Need Advice - Dog Sick / Diabetes Now Unregulated

[jaycapz]

Hi All,

So I havent been here for a while. 1 year ago exactly, my dog jude was diagnosed with diabetes. Hes a 8 yr old doxie/chihuahua mutt mix. For the past year he has been pretty good, almost had this down to a science. He was 35 lbs, not great weight but he could afford to lose 2-3 lbs. His routine was:

Morning = 3/4 cup dry glycobalance royal canin, 1/4 can evo, 16 units Novilin N
Night = 3/4 cup dry glyco royal canin, 14 units Novilin N

His numbers ever 12 hours were in range of 125-175 (once a week he would hit 200-250, just random)

Anyway, the past few months he has gained some weight. It has been slowly happening, but really noticed it past few months. Hes become less active, he wants to be on our laps 24x7, somewhat needy. Just seems more tired than normal. In an effort to help with weight, I removed the canned food 2+ weeks ago, the insulin requirement stayed the same and it appeared he lost a little. Lets fast forward to present day. 2 days ago he was acting off, he got ill, he vomited a few times after eating, he has been lethargic and what appears is dizzy. Very inactive, very slow moving. Stool is hard, no blood in stool or urine. Water intake is acceptable, not begging for more food but getting fussy that he wants canned again. I brought him to the vet yesterday, I am waiting on the blood work results. Vet thinks thyroid, but not sure as of yet. He was not sure, says the symptoms dont all add up. His BG levels for past 1-2 weeks have been 175-225 on most days, with spikes of 300 at 12 hour mark. Hes now at 1 add'l unit morning, 2 at night (morning 17 units/16 units night). Could weight gain do this? I cut his food, but more insulin is needed? I feel as though there is an underlying issue, maybe its multiple issues I dont know!

I don't want to start fearing the worst, but something is wrong. Hes not the same dog that he was. I know he needs more exercise, I know I need to figure out whats up with the BG levels and get insulin back on point. I was hoping someone out there had something similiar, or maybe had a theory. I just dont see the nausea and vomiting being part of a thyroid issue. I also dont see him screaming for water, so I dont know if the high BG level is even really affecting him as much as it should. I should also mention as well, hes been weaker, doesnt want to climb stairs, wants to just lay down. His back legs sometimes shake a little, like hes weak.

I know this may not be a complete diabetes related issue, but maybe theres something being missed here. I dont want to lose the guy to an oversight, and want to make sure I do all that I can.

I appreciate all your feedback and thoughts

Jason

[wild lady wolf]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

This is just my opinion, as I am fairly new at this, but do trust your gut feeling if you think your dog needs more exercise, try to make it fun for him, like a playing a game. I know Mr. Shadow has a weight issue and he could definitely lose more weight, but he is basically a "couch potato" personality. So exercise is a real challenge in my house! We act as if we're going to play with him and his non-diabetic sister, and get him all excited about "running" even if it turns out to be a walk, it's better than no exercise! Mr. Shadow also has back leg problems, and perhaps climbing stairs is too much of a challenge for your dog, I would say make it a daily habit to do some type of physical activity with him, always with a positive attitude (and this is where it is really hard for me too because my fears sometimes of him getting hurt are too obvious even for him and he'll panic and will not stop begging me to pick him up in my arms) like the TV show with Cesar Milan suggests, you are the calm & assertive leader no matter what. I have switched veterinarians since he was diagnosed because I did not feel my dog was properly cared for by the first & nearest one.

[jaycapz]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

I agree, thanks Wolf. If we get out of the woods of the immediate issue he is going for works daily with me. However, the immediate issue is the problem. I just don't get the sudden change in behavior and worry that this is going to be something internal.

I have thought of more severe issues, such as growth on a gland. Jumping the gun I know, but I know diabetes itself can be a symptom. That I remember back when first looking into it, cushings was a possibility and that petuitary issues could lead to diabetes and eventually thyroid issues. Its been 1 year and would think there would be more severe symptoms. Can't help but think the worst. The weight gain is through the full body, and not just the stomach area which is a good thing.

[momofdecker]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

Hi All,

So I havent been here for a while. 1 year ago exactly, my dog jude was diagnosed with diabetes. Hes a 8 yr old doxie/chihuahua mutt mix. For the past year he has been pretty good, almost had this down to a science. He was 35 lbs, not great weight but he could afford to lose 2-3 lbs. His routine was:

Morning = 3/4 cup dry glycobalance royal canin, 1/4 can evo, 16 units Novilin N
Night = 3/4 cup dry glyco royal canin, 14 units Novilin N

His numbers ever 12 hours were in range of 125-175 (once a week he would hit 200-250, just random)

