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  #1  
Old 04-24-2012, 04:07 PM
annie annie is offline
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Default Koby is now at the Bridge

On March 20 my dog Koby went in for a teeth cleaning. That went ok, so I was able to bring him home after 3 hrs. The vet called later in the day and said there were some high numbers in Koby's liver enzymes and glucose readings. He put him on Marin for 30 days and had another blood test yesterday. The vet said liver enzymes were down but not the glucose and informed me Koby was diabetic. My heart sank and I think the only thing that stuck in my head from the conversation was insulin and shots at home.
My husband and I have a meeting with the vet tomorrow for more information.
I want to make a list of questions for him to make sure everything is covered.
What questions should I start with?

I'm so sick about this. I've had many dogs in my lifetime, each one loved and of course spoiled. But I've never had to deal with something like diabetes. I did find a lot of information here today, but for me reality hasn't set in yet.

Has anyone had a second opinion in these situations?

Thanks for any input,
Annie
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  #2  
Old 04-24-2012, 05:38 PM
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k9diabetes k9diabetes is offline
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Default Re: What to ask the Vet

Hi Annie,

Welcome to you and Koby!

Diabetes is a pretty straightforward diagnosis. High sugar levels in the urine and blood so a second opinion is rarely needed. And in Koby's case, with blood sugar remaining above normal for a month, it is likely that he truly does have diabetes.

But there is a lot of good news.

One is that as long as his diabetes is managed, it should not shorten his life span or even change his life very much.

And dogs handle high blood sugar better than people do, so they don't suffer from the kinds of really awful side effects that human diabetics sometimes experience. This is probably partly due to the fact that they don't live with the disease for 50 years. But it is largely due to species differences. Dogs, cats, and people all respond to diabetes and high blood sugar a bit differently.

The most common side effect is cataracts. They are not guaranteed but they are extremely common in dogs. The high blood sugar disrupts the structure of the lens in the eye and beyond a certain point, it cannot be saved even if the blood sugar is good.

Dogs generally adjust very well to blindness though. Our dog was blind four of his five years with diabetes and he continued to walk every day, travel with us, wade in the river (and find stinky dessicated fish carcasses), roam the house and yard... most people who saw him didn't realize he was blind.

And cataract surgery is possible for many dogs to restore their vision. It's expensive (several thousand generally) and there is a complication rate of about 10%. And not all dogs are good candidates. Ours was one who wasn't a good candidate and who adjusted so well to blindness that it wasn't a big deal.

Really, establishing a routine for meals and injections is the biggest change to adapt to.

My advice is to "dive in"! I highly recommend learning to test blood sugar at home once you are comfortable with giving injections. That allows you to closely monitor your dog's blood sugar.

Since he didn't go to the vet for problems with urinating, drinking, and weight loss - the classic signs of a dog with undiagnosed diabetes - you may have caught Koby's diabetes early, which gives you a shot at avoiding cataracts.

And things may be a bit of a rollercoaster at first if you've caught the diabetes early, so home testing would be very useful.

Natalie
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  #3  
Old 04-24-2012, 05:53 PM
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Cebe Cebe is offline
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Default Re: What to ask the Vet

Welcome! I know your head is spinning around and I was where you are about a year ago. It gets better, and you will do fine.

If you can, home testing is important and hopefully your vet will support that. Be firm about it, if you get resistance because this your dog and you get to make the decisions. Of course that's only if your comfortable doing it. I was very scared at first to home test but it didn't take long to get the hang of it.
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Zoe: 12 yr old Black Lab/shepherd mix. Diagnosed 6/1/11. Currently on 15 units Novolin NPH 2x day, and hopefully as close to regulated as possible. Feeding merrick Grain Free Salmon and Sweet Potato. Weight 63lbs.
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  #4  
Old 04-24-2012, 07:33 PM
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momofdecker momofdecker is offline
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Default Re: What to ask the Vet

Quote:
Originally Posted by annie View Post
On March 20 my dog Koby went in for a teeth cleaning. That went ok, so I was able to bring him home after 3 hrs. The vet called later in the day and said there were some high numbers in Koby's liver enzymes and glucose readings. He put him on Marin for 30 days and had another blood test yesterday. The vet said liver enzymes were down but not the glucose and informed me Koby was diabetic. My heart sank and I think the only thing that stuck in my head from the conversation was insulin and shots at home.
My husband and I have a meeting with the vet tomorrow for more information.
I want to make a list of questions for him to make sure everything is covered.
What questions should I start with?

I'm so sick about this. I've had many dogs in my lifetime, each one loved and of course spoiled. But I've never had to deal with something like diabetes. I did find a lot of information here today, but for me reality hasn't set in yet.

Has anyone had a second opinion in these situations?

Thanks for any input,
Annie
Annie - Welcome to you and Koby! You've found a great place for advice and support.

