Exocrine Pancreatic Insufficiency (EPI)

[Steve]

Re: Exocrine Pancreatic Insufficiency (EPI)

I looked at a few of the Alpo products and some of them have a fat content (dry matter basis) in the low 20's. A bit high for my liking. Others were in the 15-16 range.
But if your dog has pancreatitis or epi, ingredients also matter in that you want highly/easily digestible food. Fat is the hardest thing to digest.

This link has a calculator for calculating dry matter content. Just input the moisture content and the fat or protein and it'll show dry matter equivalents.

http://fnae.org/dmb.html?inputboxm=8...64&button.y=21

Thank you all for your responses. I am figuring the "Dry Matter Bases" is every thing in the Guaranteed Analysis list except Moisture Content. Is this true? Is the Crude Fat Minimum " the most critical? As far as Rusty and his fresh rodent diet, It is worse in the spring, but daily catches diminish and almost disappear as we move toward summer and the rodents get smarter.

I guess my final (ya right) question is in his feeding habits. I give Rusty food in the evening when I give him insulin. Is it a bad thing to give him more food a couple hours later or should I try to keep his food consumption on the little in the AM with insulin and restrict the evening meal to one setting withe the insulin?

[Raysaint]

Re: Exocrine Pancreatic Insufficiency (EPI)

The guaranteed analysis on food labels is the basic percentage of each aspect, including moisture. It has to add up to 100%, but high moisture decreases the other numbers as a whole.
Those guaranteed analysis numbers are what you want to convert to a dry matter percentage.
Example, crude or minimum fat is 5%, moisture is 78%; on a dry matter basis fat is actually 22%. That's the number you go by when analyzing food.

For diabetics, it's usually best to stay consistent on food time and insulin times, with nothing major in between. More food 2 hours after eating will probably raise his sugar, and it may not be timed properly with his insulin; nor will it probably be enough insulin, if your current dose is giving the results you want.

[Steve]

Re: Exocrine Pancreatic Insufficiency (EPI)

Thanks for the info on feeding times. I thought I might get that advice. I am trying to save the I/D wet food for the mornings, as I have to coax Rusty to eat a little in the morning (with insulin injection) as he never has eaten except in the evenings.

I may be a little dense, but let me have you explain the Alpo label. The Guaranteed Analysis list includes, "Crude Protein (Min) 10.0%, Crude Fat (Min) 3.0%, Crude Fiber (Max) 1.5%, Moisture (Max) 80%. This only adds up to 94.5%.

In your example, (Example, crude or minimum fat is 5%, moisture is 78%; on a dry matter basis fat is actually 22%. Do you disregard the protein and fiber numbers and increase the crude fat so the total is 100% for the dry matter calculation?

If I am on the right track, if the contents of the can in addition to moisture content does not equal 100%, the remaining % is crude fat?

Maybe I am out in left field, but what am I looking for? A high or low moisture content% or high or low other ingredients %? If so is the Alpo brand varieties canned food that are "Crude Protein (Min) 10.0%, Crude Fat (Min) 3.0%, Crude Fiber (Max) 1.5%, Moisture (Max) 80% an acceptable canned food? If not, what percentage in a canned food should I look for?

The I/d label lists: "Crude Protein (Min) 5.5%, Crude Fat (Min) 2.0%, Crude Fiber (Max) 1.5%, Moisture (Max) 78%". That does not seem much different than the Alpo?

[Raysaint]

Re: Exocrine Pancreatic Insufficiency (EPI)

In my example, and on labels, the remainder is the minerals, vitamins, and a bit of ash (residue after processing). Those little things would be the other 5.5%
Diabetics generally want low fat and moderate protein and fiber content.

With commercial brand dog foods, you can't get super low fat as they need to meet certain criteria to be able to call their food balanced and complete. So the prescription brand diets can achieve amounts that others can't.

However, you don't absolutely need the lowest fat you can find, every dog on this forum does well with different foods.

So your Alpo and I/D may have similar percentages of protein/fat/fiber on the label, but convert those to dry matter for comparison.
But even if they are similar percentages, it's what ingredients make up those numbers.
All the fiber can come from grains or starches or whatever, or fiber can come from fruit and vegetables.
And some people are more particular about what the protein sources are; the "quality" of meat and meat ingredients. And even where the meat is sourced.

[amydunn19]

Re: Exocrine Pancreatic Insufficiency (EPI)

Maggie had lifelong pancreatitis and during her diabetic life, she primarily ate a food that was about 18% fat. It was really too high, but she was so picky and her pancreatitis was particularly bad if she ate rice or food with white potatoes. She also got pancreatitis attacks from certain meds - rimadyl, rabies vaccine, and an antibiotic that I can’t remember the name. After a few years, I was able to switch her to Natural Balance Limited Ingredient and Weruva canned which were the lowest fat commercial food I could find that she would eat.

