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Old 09-10-2018, 11:50 AM
RowansRys RowansRys is offline
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Default BC Bean the Medical Weirdo

Hi everyone, I've been reading along behind the scenes for a month or so off and on, and finally have a question or issue that I could use experienced voices chiming in about.



First, Bean shall have her intro (although frankly she'd be happier if you'd just throw the 'toy' for her, be that a ball, mulch, leaf, or baby pine cone). Bean is an 11.5 year old Border Collie, and as the title says, a medical weirdo.



June 3, 2018 her 15.5 year old "big sister" passed away from kidney and heart issues. Prior to this, Bean had been acting a little dizzy occasionally, but it would resolve fairly quickly. 28 hours after her sister was gone, Bean woke me up by having a seizure in bed next to me. A few days later we were at the vet getting a likely diagnosis of an Insulinoma, with a BG of 42 (they didn't measure insulin, no idea why). Ultrasound confirmed a pancreatic mass with possible lymph node involvement. Fast forward a week or so, we're talking to a veterinary surgeon, and going ahead with surgery to remove the mass and get a biopsy. Or, as it turned out, the world's most expensive biospy, since the tumor had spread in the 2 weeks since the ultrasound, and was in both lobes and the center of the pancreas, lymph node, and on her liver. He said that optimistically she might make it to the end of summer. Biopsy results returned consistent with insulinoma. Off we went with our prednisone, frequent feedings and some desperation.



At this point I put her on a bunch of supplements, hugged her a lot and tried to be as normal as possible (if you don't count the random tearing up while driving around for work). About a month after surgery, she suddenly started producing poop similar to an EPI dog, so back to the regular vet we went. At that visit we decided to casually throw in a BG measure, to see where she was, having seen no hypo episodes, and on 5mg prednisone. Tiny problem, her BG was in the 500's.


It took about a month (changed to the vet I like best at the practice, weaning off pred, and me getting an AlphaTrak2 all my very own) for the vet to concede that it wasn't a fluke and she is in fact really honest to god diabetic. Meanwhile, we've resolved the poop with vet strength OTC porcine enzymes (so much cheaper than the vet ones), continued with all the supplements (for the tumors and for general nutrition and liver support). So for the past month-ish, we've been working on her insulin dose, having started ultra-conservatively due to the vet having NO IDEA where the heck her insulin went. I took her to see an internist at the emergency/specialist place, and got a $160 shrug and a "keep testing". He has no idea where her insulin went either, and says it makes no sense at all. Also no idea where her enzymes went during the Clay Poop Weeks, since they have 2 different avenues of delivery, despite being produced by the same organ. I tried weaning her off the enzymes, but while her poop seemed to stay mostly normal, it spiked her BG, so the vet said it can't hurt to keep her on them.



Right now Bean's BG readings are hanging out in the 250-350 range. We had some food changes, so we're due for another curve in a couple days when she's had her standardized meals for a couple days. Her energy is fabulous (and I just have to laugh when she's being a complete jackass because she feels so darn good!)


Data stuff and then the actual question that started this War and Peace intro:
Insulin stuff:
Novolin N 3 units (~7:30-8 am/pm) [yes, dose wise we're still below the usual starting point, because weirdo, we've walked up from 2 units to start]
monoject u-100 3/10 1/2 unit syringes.

testing: lip
shots: scruff



Food:

Primal frozen patties, down to 3/4 per meal now that the enzymes/insulin have allowed her to come back up to weight and rebuild rear leg function that had been lost (from struggling to walk up 5 stairs and occasionally needing to be carried to doing 2 flights in a row solo and jumping in the minivan side door unaided!!)
Raw Kefir for dogs with turmeric and cinnamon
Ziwi Peak dried lamb and tripe bits as a post-test treat (Poke-Treat )



Supps:
CBD oil, at sick dog dose
Apocaps, full dose now that off prednisone
K9 Immunity Plus (mushrooms, colostrum, omega-3) sick dog dose
Probiotic
Dr Dobias supplements (vitamins, minerals) and liver cleanse
Pantenex enzymes, 30 minute incubation on room temp raw food
Partridge in a Pear Tree (kidding, but she's totally eat the partridge, and the pears, and ask you to throw the tree for fetching)


The Actual Question:
Her only exercise has been in the yard with other dogs for 2 hours a day roughly, going at her own pace, much perkier now than most of the summer after she was cleared to be off leash post surgery. In just under 2 weeks, I get a weekend off and she's feeling so well that I thought we'd head up to some land I have to tromp around the woods. Since my plan is to work on boundary marking, she'd be free to roam around near me with her OCD 3 year old "sister" and my pace would be somewhere between mosey and glacial, so nothing like the speed implied by "going for a hike".



