Angel Scooter... August 31, 2013

[peeweek9]

Scooter, my Maltese 10 y/o was doing great on 8 units 2x's daily and on WD for 2.5 years. We didn't curve at home, but I tested him at vet and everything was perfect...UNTIL...he developed bladder stones with one stuck in his urethra, so surgery was mandatory. Took him to original vet, but the cost was so prohibitive I took him to a vet that is closer to my home and his clinic is very advanced and I thought they would be more expensive. Not to mention the vet lives in my neighborhood and I was able to get a 2nd opinion and made the choice to go with him for surgery. The one thing he did was change him to less food and lowered his insulin after surgery. I didn't want to do it, but I decided to go with his protocol. I should have known something was happening with Scooter because he was starving for the next 10 days and I told the vet. He said we would wait for 2 weeks and curve him. The stones are being analyzed.

Long, long story short....surgery was successful. They removed 2 stones including the one stuck. He got 3 units (no food) morning of surgery. He came home same day, didn't eat, no insulin, slept great, wasn't hungry. For the next 9 days he ate, was happy alert, was able to urinate, and was on 3 units twice daily. Exactly 10 days after surgery he had a seizure. I KNEW it was a hypo incident and I put the Karo on his gums, but I rushed him immediately to the vets office (thank God he is closer to my house than other vet). It was 4:30 pm and they don't do overnights, so they inserted a catheter and gave him sub q glucose and I rushed him to a hospital 30 minutes away. The whole time he was seizing and I thought he (and I) were going to die. All night in hospital and back to vet to be monitored the next day where they did curves all day.

I got a meter and readied myself to do home testing. And I also was told about Somogyi. This was the first time I had heard of the Somogyi effect (shame on me for not every reading about it). By the way the vet said I got lucky keeping him regulated, but I don't agree. 2.5 years of perfection wasn't luck. It was dedication, consistency and being very careful.

My question is this to anyone who has had to have surgery on their diabetic dog: What steps, if any, did you take to make sure your dog's glucose remained constant knowing they can't eat 12 hours prior to surgery? And possibly would be too groggy to eat in the evening? Could this have been what kicked him into Somogyi? Was lowering the food and changing the insulin (without testing along the way) have caused the hypo and somogyi effect?

It makes sense to me that knowing now how somogyi happens it could have been the 36 hours w/o food and 3 units of insulin and then lowering his food intake. But, could this have been avoided? Is there a protocol for this type of surgery and diabetic dogs? Scooter has had his teeth cleaned after diagnosis and not problem, but he was hungry and the procedure was pretty generic. He missed one meal, but not the 2nd.

It has been a very long day of testing, poking, recording, etc. Very scary for a first timer to home testing. I cannot believe that I was dosing him while his body was adjusting so he was getting too much insulin. He was very close to dying, but he is a real fighter. In fact, he loved the baby food, the chicken and all the goodies he got at the hospital to bring him back up. He thought he was staying the night at the Ritz. Cost to date: $2400.00 including surgery, emergency hospital and supplies.

I tested him all day and vet doesn't think Somogyi is present at this time based on numbers and curve. But, we are carefully upping his dose. He is now at 2 units, 2x's a day and I'll be testing at home. His numbers were:
465 Morning, then every hour, then every two hours
Fed got 3 units
462
211
146
409
461
465
Fed got 2 units

Can I have some thoughts, please? Thanks so much.

[Riliey and Mo]

Re: Surgery on a diabetic dog, Possible Somogyi

Welcome to the forum

Congrats on home testing now your in control and can save a few dollars

Doesnt look like a symogi but others can chime in. Theres no real big drop in his bg.

Can you post how much Scooter presently weighs?

What food he is eating?

You, ve been through a lot looks like your back on track.

Mo

[Monsters Momma]

Re: Surgery on a diabetic dog, Possible Somogyi

Wow! That sounds like a lot for anyone to handle! So glad you and Scooter pulled through!

At the end of your story you said you were upping his dose but then said you went from 3 to 2. Are you lowering it? The numbers you have wouldn't tell me you should be lowering it, but there are those two low number that would be scary if they got much lower. I guess I'm just confused why you would lower it?

You will get the hang of poking him for a test and in another week it will seem so easy. Vinny gets a special treat we save just for that and he knows he's going to get a treat so he is very good about poking him! I honestly never thought he would be. Every time I feel something is off in his behavior, I can test him rather than taking him to the vet. It has saved us a lot of money.

