My Zoe's Journey- Zoe has passed

[Zoe's Mom]

Hi Everyone,
I am a member on the diabetes board, and I've read this board from time to time. I have a wonderful 10 year old mini schnauzer who has diabetes, cushings, an ever worsening heart murmer, and just last weekend pancreatitis. Her diabetes and cushings were relatively well controlled on 19 units of NPH 2x a day and 50 mg Trilostane in the mornings until the pancreatitis hit. Now that she's home recovering from pancreatitis, I've seen a massive need to re-adjust her insulin. We initially reduced her to 10 units 2x day, but then 2 days ago, I checked her BGs and she was at only 56...Holy Cow! I had only gotten her below 200 two times in her life and that was on the 19 units NPH. So, I gave her maple syrup with rice multiple times and by bedtime she was at a comfortable 109. So we skipped her pm shot. Anyway, the next day she awoke at 260, so I gave her just 5 units, and noted that by noon she was down to 99 and since we were running out I gave her some maple syrup with rice. So, then 3 hours later she was at 331. And she continued to climb until shot time and got a "HIGH" at 7 p.m.. I gave her 5 units at bedtime, and this morning she was still at "HIGH." So, stupidly, I moved her back to the 10 units the vet had her on. When I checked her at noon today, she was only 51...so more maple syrup & rice. She's been snacking on the stuff all afternoon and is still hovering around 70. So, I am wondering, what the heck? The vet thinks maybe she is producing some insulin now as a result of the pancreatitis. But, then I wonder, why the heck was she HIGH this a.m. on 5 units when I know yesterday it got her down to at least 99 (and surely more without the maple syrup) and previous to pancreatitis the insulin had been lasting 12-14 hrs per shot. So, then I was thinking about the symogi effect & possibly moving her down to 4 units for a couple of days to see if that has an impact and levels her out more. Also, it was suggested that maybe her cortisol levels are high due to the pancreatitis and that is causing increased insulin absorbtion. I was wondering if anyone out there with diabetic/cushionoid dogs have had pancreatitis and experienced something similar? I am wondering if maybe her Trilostane dosage should be reduced? If anyone has any ideas, I would appreciate hearing them because I am just puzzled over this.:confused:

[Barney's Mom]

I have a dog who is recovering from pancreatitis now as we speak. No diabetes though. The only things I can think of are if his diet was changed due to the panceatitis, and if he has had weight loss. Those things could result in less insulin being needed?

[Wylie's Mom]

I'm sorry I can't help with your question, but maybe you can find something in this site that may help to prevent further episodes of pancreatitis:

http://www.dogaware.com/wdjpancreatitis.html

-Susy

ETA - I'm thinking this still doesn't answer your question, but here is a site that explains the diabetes-Cushing's connection... I don't know how accurate it is and you may already know the connection;):

http://petdiabetes.wikia.com/wiki/Cushing's_disease


The basic connection between Cushing's and diabetes is this: the excess cortisol produced by the faulty adrenal gland is a signal for the body to produce new, non-sugar sourced glucose (Gluconeogenesis).

When this additional glucose reaches the bloodstream, another signal goes off; this one to the endocrine pancreas to produce more insulin to handle the glucose present in the blood.

When the insulin production ability of the pancreas can no longer keep up with the additional blood glucose which the excess cortisol from the malfunctioning adrenal gland keeps emitting, the islet cells of the endocrine pancreas are exhausted, and diabetes results[9]. In effect, the overproductive adrenal gland has the capability to "burn out" the insulin producing capability of the pancreas.

If the islet cells of the pancreas are still able to produce sufficient endogenous insulin for the body's needs, controlling the Cushing's will also control the blood glucose, meaning there would be no need for insulin injections. If the pancreas' islet cells have sustained such damage as to be unable to produce enough insulin for the body, insulin shots are necessary.

For dogs with both Cushing's and diabetes, the key to starting or maintaining regulation is effective control of the Cushing's. Ending the excess of cortisol production allows the diabetes to be managed. In cases where Cushing's is the primary condition, causing transient, or secondary diabetes, it may be possible to return to non-diabetic status with successful management of Cushing's.

