Nima's crazy journey

[parisa]

Hi all,

I found this forum via google, so I am apologize if this post is in the wrong section. I am also jet-lagged from being in Bangkok for 10 days and now back home in Seattle.

My dog 8 year old lab/springer mix Nima was diagnosed with diabetes probably 1 year ago. He was placed on pork insulin, responded for a short period then switched to lispro, then to regular insulin. He was on regular insulin for a good chunk of time but continued to lose weight. I don't feel that he was ever properly regulated/monitored by his old vet. The vet at the time basically gave up on us/him and said we need to just feed him more. He didn't check Nima's blood sugar often, only when we switched insulins at the beginning.

1 month ago Nima was lethargic and had non-stop vomiting. Nima was in the ICU for 4 days due to DKA (we fired the first vet because we brought him to the vet and the vet didn't even take his blood sugar, but instead gave him IV fluid and sent him home). Post ICU stay at a new vet, he was then started on 10 units NPH twice a day. We've done 3 glucose curves and he is now on 14 units of NPH insulin twice a day, but his blood sugars remain in the 400s. I'm not really an expert, but I am an RN, and when I look at the curves he has obvious resistance. He has had chronic UTIs so right now he is being treated for a month with Amoxicillin, he's been on it already for about 1 week. There are talks of switching him to Detemir insulin.

It really distresses me that his blood sugars aren't moving in the right direction. I am concerned that he has Cushing's disease as in the last 8 months I've noticed the hair on his stomach is sparse. Additionally, he has calluses on his elbows that through research I have found to be consistent with canine Cushing's. I left a message with his Internist last night discussing my desire to have him tested, so I'll hear back in the AM. Has anyone had experience with Cushing's and Diabetes in their dog?

Can anyone give me any advice, direction, words of encouragement? Also, Nima REAAALLY hates being stuck at the vet for 12 hrs when they do his glucose curves. Has anyone had experiences where the vet let you perform the curves at home?

Thanks for all your help, advice, words of wisdom....
~P

[amydunn19]

Re: Nima's crazy journey

Hi and welcome to you and Nima! There is a wealth of information and experience here.

First, it sounds like you have really had a tough time with your diagnosing vet. I, too, had to fire my original vet. My dog had pancreatitis and diabetes and she was way over her head.

First, what is your dog's weight? I am not sure your dog has resistance because the nph dosage doesn't seem to indicate that you are near the dosage for that size of dog.(I am assuming here that a lab/springer mix is a bigger dog). It is generally 1 unit per pound per injection. Keep in mind that you are literally starting over with all the changes your dog has experienced. It will take time to work up to the Nph dosage that your dog may need. Most vets start with either nph or vetsulin at a low dose and work up to the actual over a period of curves and small adjustments. I hope I understood correctly that Nima has only been on NPH for the last month?

I highly recommend you begin testing at home. It is your choice, not your vet's and after my experience with my first vet, I was adamant about testing at home. I pretty much told my new vet that I was testing at home and if it was a deal breaker for him, I would have to find someone else. You have to take charge of Nima's health yourself. There are many good vets out there - an internist is a great choice. General vets can lack experience in treating diabetes and tend to go by the "book" - on this forum, we have figured out that not all dogs respond the same to the one size fits all treatment. Testing at home has added years to my dog's life.

Many diabetic dogs exhibit symptoms of cushings and unfortunately get false positives when tested. Not to say Nima doesn't have cushings but in an uncontrolled diabetic dog, it is hard to definitively diagnose cushings.

[Eddie]

Re: Nima's crazy journey

Hello and welcome!

Yes - home testing is a great alternative to curves at the vet. Our dog has only ever had one curve done at the vet in 14 months since diagnosis.

We just started home testing (encouraged by what we found on this site) and then told the vet that that was what we were doing. He was surprised as none of his patients had ever done that before but he is happy with our results and will prescribe insulin on the basis of our info.

At one stage we compared our (human) meter with his hand held one and found that ours was significantly more accurate than his (we got a definitive result from his lab analyser).

You can just get started (loads of help on here) and tell him that that is what you are doing. It saves money and gets rid of any stress associated with visits to the vet so gives probably more accurate readings.

