Help..It's me again with 2nd dog Squeaker.Diabets+ Cushings and more

[bichons9]

Hello again..Because all of you seem to be able to manage your insulin dosages and changes needed to satisfy your dog's needs, often without the DVM..is amazing..and so...I need help and so here I am with serious issues that DVM admits treatment is challenging for him and his partners. As far as Suzie:my diabetic 4+ years in fine physical condition but may have FBG 400 or 70...never predictable...and still on awful Vetsulin..Jan 2021(8 lb) SQUEAKER drinking and urinating alot. Cushings disease borderline. cortisol .9 no treatment ordered..BG 165 surgery on torn ACL 1/4/2021...4/26/2021..much increase in H20 and urination + lost so much weight..suspected diabetes since wgt loss not assoc with Cushings..DM test=cortisol 45..CT scan showed NOT pituitary..adrenal dependent cushings with 1 cm mass the extends into caudal vena ca 1 cm. Adrenalectomy planned but DVM decided too risky, suspects carcinoma from CT scsn and might kill him in surgery. AND SO..we have diabetes >700 not reduced with NPH while in hospital 1 week..used regular to decrease BG? And though when I suggested to DVM (for Suzie) and others, "What about N70/30?"..no body agreed or was not familiar with using it. Result tonight no sleep with Squeaker and that's ok..scared of these high BG but 1 u of Regular insulin lowers BG within 1 hour drastically..My DVM's were very honest stating they were not sure what to do. He cannot live at the hospital and so I am tryin to figure out the insulin situation since NPH not working alone. It seems when giving R 1unit 12a a d 12p BG drops .I don't know what to do...The day began with reasonable BG's but wonddr if the R is hanging on to help the NPH..but ended with BG 735 @12a followed by 1 u R that decreased BG to 302...I know this is not a cushings forum..but right now need to get this BG under some control..Any thoughts?? The Vetoryl is given to stop Cortisol secretion but so far not doing its job very well..Thank sor reading...SQUEAKERS SPREAD SHEET: https://docs.google.com/spreadsheets...wD4/edit#gid=0

[Riliey and Mo]

Re: Help..It's me again with 2nd dog Squeaker.Diabets+ Cushings and more

Yes hello again

Please post

Weight
Food, amount
Insulin, how much
A recent curve
Thanks

[jesse girl]

Re: Help..It's me again with 2nd dog Squeaker.Diabets+ Cushings and more

I used R and the even faster working log type insulins on Jesse . We also were struggling with high blood sugar but also we struggled with large swings in sugar which I know now is problematic to regulation

The fast acting I gave every 6 hours if blood sugar was high and as late as midnight and if this was the only way to mange her diabetes I would have done that but I new this was not ideal and a bit risky

The only thing that solved our problem was going to one meal a day and a small snack for the morning dose of NPH and It was like a giant weight had been lifted off my shoulder . The reason I went to one meal is I was hoping for half the day we would not see any influence from food but it actually helped with her meal dose to . I added a milkbone type snack with her morning dose . It was ok without but the snack made it more consistent and better numbers .

I added a third shot of nph 2 hours after her one meal as I could not give her a full dose at mealtime as she might go to low

With high sugar there could be some affects form that . DKA comes to mind if your dog is losing weight and sill eating . I would think the hospital would have tested for Ketones . You can test for them at home buying a kit from a pharmacy . The other is pancreatitis . My jesse had both when she was diagnosed diabetic at 5.5 years old and barely survived

You may have to get back to the basics . First off is there something else going on and try to eliminate that . Next you have to look at your dosing . I always say if you have big swings in sugar from high and low then the dose maybe to much or you have an imbalance between food and insulin . If insulin is working that may eliminate the possibility of resistance which cushings can create

Have to be a detective and decide what direction you want to go . The vets were not of much use for jesse after she got out of the hospital so I jumped in head first to figure how to get jesses life back and have a longer life than just a few years as she was a young girl . You may need a resset on dosing . Post any recent curves you have

[bichons9]