[rhodesian46]

Hi I had a Siberian Husky named Pebbles that had Cushings,hypothyriodisn, and diabetes. Also had a bout of pancreatitis. She was on 49 units of Novolin N at 55 lbs. After having the bout her insulin dosage was reduced. I believe she went down to 38 u BID then up to 42u BID.

I am wondering what kind of meter you are using and if you had the meter calibrated with your vets ? As a human meter will be lower than a dog meter. Second when was the last time an ACTH stim test was done? Have you increased or decreased the trilo per your vets instructions? Also after the bout of pancreatitis with Zoe did your vet switch to a lower fat food? Dogs with pancreatitis episodes need a low fat diet. As you know already cush pups and diabetic dogs are prone to getting this. The system is also compromised Has blood work been done?Am not sure when Zoe was diagnosed with Diabetes and Cushings. Can you tell us?

With Pebbles her diagnosis with diabetes was first then Cushings a few months later. We believe she had had Cushings for quite some time though. So once the trilostane was started an ACTH Stim test was to be done in a week. then 30 days thereafter. The IMS expected (her insulin dose to decrease and wanted me to watch for this and to do weekly curves( 12 hour) and to do fasting bg's and one one mid day every day in which I did. With the curves being done weekly the IMS could direct me to decrease NPH insulin or increase it. Pebbles did not folllow the insulin decrease as expected .

With diabetes and Cushings it makes it very frustrating. The most difficult complications of these 2 illnesses is that they both have the potential to exacerbate the diabetes. This is because the excess steroids antagonize the effects of the insulin.That is why I had to keep a close eye on Pebbles bg's because if she needed a decrease and I didn't check her bg's then I could end up with a hypo (hypoglycemia) incident (stumbling,seizures,comatose state,vomiting etc.)

For dogs with both Cushing's and diabetes cushings needs to e controlled first. Lowering the cortisol production will in turn allow the diabetes to be managed.

With pancreatitis a low fat diet should be fed. Pebbles was on Purina OM. When she had her last chemistry panel her triglycerides were sky high.Because of the 2 diseases it is not uncommon for these to be elevated due to the fact that these disorders change the way the body metabolizes fat.And high triglycerides can cause pancreatitis besides causing seizures,vomiting and diarrhea. So I would recommend having a chemistry panel done . Whenever we had an ACTH stim test done we also did a urinalysis ,chem panel and electrolytes. Pebbles was on Purina OM( high fiber and low fat food) but the IMS wanted to change her to a lower fat food called Royal Canin LF 20. She was put on fish oil twice a day to help with the triygleride level.

It is important that dogs with complicated disorders be seen by an experienced vet. Most general vets don't have the experience with the balance act of these disorders. That is why I took Pebbles to an Internal Med Dr. It is also important to have a Dr. that has told you what to look for as far as too much insulin,decreasing trilostane, increasing etc. And a vet that knows the protocol for Trilostane as far as when to do ACTH Stim tests and any other tests that need to be done along with this and to dicipher these tests. I hope that I have helped.



Marianne

[k9diabetes]

Cush Trilostane folks... is the trilostane dosage affected by severe illness?

Natalie

[labblab]

Cush Trilostane folks... is the trilostane dosage affected by severe illness? Natalie
I'm afraid that I, for one, do not know the answer. But I'm guessing that anything that affects a dog's metabolism will affect the efficacy of the drug's action. For instance, since Dechra recommends that trilostane always be given with a meal for maximal absorption, it seems as though a dog who is suddenly not eating or drinking normally may end up with a differential drug effect. If the drug is not being absorbed as efficiently, you would think that the cortisol level will trend higher...

Marianne

[zoesmom]

Hi - from another Zoe's mom (zoesmom, here).

I've been watching your thread to see if anybody had an answer for you. Since I don't have any experience with diabetes, other than what I've learned here and at Natalie's board, I hesitated to comment. I think most of the others here feel the same way.

