't done so, you might want to think about having a stool culture done to see if there might be a hidden infection still there. A hidden infection can send the bg's either way--too high or too low.

Hoping this is at least a start to helping you and Hero!

Kathy
  #3  
Old 07-27-2008, 06:52 PM
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Default Re: Hero

Hi Lisa,

I have often wondered how Hero is doing.

I have some questions and some suggestions.

As far as refusing to eat...

Have you seen a correlation between his refusing to eat and higher blood sugar or did the refusing to eat start before the higher BGs?

It sounds like the IBD issue could be behind his not wanting to eat... does the flagyl improve his appetite?

Anything you can think of, just in terms of time, that could be related to the refusal to eat. Weather changes, routine changes, food changes?

Insulin and curves...

As I recall, the insulin has never lasted him 12 hours and we have already talked about the ideal probably being more frequent injections (three times a day 8 hours apart) but that would be too difficult given everything you have going on.

Not sure if we also talked about a modified schedule like 10,10,4 where NPH would be given in two injections 10 hours apart and then an evening injection of Regular to cover the short 4 hour period. That is one possibility. Theoretically, that might be more manageable and accomplish the goal.

Also, either insulin can be given without a meal in a smaller dose just to cover basal insulin needs. Chris can take 1/3 to 1/2 of his normal dose of insulin without any food.

So you could, say, feed at 8am and inject Regular - feed at 12pm and inject NPH, and then inject a basal dose of NPH at 10pm with no food to cover him through the night.

That's essentially what you've been trying to do by feeding and injecting early. Perhaps the best approach is to incorporate that into his regimen with the short dose of Regular.

Is he better about eating at any particular time of day?

I wouldn't be surprised if he simply needs more insulin as he's finishing up his growth spurts.

I wouldn't worry about consistent diet. Go ahead and do a curve and just see what his blood sugar is doing with what he's working with now.

If you can check him fairly frequently for 8-10 hours, you will see whether he's rebounding. If he just stays high all the time, you will know he needs an increase in insulin.

The information will be useful regardless of whether his routine is consistent.

In fact, it can sometimes be helpful to do a curve with a basal-sized insulin dose and no food. Then you really see what he's doing with the insulin alone. And in your case, you really do need to know how much insulin he can safely handle if he refuses to eat so it could be just the information you're needing right now.

More information is always better. If he really is rebounding, you will see low numbers at some point after injection regardless of whether the food is screwed up.

Post what you get, what he ate, etc. and we can talk it through to see what it tells you.

I'm almost more concerned about his lack of interest in food. That's not typical of a puppy. If you can get a better handle of what's bothering him, the desire to eat and blood sugar may fall into line. Maybe he's just one of those dogs that has a very sensitive stomach and/or allergies/IBD. If you look at Oreo's thread, it took Oreo's mom a long time to find something he could eat for an extended period of time.

Natalie

Quote:
His insulin doesn't last for twelve hours and I find myself feeding him and injecting around supper time when he really shouldn't be due until about 9pm before he spikes up again. As his insulin wears off he gets too high. Plus I use the competition of the other dogs eating at dinner time to make him interested in food period. It is almost impossible to get him to eat alone at a time other than the other dogs eat and I can't feed all of the others so late at night 9pm.
I don't know whether to increase his insulin (which I suspect he needs) or decrease it hoping for signs of rebound. Is there someone who is an expert on here? We aren't getting numbers in the 100's anymore, and the lowest I have seen in a while is 260.. I know you will ask for his curve but there just isn't one to offer on a day where he ate both meals and I didn't need to give any R that day. We use R intermittantly because of the high numbers.
  #4  
Old 07-28-2008, 09:35 AM
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Default Re: Hero

Just wanted to welcome you and Hero to the board...I can see that there is a whole different set of problems for a juvenile diabetic. I hope things start to even out for Hero, but you are doing a great job so far. The moderators here are super knowledgable...you will benefit from that. It's good to have you with us!!

Love and hugs, Teresa and Ricky
  #5  
Old 07-29-2008, 07:55 AM
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Default Re: Hero

Lisa,

Am posting these links so you can see how these folks have coped with canine juvenile diabetes.

This is the story of Cody, who was diagnosed at age 4 months.

http://www.saveourpuppy.com/

Another story which I first read not long after Lucky was diagnosed was Molly's, who is another juvenile diabetes case.

http://members.aol.com/bobbytails/HOME/Page1.htm

With the proper care and attention, children with diabetes grow up to be adults with diabetes. One of my friends was diagnosed at age 10; she has an active life with her children and grandchildren. Puppies with diabetes can grow up to be dogs with diabetes too.

