Desperate Husky mom from South Africa

[Tammy_s]

Hi there. My Husky, Tequila, was diagnosed a few weeks back with diabetes. We live in Cape Town, and diabetes (or rather treating it) is not as common as in the States. Tequila seems to be insulin resistant.



She is currently on Hills Perscrption Diet: W/d: Digestive/ Weight/ Diabetes Management. She gets 250g twice per day (06:30-07:00 and 18:30-19:00) which is followed by an insulin injection. We currently administer 12 units of isophane insulin. She is currently 21 kgs, but is extremely thin, and has (what feels to me like) low muscle tone.



A full blood panel and Cushings screen was performed on 8 May, and according to the vet’s interpretation of results, Tequila does not have other organ involvement, indications of cancer or Cushings. Results as follows:
Glucose: 27.57 mmol/L (high)

Crea: 42. umol/L (low)
Urea 4.1 mmol/L
Bun/Crea 24
Phos 1.28 mmol/L
CA 2.69 mmol/L
TP 65 g?l
ALB 34 g/L
GLOB 30 g/L
ALB/GLOB 1.1
ALT 106 U/L
ALKP 132 U/L
GGT 3 U/L
TBIL 8 umol/L
CHOL 9.55 mmol/L (high)
AMYL 201 U/L (low)
LIPA 898 U/L
Na 156 mmol?l
Na/K 37
Cl 112 mmol/L
Osm Calc 330 mmol/kg






I have spoken to the vet about trying out biguanides such a metformin (at 5-10mg/kg) to increase Tequila’s insulin sensitivity, but she is not too familiar with the literature and will look into it. I am just nervous that Tequila’s condition deteriorates faster than we can find a solution for.



Tequila has cataracts in both eyes. Her energy levels are very low, but still wants to play at times, and loves going for her walk.


Please help.



Taime

[k9diabetes]

Re: Desperate Husky mom from South Africa

Welcome to you and Tequila!

We actually have had a few members from South Africa over the years.

So at 21kg, she's about 46 pounds so a dose of 12 units of Isophane (NPH) is not particularly large for her size and certainly should be increased.

27.5 in your units translates to about 495 in U.S. units

If she's only been on insulin for a few weeks, her body may be temporarily somewhat resistant to the effects of insulin just from having had such high blood sugar for a while. Once it's down lower, even just into the low 400s, for a while, she could break through some of that resistance and get more oomph from the same number of units.

Has the vet done (or you done at home) a serial blood glucose curve to see how high and LOW the blood sugar is going during the day between injections?

It's possible that its 27.5 at breakfast, for example, but drops to just 8 mid-day. Or starts as low as 8 and goes up to 27.5 during the day and then drops back down.

Does she have ketones?

If so and more than a trace, the vet should be moving to rapidly bring her blood sugar down into the 200s to 300s with fast acting insulin and giving fluids to flush the ketones out.

Feeling poorly with blood sugar of 27 is expected - if there are no ketones, she shouldn't be in any serious danger and the insulin dose should be raised as long as the blood sugar is not going quite low at other times of the day.

Fill us in regarding these questions and we can talk more.

And take a look at the main website for more information and links to demos on testing her blood sugar at home.

www.k9diabetes.com


Natalie

[Tammy_s]

Re: Desperate Husky mom from South Africa

Hi Natalie,


Thank you for your reply. At the moment she doesn't have high ketones in her urine (ketone 1+ , protein negative).



She has gone into the hospital every week for a glucose curve. On Saturday I did one at home with results as follows:
Breakfast: 07:30- 250g Hills w/d
Insulin: 07:35- 15units
08:08- 32.9
09:10- Hi (too high for the meter to register)
10:54- Hi
14:00- 30.2
16:07- 27.6
17:52- 28.9
A similar trend has been reported by the vet.


Her full history:
05/04/2018: Diagnosed with DM, baseline blood glucose: 28.4. 6units protophane BID prescribed. (21kg)

26/04/2018: Glucose curve in hospital, lowest reading 29. Insulin increased to 8units.
08/05/2018: Glucose curve in hospital. Lowest reading 25.2. Insulin increased to 10 units.
15/05/2018: Glucose curve in hospital. Lowest reading 28.1. (20.2kg). Dose increased to 12 units.
After the glucose curve on 15/04 I started looking into insulin resistance. The vet is not too familiar with oral medication and says digs do not respond well. I have said I will investigate and let her know what course I think we should take (and provide the evidence for it).I have also sent Tequila's file to an American vet I know who will discuss it with some of her internal medicine friends. But I would like to find answers....



