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  • Jessie, Min schnauzer just dx-ed

    Hi all! I am a mod over on the cushings forum but my mom and stepdad's little girl Jessie was just dxed with diabetes today. Here is what I know for now:

    All blood panel normal except for glucose - 450

    Her symptoms were ravenous appetite for a while now and just recently excessive thirst and urination in house.

    The vet gave them Vetsulin (which even I know is off the market) and told him to give 2 shots a day (6 units) and come back in a week to have the levels checked? Does this sound normal? I was expecting them to keep her and monitor more closely but this is new to me.

    The vet did mention that they'd have to change to perhaps human insulin. My quesion - why not start there? Should I be concerned? I think he has a week's supply. Again, not sure.

    I asked what he was told to do in emergency and he said give some karo syrup.

    My stepdad doesn't ask alot of questions and tends to be very trusting in docs so if there is anything missing - let me know so I can let him know!!

    Thanks guys!!! Kim

  • #2
    Re: Jessie, Min schnauzer just dx-ed

    Hi Kim,
    I'm sorry about the diagnosis but glad you stopped over here.

    I do have some questions...
    How much does Jessie weigh?

    What is she currently eating?

    I'm not a fan of vets starting out on Vetsulin when they aren't going to be able to continue using it. I'd rather see Jessie started on NPH. You might ask or have him ask about Humulin or Novolin N. Walmart sells Novolin N under their contracted brand Relion in the $20 range. This is a U100 insulin (Vetsulin is U40) so the syringes will be different. We can recommend syringes if they do switch.

    I am glad the vet recommended 2 shots a day. Some are still starting at 1 shot. Did the vet also tell your stepdad to give them with food 12 hours apart?

    Would your mom and stepdad be up for hometesting with a glucometer? Here are some videos Natalie has on different places that can be tested: http://www.k9diabetes.com/bgtestvideos.html The OneTouch Ultra meter is a very good one. The Freestyle meters also work well for smaller dogs.

    Some vets do keep newly diagnosed dogs for observation but the majority are sent home with insulin and told to come back in a week for testing. I will tell you that some vets prefer to do fructosamine tests versus a blood glucose curve. The fructosamine is more or less an average of your dog's blood sugar over a 2 week time frame and doesn't provide information on how high or low the blood sugar has gone. So I would opt not to have this test run. A curve provides more information. Blood is drawn every 2 hours starting at premeal/insulin over the next 12 hours to determine how well the food/insulin are working together.

    I would recommend picking up some KetoDiastix to test Jessie's urine to get a general idea where her blood sugar is. (Some pharmacies only have Ketostix in stock so I'd call around). If she is running higher, they will want to monitor for ketones. Anything more than trace is considered an emergency and should be addressed immediately by a vet.

    I hope that helps get them started. Let us know about the weight and food.

    Again welcome Kim
    Patty
    Patty and Ali 13.5yrs 47lbs diagnosed May '08 Ali earned her wings October 27, 2012, 4 months after diagnosis of a meningioma ~ Time is precious ~

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    • #3
      Re: Jessie, Min schnauzer just dx-ed

      She weighs 23 lbs. She is short and very stocky. I have suspected diabetes or thyroidism for years.

      Yes, he did tell them to feed 12 hrs apart and same with shots.

      Food - I don't know the brand but it is kibble. He told the vet and said the vet said that it was fine. It is my understanding that it should be relatively low fat yet high protein - is this right?

      Re checking the levels...uhm... maybe in the future. He was quite proud of having given the shot. It took alot out of him. My mom says she won't do it but she is playing hard ball and will come around... so up the road I'll bring that one up.

      I like the idea of the urine strips. Thanks.

      I am sure he will go with the Walmart brand. You said the syringes are different? What is the easiest one to use with the Walmart Novolin NPH? Thanks so much!

      Kim

      Comment


      • #4
        Re: Jessie, Min schnauzer just dx-ed

        Kim,

        If Jessie is 23 pounds, that's 10.4 kg.

        "The starting dose of insulin is 0.25-0.50 units per kilogram, twice daily-rounded down to the nearest whole unit." http://k9diabetes.com/forum/showthread.php?t=980

        That would be a range of 2-5 units, so a 6 unit starting dose is just above the recommendation. I think the urine strips would be a very good idea to see how Jessie's doing with this.

