Abby's Story - 12.24.1999 to 12.31.2013 - Forever in our hearts

[Abby's Mom]

Hi,

I am new to this forum, but I have been reading the posts for about 4 weeks since my Abby (20 lbs Yorkie/Schnauzer) was diagnosed as being diabetic, glucose level 385.. after the symptons of increased thirst and urinating in her bed. She was sent home with very little instructions, NPH (Humilin N) to use 10 units 1x a day, did not matter if she ate or not is what the Vet stated. She was kept originally for 3 days to get her regulated.

Since then, it has been a roller coaster ride. I switched vets, as this vet did not believe in home testing, nor would be open to any form of communication, and felt that the once a day method was not the correct way to control diabetes.

The new Vet was more concerned about her high liver functions, and after a week on 10units a day, her Glucose levels were at 120, 7 hours after her last shot. The new Vet suggested 5 units 2x a day. Continued this for a few days, and Abby had a Hypo event. Vet then suggested to take her off of insulin thought she may have Cushings. I only monitored her by taking her to the Vet for testing, or by urine strips.

Since then we have been going down the Cushings path, and she was put back on insulin with 2 units (her glucose when tested was 285). Tested again with urine strips, and with changing to a raw diet, urine strips were negative. After 1.5 weeks, with missed insulin, fasting, as well as Aspirate test of the liver and a liver ultrasound, and a ACTH test her glucose has risen (I have no numbers... just urine test strips), and they have diagnosed her as having Cushings and wanted me to start Trilostane, and then stop the insulin the day I start Trilostane. They did see enlarged adrenal glands in the ultrasound.

Needless to say, at this time, I am just beside myself. I have not started her on the Trilostane, as what I have heard is that she could be giving false positives on the Cushing's test, in addition if she does happen to have both, then she should be regulated with the diabetes first before treating the Cushings. My vet seems to think that the diabetes is caused by the Cushings.

I'm having doubts.... her coat is wonderful, shining not falling out. Her increased water consumption stopped once on insulin. Her activity level is normal since she is on insulin. There are no other signs that I can see that leans towards just Cushings.

Your forum has been a wealth of information (I am also a member of the sister site for Cushing's) and the advice and support that you all give is a wonderful feeling, especially when you feel you are on your own.

First in order, is that I need to get a glucose meter and start to do some home testing. Do you have any suggestions? Also, I'm little frighten of the whole process, as I was originally when giving the insulin (but I have gotten use to this). Abby is not a big fan of touching her mouth in any way. Any other suggestions as to where to test?

Currently right now, Abby is on 3units 2x a day. I am feeding her a raw diet, with minced sweet potatoes, carrots, broccoli, cabbage, brown rice with either lamb, chicken, turkey or beef. The portions are 80% vegetable and 20% meat. In addition, I have added Flax Seed, cod liver. She gets a 1/2 cup of this in the PM. In the AM, she receives 1/2 cooked egg (with egg shells), oatmeal, organic pumpkin, low fat cottage cheese (1/2 cup as well) with Milk Thistle w/Dandelion. I also have added Kelp (to support the thyroid and provide iodine). For a snack (if she receives one) is a dehydradated sweet potatoe.

She originally was overweight at 27 lbs, but she is now 20 lbs.

Thank you for all that you do.

[Soaphie & Sydney's Mom]

Re: Abby Diagnosed about 4 weeks ago

Welcome!

I cannot help you with the cushings items (there are others that will reply).

You are very wise to want to start to home test. Many here use the One Touch Ultra2 meter (it's what I use on my two sugar babies). Save money by buying the strips etc on Ebay (just watch the expiration date). I test my pups on the upper lip, but some test on the base of the tail, the ear, calluses etc. There are videos on the main page of this site to show you how to go about testing.

I cannot attest to the diet you are giving Abby, but can tell you that carrots are high in sugar - my opinion is to avoid them. Also important with diet is to give the same thing each day at each feeding. It sounds to me like she is getting different food and amounts in the a.m. and p.m. I would recommend making it the exact same for now until you get a handle on things - then make small changes - only one at a time.

I'm sure others will chime in - but I do want to welcome you and to tell you that you have come to the right place! Lots of knowledge here!

