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  #1  
Old 06-09-2009, 07:38 AM
delilah delilah is offline
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Default Delilah - need advice on home testing

Hi,
My 10 year old dog, Delilah, was recently diagnosed with diabetes, but it is not straightforward. In addition to having VERY high blood sugar (in the 600s), she had a bunch of other symptoms that caused many vets to be perplexed. She has ulcers in her mouth and throat, infections on her elbows, and crusty paws. Also elevated liver levels. After taking her to an internist and dermatologist (who worked together) they gave her a preliminary diagnosis of a glucagonoma which is a malignant tumor, in her case on her pancreas, that causes both the diabetes and the other lesions that are not characteristic of typical diabetes. We didn't confirm this diagnosis because the only way to do this for sure is a biopsy which we opted not to do because it is very expensive and if it is positive the prognosis is very bad. She was really sick, lost 25 pounds, and we really thought that she was going to die.

We decided to treat the diabetes and see if it would help. Since then, her behavior is markedly improved. She is acting like herself and gaining weight slowly. Also, her mouth ulcers are gone. I am wondering if she really has the glucagonoma. The perplexing thing is that her blood sugar is still very high (in the 300s and 400s), even though she is acting fine. We were warned that if she does have the glucagonoma, she would be very hard to regulate. She has had multiple curves at the vet and is now up to 18 units of vetsulin twice a day. He thinks that that she may be stressed at the vet which is making it higher, so we are going to take a break from curves for 2 weeks and he is going to do a blood test where you can get an average of their blood sugar for the past 2 weeks (I can't remember what it is called). We both work full time and have 2 young children, so I just don't think it is realitic that we would be able to do home monitoring on a regular basis. We feed her wellness simple solutions and are trying to switch to wellness core (high protein, low carb) to see if that helps to regulate her bs.

I asked the vet about switching to NPH after reading about it here. He said that in his experience, NPH doesn't work as well with dogs who are large breed and hard to regulate, and that it would be like taking 2 steps backwards, but that he would be willing to try if we wanted. I like our vet for the most part and he is not trying to get money from us- in fact he has deeply discounted the insulin curves for us.

So my questions are:
1. Has anyone had experience with a glucagonoma?
2. What has been your experience with NPH and large breed, hard to regulate dogs?
3. Any other thoughts?

Thanks for reading this and any advice- sorry it is so long!!!
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  #2  
Old 06-09-2009, 12:19 PM
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k9diabetes k9diabetes is offline
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Default Re: Introduction and questions- complicated case

Hi!

Never apologize for a long post!! We love details!!

I am not familiar with this as it is apparently very very rare:
http://www.vetlearn.com/Media/Public...V_25_01_56.pdf

I was interested to see, though, that the tumor may be associated with the islet cells, which typically die in a dog with diabetes.

I take it Cushing's disease was ruled out?

Was an ultrasound done to actually look at the pancreas?

What breed is Delilah and how much does she weigh?

It sounds like she is quite large, in which case 18 units twice a day would not be a lot of insulin and the dose could definitely go higher. If she weighs 80 pounds, 40 units per injection would be a fairly common dose.

I actually prefer NPH for large dogs just due to the volume of liquid you have to inject with Vetsulin, which is a U40 insulin. Plus NPH is a LOT less expensive, which makes a big difference when you're using a fairly large dose.

I know of many dogs in the 60-80 pound range that have used NPH very successfully.

Our dog weighed 60 pounds and his regulation was good with NPH. He was, unfortunately, allergic to it so eventually we had to go back to Regular insulin.

But if Delilah's BG is always in the 300s to 400s, I'd look to raising her dose of insulin first (unless the money and volume injected are a big deal) and see what the Fructosamine test shows - that's the one that gives an average of the blood sugar over the past couple of weeks.

I think far from finding home testing too difficult you would find home testing a time and money saver. Once you know how to do it, it takes literally seconds to test and you get good results in Delilah's home environment.

You can use home testing however much you want or only for curves or even just to check if you're worried about her levels.

Have you seen the video of me testing Chris on the lip?

www.k9diabetes.com/bgtestvideos.html (big file so give it time to download)

If Delilah has any leg callouses, these are also great places to test. Usually you use a lancet by hand there rather than a clicker.

Just something to consider.

I think you've made some great progress already and can probably get still better regulation.

