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Old 06-18-2011, 08:30 AM
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Post Abby's Story - 12.24.1999 to 12.31.2013 - Forever in our hearts

Hi,

I am new to this forum, but I have been reading the posts for about 4 weeks since my Abby (20 lbs Yorkie/Schnauzer) was diagnosed as being diabetic, glucose level 385.. after the symptons of increased thirst and urinating in her bed. She was sent home with very little instructions, NPH (Humilin N) to use 10 units 1x a day, did not matter if she ate or not is what the Vet stated. She was kept originally for 3 days to get her regulated.

Since then, it has been a roller coaster ride. I switched vets, as this vet did not believe in home testing, nor would be open to any form of communication, and felt that the once a day method was not the correct way to control diabetes.

The new Vet was more concerned about her high liver functions, and after a week on 10units a day, her Glucose levels were at 120, 7 hours after her last shot. The new Vet suggested 5 units 2x a day. Continued this for a few days, and Abby had a Hypo event. Vet then suggested to take her off of insulin thought she may have Cushings. I only monitored her by taking her to the Vet for testing, or by urine strips.

Since then we have been going down the Cushings path, and she was put back on insulin with 2 units (her glucose when tested was 285). Tested again with urine strips, and with changing to a raw diet, urine strips were negative. After 1.5 weeks, with missed insulin, fasting, as well as Aspirate test of the liver and a liver ultrasound, and a ACTH test her glucose has risen (I have no numbers... just urine test strips), and they have diagnosed her as having Cushings and wanted me to start Trilostane, and then stop the insulin the day I start Trilostane. They did see enlarged adrenal glands in the ultrasound.

Needless to say, at this time, I am just beside myself. I have not started her on the Trilostane, as what I have heard is that she could be giving false positives on the Cushing's test, in addition if she does happen to have both, then she should be regulated with the diabetes first before treating the Cushings. My vet seems to think that the diabetes is caused by the Cushings.

I'm having doubts.... her coat is wonderful, shining not falling out. Her increased water consumption stopped once on insulin. Her activity level is normal since she is on insulin. There are no other signs that I can see that leans towards just Cushings.

Your forum has been a wealth of information (I am also a member of the sister site for Cushing's) and the advice and support that you all give is a wonderful feeling, especially when you feel you are on your own.

First in order, is that I need to get a glucose meter and start to do some home testing. Do you have any suggestions? Also, I'm little frighten of the whole process, as I was originally when giving the insulin (but I have gotten use to this). Abby is not a big fan of touching her mouth in any way. Any other suggestions as to where to test?

Currently right now, Abby is on 3units 2x a day. I am feeding her a raw diet, with minced sweet potatoes, carrots, broccoli, cabbage, brown rice with either lamb, chicken, turkey or beef. The portions are 80% vegetable and 20% meat. In addition, I have added Flax Seed, cod liver. She gets a 1/2 cup of this in the PM. In the AM, she receives 1/2 cooked egg (with egg shells), oatmeal, organic pumpkin, low fat cottage cheese (1/2 cup as well) with Milk Thistle w/Dandelion. I also have added Kelp (to support the thyroid and provide iodine). For a snack (if she receives one) is a dehydradated sweet potatoe.

She originally was overweight at 27 lbs, but she is now 20 lbs.

Thank you for all that you do.
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Barb & Abby 12/24/1999-12/31/2013 ~ dx 5/10/2011 ~ Forever in my heart ~

Last edited by Abby's Mom; 06-18-2011 at 08:33 AM.
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Old 06-18-2011, 08:48 AM
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Soaphie & Sydney's Mom Soaphie & Sydney's Mom is offline
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Default Re: Abby Diagnosed about 4 weeks ago

Welcome!

I cannot help you with the cushings items (there are others that will reply).

You are very wise to want to start to home test. Many here use the One Touch Ultra2 meter (it's what I use on my two sugar babies). Save money by buying the strips etc on Ebay (just watch the expiration date). I test my pups on the upper lip, but some test on the base of the tail, the ear, calluses etc. There are videos on the main page of this site to show you how to go about testing.

I cannot attest to the diet you are giving Abby, but can tell you that carrots are high in sugar - my opinion is to avoid them. Also important with diet is to give the same thing each day at each feeding. It sounds to me like she is getting different food and amounts in the a.m. and p.m. I would recommend making it the exact same for now until you get a handle on things - then make small changes - only one at a time.

