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Franklin'sMum 09-05-2010 09:05 AM

Franklin- slightly elevated glucose
 
Hi All,

My sweet child Franklin has atypical cushing's (after originally being dx'd with PDH cushing's), proteinuria, and since the end of July has shown glucose in his urine, ranging from + to 4+. On both multistix and lab urinalysis.

Our vet had said that it's probably nothing to worry about, and that they go by blood glucose to dx and monitor diabetes. I originally thought it might have been caused by my attempt at home cooking (a fair bit of rice- because of the proteinuria he needs a moderately restricted protein diet). We've since gone back to commercial food.
We had some blood work done on 30 Aug, and it showed just a slight glucose elevation. 7.2mmol/l (3.5-6.7) converting from http://http://www.childrenwithdiabet.../converter.htm makes those numbers 129.6 mg/dl (63-120.6) which I realise is extremely minor, and truthfully I don't know if we need to be here, but I am extremely grateful for this forum and the knowledge you all provide.

I've been trawling through the links and info, but haven't had much time to go through threads so far. Our vet did say it's very slight, and quite probably nothing to worry about (yet), but that's not going to stop me from worrying :o or trying to learn about the condition. The IMS hasn't given her opinion yet. The vet said that if an und'xd diabetic pup came in, he would expect readings of 10+

I've bought an Abbots freestyle lite glucometer, just in case. I like the idea of just a small blood drop, and it was written up here as being a good choice for little pups, and fairly accurate. It seems pretty easy to use also :o. Don't worry, I tried it out on me, not Franklin ;).

Considering we got the results on Thursday, I haven't had too much time to study. Well, it's not sinking in to my head. So I havn't had a lot of time to come up with decent questions, so I apologise in advance if these are incredibly stupid.

If glucose is showing in his urine, that means that it's over the renal thresh-hold of 180 ish, correct?

So even if it's not diabetes, it still needs to be addressed?

Is there such a thing as pre-diabetes? Early diabetes?

If it turns out that it is diabetes and we need to home glucose test, is there a difference in glucose readings depending on where the blood is taken from? ie: inside lip, outside lip, base of tail, ear flap?

What is a spot test?

Can a glucometer be used for a curve (say in between curves from the vets)?

I've read that when the meals are given depends on what brand of insulin used- but on one of the threads it said to give the meal first, just in case it's rejected or only half eaten, so the insulin dose can be adjusted accordingly. Does it sometimes depend on the brand?

Other info- Franklin is a maltese and weighs 7.7kg (16.9lbs) - not fat but stocky. He's on melatonin and lignans for the atypical cushings, and 2.5mg enalapril for the proteinuria. Because of the cushings, he has an increased risk of pancreatitis, but spec cpl (July 2010) was 59ug/l (<201), often has high cholesterol, triglycerides and lipids.
Blood pressure has mostly been within range, except once when we were using 5mg enalapril. Repeated testing that day gave results of 60/30 with their oscillometric, and their doppler wouldn't give a consistant reading, even with other dogs. We stopped the enalapril until we could get a proper reading (8 days later). It was back to normal, so we started enalapril again but at 2.5mg.
He gets omega 3, vitamin e, vitamin b, milk thistle, carnitine, taurine, glutamine, and coenzyme q10, but not all of them each day.

I thank you in advance for any help or insights you have,

Jane and Franklin

k9diabetes 09-05-2010 10:33 AM

Re: Franklin- slightly elevated glucose
 
Uncontrolled Cushing's disease can cause elevations in blood sugar so it may be that this truly is only Cushing's disease and not diabetes and that with time the medication will resolve that.

The melatonin and lignans take several months to improve the atypical Cushing's disease, though, so you won't see a quick resolution of the high blood sugar if it's solely from his Cushing's disease.

But it also sounds like you have had some very strongly positive urine glucose tests - that would make me think there are times when his blood sugar may be a lot higher.

Yes, you're right - blood sugar usually doesn't spill into the urine until it's about 180. So it seems like his blood sugar has been running quite a bit higher than 129 and perhaps for extended periods of time.

I think testing and monitoring his blood sugar now is a good idea. You can use the monitor you have to do a curve at home....

Is he being fed on a set schedule?

Doesn't matter where you take the blood from.

If you find that his blood sugar is a lot more elevated than the vet saw, then I would want to treat it with insulin. Elevated blood sugar can cause blindness pretty quickly when it is severely elevated.

A spot test is just a draw at some random time of day whereas a curve is done according to a schedule, starting with a glucose reading before breakfast and then a reading every 2 hours for at least the next 12 hours with a reading before dinner and injection.

Diabetic dogs are typically on a set feeding schedule of meals and injections every 12 hours. If Franklin's not. I'd just take a reading every couple of hours throughout the day and note when food was given and see what you get.

Personally, I don't favor giving extra meals with Caninsulin unless a curve shows that it is needed. I like to see dogs started with two meals and injections 12 hours apart and then assessed to see if additional food should be given for best regulation. It varies a lot from dog to dog how food and insulin are processed so you want the dog to tell you what he needs rather than the book! :)

Let's first find out if Franklin seems to be truly diabetic. Are you up for doing a curve?