Natalie
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Old 06-09-2009, 01:06 PM
delilah delilah is offline
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Default Re: Introduction and questions- complicated case

Thanks, Natalie. I forgot to say that Delilah is a lab. When healthy (and a bit chubby) she was close to 70 lbs, but went down to 44! She is now about 50. We did have an ultrasound but it was originally to look at her liver because that was one of the problems suspected early on. The pancreas could not be seen on the ultrasound. We opted not to do a repeat ultrasound at this time because we are trying to keep the costs down and the dr. said that it is VERY hard to see the glucagonoma on the pancreas because it is so small. What would we look for if we were looking for cushings? It never came up with any of the vets, and I can't imagine it wasn't considered, but you never know. Money is a major factor here which is why I was asking the vet about NPH, but we are leaning towards trying to get her better regulated first and then considering switching. Any tips on keeping costs down with Vetsulin? I figured out that if I buy in bulk online (10 bottles) I can save about $10 per bottle.

Thanks for the link and info- I'll check them out.
Martha
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  #4  
Old 06-09-2009, 01:28 PM
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Ricksma Ricksma is offline
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Default Re: Introduction and questions- complicated case

Just want to welcome you to the board, and tell you that even though it might be daunting at first, there is really nothing to the blood testing...and with a larger dog, you have more options of testing sites. If you decide to try it, the folks here will give you all the information you will need to be successful with it. It gives you a real feeling of confidence if you are able to actually find out at any time what your dog's bg reading is...confidence that I sorely need from time to time. Welcome, and here's hoping Delilah continues to feel better.

Teresa and Ricky
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Old 06-09-2009, 02:15 PM
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Patty Patty is offline
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Default Re: Introduction and questions- complicated case

Hi Martha and welcome!
I just wanted to say my golden is on NPH. She was 51 pounds at diagnosis and went down to 45. She's now back up to 48 lbs and holding steady.

Early on I fed her Wellness Simple solutions but she stopped eating it after diagnosis and I went searching for another food. I found the reduced fat CORE (has higher fiber content than the regular) and started her on that. I had some beautiful curves on this food with NPH as long as I gave a biscuit at 3-4 evenly spaced times throughout the day. This kept her blood sugar from dipping too low. I no longer feed it because Ali's ears got really red on it (she's my allergy girl)

I have heard many others say that their dog doesn't get a rise from this food or rises much later in the day from it. I would be wary of matching this food alone to vetsulin. Just know that you may have to add something to it to offset the fast acting portion of vesulin especially.

I wouldn't discount the NPH just because of a large breed dog. I know many that it works very well for.

One very simple screening tool for Cushings would be to have a urine creatinine to cortisol ratio (UCCR) test done. This test is very sensitive to stress so ideally you would want to catch the first urine of the day while at home (you can pick up a sterile container from your vet) in a less stressful environment. Refrigerate it until you leave for the vet's office. If the test is negative, most likely the dog does not have typical cushings disease or Hyperadrenocorticism. If positive, further testing will need to be done. There are more extensive tests that can help identify cushings but this would be a low cost place to start.

If you decide you want to do some home testing, even if it is spot checks on the weekends or to check low points, there's a link on here to a couple of free meters: http://k9diabetes.com/forum/showthread.php?t=881

Hope that helps some!
Patty
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  #6  
Old 06-09-2009, 02:57 PM
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janspack janspack is offline
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Default Re: Introduction and questions- complicated case

Hi Martha,

Welcome to the forum.

I agree with others who have suggested that home testing might not be as difficult as you think. It certainly does cut down the costs considerably as there are not so many vet visits to pay for! I normally only test once a day and as Kathy said, it only takes a couple of minutes to do. Must take you a lot longer than that to take her to the vet. I don't always do the tests every day either - most days but not every day - so missing the odd one wouldn't be the end of the world. If you don't want to blood test, then you could always monitor things at home with urine testing.

I have just looked glucagonoma up on Wikipedia and it says there that in people at least, the glucagon levels are astronomically high - I wonder if it's possible to measure those levels in a dog?? That might give you the answer as to whether she does have the tumour or not perhaps? Apparently, this is one of the diagnostic tests they use for people with this disease.

I'm sure you've done all the research but just thought I'd put this link in for you to look at if you haven't seen it already.

http://en.wikipedia.org/wiki/Glucagonoma

There seems to be things that can be done to help in humans so maybe some or all can be done for dogs.

