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  #1  
Old 01-14-2014, 04:38 AM
parisa parisa is offline
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Default Nima's crazy journey

Hi all,

I found this forum via google, so I am apologize if this post is in the wrong section. I am also jet-lagged from being in Bangkok for 10 days and now back home in Seattle.

My dog 8 year old lab/springer mix Nima was diagnosed with diabetes probably 1 year ago. He was placed on pork insulin, responded for a short period then switched to lispro, then to regular insulin. He was on regular insulin for a good chunk of time but continued to lose weight. I don't feel that he was ever properly regulated/monitored by his old vet. The vet at the time basically gave up on us/him and said we need to just feed him more. He didn't check Nima's blood sugar often, only when we switched insulins at the beginning.

1 month ago Nima was lethargic and had non-stop vomiting. Nima was in the ICU for 4 days due to DKA (we fired the first vet because we brought him to the vet and the vet didn't even take his blood sugar, but instead gave him IV fluid and sent him home). Post ICU stay at a new vet, he was then started on 10 units NPH twice a day. We've done 3 glucose curves and he is now on 14 units of NPH insulin twice a day, but his blood sugars remain in the 400s. I'm not really an expert, but I am an RN, and when I look at the curves he has obvious resistance. He has had chronic UTIs so right now he is being treated for a month with Amoxicillin, he's been on it already for about 1 week. There are talks of switching him to Detemir insulin.

It really distresses me that his blood sugars aren't moving in the right direction. I am concerned that he has Cushing's disease as in the last 8 months I've noticed the hair on his stomach is sparse. Additionally, he has calluses on his elbows that through research I have found to be consistent with canine Cushing's. I left a message with his Internist last night discussing my desire to have him tested, so I'll hear back in the AM. Has anyone had experience with Cushing's and Diabetes in their dog?

Can anyone give me any advice, direction, words of encouragement? Also, Nima REAAALLY hates being stuck at the vet for 12 hrs when they do his glucose curves. Has anyone had experiences where the vet let you perform the curves at home?

Thanks for all your help, advice, words of wisdom....
~P
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  #2  
Old 01-14-2014, 05:24 AM
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amydunn19 amydunn19 is offline
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Default Re: Nima's crazy journey

Hi and welcome to you and Nima! There is a wealth of information and experience here.

First, it sounds like you have really had a tough time with your diagnosing vet. I, too, had to fire my original vet. My dog had pancreatitis and diabetes and she was way over her head.

First, what is your dog's weight? I am not sure your dog has resistance because the nph dosage doesn't seem to indicate that you are near the dosage for that size of dog.(I am assuming here that a lab/springer mix is a bigger dog). It is generally 1 unit per pound per injection. Keep in mind that you are literally starting over with all the changes your dog has experienced. It will take time to work up to the Nph dosage that your dog may need. Most vets start with either nph or vetsulin at a low dose and work up to the actual over a period of curves and small adjustments. I hope I understood correctly that Nima has only been on NPH for the last month?

I highly recommend you begin testing at home. It is your choice, not your vet's and after my experience with my first vet, I was adamant about testing at home. I pretty much told my new vet that I was testing at home and if it was a deal breaker for him, I would have to find someone else. You have to take charge of Nima's health yourself. There are many good vets out there - an internist is a great choice. General vets can lack experience in treating diabetes and tend to go by the "book" - on this forum, we have figured out that not all dogs respond the same to the one size fits all treatment. Testing at home has added years to my dog's life.

Many diabetic dogs exhibit symptoms of cushings and unfortunately get false positives when tested. Not to say Nima doesn't have cushings but in an uncontrolled diabetic dog, it is hard to definitively diagnose cushings.
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Old 01-14-2014, 05:40 AM
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Eddie Eddie is offline
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Default Re: Nima's crazy journey

Hello and welcome!

Yes - home testing is a great alternative to curves at the vet. Our dog has only ever had one curve done at the vet in 14 months since diagnosis.

We just started home testing (encouraged by what we found on this site) and then told the vet that that was what we were doing. He was surprised as none of his patients had ever done that before but he is happy with our results and will prescribe insulin on the basis of our info.

At one stage we compared our (human) meter with his hand held one and found that ours was significantly more accurate than his (we got a definitive result from his lab analyser).

You can just get started (loads of help on here) and tell him that that is what you are doing. It saves money and gets rid of any stress associated with visits to the vet so gives probably more accurate readings.

Let us know how you get on
Antonia
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Old 01-14-2014, 05:44 AM
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Abby's Mom Abby's Mom is offline
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Default Re: Nima's crazy journey

Welcome, and glad you found K9Diabetes. I would highly recommend becoming a member on the K9Cushings site as well. www.k9cushings.com They will help you in determining whether or not your dog may have Cushings, and highly recommend getting an IMS (Internal Medical Specialist).

In my humble opinion, there are not many vets that have the experience in treating diabetes. If you are lucky, you can find one that will work with you, learn with you. They are generally good vets for preventive, vaccinations and common ailments, diabetes not being one of them.

My Abby was diagnosed as having both originally, but ended up only have diabetes. She did not have any other symptoms, other than some Cushings tests coming back positive, which are not always accurate when a dog has diabetes. Her insulin levels did not indicate that she was insulin resistant.

If you can provide some blood work tests, post them to the K9Cushings site, and if you are willing, I would highly recommend home testing. A lot of folks have human meters, some have the AlphaTrak2, and some have a collection of meters. The OneTouch seems to be a good human meter and pretty consistant with averages. As you may be aware, a human meter will read lower with canine blood, so we use an average of the difference to get a good reading. If you have any curves, please post them here. Human meter are used because the strips are less expensive, than the AlphaTrak, which are about .75 to $1 a piece.

