So Frustrated!

[NuZooRevu]

My 8 yr old mini Schnauzer was recently diagnosed with Diabetes. We first noticed something was wrong in Sept, but the vet diagnosed him with Cushings. His condition continued to get worse (lethargy, excessive thirst, excessive hunger, confusion) even tho we were dosing him with Trilostane at the max dose.

Cooper became blind within 6 months. Thank goodness we went on a long car ride a few weeks ago...the close quarters allowed me to smell his ketone breath--unmistakeable.

I insisted on a blood sugar test; his fasting BS was 389. The vet started him out on 4 IU of Humulin-N twice a day. No suggestions on diet, no info on ANYTHING else.

Cooper has been getting the same meal every 12 hours with his insulin: 4oz of boiled chicken breast, and 1/2 C of sweet potatoes. No snacks at all, and only passive exercise at this point (hes still too tired). I stopped the Cushings meds altogether.

After 1 week, his FBS was still 359. Insulin increased to 8 IU every 12 hours; I maintained the same diet.

2nd week in, and Cooper's FBS was 451; his weight went from 26lbs to 24.5lbs. WHAT?!? Doctor said I got an "A" for initiative, but I'm killing him by withholding carbs. Sweet Potatoes are "minimal carbs". The new orders are to INCREASE his carbs (to what?) and maintain the insulin dose.

What should I be doing here?? Am I not feeding him enough? If I add more carbs, won't it jump up his BS even more?

Why is his HIGHER if the carbs are 'minimal' from the sweet potatoes?

I'm frustrated. I feel like this "trial and error" is wasting time for Cooper...and the advice is counter-productive.

[CraigM]

Re: So Frustrated!

Welcome to the forum.
4 units of Humulin-N is a slightly low starting dosage for a 24 pound pup. A general starting dosage is frequently .2 units per pound, so .2 X 24 = 4.8 units.

Are you blood testing at home? Although the fasting reading is high, we adjust dosage based on the lowest number after doing a 12 hour curve. If you haven't done a curve, testing about every 2 hours, you probably don't know what / when his lowest number is. Since you started at 4 units, you are probably safe to increase to 5, or 5.5 units, but in the future you will probably want to produce a curve before any more insulin adjustment.

Craig

[CraigM]

Re: So Frustrated!

Food / meals are always good for a discussion!. I'm certainly no dietitian, but wonder how complete a pure chicken & sweet potato diet is? Also, I wonder if you might (just guessing) be over feeding? Hopefully others will comment. The reason I say this is because I feed my 18 pound Annie 1.9 ounces of her dry kibble food per meal. As I said, I'm no dietitian and hope others will comment

Craig

[jesse girl]

Re: So Frustrated!

that 389 at diagnosis is not very high for a dog that may have been diabetic for a long time

i would look into a second opinion with the symptoms your pup displayed you would definitely test blood sugar and probably should have been the first thing to do to establish if the dog is diabetic . one of the easier things to diagnose.

its possible the cushings may have been a misdiagnosis and medication may push the dog in the opposite direction from cushings to addison .

you have to be sure your going in the wright direction . going in the wrong direction with either of these diseases is dangerous

[Charlie's mom]

Re: So Frustrated!

Welcome to the forum and the wonderful world of trying to regulate a dog! Just as an FYI for reference, we feed our 29 lb old man just over a cup of the mix of his two kibbles at each meal plus an egg in the morning and some chicken at night. It took nearly 3 months to get him under control.

Laura

[NuZooRevu]

Re: So Frustrated!

Well, as for my food choice for Cooper, I opted for Chicken/sweet potatoes because I could measure each ingredient and monitor quantity of each. Once I figured out the insulin/food balance, I intended on introducing other things, a few at a time. The amount was on par with what he usually eats, so I didn't think it was too much--especially since he's lost weight, which was not the goal!

Thank you for the tip on establishing his baseline BS by testing throughout the day...so far, I've been monitoring his behavior, but obviously thats not working. I will be buying a glucose tester tomorrow.

Can someone tell me where they obtain the blood samples? Preferably the least painful for him!

I believe the Cushings diagnosis was incorrect. Cooper was never "better" on his meds. He's had all the hallmark symptoms for diabetes.

I'm perplexed why his blood sugar is HIGHER after beginning insulin tx and modified diet!

[Monsters Momma]

Re: So Frustrated!

Hi and welcome!
Do your vet really double Coopers dose of insulin?! That is a lot of increase for a little guy! I wouldn't be surprised if you are overdosing him therefore getting the high numbers.

http://www.k9diabetes.com/forum/forumdisplay.php?f=15. This is where you'll find all kinds of info for blood testing. I test Vinny on his inner lip, some test on their carpal pad, some on their ear...it really depends on you and Cooper.

