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  #1  
Old 08-02-2013, 12:30 PM
otis'mom otis'mom is offline
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Default Otis is out of control - Please help

Otis is a 14 lb., pug mix. At the beginning of March he weighed in excess of 17 lbs. On March 4, we took Otis to the Vets because he had started having accidents on the bed. We thought he might have a UTI, but no, he was diagnosed with diabetes. After spending a couple of days in the hospital, he was released to go home with 4 units of Novolin N twice daily.
We were instructed to keep him on his same diet (1/3 can of ID twice daily, and evening snack of ¼ cup of dry ID), with the exception of cutting back on his mini bones. As a matter of information Otis thrived on this diet for several years.

For the first couple of weeks everything seemed to be going smoothly, our problems seemed to be solved. There were several curves, and all seemed to be going well until April 25th. He started to show a major change in his curve, and the Vet changed his insulin to 5 units twice daily. That was the last time that Otis had a normal curve, and we started noticing a significant weight loss.

After several attempts to get a curve, the Vet would become frustrated and send him home before the second or third test could be done. Not only was the Vet frustrated, but we were becoming very upset because the costs were still increasing, and we were not getting results.
On April 29th we increased his food to ½ can of ID with some dry food mixed in.

A couple of weeks later the Vet started to theorize that maybe he had Cushion’s disease. We thought that was a big leap, and fought the expense of having the test done.

On May 3rd, Otis acted sick all day, and we made an appointment with the Vet (not our normal Vet, but in the same practice) for May 4th. The result of this visit was a diagnosis of Pancreatitis. After giving him several medications for a period of 10 days he started to get better. One of the medications she prescribed was Denamarin for liver rejuvenation for 30 days. While on this medication his curve started to become more realistic, maybe this was just a coincidence.

On May 10th, Otis decided to stop eating his ID wet food, and thank God we had a can of W/D on hand. He did eat the W/D and has been on it ever since.
On May 17th after a couple of low blood glucose readings, the Vet reduced his insulin dosage back to 4 units twice daily. Now she was really starting to push the Cushion’s diagnosis. She assured us that once the Cushions was under control, we would get control over the insulin.
On May 28th, Otis started Vetoryl 30 mg once a day. Otis’ May 29th blood glucose readings were; 7:00 a.m. 212; 2:00 p.m. 190; 8:20 p.m. 144. We thought this was great.

June 12th was the last day of the Denamarin. The next day Otis’ glucose readings were: 10:45 a.m. 308; 12:45 p.m. 223; 5:45 p.m. 352; 7:45 p.m. 415. The next day, the Vet changed his dosage to 6 units twice daily. On June 24th we had the following readings: 9:00 a.m. 208; 11:00 a.m. 108; 2:00 p.m. 124; 4:00 p.m. 286; 6:00 p.m. 308; and 9:00 p.m. 480. This is the last time we have seen anything that looks like it was near normal.
On June 30th we switched from Novolin N to 4 units of Vetsulin. And it was increased to 5 units on July 1st, and increased again to 6 units on July 6th. On July 8th Otis’ curve results were: 9:40 a.m. 429; 11:30 a.m. 254; 2:00 p.m. 92; 4:00 p.m. 259; 6:00 p.m. 225; 7:45 p.m. 343. Otis’ July 15th curve was as follows: 8:00 a.m. 371; 10:00 a.m. 202; 12:00 p.m. 185; 2:00 p.m. 420; 4:00 p.m. 681.

On July 16th, the Vet changed Otis back to 6 units of Novolin N, and increased it to 7 units the next day. On July 19th she again increased the insulin to 8 units. On July 21st his curve was as follows: 8:00 a.m. 552; 3:00 p.m. 275; 6:00 p.m. 323; and 8:00 p.m. 377. On July 22nd the Vet increased Otis’ insulin to 9 units. On July 23rd his curve numbers were: 8:30 a.m. 691; 1:30 p.m. 193; 3:00 p.m. 220; and 7:30 p.m. 479.
On July 24th the Vet had us switch back to 7 units of Vetsulin, and increased it to 8 units on July 26th. As of today July 29th we only have a couple of readings and they are as follows: 7:00 a.m. 437 (fasting); 8:30 a.m. 578; 10:30 a.m. 456; 12:30 p.m. 267. On August 1st the Vet increased his Vetsulin to 9 units, and advised us to do readings on August 2nd.

There have been two ACHT stimulation tests done, and we were told that everything looks good. We are not sure what that means, but we were assured everything was fine. Although we are still waiting for the glucose curve to come into a normal range.