A lot of advice, good advice can be found here.

Barb
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Old 01-14-2014, 08:09 AM
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jesse girl jesse girl is offline
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Default Re: Nima's crazy journey

hi and welcome DKA is serious and its to bad your original vet did not understand the situation sometimes a vet just have to raise there hands and say i dont know and maybe you should look for more experienced person . its not an easy profession .

another thing to add is to make sure your pup is tested for pancreatitis my jesse was diagnosed DKA and pancreatitis

most here on the forum do test at home i have reached a point where i do not discuss jesses diabetes with the vet and manage it on my own pretty scary with 0 medical knowledge but my jesse was very sick and knew it was up to me with help from the forum
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Old 01-14-2014, 11:22 AM
parisa parisa is offline
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Default Re: Nima's crazy journey

Hi there!

Here is Nima's curve when he was started on 10 units twice a day of NPH. I have his curve from when he was started on 12 units but I can't find it at the moment. I will post it soon though.

Blood Glucose Curve:
8:20am 508mg/dL
10:20am 426mg/dL
12:20pm 382mg/dL
2:20pm 351mg/dL
4:20pm 359mg/dL
6:20pm 395mg/dL
6:45pm Fed 1/2 can w/d and 1 can chicken
7pm Administered Humulin N 10 units SQ

Thank you for your advice!

Last edited by parisa; 01-14-2014 at 12:01 PM.
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  #7  
Old 01-14-2014, 01:19 PM
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Default Re: Nima's crazy journey

Just have a moment, but even 14 units isn't much insulin for a 59 pound dog. He could easily need as much as twice that to regulate.

He did respond to 10 units as his blood sugar dropped quite a bit. Will be interested to see how he is doing on 14. My guess, since he gained some weight back, is that he's doing quite a bit better.

I'm very thankful you will start testing him at home. By doing tests and curves at home, you will be able to see how well regulated he is and how he responds to an increase in insulin if one is needed.

Cushing's and hypothyroid are both possibilities for the insulin resistance, but I'd like to see more information on how regulated he is now and perhaps on more insulin before pursuing those possibilities.

If you do a Cushing's test, ask the vet to do the ACTH instead of the LDDS - the ACTH tends to be ore accurate in a less than regulated diabetic.

Natalie
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Old 01-14-2014, 03:41 PM
parisa parisa is offline
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Default Re: Nima's crazy journey

Thanks for your reply! He is doing tons better in terms of attitude, activity level.

I am curious if you have any in put, why does the vet adjust his insulin so slowly? Every week she's doing a curve and then only increasing by 2 units each time. I have read in multiple places that dogs can require 1 unit/1 lb so I don't understand why we're moving so slowly. Nima has never, ever, ever been hypoglycemic or anywhere close.

Thanks again!
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Old 01-14-2014, 05:01 PM
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amydunn19 amydunn19 is offline
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Default Re: Nima's crazy journey

Regulation is a process and if done correctly, it takes a long time. If your vet were to go too fast in raising the dose, the correct dose could be passed easily and overdosing could occur. Overdosing doesn't necessarily manifest as hypoglycemia. Many times, a dog may go higher instead of lower because of a natural defense the liver has in response to low blood sugar - releasing glucose to protect the body. If you continue to increase the insulin and this is occurring, it can be dangerous.

Insulin doses need time to "settle" - generally five to seven days. You may give a certain dosage and see an immediate change and after a couple of days, the bg starts drifting up again. It is also possible that you might not see an immediate change in numbers that day but a couple of days later, the bg might start falling. The body needs time to adjust and not very dog responds in a predictable manner. They are very individual and since they can't communicate in words how they feel, the process just takes longer to get them to a stable dose.
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Old 01-15-2014, 03:53 PM
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Default Re: Nima's crazy journey

Actually, your vet may be adjusting insulin faster than I would recommend - I almost never think a 2 unit increase is a good idea unless the dose is quite large.

A dog is considered "resistant" to the effects of insulin at 1 unit per pound but the most common dose for a diabetic dog is closer to 1/4 unit per pound. It varies a lot from dog to dog and it's easy to overshoot the dose if you don't proceed slowly.

Our 60-65 pound dog needed only about 8-9 units of insulin per injection.

Also, the first response you see to a dose of insulin isn't necessarily the long-term response. Especially at first, simply having had high blood sugar can make the body somewhat resistant to the effect of insulin. When that happens, after they have been on insulin for a while, a dose that used to be about right can become more than they need. Also, there can be overlaps of insulin injections, and the effect of those won't show up in a day or two or three.

So paradoxically, the fastest way to regulation is a slow methodical approach of small increases in dose with at least a week - and sometimes two or three weeks - in between dose increases so the body has time to develop a long-term response.

I've worked with a bunch of dogs who were rushed through the dosing process and wound up having to start over again.

Natalie

Quote:
Originally Posted by parisa View Post
Thanks for your reply! He is doing tons better in terms of attitude, activity level.

I am curious if you have any in put, why does the vet adjust his insulin so slowly? Every week she's doing a curve and then only increasing by 2 units each time. I have read in multiple places that dogs can require 1 unit/1 lb so I don't understand why we're moving so slowly. Nima has never, ever, ever been hypoglycemic or anywhere close.

Thanks again!
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