I'm sure others will chime in - but I do want to welcome you and to tell you that you have come to the right place! Lots of knowledge here!

Tami, Sydney and Soaphie
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Soaphie = 15 yr old Border/Berner mix dx 07/08. ~8.25 units a.m./p.m. vetsulin, blind/deaf. Ultra Senior, Vital Beef/Bison, Brown Rice and lots of loving. Soaphie passed on October 29, 2015. Sydney = 14.5 yr old Aussie/Shar Pei mix dx 11/10. NPH-varies w/ predinisone a.m./p.m., blind/deaf. Sydney passed on June 3, 2014.
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Old 06-18-2011, 09:09 AM
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Default Re: Abby Diagnosed about 4 weeks ago

I agree with tami home testing will give you a clearer picture as to what is going on and keep her safe

my jesse is on a raw diet also completely raw for 6 months she has 80 percent meat and 20 percent vegetables the opposite of you the veggies are green leaf type processed and mixed into the grounded meat to help digestion as you said the diet has improved her health and it has reduced her insulin needs which is a plus for my jesse because she appears to have a reaction to the nph but smaller amounts seem to lessen it to almost nothing

I have learned to listen to my instincts if I did not jesse would probably not be here to day so you have to be a pain in the butt sometimes keep those vets on there toes and be an advocate for you baby I have no knowledge on cushings either but you might want to just see if you can control the blood sugar at this time and testing will definitely will help with that just a thought

welcome to both of you and you will sort this out
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Old 06-18-2011, 09:27 AM
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Default Re: Abby Diagnosed about 4 weeks ago

Thank you everyone! I am going to purchase the glucose meter today, and give it a whirl! Wish me luck, not that Abby will bite, but she can certainly dance around a bit when something is unpleasant.

Thanks for the heads up about the carrots. Some of the raw foods are good for the cushings, and not for the diabetes, and vice a versa. This is going to be difficult journey... but I will do anything for my pup!!. (Well my 11.5 year old puppy).
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Old 06-19-2011, 01:40 AM
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Arrow Re: Abby Diagnosed about 4 weeks ago

Barb,

Dogs have to learn about testing blood glucose (BG) levels, same as we humans have to learn. If you take things slow and easy, and use canine calming signals, that should help you get to being able to test.

For actual testing, here are excruciatingly detailed pages, with pictures:

http://www.coherentdog.org/vek/bgtest.php

Throughout, don't be in a rush. Take your time. Remember to breathe. Use the calming signals. Give tiny treats.

And yell for help when you need it!

A Big, Fat Welcome to you and Abby!
Sun, 19 Jun 2011 01:39:46 (PDT)
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Old 06-19-2011, 04:23 AM
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Default Re: Abby Diagnosed about 4 weeks ago

Thank you Carol, that was helpful. We are learning together. I am using the "above the tail" method. It seems to be the least amount of stress for both of us. I'm realizing, however, that there is a lot of squeezing that needs to be done. After 3-5 attempts (those testing strips can be expensive, and at this rate 3or 5X more), I am successful!!

The levels have been high!

4:30PM: 375
Feed: 6:30 PM
12:30AM: 400
6:30 AM = 475
Feed: 6:45 AM

How often should I test to get a good curve?

I also got some Ketone strips, and they appear to be Negative (I'm thankful for some good news).

Thanks everyone!!
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Old 06-19-2011, 07:28 AM
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Arrow Re: Abby Diagnosed about 4 weeks ago

Barb - HUGE congratulations on your SUCCESS in testing! This is the greatest tool you can have to help your dog!

Some additional remarks:

OneTouch Customer Care told me NOT to "milk" (squeeze) the prick site to bring up blood; they said that squeezes fluid from between the cells, which can corrupt the readings some. Also, there would be a tendency to bruise the tissue, and you don't want to do much of that when you'll be testing again later.

So, to aid bleeding; you can try a few things.

1) Get thicker-needle lancets. The lancets, same as syringes, with the LOWER-gauge numbers are thicker than those with the higher-gauge numbers. Some lancets aren't labeled for gauge! - primariliy, OneTouch lancets, for instance! With the OneTouch lancets, the Fine Point lancets are 25-gauge. Those should work for you, with some persistence on your part.