We do love our dog, but we are a retired couple, living on a fixed income, and we are already into this for almost $4,000. We have been back and forth between the Novolin and the Vetsulin twice and it just doesn’t seem to be working. Can anyone offer some advise?
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  #2  
Old 08-02-2013, 12:55 PM
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CraigM CraigM is offline
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Default Re: Otis is out of control - Please help

Welcome to the forum. Boy, you & Otis have been through a lot.

Are you doing the curves / BG readings at home? If so, what meter are you using?

What is the diet now, and are you very consistent with the amount, and no between meal treats? I use a kitchen food scale to weight out Annie's kibble because just a few pieces of kibble seems to affect Annie. Also, a Milkbone type of snack would send Annie's BG soaring. Of course, every dog is different, and Otis might not react the same as Annie. Anyhow, we recommend two identical meals a day.

Craig
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Annie was an 18 pound Lhasa Apso that crossed the rainbow bridge on 10-5-17. She was nearly 17 years old and diabetic for 9½ years.
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  #3  
Old 08-02-2013, 01:05 PM
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Riliey and Mo Riliey and Mo is offline
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Default Re: Otis is out of control - Please help

Welcome to the forum Otismom

Theres lots of experienced people here to help you

It looks like the vet already had him on 9 units, i would keep him on 8 or even lower the dose to 7.

I dont know why the vet changes his dose without waiting 5 to 7 days then doing a curve.

Any raise over 7 his numbers do rise. Just my opinion

Consistency us the key test prior to meals and insulin, then feed, inject same amount, same time every day twice a day 12 hours apart. Feed abit of green beans midway at the 6 hour mark. No milkbones, treats they, ll raise his blood sugar.

I, m not familiar with cushings disease but there are people here who are.

Thanks for posting, lots of info here.

Mo
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20 lb male. 5 1/2 nph insulin. 1/2 cup fromms. black cockapoo, dx Apr 2012 . 5 1\2 yrs diabetic. 2000 to 2017

Last edited by Riliey and Mo; 08-02-2013 at 01:59 PM. Reason: 9 iu too much
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  #4  
Old 08-02-2013, 01:07 PM
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k9diabetes k9diabetes is offline
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Default Re: Otis is out of control - Please help

A couple of very quick thoughts...

One is that the Cushing's tests will raise the blood sugar in a diabetic dog for as much as 48 hours after the test. So depending on where curves and blood sugar checks were done, the ACTH tests may have generated some high blood sugar and then left Otis's body playing catch up on the following days.

Also, pancreatitis would both raise his blood sugar due to illness and inflammation and also would further reduce any insulin producing ability he still had. So that too would raise his blood sugar and the amount of insulin needed. He could have lingering affects of pancreatitis as well.

Was the Denemarin discontinued because of the expense?

It seems like that was helping him and his blood sugar so one option, if it's financially feasible, is to put him back on that.

The curves the vet has done are not very detailed - testing blood sugar at home would not only save you a lot of money and your dog a lot of stress but would allow you to do more detailed curves.

I think it's unfortunate that the early curves weren't continued through the rest of the day. Considering the large swings in blood sugar he has had, it would have been helpful to have complete curves.

I have a donated meter that I can send you if you are willing to test his blood sugar at home. Both insulins work for him. Right now, Vetsulin seems to have a fairly flat profile.

The insulins work for him. Otherwise, you wouldn't see blood sugars in the 300s and 200s ever.

BUT an increase to 9 units is WAY too much of a jump in dose when his blood sugar got down to 267 on 8 units.

And the doses are being changed too quickly.

I would go back to 8 units of Vetsulin and hold there for five days and then evaluate the blood sugar and see if a SMALL increase is still recommended.

His body needs time to adjust to changing doses.

Send me an email (k9diabetes@gmail.com) or a private message if you are interested in receiving the blood glucose meter.

Natalie
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  #5  
Old 08-02-2013, 01:10 PM
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k9diabetes k9diabetes is offline
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Default Re: Otis is out of control - Please help

Also, please request copies of all of his test results from the vet and post the results of the Cushing's tests and curves and any laboratory blood panels here.

We can take a look and see what the results suggest to us. Many vets are not very experienced with diabetes or Cushing's disease.

It sounds like Cushing's diagnosis was not very thorough...

It is extremely difficult to accurately diagnose Cushing's disease in a newly diagnosed diabetic and virtually impossible in a dog with pancreatitis too.

Is he still taking Vetoryl?

