Aragon, Alaskan Malamute with Diabetes possibly Cushing's

[Malamutt]

Picture: Aragon (white) and Gandalf (grey) after grooming.

• 10 years old
• 126 lbs
• Date diagnosed - June 24, 2013
• Humulin N, 36 units 2x a day
• Currently on ground beef and rice mixture due to cracked tooth
• AlphaTrak glucose monitor 2x a day. Ketone urine test every few days
• fur loss, heavy breathing, weight loss (12 lbs over the last few months)

Aragon started having balding issues last summer. That's it. No other symptoms. Blood tests, scrapings, and biopsies all showed normal results.

Two weeks ago he was urinating every hour and drinking a lot. Glucose was found in his urine, and after a blood test to confirm, he was diagnosed with diabetes. Initially, insulin dose was 20 units, and it had no effect on his glucose levels. They ranged from 400-500. Home testing was done 3x a day. Injections were changed from his shoulder to his side. He is currently up to 36 units twice a day. Right now, he is ranging in the 300-400 which is an improvement, but he is running out of fat to burn through. We keep worrying about ketoacidosis.



His ACTH Stimulation test came back positive.
Pre 3.8 ug/dL
Post 30.6 ug/dL
And already a member of the Cushing's crew here at k9 forums. They are dears with web links of infinite knowledge.


Does anyone have bad experiences with the flea/heartworm med Trifexis and diabetes?


Also, he goes for a 45-60 min walk every day. Always has. Should I cut that down until we get his glucose down and his weight up?

[jesse girl]

Re: Aragon, Alaskan Malamute with Diabetes possibly Cushing's

hi and welcome my jesse was shedding like crazy before diagnosis of diabetes so many of the symptoms of uncontrolled diabetes can resemble crushings which i have no experience with .

he is a big boy and may need more insulin . on the forum we usually base dose adjustments on a curve ( a test every 2 hours starting with fasting and at least to next fasting ) this way you catch any major drops or rises in blood sugar and evaluate on how to proceed .

some larger breeds have done well on levemir especially for dogs with a higher dose on nph it is four times more potent so that would be 9 units compared to your 36 units of humulin .

now you do have to be careful that you do not cross the dose that is needed and if that does happen you could just see some elevated numbers if testing sporadically and thinking you need more insulin but maybe going in the wrong direction .

if you are seeing just elevated numbers and the levels are fairly flat (maybe a 100 points difference from low to high ) and your seeing an incremental drop in sugar levels raising the dose you just may need more insulin . if raising the dose sees a deterioration in the numbers then that may point to to much .
insulin

as far as exercise i built my jesse routine around it for quality of life so yes you can exercise testing before and after walk would tell you how his body reacts many dogs drop quite a bit and sometimes they can rise . its best to stay consistent with amount and time of day . my jesse can only go for her walks certain time of the day and she goes for a couple walks a day 1 hour each .

i feel every dog has potential to have adequate blood sugar some take a bit more work than other and i believe your pup can get to a better place.

[Abby's Mom]

Re: Aragon, Alaskan Malamute with Diabetes possibly Cushing's

I totally agree the people on the K9 Cushings forum are very, very sweet. I started over there as well with my Abby, with an ACTH test as positive.... and I believe that Abby does not have Cushings, just diabetes.

Not to say that Aragon does or doesn't, but I think it is good to go slow, and treat one at a time. In time, you will know whether or not to go the Cushings route or not.

Exercise... I would recommend testing before and after exercise to see what the impact is. At first, I never saw a difference, but once we got closer to regulation, a huge difference. I think overall a walk is good... and you can certainly fit it in. Just recently, I give two small treats with honey on top, to be sure that Abby does not go too low. This has worked well for her... but I only mention this because of different way to handle different situations.

Do you have a curve that you can share (a curve is a BG testing every 2 hrs), indicating any meals, treats, or extra activity. I am no dietcian, but the diet, may not be balance, and there are other foods that are soft, if he has a broken tooth.

Let us know if we can help.