I hope you get the answers and support you are looking for here...I know I have.
Mel

[peeweek9]

Re: Surgery on a diabetic dog, Possible Somogyi

Thank you for posting. Yes, we have been through a lot and thank you for your compassion. He weighs 10 pounds and is on Science Diet W/D.

After the hypo crisis, vet said to test at home so we could find his dose and get him back on track. He had me do 3 units yesterday morning after checking initial number. Then I tested 9 times during the day and after all that he said go to 2 units. I was not happy with 2 units since he had been on 8 prior to surgery (all 2x's a day). He was looking for Symogyi clearly, but yesterday we established it wasn't in effect. It is like we are starting over finding his correct dose and increasing the dose gradually one unit at a time until he gets stable.

My concern is obvious in that the dosing isn't enough (now that we feel Symogyi isn't in play) and that he will become hyper, go blind or worse.

This has been a real nightmare for over two weeks. Surgery, seizures, emergency vet, no sleep for several days, back to vet, learn to do curves, do curves all day...on and on.

This morning I poked his lip at least 4 times, got very little blood, but when I did get blood the meter wouldn't register and it didn't even register err code. I am taking the monitor back to vet. Very frustrating. I had a few good pokes and moments yesterday and Scooter is a real patient guy, but it pains me to poke. I know this is a learning curve just as it was to stick with needle (which is a breeze now), but his little lips are covered with red dots.

By the way, during crisis, Scooter was at 24! It was a terrible to witness. I was speeding from vet to emergency hospital while he was in the crate next to me seizing. I honestly don't know how he pulled through, but he got immediate care at hospital and they were able to get his numbers up, but it was touch and go as a cath came out and his numbers sank at one point.

He was perfect before the surgery. The vet (out of the blue) lowered his food intake, lowered his dose to 6 (from 3) after surgery, he survived the surgery and within 10 days he was in crisis. Was it the stress of surgery, was it the lowering of food intake and insulin, was it the 36 hours after surgery where he didn't eat? I am searching for why this happened. And if anyone has had a similar event happen could you tell me what preceded it?

Thanks to everyone who is willing to help.

[Abby's Mom]

Re: Surgery on a diabetic dog, Possible Somogyi

Welcome.... what a story!!

A couple of things, and that is if Scooter ever starts to seize again, or if you have any suspicion of low blood sugar, the best way, and quickest way to get his blood sugar is a dollop of Karo Syrup and/or Honey. Have some on hand. If he is seizing, rub it on his gums. This can save you from panicing, and save his life.

He is one lucky pup!!

Once Somogyi takes place, and you don't know how long it had been going on, it will take quite a while for the body to adjust and settle down. Definitely 3 -5 days. I think during this time, I would not raise his dosage, based upon the 146 he is getting and as quickly he rose to 409 (I don't know the time difference between these readings..... perhaps every 2 hrs??).

I see a big dip in those readings. When we home test, we strive for a flatter curve, say within 100 pts of each other, but poor Scooter has been through quite a lot, and I am sure it will take some time for his body to adjust. I think after 3-5 days, if you start not to see any readings under 150, then it may be safe to raise, perhaps 1/2 unit depending upon the readings.

I have found that testing is not so bad on them. My Abby comes running when it is time for a test.... it is because of that tiny bit of chicken I give as a treat, but she truly doesn't mind the test.

Some theories as to why this whole episode may have happened.

1. Pain can increase insulin levels, so he may have been on a higher dose and ok with the high dose, if he was in pain, prior to the surgery. Once the surgery took place, and he was not in pain, he may have required a lower dose.

2. Typically when there is no food, 1/4 of the dose is giving. If 1/2 food, then 1/2 dose.

I think this is a great example of home testing. Especially when pain/surgery, even other ailments can be detected quickly when home testing. Excercise, excitement, thunderstorms all can affect blood glucose in a diabetic. For some dogs more than others.

So glad you found us, and so glad that you have Scooter. He is one lucky dog

Barb

[Judi]

Re: Surgery on a diabetic dog, Possible Somogyi

I'm not one of the experts but I definitely think his body could just be reacting all over the place and needs to settle down. You may want to ask your vet if you can just decrease the insulin for a week to let him settle out and run a little high. poor baby, seizures are so scary.