Anyway, the past few months he has gained some weight. It has been slowly happening, but really noticed it past few months. Hes become less active, he wants to be on our laps 24x7, somewhat needy. Just seems more tired than normal. In an effort to help with weight, I removed the canned food 2+ weeks ago, the insulin requirement stayed the same and it appeared he lost a little. Lets fast forward to present day. 2 days ago he was acting off, he got ill, he vomited a few times after eating, he has been lethargic and what appears is dizzy. Very inactive, very slow moving. Stool is hard, no blood in stool or urine. Water intake is acceptable, not begging for more food but getting fussy that he wants canned again. I brought him to the vet yesterday, I am waiting on the blood work results. Vet thinks thyroid, but not sure as of yet. He was not sure, says the symptoms dont all add up. His BG levels for past 1-2 weeks have been 175-225 on most days, with spikes of 300 at 12 hour mark. Hes now at 1 add'l unit morning, 2 at night (morning 17 units/16 units night). Could weight gain do this? I cut his food, but more insulin is needed? I feel as though there is an underlying issue, maybe its multiple issues I dont know!

I don't want to start fearing the worst, but something is wrong. Hes not the same dog that he was. I know he needs more exercise, I know I need to figure out whats up with the BG levels and get insulin back on point. I was hoping someone out there had something similiar, or maybe had a theory. I just dont see the nausea and vomiting being part of a thyroid issue. I also dont see him screaming for water, so I dont know if the high BG level is even really affecting him as much as it should. I should also mention as well, hes been weaker, doesnt want to climb stairs, wants to just lay down. His back legs sometimes shake a little, like hes weak.

I know this may not be a complete diabetes related issue, but maybe theres something being missed here. I dont want to lose the guy to an oversight, and want to make sure I do all that I can.

I appreciate all your feedback and thoughts

Jason

I'm sorry your pup is not doing well. My diabetic dog had a lot of the same symptoms you describe, plus a few more. He was overdosed when his diabetes was originally dx. and then once we reduced his insulin to a more reasonable starting dose, he became nearly impossible to regulate. I knew in my heart something more was going on with him, but didn't have enough knowledge to know what.

It took about six months before I requested his vet run a variety of tests to see if there was an underlying cause that was causing him to be insulin resistant. My boy was overweight despite being an uncontrolled diabetic who only ate about 2-3 c of food per day for an 80+ pound dog. He started having challenges with his rear legs and over time developed problems with his front legs as well. Prior to that, he was a very high energy, crazy dog.

He had a pot belly and was groomed (shaved) and had a lack of fur re-growth. He would foam at the mouth on a five minute walk. His cholesterol value was off the charts high. I really thought maybe he had cushings.

We tested him via the UCCR urine test to rule out cushings. It was negative and did indeed rule it out. Had it been positive, it would not have confirmed cushings, it would have simply indicated that further testing would have been needed to confirm it.

We fasted him and got a reading on his chol value and got his triglyceride value. His fasting chol value was over 1000, which put him at high risk of having a stroke. His fasting trig value was also high.

We tested him, via the SPEC cPL, for pancreatitis, despite the fact that he inhaled his food at every meal and never vomited. He was positive for pancreatitis.

His CBC/Chem panel had several other values that were high and low. You can view it in PDF format from this link:
https://inmemoryofdecker.shutterfly.com/27


We tested his T4 value. Diabetic dogs can have a low T4 value. Hypothyroid dogs can also have a low T4 value. His was low. Diabetic dogs can also have high cholesterol and high trig values. So can hypothyroid dogs. We had a full thyroid panel run and every single value on his full panel was well below range. Here are his results:
https://inmemoryofdecker.shutterfly.com/28

I started him on thyroid meds when I was on a vacation for a week. The first five days his insulin needs reduced by 40%. A little bit beyond that they reduced further - for a total of about a 50% reduction in insulin needs.

It took a few months but he slowly started showing signs of life again. Three months after starting thyroid meds we re-tested everything. His fasting chol and trig values were back in normal range. The pancreatitis cleared. His thyroid levels were a tad high so we adjusted that medication.

Guess my long winded story is this...hypothyroidism can cause high chol and trig values. The high lipids can cause insulin resistance. High lipids can cause pancreatitis in dogs. Pancreatitis can cause insulin resistance. Hypothyroidism itself can cause insulin resistance.

I think your vet was wise to run a check for thyroid. I do hope a full thyroid panel was run. Here is a pretty comprehensive list of symptoms that hypothyroid dogs can display. It's not one of those diseases that shows the same symptoms in all animals. Some dogs may only show one symptom. Some dogs may show many.
http://siriusdog.com/hypothyroid-dog-signs.htm

Having said all of this, there could also be other things that may cause the symptoms your pup is experiencing. It's good that your vet ran blood work and a thyroid panel. Hopefully the results will give you a clear direction to explore in terms of getting your pup feeling better.