Part A of my plan is to bring all her supplies along in a backpack (meter, strips, insulin, needles) and some carbohydrate sources of varying speeds in case she looks like she's going hypo and confirms it by testing low.



I'll do a 12-hr curve either Wednesday or Thursday, just to get an idea of what kind of range we're getting. Our travel food is the same brand and variety as the frozen, so I can shift over to that a few days before we go.



Should I start ramping up a regular walking program now that she's stronger and energetic (and it's not 90 degrees feeling like 100) and see where that lands us before fiddling with her insulin dose? It might put us at roughly what we'd be doing in the woods (although that's a big old fuzzy ballpark guess) so wouldn't be as big a change, which seems like it would make sense, and then after getting that pattern down, adjust insulin if needed...?


(oh cr...ud, I'm about to be late for work, so that'll have to be it, i think that's all of it anyway... for now...)


Rys (and Bean)
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Old 09-11-2018, 06:43 AM
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Raysaint Raysaint is offline
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Default Re: BC Bean the Medical Weirdo

If I'm correct, your concern is that exercise will lower sugar levels more than a normal day. As it should.

First thing, compare travel food carb levels with normal daily food. You want to measure apples to apples. If you're trying to gauge sugar drop related to exercise, I'd want to test based on a similar carb amount.

Second, I wouldn't change insulin dose during hikes or other activities. It's always best to keep dose the same once you find the right daily dose. Use food/carbs to compensate for exercise. Easier for the body to adjust temporarily to the carbs.

Just like human diabetics {like me), if I'm exercising or being more active, I just have extra food. It's more difficult for the body to keep trying to adjust and process differing insulin doses. It likes consistency.
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Riley, 7 yr. old maltipoo, 25 lbs., diagnosed Feb 2017, taking thyroid meds, had pancreatitis and DKA mid March, eating Wellness Senior formula can food. NPH dosage now at 8.0 units Humulin N. Adding either pumpkin, spinach, blueberries, yams, or green beans to his food. Also omega-3 oil.
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Old 09-11-2018, 09:22 AM
RowansRys RowansRys is offline
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Default Re: BC Bean the Medical Weirdo

The travel food is the freeze dried version of the frozen raw that I use, same flavor and ingredients (and I just got the equivalents off their website calculator, so thatís easy). I wouldnít raise her insulin at all. My question with that was since sheís still slightly higher than Iím looking for (without flirting with going hypo) should my next factor to add be some measured walking exercise daily and see where that puts her numbers before even considering bumping her insulin another half unit. Other than that Iíll have her tester with me when we go have fun and some fast and less-fast extra carb sources in case she needs a boost. (Of course, after I hit send yesterday, she gave me a few numbers in the high 100ís, so who knows, maybe weíll have to back the insulin down to 2.5 units if itís a trend and not just a blip.)

Rys
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Old 09-11-2018, 10:45 AM
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jesse girl jesse girl is online now
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Default Re: BC Bean the Medical Weirdo

Just to keep in mind exercise can drop blood sugar and it can be substantial during active insulin . There was a time my jesse could drop a 100 points chewing on a bone . So testing before exercise and after is helpful . Now i am not saying a dog cant be a dog you just have to be aware your in a different reality now with your dog being diabetic

Steroids have been known to cause diabetes in dogs so that could have pushed your dog over the edge but with all the pancreas problems it was probably inevitable . I also thought jesse could have some EPI problems as sometimes stools can be a bit off at times but i have never went beyond just over the counter supplements . I started giving her milk thistle early summer .
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jesse-26 lbs - 13 years old - 8 years diabetic - one meal a day homemade and a vitabone snack - 3 shots of novolin a day sometimes novolog or r as a correction to higher sugar . total insulin for a 24 hour period is between 6 and 8 units of nph insulin depending on her fasting number
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Old 09-11-2018, 12:27 PM
RowansRys RowansRys is offline
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Default Re: BC Bean the Medical Weirdo

Good to know about the big drops. Iíll definitely keep on top of testing, and err on the side of caution, especially since sheís presumably no longer used to living in a hypo state.
I had read about diabetes as a side effect of long term use, no idea how long ďlong-termĒ is, or if thereís a specific dose tipping point. I understand how her regular beta cells would burn out or have pred affect them, I just donít know where the insulin is from the cancerous cells (I mean, if Pred did that I figure theyíd use it as a treatment for insulinoma, not just a method of keeping glucose in the blood for the brain to use instead of in the muscles). Itís probably time to get another ultrasound and a fructosamine test.
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Old 09-12-2018, 07:22 AM
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Default Re: BC Bean the Medical Weirdo

generally you wouldn't use exercise to be part of regulating diabetes. Regulate diabetes with food and insulin. Exercise is too variable. So if she's still a bit high on a regular basis, probably a half unit increase is needed.