We test Jenny on the lip and I can only get decent blood near her canine tooth. If I try to move where I poke her around too far, no blood. I know when I've tested my finger it stings for about 10 minutes but isn't awful and dogs supposedly have fewer nerve endings in their lips

Also if Jenny isn't cooperating blood wise I'll give her a tiny treat. the chewing seems to get the blood circulating.

I hope this rough patch is over soon. hang in there. Judi

[Eddie]

Re: Surgery on a diabetic dog, Possible Somogyi

Sorry you and Scooter have had such a rough time. It all sounds incredibly stressful.

Have you increased the dose back up to 3 again now?

With the meter have you tried testing a drop of your own (or someone else's!) blood to see if it is a problem with the meter?

If I feel bad about poking Eddie's lip I just give him a tiny treat and a cuddle and remind us both that I am saving his life! The little red spots will soon vanish when you don't have to test so intensively.

Antonia

[Monsters Momma]

Re: Surgery on a diabetic dog, Possible Somogyi

If I feel bad about poking Eddie's lip I just give him a tiny treat and a cuddle and remind us both that I am saving his life!

Antonia

Antonia gave me the same advice...I am saving his life by monitoring him and you are too with Scooter! Vinny gets a little extra lovin' and a treat and he really doesn't mind being tested at all now!
Mel

[peeweek9]

Re: Surgery on a diabetic dog, Possible Somogyi

Hi Abbys Mom (and the others who are so kind to write) Thank you so much and please continue to share and offer opinions because knowledge is power.

I did the Karo Syrup, but I panicked and thank God because I don't think he would have made it, so I rushed to vet then hospital. I had the Karo since diagnosis, but had never needed it.

As to the times between testing, I ran tests hourly from 5:30 to 8:30, then every two hours 10:30 to 4:30. Then fed, then waited for reply from vet whether to shoot or not based on last number. I didn't hear back and I fed Scooter and didn't shoot because I hadn't heard from him. Better to err on the side of NO insulin vs giving a shot and since I didn't know what the adjustment was going to be, I just fed and waited. Three hours later he texted me back to give two. He also said: I have consulted a specialist and will call me today. This morning I fed, I shot 2 units and am waiting.

Maybe the pain from the stones....I hadn't thought of that. Frankly, it took a while to notice that he wasn't peeing properly. One day I said wow, he is taking a while to pee. So next time I watched and clearly he was attempting to pee and nothing was coming out. I knew that was an issue and that is when the process started. He was x-ray'd, two stones, removal, lower dose and food, seizures, vet, emergency hospital, back to vet, all day curving, on and on. I am exhausted, sleep deprived. But Scooter seems none the worse for wear. Mindful of course that his body is a machine and there are reactions inside that are going on...therefore the very slow, increase of insulin.

I found this on a closed thread earlier today (wow, there are some amazing people on this site and this gave me some true insight and the need to work on some patience as well:

I haven't had a chance to read through today's discussion in detail but have a couple of thoughts after a brief skimming of it.

First, this might sound crazy to you right now but I've seen a lot of people who would fall down to the ground in thanks if their dogs' blood sugar ever consistently fell into the mid-200s. Harry's mom, Yunhee, is one who didn't see numbers that good for months because Harry has a lot of other health issues that have made him very difficult to regulate.

And Harry's vets are really great - he has a regular GP vet and an internal medicine specialist - but neither one of them was the one who understood the interplay of food and insulin well enough to formulate a plan that worked for Harry. A holistic practitioner who understood how adjusting diet and the timing of insulin and exercise was the one who figured out a plan that significantly improved Harry's blood sugar through some simple diet changes and timing changes.

Dogs don't have to have perfect blood sugar to live long healthy happy lives. I've seen a lot of dogs who never got blood sugar lower than the 200s and they did absolutely great.

Is it worth trying to get the blood sugar lower? Yes. Absolutely.

But if it never gets any better, it won't be the end of the world - or your dog's life or happiness.

And it definitely is not a reason to panic and rush to change the dose.

It is much much better to take the time to sort out what's going on with Hattie all day instead of at just one point in the day.

I know that might be hard to feel comfortable with....

For a little more perspective, it took my dog more than a year to regulate properly! He had some problems with the way he used insulin and his blood sugar went from 100 up to 450 and back down to 100 again in 12 hours.