Suggestions of questions to ask your vet:
For copies of everything done while Koby will be under their care. If Koby needs to stay overnight to find his 'maintenance' dose - will Koby evaluated at night (will a vet tech present to observe him)?

What was Koby's blood glucose (bg) at initial diagnosis? What was his feeding schedule (including type of food and amount) while under the care of the vet? Was Koby receptive to the food or did he have to be hand fed? If Koby is not a picky eater, is a diet change something to consider?

What were his drinking habits - was he consuming above average amounts of water while under the care of the vet?

Were blood glucose curves (checking his bg ever two hours, for at least a 12 hour period, to better understand what it is doing through out the day) done - if yes, please ask for copies. If you are able to post the curve numbers here there are many folks that can offer advice.

Did the vet check for ketones? http://pets.webmd.com/dogs/diabetes-...ary-management

Were other tests done - urinalysis? Complete blood work panel? Again, if yes, please ask for copies.

What type of insulin was given, how much and how often? If it is NPH - Wal-Mart and Sam's carry the same thing under a generic lable for around $25.00. What is the injection sight? http://www.k9diabetes.com/forum/showthread.php?t=973

It may be worth asking your vet what his/her idea of a safe diabetic blood glucose range is. Make sure your vet discusses what to do if Koby dips below that safe range -http://petdiabetes.wikia.com/wiki/Hypoglycemia

For you - Is home monitoring something you may consider? The folks on this forum can offer a weath of suggestions for what meter to use, the different areas you can test blood from on a dog, and how accurate the meters typically read.

Again, welcome! This can be very overwhelming in the beginning - but over time it will become more routine! Holli
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Holli & Decker // diagnosed November 5th, 2011 // Journeyed to the bridge January 26th, 2013, surrounded by his family at home // 9 years old // Levemir insulin // Hypothyroid // C1-C5 cervical spinal lesion // weight 87 lbs // Run with the wind my sweet boy. Run pain free. Holding you close in my heart till we meet again!
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  #5  
Old 04-25-2012, 06:10 AM
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Rubytuesday Rubytuesday is offline
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Default Re: What to ask the Vet

Hi Annie, I know right now you are feeling scared and disheartened. The good news is with the help of this group the way will become clear pretty quickly. You are so far ahead of the game that the diabetes was discovered before Kobi had started showing symptoms.
I don't think a second opinion is needed.

The questions I would ask:

*How they feel about home testing for the blood glucose?
Doing your own bg testing can save you a lot of money and yield truer results as when the dog's curve is done at the vet's they are often stressed which can alter the bgs. Home testing will also enable you to understand your dog's trends better.

* (If you decide to home test) At what bg number would they consider it too low to give the precribed insulin dose?
There is a range of starting doses for insulin and some vets start off higher then others. They usually pick a starting dose and then have the dog back to do a blood glucose (bg) curve about a week later. If you are home testing and see a low number that would enable you to back off the dose sooner rather then waiting for the full curve.

*What changes they would recommend to Kobi's diet?
The diet and insulin working together is key. Some vets like to delay this change.

* Are there any supplements for eye health that they would recommend?
Again you are so far ahead of the game in regards to cataracts that Kobi wasn't showing any symptoms.

*What would be the bg range that they would like to see Kobi in?

I will say that the guidance of a group such as this was so crucial to me when I started out with Ruby's diabetes. I found the vets didn't have the time to really explaing to me all I needed to know to deal with the disease. There are some really basic foundational principles to work from with diabetes. Whenever I spoke to the vet we were dealing with an issue so never really had time to go over the basics to better understand and therefore alter our routine.

Stick around and you will get there. Ask all the questions you want to. Someone here will have had experience to share with you. I use my vet very little for Ruby's diabetes. Truth be told if I did rely on them for that Ruby would not be in as good shape as she is now. Ruby has two other significant conditions that treatment for one is often contraindicated for the other. Whenever I went into the vets and we started discussing fixing one problem, but then it wouldn't work with the other condition, I could see even them getting confused. With the help of a group for each condition we have been able to figure it out.

Let us know if you are up for the home testing and we can tell you what you need to know.

Keep your chin up and one foot in front of the other.

Tara
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  #6  
Old 04-25-2012, 06:26 AM
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eileen eileen is offline
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Default Re: What to ask the Vet

Welcome Annie,

You've gotten alot of wonderful suggestions already so will only touch quickly on two points...

How much experience does your vet have with treating diabetes in a dog and, importantly, does he/she support home blood testing.
Learning to home blood test can be such an important tool as you begin treating your Koby's diabetes on a daily basis.

The fact that the diabetes was caught early on puts you ahead with being able to possibily ward off the development of diabetic induced cataracts that seem to come on very quickly for alot of dogs.

Again, Welcome!, Altho it has been quite a few years since my girl was dx with diabetes I do remember the overwhelming feelings I had at the time.