Let us know how you get on
Antonia

[Abby's Mom]

Re: Nima's crazy journey

Welcome, and glad you found K9Diabetes. I would highly recommend becoming a member on the K9Cushings site as well. www.k9cushings.com They will help you in determining whether or not your dog may have Cushings, and highly recommend getting an IMS (Internal Medical Specialist).

In my humble opinion, there are not many vets that have the experience in treating diabetes. If you are lucky, you can find one that will work with you, learn with you. They are generally good vets for preventive, vaccinations and common ailments, diabetes not being one of them.

My Abby was diagnosed as having both originally, but ended up only have diabetes. She did not have any other symptoms, other than some Cushings tests coming back positive, which are not always accurate when a dog has diabetes. Her insulin levels did not indicate that she was insulin resistant.

If you can provide some blood work tests, post them to the K9Cushings site, and if you are willing, I would highly recommend home testing. A lot of folks have human meters, some have the AlphaTrak2, and some have a collection of meters. The OneTouch seems to be a good human meter and pretty consistant with averages. As you may be aware, a human meter will read lower with canine blood, so we use an average of the difference to get a good reading. If you have any curves, please post them here. Human meter are used because the strips are less expensive, than the AlphaTrak, which are about .75 to $1 a piece.

A lot of advice, good advice can be found here.

Barb

[jesse girl]

Re: Nima's crazy journey

hi and welcome DKA is serious and its to bad your original vet did not understand the situation sometimes a vet just have to raise there hands and say i dont know and maybe you should look for more experienced person . its not an easy profession .

another thing to add is to make sure your pup is tested for pancreatitis my jesse was diagnosed DKA and pancreatitis

most here on the forum do test at home i have reached a point where i do not discuss jesses diabetes with the vet and manage it on my own pretty scary with 0 medical knowledge but my jesse was very sick and knew it was up to me with help from the forum

[momofdecker]

Re: Nima's crazy journey

Hi all,

I found this forum via google, so I am apologize if this post is in the wrong section. I am also jet-lagged from being in Bangkok for 10 days and now back home in Seattle.

My dog 8 year old lab/springer mix Nima was diagnosed with diabetes probably 1 year ago. He was placed on pork insulin, responded for a short period then switched to lispro, then to regular insulin. He was on regular insulin for a good chunk of time but continued to lose weight. I don't feel that he was ever properly regulated/monitored by his old vet. The vet at the time basically gave up on us/him and said we need to just feed him more. He didn't check Nima's blood sugar often, only when we switched insulins at the beginning.

1 month ago Nima was lethargic and had non-stop vomiting. Nima was in the ICU for 4 days due to DKA (we fired the first vet because we brought him to the vet and the vet didn't even take his blood sugar, but instead gave him IV fluid and sent him home). Post ICU stay at a new vet, he was then started on 10 units NPH twice a day. We've done 3 glucose curves and he is now on 14 units of NPH insulin twice a day, but his blood sugars remain in the 400s. I'm not really an expert, but I am an RN, and when I look at the curves he has obvious resistance. He has had chronic UTIs so right now he is being treated for a month with Amoxicillin, he's been on it already for about 1 week. There are talks of switching him to Detemir insulin.

It really distresses me that his blood sugars aren't moving in the right direction. I am concerned that he has Cushing's disease as in the last 8 months I've noticed the hair on his stomach is sparse. Additionally, he has calluses on his elbows that through research I have found to be consistent with canine Cushing's. I left a message with his Internist last night discussing my desire to have him tested, so I'll hear back in the AM. Has anyone had experience with Cushing's and Diabetes in their dog?

Can anyone give me any advice, direction, words of encouragement? Also, Nima REAAALLY hates being stuck at the vet for 12 hrs when they do his glucose curves. Has anyone had experiences where the vet let you perform the curves at home?

Thanks for all your help, advice, words of wisdom....
~P

Welcome to the forum. You are in the right place! Sounds like you've had quite the journey so far with Nima's diabetes. I'm glad you found your way here. Sounds like he is quite the fighter and glad he was able to overcome the DKA.

Like others have asked, what is Nima's weight? In terms of having a UTI - that itself could be causing elevated blood glucose (bg). Not all, but many diabetic dogs do see an increase in bg with infection. Some will see an increases with antibiotic use as well. So in terms of considering resistance - the UTI/infection could be a cause of what you might be seeing. There may be other considerations as well but until that is cleared and Nima's been off antibiotics for a few days afterwards it may be difficult to get a clear picture.