But my Zoe does take trilostane and has suffered bouts of pancreatitis - and a number of other things. Pancreatitis is painful and to me, it seems like that pain would increase the dog's cortisol and make the dog's normal dose of trilostane (and maybe the insulin???) slightly less effective? One time Zoe had a severe bout of pancreatitis and was so sick that I stopped the trilo and gave her prednisone, instead. We were out of town and I have no idea if that was a good idea or not, but she wasn't eating anyway, so that meant no trilostane. Anyway, I have come to suspect that some of Zoe's meds do interact and affect how one or the other is being absorbed. But beyond that, I don't have any real concrete advice to give.

In my Zoe's case, it's come down 'tweaking' her doses a little bit until things seem to settle back down. She takes a bunch of stuff besides trilo - thyroxine (thyroid), bromide (for seizures), proin (incontinence), and either a tramadol or meloxicam for arthritis (not to mention her glucosamine, melatonin, cranberry extract (utis') and freqently antibiotics.) So as you can guess, there are plenty of opportunities for drug/supplement interactions. One suggestion: A doggy Journal. Keep one. That has helped me in the past, when I wasn't sure what was going on. Note any dose changes, any symptoms, test results, etc. Then, you might find that as you read and reread back over it, you may see a pattern and some things will start to make more sense. Wish I could be of more help. Sue/Zoe

PS - we do have quite a few members who are dealing with both cushings AND diabetes. But I think most of them are also on the k9diabetes board and have probably commented there already??

[Zoe's Mom]

I am wondering what kind of meter you are using and if you had the meter calibrated with your vets ? As a human meter will be lower than a dog meter. Second when was the last time an ACTH stim test was done? Have you increased or decreased the trilo per your vets instructions? Also after the bout of pancreatitis with Zoe did your vet switch to a lower fat food? Dogs with pancreatitis episodes need a low fat diet. As you know already cush pups and diabetic dogs are prone to getting this. The system is also compromised Has blood work been done?Am not sure when Zoe was diagnosed with Diabetes and Cushings. Can you tell us?

the IMS wanted to change her to a lower fat food called Royal Canin LF 20. She was put on fish oil twice a day to help with the triygleride level. Marianne

Hi Marianne,
I am using a Freestyle Freedom Lite and it has not been calibrated with the vets meter.

The last ATCH test was last March. The pre was .9 and the post was 1.3. Trilo has never been adjusted. The vet is comfortable with where her numbers have been since we got her on the 50mgs.

Zoe was diagnosed with diabetes in April 2007, and cushings in January 2008.

Bloodwork was done on 7/31. She also had a full panel done in mid-June before she had surgery to remove a rupturing cyst. I don't have copies of those reports.

The bout of pancreatitis just ended. We've had her home from the vet for a week, and they had her on a rice/cottage cheese or rice/boiled chicken diet given in very small (a couple of tablespoons) very frequently throughout the day. Starting yesterday I started to substitute in Hills I/D which I understand is very bland. Prior to the pancreatitis, she was on Purina DCO which I understand is high fiber. Do you think the I/D is low in fat enough? Or should we also put her on the Royal Canin LF 20?

We think the pancreatitis was brought on by her chewing on the chew sticks our puppy chews. Zoe hasn't had them around since she was a puppy, and it surprised us that she really seemed to like them in her advanced age. So I let her have them whenever the puppy had one. Big mistake. So, I am hoping that by keeping the chews away from her we won't have any repeats.

I'll check with the vet on her triglyceride levels from her June & July blood work and ask about fish oil for Zoe. How much fish oil do you give your pup?

Unfortunately, my husband says that he's done paying for any more expensive tests for Zoe. :( She's about broken the bank over the last two years... we have children to raise, college to plan for etc.....

Thank you so much for your help! Sincerely, Sandy (and Zoe)

[rhodesian46]

Pebbles was 55 lbs and was on 100o mg of fish oil 2 x a day. When her triglycerides came back high the IMS wanted me to gradually increase to 2000 in the morning 1000 in the evening for a few days. Watch for diarrhea as too much too soon can cause this. Then after a few days we increased to 2000mg 2 x a day.

