Newly Dx: Ruby, my foster rescue Yorkie mix

[MaryLea]

Long story made short, I am fostering Ruby, who presented with chest/abdominal tumors, high liver numbers and pancreatitis. She was emaciated at 4 pds. Surgery to remove tumors. Treatment of pancreatitis with enzymes added to food. She was given prednisone along the way. I was not involved then, and do not know what that was for. I became her foster about three weeks ago. She was drinking excessively and peeing, of course. I waited until the prednisone should have been out of her system. But the symptoms persisted. Back to the vet for UA and blood work. BG was in the 400s, ketones in urine. Vet ran a curve the next day, Rx is .5 ml Vetsulin, BID. UA today or tomorrow. Another curve next week. This morning she ate very little, so I opted to skip her injection. 1/4 of .5 ml is too small for me to judge. I contacted our vet with an update, but frankly, with our girl Ruffles, other owners of diabetic dogs (HERE!) were a better source of helpful information. I know I need to begin testing here at home, and have the supplies needed. I was out of town and her former foster took her to the vet for the curve. She is almost 7 pds now, but still not much meat on her bones. Sweet temperament, mostly calm. My question now is, do I just resume feeding and injection on schedule? I think so, unless the vet chooses to intervene. This is kind of tricky, since she is a foster, but the director of the rescue is on board with what I have suggested so far.

The vet did not intervene, so I plan to feed and inject tonight on schedule. Vet is hoping that liver numbers will become lower once we get her on a better dose of insulin. This vet seems to be more knowledgeable than the one we had when Ruffles was Dx. She is taking a conservative approach to dosage, which is the opposite of what was done for Ruffles.

[jesse girl]

Re: Newly Dx: Ruby, my foster rescue Yorkie mix

I think your plan is good and follow the typical schedule . The half unit is small but maybe the diabetes could still be temporary or the possibility of the pancreas still producing some insulin with a honeymoon period

With all what is going on home testing will be a plus

[MaryLea]

Re: Newly Dx: Ruby, my foster rescue Yorkie mix

Hi, Jessie Girl! I remember you from when we had Ruffles. I had not thought of the diabetes being temporary. We can hope, can't we!

Ruby's food is soaking in the enzymes as Rx by the vet for pancreatitis. Then I am going to add a spoonful of pureed baby turkey food to see if that helps her to eat. (It worked!) The low fat chicken broth this morning did not get her to eat.

She also gets a drop of B12 added to the food each meal.

Waiting 15 minutes to be sure she keeps the food down.

[MaryLea]

Re: Newly Dx: Ruby, my foster rescue Yorkie mix

More information!

Last Thursday: Check curve- slightly dehydrated Ate about 7:30AM
Norm-R fluids at 9:00 AM- 15ml /hour
8:54AM: Gluc 497
9:19AM .5 U Vetsulin SQ
11AM: Gluc 420
2PM:GLUC 360
4PM: GLUC 322

CBC-inc neu-12.79 (2.95-11.64), Bands-sus, dec lymphs, inc Mono, inc PLT-787CHEM- inc Gluc (453), dec Crea (.3), Inc TP (>12), Inc ALT (470), inc GGT (23), ALKP (needed dilution), TBIL-6.8, Dec AMYL-311, Dec Cl(104)UA- SPG1.037, KEtones (2+), GLU (4+)7-8% dehydrated

This (UA result) is more information than I understand. We take a urine sample in this afternoon or tomorrow morning. Another curve is scheduled for next Thursday. She is calm enough that those curves may be OK, but I hope to have everything in place by next week to begin home testing.

I think I should weigh one cup of her kibble and calculate the .9 needed for an 8 pd dog (she is only 7 pds now). Of course, divide that by 2 for the feedings. Is it unrealistic to hope she will begin to gain weight as we get BG lower? Should I push for an increase to 1 unit/BID? the .5 unit lowered from 497 to lowest of 322. If that is consistent, 1 unit should put her about 150 at lowest. .75 units would be difficult to measure. She is still drinking excessively, but not quite as much as before. urine output still elevated. Hunger is too, but I have not increased her food yet. Vet has her on Kirkland Adult Dog Lamb, Veggie, and Rice with enzymes over the food (for pancreatitis).

Added note: UA today showed no improvement. Raise insulin to 1 unit, BID.