There are a several people here that home cook their pups food, they will be able to tell you better what you could add to the chicken and sweet potatoes.

It can be very frustrating in the beginning, but nothing happens quickly with this diabetes thing. Patience is key and you'll need a lot of it! . Hang in there!
Mel

[amydunn19]

Re: So Frustrated!

Hello and welcome! Mel took the words out of my mouth- your dog is not that high (500+ would be high). That increase was way too much. When you increase and the numbers go higher, it is indicative of overdosing. I would take that dose down to 5 units and hold steady for a few days. Normally, it goes like this: the dose is set, let the dose settle 5-7 days, then do a 12 hour curve. Base any changes on the lowest number on the curve, not the highest. This is a process and it takes a little while so, you have to be patient. You don't want to pass the dose.

Also, your vet may be onto something- many folks lately have been coming on with these high protein and super low carb diets. I think the philosophy has to do with the principle of treating type 2 human diabetes and dogs are different. The type of insulin we give is a long acting insulin and really works best with some type of long lasting carb(complex) to keep the sugar steady throughout the day. Higher protein tends to give a higher fasting number. This being said - every dog is different so finding the right combo that works for your dog can take some doing. It is a matter of balancing food and insulin.

Nothing is wrong with home cooking for your dog. Some people find it difficult to replicate the same meal every time. But, if you carefully measure your ingredients, then that part should be ok. I tried it - my dog refused to eat it-epic fail.

I have always used the one touch ultra mini for testing. It is the closest human meter. You can invest in an Alphatrack, the animal meter, which is more expensive and the strips are more expensive. I have always found the onetouch to be just fine but if my dog was younger and money was no object, I would probably buy both. Use the alphatrack for curves and the one touch for daily testing. You can buy your strips on ebay or amazon cheaper too. Buying at the pharmacy will get expensive.

[NuZooRevu]

Re: So Frustrated!

Wow. This is all so much info at once! My degree is in Nursing, but that was not the career path I followed. Now, I'm digging into my memory and dusting off 20-yr old rusty info from my nursing days...only to hear that k9 diabetes reacts differently than humans. Sigh

I was wondering why the vet didn't put him on IV fluids, drop his BS to normal, run some labs, then send me home with the Humulin and some Regular with a sliding-scale "as needed". Apparently I'm over-thinking this, and the "git 'er done" hustle isn't going to work here!

I am going out first thing and buying testing equipment. I started adding complex carbs to Coop's diet, and I started a food/insulin log...

But here's my Question of the Day: Cooper's been on 8 IU twice a day for 5 days now. His FBS was high yesterday (and based on you all's info, I "get it" now) So...should I leave it at 8 IU and continue to wait for his body to adjust? Or drop it down?

[Monsters Momma]

Re: So Frustrated!

Wow. This is all so much info at once! My degree is in Nursing, but that was not the career path I followed. Now, I'm digging into my memory and dusting off 20-yr old rusty info from my nursing days...only to hear that k9 diabetes reacts differently than humans. Sigh

I was wondering why the vet didn't put him on IV fluids, drop his BS to normal, run some labs, then send me home with the Humulin and some Regular with a sliding-scale "as needed". Apparently I'm over-thinking this, and the "git 'er done" hustle isn't going to work here!

I am going out first thing and buying testing equipment. I started adding complex carbs to Coop's diet, and I started a food/insulin log...

But here's my Question of the Day: Cooper's been on 8 IU twice a day for 5 days now. His FBS was high yesterday (and based on you all's info, I "get it" now) So...should I leave it at 8 IU and continue to wait for his body to adjust? Or drop it down?

It is a lot to take in at once and I've had to go back and re-read things over and over again. You'll get the hang of it all, it will be faster than you think.

If you are going to buy testing equipment, the short answer to your question is...do a curve. Test at fasting (before breakfast and insulin), then every 2 hours for a 12 hour period ending at fasting (before dinner and insulin). This will show you so much more than any one test can. You can post it here and we can help you to understand the curve. Now the only thing I can see that is going to affect the curve is the food change. Here's another link for you http://www.k9diabetes.com/forum/showthread.php?t=4051 The Milk Shake Analogy helped me to understand how the food and insulin works together.

Hope this helps.
Mel

[NuZooRevu]

Re: So Frustrated!

Thanks Mel!
I bought a meter yesterday: One Touch Ultra 2. I won't have a chance to do the Curve test until Sunday, but I'll definitely post the results when I get them done.

In the meantime, I've been reading the boards and researching supplies. We have been using Humulin-N which was $100 at Walgreens. OUCH! Especially when I looked up Relion Novolin-N, which is $25. That's a pretty big difference!