The best thing I did was to jump in with both feet, I knew this was something I had to learn to deal with for the life of my girl.
I began blood testing on the same day as she was dx, it became a part of our daily routine as were the insulin injections.
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Eileen and Mildred, 12 yo Border Collie Mx, 24.6 pounds, dx diabetic/hypothyroid 2004, gallbladder removed 2005, cataract surgery 2005, spindle cell sarcoma removed 2009, stroke 2009, tail removed 2011, dx with bladder cancer 2011, CDS, Organix~chicken / NPH,Humalog

Last edited by eileen; 04-25-2012 at 07:00 AM.
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  #7  
Old 04-25-2012, 06:39 AM
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momofdecker momofdecker is offline
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Default Re: What to ask the Vet

One other thing I forgot to mention. Ask about exercise. For some dogs a simple walk can drop their bg 100points or more. My Decker was started at 40u twice a day. Thankfully we were home testing. His bg would go from over 600 to under 50. It wasnt until I joined this forum that it was discovered he was being overdosed. Also discovered the impact of exercise. Thank goodness he was dx. in nov. and the weather was too unpredictable to go for walks. Had it been spring we likely would have put him in a hypo state with a walk. Hope all goes well for you. Holli
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Holli & Decker // diagnosed November 5th, 2011 // Journeyed to the bridge January 26th, 2013, surrounded by his family at home // 9 years old // Levemir insulin // Hypothyroid // C1-C5 cervical spinal lesion // weight 87 lbs // Run with the wind my sweet boy. Run pain free. Holding you close in my heart till we meet again!

Last edited by momofdecker; 04-25-2012 at 06:42 AM.
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  #8  
Old 04-25-2012, 12:24 PM
annie annie is offline
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Default Re: What to ask the Vet

First of all, thanks for all the responses and much needed information.

Just got back from our consultation concerning Koby. A lot of questions were asked and answered by the vet. He seemed knowledgeable regarding diabetes, at this time he is treating 6 dogs.

On 3/20 before Koby's cleaning, his glucose level was 202. I forgot to mention Koby also had a tooth pulled at that time and was put on clindamycin for 10 days along with Marin for the liver. On 4/23 his glucose level was at 491. I did ask if possibly the antibiotic had something to do with the rise. He said there's a slight chance, but not likely.

No change in food as of yet since Koby is already on weight management.

He did not do a urinalysis yet. That will be done tomorrow and he will also check for Cushings. Then we go from there.

Regarding the 24 hr. test yet to be scheduled, he didn't feel it necessary to keep Koby overnight, maybe 8-10 hrs. during the day. I was relieved on that since Koby does not do well in a cage. Gets very stressed so I hope that won't alter any testing.

He did explain a little about home monitoring if we choose to do that, but his other patients aren't done at home. Our choice. Not sure on what insulin will be prescribed yet.

I think now the reality has set in and I realize this will be life long for Koby.
I will post more results when I have them and I'm sure I'll be looking for more help in the future.

Thanks again,
Annie
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  #9  
Old 04-25-2012, 12:45 PM
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MaryLea MaryLea is offline
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Default Re: What to ask the Vet

Quote:
Originally Posted by annie View Post
He did not do a urinalysis yet. That will be done tomorrow and he will also check for Cushings. Then we go from there.

Thanks again,
Annie
You are welcome for any and all help we can give. I did not have to deal with possible Cushings, but am certain you will be told by others here to wait until the diabetes is regulated before testing for Cushings. Hope they come along soon, because all I know is what I read here. If Koby is not on insulin yet, I don't think there is a point in testing for Cushings.

Mary
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Izzy--BD unknown;~~ RIP 7/13/2013 ~~; she was a sweet Yorkie spirit and we miss her
Bella--Yorkie rescue; BD 9/2013 +/-; RIP 5/2015
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Old 04-25-2012, 01:05 PM
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CraigM CraigM is offline
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Default Re: What to ask the Vet

Quote:
Originally Posted by annie View Post
Not sure on what insulin will be prescribed yet.
So, not getting ANY insulin yet? If you are in the U.S., more than likely the vet will put Koby on NPH insulin. There are two main brands of NPH: Humulin-N and Novolin-N. As MOMOFDECKER mentioned in her post, Walmart repackages Humulin-N under their ReliOn brand name for a BIG discount. Most pharmacies (vet office) will sell the Humulin-N / Novolin-N for $60-75. You get the SAME ReliOn Humulin-N at Walmart for $25. No prescriptions are required in most States, don't know where you live.

Syrings are also usually less expensive at Walmart. I'd suggest asking for either 30 or 31 gauge, 8mm length, 30 unit maximum syringes. I'm assuming Koby isn't a 100+ pound boy that might require more than the maximum 30 units in these syringes.

If you are NOT in the U.S., forget everything I've just said because you might be getting a different insulin
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