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Hello everyone,
I have a family dog named Bailey who is 11 years old and as resilient as can be. He is a Dachshund who befriends anyone on the street and warms people's hearts. We have been struggling since his diabetic diagnosis to get his sugar under control and now he has an additional complication: a large leg wound that has been taking months to heal and has gotten worse. I have a hypothesis but would like additional feedback from this wonderful community.
Bailey has lived a great life until complications started to form.
1. Around age 5 he had calcification of the spine which we spent a pretty penny on surgery. He has been fine since then for his back.
2.A few years later they discovered that he has a heart murmur but it hasn't progressed to the later stages as of yet and the vet's are still monitoring it.
3. Later in life, around 10 years of age we discovered that he had thick bile in his gallbladder and he had developed pituitary tumors around his adrenal glands which is the cause of his Cushings condition. The Cushings has been monitored and medicated (Trilostan, special 7 mg mix) and it has been stable ever since. The thick bile was being softened by an additional drug they provided (Ursodiol 250mg but cut in 4 pieces so 62mg each dose).
4. Months later, he was not feeling well and we learned that he developed diabetes from the Cushings. They started him on Levemir (Detemir) at .5 U. Over the course of the year we have been trying to find the sweet spot with little success. Here is an excel sheet of the diabetic curves my parents did over time. Sadly it does not mention how much of the Levemir they were giving at the time but it was between 1U and 2U. At the moment he is on 4U and his sugar is high on the daily.
5. A few months ago he was incredible pain and they found that his gallbladder was completely blocked. They did an emergency gallbladder removal and he had a 50% survival rate to pull through. He pulled through and his surgery has healed but a consequence of it was that one of his back paws swelled up 3 times the size for almost 2 weeks. It caused loss of oxygen for the skin and open tears which grew to a considerable size with signs of narcosis. After hydrotherapy was preformed, the leg as returned to normal but the large wounds are too large for a skin graph and naturally healing albeit slowly.
6. Because of the high sugar levels, I am starting to see while clouds in his eyes.
It was healing fine for about a month and a half but lately it has reverted and the healing layer of the skin rips off with the removal of the bandage. The doctor has told us that if it doesn't improve the only option is amputation and at that point I fear we will be putting our favorite pupper to sleep as the costs have been astronomical and we don't want him to have a bad way of life.
He currently eats Hill's Prescription Diet w/d Multi-Benefit Digestive, Weight, Glucose, Urinary Management Chicken Flavor Dry Dog Food and wet dog food.
Hypothesis:
I believe that Bailey's unregulated high blood sugar on 4U Levemir is making matters worse for his skin condition. Not only is his leg not healing properly but his stomach skin and general coat skin is usually seen as flaky an peeling. The only times his leg was seen as getting better was when his diabetic curve as more stable. Normally he is in the high 20 mmol/L's. The vet says that he should be around 15 mmol/L but even I find that high. Shouldn't a dog's diabetic curve be between 5 mmol/L- 10 mmol/L?
This is a link to the excel sheet my parents maintained for months to watch his curve. They were using between 1-2U of Levemir at the time.
Link: https://1drv.ms/x/s!AgfijvC-cKDdgUNY...i5OHL?e=PwOSf0
I looked into Levemir for dogs and didn't see much on this forum or elsewhere. I am assuming this isn't something often given for sugar maintenance. After reading that the drug is 4x more effective in dogs than humans and that the starting dose should be .1/kg..Bailey should technically be on .07 as he weighs about 16 pounds. The Vet has been increasing the dosage unit after a few weeks to see if there are any balance changes and now we're at 4U every 12 hours.
https://www.petcarerx.com/medication...-diabetes/1238
Side effects that is known on the drug is the following: hypoglycemia (low blood sugar), Somogyi effect hyperglycemia (overproduction of insulin by the liver during sleep).
http://www.caninediabetes.org/pdorg/somogyi.htm
Bailey does sleep a lot during the day as he normally did before diabetes. I am wondering if the 4U is too much and that it is indeed doing the somogyi effect thus spiking his sugar levels.
We are doing a full blood work on Monday so I should have more information then.
I think we should be cutting the dose back to .7/kg and move up .05 until we find a sweet spot. I think moving up .5U is passing by the sweet spot maybe. I think maybe another type of insulin may also be better for our pup.
Based on all this information, what do you think? I am also considering getting a second opinion from another vet.
Thanks for the feedback!