        A consistent schedule will be very important with it comes to regulation. And they should know exercise has the potential to significantly drop blood sugar.

        We have dogs that are on a wide range of foods here. Typically you're looking for low fat, higher fiber. You'll know more about how the food is working with the insulin after having a curve done.

        As far as the syringes, if they switch to NPH I'd ask for a prescription for:
        U100 sryinges 3/10cc, 5/16" length, 31 gauge with 1/2 unit markings. The 1/2 unit markings make it easier to fine tune the dose.

        NPH is a more concentrated insulin than Vetsulin which is the reason for the difference in syringes.

        Take care,
        Patty
        Patty and Ali 13.5yrs 47lbs diagnosed May '08 Ali earned her wings October 27, 2012, 4 months after diagnosis of a meningioma ~ Time is precious ~

        Comment


        • #5
          Re: Jessie, Min schnauzer just dx-ed

          Hi Kim!

          I agree with you completely...why start Jessie on an insulin that is in short supply?? It seems that it would be a great idea to start her on NPH now rather than have to readjust her later, since she's just starting out! WalMart and Sam's Club sell Relion Novolin-N which is manufactured exclusively for them and it is about half the cost of the NPH's at retail pharmacies. I use Humulin-N simply because Ozzi peaked too early on Relion Novolin-N, but for most dogs, it is interchangeable. Regarding syringes, Relion also makes U-100 syringes which are also half the cost of the retail pharmacy. I still use those and having used both, they are the same from what I can tell (except for the cost!) They make different sizes. I use the 29 gauge 1/2" length because Ozzi is a big boy with lots of fur and found the shorter needles too difficult for him. In Jessie's case, she is smaller, so you might do very well with the shorter needles. Also, the shorter needles are 31 gauge (which has a smaller lumen), so that is desirable as well!

          There are lots of dogs here on lots of diets. Personally, I am trying to manage Ozzi as humans manage diabetes, and I am using a low-carbohydrate, high-protein, grain-free product, Blue Buffalo Wilderness. I am very happy with that, but there are many here who use every other kind of diet successfully, from raw diets to every commercial dog food out there. If you can control her glucose with her current food, you probably don't even need to change, unless you want to. Others here will probably have more helpful suggestions for you.

          It's super important to give the insulin and feedings twelve hours apart. Consistency is critical. I learned that the hard way! Ozzi used to free feed, and my vet told me to continue that, but it was impossible for me to get him regulated that way. Having changed to two feedings a day has changed his sugars in a positive way. Others feed 3 or 4 times/day. Alot depends on what you are doing now, and how Jessie's glucose curve goes. Is she having one soon? That will really be telling regarding how her body metabolizes insulin and how quickly it does or doesn't react with food.

          Two important things regarding injections. The insulin can be painful. Ozzi yelped in the beginning. Then I learned about drawing it up in the syringe and warming it under my arm. That helps IMMENSELY to take the sting out! Also, the bevel (the opening on the tip of the needle, which "shines" in the light) should be UP when injecting. Those two things will make it easier for Jessie and less painful.

          Congrats to your Dad for giving the shot...I remember how nervous I was the first time, and was sure I had screwed it up!! As soon as he's comfortable with that, ask him how he feels about learning to test her blood glucose!! There are lots of videos and resources here to learn, and I personally cannot imagine managing Ozzi's glucose without home testing. It's just like giving the injection...scary at first, then it becomes old hat....I promise!!!!

          I test Ozzi's urine for ketones when he has high sugars. I haven't had a hypoglycemic event, but my understanding is that you want to rub a teaspoon of Karo syrup on the dog's gums (if unconscious) or give it to them orally if conscious, and then feed them.

          Best of luck,
          Kevin
          Last edited by ozzi; 03-29-2010, 08:42 PM.
          Ozzi, Dalmatian/Australian Cattle Dog mix, 12/03/1996 - 08/15/2010. Diabetes, blind from cataracts, cauda equina syndrome, and arthritis of the spine and knees. Daddy loves you Ozzi

          Comment


          • #6
            Re: Jessie, Min schnauzer just dx-ed

            Thanks everyone! We have lots to learn. I don't know what I don't know yet so will ask along the way. You have been very helpful. Thanks so much. Kim

            Comment


            • #7
              Re: Jessie, Min schnauzer just dx-ed

              Hi all. Jessie seems to be adjusting to the insulin. I saw her get her first shot last night and she was fine.