Typically, it is best to start with 2 equal meals 12 hours apart. Consistent repeatable meals give you an idea of how the insulin is working and it gives you a place to start when crafting his routine.

Maggie had trouble with just two meals a day so my vet and I worked on a way to feed her four times a day. She would throw up this foamy stuff if she went 12 hours without eating. Our theory was to keep her stomach working steadily and it solved the issue.

I can’t say for sure that you have to change food to have success but keep in mind that it may happen later if he gets pancreatitis attacks more often. Maggie actually did ok for about 7 years on a relatively higher fat food. I think the fact that the food had chickpeas was the reason she tolerated it so well.

[Steve]

Re: Exocrine Pancreatic Insufficiency (EPI)

Finally after having a chance to digest all the responses to my questions, I find a few questions I failed to respond to. I am new to this venue and hope my lengthy explanations are not out of place. I feel a little background might not only help me, but help others who might have similar pet.

Rusty became ill the last day in January, this year. After changing and modifying insulin levels and types, as of a week ago we are back to a level we were using in March. I returned to nine units of NPH insulin twice a day. Rusty has already returned to his energetic afternoon activity. His first dose is at 6AM and I test his glucose level at 1000 and it has been a little over 200, which is far better than the 400 and 500 readings I was getting with the low dose of NPH. This morning at four hours after NPH, the level was 140. I will soon explain why I think there is still a fluctuating reading at (my determined low point ) at four hours. I am feeling the real low readings I got in March may have been an error or due to his lack of eating any food in the AM. At that time, I was just learning how to perform the tests, and get a good sample sometimes utilizing two or three (expensive) test strips before I got a reading and not err. Also,Rusty's behavior was not reflective of a really low blood glucose level.

I found Rusty in 2012. A month after his arrival on my property I decided to adopt him. According to the vet he was two years old at that time. He had a broken hip I diagnosed as a sprain. He was occasionally limping, but upon my feeling his leg he did not respond in pain. The break healed on its own due my lack of intelligence. The break was revealed later through an ex ray at the vets for another issue. Early this year he is going on eight, things have been difficult.

Rusty's diet is a very difficult thing to deal with. For years he has been eating 12 to 18 ounces of Alpo canned food once a day in the evening with a few ounces of dried kibbles and bit small bites later in the evening. He loves the variety and will lick the Alpo can clean before eating the food.

When he first started exhibiting lethargic behavior (prior to his diagnosis of Pancreatitis) he had gained some weight, approaching 34 pounds. I tired to get him to eat some (alleged) healthier food. Upon my attempted change to Orijen Six Fish dried food. In the evening (in protest) he caught a (maybe one-pound) ground squirrel and ate the whole thing. He would not touch the new food. I tried to soften it with water and he still shunned the mixture. I tried Science Diet Vegetable and Chicken Stew in a can and it was tolerated for a couple of nights and then he resorted to catching rodents (Mice, moles, squirrels and rabbits) or digging up rodents he had buried in the back yard. Rusty is an American Hunt Terrier and is extremely good at hunting down his own meal if I do not produce satisfactory results.

Once the Pancreatitis hit and insulin was being administered I began (per Vets request) to feed him in the morning (AM) when I injected the insulin. At first he would not eat in the AM, as he never had. I was very concerned, as he had lost more than ten pounds in just a few days prior to his being diagnosed with Pancreatitis. I found Prescription Diet Digestive Care i/d with turkey he enjoyed and seemed like as a treat. For a long time I had given him a couple of slices of smoked turkey breast as an evening treat. The i/d variety was a good substitute. I could get him to eat a quarter of a can (3 ounces or so) when I administered the NPH. He is still eating the Alpo varieties, some evenings a can and a half, and is starting to gain a little weight (today 24.0 pounds). I am keeping the i/d as a treat so he will eat in the AM and is also a good medium for me to hide medication (antibiotics, ect.).

Rusty sleeps most nights, but has open access to the backyard where he roams and forages some evenings. I cannot and will not try to change his hunting instinct. He is very proud when he catches something, whether a bird or rabbit (sorry rodent lovers, survival of the fittest).

Rusty's daily routine includes sleep most all morning, whether I am working or at home. In the afternoon we head for a local park where there is a major walkway as well as acres of open undeveloped space. I consider this time to be his walk and have told people he is taking me for a walk, not the other way around. Except for occasional redirection, I let him go where he wants to go.

We begin on the developed walkway ultimately ending up in the open space. The open space is infested with rodents and Rusty loves the place especially in the spring when he can take advantage of the inexperienced pests. I do not discourage his chasing or digging. Our exercise routine lasts from two to three hours (shorter in the winter months). It is good daily exercise for both of us.