If you're not already, you will want to join our sister forum for canine Cushing's: www.k9cushings.com/forum

Natalie
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Old 08-03-2013, 03:05 AM
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Monsters Momma Monsters Momma is offline
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Default Re: Otis is out of control - Please help

I just wanted to add my Welcome to you and Otis! It sounds very frustrating what you have gone through so far!

I would agree with Natalie, it does sound like the vet is changing the insulin way too fast...units and brands...and not giving Otis time to adjust.

Also, I've become a big advocate of testing at home. It certainly does save us money, but more than that, it gives me peace of mind that I can check Vinny whenever I feel I need too.

Hang in there and take it a bit slower would be my advice.
Mel
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Mel: My monster is Vinny! He's a black lab, diagnosed with diabetes June 21, 2013. His birthdate was celebrated the last weekend of May. He left this world on July 27, 2018, he was 12 years old.
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  #7  
Old 08-03-2013, 04:32 AM
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farrwf farrwf is offline
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Default Re: Otis is out of control - Please help

Welcome to you & Otis from another Otis.

You couldn't have landed in a better place for help with your complex doggy diabetes situation.
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Otis Farrell dx'd 12/10, best friend to his dad, Bill, for over 14 years. Left this world while in his dad’s loving arms 10/04/13. Sonny Farrell dx'd 1/14, adopted 5/15/14. Left this world while in his dad's loving arms 9/06/16. Run pain free, you Pug guys, til we're together again.
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Old 08-03-2013, 08:15 AM
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Emily Emily is offline
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Default Re: Otis is out of control - Please help

Welcome to you and Otis! Sorry to hear that you both have been going through such an ordeal!

My dog, Elliot, started on NPH and was switched to Vetsulin. However, this was after 2 months of slowly increasing the NPH dosage and frequent curves...testing his blood every 2 hours for 12 hours.

After reading your post, I have to say that I am a bit alarmed by the speed the vet changed dosage and insulin....especially back and forth! I've never heard anything like that before. Small changes and consistency is the key to regulating dosage etc. You may want to seek a second opinion. You can look online for a reputable internist in your area that may have more experience with diabetes.

It looks like Otis was responding to the NPH insulin and you can purchase the ReliOn brand at Wal-mart for $25. That is much more reasonable than the cost of Vetsulin. If possible, I would try to regulate Otis on that before changing to a more expensive formula.

Also, you can easily do your own curves at home. I purchased a "cheap" meter from Wal-mart and compared it's reading to the lab test done at my vet's office. My meter read 30 points lower, so I just add that on to my readings to get an approx. "true" reading. You can also purchase a meter specified for dogs called an AlphaTrak. I recently ordered one to use occassionally to double check if I get really low/high readings. The strips for this meter are much more costly. Either way....until I started doing my own curves...I didn't really understand how diet and insulin was effecting Elliot all day.

It sounds like you are doing everything you can to help Otis through this difficult time. Please keep updating us on his progress. Best of luck...
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Elliot is a 25 lb. min. schnauzer, 10 yrs. old, dx 3/2013. dx Cataracts 8/2013 resulting in loss of sight. AlphaTrak 2 Meter with Freestyle Lite strips. Hills W/D glucose management kibble with add ins of poached chicken and Beneful soft food.
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Old 08-03-2013, 12:00 PM
otis'mom otis'mom is offline
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Thumbs up Re: Otis is out of control - Please help

First, I would like to thank you for the offer of the meter, but we bought the AlphaTrak for him back in May, but have only recently become proficient with its use. Our Vet was really against us using it and told us in the beginning there was nothing on the market for home glucose monitoring for dogs. That was until we saw an advertisement for the Alpha Trak on the door to her restroom.

Here are the answers to the questions you have asked.
The results to the Cushing’s tests are as follows:
5/14/13 Dexamethasone Suppression Test
Time 1 9:15 a.m. 2.0
Time 2 1:15 p.m. <0.7
Time 3 5:05 p.m. 3.3

6/18/13 ACTH
Test results not available. We are still trying to get them from the Vet.