              I have been reading other newbie's posts to see what I can pick up and pass along to my mom and stepdad. Something caught my eye. I just read a post from Natalie saying it was important that the dog eat a full meal before the injection.

              My stepdad gave her a treat, then a shot and then the meal. I am wondering if he was told wrong, not told or what... can someone explain this to me so I can pass along? Thanks!! Kim

              Comment


              • #8
                Re: Jessie, Min schnauzer just dx-ed

                Hi Kim,
                It's wise to give the meal before the injection. If for some reason, the dog refuses to eat or only eats part of a meal and the full dose of insulin has already been given, hypoglycemia can result. Too much insulin for not enough food.

                Some people have dogs that are prone to vomiting after eating. They may wait 30 minutes to be sure the dog keeps the food down. But if that's not an issue, usually insulin is given right after the meal.

                Hope that helps
                Patty
                Patty and Ali 13.5yrs 47lbs diagnosed May '08 Ali earned her wings October 27, 2012, 4 months after diagnosis of a meningioma ~ Time is precious ~

                Comment


                • #9
                  Re: Jessie, Min schnauzer just dx-ed

                  Kim,
                  If you have the time, Linda and Ladybug's thread is a good one to go back through http://k9diabetes.com/forum/showthread.php?t=1614 As she was learning there were a lot of tips and tricks that seemed to come out in her thread.

                  Take care,
                  Patty
                  Patty and Ali 13.5yrs 47lbs diagnosed May '08 Ali earned her wings October 27, 2012, 4 months after diagnosis of a meningioma ~ Time is precious ~

                  Comment


                  • #10
                    Re: Jessie, Min schnauzer just dx-ed

                    Kim,
                    The important thing is that Jessie eats when she gets insulin so that the insulin can work together with the glucose. Theoretically, it doesn't matter if you feed just before insulin or just after, as long as the dog eats! However, it is safer to feed first and give the insulin after because if the dog doesn't eat, or vomits the food for some reason, the insulin is already given, and you can't take it back. I think many people here either give insulin right after eating or wait 20-30 minutes after feeding. Maybe your step-dad could change the order, and give Jessie the meal, then the injection, and then the treat.
                    Kevin
                    Ozzi, Dalmatian/Australian Cattle Dog mix, 12/03/1996 - 08/15/2010. Diabetes, blind from cataracts, cauda equina syndrome, and arthritis of the spine and knees. Daddy loves you Ozzi

                    Comment


                    • #11
                      Re: Jessie, Min schnauzer just dx-ed

                      Thanks to everyone. Much to learn. I will forward all of this on. Again, thank you!! Kim

                      Comment


                      • #12
                        Re: Jessie, Min schnauzer just dx-ed

                        I knew it wasn't good when my mom said Jessie is urinating in the house still.... She had her first curve today.

                        Jessie is 23 lbs, original dx one week ago Bs was 450. She was put on vetsulin 6 units and switched to Human (Walmart) sometime this week. The doc kept the units the same 6, 2 times daily.

                        Here is the email update tonight from my mom:

                        After the curve test today and with Jessie's BS at 590 he increased the insulin to .8 2 times a day. They told Pete to give the dog only half of the dose of insulin if she won't eat. She wouldn't eat this a.m. and Pete gave her the shot thinking she'd eat. Well she didn't. So, I guess she went all day without eating. They had her down at the clinic from 8-3. She goes back a week from today to check the dosage again.


                        --------------
                        I am concerned about the increase while on insulin... I passed along the info regarding the keton. strips but no takers. I think they are still in the stage where they believe the vet has it under control and all will be well if they just follow instructions.

                        Advice??!!!

                        Oh - I did pass along the info about feeding Jessie AFTER the shot which makes it even worse that my stepdad gave him the shot anyway. He will learn how serious this is. He loves the dog dearly ... just think he doesn't understand this disease. Not sure how much coaching the vet is doing. He is pretty gentle and I can't imagine him giving anyone a lecture.

                        I just took my 2nd dog in for a cushings test today. At least I have experience but... the stress from these dogs is killing me!!