I am sure everyone in this group understands my desperation and 'exhaustion'.


Thanks for this platform!


Tammy

[jesse girl]

Re: Desperate Husky mom from South Africa

Hi and welcome

Has your dog been spayed ? That also can provide some resistance to insulin

Have not heard of oral diabetic medications given to dogs . I believe those drugs are given to type 2 diabetics . Dogs usually dont produce any of there own insulin so they are type one and would not benefit from those medications

Are you still seeing diabetic symptoms like thirst and urination ?

[Tammy_s]

Re: Desperate Husky mom from South Africa

Hi there,


No she has not been spayed. She is still drinking excessively as well as urinating frequently and larger volumes. I inquire about the oral medication because I recently read an article saying dogs could respond well.


Thanks,
Tammy

[Raysaint]

Re: Desperate Husky mom from South Africa

Seems like her insulin dose is just not enough. 12 units is just the starting dose for a 46 lb. dog.

And I've never heard of a diabetic dog treated with oral medication. I've read research and articles on dog diabetes until I'm blue in the face, and have never seen anything about oral meds or dogs being type 2.

[jesse girl]

Re: Desperate Husky mom from South Africa

thats usually a big problem for a diabetic intact female . we have seen it time and time again here on the forum . Regulation for you pup will be difficult until the spay is done

We have actually seen dogs return to not being diabetic shortly after a spay . My jesse was intact and went into an heat cycle and thats when her diabetic symptoms appeared. It could have been temporary but she developed pancreatitis which i suspect made her diabetes permanent

[amydunn19]

Re: Desperate Husky mom from South Africa

She should be spayed as soon as possible. In the meantime, please watch the blood sugar. The hormones can give them very high blood sugar and then it will suddenly drop like crazy. It is very difficult to regulate an unspayed dog.

[Tasha]

Re: Desperate Husky mom from South Africa

Hi I feel for you as my Tyson has been through a similar experience and 2 years in, we are still trying to regulate him. He's in the care of the best endocrine team in Europe at a university hospital and we still aren't at perfect so it's hard for everyone. Has your doctor tried Lantus or Levemir or Novolin insulin? Every dog reacts differently to different types of insulin so successfully getting levels under control is very individual and you may need to try various insulins before finding what works. Tyson went into DKA twice now and it's a horrible experience. Ask your vet to get your dog on Lantus if the Caninsulin isn't working and get an Abbott Freestyle Libre Meter put on your dog asap so you really see what's going on: you may be suprised at the curves you see when the dog is home versus at the vet (search the internet and you'll find a few videos of this device on dogs) and start monitoring day and night. There are hardly any dogs who are insulin resistant. It's just finding the right insulin and finding it before your baby is in DKA. Don't exhaust yourself experimenting with diet or exercise as I've found it has only minor effect on a dog who's severely unregulated. Keep your baby on low fat good to avoid and pancreatic upset and take him or her for normal walks and stay calm. Do a urinalysis and pancreas test to make sure nothing is interfering with the insulin uptake. Be wary of doing a cushings test as unregulated dogs often show a false positive for cushings and cushings is not something you want to treat unless your are 99.9% sure the dog has cushings. Stress is also a big factor for the dog and for you! Pray, breathe and keep calm if you can. Get Ketone strips and measure ketones in the urine 3 times a day. If you see any levels over "small or trace" get your dog to the vet and on an IV immediately. Do NOT wait for the ketones to dissapear as they won't and your dog will be very sick and may die. Have the hospital regulate your dog and once discharged look at insulin options with your vet. Your dog may be experiencing the symogi effect on NPH as it's very potent and not something pet owners normally use at home so you may want to switch to Lantus as a first step and try low dose at first.

[k9diabetes]

Re: Desperate Husky mom from South Africa

As others have noted, her being unsprayed is a big part of the problem. Rarely, unsprayed female dogs are diabetic only when they are in heat and the blood sugar goes back to normal between cycles.

However, that is quite rare and usually the dog is diabetic but the blood sugar level - and hence the need for insulin - varies wildly as the hormone levels fluctuate.

It's risky for the dog because a dose that was not enough insulin a few days ago can be too much insulin now and they are at risk of both ketoacidosis from high blood sugar and severe low blood sugar, both of which can be fatal.

Natalie