Best wishes,
Holli

[jaycapz]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

momofdecker...

That is a great write up you provided. Well, I will say based on the information you provided you made me want to go back and look at Judes blood work up from 1 year ago. Even though 1 year old, I was just curious. At that time his cholestoral was 463, I can't find any trig work up. I would assume this was higher since I Know these usually rise/drop together.

Its crazy how cushings, diabetes and thyroid issues are all tied back to similiar or same symptoms when you think about some of these levels..

Heres some other things that get me worried. The original test came back slightly high for cortisol, his cholestoral was high, and T4 total was low (0.5). Soooo its like, ok, is it possible cushings is at the bottom of all this? If not, is it just cause these are all so closely linked that they all mimic each other? His blood and urine tests were looked at by two different vets, both zoned in on the diabetes and nothing else. I mentioned cushings two both at the start, they both said his cortisol was high but they doubt it. Is it possible they dismissed the low T4 and he has had a thyroid issue brewing? Its crazy.

To some of your other points. He hasnt lost hair, he doesnt have a pot belly but he has some fat near his mid section that hangs a little (two vets said it was ok, its just fat), hes just getting fat, he does pant very heavy after a 5 minute walk but wouldnt say its alarming but he does get worked easily. Could be just the weight. Oh and he was really well regulated, just as he put weight on I had to keep upping the insulin and high numbers flucuated because of it. so I am not sure if its resistance, or just a result/side affect.

I guess its really going to be all on this blood work. Hes been more sturdy on the legs tonight, I was able to get him to go for a 5 minute walk, he had a little trot going. he then wanted to go back in, at which point he ate, got his shot, drank and decided to throw himself in his bed to lay down and stare at me for the past couple of hours. Hes ansy, slight shake in back leg, little more coherent, but tired/depressed. I should add, hes now not had a good bowel movement in over 24 hours, very little but not sure its anything worry about since he is doing something.

[Rubytuesday]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

I'm glad Holli was able to respond regarding Thyroid concerns. Here is a website that may give you some more info:

http://drjeandoddspethealthresource.tumblr.com

Somewhere in her site I read that something like 52% of Hypothyroid dog went undiagnosed due to lack of appropriate testing.

The fact that he is overweight while having diabetes would make me look hard at thyroid issues.

Tara

[amydunn19]

I would look hard at the thyroid rather than cushings. High cortisol, itself, is not an oddity, with diabetes and other issues. Cushings dogs usually have clear physical signs, like the pot belly, thinning hair, etc and usually don't respond to insulin.

[momofdecker]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

My understanding of cushings is that it is a difficult disease to 100% accurately diagnose. It's even more difficult to accurately diagnose in a diabetic dog. There is a sister site to this one: k9cushings.com/forum. Depending on what the blood work and thyroid panel show, if you still have cushings concerns, you could check in there and ask a few questions.

It seems like years ago vets often only tested the T4 value for hypothyroidism diagnosis. Meaning that testing the T4 value in a diabetic could be a waste of money for the customer becuase the results would not 100% confirm hypothyroidism. Times have changed and they now have the capability to run a full thyroid panel, which gives them more information. Unfortunately, some vets still practice old school medicine and only check the T4 value.

I wonder if the vets saw the diabetes as the immediate concern and had hoped the T4 value was a result of that dx? Seems some make decisions based on what they think - but are not great about explaining all of the options to you so YOU can make an informed decision on what YOU think is best for your pup.

My dog's diagnosing vet (the one who overdosed him) told me he was a healthy dog and that he did not recommend any further diagnostics (urine sample, blood work, nothing). I blindly believed him because he never explained to me the impact other diseases could have on diabetes (and I knew absolutely nothing about diabetes at the time). I'm 100% confident that had we run blood work, his hypothyroidism would have been dx. right along side his diabetes. To me it wasn't about the cost - it was about not having all of the information I needed to make a fully informed decision.

[jaycapz]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

I appreciate everyones feedback. I am extremely frustrated, the vets office was closed again today due to an emergency. So, another day with no answers. I was advised they would resume normal hours tomorrow morning at 10am. Theres a new development, as of yesterday morning he is no longer responding to his normal dose of insulin. He was 340 yesterday morning, 384 last night and then this morning 444. So, hes within a range but completely toooooo high. 2 days ago he was 200-250 pts lower on average. I tried giving him an extra unit last night with slightly less food to try and see if there would be any reaction, clearly none. He is also not going his full bowel movement for 2 days (1/4 the amount), so he is clearly not metabolizing anything (my opinion). I gave him an extra unit this morning, normal food amount and checked 2 hours later, 498, then another 2 hours later and now 493. So at this point, I am extremely concerned.