I too would encourage you to check out the sister cushings site. I believe folks on there would discourage you from testing for cushings with an type of illness/infection going on. If the resistance suspicion and other symptoms still manifest themselves when the UTI is gone, and you are still wanting to pursue a cushings diagnosis, I would recommend the UCCR urine test as a starting point. You would take a sample of the first pee of the day (presumably at home in a stress free situation) and then take it to the vets for evaluation. A negative test result would rule out cushings. A positive test result would not confirm it but might point you in the direction of more testing being needed.

Having said all of that, I would also encourage you to keep an open mind in terms of symptoms as there are many symptoms of diabetes, cushings and hypothyroidism that overlap with each other. And sometimes as the diabetes comes under better control the symptoms disappear. Assuming your boy is a larger pup, 14u of insulin twice daily is not a large amount. And seeing 400's on 14u would indicate that the insulin is working - maybe not where you want it to be - but it would indicate that it is working to some extent.

So if you are testing for now I would consider recording the readings you are seeing mainly to check for patterns/trends, as the numbers themselves may be more elevated due to infection/antibiotics, and might not give you an accurate picture of how well the 14u of insulin is working. You can also pick up some urine strips to check for ketones at home - most local pharmacies carry them. Once the infection has cleared you could run a curve at home, checking bg before morning fasting and every two hours up till evening fasting. Post it here and folks can offer feedback.

Can you tell us what you are feeding Nima? Any other medications or medical conditions in the mix besides the UTI/antibiotics?

Welcome aboard!

[parisa]

Re: Nima's crazy journey

Hi everyone!

I want to thank you all for your responses, you guys are great!

Nima weighs 59.12 lbs right now. In the past 2 weeks he has gained 7 lbs which is great! So he is somewhat responsive to the insulin. He has been on NPH for the past month so far. I am sorry I forgot to include this in the original message.

I did talk to his Internist this morning and she said she wants to check for Cushing's but once his UTI is resolved and once the Amoxicillin is done in mid Feb (6 week course). She said that with a UTI going on, the urine cortisol test that some of you mentioned is not accurate.

I have been using a human glucometer at home, it's Freestyle Lite, but I feel it is very inaccurate. I have purchased the AlphaTrak 2 online and it should be here tomorrow or Wednesday (hooray!). I really want to try and do his curves at home. Has anyone ever noticed or thought that perhaps blood sugars are higher at the vets because they are stressed? Nima really hates going there and I feel like that could possibly be contributing to his blood sugars being elevated?

Also, I just wanted to add, he was tested for pancreatitis and had an abdominal ultrasound. I am not sure if they saw his adrenal glands on the ultrasound, but I would assume they did and they were normal. There was nothing concerning on the ultrasound. He did have slightly elevated liver enzymes when he was in DKA but that is to be expected. Once the DKA resolved his CBCs and BMPs were normal. Simply put all his other labs are normal thankfully.

I am really thankful to everyone of you has read and/or replied to my message. You have given me a piece of mind that I am not alone nor going crazy

[parisa]

Re: Nima's crazy journey

Hi there!

Here is Nima's curve when he was started on 10 units twice a day of NPH. I have his curve from when he was started on 12 units but I can't find it at the moment. I will post it soon though.

Blood Glucose Curve:
8:20am 508mg/dL
10:20am 426mg/dL
12:20pm 382mg/dL
2:20pm 351mg/dL
4:20pm 359mg/dL
6:20pm 395mg/dL
6:45pm Fed 1/2 can w/d and 1 can chicken
7pm Administered Humulin N 10 units SQ

Thank you for your advice!

[k9diabetes]

Re: Nima's crazy journey

Just have a moment, but even 14 units isn't much insulin for a 59 pound dog. He could easily need as much as twice that to regulate.

He did respond to 10 units as his blood sugar dropped quite a bit. Will be interested to see how he is doing on 14. My guess, since he gained some weight back, is that he's doing quite a bit better.

I'm very thankful you will start testing him at home. By doing tests and curves at home, you will be able to see how well regulated he is and how he responds to an increase in insulin if one is needed.

Cushing's and hypothyroid are both possibilities for the insulin resistance, but I'd like to see more information on how regulated he is now and perhaps on more insulin before pursuing those possibilities.

