Need help with Ben

[jesse girl]

Re: Need help with Ben

i believe its an intermediate type of insulin as nph which many in the states use for there dogs

now dosing as far as measurement on the specific syringe usually adds up to be about the same with caninesulin. so i am wondering what type of syringe your using . in the states we would use u-40 for pet insulin and u-100 for humane

did you change syringes when you switched insulin's ?

[Vanessa]

Re: Need help with Ben

No, we kept the same syringes. They have an orange cap. The needle is very fine. There is no indication on the packaging if they are 40 or 100. I will ask my pharmacist, as it will be good for me to know too.

[k9diabetes]

Re: Need help with Ben

I am so happy to hear that Ben is doing better!

Insulatard is the European name for Novolin NPH.

http://diabetesindogs.wikia.com/wiki/Insulatard

It sounds like you were already using U100 syringes, which is the right type for Insulatard. If you were using U100 syringes with Caninsulin, you were giving him less units than shown on the barrel of the syringe.

But all that matters is what you are doing now, since it's working fairly well!

It is a good idea to determine for certain what type of syringes you are using. I think the color coding is the same in the UK and Europe but I am not certain of that.

Natalie

[Vanessa]

Re: Need help with Ben

Yes, we were using u-100 syringe all along. This might explain why Caninsulin was not having any effect on Ben.

Test results have come out.

TLI is + 50 Ig/l - vet said that this point to pancreatitis or renal insufficiency. Having blood tests in Monday to check on the latter, though previous blood tests showed that everything was working properly.


Urea normal. Creatinine slightly below normal.

Urine cortisol: creatinine ratio 80 - vet said above 25 points to Cushing's

LDDT 126.7, 121.9, 15.3 (hope I got the last number right as this information was communicated to me over the phone)

I am not sure if I am to take these tests at face value.

They were taken while Ben was undergoing a severe DKA episode and receiving intravenous fluids - therefore, a period of huge stress. With all our good will, we were the ones to cause it as we stopped giving him insulin if he did not eat. He was not eating his kibbles from another brand, we gave him boiled chicken, and were just happy to see him eat again. All this while Ben was on Caninsulin.

What puzzles me in all this is that Ben shows none of the physical symptoms associated with Cushing's - no fur problems, no skin infections, no pot belly, drinking and peeing returned to normal.

The only thing is that he is always hungry, but he is getting only 120 gr of kibbles for diabetics per day (accurately measured and strictly timed), whereas before he used to graze all day long. Other than that he is happy, lively, and energetic (read flashes away when we take him out).

Ben is still on 5 iu of Insulatard x 2 daily, 12 hours apart. We haven't measured sugar levels for past 4 days or so, as vet said no changes were being observed. The last reading we had was 26 in the morning, 14 in the afternoon, and 20 in the evening. I am still not doing home testing as glucometre is taking ages to be delivered. However, in my limited knowledge, these figures seem to indicate that the insulin is not lasting for the whole 12 hours, and not necessarily that there is an underlying cause for Ben's unregulated sugar levels. The more I read the case study in this website, the more I see similarities between that case and Ben's and it might just be that he is metabolising his insulin too quickly.

Vet is proposing that we stop the insulin, and start treatment for adrenal Cushing's. I am not so much ikeen on this:
A) we do not know if it is adrenal or pituitary-based
B) Ben will have to go without his insulin during treatment, and if his Cushing's (if indeed he has it) is pituitary, then I have no idea if this could lead to another DKA

Now that Ben is less stressed I have a good mind to ask vet to start tests from scratch. What worries me is that to do LDDs we have to stop giving Ben insulin for two days, and again I fear DKA. Vet said we could do the high- dose test. Cannot do ultrasound as there are no specialists on it where I live.

I really do not know what is the best decision here.
If waiting another 2 weeks will not be dangerous for Ben, I would really like to have the time to do a proper curve for him, to see if we can stabilise his sugsr levels.

I am also concerned about the side-effects of the treatment for Cushing's, especially if it is a false positive.

Any ideas or advice please?

[CraigM]

Re: Need help with Ben

Ben's conditions are way over my knowledge level, but 5 units of NPH isn't an overly high dosage for a 8kg / 18 pound dog. All dogs / situations are different, by my Annie is also about 18-19 pounds and is getting 8 to 8 1/4 units of NPH.

I understand you have a meter on order. Is it the AlphaTrak, or a human meter? You might think about getting a human meter from a local pharmacy if they are available and not too expensive. Staying in the 20s mmol/L (300s mg/dL) can't be good for him.

Craig

[amydunn19]

I am concerned if your dog doesn't look like a cushings dog, he probably isn't. The majority of cushings dogs have the physical characteristics of the disease. Many cushings tests are false positives in unregulated diabetics. You might want to visit our sister site, k9cushings.com and run the results past them.

The hunger can be related to unregulated diabetes - most diabetic dogs are very hungry until they reach a dose of insulin that controls their blood sugar.

Also, I have never heard of stopping insulin while treating for cushings. That is an incredibly bad idea and could send him back to DKA.

[Vanessa]

Re: Need help with Ben

Thank you for your helpful replies.