Tami, Sydney and Soaphie

[jesse girl]

Re: Abby Diagnosed about 4 weeks ago

I agree with tami home testing will give you a clearer picture as to what is going on and keep her safe

my jesse is on a raw diet also completely raw for 6 months she has 80 percent meat and 20 percent vegetables the opposite of you the veggies are green leaf type processed and mixed into the grounded meat to help digestion as you said the diet has improved her health and it has reduced her insulin needs which is a plus for my jesse because she appears to have a reaction to the nph but smaller amounts seem to lessen it to almost nothing

I have learned to listen to my instincts if I did not jesse would probably not be here to day so you have to be a pain in the butt sometimes keep those vets on there toes and be an advocate for you baby I have no knowledge on cushings either but you might want to just see if you can control the blood sugar at this time and testing will definitely will help with that just a thought

welcome to both of you and you will sort this out

[Abby's Mom]

Re: Abby Diagnosed about 4 weeks ago

Thank you everyone! I am going to purchase the glucose meter today, and give it a whirl! Wish me luck, not that Abby will bite, but she can certainly dance around a bit when something is unpleasant.

Thanks for the heads up about the carrots. Some of the raw foods are good for the cushings, and not for the diabetes, and vice a versa. This is going to be difficult journey... but I will do anything for my pup!!. (Well my 11.5 year old puppy).

[CarolW]

Re: Abby Diagnosed about 4 weeks ago

Barb,

Dogs have to learn about testing blood glucose (BG) levels, same as we humans have to learn. If you take things slow and easy, and use canine calming signals, that should help you get to being able to test.

For actual testing, here are excruciatingly detailed pages, with pictures:

http://www.coherentdog.org/vek/bgtest.php

Throughout, don't be in a rush. Take your time. Remember to breathe. Use the calming signals. Give tiny treats.

And yell for help when you need it!

A Big, Fat Welcome to you and Abby!
Sun, 19 Jun 2011 01:39:46 (PDT)

[Abby's Mom]

Re: Abby Diagnosed about 4 weeks ago

Thank you Carol, that was helpful. We are learning together. I am using the "above the tail" method. It seems to be the least amount of stress for both of us. I'm realizing, however, that there is a lot of squeezing that needs to be done. After 3-5 attempts (those testing strips can be expensive, and at this rate 3or 5X more), I am successful!!

The levels have been high!

4:30PM: 375
Feed: 6:30 PM
12:30AM: 400
6:30 AM = 475
Feed: 6:45 AM

How often should I test to get a good curve?

I also got some Ketone strips, and they appear to be Negative (I'm thankful for some good news).

Thanks everyone!!

[CarolW]

Re: Abby Diagnosed about 4 weeks ago

Barb - HUGE congratulations on your SUCCESS in testing! This is the greatest tool you can have to help your dog!

Some additional remarks:

OneTouch Customer Care told me NOT to "milk" (squeeze) the prick site to bring up blood; they said that squeezes fluid from between the cells, which can corrupt the readings some. Also, there would be a tendency to bruise the tissue, and you don't want to do much of that when you'll be testing again later.

So, to aid bleeding; you can try a few things.

1) Get thicker-needle lancets. The lancets, same as syringes, with the LOWER-gauge numbers are thicker than those with the higher-gauge numbers. Some lancets aren't labeled for gauge! - primariliy, OneTouch lancets, for instance! With the OneTouch lancets, the Fine Point lancets are 25-gauge. Those should work for you, with some persistence on your part.

Kumbi and I found 21-gauge lancets were MARVELOUS! Bled first time, one prick. It's not always easy to FIND 21-gauge lancets, though.

2) Warm the site before pricking. I used a paper towel that I'd run under hot tapwater, and checked for temperature so I wouldn't burn Kumbi. Then after warming - about 15 seconds - I'd blot dry with a dry paper towel; THEN I'd prick. That helped a lot.

3) Make sure, if you're pricking by hand, to sink the needle to its full depth.

4) If you don't see blood welling up quite promptly, you can prick again, very close to the first prick-hole; then sometimes, the two will merge, and you'll get some kind of drop.

(If you get a FLOOD of blood, don't use it; it'll only foul your meter!)

There's a start; I'm sure I'm forgetting stuff. But if you try these things, likely you won't have to squeeze much. A bit of a squeeze won't hurt - just not a lot.

