Mini-Me's diabetes

[momofdecker]

Re: Humilin N vs. Vetsulin

Glad your post worked the second time around Al. Happy to see you respond to the cushings questions too. This is really is an amazing site where both the K9D & K9Cushings work closely together.

Decker did bounce around a lot on the NPH. His curves looked like a roller coaster ride gone bad.

Here is a picture:


You can have a full thyroid panel run through Dr. Dodd's by having your GP vet do the blood draw and then you mail the sample to hemopet. Dr. Dodd's recommended the Thryoid Profile 5 for Decker.

Here is a link to the form:
https://labordatenbank.com/cake/hemo...s/hemopet_form

Here is a link to some FAQs on the Hemopet site:
http://www.hemopet.org/index.php?opt...=faq&Itemid=27

Here is Dr. Dodd's email: hemopet@hotmail.com
I would recommend emailing her if you have any questions regarding her testing. Might be worth asking her about the steroids ahead of time because I think I remember reading that steroids can impact thyroid testing. I'm sure she'd be able to give you much more detailed information. She has always been great about responding to me. Only one time, when she was out of the country, was there more than a two day delay in response time.

We overnighted the sample because of the summer temps but there is no need to overnight them. Cost us around 25.00 for vet blood draw, 80.00 for Hemopet testing and 30.00 for overnight mailing. There was around a two day turn around time. The results were emailed to me and my vet was copied on them as I had asked. Dr. Dodd's takes into account a dogs breed, age, and other factors - thus Decker's 'case specific' reading was based on his specific information.

Will follow up later to address some of your other questions.

[k9diabetes]

Re: Humilin N vs. Vetsulin

Just have a moment but wanted to note that there's nothing inherently wrong with an unconventional treatment or approach. And none of the treatments for Cushing's and atypical Cushing's disease are risk-free.

I do wish, though, that vets did not so often paint Cushing's treatment medication as if it is a horror show. I've been around the Cushing's forum a long time and have seen incredible results from both Lysodren and Trilostane where, like insulin for diabetes, treatment saved dogs' lives and allowed them to live many healthy happy years they wouldn't have otherwise.

As a matter of fact, our own CrissyAnn was a pioneer in diagnosis of atypical Cushing's disease in dogs and did wonderfully on Lysodren. You can read her story and see her Before and After pictures here:

http://www.k9diabetes.com/forum/showthread.php?t=83

I've seen all of the successful cases of treatment through the K9 Cushing's forum and I wouldn't hesitate to treat a dog for Cushing's disease if I was ever to wind up with one.

Unfortunately, many GP vets in particular picked up a mantra somewhere along the way about the treatment for Cushing's being worse than the disease... not true in most cases (maybe it was at one time, I don't know; I just know it's not true now). It's like any medication, fine for most dogs and problematic for a few, as are NSAIDS, various insulins, heart meds, any medication.

Any time steroids are given, you run the risk of inducing diabetes and possible side effects of excess cortisol on the body. That may be where the diabetes came from in your case or it may have just come along on its own since the two diseases commonly occur together. So you avoid some risks with Lysodren or Trilostane but become subject to other risks with steroid treatment.

Camps on both sides would best serve their patients and their clients by giving an objective and unbiased assessment of the options and potential side effects and benefits of each since none of them are risk-free or perfect solutions.

Natalie

[Rubytuesday]

Re: Humilin N vs. Vetsulin

Hi Alan and Mini , I haven't been able to catch up on your thread, but on a quick glance it doesn't look like you have gotten an aswer to whether or not you should join at the k9cushings site. Yes, please join that group as it will easier for you to get all of their members input.

I think Glynda is going to provide the link here for other contributors to your thread, so that we might follow along and learn with you.

Like Natalie, if I had a cushings dog I would treat it, but I would avail myself of all the collective experience at the k9cushings site to filter whatever the doctors were telling me. I know that sounds cynical, but with a doctor you only get that one person's experience and beliefs which may or may not be current or accurate. Depending on the experience of the vet they may not have dealt with many dog's with Cushings or diabetes for that matter. On k9D and k9C there is so much collective, unbiased, day in and day out experience that can litterally save a dog when all hope seems gone.

Tara

[momofdecker]

Re: Humilin N vs. Vetsulin

Decker’s numbers were, indeed, all over the place. When you went back to 15 units and worked up to 35 units he was then consistently high instead of the bouncing up and down. Pardon my ignorance, but is this what defines resistance? I ask that because Mini has done the same thing.