Kathy
  #6  
Old 08-26-2008, 08:21 PM
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Default Hero at the vet again

I posted recently about Hero's serious lack of appetite. It improved after his last dose adjustment to 8 units twice daily for about two weeks and now he has been on a hunger strike since last Sunday the 17th. I noticed a rather large and distended abdomen today, that I have only previously noticed in pregnant bitches. Obviously Hero is male, and not pregnant so off we went packing to the vet. She was concerned about the fluid like feel and possible enlarged liver and took radiographs. She then proclaimed Hero's liver to be the size of Texas. A bunch of liver related bloodwork was run. His liver enzymes were low and she was worried about loss of liver function. So a bile acid test was performed. Hero had to be force fed the small meal required for the second blood draw of the bile acid test. The first reading fasted was less than 5, the second gave a reading of 6. Both proclaimed his liver to be normal functioning. So the puzzlement of why it is so large and possibly inflamed. She feels this is likely cause contributing to his loss of appetite. The instructions were to give him Vitamin B12, Baytril and metronidazole for 7 days. He was a little anemic but she didn't feel that needed to be addressed. She also instructed me to get him to eat whatever he wanted. I plan to try a raw packaged diet next. I have already exhausted every canned variety, several dry options. He likes my cooked hamburg or cooked chicken, but I never can give him the right insulin injection off those foods. I have read and investigated a food called Primal. It seems pretty similar to the canned diet I have been using in terms of proteins, fats and carbs. The next steps in the process here would be ultrasound and liver biopsy. Interestingly to point out that Hero's initial bile acid test done at 8 weeks old revealed a normal functioning liver, but with much worse values than he has now, but without the disended abdomen. Go figure. Any thoughts on this? Much appreciated.
Lisa & Hero
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Lisa & Hero DOB 11/25/2007-June 21st, 2013
DX Jan 2008
  #7  
Old 08-26-2008, 10:17 PM
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Default Re: Hero

Lisa,

What comes to my mind is hepatic lipidosis, or fatty liver disease. You see this much more frequently with cats, but it's not impossible to find in other animals:

http://www.addl.purdue.edu/newslette.../finaldx.shtml

"Diabetes mellitus is often, in turn, involved in the pathogenesis of hepatic lipidosis. Hepatic lipidosis is a manifestation of abnormal metabolism in which the accumulation of lipids in the liver of a diabetic animal can result from increased fat mobilization and decreased utilization of lipids by injured hepatocytes."

http://www.lbah.com/liver.htm#IHL

"Hepatic Lipidosis Pathogenesis

"A small amount of fat is normally present in hepatocytes. The original source of this fat is from the diet. From the intestines (remember, bile needs to be present for this to occur) fat is absorbed into bloodstream, binds to albumin and is presented to hepatocytes. This fat is in several forms, the main ones being cholesterol, triglycerides, and fatty acids.

"Secondary

"In this form of hepatic lipidosis the fat accumulation occurs secondary to some other problem. This is more common than primary hepatic lipidosis. Secondary hepatic lipidosis does not cause liver failure. When the primary disease is treated the liver problem tends to resolve. A large percentage of cats have hepatic lipidosis secondary to these diseases:

"Diabetes Mellitus

"hepatocyte- individual liver cell

"hepatomegaly- enlarged liver

"Bile Acids

"This is a liver function test, not an enzyme test, and is not a routine part of the BCP. We will request this test when we suspect a liver problem, whether the enzyme tests are normal or not. This test is performed by taking a blood sample, giving a meal, then taking another blood sample 2 hours after the meal. Comparing the pre-meal and post-meal blood results gives us valuable information. The bile acids test is an accurate measure of liver function."

From what you posted about Hero's treatment, it sounds like this may be what your vet believes is the matter:

http://www.petshealth.com/dr_library/liver.html

"Hepatic Lipidosis (Fatty Liver)

"The accumulation of fat within the liver.

"Causes: loss of appetite which promotes the accumulation of lipid in the liver. This leads to a decreased in liver function. Underlying causes include-primary liver disease, shunts, diabetes, intestinal disease, pancreatitis, cancer, and other illnesses causing loss of appetite.

"Signs: loss of appetite, weight loss, icterus, vomiting, enlarged liver on palpation.

"Treatment: Dietary therapy is the primary treatment . High protein high calorie diets should be fed either by force feeding or by stomach tube. This process of tube feeding may last for 6-8 weeks. In our practice we place a either a PEG tube or pharyngeal tube surgically. Iv fluid therapy and antibiotics as well as vitamin therapy is also done."

Not certain this is what's ailing Hero but it might be of interest.