                        Appreciate the "Cliff's Notes" advice guys!!!
                        Kim
                        Last edited by frijole; 04-05-2010, 05:49 PM.

                        Comment


                        • #13
                          Re: Jessie, Min schnauzer just dx-ed

                          Boy, I don't know how you convince people about the significance of testing for ketones, feeding first & then injecting, and all of the other knowledge that is required to manage this well. I think those of us who found our way to this group are already highly motivated for the most part, so that makes it easier.

                          Do you know what time they gave that first injection on an empty stomach? I'd be curious to know how much time passed between the first injection and the first BG test at the vets. There is always the possibility that the insulin made her drop too fast and she rebounded. Unfortunately, since they aren't testing at home, we don't know whether Jessie has been having much of a result at other times of the day from her current dose. Also, while my dog reacts to excitement/stress by having lowered BG, some dogs have increased BG from stress, like vet visits. That's another benefit of home testing since you are getting a more accurate reading of your dogs BG in their normal, every day, non-stressed environment.

                          Do you take your dogs to the same vet as your parents by any chance? Maybe you could have a chat with him and bring up some of the more important points that you feel your mom and step dad aren't fully accepting, and then he could talk to them? I know you mentioned he is soft spoken, but if he knows things like a shot on an empty stomach are occurring, perhaps that would motivate him to make sure they fully understand. Long term high BG can certainly have a detrimental effect on a dog, like ketoacidosis. But a sudden crashing low can kill and they need to understand that as well.

                          As far as how high her numbers still are despite being on insulin, it can take a while. Some dogs need a much higher dose then they start out on. Noodle was started on only 8 units, 2x a day (he was around 60 pounds at the time) and he ended up needing 30 units, 2x day. His BG went higher than when he was originally diagnosed during those early days until we got closer to the correct dose. Also, there tends to be some insulin resistance that they build up with the continually high BG they've been living with and it can take a little while before the insulin finally breaks through that. At her current weight, she could end up on more than 15 units per injection without any positive results, and as much as 20 units needed to maintain decent BG numbers, before she would be considered truly insulin resistant, so she has quite a bit of wiggle room with regards to insulin dosage. Here's a link to dosage information and insulin resistance. I'd also make sure they are strictly following other guidelines as well, like feeding the same measured amount at each meal, no snacks, correctly handling the insulin, etc.

                          I'm sorry you are having to deal with helping your parent's manage Jessie's diabetes on top of your own dogs illnesses. That is a lot to have on your plate at one time! But I admire you for working so hard to help your parent's understand there is more they can do to help Jessie lead a happy, healthy life. I wish they had pet diabetes educators that every family was given access to, like human diabetics have available to them. Thank goodness for this board and the cushings board!
                          Daisy & Noodle - 9 yr old Lab mix dx 1/09 ~ 51lbs ~ 38U Humulin N, 2x ~ 1 3/4 cups am/pm Blue Buffalo dry, 1/4 can am/pm BB Wilderness.

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                          • #14
                            Re: Jessie, Min schnauzer just dx-ed

                            Thanks... I am really struggling because this is like greek to me and I don't have time to research as I normally would. Anyway - thanks for helping me help them.

                            I would guess it was the 7 am feeding/shot. She was at the vets from 8 to 3 but I don't know what time they tested her. When they do a curve and the results are like this do they (vets) usually check ketones? I emailed my mom and asked if the vets checked the ketones and her response a few minutes ago was "Pete knows nothing about ketones".

                            This is why I am here trying to absorb at least the basics so I can inform them. Is there a real basic overview of ketones I could send her?

                            Yes I go to the same vet. I think it's easier for me to teach them. My vet is very compassionate but I moved from a city to a small town (20,000 or so) and this is my 2nd vet. Fired the first one due to them botching cushings. This guy is very compassionate but he doesn't do a good job of explaining things. I did a ton of research on cushings and after 4 yrs I struggle to get info out of him. It isn't ego at all... hard to explain.

                            On the other side are my parents - mid 70s. Mom is like me but she isn't the "dog lover". She loves the dog but not nutty like he and I are. My stepdad is crazy over this dog and scared out of his mind and a very proud person. He was very proud of the fact he is giving the shots and all. So baby steps.