Kumbi and I found 21-gauge lancets were MARVELOUS! Bled first time, one prick. It's not always easy to FIND 21-gauge lancets, though.

2) Warm the site before pricking. I used a paper towel that I'd run under hot tapwater, and checked for temperature so I wouldn't burn Kumbi. Then after warming - about 15 seconds - I'd blot dry with a dry paper towel; THEN I'd prick. That helped a lot.

3) Make sure, if you're pricking by hand, to sink the needle to its full depth.

4) If you don't see blood welling up quite promptly, you can prick again, very close to the first prick-hole; then sometimes, the two will merge, and you'll get some kind of drop.

(If you get a FLOOD of blood, don't use it; it'll only foul your meter!)

There's a start; I'm sure I'm forgetting stuff. But if you try these things, likely you won't have to squeeze much. A bit of a squeeze won't hurt - just not a lot.

Those BG levels aren't bad at all, for a newly-diagnosed dog!

I'm glad you're testing for ketones; should do so when the numbers are over 300. Say, once a day.

Keep up the great work, and keep yelling for help when you want it!
Sun, 19 Jun 2011 07:27:59 (PDT)
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Old 06-19-2011, 07:55 AM
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Default Re: Abby Diagnosed about 4 weeks ago

Quote:
Originally Posted by Abby's Mom View Post
After 3-5 attempts (those testing strips can be expensive, and at this rate 3or 5X more), I am successful!!
As usual, CarolW has given great advice.

If you are "wasting" strips with the meter timing out before getting a blood droplet you can turn the meter on after you see the droplet form. On my meter that turns on automatically when I insert the strip, I just barely insert the strip and then when I see the droplet form I can push the strip in the rest of the way.
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Old 06-19-2011, 10:10 AM
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Default Re: Abby Diagnosed about 4 weeks ago

My dog also has diabetes and Cushing's. In my dog's case, I believe that his diabetes was caused by untreated Cushing's. We knew that he was marching towards Cushings (started seeing elevated liver enzymes two years ago - did complete workup including lepto, ticks, ultrasounds, full blood - nothing found but bilaterally enlarged adrenal glands, full U Tenn Adrenal panel showing elevated estrogen initially, positive on LDDS) - but we were afraid of the treatment and delayed it as long as possible until we could not ignore all the skin infections and stomach problems (from eating all the crap out there - my dog was constantly hungry).
Elevated cortisol causes insulin resistance (meaning that body does not use insulin properly) - and pancreas ends up working even harder to produce more insulin, eventually exhausting itself.
With the ultrasound showing enlarged adrenals and elevated liver enzymes, I think your dog probably does have Cushings - esp if the ACTH stim test was positive. Usually, LDDS is a better test for the diagnosis, but it tends to have more false positives, so if your dog has other health problems, it is not the best test. ACTH test is the better test since it has more false negatives, and most experienced vets use this test to diagnose Cushing's in a diabetic dog.
You can aggressively start treating the diabetes first. We stopped Trilostane for a few months when we started our dog's diabetes treatment, but we ended up re-starting the treatment because we really could not get a good handle on blood glucose without this treatment.
With Trilostane, Harry's proteinuria (protein leakage in urine) and elevated liver enzymes all became significantly better.
If you are starting the Trilostane treatment, start slow and low. UC Davis protocol is to start at 1mg/kg once a day, but with diabetes, it is better to do twice a day dosing (0.5mg/kg twice a day). You should run the stim test about 10-14 days after the initial dosage.
Note that the ACTH stim test stimulates production of cortisol - so after the test, your dog's glucose level will likely run high for a day or two.
Hope this helps.
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Old 06-19-2011, 10:16 AM
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Default Re: Abby Diagnosed about 4 weeks ago

What was your dog's stim test results? Once again, if your dog tests positive through the ACTH test, she likely does have Cushing's - esp if she has all the symptoms (hunger, hair loss, elevated liver enzymes, sometimes protein in urine, muscle loss, skin problems, thirst / urination).
You should think about switching to fish oil (from deep sea sources to avoid mercury). Cod liver oil has too much Omega 6 (your dog already gets that from his food), not enough Omega 3 and too much vitamin A and mercury.
Keep an eye on your dog's glucose level after sweet potato snacks because these will likely raise the glucose level.
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