My diabetic dog is somewhat insulin resistant and has been very difficult to stabilise (still isn't there yet after 4 months) and has had very high glucose readings for most of that time. This forum has played a big part in preventing me from going mad! so hopefully we can all do the same for you.
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  #7  
Old 06-09-2009, 03:36 PM
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Margaret Boyle Margaret Boyle is offline
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Default Re: Introduction and questions- complicated case

Quote:
Originally Posted by delilah View Post
Thanks, Natalie. I forgot to say that Delilah is a lab. When healthy (and a bit chubby) she was close to 70 lbs, but went down to 44! She is now about 50. We did have an ultrasound but it was originally to look at her liver because that was one of the problems suspected early on. The pancreas could not be seen on the ultrasound. We opted not to do a repeat ultrasound at this time because we are trying to keep the costs down and the dr. said that it is VERY hard to see the glucagonoma on the pancreas because it is so small. What would we look for if we were looking for cushings? It never came up with any of the vets, and I can't imagine it wasn't considered, but you never know. Money is a major factor here which is why I was asking the vet about NPH, but we are leaning towards trying to get her better regulated first and then considering switching. Any tips on keeping costs down with Vetsulin? I figured out that if I buy in bulk online (10 bottles) I can save about $10 per bottle.

Thanks for the link and info- I'll check them out.
Martha

Welcome Martha, I cannot offer you any advice except go for the home blood testing and you will manage it fine it is frightening at first but you will soon get the hang of it. There are plenty people here who will help you.
Look at Natalie's video of her testing Chris and she makes it look so easy and
it is once you get the first few over and you feel comfortable.
We make a lot of mistakes to begin with and there was nobody more nervous than me now it only takes a couple of minutes. Good luck and welcome.

LOL
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  #8  
Old 06-09-2009, 06:35 PM
delilah delilah is offline
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Default Re: Introduction and questions- complicated case

Thanks to everyone for your thoughtful responses. In response to a few- when I took Delilah to the specialist he called around and said that there are no labs that test for glucagon- one in Michigan used to but doesn't anymore because it is so rare than anyone would want a test for it.

In terms of the home testing, I meant that we're not home all day to test throughout the day. I would be too worried to test in the am, determine that she didn't need insulin, and then go to work for the rest of the day. I'm open to testing it once daily or if I'm concerned. I will look into it.
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Old 06-09-2009, 06:42 PM
delilah delilah is offline
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Default previous message cont'd

oops- i sent my last message accidentally without finishing it.

Patty- I'm not sure what you mean about the wellness core- why would you be wary about feeding it alone? I'm not sure what you mean about the fast acting aspect of Vetsulin (I'm new to all of this). Actually, we mix in some turkey and pumpkin for extra fiber. I can't give her something every 3-4 hours because I'm gone for about 8 hours or so to work.

Thanks!
Martha
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Old 06-09-2009, 07:44 PM
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Patty Patty is offline
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Default Re: previous message cont'd

Quote:
Originally Posted by delilah View Post
Patty- I'm not sure what you mean about the wellness core- why would you be wary about feeding it alone? I'm not sure what you mean about the fast acting aspect of Vetsulin (I'm new to all of this). Actually, we mix in some turkey and pumpkin for extra fiber. I can't give her something every 3-4 hours because I'm gone for about 8 hours or so to work.
Martha,
Vetsulin "is a lente product, and contains 30% "fast" insulin (semilente) and 70% "slow" insulin (ultralente)." http://www.caninediabetes.org/cdinsulin.html
Take a look at the vetsulin graph on this page. The red line indicates when the insulin is typically strongest and blood sugar is lowest. Hopefully Kathy will add to this...she knows all the good links!

The reduced fat CORE dry food has not caused a rise in blood sugar levels in 3 dogs that I know of and caused a late afternoon rise in another. The turkey and pumpkin are good but I'm not sure they will match the "fast acting" portion of the insulin which drops blood sugar fairly quickly. You may need something that gets into the system quicker like unenriched white rice.

This is also where even weekend home testing can help figure out what the food is doing and give you the results you want.

I think reduced fat CORE is a decent food if you're looking at dry foods but I would caution against using it alone as I think you may have some unexpected lows.

You might take a look through Soaphie's thread: http://k9diabetes.com/forum/showthread.php?t=400 Soaphie is on Vetsulin and eats the Wellness venison and rice formula.

You also mentioned worrying about finding a low in the morning and not giving insulin. If you do test and get a low, the insulin can be reduced or a snack given to offset this.

I know it's a lot to take in, but this board is great at helping to answer any questions you have.

Take care,
Patty
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