Al - I believe Natalie has shared the clinical definition of insulin resistance with you. But any time you have a dog that initially responds to insulin stop responding, I would say it's time to put your detective hat on. My personal belief is that there is also a resistance to insulin that can be caused by any number of unidentified factors, with medications and concurrent diseases being on that list. You know your dog best and can see what is normal and what is 'off' with her. If we'd followed the clinical definition of insulin resistance for Decker he still would be unregulated, assuming we kept him on the NPH and he continued to show a lack of response. He started over at 15u of insulin. To get him to 75u per injection, he would have needed another 60u. We raised him mostly 1u every week. So 60 weeks would have had to pass. Divide that by four weeks and it would be around 15 months before Decker would have hit the clinical definition of insulin resistance. I'm sorry, but in my personal opinion, making a large breed dog suffer for almost a year and a half before defining them as insulin resistant is not acceptable. Knowing what we saw and experienced with Decker's bg being uncontrolled for only six months, I feel very strongly that definition should be re-evaluated for large breed dogs.

What I've since learned about endocrine diseases, which I believe further complicates the resistance question, is that many of the symptoms of endocrine diseases overlap. Diabetes, hypothyroidism and cushings can all cause leg weakness, lethargic behavior and high cholesterol. They can all cause increased thirst and urination. Cushings & hypothyroidism can both cause pot bellies, fur loss and lack of fur re-growth. So a diabetic dog with lethargic behavior and high cholesterol, who is not responding well to insulin, may not raise a red flag as the symptoms fit the diabetes. When in fact, those same symptoms may also be a sign of hypothyroidism, which would indeed cause insulin resistance in a diabetic dog. Yet the definition of insulin resistance does not factor such considerations into the equation - rather it a simple mathmatical equation. An equation that, in my opinion, leaves a lot to be desired when it comes to regulation in large breed dogs.

So I’m assuming that caused the switch to Levemir which didn’t show great numbers until the hypothyroidism was addressed.

The bouncing around was one of the main causes for the switch. Decker had no stability on the NPH. The other cause was pure frustration with his lack of progress. When we switched vets in December, the new (our current) vet wanted to try him at 20u of NPH again. Once again it proved to be too much for him. My mind was unable to accept that he simply needed more insulin when I knew for certain that on two different occasions 20u had been too much for him. I had no idea what was wrong but just could not accept that more insulin was the simple answer.

We also had the rear leg weakness, laying down all the time, and general lethargy.This improved somewhat when we started giving insulin but we were not sure if this was diabetic neuropathy, arthritis, or what and we wanted to get the glucose under controlbefore going to a neurologist. We did, however, have x-rays, ultra-sounds, blood and urine tests.

Did anything show up on the x-rays? There have been some dogs who have presented with leg weakness after initial diagnosis. Most seem to be labs or lab mixes. A lack of balance and any type of nail scraping would lead me to believe there is more involved though.

A little confused by your comments regarding thyroid levels. “Free T4” “case specific” and “general range”. When we had Mini’s T4 checked it always came within the range set forth by the lab (i.e. range 2.0 to 4.2 with her showing 2.8).

Because Dr. Dodds takes the breed and age of dog into consideration, Decker's results had a 'case specific' range. The 'general range' was also listed as a reference. Dr. Dodd's also recommends testing the T4, free T4, T3, free T3 and the TgAA to confirm and/or rule out hypothyroidism. The T4 alone can be skewed in the presence of diabetes and other endocrine diseases.

Back to the leg weakness for a moment. We were also sent home with Tramadol, Gabapentin, and steroids. Don’t even want to comment on the treatment you received by Neuro but that’s not at all uncommon. Compassion often equates to revenue.

Thanks for your understanding on the Neuro. I'd love to know more about Mini's dosing of the tramadol & gabapentin. Both are known to potentially cause sedation in dogs. We do see some sedation in Decker. But not to the extent of lethargic behavior he presented with prior to the start of thyroid meds. Prior to he slept all the time. He did not engage in play. He sleeps a lot now but we are hoping that if there is any chance scar tissue is causing his compression, the rest will allow some healing of it. All I have to do is run across the living room floor and he will be up and barking and trying to herd me. So though he doesn't instigate play on his own, he can easily be instigated into playing. I'm ok with the sedation as long as I know the spunk is still there. Playing is difficult because Decker loves to herd and play tuggie and jump. None of which he should be doing. He also likes to rip apart his stuffed squeaker toys. Again, this puts pressure on his neck area - which we are suppose to avoid. So we've been letting him rest in hopes that some healing takes place. The last two days he's gotten up on the couch himself a few times and onto the daughter's bed once. He has not done that for months... for now we celebrate the small victories. I had considered the sedation as a partial theory as to why his insulin needs have not increased since starting the prednisone. He gets 300mg of gabapentin three times a day. Tramadol is 50mg three times a day.