Those BG levels aren't bad at all, for a newly-diagnosed dog!

I'm glad you're testing for ketones; should do so when the numbers are over 300. Say, once a day.

Keep up the great work, and keep yelling for help when you want it!
Sun, 19 Jun 2011 07:27:59 (PDT)

[CraigM]

Re: Abby Diagnosed about 4 weeks ago

After 3-5 attempts (those testing strips can be expensive, and at this rate 3or 5X more), I am successful!!

As usual, CarolW has given great advice.

If you are "wasting" strips with the meter timing out before getting a blood droplet you can turn the meter on after you see the droplet form. On my meter that turns on automatically when I insert the strip, I just barely insert the strip and then when I see the droplet form I can push the strip in the rest of the way.

[HarrysMom]

Re: Abby Diagnosed about 4 weeks ago

My dog also has diabetes and Cushing's. In my dog's case, I believe that his diabetes was caused by untreated Cushing's. We knew that he was marching towards Cushings (started seeing elevated liver enzymes two years ago - did complete workup including lepto, ticks, ultrasounds, full blood - nothing found but bilaterally enlarged adrenal glands, full U Tenn Adrenal panel showing elevated estrogen initially, positive on LDDS) - but we were afraid of the treatment and delayed it as long as possible until we could not ignore all the skin infections and stomach problems (from eating all the crap out there - my dog was constantly hungry).
Elevated cortisol causes insulin resistance (meaning that body does not use insulin properly) - and pancreas ends up working even harder to produce more insulin, eventually exhausting itself.
With the ultrasound showing enlarged adrenals and elevated liver enzymes, I think your dog probably does have Cushings - esp if the ACTH stim test was positive. Usually, LDDS is a better test for the diagnosis, but it tends to have more false positives, so if your dog has other health problems, it is not the best test. ACTH test is the better test since it has more false negatives, and most experienced vets use this test to diagnose Cushing's in a diabetic dog.
You can aggressively start treating the diabetes first. We stopped Trilostane for a few months when we started our dog's diabetes treatment, but we ended up re-starting the treatment because we really could not get a good handle on blood glucose without this treatment.
With Trilostane, Harry's proteinuria (protein leakage in urine) and elevated liver enzymes all became significantly better.
If you are starting the Trilostane treatment, start slow and low. UC Davis protocol is to start at 1mg/kg once a day, but with diabetes, it is better to do twice a day dosing (0.5mg/kg twice a day). You should run the stim test about 10-14 days after the initial dosage.
Note that the ACTH stim test stimulates production of cortisol - so after the test, your dog's glucose level will likely run high for a day or two.
Hope this helps.

[HarrysMom]

Re: Abby Diagnosed about 4 weeks ago

What was your dog's stim test results? Once again, if your dog tests positive through the ACTH test, she likely does have Cushing's - esp if she has all the symptoms (hunger, hair loss, elevated liver enzymes, sometimes protein in urine, muscle loss, skin problems, thirst / urination).
You should think about switching to fish oil (from deep sea sources to avoid mercury). Cod liver oil has too much Omega 6 (your dog already gets that from his food), not enough Omega 3 and too much vitamin A and mercury.
Keep an eye on your dog's glucose level after sweet potato snacks because these will likely raise the glucose level.

[Abby's Mom]

Re: Abby Diagnosed about 4 weeks ago

Harrys Mom: I only had her on Trilostane for 2 days, but her ACTH test was 26 (I believe the high range is 22). She has now been off of Trilostane for 3 days, until my Vet gets back tomorrow. I am very prepared to talk with her, thanks for everyone on this forum. We did not do the U Tenn Adrenal panel, which is something that I am going to request. The other concern I had is that they started her with 30 mg 1x a day. So, another reason why I had my doubts to continue, and my vet was away for the week.

Her only sympton for Cushings is increase thirst (but I believe this is related to her BG, because when they are under 400, her intake is normal). No skin issues. She did have a potbelly, but that is gone now with the weight loss. Of course her liver enzymes were high, but they were in fact lower last time we check without any therapy. Her hair grows fast and is a beautiful coat. I groom her, and I typically have to give her a cut every 4 weeks. She is hungry, and she has lost some weight. This could also be related to the Diabetes. When she was normal for those few weeks, and we were giving her a low dose of insulin, she did not have any symptons. In fact everyone comments how well she looks. I am not saying that she does not have cushings, but all the symptons go away when she has normal BG levels, which makes me think why put her through the Trilostane, unless we can not get her regulated.