7/10/13 ACTH
Amylase 596
Comment: Hemolysis 1+. No significant analyte interference.
Cortisol Sample 2 4.7 (LOW)
Some other items on the test that were not in Ref. Range were:
ALT (SGPT) 140 High
ALK Phosphatase 1496 High
Phosphorus 1.0 Low
Cholesterol 367 High


8/2/13 ACTH
Amylase 622
Comment: Hemolysis 2+. No significant analyte interference
Cortisol Sample 1 0.8 (LOW)
Cortisol Sample 2 2.5 (LOW)
Some other items on the test that were not in Ref. Range were:
ALK Phosphatase 1873 High
Creatinine 0.4 Low
Phosphorus 2.1 Low
Cholesterol 367 High
Glucose 171 High
 
 
Some of the curves:

5/21 Novolin N - 4 units 8 am 469; 2 pm 169; 2 pm 144; 4 pm 268

5/30 (began Vetoryl 5/28) Novolin N 4 units 8 am 329; 2 pm 246; 8 pm 381

6/11 Novolin N - 5 units 8 am 436; 10 am 287; 4 pm 239

6/24 Novolin N - 6 units 8 am 208; 12 pm 108; 2 pm 124; 4pm 286; 6 pm 308; 8 pm 480

7/1 Vetsulin 5 units (started 6/30) 10 am 436; 4 pm 302; 6 pm 319

7/8 Vetsulin 6 units 10 am 429; 12 pm 254; 2 pm 92; 4 pm 259; 6 pm 225; 8 pm 343

7/15 Vetsulin 6 units 8 am 371; 10 am 202; 12 pm 185; 2 pm 420; 4 pm 681

7/17 Started antibiotic for Kennel cough

7/18 Novolin N 7 units (started 7/16) 8 am 575; 2 pm 108; 6 pm 223; 8 pm 247

7/29 Vetsulin 8 units (started back on Vetsulin 7/24) 8 am 578; 10 am 456; 12 pm 267; 2 pm 244; 4 pm 266; 6 pm 377; 8 pm 656

Is all of this swithcing back and forth, and all of the changes of dosing normal? We are starting to doubt our vet.
 
The answers to some of your other questions are:

Otis was treated for pancreatitis on May 5, 2013, and was put on antibiotics for 10 days. His numbers were 1169 Amylase (HIGH) We were also told that his test showed slight elevation in his Liver, and the emergency vet did an X-Ray, but did not see any tumors.

She did tell us that his liver looks swollen and suggested 30 days of Denemarin after he started to eat again. The vet who treated Otis for this visit is not our regular vet, she works at the same facility, and was doing all emergencies that weekend. Denamarin was not discontinued due to the expense. It was discontinued by our regular vet who takes care of Otis, and also owns the facility. Based on the conversation that I had with the emergency vet it’s the owners way or the highway. I take it that they do not see eye to eye. When our vet was updated about our emergency visit, right away before any testing was done she told us that he most likely Otis had Cushing’s disease. She preformed the Cushing’s test on 5/14/13 (see results above), and determined it was Cushing’s pituitary-dependent hyperadrenocorticism (ADH). Otis is still on Vetoryl 30mg once daily.

We took your advise and decreased his Vetsulin to 8 units twice daily, every 12 hours. We will do a 12 hour curve on 8/10/13. The diet that Otis is on is Hills W/D. We give him 1/3 can of wet food, along with ½ cup of dry twice daily. We keep ¼ cup that we use for treats and rewards throughout the day.

Today, August 3rd, she tested him for a bladder infection. The urine test came back negative. She told me that she was going to talk to an internists, and that she would get back to me sometime next week. We are approaching $4,000. in vet bills. I just wish she could get it right! By the way, right now he weights 14.3 lbs.

One other concern we have is that we are getting ready to go on vacation, and we will be in an area where deer are common. The vet suggests that we get his Lyme disease vaccine updated, but we are concerned because even when he is feeling well it make him lethargic. Do you have any suggestions on whether or not we should do this vaccine?

Any suggestions you may have will be greatly appreciated.
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Old 08-04-2013, 03:45 PM
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k9diabetes k9diabetes is offline
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Default Re: Otis is out of control - Please help

I am asking the admins of the Cushing's forum to advise me about the results of the Cushing's testing.

However, unless your dog visually screamed Cushing's disease, a single LDDS test in a recently diagnosed diabetic would not be considered adequate testing to be sure Cushing's disease was present.

Please see the following article on diagnosing Cushing's in a diabetic dog.

http://endocrinevet.blogspot.com/201...e-in-dogs.html

The liver enzymes are elevated, but that just means the liver isn't very happy, which was known, and the Denemarin might be more useful than the Vetoryl if the Cushing's is not a certain diagnosis.

Once he's been held on a dose of insulin for four or five days, I will be interested to see what his glucose levels look like. I'm not sure his prior levels are very informative given how much he's been bounced around. More interesting will be his longer term response to a steady dose of insulin.

Natalie
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