10 1/2 year old basset hound just diagnosed. Questions ???

[snyderes]

My basset hound Max was diagnosed last week with diabetes. He has been healthy for most of his life except for a vestibular episode about 2 years ago. In fact this past summer I was noticing how well he seemed to be doing. Starting about September i noticed he didnt seem to be feeling well. Especially at night he acted like he couldnt get comfortable. I took him to the Vet and they did physical exams and a series of tests including x-rays and everything seemed fairly normal for a 10 year old dog. He has always been active and never overweight. He still jumps up on my bed or couch with no problem and has no limps. I took him to a different Vet clinic for a second opinion and they said pretty much the same thing. I thought it might be a problem with his back but X-rays and physical exams showed nothing. Well about a month ago I took him back to my family Vet ( Franklin, Pa. ) and they did bloodwork and urinalysis again. This time his liver number were up as was his blood glucose. The Vet suspected cushings disease. She did another liver test .... ( pre & post bile acid something ? ) and it showed a slight abnormality but ruled out cushings. They also did some sort of blood glucose test that showed what his blood sugar has been in the fast few months. She said it indicated that it was normal more than it was high most of the time. She wanted me to take him to Pittsburgh Specialty Veterinary & Emergency Center and see a Dr. in internal medicine. They were going to call and make a referral. A week went by and I hadnt heard anything so he was not feeling well at all one night so I took him to PSVES. To the emergency room. They kept him for 2 days and did more tests and said his blood glucose was over 400 the whole time he was there. they put him on 8 units twice daily of Novolin N insulin. They said they gave him a higher dose when he was in the hospital but they backed off a bit until I could bring him in to do a curve. I ordered a Alpha trac 2 glucometer that is suppose to arrive tomorrow. They cant see him for another 2 weeks and I just dont think he is feeling better yet. They said it might take a few weeks for the insulin to take full effect. I plan on doing a curve myself when my meter arrives, but I hate to make him go through another 2 weeks of not feeling well. Should I call them back and tell them he isnt feeling well yet? I did get some Keto _ Diastyx and they show he had sugar in his urine. I found a spot where he had an accident in my house on my harwood floor and it was sticky, like someone spilled a can of soda. PSVES is about an hour away and my family vet is only about 10 minutes away. Im half tempted to call my local vet and see what they have to say, or am I just jumping the gun and being too impatient ? My bill at PSVEC was $2300 for emergency visit and 2 days stay with tests. They did an ultrasound on his liver and it looked normal. They want another $400-$500 to see the internal medecine Doc and do a blood glucose curve. I hate to put a money value on my dogs life but what do I do ? Its getting expensive. Im afraid if I dont keep the PSVES appointment and go back to my family vet that there is something that my family vet isnt seeing.... What do you all think ? Thanks in advance.....

[jesse girl]

Re: 10 1/2 year old basset hound just diagnosed. Questions ???

hi and welcome

yes its a bit of a slow process letting the body adapt to the new reality of injected insulin ( far different from the natural process )

glad you will be home testing that will be a big help to the management of the disease

as far as going to a specialist or the regular vet for diabetes its not that complicated but some vets dont seem to have the up to date knowledge

your pup gets 2 shots and meals same amount everyday a curve is done after a week many vets wait 2 weeks because of cost of doing curves at the vets office you can do curves at home ( which is a more normal environment ) and email the results to them but thats up to you and your vet many will do it but some wont and actually frown upon testing at home . after a curve is done we base the lowest number in that curve on raising or lowering the dose for the next week on that specific dose . stable blood sugar is preferable like having sugar from the highest to lowest for the day of a 100 points or less is very stable blood sugar for a dog . adequate blood sugar can be from 150 to 250 for the day if not testing blood sugar at home but can do a bit better with testing . some dogs dont ever get close to that and did ok

many of us including me manage the disease exclusively at home without any vets assistance . in our situation jesse was a challenge to regulate and just going to the vet periodically was not going to get the job done for her . it was a difficult decision having no medical background

its a bit tough for your pup in the beginning many dogs perk back up to normal in a couple months my jesse was about 6 months and a year to have an established routine that worked

[Janeyp]

Re: 10 1/2 year old basset hound just diagnosed. Questions ???

You will find that the urine test kit is not as reliable as the alpha trak blood test unit you'll get tomorrow, mainly because the urine results are a measure of the past few hours rather than right now. If your dog acts like he doesn't feel well, it is probably because his blood sugar is either too high or too low, and you don't have enough information yet to know which it is. Could you take Max to your local vet today for a quick blood glucose test? They use the same kind of alpha trak unit you will get tomorrow, most likely. That way you'll know for sure if he is hypo- or hyperglycemic on his current dose of insulin. See if you can schedule the test for 6-8 hours after his morning insulin injection so you are catching the blood value at maximum insulin response.