Pebbles last food was Purina OM. The IMS wanted to switch to Royal Canin because it was lower in fat. You ma have to add some fiber such as green beans( not in a can) But frozen, I got mine from WalMart or Costco( their organic green beans). I also gave Pebbles Metamucil for fiber ( sugar free of course) .

I am hoping a mod can come on as far as the ACTH stim test of Zoes. I would of thought that the vet would of decreased the trilo dosage with pre and post that low. Was the ACTH stim test done March 2009? I know that if Pebbles ACTH stim was within range and no dosage increase or decrease was warranted then the IMS wanted her back in 3-4 months to check her again( ACTH stim,electrolytes etc). If we had a decrease or increase in Trilo then the ACTH stim was done again in 2 weeks.

When Pebbles had her bout with pancreatitis and was hospitalized A & M never did an ACTH stim test. That wasn't a concern . They were more concerned with any vomiting,weakness, inappendence which in turn would lead then to do an ACTH stim test. Also with pancreatitis there would be some discomfort in the abdominal area. Also her electrolytes.

I would address the food issue with your vet and compare the fat content. Lowfat is preferable. As far as the ACTH stim your vet should be able to tell you when the next one should be. What I would be afraid of is the Cush pups can produce less cortisol and be pushed into an Addisonian stage. So it is important to have a plan and know what to look for.

[k9diabetes]

My apologies as I didn't have time to write more earlier...

What Sandy is seeing with Zoe since she recovered from the pancreatitis attack is a marked reduction in the need for insulin... as in going down from 19 units twice a day to only 5-7 units twice a day.

Which is what made me think about an Addison's type effect here since a lack of cortisol makes the body extremely sensitive to insulin. Also considered that perhaps there has been chronic pancreatitis for some time that was raising the insulin need that now has been relieved...

I see from what Sandy posted that the 50 mg was keeping Zoe's cortisol levels quite low... So it seems possible that 50mg of Trilostane is just too much for her now.

I just posted on the K9D thread (http://www.k9diabetes.com/forum/showthread.php?t=147&page=17) that perhaps she could afford just a baseline cortisol test - save the cost of stimulation and the second blood test - to see if the baseline cortisol is too low. That might not be terribly expensive. I think the stimulatory drug alone is a fair amount of the cost.

Natalie

[rhodesian46]

The cortrosyn (cosyntropin) is expensive as the amount used is by weight.

[ventilate]

Hi;
As far as fish Oil goes. my vet and IMS told me it was the EPA and DHA that were important, the higher the better. I also use the Nortic essentils Omega 3 fish oil. it has the highest amount of EPA and DHA I think it is 825 mg and 550mg in a teaspoon or 5 ccs. Nike and kenai both get 5 ccs per day. it is good for their hearts as well as for arthritis. I have tried to find caps that had that high of EPA and DHA and have not been able to find any, rather I could find some but would have to give 5 or so pills so was waymore expensive. I found a site where it had listed how much fishoill to give a dog, try googling fishoil for dogs or proper dosage of fish oil for dogs.
cant help with the pancreatitis or diabetes, nike is cushnoid and has DI and hypothyroid so no help to you.
Sharon

[Zoe's Mom]

Hi Natalie,

I saw your post on the other board.

It does look from Marianne's post that at least Zoe's reduced need for insulin mirror her pup's response after having pancreatitis. So, I do have some comfort in that.

But, I also certainly don't want to end up in an addisonion crisis -- which is what helped kill my sweet Sadie in May. I also see your point about a possible chronic pancreatitis which would mirror the almost constant need to slowly increase in insulin dose...although she had labs done in June before surgery and the vet didn't see anything suspicious; wouldn't pancreatitis have shown up on those labs?

I'll call the vet tomorrow and check into the cost of a baseline test & discuss food with him. He did confer with a specialist on her for each stim test she had done, and they concluded, even though low it was a reasonable number especially since all of her symptoms resolved.