What advice can anyone give me here? He is acting the same, there is no difference - only that he is less interested in food (but eats) and a tad more sluggish but personality wise the same since first showing whatever ailment this is. I was able to get him to go for a walk last night for about 15 minutes, and will do so again tonight if he will let me. I also want to cut food in half to give his system a brake, but trying to determine how much insulin to give with that. I hate to cut food completely, cause I dont know whats really wrong.... If the vet is closed again tomorrow I plan to take him into the vet hospital and roll the dice with a stranger. I am confident the vet will be in tomorrow, I just dont know how much damage is being done while I wait another 24-48 to treat him. Its since late monday/tuesday morning that hes like this. I am very proactive, and patience is not one of my finest points.

Appreciate all your feedback guys, I am going off the rails. Hate being in the dark, if its thyroid then so be it and like to move on.

Oh on another note, I did more reading. I did notice now slight constipation that I mentioned, and he has had a slow formation of fat in the abdomen that kind of hangs a little now. Its on par with symptom for diabetic dog with thyroidism. So add insulin resistance into the mix, but again dont know if its due to metabolism backing up? I dont know.

This sucks, best way to describe the feeling.

P.s The vet is running a full thyroid panel, along with a full CBC blood panel - I checked the form he gave me.

[jaycapz]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

By the way, I think I need to ask this.. because I feel like I am approaching this concern. What BG level do I need to grab him and run him in as an emergency??? Cause now hes dancing on the 500 threshold, and its the first time I am in this area. His highest when diagnosed was 450 area.

I have the strips, checked this morning for ketones it came back negative. Is that the real gauge? I gotta get him back down under 250-300 until I get things worked for him. Any recommendation? I ll keep checking him with the ketone strips, I guess.

[momofdecker]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

I'm sorry that things have become more worrisome.

The biggest concern you may face with higher bg readings is the development of ketones. You can encourage him to drink lots (if he is not already doing so).

Most local pharmacies carry ketone strips (just ask the pharmacist to point you in the right direction). You can test your dog's urine for ketones. Anything more than trace ketones should be considered an emergency phone call/visit - as it could quickly develop into DKA and become life threatening.

When my boy was insulin resistant his bg readings ran mostly 300-600+ for about six months. He drank a lot, urinated a lot, and did end up losing his vision to cataracts, but there was no damage from his bg being elevated for so long.

[jaycapz]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

I'm sorry that things have become more worrisome.

The biggest concern you may face with higher bg readings is the development of ketones. You can encourage him to drink lots (if he is not already doing so).

Most local pharmacies carry ketone strips (just ask the pharmacist to point you in the right direction). You can test your dog's urine for ketones. Anything more than trace ketones should be considered an emergency phone call/visit - as it could quickly develop into DKA and become life threatening.

When my boy was insulin resistant his bg readings ran mostly 300-600+ for about six months. He drank a lot, urinated a lot, and did end up losing his vision to cataracts, but there was no damage from his bg being elevated for so long.

Thanks momofdecker.. Well thats what I am doing. I got the strips, familiar with that concern (DKA). So far, the strips are negative (not even a shade change). I dont trust strips to be honest.

As for the cataracts, that is one of my top fears. It has been for a year. I put my guy on ocu-glo, eye sight was consistent before this. Slight grey in the eyes, doc says hes ok. After this I am going to really worry. Like I said, over 1 year he was 125-175 avg and peak he never really broke 250 during the day. So, I hope all that good proactive early on saves his eyes for a while longer. I dread that, big time. Hopefully this little stint wont break all that hard work.

[jesse girl]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

It's possible your going in the wrong direction and need to reduce .a clue to that is the numbers deteriorate as you raise the dose

[amydunn19]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

Cataracts and development of ketones are really the biggest concern with high blood sugar. Many dogs never get below 300's for whatever reason and still do just fine. Organ damage is not a concern and dogs can take high blood sugar much better than humans. Of course, when you have a dog who has been regulated and then suddenly not, you want to get to the bottom of it. I just wouldn't worry about damage in the meantime as much as if it was a person. We humans are delicate by comparison

[jaycapz]

Re: Need Advice - Dog Sick / Diabetes Now Unregulated

The only issue I have with that, is that his numbers were fine until he got sick. So basically, in the last 72 hours his insulin requirements change which was coincidentally the same time he got sick?

Also, wouldnt too much insulin lead to hypoglycemia?

So now he was 416 when I got home, just before his meal time. I decided to try and cut his food in half, and give him 16 units instead of 18. I know this is a huge risk, in the past he has had some resistance to any insulin that was under 12-14 units. Not enough to move the bar at all. I tested him now 3 hour after eating, hes 506.

The more I read, the more it seems like hypothyroidism could be the case. I read that fat lipids are increased in the blood which cause a block on insulin.

I pray the vet is actually in tomorrow.