Once you get your alpha trak, just test his blood yourself every two hours for a 24 hour period and record the results. Once you figure out the setting on the pricking device needed to get the prick to bleed the right amount, this is a piece of cake; we use the ear. Watch the video.

We found that we needed to make much smaller incremental increases or decreases in our dog's dosage of Novolin N in order to get him regulated. It took 4 months. He had and will still occasionally have rebound or symogyi effects (read the link on this blog). I keep daily records of blood glucose values and insulin dose.

I recommend you buy a digital food scale and weigh your dog's canned food (and/or measure dry food with cup measure) to be sure of how much he eats at each meal, as that will affect his insulin dose and response.

[Monsters Momma]

Re: 10 1/2 year old basset hound just diagnosed. Questions ???

many of us including me manage the disease exclusively at home without any vets assistance .

This is definitely the group I fall into!

Hi and Welcome!

Max sounds like he is well-loved! It's so hard knowing our pups aren't feeling well and needing to guess at what is going on. Then we get a diagnosis like diabetes and honestly, it's overwhelming at first. I add my caution...this will take time to have Max feeling better. Time and patience.

I am the type of person that digs in and starts doing research...luckily I found this site early on and you did too! This site is made up of people that are (have) dealing with this diabetes thing day to day...sometimes hour to hour. I have found more answers and more support here than I have at my vets in the early going. Read what you can here, ask questions.

In answer to a couple of your questions...

1. I do all my curves at home, I know Vinny's numbers would be skewed at the vet. He just gets too excited.
2. I have taken Vinny to an internal medicine vet, but only a couple of times and we had something in addition to diabetes going on. There are people here that deal exclusively with an IMV, maybe they will chime in.
3. Unless you are uncomfortable with your vet, I would make sure she/he has all the info from PSVES and work with them.

That's all I've got. Hang in there, have patience. You'll get this and Max will start feeling better!
Mel and Vinny

[LizE]

Re: 10 1/2 year old basset hound just diagnosed. Questions ???

Hi and welcome. I'm new here too so I can't offer any diabetic advice but I can speak to the expense of treating an older dog.

My dog was 15 when she was diagnosed. She got very sick very fast. My vet did warn me that we could spend a lot of money on her and still lose her (he suspected an underlying cause triggered her diabetes and that whatever it was might not be treatable or even something they would be able to diagnose). He hinted towards putting her down if we couldn't afford to treat her either through his clinic or the emergency center.

We opted for treating her with the our original vet. It seemed like a reasonable compromise. We didn't do the really expensive option but we didn't give up on her either. We just did reasonable treatments and fortunately she recovered. Having a vet only a few minutes away and that will always take my questions via phone has been worth a lot to me.

You are entering the twilight years of your dog's life. Like others have said, recovery takes a long time. If you think your local vet is competent I would work with her first. There is no guarantee that the emergency center would diagnose any additional problems or would offer better care.

Good luck!

[snyderes]

Re: 10 1/2 year old basset hound just diagnosed. Questions ???

I received my glucometer today. I calibrated it and did a test on Max at 2PM. His level was 522. He had 1 cup of homemade chicken, brown rice, and vegetables and 1 cup dry Pure Balance dog food at 8am. That seems awfully high. No wonder he dosent feel good. His appetite is and always has been real good.

[CraigM]

Re: 10 1/2 year old basset hound just diagnosed. Questions ???

Good work on getting a blood droplet.. Yes, 522 is high, but not all that unusual when first starting.

How much does Max weigh, what insulin dosage did he get today, is he still on Novolin-N?

Craig

[snyderes]

Re: 10 1/2 year old basset hound just diagnosed. Questions ???

Hi Craig,
Thank You so much for your help. Max weighs about 65 lbs. He got 8 units of Novolin N at 8 am this morning. Thats another question.... My prescription is for Humulin N but the pharmacist at Wal Mart told me Novalin N is the same thing and no prescription is needed. Is this correct ? BTW, I just checked again and it was 475. Thanks again...

Eric Snyder
Harrisville, Pa.

[CraigM]

Re: 10 1/2 year old basset hound just diagnosed. Questions ???

Hi Craig,
Thank You so much for your help. Max weighs about 65 lbs. He got 8 units of Novolin N at 8 am this morning. Thats another question.... My prescription is for Humulin N but the pharmacist at Wal Mart told me Novalin N is the same thing and no prescription is needed. Is this correct ? BTW, I just checked again and it was 475. Thanks again...

Eric Snyder
Harrisville, Pa.

8 units is very low for a 65 pound pup. A general starting dosage we often see is .2 units per pound. So, many would have started around 13 units. 8 units is very conservative and would be fine as long as curves are done every 5-7 days and insulin increased as indicated. If possible, it would be great if you could do a home curve tomorrow or as soon as possible.