If I had checked his blood sugar at the midpoint of that rise and fall, I would have gotten a level in the 200s. I would not have known that it was going to drop another 100 points in the next few hours. And if I had given him significantly more insulin without knowing that, he would have gone hypoglycemic in a hurry.

You can read more about Chris' blood sugar, the sharp drops and rises in his curves, and his road to regulation in his case study:
www.k9diabetes.com/k9diabetes.pdf

Once we found what worked for Chris, he went on to have really great blood sugar and he lived to be 14.5 years old, a serious senior for a dog his size (62 pounds).

Diabetes didn't kill him and the truth is that diabetes almost never kills a dog. The only time I have seen diabetes kill a dog was from overdoses of insulin. Our dog died of cancer and suffered from severe heart disease for years, heart disease that preceded his diabetes diagnosis. Diabetes, even as difficult as his was to control, was literally the least of his problems.

So Hattie will be fine. She will be fine even if you don't raise her insulin at all for a few days. There is time, plenty of time, to take a methodical approach to her insulin dose.

I understand the panicky feeling... truly I do. I will try to remember to share my diabetes panic story with you! But Hattie is okay and there's really no need to panic. The worst decisions are made in panic - that's how you wind up giving too much insulin and getting started on a rollercoaster ride of highs and lows.

The best thing you can do for Hattie right now is set aside your fears and work the problem, learn to read Hattie's "book" with curves of her blood sugar.

Welcome.... what a story!!

A couple of things, and that is if Scooter ever starts to seize again, or if you have any suspicion of low blood sugar, the best way, and quickest way to get his blood sugar is a dollop of Karo Syrup and/or Honey. Have some on hand. If he is seizing, rub it on his gums. This can save you from panicing, and save his life.

He is one lucky pup!!

Once Somogyi takes place, and you don't know how long it had been going on, it will take quite a while for the body to adjust and settle down. Definitely 3 -5 days. I think during this time, I would not raise his dosage, based upon the 146 he is getting and as quickly he rose to 409 (I don't know the time difference between these readings..... perhaps every 2 hrs??).

I see a big dip in those readings. When we home test, we strive for a flatter curve, say within 100 pts of each other, but poor Scooter has been through quite a lot, and I am sure it will take some time for his body to adjust. I think after 3-5 days, if you start not to see any readings under 150, then it may be safe to raise, perhaps 1/2 unit depending upon the readings.

I have found that testing is not so bad on them. My Abby comes running when it is time for a test.... it is because of that tiny bit of chicken I give as a treat, but she truly doesn't mind the test.

Some theories as to why this whole episode may have happened.

1. Pain can increase insulin levels, so he may have been on a higher dose and ok with the high dose, if he was in pain, prior to the surgery. Once the surgery took place, and he was not in pain, he may have required a lower dose.

2. Typically when there is no food, 1/4 of the dose is giving. If 1/2 food, then 1/2 dose.

I think this is a great example of home testing. Especially when pain/surgery, even other ailments can be detected quickly when home testing. Excercise, excitement, thunderstorms all can affect blood glucose in a diabetic. For some dogs more than others.

So glad you found us, and so glad that you have Scooter. He is one lucky dog

Barb

[peeweek9]

Re: Surgery on a diabetic dog, Possible Somogyi

Sorry you and Scooter have had such a rough time. It all sounds incredibly stressful.

Have you increased the dose back up to 3 again now?

With the meter have you tried testing a drop of your own (or someone else's!) blood to see if it is a problem with the meter?

If I feel bad about poking Eddie's lip I just give him a tiny treat and a cuddle and remind us both that I am saving his life! The little red spots will soon vanish when you don't have to test so intensively.

Antonia

Hi...no I have left the dose at 2 because that is the last I heard from the vet. He did get three the day before, but just in the morning, so we are at 2 units twice daily (for now). I am using the Alpha Trak and since I understand it is specifically for dogs, I'm not sure how testing my blood would help. I may be wrong on this, but my vet insisted I used this one for accuracy. I have read where others get the human (cheaper) versions and calibrate them, but in my panicked mode and wanting to follow his protocol I got the meter. They 'gave' it to me, but the strips are $69.00.