THANKS again everyone! Don't know what I would do without you! Sandy and Zoe

[k9diabetes]

Advice please... best time to run the baseline cortisol test if Sandy does one?

I'm thinking one to two hours after Trilostane to see how low the cortisol is going from the med...

Natalie

[k9diabetes]

As I understand it, low simmering chronic pancreatitis can be extremely difficult to diagnose. I want to say that it's only recently been recognized as a problem. I am pretty certain that a standard blood panel would not pick it up. And I'm not even sure if the Pancreatitis test they have now picks up the chronic subacute type.

[lulusmom]

According to Dechra, the manufacturer of Vetoryl, the best time to test is 4 to 6 hours after dosing. U.C. Davis has developed their own protocol and they indicate that Trilostane is at its peak effectiveness 1 to 3 hours after dosing. When my two cushdogs were taking Trilostane, the first draw was done 4 hours after dosing.

Glynda

[rhodesian46]

The abdominal area may be tender when palpitated. May be the start of a pancreatic attack

Also Texas A & M developed a test for pancreatitis It is called the Spec cPL test.If positive then the dog may have pancreatitis. But would like to add that this test was used at Texas A & M before Pebbles passed. The necropsy showed no pancreatitis. SO there are exceptions to every test I guess.

Could you find another vet to do the ACTH stim test more reasonable? Maybe call around. But be prepared that if in fact her Acth warrants a decrease that you will have to repeat this test a few weeks later. With the ACTH stim should be an electrolte test as well. Not very expensive to do that.

I just don't want to see Zoe get really sick. Some of the symptoms of Addisons such as lethargy mimic overdosing of trilo. So it is real important to watch her like a hawk as 2 endocrine disease are more difficult to manage

If I may add the fish oil is 3-5mg per lb of weight. Of couse I would ask your vet as well.

Marianne and Angel Pebbles

[k9diabetes]

I don't think the ACTH is a test a vet would do on a dog that is not his/her patient - I guess I hope they wouldn't anyway. And as long as Zoe is feeling okay - eating well and feeling well - I don't know that you would need to check electrolytes either. A dog who is extremely low on cortisol, so low that the electrolytes are off, usually feels pretty awful.

I'm not concerned about the presence of Addison's disease, only of the possibility that 50mg of Trilostane is now too much, especially since that dose was keeping the cortisol at a pretty low level already. It wouldn't take much to make the 50mg too much. You would definitely know if she had Addison's disease as that combined with giving her Trilostane would be a very deadly combination and she would be a very very sick little girl.

It could be there's a bit of both effects - decreased inflammation in the pancreas and a little too much Trilostane both at work to make her more sensitive to insulin.

Here's a bit of information on the test for pancreatitis:

IDEXX: http://www.idexx.com/animalhealth/laboratory/speccpl/

Texas A&M: http://www.cvm.tamu.edu/gilab/assays/cPLI.shtml

Interesting note in the Texas A&M GI lab material:


Finally, we believe that there are certain dogs that should be checked for possible chronic pancreatitis regardless of any clinical signs. Currently, we believe that any dog treated with potassium bromide and any miniature Schnauzer that presents with vague clinical signs should be tested.

Apparently there's a lot of concern about simmering chronic pancreatitis in mini Schnauzers.

Natalie

[k9diabetes]

Thanks Glynda.

I know this isn't how it's typically done... Sounds like 4 hours after the Trilo is given would be a good time to do the test.

Natalie

[k9diabetes]

Sandy,

Does Zoe take 50 mg once a day or twice? It looks like she was on once a day back in March.

Especially if she takes it only once a day, when does she take it?

The Trilostane could be lowering the cortisol too much only in the 3-8 hours after she takes it so could be driving the blood sugar low at that point.

Natalie

[zoesmom]

Just a couple of quick comments. Natalie has commented on an important factor and one which I would think would be even more important in a diabetic dog - where you need to keep things fairly constant throughout. If Eden is only on an sid (once a day) dose of trilo, I would wonder if bid (twice a day) dosing wouldn't be better. Over the time I've been a member of the cushings board, I've seen the recommended once a day slowly become twice a day for most cush doggies on trilo. Our Zoe has even done tid (3). We started with sid, and now she's been on bid for some time and it seems to work best for her (and most of the other trilo pups here, too.) But maybe some of our trilo/DM owners will comment on their dogs' trilo dosing. Just seems to me that two doses, 12 hours apart, would work better.