[Riliey and Mo]

Re: Newly Dx: Ruby, my foster rescue Yorkie mix

Hi and welcome
As JG said the insulin dose is small
Its recommended when you do a change to wait a week then do another curve before raising the dose.
I would raise the dose to 1 unit total from the .5
Recommended dose for 7 pounds is 1.4
In the meantime it will really help to start spot checking before breakfast ..then. 2 hours after..then another at the 6 hour point.
This will help catch any lows.

[MaryLea]

Re: Newly Dx: Ruby, my foster rescue Yorkie mix

Thank you for your response. The vet has raised the dose to 1 unit as of this evening. There was no change in ketones in urine. She is still exhibiting the 3 main symptoms: Polyuria - the need to urinate frequently; Polydipsia - increased thirst & fluid intake; and Polyphagia - increased appetite. I hope we will see some improvement by next Thursday.

I am going to feed just under 1/2 cup of kibble (which is for an 8 pd. dog) to try to help her gain a little weight. She is SO skinny. We put enzymes on it with warm water and let it soak for 20 minutes before serving it to her. I added 1/2 tsp pureed turkey baby food this morning, which helped her eat all of her kibble so she got a full dose of insulin.

The Alpha Trak will be here by Friday or Saturday, so we can begin home testing BG. We need to know the lowest reading in order to determine whether to increase the dose or not. The vet wants to do another curve next Thursday, but that only goes through 4 pm and has no beginning fasting test, so we don't know if the 6 pm or 8 pm reading would be higher or lower. The trend is down during the day, but i will not be surprised if it begin to rise a little. (I tested Ruffles before nearly every injection and ran curves once a week. She had other issues, but so does Ruby. They are just different issues.)

As of today, her feeding times are 9 and 9.

[Raysaint]

Re: Newly Dx: Ruby, my foster rescue Yorkie mix

Most changes/improvements with diabetes takes time. UA may take days to start improving, as blood sugar starts to consistently improve.

As sugar improves, most dogs gain weight back.

Starting dose for insulin here in Canada is 0.5 units per kilogram (2.2 lbs.) So 1.5 units should not be dangerous.

[MaryLea]

Re: Newly Dx: Ruby, my foster rescue Yorkie mix

Thank you, Raysaint. I wondered why the vet started her so low, since 1.4-1.5 is the recommended beginning dose. Her highest BG was 497 and after the .5 dose, it did come down during the day. We have ordered an Alpha Trak which should arrive tomorrow, and I will go to the rescue director's house to get it.

Today, we are working on becoming friends, Ruby and I. She does not know how to relax and snuggle, is uncomfortable being next to a human. So I'm picking her up often, petting her and praising her every time she pees outside (taking her out every time she drinks, which is sometimes twice an hour right now). I want her to learn to at least sit on the ottoman and relax. She came up there once on her own just a few minutes ago, so that is limited progress. Her reluctance is making the injections more difficult, but I am still trying to figure out the best place and posture for her when injecting. A treat does not seem to get her attention when placed within eyesight.

Judging by her water consumption, Ruby did not have much change during the first week. We just began the 1 unit injections last night, so it is to soon to tell if the increased dose will help. She may be a little more perky today. I hope to begin testing her BG this weekend so we will have better information. The vet did not do a fasting BG since she had eaten before being taken in last Thursday, and they stopped at 4 pm because they close at 6. So we do not know what a 6- or 8-o'clock evening reading would be.

I also increased her kibble last night since the recommended amount is more than she was getting. She is still quite under weight, and has little meat on her bones. So the extra food will impact BG as well. Of course, being a rescue, we do not have a medical history on her, so there is a multitude of unknowns.

[MaryLea]

Re: Newly Dx: Ruby, my foster rescue Yorkie mix

Well, we are not yet friends. This morning was a hassle with her injection. After 3 tries, I used the U100 syringe, which I already had. Much easier!!! May just switch to them. (Had to make a conversion of 2.5 to 1 units.) When we woke up this morning, she had spit up a little during the night. No way to tell if it was pancreatitis or a hypo, so she got some honey and a treat, just in case. Ate her breakfast OK, but slowly, which is not unusual. I waited a few minutes before trying the injection and then it took a while, so the kibble and topper had plenty of time to begin working. She has been fine all day. the Alpha Trak was delivered to the rescue this afternoon, so I picked it up tonight before her evening food with hopes for a fasting BG at 9 pm.