Scooter doesn't seem to be bothered by my poking him, but I agree with the earlier post that some areas of the lip don't produce blood as well as others. It will take some time to get the hang of it, I just don't like Scooter being part of my learning curve. Ouch.

[Abby's Mom]

Re: Surgery on a diabetic dog, Possible Somogyi

I see you have been reading.

Yes, you are absolutely right, it does take patience, alot of patience.

It takes some knowledge to realize that you may not always get perfect blood sugar, but they do survive, and for years. But we love them and want the best for them always.

It takes some thinking out of the box.... but you can get so many ideas from this forum, and then run with it.

And I have never been part of a group of people that care so much for each other, and a group of people that are so willing to help... perhaps because we already have one thing in common, a diabetic pup that we truly love.

It is funny you mentioned Yunhee, Harry's Mom. I was just thinking about her the other day. It was sad day when she lost Harry. Those types of days, make you feel how precious the time that you have with your pup is truly precious.

Barb

[Abby's Mom]

Re: Surgery on a diabetic dog, Possible Somogyi

I am using the Alpha Trak and since I understand it is specifically for dogs, I'm not sure how testing my blood would help. I may be wrong on this, but my vet insisted I used this one for accuracy. I have read where others get the human (cheaper) versions and calibrate them, but in my panicked mode and wanting to follow his protocol I got the meter. They 'gave' it to me, but the strips are $69.00.

You are correct that is the most accurate.... however, if you read Annie Getting too Smart thread, Craig has done some tests where you may use the Abbott's FreeStyle Freedom strips in the AlphaTrak2.... After you feel more comfortable with the readings, you may want to do some side by side comparisons. I have some strips on order, and will be doing some tests as well, and see how accurate they are with the AlphaTrak2 meter.

Barb

[peeweek9]

Re: Surgery on a diabetic dog, Possible Somogyi

I see you have been reading.

Yes, you are absolutely right, it does take patience, alot of patience.

It takes some knowledge to realize that you may not always get perfect blood sugar, but they do survive, and for years. But we love them and want the best for them always.

It takes some thinking out of the box.... but you can get so many ideas from this forum, and then run with it.

And I have never been part of a group of people that care so much for each other, and a group of people that are so willing to help... perhaps because we already have one thing in common, a diabetic pup that we truly love.

It is funny you mentioned Yunhee, Harry's Mom. I was just thinking about her the other day. It was sad day when she lost Harry. Those types of days, make you feel how precious the time that you have with your pup is truly precious.

Barb

Thank you, Barb. Yes...I am finding my own emotions on a roller coaster that match Scooter's curve results. When the meter didn't work this morning and the strips didn't even produce an 'err' code, I thought...well guess I will drive to vet and get another meter...or what the heck am I doing wrong?

This forum is wonderful and the people so very caring. It was nice to get some feedback because it is a lonely path sometimes when you are doing your best and because of the insidious nature of, and the balancing act we juggle with diabetes management.

I hope that everyone who reads my post will please write and let me hear what you have gone through with hypo incidents and effects of somogyi and then reestablishing good numbers.

A million thanks.

[stylynjm]

Re: Surgery on a diabetic dog, Possible Somogyi

Hi and Welcome,
I just got alphatrak strips from AmericanDiabetesWholesale for 49.00 + 3.50 shipping...better price and takes 4-5 days

[jebsmom]

Re: Surgery on a diabetic dog, Possible Somogyi

My dog, Jeb, had a seizure just over a year ago following a 1500 mile road trip. We never knew what caused it because there were so many variables (routine, exercise, temperature, humidity, elevation, etc.). I knew enough, barely, to put pancake syrup in his mouth and he came out of it. I know what you’re saying when you talk about how frightening it is. The vet cut his dosage more than in half, from 10.5 to 5. I learned to test (that’s another long story) and we increased gradually over a period of several months to our current 9.5. A very wise woman, who is a member of this forum, told me “Low and Slow,” and I believe that advice probably saved Jeb’s life. We increased his dosage in .5 and sometimes .25 increments and waited at least 2 weeks after each change to give his body time to become accustomed to the increase. We found that his bg increased for 2-3 days after every change before settling into a pattern. He weighs 53 lbs. but is sensitive to even tiny changes. It’s been a long haul, but he’s doing very well now. Every dog is different, but for us, this is what has worked. Best of luck and hugs to you and Scooter.