Natalie

Franklin'sMum 09-05-2010 09:11 PM

Re: Franklin- slightly elevated glucose
 
Hi Natalie,

Thanks so much for your reply and info. Franklin's not on trilo at the moment, and hasn't been since mid March, and his cortisol is lower now than what it was in Jan/Feb. (Jan/Feb pre 9-10 ug/dl post 19/20 ug/dl) Last week pre 5 post 10 :confused: Cushings symptoms aren't a problem, just a few days in the past month he was begging, barking and tapping at me for more food.

He usually has 3 meals a day, and treats are the only way I'm allowed to leave the house :o There's no set schedule for food, I'm a shift worker so our schedule changes week by week.

I'm up for trying a curve... glucose level and test times and join the dots? Will that be good enough to start with? I can do 7 and 1/2 hours worth tomorrow before work, then another couple when I get home.

Thanks again Nat, and wish me luck :eek:!
Jane and Franklin xx

CarolW 09-05-2010 09:40 PM

Re: Franklin- slightly elevated glucose
 
I think Natalie has covered the needed topics very well, so I don't have anything to add (and my knowledge is considerably lesser than hers, too!)

But I did want to say, there IS no such thing as a stupid question, unless you didn't ask the question! I understand about not knowing what to ask, because until you have something close to an answer, it's tough to have any IDEA what to ask!

I have a big soft spot for Maltese. Franklin sounds like a big one! Only a trace smaller than my Havanese, Camellia, who is 7.8 Kg, or, 17.1 pounds - and big for her breed, too. (She's healthy so far, though; I've only had her just under 3 weeks; she's 3.5 years old, and I had enough diabetes with Kumbi, though if Camellia were to develop it, I'd have a pretty good idea what to do!)

If or when you can send a picture of Franklin, I'd just love to see one or more!

Kumbi didn't have Cushings, but I read the sister forum to this one, the Cushings forum, at times, so I have at least an idea about what atypical Cushings is.

Above all, though, I really just want to welcome you here. I prefer this forum to any other on canine diabetes. It's the best organized, and has the most responsible and well-educated administrator and moderators of any other I know of. And you can absolutely count on friendliness from forum members, whoever might post to you.

So, a big, fat welcome to you and Franklin!

Sun, 5 Sep 2010 21:40:21 (PDT)

Franklin'sMum 09-06-2010 08:43 AM

Re: Franklin- slightly elevated glucose
 
Hi Carol,

Thank you so much for your warm welcome :D. As you know, we have a few cross-over members, and when a diabetic pup's parent comes over to k9c and links to their thread what they've been going through, I've been known to poke around over here as well :). Not necessarily understanding things though :o. This forum is great, filled with info and easy to navigate.

Is that Kumbi as your avatar pic? Absolutely gorgeous!!!:D I'll try and put up Franklin as my avatar, or start an album or something.
Thank you again, Carol.

Jane and Franklin

CarolW 09-06-2010 07:51 PM

Re: Franklin- slightly elevated glucose
 
Yes; that's Kumbi in my avatar. You can read more about him here:

http://www.coherentdog.org/kumbi.php

That page contains a link back to this forum, with suggestions for picking up the relevant detail around the time he died.

I do trust Franklin and Bailey have sweet, long lives to come, ahead of them. Well-managed diabetes doesn't make a lot of difference to lifespan, and from the little reading I've done on Cushings, the same is true for that. (Kumbi died of cancer, not diabetes.)

I went and looked at your album on Franklin. Just loved it! That guy is quite a gardener! haha!

Hugs to you, Franklin and Bailey!

Mon, 6 Sep 2010 19:49:45 (PDT)

Franklin'sMum 09-07-2010 09:51 AM

Re: Franklin- slightly elevated glucose
 
Hi Carol,

Thank you for your kind words :). Kumbi was a seriously beautiful boy, and I'm very sorry for your loss. I haven't read your thread yet, work got in the way.

The planned curve didn't go as planned, or at all. Franklin had a very unsettled night, and so did I. Planning for tomorrow, but I haven't told him about that ;). Will post more tomorrow night. Thanks for our hugs, Carol, much appreciated.
Hugs from our home to yours,
Jane and Franklin

Franklin'sMum 09-07-2010 06:56 PM

Re: Franklin- slightly elevated glucose
 
Hi Everyone,

I probably should have asked this before today, but... if I'm using a human glucometer, do I use the finger cap and just adjust the dial to a higher setting or use the other body part cap?

I had shaved his tail near the base, but couldn't get enough of a blood drop. Lifted his ear flap- and he rolled over and started batting my hand away. I pricked a paw pad (the big one on his front foot), no blood drop at all. This was all with the finger cap on, I'd completely forgotten about the body cap. There's no problem with his mouth being touched, however I'm not confident to do a lip prick at this stage. Are there any other tips or tricks you could share with me?

Thank you
Jane and Franklin

eileen 09-07-2010 07:18 PM

Re: Franklin- slightly elevated glucose
 
Jane, I'm assuming you are referring to the lancing device?

Many of us find that it is much easier without the device at all but instead just the tiny lancet in hand.

This gives much better control and without the intrusive device.

The lip prick is a breeze, really!

Franklin'sMum 09-07-2010 08:15 PM

Re: Franklin- slightly elevated glucose
 
Hi Eileen,

Yes, was referring to the lancing device, but will try just the lancet. Thank you HEAPS :)

Jane and Franklin


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