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|Lucky — The Road from Most Difficult Diabetes Patient to Best Controlled / Easiest to Manage|
In March of 1993, we found Lucky—and Lucky found us. He was abandoned in a vacant apartment along with a gerbil, a rabbit, and a turtle. We were able to place the rabbit and gerbil, but nobody wanted the little dog or the turtle, so we brought them home to live with us. After calling around, I was able to find out through the rabies tag information that his name was Lucky.
According to the rabies tag information, Lucky was about 5 or 6 years old; our vet and friend agreed with that when we brought him for his first of many visits with John and his Dad. Over the course of the years, Lucky had 2 cruciate ligament surgeries (both back legs) and had a large bladder stone removed. His bladder biopsies were benign, but we were told that we needed to be very vigilant for any signs of urinary tract infections because it was possible that they could lead to cancer after having the stone problem.
In January of 2003, I noticed Lucky was drinking more water than normal and found that he'd urinated in the house. When I saw that, my mind instantly went toward the caution about UTIs so I got him an appointment that afternoon. We took a urine sample—visually, it had no signs of a UTI. Then the question from me was, "If it's not a UTI, what could it be?" There were a lot of possibilities, so we also took a full blood panel. While I waited to know the results, my mind was thinking things like renal failure, etc. It was a relief to hear that high blood glucose had been found—that Lucky had diabetes, as it's treatable. I also learned that some of his liver enzymes were a bit higher than normal, but was told not to worry because they would revert to normal values after the diabetes was successfully under control.
Lucky began treatment with human lente-type insulin. After one week of that, everything had improved immensely—blood glucose levels, etc. It was during week two of diabetes that the problems began. After two weeks of treatment with the human insulin, Lucky was not responding to it at all—it was doing nothing to control his blood glucose so he was basically in the same shape as he was before we started treatment.
We recognized that he was using the human insulin far too quickly, so we initially tried some compounded beef insulin, which has more duration than human insulin. The longer duration of the beef insulin didn't matter to Lucky, as he was using the beef insulin just about as quickly as he did the human insulin. We attempted increasing the beef insulin to the resistance threshold and it still did nothing about Lucky's blood glucose values; within a few hours of receiving an injection, he would be right back into the meter-burning 600+ readings. Mercifully, he never had ketones no matter how high the glucose readings were.
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I asked John if, in more than 30 years in practice, he'd ever had a diabetes case like Lucky's—he told me no. I asked if he believed we could help Lucky—and he told me that if we both worked together, yes we could. I told him that I would be happy if we could just get some sort of control over Lucky's diabetes—if it wasn't the best control, I could accept that—just as long as we never had to say that diabetes killed Lucky.
We realized that Lucky had what's called immune-mediated insulin resistance. His immune system was recognizing the human and beef insulin as something foreign. When someone gets a cold or the flu, one's immune system goes into high gear to destroy the invading bacteria or viruses. The problem was that Lucky's immune system was doing this to the "invading" insulin, which his body recognized as not being his own, so it would destroy most of it before the injected insulin ever had a chance to do what it was meant to—control his blood glucose.
While human insulin is an exact amino acid match to a person's own insulin, pork insulin is an exact amino acid match to canine insulin. John prescribed Iletin II lente (pork lente insulin formerly made by Lilly). After a week's worth of treatment with that, Lucky's blood glucose had come down to the low 200s—we found the answer and now it was a matter of tweaking for the right dose.
Not long after we had Lucky regulated to the point where he was holding steady at about 100 with the blood glucose levels, Eli Lilly had some bad news for us—they were discontinuing the production of Iletin II lente. This meant we had to try Lucky with their Iletin II NPH (pork NPH insulin formerly made by Lilly).
There are different preservatives in NPH insulin than in Lente insulin—there is also a different suspension—NPH is suspended by protamine—lente's suspension is the size of the insulin crystals. It took more pork NPH than pork lente to control Lucky's blood glucose—and then some other problems began. Lucky developed neuropathy where he had none before—not even with the uncontrolled diabetes—and his eyes became constantly watery and irritated. He'd grown a winter coat during this time, which was thin, dry and lifeless—his skin was abnormally dry also. What he also did was sleep most of the time instead of being his normal, active self. We realized that Lucky had intolerances to the different preservatives and the protamine suspension of the pork NPH. The insulin itself was not the problem, but the type of it was, due to the differences in the way NPH insulin is produced.
Both of us were aware of Intervet's Caninsulin—that it was identical to the Iletin II lente in everything except strength; we both did a lot of reading about it early in Lucky's diagnosis. But at the time, Caninsulin was not approved for use in the U.S. We learned about how one would go about applying for personal permission to import Caninsulin for Lucky's use, and we got in touch with Intervet. They assisted us with what was needed to allow Lucky to be able to get their insulin. I believe he was the first U.S. patient who had not used the insulin previously.
I still remember the day I gave Lucky that first shot of Caninsulin—December 10, 2003. I could see him getting better from that point on. Within 2 weeks of going to Caninsulin, the neuropathy was gone, his eyes were no longer irritated and watery, and he shed the sparse dry winter coat he'd grown with pork NPH insulin—replacing it with his normal, shiny, healthy, winter fur. He was no longer sleeping almost constantly and was once more happy, active, and playful.
We got an added bonus because with the U40 Caninsulin, we could more finely adjust his unit dosage for control. Where on the U100 strength Iletin II lente he would be at about 100 for a blood glucose reading, with Caninsulin he would be at 85 at 8 to 10 hours after his morning meal and insulin.
Lucky never had a hypo incident, nor was he ever hospitalized a day for diabetes or for any illness after diagnosis. He went from the most difficult diabetes patient to the best and easiest to manage.
In early 2004, the U.S. Food and Drug Admministration approved the insulin Lucky used under the U.S. brand name Vetsulin. My old timer was able to be here to see that happen—he was about 17 years old at the time.
At the end of November, 2004, Father Time caught up to my baby—his body was simply worn out from age and we couldn't make it young again. His diabetes was in tight control until he left us. He's the reason I was involved in CDMB, the Pet Diabetes Wiki, and am now at K9diabetes. I am forever grateful for our dear friend John, who never gave up and kept holding us both up during the hard times in the beginning, and to the wonderful people at Intervet, who both assisted us and who make the insulin that let him have a long and quality life.
— We Hope