My local Vet is suggesting we continue to up the dose a bit further on Mini (i.e. to max of 40 units per injection) and if that doesn’t work, make the switch to Levemir.

Are you or your vet running curves inbetween the increases? How much longer do you predict before Mini hits 40u?

At this point, I don’t know what the best course of action is. Continue to increase the Humilin N? Switch to another insulin? Gradually reduce the steroids and try to live with the consequences?

If the steroids are the suspected cause of resistance to insulin, would it be possible to scale back just to test the insulin theory? I know you've mentioned that she backslides when you scale back. But if you could rule in or rule out the steroids as a complicating factor, it may help you move forward? I'd recommend choosing a time that you plan to be around so you could test her a bit more frequently in case she does show a wide change in bg.



Another question for you... can you tell me if what Mini is currently eating, in terms of amount of food, is what she was eating prior to diabetes. Something I read in a previous post led me to believe your vet may have increased her amount because of weight loss. If that is true, I also wonder if the increased amount of food may be factoring into her elevated numbers. Most times when food is increased, insulin has to be increased to balance it. So though it seems logical to increase food in a diabetic dog because of weight loss (due to elevated bg), if the insulin is still not working to lower bg, the extra calories may only add to elevated bg and still not provide weight gain. Does that make any sense?

A couple of other random thoughts... some folks have used B12 methylocbalamin in dogs who have neuropathies/weakness. We've used it with Decker for some time. Can't say it's proven to help but don't see any harm in doing it so we've continued. We also added cosequin to his daily cocktail mix. He'd been licking his front paws a lot prior to cosequin and it stopped within a day of starting it. Glucosamine, used for humans, raised Decker's bg. Cosequin, which we get through his vet office, has not shown an impact on his bg.

I did go back and look at the L-glutamine again. I'm pretty sure Patty may have told me to look into that some more as it was suspected that could raise bg in diabetic dogs. Still looking for the documentation on that one.

[Lulusmom]

Re: Humilin N vs. Vetsulin

Hi Al,

Yes, please do register at www.k9cushings.com. I am still unclear as to whether or not your vet had a full adrenal panel done by UTK to determine if intermediate (sex) hormones were elevated before starting low dose steroid treatments. Has your vet done any testing in the last four years to see if the low dose steroid treatment has been effective? If the answer to both questions is no, I seriously question the wisdom of initiating low dose steroid treatment based solely on negative diagnostics for typical cushing's and using only symptoms to assess the efficacy of this treatment.

With the exception of Lysodren as an adjunct treatment for atypical cushing's, the usual recommended treatment of melatonin and lignans is quite benign. It's also a crap shoot as to efficacy. While Lysodren is a serious drug, when given as a maintenance dose, as recommended by UTK, it is much less likely to cause adverse reactions as a result of cortisol deficiency.

To expand on Natalie's comment about vets who refer to treatment for cushing's as a horror show, vets who feel this way are usually very inexperienced with cushing's and not at all familiar with the drugs. Because of their inexperience, they are much more likely to fail to counsel pet owners on how the drugs work, common adverse reactions and the importance of monitoring their dog. An experienced vet and an educated pet owner is a winning combination that can facilitate safe and effective treatment.

I realize that getting a handle on Mini's diabetes is your first priority and that your focus will be on this forum but it would be great to see you over on the k9c board so that members can provide you with feedback and/or ask their own questions about your vet's adrenal exhaustion diagnosis.

Glynda

[alan]

Re: Humilin N vs. Vetsulin

Hi Holli,
I wanted to address your specific questions. More detail to come.

Mini X rays were negative except mild arthritis.
Tramadol is 100mg twice a day -- Gabapentin is 300mg twice a day
Great to hear Decker getting around a little better.
We are now running curves with changes in dosage. Will be at 40u in week to ten days.
Agree reducing steroids to test insulin theory.
Using B-12 and L-Glutamine which is supposed to help neuropathy.

Happy New Year !
AL and Mini

[alan]

Re: Humilin N vs. Vetsulin

Hi everyone & a Very HAPPY NEW YEAR TO ALL.

My husband, Alan (Al), has been getting quite alot of very good information from all of you, and I thank you for same. We've been going crazy ever since Mini-Me was diagnosed with diabetes about 2 months ago.

