Exocrine Pancreatic Insufficiency (EPI)

[Steve]

Recently diagnosed with Pancreatitis, my friend Rusty underwent a couple of days in the hospital. Upon returning home with antibiotics and instructions for administering insulin injections and ultimately performing glucose tests at home, we have had quite an ongoing battle.


When performing lancing device blood sample pokes, success is very unpredictable. I have watched numerous videos laying out the ease of the glucose test. Rusty is not like any of these docile dogs. The lips are untouchable. The ear is a very closely guarded area except when he wants me to rub inside. I have only one alternative at his time and it is his paw pad. Even that area is sensitive to my terrier friend.


As we have proceeded with our insulin balance program, I have performed two glucose curves at home. By the time I performed the second curve, I had to purchase a muzzle, as Rusty was beginning to nip at the poker. If I could get a good blood drop the first poke, I believe I could convince Rusty to cooperate, but many occasions it takes several pokes to get a good blood drop. Poking and squeezing his paw pad while telling him “almost done” is very difficult when he thinks I am lying.



I started out with a “Free Style” lancing device and it was very difficult to get a good drop, though Rusty felt every attempt. I gave up on the Free Style and reverted to poking with an insulin syringe, but Rusty really hated that. I finally acquired an “Accu-Chek Fast Click” which worked better with less response from Rusty, but still unreliable at getting a good sample the first time. I have the lancing device set on the deepest poke setting.



When I get a blood drop the first poke both Rusty and I are in heaven. Even the numerous tests of the glucose curve (which I am getting ready to perform again) would be workable if I could get a good blood sample the first time every time. My question is this: Has anyone encountered this paw pad glucose test sample acquisition difficulty?

[Lolo]

Re: Glucose test poke success

Does Rusty have any bald spots or calluses on his elbow? This is where I test. My Lucy doesn’t have hard calluses but there are spots on the elbows that are mostly hairless. It’s perfect for us for testing because she has no tolerance for anyone touching her tail, ears or mouth. And she’s not all that great about me messing with her feet either. She yanks them away. With the elbow I just sneak up when she’s lying on her side, pinch the elbow skin a little bit and poke with the lance.

[Steve]

Exocrine Pancreatic Insufficiency (EPI)

New to this Forum, I am just learning to get around. I posted my first question earlier today and hope to get a helpful answer in the near future. Answers to many of my questions are likely somewhere in a forum, but I would like to know the answer to this simple question. Has anybody heard of Exocrine Pancreatic Insufficiency? I found a United Kingdom based website where the disease is discussed. If anyone has heard of this disease could it be confused with the pancreas requiring insulin injections to correct its failure to process sugar?

[mrgregj]

Re: Glucose test poke success

have you tried the carpal pad on the front paws? Its the pad that sits a little higher and doesnt touch the ground when they walk. I struggled quite a bit with blood tests with my dog as well, I couldnt get any blood from his ears and I didnt want to do the pads that touch the ground as they could get infected. With the carpal pad my dog doesnt seem to mind as much and its a little easier to pinch on each side to get the blood flowing.

[carolc]

Re: Glucose test poke success

steve,
I did the carpal pad as well. i tried poking my dog everywhere, i got nothing. except an angry dog. mine was part terrier too, they dont really sit still.
I found the easiest thing was take the lancet out of the pen, just poke him with that. that way you see the needle go in, and the click wont scare the dog.

[jesse girl]

Re: Exocrine Pancreatic Insufficiency (EPI)

I believe EPI is the complete failure of the pancreas . Now i believe it includes no natural production on insulin anymore making a dog diabetic and the loss of digestive enzymes that the pancreas use to produce .

So you have to give a dog with EPI digestive enzymes when they eat . We have had EPI dogs on the forum and they did well once they figured the combination of enzymes food and insulin . I dont believe there are any active members at this time .

Is your dog EPI

[k9diabetes]

Re: Exocrine Pancreatic Insufficiency (EPI)

I don't think so. EPI refers to the digestive enzymes not being produced rather than insulin. We have had a few dogs here with both diabetes and EPI so both is definitely a possibility.