If you do a Cushing's test, ask the vet to do the ACTH instead of the LDDS - the ACTH tends to be ore accurate in a less than regulated diabetic.

Natalie

[parisa]

Re: Nima's crazy journey

Thanks for your reply! He is doing tons better in terms of attitude, activity level.

I am curious if you have any in put, why does the vet adjust his insulin so slowly? Every week she's doing a curve and then only increasing by 2 units each time. I have read in multiple places that dogs can require 1 unit/1 lb so I don't understand why we're moving so slowly. Nima has never, ever, ever been hypoglycemic or anywhere close.

Thanks again!

[amydunn19]

Re: Nima's crazy journey

Regulation is a process and if done correctly, it takes a long time. If your vet were to go too fast in raising the dose, the correct dose could be passed easily and overdosing could occur. Overdosing doesn't necessarily manifest as hypoglycemia. Many times, a dog may go higher instead of lower because of a natural defense the liver has in response to low blood sugar - releasing glucose to protect the body. If you continue to increase the insulin and this is occurring, it can be dangerous.

Insulin doses need time to "settle" - generally five to seven days. You may give a certain dosage and see an immediate change and after a couple of days, the bg starts drifting up again. It is also possible that you might not see an immediate change in numbers that day but a couple of days later, the bg might start falling. The body needs time to adjust and not very dog responds in a predictable manner. They are very individual and since they can't communicate in words how they feel, the process just takes longer to get them to a stable dose.

[Auddog]

Re: Nima's crazy journey

I have been using a human glucometer at home, it's Freestyle Lite, but I feel it is very inaccurate. I have purchased the AlphaTrak 2 online and it should be here tomorrow or Wednesday (hooray!). I really want to try and do his curves at home. Has anyone ever noticed or thought that perhaps blood sugars are higher at the vets because they are stressed? Nima really hates going there and I feel like that could possibly be contributing to his blood sugars being elevated?

Hi there,
Bazz and I wanted to extend to you our warm welcome too

You've gotten some great advice so far! I just wanted to touch on what you mentioned here. I've read about a lot of members (myself included) who's pups show totally different numbers at the vet's office than they do at home. I think it was a factor in my boy's original insulin overdose that sent him to the animal ER on more than one occasion. That all happened before I found this forum, and started home testing.

Good for you to start the home testing process . This can be such useful knowledge to have. It made me feel like I had better control over my pup's health, and has brought both our stress levels down. I'm assuming that because you say you were worried about the accuracy of the lite, that you have successfully tested Nima with it.

Bazzle and I have two meters as well. We have the one touch ultra mini, and the alpha track 2. I remember the sticker shock I had when I saw the price of the strips for the AT2 ! We then did a series of same blood drop comparisons between the meters and came up with an average "Bazzle conversion number". I only bring this up because these fur babies can get expensive, and if you can find your "Nima conversion number" you will then have the option to stick with the less expensive freestyle lite strips.

Let us know how things go, we are all here to help

Audrey & Bazzle

[parisa]

Re: Nima's crazy journey

Auddog,

I have tested him at home for quite sometime, though I'm not sure how accurate the numbers were. He has always been in the 200-300s at home, but at the vet he's in the 300-400s. The Alpha Track 2 comes in the mail tomorrow so I'm going to test his blood sugar once I get it and see how it goes. I want to by the ultra touch mini you mentioned, others have said good things. Then I can figure out his conversion number.

I hope the vet will let me just perform his curves at home. I hate having to take him there just to be stuck in a cage all day

I will keep you all updated!

[parisa]

Re: Nima's crazy journey

Hi there,

Nima has no other known medical conditions. He did go blind in July and had very successful cataract surgery. The only medication he takes regularly besides insulin is a once a day eye drop, Diclofenac.

We feed him Royal Canin Diabetic food (the can), and pure chicken. He is trying to gain weight at the moment, He is almost 60 lbs and his ideal weight is 75 lbs. He is consuming about 1200 calories a day (instructed per his Internist).

[Riliey and Mo]

Re: Nima's crazy journey

Hi Parisa

You will find the alphatrack uses a real small droplet to get a reading. Glad I got mine. I never use my one touch meter any more.

Your vet is losing money not taking Nima in for curves. Nima is more nervous getting it done there sooo glad your going to home test. Its your decision to be in control if your dog, s bg not your vet

Really looking forwarded to seeing Nina, s first home curve