To CraigM: Yes, I am waiting for the Alphatrak kit. I need to discuss dosage again with my vet - especially why he is not increasing dosage or increasing the frequency of insulin injections. Apart from my constant fear of a dka relapse, I am also worried that the fact that Ben is spending so many hours with high glucose levels in his blood is eventually going to lead him to blindness (already has cataracts). I am going to wait a couple of days more for the metre, and then get a human one (I hope they come with lancets too, as that is what worries me most).

To amydunn19: I just posted on k9cushings. I already got the same advice as you gave me, not to stop giving Ben insulin, which is exactly what I will see to.

Just to be prepared for home testing:

- is there a need to disinfect with surgical spirit the area from which blood will be taken?

- I will be trying to test first near the tail area as in one of the you tube videos on this site (Ben has a very low pain threshold!). He is short-haired - do I need to shave the area or it doesn't make any difference?

[CraigM]

Re: Need help with Ben

Just to be prepared for home testing:

- is there a need to disinfect with surgical spirit the area from which blood will be taken?

- I will be trying to test first near the tail area as in one of the you tube videos on this site (Ben has a very low pain threshold!). He is short-haired - do I need to shave the area or it doesn't make any difference?

i know the instructions for human diabetics recommend to wash their hands (finger) before testing. To tell the truth, my wife & I are type-2 diabetics and don't always wash just prior to testing. I would think trying to clean a dog would be difficult most of the time and not required.

I test Annie on her ear and do shave a strip where I normally test. I use a small battery powered grooming razor, but any razor (your husband's?) would work. I'd think a hair / fur free area is needed or the blood might flow into the hairy area. I shave the strip every week or two. Btw, I also shave the area where I inject the insulin so that I can see the needle enter pink skin. Annie is a longer haired dog, so that might not be required for you.

I do use alcohol wipes (little individual squares of tissue soaked with alcohol bought at the pharmacy) to clean Annie's ear flap after cleaning them with an ear cleaning solution. Annie gets "goopy smelly" ears and needs them cleaned every 2-3 months. The cleaning solution is sticky and I need to clean it off with the wipes before blood testing from the ear. Of course if you test near the tail, this wouldn't be a problem.

Craig

[k9diabetes]

Re: Need help with Ben

Hi Vanessa,

I imagine that the Cushing's folks are also telling you to hold off on worrying about Cushing's at this time. That would be my strong advice. Dr. Peterson, a veterinary endocrinologist, has written about working on the diabetes first and worrying about Cushing's later:

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

If there is any "good" news about your dog's diabetes, it is that it can tell you whether your dog has Cushing's disease.

If he does, he will need a very high dose of insulin for his weight. If his insulin dose is normal and his blood sugar regulates, he does not have Cushing's disease. It is something far too many vets jump to at the first sign of any rise in liver enzymes. Really no need to test for it right now and absolutely no reason to treat for it since his diabetes would likely skew any tests for it now.

Natalie

Thank you for your helpful replies.

To CraigM: Yes, I am waiting for the Alphatrak kit. I need to discuss dosage again with my vet - especially why he is not increasing dosage or increasing the frequency of insulin injections. Apart from my constant fear of a dka relapse, I am also worried that the fact that Ben is spending so many hours with high glucose levels in his blood is eventually going to lead him to blindness (already has cataracts). I am going to wait a couple of days more for the metre, and then get a human one (I hope they come with lancets too, as that is what worries me most).

To amydunn19: I just posted on k9cushings. I already got the same advice as you gave me, not to stop giving Ben insulin, which is exactly what I will see to.

Just to be prepared for home testing:

- is there a need to disinfect with surgical spirit the area from which blood will be taken?

- I will be trying to test first near the tail area as in one of the you tube videos on this site (Ben has a very low pain threshold!). He is short-haired - do I need to shave the area or it doesn't make any difference?

[Vanessa]

Re: Need help with Ben

Dear all,

I finally managed to get a curve with a loaned pet glucometre. Ben cooperated all the way through. I took blood from the base of the tail, and Ben hardly noticed.

I am copying the figures here as I cannot find a way of copying the curve proper here. I have converted the values to US ones already.

Time of day - Glucose Levels
at 7.15 - 129.6
at 9.45 - 82.8
at 11.50 - 68.4
at 14.20 - 156.6
at 16.20 - 140.4
at 19.20 - 154.8

We had a walk at 7.00 (10 mins), 8.30 (30 mins), noon (10 mins), 16.30 (20 minutes) and 19.45 (10 mins).

Insulin injection was at 7.30 am and 7.30 pm, preceded immediately by feeding, in our case, 0.14 pounds of Royal Canin for diabetics for each meal (62 gr). We are still using Insulatard, 5iu x2 / day.

I am suspecting the lower figures might have been an error, as Ben was not hypo at the time, though he looked a bit tired. Still, I am now eliminating the long morning walk and will try doing it in the afternoon, where we seem to have the higher figures.

I will be repeating the curve once I get my own glucometre (hopefully next week!).

I still have not managed to come to the bottom of the Cushing's issue.