If you are just giving once a day, then going to twice a day almost always requires a decrease in dose. And given those low acth numbers, that makes even more sense. I don't know if they shoot for lower ACTH numbers in DM dogs, but those are pretty low, regardless. The recent thinking for dogs on trilo is that that post ACTH number be somewhere between 2.5 and the low 7's. Eden's numbers were below that, and if I recall, you said her baseline number was below 1. To me, that's a concern. Now how this plays into her insulin requirements, I have no idea. When was the last time your vet consulted with the specialist??

I guess, given those low ACTH numbers, that I would still do both the baseline and the post number, on her next ACTH. 'Cause I think you need to make sure that there is a stimulatory effect and not a flat or negative effect (i.e. where the pre and post numbers are equal or the post number is actually LOWER than the pre#). That could indicate a need to stop the trilo for awhile (or in rare cases, remission of cushings) When things were going along ok, then that's when I think you can get away with skipping the baseline and just getting the post number. We do that most of the time now for our Zoe, just to save a little on costs.

But back to the dosing. If you were to decrease the trilo (i.e. go to twice a day dosing, assuming she's on once a day), that 50 mg. sid should probably become something like 30 mg bid. Again, with her already low numbers, tho, I think an even more conservative approach might be wise. In other words, 20 or 25 mg. bid would be the best place to start in a transition, just to be safe.

It's so trickly managing the two diseases together. But maybe these are some suggestions that your vet could run past that specialist. Sue/Zoe

PS - one other thought on the cost. If you are giving one dose a day and decide to go to two (using a lower strength, of course), you might be able to get away with not doing an acth first. A considerably lowered dose (like the 25 mg. bid), given twice a day, would surely allow her cortisol to creep up a little bit and then, assuming she had no adverse reactions, you could probably just do the post # on the ACTH test at ten days (after the dose change.)

[labblab]

PS - one other thought on the cost. If you are giving one dose a day and decide to go to two (using a lower strength, of course), you might be able to get away with not doing an acth first. A considerably lowered dose (like the 25 mg. bid), given twice a day, would surely allow her cortisol to creep up a little bit and then, assuming she had no adverse reactions, you could probably just do the post # on the ACTH test at ten days (after the dose change.)
Sue is absolutely right that we have had a number of pups here who have done very well with twice-daily trilostane dosing. However, a recent comment by a member of our website who is a veterinary endocrinologist (Dr. David Bruyette) has made me revise my own thinking a bit re: the advisability of making the switch unless there is evidence that once-daily trilostane dosing is not adequately controlling a dog's Cushing's symptoms throughout a 24-hour period.


...With regards to once vs twice a day dosing if we look at all the studies throughout the world you will see that about 80% of dogs do well with once daily dosing. One huge advantage of once daily dosing is owner compliance which goes up substantially when owners only have to dose once a day. While twice a day dosing may result in a lower amount of trilostane being used pre day it will require closer monitoring as the ACTH stimulation tests tend to be lower so we have to look for both hypocortisolemia and electrolyte abnormalities.

Dave Bruyette DVM DACVIM
Prior to reading Dr. Bruyette's comment, I had also assumed that splitting the daily dose into halves (and giving 12 hours apart) might tend to allow the cortisol level to drift upward. But from what he is saying, the opposite is the case, and a dog on a twice-daily dosing schedule needs to be monitored and tested even more rigorously. If that is so, then that may not be the best solution for Zoe given the testing constraints.

Of course, the original question that was posed to Dr. Bruyette did not involve a diabetic dog. So I don't know whether or not that would alter his comments. Perhaps there would be a benefit from having more a more consistent cortisol level throughout an entire 24-hour period that would offset the "negatives" associated with a need for closer monitoring? I just don't know -- I think that would be a great question for the specialist.