Once regulated, exercise effects can be tested, and compensation {carb snack) can be determined.
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Riley, 7 yr. old maltipoo, 25 lbs., diagnosed Feb 2017, taking thyroid meds, had pancreatitis and DKA mid March, eating Wellness Senior formula can food. NPH dosage now at 8.0 units Humulin N. Adding either pumpkin, spinach, blueberries, yams, or green beans to his food. Also omega-3 oil.
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Old 09-14-2018, 07:48 PM
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Default Re: BC Bean the Medical Weirdo

I only have a few things to mention with the already good advice you have gotten. Being out of familiar places can cause some anxiety (even if she is acting normal) so, numbers may be higher or lower depending on her reaction.

I am wondering about the diet - are there any carbs in the food? Sometimes, with dogs and intermediate insulin, without sufficient carbs and more protein, they can use the insulin up much quicker. A proper balance of carbs and protein will keep them steadier. Also, check the fat content and try to keep fat on the lower end of the scale.

Supplements can also be tricky so when first attacking a diabetes diagnosis, I would say eliminate some of the extras. There are some supplements that help with UTIís and other related conditions, but there is no supplement that has been proven to lower or stabilize blood sugar per se. just the sheer number of add-ins can make the waters pretty murky. Keep things as simple and straightforward as possible. And then you can add them back as needed.
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Maggie - 15 1/2 y/o JRT diagnosed 9/2007, Angel status on 6/20/16. Her mantra was never give up but her body couldn't keep up with her spirit. Someday, baby.......
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Old 09-17-2018, 10:18 AM
RowansRys RowansRys is offline
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Default Re: BC Bean the Medical Weirdo

The food has about 10% carb (6.78% plus fiber) if Iím calculating dry matter correctly. Itís 25% fat, 57% protein. Plus her kefir (about 2g of carbs a day, or 44% of a dollop). I could add pumpkin or something to up the carbs. Iíve read that enzymes donít do so well with higher fiber so I donít want to go too high with that, so weíre leaning on that fat content a bit for calories since sheís always been light to average and has only mostly recovered her lost muscle and fat reserves.

Iím not really sure which supplements I could stop. CBD oil, probably. The liver cleanse is nearly done, I guess we could end that early. The vitamins and minerals? I really donít want to stop the cancer supplements since I have no idea where thatís at without an ultrasound which I need to schedule along with fasting blood tests. My hope is that itís greatly reduced, based on how well sheís doing energy wise and given that her insulin is plainly low (though I donít have an exact measure on what sheís producing if anything). Hypoglycemia and steroids was far harder to watch than perky and diabetic.
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Old 09-17-2018, 01:27 PM
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Default Re: BC Bean the Medical Weirdo

Everyone has opinions on food, but mine, the fat is too high and carbs too low. Carbs and more fiber is generally a typical diabetic recommendation, with moderate protein. High protein can be hard on the kidneys.

If the enzymes you're giving is just for gut bacteria, good bacteria feeds off of fiber. My dog used to have bouts of colon inflammation, started to give him a probiotic. Once he became diabetic and his fiber increased with a new food, no probiotic needed and no more colon inflammation.

I looked at all the raw foods, and while they may seem healthy for a normal dog, I didn't like the fat and protein percentages. Not a good idea to get extra calories from fat. You don't want pancreatitis potential.
__________________
Riley, 7 yr. old maltipoo, 25 lbs., diagnosed Feb 2017, taking thyroid meds, had pancreatitis and DKA mid March, eating Wellness Senior formula can food. NPH dosage now at 8.0 units Humulin N. Adding either pumpkin, spinach, blueberries, yams, or green beans to his food. Also omega-3 oil.

Last edited by Raysaint; 09-17-2018 at 01:34 PM.
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Old Yesterday, 05:15 AM
RowansRys RowansRys is offline
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Default Re: BC Bean the Medical Weirdo

They’re actually prescription strength digestive enzymes since she abruptly lost hers a while ago. I need to get a test to see if she’s producing any of her own. She was effectively an EPI dog (pancreatic insufficiency, they don’t produces enzymes to digest the food and lose massive amounts of weight because nothing is broken down enough to be absorbed), which calls for lower fiber generally due to the enzymes being less effective on higher fiber diets from what I’ve read. Undigested food can create bacterial overgrowth issues in the small intestine (SIBO).

Last edited by RowansRys; Yesterday at 05:36 AM.
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