I have a family dog named Bailey who is 11 years old and as resilient as can be. He is a Dachshund who befriends anyone on the street and warms people's hearts. We have been struggling since his diabetic diagnosis to get his sugar under control and now he has an additional complication: a large leg wound that has been taking months to heal and has gotten worse. I have a hypothesis but would like additional feedback from this wonderful community.
Bailey has lived a great life until complications started to form.
1. Around age 5 he had calcification of the spine which we spent a pretty penny on surgery. He has been fine since then for his back.
2.A few years later they discovered that he has a heart murmur but it hasn't progressed to the later stages as of yet and the vet's are still monitoring it.
3. Later in life, around 10 years of age we discovered that he had thick bile in his gallbladder and he had developed pituitary tumors around his adrenal glands which is the cause of his Cushings condition. The Cushings has been monitored and medicated (Trilostan, special 7 mg mix) and it has been stable ever since. The thick bile was being softened by an additional drug they provided (Ursodiol 250mg but cut in 4 pieces so 62mg each dose).
4. Months later, he was not feeling well and we learned that he developed diabetes from the Cushings. They started him on Levemir (Detemir) at .5 U. Over the course of the year we have been trying to find the sweet spot with little success. Here is an excel sheet of the diabetic curves my parents did over time. Sadly it does not mention how much of the Levemir they were giving at the time but it was between 1U and 2U. At the moment he is on 4U and his sugar is high on the daily.
5. A few months ago he was incredible pain and they found that his gallbladder was completely blocked. They did an emergency gallbladder removal and he had a 50% survival rate to pull through. He pulled through and his surgery has healed but a consequence of it was that one of his back paws swelled up 3 times the size for almost 2 weeks. It caused loss of oxygen for the skin and open tears which grew to a considerable size with signs of narcosis. After hydrotherapy was preformed, the leg as returned to normal but the large wounds are too large for a skin graph and naturally healing albeit slowly.
6. Because of the high sugar levels, I am starting to see while clouds in his eyes.
It was healing fine for about a month and a half but lately it has reverted and the healing layer of the skin rips off with the removal of the bandage. The doctor has told us that if it doesn't improve the only option is amputation and at that point I fear we will be putting our favorite pupper to sleep as the costs have been astronomical and we don't want him to have a bad way of life.
He currently eats Hill's Prescription Diet w/d Multi-Benefit Digestive, Weight, Glucose, Urinary Management Chicken Flavor Dry Dog Food and wet dog food.
Hypothesis:
I believe that Bailey's unregulated high blood sugar on 4U Levemir is making matters worse for his skin condition. Not only is his leg not healing properly but his stomach skin and general coat skin is usually seen as flaky an peeling. The only times his leg was seen as getting better was when his diabetic curve as more stable. Normally he is in the high 20 mmol/L's. The vet says that he should be around 15 mmol/L but even I find that high. Shouldn't a dog's diabetic curve be between 5 mmol/L- 10 mmol/L?
This is a link to the excel sheet my parents maintained for months to watch his curve. They were using between 1-2U of Levemir at the time.
Link: https://1drv.ms/x/s!AgfijvC-cKDdgUNY...i5OHL?e=PwOSf0
I looked into Levemir for dogs and didn't see much on this forum or elsewhere. I am assuming this isn't something often given for sugar maintenance. After reading that the drug is 4x more effective in dogs than humans and that the starting dose should be .1/kg..Bailey should technically be on .07 as he weighs about 16 pounds. The Vet has been increasing the dosage unit after a few weeks to see if there are any balance changes and now we're at 4U every 12 hours.
https://www.petcarerx.com/medication...-diabetes/1238
Side effects that is known on the drug is the following: hypoglycemia (low blood sugar), Somogyi effect hyperglycemia (overproduction of insulin by the liver during sleep).
http://www.caninediabetes.org/pdorg/somogyi.htm
Bailey does sleep a lot during the day as he normally did before diabetes. I am wondering if the 4U is too much and that it is indeed doing the somogyi effect thus spiking his sugar levels.
We are doing a full blood work on Monday so I should have more information then.
I think we should be cutting the dose back to .7/kg and move up .05 until we find a sweet spot. I think moving up .5U is passing by the sweet spot maybe. I think maybe another type of insulin may also be better for our pup.
Based on all this information, what do you think? I am also considering getting a second opinion from another vet.
Thanks for the feedback!
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