Marianne

[ladysmom06]

Hi Sandy,

But maybe some of our trilo/DM owners will comment on their dogs' trilo dosing.

Lady had diabetes, cushings and was on trilo. We always did once a day dosing. Her IMS liked to keep her cortisol #'s low. She did very well on the once a day dosing - never had a return of cushings symptoms. She weighed 10 lbs and was on 30 mgs of trilo. She never had pancreatitis so I can't comment on that. Hugs to you and Zoe.

[Zoe's Mom]

I just posted on the diabetes board. Now I am doing the same on this board just so I don't miss any good advice or thoughts.

I just got home from being out for a couple of hours, and after feeding her some dinner, I noticed a spot on the carpet indicative of Zoe having vomited her snack of 3 TBS rice with 1 TBS kibble while I was out. She seems to feel fine otherwise. Called the vet. They don't seem alarmed. But said tomorrow we are back to square one feeding even smaller meals again with rice & chicken. I haven't even checked her BG tonight, throughout today she was mainly in the upper 200's on 6 units. I gave her 4 tonight just in case she vomits again..... :eek:

Also she is getting noticably thin again, although I guess I would be too if I were eating just a couple of tablespoons rice every few hours.

[Zoe's Mom]

She takes the Trilo each day around 7:30 a.m., when she gets her shot. The peak on her NPH appears to be around 7 - 8 hrs later. It would be interesting to see how her curve would be affected if I dosed her with Trilo at night instead.

[Dollydog]

Hi,
I'm going to give a brief comment now but will be back to elaborate. When Lady had a pre number of .9, her next pre number was .43 so we backed off of her trilo dose and went to twice daily dosing. Her single daily dose had been 35mg for a 15lb dog, her twice daily dose is 15mg each time for a total of 30mg a day. That brought her numbers back up a little more.
I like twice daily dosing for a diabetic dog....it makes more sense to me. It's also very easy to give 2 doses of trilo in a day to a diabetic dog as we are on a 12 hour schedule anyway. If Dr. Bruyette is talking about a non-diabetic pet then "owner compliance" does not apply to us diabetic/cushings owners!! ;)
Be back later with more details,
Jo-Ann & Lady :)

[Dollydog]

Back again, not sure if this is going to be helpful or not but here goes:

After 10 days on trilo Lady had perfect numbers on 60mg sid.(Jan.8/07)

Apr. 19 pre 1.3 post 1.2 -----so she was put on 40mg sid

June 14 pre .7 post 1.2 -----so she was put on 35mg sid

July 9 pre 2.5 post 3.6 -----so no change in dose

Dec 4 pre .91 post 2.7 -----so no change again

May 27/08 pre .43 post 2.79

Our vet in Nevada is the one who prescribes the trilo and he didn't like this last pre number and neither did I or the specialist that he consults with, so her dose was changed to 15mg twice daily. Her stim test on
Jan 6/09 pre 1.3 post 2.8
And we're quite happy with that dosage.

My husband is retired and we're on a fixed income so I certainly understand budgets limitations. It's very difficult to treat a pet with multiple health issues but as Lady might be my last dog I'm trying very hard to take care of her as long as we can manage it.
Must run but will post again if I've forgotten anything,
Jo-Ann & Lady :)

[Zoe's Mom]

Thanks JoAnne & Lady,
I'll compare your numbers to all Zoe's stim tests to see if I can make heads or tails of where she's at.

She had a better day today. No vomiting and her BGs look good. :)

Sandy

[Dollydog]

That's good news!! Always like to see that food go in and come out right!!:p
Jo-Ann & Lady :)

[Zoe's Mom]

It is with sadness that I let you all know that my sweet Zoe died in my arms this morning. :( She never truly got over the pancreatitis, and had another attack yesterday. She was her sweet stoic self all the way to the end.


Sandy

[lulusmom]

I am so sorry for your loss. My thoughts are with you during this very difficult time.

Godspeed sweet Zoe.