Natalie

[k9diabetes]

Re: Glucose test poke success

There are a few breeds of dogs that are infamous for being uncooperative with home blood testing (and just about any other kind of testing - and even the insulin injections) so you're definitely not alone. Min Pins in particular are a challenge along with a lot of dachsunds. Some dogs have had to be muzzled in the beginning just to get injections.

Plus most of us didn't video our first attempts. Although our Chris wasn't a huge problem, he was much more fidgety and uncooperative in the beginning.

Because the insulin is so desperately needed, I would take it slow trying to home test Rusty as that's a benefit but not a requirement and you don't want to get him so upset he starts refusing insulin injections as well.

Try a test once time three or four times a day maybe. Praise him like crazy and set it aside regardless of whether you succeed or not. The main thing is to make it as pleasant as possible and not keep pushing him. Just make it a regular part of the day with a joyful attitude and let him get used to the process without it being prolonged or a struggle.

You can even start with a clicker with no lancet in it and just practice that first. There are a few treats that are essentially "free" if your dog likes them, such as green beans, cauliflower, broccoli, that you can use as rewards.

Also experiment with where you test in terms of the space. Some dogs don't like to be restricted. Others actually do better when they have limited space, such as being up on a counter or in a sink.

If you're having trouble getting a drop of blood even when he's calm, you probably need a bigger lancet. The ones that come with the Accuchek Softclix are a nice size. And the Softclix is my favorite lancing device - quiet, not to forceful, effective.

Take your time, experiment to find what's most calming for him, and be happy, happy, happy about the process. And if, in the end, he just won't sit for it, that's not the end of the world.

Natalie

[LizE]

Re: Glucose test poke success

I poke on the carpal pad and had a lot of difficulty in the beginning (I know all about terrier attitude). It took some time but here are some of the things that worked for me.

-I use Reli On's Confirm meter. It uses a smaller blood sample.
-I use a 26 gauge (thicker) lancet. This made a huge difference
-I could never get the lancet holder to work so I just depend on the lancet itself.
-I try to spend some "quality time" with Snickers before the poke. She gets a massage and then a tummy rub.
-I sit on the floor with her between my knees/legs with her on her back and use my legs to confine her movement. Then I try to message her legs and stretch them (all of them, not just the one to be poked) to try to get her circulation going. Then more tummy rub. Then a little more rubbing on the pad I'm going to use. Then a little prayer. Then one big poke.
- At first I just did one poke and if it didn't work I would wait until next time. Now she doesn't have a problem with it so I poke until success.
-I try to moisturize her pads occasionally as the blood doesn't flow as well when they are dried out.

I know how frustrating it is. Even now I swear she can keep herself from bleeding if she wants to. Hang in there. It gets easier.

[amydunn19]

Re: Glucose test poke success

The carpal pad was a no go for us as well as lips and ears. Luckily, Maggie had skin tags that bled easily and pretty painlessly. Look for any warts, lumps or bumps. Also, the base of the tail to the side is fairly painless. Shave some hair and use a thick lancet(the skin is thick there).

I never had luck with those devices. I just used the lancet by itself. IMO, it was easier to handle. You may need a bigger lancet - they make 25 or 26 gauge and even as big as 21 or 23.

It takes time. The more tense you are, the more tense they are! Lots of praise and a treat is key.

[Raysaint]

Re: Exocrine Pancreatic Insufficiency (EPI)

The pancreas can stop making insulin (diabetes) but still makes enzymes to digest food.
If it stops making enzymes, then you have EPI.
I discussed it with my vet.

[Riliey and Mo]

Re: Exocrine Pancreatic Insufficiency (EPI)

there's an EPI dog forum if you want some info

epi4dogs.com

[Steve]

Re: Glucose test poke success

New to this forum, I am not sure how to reply to all the responses to my post. I appreciate all the information and experiences. It makes me feel good that others have experienced this difficulty. Thank you.

[Steve]

Re: Exocrine Pancreatic Insufficiency (EPI)

I believe EPI is the complete failure of the pancreas . Now i believe it includes no natural production on insulin anymore making a dog diabetic and the loss of digestive enzymes that the pancreas use to produce .