                            I think if I understood the basics - what to do, what not to and could just go buy the dang ketone strips and explain what to do then they would. Right now I think that like alot of people - they are still in the dark. I just don't want Jess to suffer as they learn. I am probably poking my neck in too far but I love the dog and will find a way to be the go between and keep everyone's egos in fine shape.

                            The vet told her their food was OK and Iams treats were ok too. I know he gives her 1/2 c at each feeding. I am wondering how many treats a day he gives. He is a softy and I bet he gives her too many. Would you recommend none? I told my mom to have him give her icecubes for treats instead. ???? good or no???

                            Thanks for the link ... I will read it now. Kim

                            Comment


                            • #15
                              Re: Jessie, Min schnauzer just dx-ed

                              Here are a couple of links for information on ketones. The first one is from a thread on this board. The first 2 posts in that thread explain ketone strips and show pictures of the results you get from both types (strips that just test for ketones and strips that test for ketones and blood sugar high enough to spill into the urine - generally over the renal threshold of 180).

                              http://www.k9diabetes.com/forum/showthread.php?t=958

                              http://diabetesindogs.wikia.com/wiki/Ketones


                              When Noodle was really high in the beginning and we first started monitoring for ketones, we found it easier to catch the urine in something and then dip the strip in it. This is going to sound silly, but we used a soup ladle, lol. It had just the right length handle and was easy to clean. Now if the need arises, we just hold the strip right in the stream for a sec, but some dogs wonder what the heck you're doing back there - so your mileage may vary.

                              You can pick up the ketone strips at pretty much any drug store. They usually sell 2 types - strips that just test for ketones and strips that check for ketones and sugar. The ketone only strips are cheaper, but it may be a good idea to pick up the ones that test sugar as well, since it will help you get at least an idea what her sugar levels are at certain points if they aren't ready for testing her blood at home. It's a good idea to mark the date you open the bottle on the label since they do expire. Both links have a picture of what you will see on the label for both types of strips. You just match the color on the stick after a certain number of seconds to the colors on the side of the bottle. Different vets may tell you to contact them at certain levels or take them directly to an emergency hospital for higher levels. My vet wanted to be contacted if they were above a trace. Thankfully, Noodle never went above that.

                              I can't imagine the vet wouldn't test her for ketones while she was there, so hopefully she is fine. Some dogs seem to throw ketones easily while others never do. Noodle routinely went off the meter ("High" on our meter which meant over 600) in the beginning and still never went beyond a trace.

                              I understand what you mean about the vet. I've had human doctors like that before and it's like playing 20 questions to get any info - very frustrating. Jessie is very lucky to have you in her corner.

                              When a dog is early in the process of trying to regulate, it's generally a very good idea to not give treats at all. There can be just as many carbs/calories in the treats (more if she is getting several of them) as the entire meal. The only way to find the correct food/insulin balance is to keep it to 2 meals a day until she is in a good range. After that, they can try a treat and see if it raises her BG significantly. Then you can experiment with different treats to see which ones don't cause a big bump. We used to give the Iams biscuits and they caused very big spikes in Noodle's BG, so we stopped. We eventually found that Newman's Own Organics made a tiny heart shaped treat that didn't increase Noodle's BG. We still use those for his after injection treat.

                              Another alternative is veggies. Many dogs on this site are given various low glycemic veggies as treats. My dog loves little cucumbers chunks because he likes very crunchy treats. A lot of people on the site use green beans. They're handy because you can just buy a bag of the frozen kind and always have them on hand. I've been told that ice cubes can cause tooth damage, but I'm not sure how serious a threat they really are. I don't give them daily, but Noodle loves an ice cube out on the deck on a hot day or a few tossed in his water bowl. If she enjoys them and it makes your step dad feel better to give her something, I say go for it.

                              I think with your guidance, once Jessie is in a better BG range, you're parents will eventually develop a solid routine. When they see that the steps you are encouraging them to take make Jessie feel healthier and happier, things will fall into place.

                              Let us know how your dogs are doing as well. I hope you get good news with your second dogs cushings test. You are doing a great job juggling all of this.
                              Daisy & Noodle - 9 yr old Lab mix dx 1/09 ~ 51lbs ~ 38U Humulin N, 2x ~ 1 3/4 cups am/pm Blue Buffalo dry, 1/4 can am/pm BB Wilderness.

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