When the Pancreatitis hit, Rusty did not want to go to the park or play with anything, even rodents. He is finally getting back an interest in life and recently started gaining a little weight (today 24.0 pounds). I recently started him on an antibiotic (from the vet) as I think he might have bladder or some kind of infection. His urination smells strange.

I do not know if the diet we have settled on is good for a diabetic animal, but he enjoys it and seems to be doing better regardless. His diet addition of fresh rodents my be causing a fluctuation in his glucose readings and I will have to monitor and maybe modify the treatments. Currently I plan to stick with the menu and insulin dosage and see what enzyme treatment produces. If you made it to the end of this lengthy post, I will keep you posted. If you have any comments, I welcome the input.

Not sure if posting this introduction in quote form is what I was told would be helpful.

I have a new inconsistency. I am still trying to regulate Rusty's insulin dosage. Still blood testing highs running in the five to seven hundred range and nadir in the one to two hundred range. Recently (with Vets approval) began an additional unit of Novlon R to his Novolin N. Still (was) getting very high highs and high nadir's. Decreased the NPH from nine units to seven units and decreased again when adding 2 units of R.

I would love to get his diet regulated, but that seems to be impossible. He has a good appetite, as long as I give him the unhealthy Alpo canned food. I need to coerce him to eat in the morning with Hill's prescription diet. The Hills he loves, but I do not want him to get used to it and think it is not a treat to eat at the time of AM insulin.

I think his diet is a problem, but recently I thought he might have a kidney or bladder infection due to his behavior. The second day of the antibiotic (Clavamox) Rusty's highs remained high, but nadir became really low at four to six hours following the morning insulin. Twice my concern resulted in Honey for correction of a low in the sixties. I cut back on the insulin, the highs remained very high, but the nadir increased also. Though I was cutting back on insulin, Rusty seemed to be doing much better once antibiotics were being administered.

I finished the antibiotics three days ago and am still utilizing a lower level of insulin (five units NPH, one unit R). Has anybody experienced a major change in glucose levels when antibiotics were introduced? If so, is there something with the pancreatic diseases that require constant antibiotic treatment?

[jesse girl]

Re: Exocrine Pancreatic Insufficiency (EPI)

You maybe making this a bit more complicated than it has to be . I do understand your worry and that may never go away . Being a caretaker is not an easy job emotionally

Is it certain your dog is EPI and needs the enzymes to digest the food and are you giving those enzymes ?

Are there any other medical conditions like infections ? Medications like antibiotics can affect blood sugar

Other medical conditions can affect regulation until they are cured or managed

Regulating a diabetic is quite simple . 2 meals a day and with those meals a shot of insulin . You adjust the dose of insulin based on the lowest number in the curve done weekly. flat , high stable sugar gives the opportunity to raise the dose . Unstable or a lower sugar at nadir may need to lower the dose . Now there are gray areas in between usually caused by additional medical challenges

[Steve]

Re: Exocrine Pancreatic Insufficiency (EPI)

After a little more research I do not believe the enzymes are necessary. Upon review of the EPI website, I was left with the impression the symptoms of EPI are variable depending on the dog. After more review of EPI cases I believe one symptom that is always present is sloppy strange looking stool. Rusty has little problem in that area. 95 percent of the time his stool looks normal. So I have ruled out that possibility at this time.

One of the reasons I was searching for other problems is due to the extreme variations or wild swings in Rusty's glucose curve testing. from hi's near or over 600 and lows below 100, I was extremely concerned the treatment attempts were not helping. I am still trying to regulate the insulin dosages. I appreciate the input I have received from this Forum and continue to monitor numerous discussions.

[jesse girl]

Re: Exocrine Pancreatic Insufficiency (EPI)

big swings in sugar can point to a dose being to much

Usually the problem is the big drop . It has to be slowed down and or the size of the drop needs to be reduced and flattened out

Either thats done through food or a dose adjustment lower or both

[Raysaint]

Re: Exocrine Pancreatic Insufficiency (EPI)

Reducing the NPH may be contributing to the highs, and the 2 units of R may be causing the lows. You may have to find a better balance to reduce the swings. R insulin can have a big effect.
Maybe do as much as you can with the NPH (increasing the dose each week), then see where nadir lies and if R is really needed.
And infections can definitely affect blood sugar, usually causing it to be higher than normal.

[amydunn19]

Re: Exocrine Pancreatic Insufficiency (EPI)

Clavamox pushed Maggie dangerously low when she took it. It also caused tremendous amounts of blood in her stools. So, the vet said never to give that one again. She usually ended up on baytril.