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Old 03-10-2008, 09:46 PM
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Default Natalie's Chris

As I write this, Chris is approaching his 14th birthday and has been diabetic for more than four years. He has many health problems - truly, it's a miracle that he's still with us. An expensive medical miracle! His diabetes is not one of those problems. Even though Chris was difficult to regulate at first, we found a regimen that works for him and his diabetes management has been on cruise control for a couple of years.

Chris uses an unusual insulin. He did not respond well to the lente insulin that was tried first (Humulin L, a human insulin that is no longer available; Vetsulin/Caninsulin is a lente insulin also). He responded very well to NPH insulin but was allergic to it. So he wound up on Regular, which is human insulin with nothing added. That makes it a faster acting insulin. It lasts about six hours and he gets four meals and injections a day, six hours apart.

To learn more about Chris' road to regulation, please see his case study.

We were fortunate that I have a flexible schedule, which makes Chris' every-six-hours routine possible. It has allowed us to give Chris fairly tight regulation of his diabetes. If we couldn't manage this schedule, as many people can't, we probably would have had to let his blood sugar run higher.

We aim to keep Chris' blood sugar in the 100s. Not that we always succeed. Especially these days as his age and many other medications sometimes make that challenging. But he spends most of his time with blood sugar in the 100s.

This tight regulation is made possible by home blood glucose testing. We use primarily a OneTouch Ultra that has been compared many many times with lab values and is a pretty consistent 30 points lower than the actual blood glucose value.

We test on the inside of Chris' upper lip. He's great about this - doesn't mind it at all even though, because of his schedule, we must test fairly often.

I check his blood sugar before three of his four meals a day and base his insulin dose on his blood sugar. Since there's nothing added to his insulin to slow down its absorption, he uses a very small dose more frequently.

Usually about 7 units per injection. He has needed as much as 10 units and as little as 5 units at various time, depending on his health, his diet, and his other medications.

Because his veterinarians did not understand the problems Chris was having with Humulin L, his diabetes was very poorly controlled for about a year. He started to have problems in March 2004, when his pancreas' ability to produce insulin finally gave out completely, and by July 2004 he was blind from diabetes-induced cataracts. This is the primary side effect that Chris has had to endure from his diabetes. He adjusted well to blindness and we opted not to have cataract surgery done because of his many other health problems.

Chris never let his blindness slow him down. Point him in a direction and off he goes. He figures we will watch out for obstacles. He continued to comb riverbanks and even swim on a long lead after losing his sight.

Chris never does anything the way a dog is supposed to so his road to regulation of diabetes was a bumpy one, just like his start in life. He came from a county pound as a puppy with fleas, ticks, worms, and kennel cough. After those started to clear up, we learned about his congenital heart defect (patent ductus arteriosis or PDA). At six months, he was too tired to walk to the end of the block because the heart defect was robbing him of oxygen. At about 8 months, the PDA was surgically repaired and Chris turned into a happy energetic puppy who was thrilled to suddenly feel so good. There was some damage to his heart from his months with the defect - his stamina and tolerance of hot temperatures were low. But he never let that slow him down and his only other periodic problem was allergies that made him itchy.

It was treatment for the allergies with Temaril-P, a combination of anti-histamine and steroid, that led to his diabetes diagnosis. The day of his diagnosis, his blood sugar was 478 mg/dL, quite a bit higher than the normal 80-120.

Chris is an old dog these days but is happy and well regulated and has survived his many health problems - he has severe heart problems, some arthritis, and chronic lung inflammation - no doubt in part because we have regulated his diabetes as tightly as possible. It was a challenge to get there but definitely worth it!
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