Re: Help..It's me again with 2nd dog Squeaker.Diabets+ Cushings and more

Yes hello again

Please post

Weight
Food, amount
Insulin, how much
A recent curve
Thanks

Sorry, I did not replace Suzie's spreadsheet with Squeaker's which details hour by hour..weight 8.4 lbs, 1/2 c Rubie Stebie modified 2X/day..Insulin NPH (ugh) and regular now when >500..the curves make no sense..I'll do a new one since i do not sleep anymore..TW..Squeaker has acc to CT scan Adrenal dependent Cushings due to a mass on R. gland..Planned Adrenalectomy not performed to risky. The Cortisol from Cushings fights the ability to regulate glucose..No ketones in urine..but soooo dilute. Squeaker behaves just fine.but he has lost so much weight from all of the usual s+s. 3 of our dogs have been ICU patients since 1/4/2021. Squeaker's sister has pulmonary hypertension and heart didease on 8 meds/day and Suzie is taking a back seat since she ONLY has insulin dependent diabetes never well regulated...We are exhausted and wish DVM's knew more!!!! No endrocrinologist available I guess??? Thanks. You members are always tryin to help me..Thanks!! I am just sooo tired. DVM staed "End of Life care" for Squeaker but explained that he did not mean death in a week or moth..He claimed that's how a 15 year old dog is referred to in such condition esp when CT scan implies the mass adenocarcinoma..Jessie I wouldn't mind giving R . The DVM even says the NPH is not working..but you implied not good overall to give long term??? I gave him subcu fluids last nigh to try to decrease BG..SEE his spreadsheet if you dare!!!!! https://docs.google.com/spreadsheets/d/1KcyKMl3nQWtN0E8eFH-Bmk4DpVDoR1DM-VNV1ZXowD4/edit#gid=0

[jesse girl]

Re: Help..It's me again with 2nd dog Squeaker.Diabets+ Cushings and more

I suggested it wasn't ideal but I was prepared to do it long term if i had to . Natalie exclusively gave her dog r I believe every 4 hours . Its just more work managing and monitoring . . Its hard to know what blood sugar is doing and how the body deals with injected insulin . I was struggling early on and the vets could not help me . Even the forum couldn't give me an exact answer but gave me wonderful support . I was very frustrated.

So for me the standard management wasn't working so I went in a very different direction but followed the most important protocol and that was consistency . If your not consistent its difficult to figure a plan

I dont think the veterinarian community and that incudes specialist can do much more that is prescribed as a general treatment and management of the disease . If the body works well with injected insulin and there isn't any other challenges to regulation it can be quick and fairly uneventful but when its difficult they dont have the time to research and manage something like diabetes

Jesse has lived longer with the disease than any dog I know and that's because we thought outside the box and tried different things Many of those things did not work and that was helpful crossing things of my list . I remember the vet telling me I would kill jesse with what I was doing and that was very upsetting but i knew the information I was getting from that individual was incorrect and dangerous . Yes Humans are not prefect even professionals . So I take everything with a grain of salt and do my research . Never take anything at face value

Your plate is full and anyone would struggle in your shoes . Jesse even with her challenges never complains and that makes it easy on me

[bichons9]

Re: Help..It's me again with 2nd dog Squeaker.Diabets+ Cushings and more

Thanks Jesse..I do recall now that someone was using Regular Insulin in total..I am willing to do this if needed. Squeaker goes for another dexamethazone test tomorrow and will ask DVM about giving q 4 hours??? I do not know why the NPH is not working at all...though I asked, "Should we raise the dose?" and DVM said no. It's 2.5u and I read that to conclude resistance the dose needs to be alot higher..Thanks again!!!!!

[Riliey and Mo]

Re: Help..It's me again with 2nd dog Squeaker.Diabets+ Cushings and more

I.ve seen dogs getting fasting acting R insulin 4 times a day.
Just a suggestion that doesnt look like its been changed is the food.
Have you tried adding in abit of dry food.
Testing half hour after they eat will show you where the food is then test 1. 1/2 hours after eating and insulin to see how insulin and food meet up.
Food is important along with the amount. I use to tweek Rileys bg by adding or subtracting food.
I.d get a good dog food calculator add up the calories for the dogs weight then weigh it into grams.
Whats the total calories for your dog? Heres a link to look at

https://www.petmd.com/blogs/nutritio...t-amount-32905

[jesse girl]

Re: Help..It's me again with 2nd dog Squeaker.Diabets+ Cushings and more

If its taking one unit of r to bring blood sugar down into the 300s you may need 4 to 5 units of NPH to do the same . It is worrisome to raise a dose to a higher level from a lower regulated level and not sure of the reason why and can the body return to needing that lower dose which is possible if the reason that caused the resistance went away.