However, we did not get a fasting BG reading. I cannot get the Alpha Trak to respond to the control liquid. Is there a secret to using this thing? It is very different from the one we used with Ruffles; of course, that was 10 years ago, so there have been advances since then. But the instructions seem disjointed for Alpha Trak. I got the code set up right according to the manual. But I have ruined two test strips trying to get the control to work. Can anyone give me some pointers, please? TIA

[Raysaint]

Re: Newly Dx: Ruby, my foster rescue Yorkie mix

From my experience with many meters for my own diabetes, they are usually accurate out of the box. Start using it and the next time you visit your vet, take it and compare with their meter.

I've done test solution a couple times with the Alpha and it was OK.

[MaryLea]

Re: Newly Dx: Ruby, my foster rescue Yorkie mix

Thanks, Raysaint. We did just that this morning without figuring out the control solution problem. Fasting BG was407. Next reading in 30 minutes.

She is perky today, but still drinking lots of water. The curve run at the vet (.5 unit Vetsulin) started at 497, but was not a fasting BG. It will be interesting to see what the next reading is. I have already asked the vet to switch to Novolin N, but plan to wait until we get some sort of stable readings, which I expect to take at least 2 weeks. It will be time to retire that vial then anyway. Vetsulin only lasts about 4 weeks. We are at 1 unit BID this week, which is week #2.

I will take our unit with us to the vet when they run their curve next Thursday. Great idea!

[Raysaint]

Re: Newly Dx: Ruby, my foster rescue Yorkie mix

Just bear in mind that once you have stable readings, changing insulin will at first probably change some of her numbers and nadir time also. Novolin has a different pattern of onset and peak. If that's what you're sure you will do, you might make the change right now.

With diabetes, every change in something can throw things out of whack.

[MaryLea]

Re: Newly Dx: Ruby, my foster rescue Yorkie mix

Thank you, Raysaint. We decided last night to make the change now. The vet put her on 1 unit of Novolin N, which I began last night. She didn't have the near hypo incident which is a relief. Next curve by vet will be next Tuesday, one week after switching. I may do a curve on Saturday if I can get some more test strips. I will need them soon, anyway.

She is still drinking much water, but not as ravenously as b4 we began insulin. Still pees a lot of course and seems hungry most of the time. Has a little more energy, so that's a good sign. Fasting numbers are still in the 300s and 400s.

The U100 syringes have a smaller needle, so she didn't even jump when I inserted it, which was nice. She is still not calm for the BG test or the injection. I'm using treats, which she eats. Still wrapping her in a blanket for the test and shot. I hope she can relax soon.

I am using her scruff for the injections, which I know is not ideal. She is so skinny that I haven't found a good alternative yet. Hopefully she will gain weight and become more calm. I can hope, can't I?

[Raysaint]

Re: Newly Dx: Ruby, my foster rescue Yorkie mix

With the new insulin, you might want to spot check around nadir time, to be sure she's not dropping lower than before.

I've used the scruff almost entirely and haven't had a problem. I occassionally inject behind the front shoulder, 3 or 4 inches down from the spine.
Absorption is generally OK in many areas, as long as you can pull skin up a bit. Using the same area can slowly cause scarring inside and may affect absorption, but I believe it takes a long time.

I've been injecting myself in the same areas for 30 years, and my insulin still works fine.

[MaryLea]

Re: Newly Dx: Ruby, my foster rescue Yorkie mix

Your comment about injecting for 30 years made me .

A friend has donated an One touch mini with 25 test strips, so I may try some parallel readings to see if they are within the 10% allowance. Besides, I failed to realize that the started kit for Alpha Trak had only 25 strips instead of 50, so I will run out one or two reading before the order arrives. I don't really want to skip any fasting readings, if possible. I am free handing the lances with the AT because i think the sound would spook her. The auto-lance with the One Touch seems much quieter, and she has little reaction to it so far. Of course, I didn't have a lance in it or try to get a sample.

I want to try the pad above the pad to see if she reacts better to that than her mouth. She doesn't offer to bite, which is wonderful, but she surely resists as much as possible. We wrap her in a blanket, but I would prefer to find a "sweeter" spot.

The vet will do a curve next Tuesday, and we may do one one Saturday.