My problem, and I hope you can help with suggestions, is getting her to eat all of her food now. Of course our vet put us on Hills Prescription kibble and canned w/d food and in the beginning she ate everything. Now that she has become "picky" we've added Evanger's canned meats just to get her to eat.

Does anyone know what a good diet is for dogs w/diabetes? Before her diagnosis I boiled chicken thighs, frozen green beans & carrots, white rice & a scoop of cottage cheese. I now know that I can't give her the rice (bad carbs?) but I want to switch from W/D.

I know I have to watch the ingredients she eats but I am at a loss right at this moment.

I know I have repeated some things that Al has already posted, and please excuse me for that, but I need help with her diet.

I do check her blood and it's all over like most of your baby's. Last night at 5:45 her blood was 337 & this morning at 9:25 she read 83 and the vet has me giving her 38 units am & pm since the Dec 31st.

Sorry to be so long winded but I want to do what is best for my baby.

Thank you,
Jeanne Mom of Mini-Me

[jim maceri]

Re: Humilin N vs. Vetsulin

Here is a diet that works for us.......I weigh everything with a digital scale and the amounts are for my 120 pound dog.

7.25 oz of WD kibble
5 oz. of boiled chicken diced.
2 omega via fish oil capsules squeezed over the kibble.
5 oz. of "WD gravy" mix. microwave for 20 seconds. (see below)

Gravy Mix:

1 Can WD mixed with 1.5 cans of water. Blend until smooth and store in a tupperware.

It seems between the chicken and gravy he gobbles up the kibble and loves to eat...no need for persuasion. I use the WD biscuits as treats also after each BG test and after he gets his shots.

[Cebe]

Re: Humilin N vs. Vetsulin

With the exception of white rice, you really can feed a diabetic dog pretty much what works for you. Don't feel like you have to feed W/D. (though, according to folks, it helps with regulation).

I just switched my dog from Pinnacle limited ingredient food, to Hill's Science Diet, limited ingredient food, and she's doing pretty darn well on it.
I may end up tweaking her insulin after I do a curve, but she looks great.

Point is, you don't have to feed diabetic food to your dog.

Now, the white rice can be an issue. I tried feeding my dog a bit of white rice to help even out her numbers, and, instead, she spiked up. So, I do think it's too simple of a carbohydrate to be eaten by diabetic dogs, but the most important thing is for the dog to eat. Find something that MiniMe will eat and stick with it.

[momofdecker]

Re: Humilin N vs. Vetsulin

Seems the most important rule for a diabetic dog is to find something they are willing to eat. Something you can measure out for each meal and be consistent with.

I did want to mention that the general rule of thumb regarding insulin for non eaters or picky eaters is as follows:
1/4 normal dose if no food or if 1/4 of the food has been consumed
1/2 normal dose if 1/2 of the food has been consumed
3/4 normal dose if 3/4 of the food has been consumed
full normal dose if all food has been consumed

Many do stay away from white rice but I've heard of others that have used brown rice as a substitute.

Also, with the B12 - if you can find the B12 Methylcobalamin - that is advertised as helping with neurologic concerns better than the B12 alone.

[Judi]

Re: Humilin N vs. Vetsulin

my dog is a lot smaller but she got picky for awhile. She eats canned Purina OM mostly but I add a bit of some grain free canned food that smells much yummier to her. Right now we are using Wellness that has some liver in it. She normally gets 3 oz total so I've been doing 2.5 ounces of OM and 1/2 an ounce of the stinky yummy stuff. So far so good.

I used to pour some hot chicken broth on her food when she was eating the WD but she got tired of it

[Lulusmom]

Re: Humilin N vs. Vetsulin

Did Mini become picky after you switched from Medrol to the Natural Hydrocortisone (NHC) ? If so, that could be the problem with her appeitite. 4mg of Medrol is the equivalent of 20mg of hydrocortisone but I have no idea what the equivalent of natural hydrocortisone would be. The prescription hydrocortisone has a half life much shorter than Medrol but again, I don't know anything about NHC. Hydrocortisone's half life is 8 to 12 hours while Medrol is 18 to 36 hours. When switching over or weaning off a drug, you have to be very, very careful to do it right; otherwise, you place the dog at risk. Even in smaller doses of Medrol taken long term, you have to assume that the adrenal glands are asleep at the wheel and you must take the difference in half life into consideration when transitioning Otherwise, you could underdose or overdose. My fear with a natural supplement is that you are underdosing and Mini is going through withdrawal or her adrenal glands are not yet producing enough cortisol. Did your vet give you specific instructions on how to transition to NHC? If not, I highly recommend that you contact your vet asap.