Glynda

[Squirt's Mom]

Oh Sandy,

I am so sorry to hear this but I am glad you were able to hold her while she crossed The Bridge. Zoe is now pain free, whole once again, strong, and full of love and gratitude to you for all you have done on her behalf.

Hold the memories of the good days as close as you have her all these years and know that she suffers no longer.

Our deepest sympathies,
Leslie, Squirt, Ruby, Goldie and Crystal

[Harley PoMMom]

Dearest Sandy,

I am so sorry to hear of the loss of your beloved Zoe...our earth has lost such a beautiful furry angel.

You are in my thoughts and prayers.

With heartfelt sympathy,
Lori

[Roxee's Dad]

Dear Sandy,
I am so sorry for you loss. Our thoughts and prayers go out to you and yours. Sweet Zoe knows she was loved and will be watching over you.

[corgipallie]

I'm so sorry about the loss of your Zoe. I'm only 3 weeks ahead of you and I am hurting all over again for you. Please keep the tears flowing as you need to and we are all here for you for as long as you need us.

Steph and Pallie forever

[Bagel's Mom]

I just had a strong urge to come on here and look around..Now I know why...
I am sooo sorry and I know that void from earlier doggie days...

Please know I am saying a prayer for you and hope you will be able to find comfort some day soon in your warm memories.....and for comfort now as you mourn your sweet baby....

Sande- Bagel's Mom

[gpgscott]

Sandy,

I am so glad she had the comfort of your arms right to the end and she now resides in the comfort of your thoughts and memories.

I know there will come a time when the memories which are now painful will bring a smile.

Mine will all get special attention tonight in the memory of your Zoe.

Scott

[Wylie's Mom]

Dear Sandy,

I'm so sorry for the loss of your sweet Zoe. My thoughts are with you.

(((Hugs)))
-Susy

[forscooter]

Sandy,
I am too also very sorry to hear about Zoe. I understand your pain and my heart hurts for you....extra special prayers for comfort for you...
Beth, Bailey and always Scooter

[MiniSchnauzerMom]

Sandy,

I am so sorry that your precious little MiniSchnauzer girl Zoe has passed. My heart aches for you.

Peace be with you sweet Zoe.

With deepest sympathy,
Louise

[sunimist]

Dear Sandy,

I am so very sorry to hear about your precious little Zoe. My heart aches for you and tears are falling for you as I can feel your agony and pain of losing her. We are just never ever prepared to let them go, but they take with them every ounce of our love, and leave with us every last bit of their love to cherish forever.

I am so glad you were with her to the end. That will always mean so much to you, and to her.

My thoughts, prayers and love are with you and your family at this darkest time.

Shelba, Suni and Angel Misty

[Carol G]

I am so sorry for your loss. My thoughts are with you.

Carol

[BestBuddy]

Sandy,
My thoughts are with you.
Godspeed Zoe.
Jenny

[frijole]

Sandy, I am so sorry to hear of your loss and am glad that you were holding Zoe as she passed over the bridge. Rest in Peace dear Zoe. Kim

[Dawn]

Dear Sandy so sorry to hear about zoe's passing we are thinking of you - RIP

[SaxLady]

Dear Sandy,
My heart breaks for you. I know exactly how you feel, as I lost my beloved little Katrina on August 19th. Words could never express the sorrow I feel for you.
Much love and comfort.
Candy, always Katrina, Joe and Heidi

[John II]

Dear Sandy,

I'm so sorry to hear about Zoe.
My thought and prayers are with you.

[muskyhusky]

I'm so sorry for your loss, my thoughts and prayers are with you.:(
Lynne

[jrepac]

very sorry to hear of Zoe's passing...I lost my first Aussie to diabetes and pancreatitis....it is very tough...

Jeff

[Dollydog]

Sandy,
I'm so sorry to hear of Zoe's passing.....I've been going over some of your threads, here and on the diabetes forum. I know how hard you've worked for your dear sweet dog....so much of your story together is so familiar to us. I need to read more of it.
Please take good care of yourself at this time and come back to let us know how you're doing...
((((HUGS))))
Jo-Ann & Lady