A curve is doing a blood test just prior to breakfast, and then every 2-3 hours until just before dinner 12 hours later. No food between the meals (maybe a green bean, tiny dog treat or tiny piece of meat as a treat after getting blood tested - a "good boy" treat). Just remember anything more than tiny could affect the results of the curve.

Single tests don't tell us much, especially in the beginning. Not unusual to see a 200 point spread early on until things smooth out. We make insulin adjustments based on the lowest number of the day. So, although not likely, you might see a 400 number, but a few hours earlier, or later, the BG could have been in the low 200s.

Yes, Novolin-N and Humulin-N are nearly identical. I use the example that two brands of top tier gasoline are nearly the same. Many of us have used both insulins. A little Walmart history: they seem to sign a contract with either Novo Nordisk (Danish company) for Novolin products, or Lily for Humulin products. Both are tops in their fields. The Walmart contract has switched three times in the past 7 years (Novolin to Humulin and back to Novolin). I didn't see any difference in dosage.

Craig

[k9diabetes]

Re: 10 1/2 year old basset hound just diagnosed. Questions ???

Is he getting insulin twice a day?

I agree that the starting dose is probably a bit low... I think it could certainly go up to at least 10 units. And, as Craig said, many dogs would have been started on more like 12 to 13.

Request a copy of the records from the emergency vet so you can see how much insulin they gave him and how far his blood sugar came down.

It does take a bit of time... you don't necessarily want to plunge their blood sugar immediately down into the 200s because it's easy to overshoot the right amount that way. Since he's had high blood sugar for a while, his body is going to need some time to get used to having insulin again before you see how much insulin he truly needs.

I take it there were no ketones?

If not, he shouldn't be in any immediate danger. I would talk to whatever vets will be following up on this about possibly raising his dose another couple of units, depending on what they gave him at the emergency vet. And then give him time to adjust.

Natalie

[snyderes]

Re: 10 1/2 year old basset hound just diagnosed. Questions ???

Natalie,

Thank You for the reply. Yes he is getting insulin twice a day, and yes the test strips showed negative on the ketones. I am going to do a blood glucose curve myself today, starting at 8am just before his first insulin & breakfast.

Thanks again
Eric Snyder

[snyderes]

Re: 10 1/2 year old basset hound just diagnosed. Questions ???

This is definitely the group I fall into!

Hi and Welcome!

Max sounds like he is well-loved! It's so hard knowing our pups aren't feeling well and needing to guess at what is going on. Then we get a diagnosis like diabetes and honestly, it's overwhelming at first. I add my caution...this will take time to have Max feeling better. Time and patience.

I am the type of person that digs in and starts doing research...luckily I found this site early on and you did too! This site is made up of people that are (have) dealing with this diabetes thing day to day...sometimes hour to hour. I have found more answers and more support here than I have at my vets in the early going. Read what you can here, ask questions.

In answer to a couple of your questions...

1. I do all my curves at home, I know Vinny's numbers would be skewed at the vet. He just gets too excited.
2. I have taken Vinny to an internal medicine vet, but only a couple of times and we had something in addition to diabetes going on. There are people here that deal exclusively with an IMV, maybe they will chime in.
3. Unless you are uncomfortable with your vet, I would make sure she/he has all the info from PSVES and work with them.

That's all I've got. Hang in there, have patience. You'll get this and Max will start feeling better!
Mel and Vinny

Thanks for your help

[snyderes]

Re: 10 1/2 year old basset hound just diagnosed. Questions ???

Update on Max.....

I started a blood curve yesterday and his numbers were all in the 500's except for his first reading which was in the 600's. I checked every 2 hours. I called the vet at the internal medicine department in Pittsburgh and told gave them his #'s and said I still didnt think he was feeling that well. His appointment isnt for another week and a half and I didnt want him to go that long with the higher numbers. They said to increase his insulin from 8 units to 14 twice a day. I checked it about midnight last night and twice already today and it has been lower every time. It was 406 at noon today. ( 150 lower than yesterday at noon )I think I can tell he is feeling better and we are going in the right direction it seems. Thanks again for everyones help. What we all do for our animals!!!!!

[CraigM]

Re: 10 1/2 year old basset hound just diagnosed. Questions ???

I nearly panicked when I first read that you went from 8 to 14 units at one time. Usually, we do small 10-15% increases. Then I remembered his weight as 65 pounds and 14 units didn't sound so bad..

Hope things continue to improve.

Craig

[snyderes]

Re: 10 1/2 year old basset hound just diagnosed. Questions ???

Actually, I thought that was an awful lot too. But I read the numbers back to the tech who got the orders from the Dr. and she confirmed. I am just home from work tonight and I can tell he is feeling better. He was actually running in the back yard which I haven't seen him do in a while. I am so glad.... Thanks again for your help