Now you probably shouldn't raise the dose of NPH while giving R and I agree with the vet holding at that 2.5 units but you could try raising the dose of NPH and eliminating the R by .5 to 1 unit depending on the curve and and the lowest number in that curve

.5 unit if the lowest number is in the 200s and 1 unit for 300s or more for lowest number and hold the dose with a low number below 200 with anything below 150 you may want to bump the does back up a bit and going as high as 5 units is not unusual . It is stated that you can go as high as 1 unit per pound of your dogs weight but for me I would not be comfortable with that

With a substantial higher dose than before you may have to monitor a bit more for sometime just to make sure something doesn't change abruptly to needing a lower dose

So your sure there is not a UTI or some other infection as that can cause résistance ?

There have been dogs on the forum that never had very good regulation and its not unusual to see dogs in the 200s and 300s for the day and I have seen dogs in the 400s for part of the day and did ok .

[bichons9]

Re: Help..It's me again with 2nd dog Squeaker.Diabets+ Cushings and more

Thanks..I'll try that..we usually give insulin 30 minutes after eating but switched to giving at the same time of meal..And so...feed give insulin and recheck BG 30 minutes later..What should I expect the bg to be? Because it's a modified Ruby Stewbie diet, we have had a hard time, spending hours, trying to calculate the calories. Now, the R.S states 265 cal/cup?..but we don't put in the carrots or chana dal (whatever it is) in it. I'll use the calculator ..Thanks... Other calcuators say 20-30 calories/lb for 8lb 4 oz elderly dog? ?? What would dry food do? I thought dry food was bad for dogs????

[bichons9]

Re: Help..It's me again with 2nd dog Squeaker.Diabets+ Cushings and more

Thanks, Jesse, the Cushings is causing all of this but Squeaker is at DVM getting anoter Dexamethazone test..I will discuss this with the DVM...I don't know all of what to do and DVM says he doesn't either because Cushings fights against Diabetes..I did wonder if he says NPH isn't working at all, why we haven't raised it..though I raised it to 3 u. Thanks soooo much for all of your insight!!!! Oh..BTW..What was Natalie's dog's name??..I wanted to re-read the article she wrote but can't find it on my pc

[jesse girl]

Re: Help..It's me again with 2nd dog Squeaker.Diabets+ Cushings and more

I think it maybe Chris . You may want to message Natalie how to retrieve his thread as its been along time ago . Well before jesse and me entered the forum

If your pup does have cushings and treatment helps then then the dose of insulin may need to be reduced with lowering cortisol levels

[bichons9]

Re: Help..It's me again with 2nd dog Squeaker.Diabets+ Cushings and more

i FOUND IT..tHANKS FOR HIS NAME!!!! .http://www.k9diabetes.com/k9diabetes.pdf..sQUEAKER'S acth TEST CAME BACK ..THE RESULTS WERE 444..NOW 11...nOT SURE HOW GOOD THIS IS..dvm TOOK DAY OFF!!!

ACTH Stimulation (One Pre, One Post)- Canine/Feline*
Endocrinology
5/14/21 (Order Received)
5/14/21 9:14 AM (Last Updated)
TEST RESULT REFERENCE VALUE

Cortisol - Pre
ACTH
5/14/21=2.3 µg/dL ....4/27/21= 7.0

Cortisol - Post
ACTH
5/1421=11.1 µg/dL... 4/27/21=44.4

[jesse girl]

Re: Help..It's me again with 2nd dog Squeaker.Diabets+ Cushings and more

If your not apart of k9 cushings you might want to join and post your results . They do a good job over there and understand the interaction of diabetes and crushing's

[bichons9]

Re: Help..It's me again with 2nd dog Squeaker.Diabets+ Cushings and more

I joined last week and I suddenly yesterday received a response with an inquiry from a member who seems to really know Cushings!!! Thanks alot!!!