I posted a few days ago and asked additional questions about the atypical/adrenal exhaustion diagnosis but I'm not sure Alan saw it. I have reposted it below.

Looking forward to your response.

Glynda

Hi Al,

Yes, please do register at www.k9cushings.com. I am still unclear as to whether or not your vet had a full adrenal panel done by UTK to determine if intermediate (sex) hormones were elevated before starting low dose steroid treatments. Has your vet done any testing in the last four years to see if the low dose steroid treatment has been effective? If the answer to both questions is no, I seriously question the wisdom of initiating low dose steroid treatment based solely on negative diagnostics for typical cushing's and using only symptoms to assess the efficacy of this treatment.

With the exception of Lysodren as an adjunct treatment for atypical cushing's, the usual recommended treatment of melatonin and lignans is quite benign. It's also a crap shoot as to efficacy. While Lysodren is a serious drug, when given as a maintenance dose, as recommended by UTK, it is much less likely to cause adverse reactions as a result of cortisol deficiency.

To expand on Natalie's comment about vets who refer to treatment for cushing's as a horror show, vets who feel this way are usually very inexperienced with cushing's and not at all familiar with the drugs. Because of their inexperience, they are much more likely to fail to counsel pet owners on how the drugs work, common adverse reactions and the importance of monitoring their dog. An experienced vet and an educated pet owner is a winning combination that can facilitate safe and effective treatment.

I realize that getting a handle on Mini's diabetes is your first priority and that your focus will be on this forum but it would be great to see you over on the k9c board so that members can provide you with feedback and/or ask their own questions about your vet's adrenal exhaustion diagnosis.

Glynda

[Rubytuesday]

Re: Humilin N vs. Vetsulin

Hey there, It looks like you got some good feedback with the food. I don't feed Ruby a diabetic formula food, but she is on a very high protien low carb food which seems to have helped her turn the corner.

Basically your curves will tell you which diet is best for your dog as all dogs process food and insulin differently. The path to regulation is balancing the food with the insulin as best you can.

There are degrees of not eating:
*refusing to eat in which case you need to give the dog whatever (within reason) they will eat
* dog needs to be enticed to eat, where maybe some tuna water from tuna soaked in water (not oil) drizzled over food will work.

I would try to get away with as little variation as I could as the inconsistencies will affect the numbers. That said, they need to eat.

Another concern I have is on 12/27 it looks as though Mini was on 25 units 3 times daily (total of 81 units) and I believe at that point you were only seeing highs and possibly trying to break through some insulin resistance.

Now since 12/31 she has been on 35 units twice daily and saw a low today of 86. If you have broken through resistance that can happen quickly and sometimes dramatically. I would recommend a dosage reduction and to test more frequently.

I believe the recommendations are to reduce by 20%, which would be from 76 to 61 which sounds like a huge amount, so I am hoping others chime in on that.

Tara

[alan]

Re: Humilin N vs. Vetsulin

Thank you all (Tara, Glynda, Judi, Holli, Cebe & Jim),

Thank you very much for getting back to me so quick.

I am in the midst of giving her baked chicken breast, chopped green beans, a few tablespoons of W/D canned & kibble and a scoop of low fat cottage cheese to try and get her stabilized. I feed her in the morning around 9:00 am then give her the insulin shot; then I give her a little snack early afternoon; between 4 – 5:00 pm feed her dinner basically the same as breakfast, then between 9:00 pm & 10:00 pm I give her last injection of the day after another snack so she will have food on her stomach. I took her readings yesterday: 83 @ 9:25 am / 244 @ 5:00 pm & 516 @ 10:00 pm. Doesn’t make sense to me as she always peaks at night. Our Vet says she is doing everything backwards. He says she should have a high reading in the morning, etc. I have to mention that she also takes 10 mg x 2 a day of Natural Hydrocortisone with the morning meal and the evening meal for her A-Typical Cushings. I know that this will raise her B/G, however she needs to have it.

Someone told me to try oatmeal. Is it better to serve it cooked? Is this considered a complex carb?

Again I thank you for your response as it is greatly appreciated!

Jeanne Mom of Mini-Me

[alan]

Re: Humilin N vs. Vetsulin

Hi Glynda,

She didn't get picky until recently (way after changing from Medrol to NHC). I've been adding low sodium chicken broth hoping that will help. She only ate 1/2 of her morning food and just barely touched her afternoon snack.

Al did see your response and I do believe he did register on that sight, thank you for that info.

I'll keep you posted thank you,

Jeanne Mom of Mini-Me