Barb

[Malamutt]

Re: Aragon, Alaskan Malamute with Diabetes possibly Cushing's

He was on the canned Purina DM food for diabetics, but it gave him a very upset stomach. Between that and his continually high glucose, the vet wanted him on the ground beef/rice diet for now. His glucose curve wasn't so much a curve as a straight line. High in the mornings (500) and low at night (400) when we started out. Feeding and exercise had little effect. Once his dosage was at 30 units, it changed to 400s in the mornings and 300s at night.

But good news; tonight after his walk, his glucose was 154. All of us were so shocked, we didn't know what to do. It was like someone asked us to construct a particle accelerator out of toothpicks. After the last two weeks of no significant change, it was a moment of relief and panic. We are closely watching him to make sure he doesn't go the other direction of too low. Tomorrow if he stays low, it will be another talk with the vet about his tooth, diet, and other issues.

[jesse girl]

Re: Aragon, Alaskan Malamute with Diabetes possibly Cushing's

i am glad your watching aragon closely when resistance is broken insulin may need to be reduced

[momofdecker]

Re: Aragon, Alaskan Malamute with Diabetes possibly Cushing's

Welcome to you and Aragon. Gorgeous pups you have! Love their cut. My sister in law just groomed a chow to have a similar look - he looked like a mini lion when she was done .

With diabetic dogs there are lots of things that can impact their blood glucose (bg) levels. Simple things like a dental problem or a urinary tract infection can cause elevated bg. Then, of course, there are other concurrent diseases like cushings that can cause resistance. Sounds like you've got a good plan to focus on the diabetes for now then see what time tells you regarding the cushings suspicion.

As you've discovered, exercise can also impact a diabetic dog's bg levels. The best way to understand how it impacts your dog is to test just before exercise and just afterwards. Some dogs drop minimal. Some get large drops. Some raise with exercise. If there is a large drop, it may even be worth testing and hour or so after exercise to see how your dog handles the drop. On NPH insulin my boy's bg would jump right back up - but he had a history of overdosing on it which I suspect factored into how he responded on NPH. On levemir he would continue to drop.

Best of luck to you in this new journey of yours.

[Abby's Mom]

Re: Aragon, Alaskan Malamute with Diabetes possibly Cushing's

Flat - is very, very good... even if the curve is high.

That is what we all achieve for, because then the resolution is simple: Increase insulin. It is when the curve is high and then really low, is when the challenge begins.

Great job. It does take a while for insulin to settle in, so keep a close watch.

Barb

[Malamutt]

Re: Aragon, Alaskan Malamute with Diabetes possibly Cushing's

Okay, at this point I think the glucose meter is just messing with us. That one blip near normal ranges was a nice vacation. The next two days he stayed firmly in the 200s. I even took readings for a new curve thinking we were getting close to control. Then today, it was madness.
Yesterday:
8:00am 281 breakfast, 39 units
10:00am 257
12:00pm 232 lunch
4:00pm 272
6:00pm 280 1 hr walk
8:00pm 259 dinner, 39 units

Now here is today:
8:10am 300 breakfast, 39 units
12:00pm 352 lunch
6:00pm 1 hr walk
8:20pm 578<--wtf? dinner, 39 units
9:30pm 360 no seriously wtf

I tested the glucometer, before I gave into the urge to destroy it. Everything was within range, so I subverted my rage by eating chocolate. Then I felt bad for eating candy in front of the diabetic dog. We're starting a new bottle of insulin tomorrow. Hoping it will all start to make sense then.

[CraigM]

Re: Aragon, Alaskan Malamute with Diabetes possibly Cushing's

Yes, today doesn't look very much like yesterday except for the breakfast reading.. Let me ask the obvious questions: any snacks during the day? Was today's breakfast exactly the same as yesterday? Did you inject into the same general area? Do you recall anything "strange / different" with this mornings injection?

The good thing is that today's post dinner test is coming down. You might be getting back to normal, fingers crossed.

Craig

[Malamutt]

Re: Aragon, Alaskan Malamute with Diabetes possibly Cushing's

Everything was the same. Even the "let him think he's sneaking the left over cat's lunch, but it's really his" food was the same. His temperament was the same, jovial idiot as always. Only thing different was that he was urinating a lot more this afternoon/evening. When we got the high reading, the reason seemed obvious. No ketones in his urine luckily.