To Nathalie: Following your comment, I asked my vet if the dose we are giving Ben is high in relation to his weight. The answer I got is that he would like to have him on a lower dose - so nothing definite so far. From my calculations, we are at 0.63 / kg (or 2.2 pounds) of weight.

My worry is now that on Monday when Ben was at the vet's in the morning and had his glucose levels tests and some routine blood tests taken, while glucose was at 120.6 in the morning, his Alk ph were 759 (range 23 - 212) and ALT 138 (range 10 - 100) .

All I can conclude now is that the insulin is working, but I am not sure if dose given is excessive.
Peeing and drinking back to normal.
There is also fur growing on the shaved patches.

Many thanks for any guidance or advice!

[Vanessa]

Re: Need help with Ben

One further general question please - as it is tick season, given that the dog is getting daily injections, do you still use chemical repellents or is there some other natural solution?

Thanks.

Vanessa

[amydunn19]

I don't think Ben has cushings. A cushings dog would never, ever see those lovely numbers without treatment for cushings. I would not pursue it at all.

The numbers around 1150 are not considered hypo so you probably wouldn't see symptoms. A true hypo would not occur until the numbers drop to 20 or 30. But, we don't want to see that. Those numbers might be a little tight for any leeway and super tight regulation is tricky - you don't want a sudden burst of energy and exercise to drop to unsafe quickly. So, I agree that raising those numbers by putting off exercise might be useful. Or consider dropping the dose 1/2 unit.

[Auddog]

Hi there,
I just wanted you to know that I used to live in a tick problem area (lots of horse pastures, and right up against some mountains full of sage brush). Anyway, I've always just used the powdery tick collars instead of gell kind you put on their backs, and they worked great. When Bazz became diabetic, i didn't want to use those anymore because I wasn't sure how it would effect his blood sugar.
I knew that prevention is the best way to avoid those little blood suckers (I always kept Bazz on a leash when we were out exploring back country, to stop him from going into tall grass and brushy areas off the path we were on), but it's always nice to have that extra sence of security. So now I keep a spray bottle that's half full of water, half full of apple cider vinegar, and has 3 or 4 dried cloves in the bottom; and i spray it on him right before we hit the trails.
I'm not sure if it's the avoidance of brushy and grassy areas, or the AVC mixture, or the fact that we don't go out at often or as long as we used to but we haven't seen any ticks since using our method. If you're not a fan of the smell of AVC, I've also heard that rubbing a little bit of coconut oil on their fur acts as a natural repellent to ticks (and mites and fleas too); but we've never tried coconut oil.
I hope that helps

Audrey & Bazzle

[Vanessa]

Re: Need help with Ben

To amydunn19: You really hit the nail on its head, as vet also suggested today that we will need to drop insulin dosage by 1/2 a unit, at least for the morning dose . We skipped the morning walk today and had it in the afternoon. Upon vet's suggestion, I am now doing a curve for the night, as yesterday I did only a 12-hour cycle.

To Auddog: Many thanks for the tip. I have prepared the mixture, ready for tomorrow. Ben likes to walk along paths and fields (I always follow him closely) and inevitably, he picked a couple of ticks over the past few days. I am actually going to use it on my other dog too!

[Vanessa]

Re: Need help with Ben

Dear all,

I had to return to this website to ask for advice.

Recap: Ben, a 12-year old small dog (cross-breed but looks like a Toy Manchester Terrier) was diagnosed with diabetes in late 2015 (if I remember correctly).
Vet struggled to find a way to control diabetes and, in fact, never did. The dog had 2 episodes of ketoacidosis, one at the beginning and the other one last week. The latter wasn’t as serious as the first one and required only some 16 hrs on the drip.
Ben weighs 6.8 kgs (15 pounds).
Glucose levels have never been controlled. This morning the machine couldn’t even register a count. This afternoon it is at 26 (468 in the US).
Caninsulin did’t work for Ben and we had switched to Insulatard early on. He’s on 5 international units in the morning and in the evening, following a meal of 82 g of Royal Canin diabetic food (portions are sometimes bigger if dog is terribly hungry).
With such high glucose levels, Ben is emaciated - just skin and bones. At least this week he feels like running and being his old self.
Eyesight almost completely gone.
I wish I could help him but don’t know where to start. I read Chris’ story and can see so much of it in what is happening to Ben.
The vet doesn’t have much experience with diabetes and is now dithering to change his insulin. In my mind, Insulatard isn’t working.
I asked pharmacies here but they’re at a loss too.
A) I asked on the availability of Humulin R (which worked for Chris). They have Humulin I or Humulin S. Does anyone have any experience with these?
B) if you change from a lente insulin to a more rapid acting one, how do you determine the doses? (I will do it with the vet, of course, but I’m afraid I have to propose it - as I had to do last time to change to Insulatard and to not treat the dog for the supposed Cushing’s disease which he didn’t have...)?
C) any experience of Actrapid or Mixtrapid on dogs? Again, how to determine the doses pls?
D) any suggestions for intermediate/ fast-acting insulins on dogs?

Apologies for throwing out all these questions... I’m trying to put together some information that may help me save Ben before more damage is done.
Thank you for any help you can give us!