I have been pricking away (this is a joke of course)... I have found that her levels are the following today:

6:30 am 475
10:30 am 325
2:30 pm 345

I will be testing again in a few hours. Abby doesn't seem to mind, that boil chicken works like a charm. I have removed the sweet potatoes and carrots from her diet, and hopefully we will see better numbers with more greens and meat. I will switch to Fish Oil (mercury free), as well thanks for the heads up. Craig, I was wasting strips because I thought I had enough blood, when I didn't.

Carol, thanks for the all the advice. I will be on the look out for the 21 gauge lancets, and will use the warm paper towel to see if this helps any. I do put some aloe on the site afterward, just so she doesn't get too sore.

Both Abby and I can be very impatient, and I can't believe that we have been learning so much patience lately.

Thanks everyone.

[HarrysMom]

Re: Abby Diagnosed about 4 weeks ago

30mg is WAY too much starting dosage for a small dog weighing 20 lbs - esp when the ACTH did not find that much elevated cortisol, and Abby did not show much symptoms. In Harry's case, hunger was really out of control - esp since he used to be a very very picky eater. He was continually finding things to eat on our walks (poop, insects, everything in sight) - he was constantly picking up stomach bugs as a result.
In addition, after each ultrasound, his tummy hair took about six months to grow back. Since Trilostane, he is getting his hair back, and hair does grow back quickly.

[jesse girl]

Re: Abby Diagnosed about 4 weeks ago

maybe you might want to determine the low point of the day the low point of the day is some where between 10:30 and 2:30 you might want o test every hour until you see a rise above the low point it is a nice thing to know when numbers are in a lower range the action of insulin is very consistent with my jesse and she usually rises at the same time if that has changed it has usually been the insulin loosing potency or she may have picked up a snack some where along the way

[CarolW]

Re: Abby Diagnosed about 4 weeks ago

Barb! You have EARNED your k9diabetes Patience Hat!

Here it is:

http://k9diabetes.com/forum/album.ph...&pictureid=765

GREAT work. Abby has earned her k9diabetes Patient's Hat! Here it is:

http://www.coherentdog.org/tidberries5.php

GREAT work, Abby!

I like the Aloe Vera idea!
Sun, 19 Jun 2011 16:27:34 (PDT)

[Abby's Mom]

Re: Abby Diagnosed about 4 weeks ago

Thank you Carol.... that reward was greatly appreciated.

I will be testing again today, but I am pleased with how the numbers are going.

I am giving her 4 units now (all last week she was on 3), and we are starting at 334 this morning, when yesterday at this time we were at 475. So, I am hoping that her low point will be below 200 today. I will test every 2-3 hrs, but will see if I can test a little more between 10:30 and 2:30. JesseGirl, I noticed yesterday that Abby's low point was somewhere between 12:30 and 3:30. She was 332 at 12:30 and 259 at 3:30, and back up at 284 at 9:30 last evening. I only gave her 3.5 units last night because we were going out for the evening.

Thanks everyone... I'll let you know what the vet suggests when I talk with her.

Harry's Mom: It is good to know that you can control both the Cushings and the Diabetes. I am hoping that we can shelf the Cushings for now, and I feel better with her BG numbers. I can't believe that Harry was eating bugs and everything else outside. I walk Abby without a leash in our neighborhood, so she would definitely have the opportunity to eat most things, but she doesn't seem to have that sympton (again when the BG's are getting closer to 200), she seems to have a normal appetite. She always had a good one.

One other concern I have is that from my readings is that cataracts is inevitable, and most dogs do go blind. Is this my assumption, or do you find that if you can control the diabetes, that the cataracts are slow in growing, or is it a given that she will go blind. She does have the beginnings of cataracts now. Some days her eyes look clear, and others they look cloudy ( when her BG levels are high, they are cloudy and when low they are clear). Anything preventive I can do?

I can not thank everyone enough, and I feel better knowing that you are out there, and I have the meter and I feel I am more in control in what is going on.