Kathy
  #8  
Old 08-27-2008, 01:14 PM
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Default Re: Hero

Quote:
I posted recently about Hero's serious lack of appetite. It improved after his last dose adjustment to 8 units twice daily for about two weeks and now he has been on a hunger strike since last Sunday the 17th.

I noticed a rather large and distended abdomen today, that I have only previously noticed in pregnant bitches. Obviously Hero is male, and not pregnant so off we went packing to the vet. She was concerned about the fluid like feel and possible enlarged liver and took radiographs. She then proclaimed Hero's liver to be the size of Texas.

A bunch of liver related bloodwork was run. His liver enzymes were low and she was worried about loss of liver function. So a bile acid test was performed. Hero had to be force fed the small meal required for the second blood draw of the bile acid test. The first reading fasted was less than 5, the second gave a reading of 6. Both proclaimed his liver to be normal functioning.

So the puzzlement of why it is so large and possibly inflamed. She feels this is likely cause contributing to his loss of appetite.

The instructions were to give him Vitamin B12, Baytril and metronidazole for 7 days.

He was a little anemic but she didn't feel that needed to be addressed.

She also instructed me to get him to eat whatever he wanted. I plan to try a raw packaged diet next. I have already exhausted every canned variety, several dry options. He likes my cooked hamburg or cooked chicken, but I never can give him the right insulin injection off those foods. I have read and investigated a food called Primal. It seems pretty similar to the canned diet I have been using in terms of proteins, fats and carbs. The next steps in the process here would be ultrasound and liver biopsy.

Interestingly to point out that Hero's initial bile acid test done at 8 weeks old revealed a normal functioning liver, but with much worse values than he has now, but without the disended abdomen. Go figure. Any thoughts on this? Much appreciated.

Lisa & Hero
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Lisa & Hero DOB 11/25/2007 DX Jan 2008 California Natural canned diet 7 units NPH twice daily
Hi Lisa,

It's tough to get them to consistently eat anything when something like liver or kidney problems are involved. Chris would turn his nose up at hamburger, bacon... all his favorite foods... at times like that. And something he'd eat on Tuesday he'd refuse on Wednesday.

Naturally, I hope it's nothing serious for Hero!! But it is kind of a relief in a way to have a "cause" for the refusing to eat.

Will they put him on milk thistle?

I will email you an article on the Bile Acid test - requires registration to view it online. I haven't read it yet but thought of Hero when I saw it and thought it might be helpful.

You might consider registering at this site as there are many good articles there that require registration for you to view them:

http://www.cliniciansbrief.com/?p=lo...es|^|newsid=16

I wonder if a basic liver dysfunction could be at the heart of Hero's issues. Perhaps the liver releases glucose at inappropriate times, driving up his blood sugar. Just a stray thought...

I will see what I can find about the liver issues when I have a chance.

If you wind up needing to feed him hamburger, is there something he likes you could mix with it? You probably need some carbs to go with it in order to balance the insulin.

Natalie
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Old 08-27-2008, 10:05 PM
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Default Re: Hero - Juvenile Diabetic, enlarged liver, won't eat

Hi, just to say welcome to the board, you found the right place, hang in there!
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Dolly & Niki passed 2010, 45 lb Border Collie Mix 8 yrs as diabetic, 13yrs old. Blind N 10.5 U 2 X * Dog is God spelled backwards*If there are no dogs in Heaven then when I die I want to go where they went. Niki's food Orijen & Turkey & Gr. Beans, See you at the bridge my beloved & cherished Niki, I miss you everyday
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Old 03-17-2010, 03:06 PM
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Default Re: Hero - Juvenile Diabetic, enlarged liver, won't eat

Since I contacted Lisa about Hero for Angie and Lisa provided a nice update about him, I thought I'd post it in his thread as well.

Natalie
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My Hero was diagnosed at 8 weeks.... He's 2+ now and is a happy healthy dog who is diabetic. I was also told to euthanize him.

He has cataracts but is still visually gifted without having had surgery as of yet. We ran the gauntlet with all the things that come with a diabetic puppy...which was unheard of here too Hero was also ketonic by 12 weeks and had a very expensive and scary trip to TUFTS for a few days.

At first we were using the urine sticks to check his glucose...which was pretty useless. After his trip to the ER for ketones I learned quickly to blood test him by lip, we have been doing this ever since.

I couldn't get good control of his insulin at first when he was eating dry food. i switched him to canned only diet and finally made some progress. After a year and fussing with his terrible eating habits, I decided to put him on the dry diet all my other dogs eat. He hasn't missed a meal since last August....truly heroic.

PS We use Novolin N & R insulin. The R is the short acting scary one, but we have managed to use it for 2+ years now carefully as suggested to us by a pediatric endocrinologist.

Lisa & Hero
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