So you have to give a dog with EPI digestive enzymes when they eat . We have had EPI dogs on the forum and they did well once they figured the combination of enzymes food and insulin . I dont believe there are any active members at this time .

Is your dog EPI

Thank you all for your help. In response to "Jesse Girl" the information I have seen on EPI seems like the symptoms are very similar to diabetes. Though not trying to find the solution for long, I am a little frustrated with the treatment of the diabetes diagnosis thus far. I try to get Rusty some exercise time for two or three hour in the park every afternoon.

I hope this is not to long of a post, but I will try to give you the back ground over the past three months.

We have had little success with insulin doses and insulin changes. We started with 2 units of NPH every twelve hours. We progressed by one unit per day after a week with a glucose test at the vets in the AM prior to insulin and any food. The glucose levels remained 5 to 6 hundred during the morning tests. After numerous in office tests, I found out I could perform the test myself and I began coordinating with the vet over the phone. Once we reached 9 units, I performed a glucose curve (per vets instructions, ten blood tests). First test prior to insulin or food. For the next two hours, every thirty minutes followed by tests every two hours until the end of the day.

The levels were as follows: 473, 394, 369, 183, 72, 112, 137, 554, 579 (The last test was prior to food and insulin)

Let me add here, with nine units twice a day Rusty's behavior seemed to be improving. He had more energy, was consuming much less water and seemed a lot more lively.

The doctor did not like the wild swing in levels, but seemed more concerned about the low readings than all the high readings. After he consulted with a Urologist friend, he had us drop back to four units every twelve hours and a few days later wanted me to perform another curve.

Dropping to four units made a notable change in Rusty's energy level and water consumption.

The second curve was as follows: 604, 531, 496, 434, 444, 228, 131, 121, 236, 503, 676, 623 (the last two were two and four hours after evening meal and insulin injection).

After this curve (doctor was out of the office for a few days) I raised the level to 8 units every twelve hours. Upon the doctors return and his review of the curve, he wanted me to change insulin type and amount to Vetsulin, two units twice a day.

I noticed an immediate negative change in Rusty, as well as a body odor I had not noticed before. The doctor was out of the office once again and after five days and random blood test results between 400 plus and Hi (over 750 according to meter instructions) I discontinued the Vetsulin and reverted back to the NPH 9 units twice a day.

I sent an email to the doctor. I told him I had changed back to NPH 9 units twice a day and was trying to change Rusty's diet, though he was very rebellious to any modification in his diet. I told him Rusty was getting very annoyed by all the poking (which he hated). I told him his condition with the Vetsulin use turned immediately worse. I asked him if there could be a problem with the vial of NPH insulin. I questioned the accuracy of the Accu-Trak tester. My frustration with the methods of treatment and the negative results in Rusty's behavior was evident in the email. The doctor had mentioned me taking Rusty to a specialist, which I told him I could not afford.

Upon the doctors return, the doctor seemed upset with me and told me diabetic dogs need consistency and these changes were not helpful. He requested that I lower the level of NPH back to 4 units and discontinue glucose testing for a couple of weeks and then we can try another curve and see were we are at that time .

Tomorrow, April 12th will be two weeks. Since the change to 4 units Rusty's lifeless behavior and excessive water consumption has resumed and the body odor seems to be present at times. I have not spoken to the doctor for two weeks, but plan to performed glucose curve tomorrow. I purchased a new vial of NPH insulin and a new container of test strips. I don't have much optimism in he curve. I performed four tests yesterday.

Prior to food and insulin: 540
Prior to our walk and run in the park: 305
Following three hours of walking and running and a little digging: 683
Bed time 10 PM: Hi

[jesse girl]

Re: Exocrine Pancreatic Insufficiency (EPI)

Are you exercising your dog at the park on curve days ? The only reason i ask is a dogs blood sugar can drop substantially during exercise . this can cause an artificially lower number preventing the dose from being raised but actually more maybe needed

Seeing a reduction in symptoms can point to the higher dose was helping . What may need to be corrected is that big drop in sugar