I'm still struggling with obtaining blood from Cooper. He's pretty patient, but stingy with his blood. I better watch some of the videos posted here before the poor guy loses his patience with me.

The good news is that his BS was down to 389 before dinner last night...thats down from 451 the evening before. Celebrate the Small Wins...

[NuZooRevu]

Re: So Frustrated!

I finally got Cooper's meals consistently 12 hours apart, and he is getting used to the needle sticks. I really hated to poke him for his blood testing, but I FINALLY figured it out. I've started seeing a pattern in his behavior and can tell when he's high (panting, lethargic, hot) and when he's within a good range (He's perky and playful). I had to change his food a couple times, so it's still a work in progress.

I finished his curve testing today. I'm not very happy with the results; hopefully someone can help me make sense of it.

5:30am 332. Breakfast and 14U afterwards
7:30am 332 (again...strange, so I tested the meter on myself...it's working)
9:30am 275
1130am 316 One thin slice turkey for a treat. Basically one bite
1:30pm 368 30-minute walk. Nothing strenuous, just strolling.
3:30pm 398
5:30pm 403


Cooper's ideal weight is 26lbs, but he's about 25lbs now, trying to gain. For meals, he gets a full can of organic dog food, total of 2 cans per day. I add 1/8t soluble fiber powder. The brand name is "Coco-licious by Party Animal" It is grain-free, and here is the basic breakdown:

361 calories
Protein:9%
Fat: 7%
Fiber:1.5%
Moisture: 78%

The ingredients:
Chicken, beef, chicken broth, coconut oil, brussels sprouts, kale, garbanzo beans, lentils, strawberries, bananas, chia seeds, liver, gar gum...plus a list of vitamins.

He got his insulin increased from 12U to 14U yesterday.His blood sugar before dinner last night was 469, so today is better.

I know it takes a few days for his body to adjust, but I worry about the super
high numbers. Anything over 400 really affects the way he feels/behaves.

Suggestions, comments, and ideas welcome!!

[jesse girl]

Re: So Frustrated!

allot of good information here.

you know your pup holds steady after eating many dogs can spike really high after meal and shot

you can see the walk had no affect on dropping blood sugar so that maybe a good time to go for walks and maybe able to pick up the pace but do watch if it drives allot higher but i dont see that in this curve .

the curve is flat seeing numbers in that 100 point range from low to high giving the opportunity for a dose adjustment upward . i consider excellent regulation with this range and lower .

you can correlate how you pup feels with the numbers you are seeing . all great info

[Riliey and Mo]

Re: So Frustrated!

It takes 5 to 7 days for any changes in diet, insulin or exersice.

You upped his insulin just yesterday from 12 to 14 iu then did a curve today. Its always good to collect data on your dog like you have. Good job

But it takes 5 to 7 days for insulin adjustments to take effect. This curve is not true. I would wait now for this 2 unit adjustment to take effect then do a 12 hour curve.

I.m also thinking for you to check the feed guide for this food. A 25 lb dog looks like 3/4 tin of food twice daily not 2 tins then adding fibre just might be too much food like Craig suggested awhile back.

Also you might want to give green beans instead of turkey at the half way mark. They dont effect there bg

Check the feed guide and wait another 5 to 7 days to do a true curve letting the upward insulin adjustment settle in.

[NuZooRevu]

Re: So Frustrated!

Awesome feedback...thank you, thank you! So much awesome information! I don't know what I would have done without this site and all the experienced folks here!

Based on this feedback, I'll switch to green beans for reward snacks. He loves them, but I never thought of that!

I'll do another curve next Saturday to test this new dosage. Slow down, let him adjust, see how it goes from there. Jesse Girl, you made a statement in another thread that totally made sense to me, "it kind of like braking a car into a traffic stop as you get closer you put more pressure on the brakes to stop " Wow. I get it now.

As for the food...
Riley and Mo, I'm still worried about Cooper's weight. He's super thin: 1 1/2 to 2 lbs underweight, which is a lot for a kiddo his size. His legs are little spindles, his ribs are sticking out, and even the ridges below his eyes are prominent! He's lost a lot of muscle, probably from a delayed diagnosis and then I triggered a rebound at first (just before finding this site; this thread is based on my frustration with the rebound)

I'm trying to reason it out, but maybe I'm thinking wrong: I want to give him more calories...but if all the calories are floating around in his bloodstream with no way to get into his storage compartments because his insulin levels are wonky...ugh. thats where I get stuck. Something about keys and locks at the metobolic level...How can I help him gain in a healthy way?

Exercise. That's another conundrum. He needs it to help regain some muscle mass (so the weight isnt just blubber...) but exercise effects his BS. Does it effect it in a good way or a bad way? I thought it would burn off some of the extra sugars, but I didnt think about it causing a rebound.