Ben
03-20-2016, 11:50 AM
Dear all,
Thank you for allowing me to join this forum as I am in dire need of information. I have been referred here by the k9diabetes forum.
To start with, let me introduce Ben. Ben is a 10-year old cross-breed, but looks like a toy Manchester Terrier. He weighs 8kg (weighed 10 kg in Dec 2015 when he was diagnosed with diabetes and had lost weight rapidly over the 6 weeks before his diagnosis as he was overweight) and is about 35 cm tall (therefore, not really a toy-sized dog).
We were noticing that Ben was drinking enormous quantities of water and also peeing frequently. We started having house incidents, he had to go out around 3 times / night to pee, and every time there were huge puddles. Ravenous appetite (but he always liked his food). Before his weight loss, he might had fat deposits on neck and shoulders, but he was fat all round.
We went to our vet with these symptoms. He ran blood tests and told us it was diabetes and potentially Cushing's. Blood glucose level was 32 at the time. We started on an insulin for pets, with a minimum dose with the intention of going up gradually. Also changed diet to kibbles for diabetics - Ben only had those kibbles for the first few days. We then had to soak kibbles in broth, add chicken, removed kibbles and gave chicken broccoli, barley, oats - to cut a long story short, come mid-Feb Ben was not eating, we (unwisely) stopped insulin and Ben had a severe case of Diabetic Ketoacidosis, from which he thankfully recovered after 5 days on a drip of IV fluids. Before this glucose levels never seemed to budge (we got 36 and once even HI) and the lowest we got was a short-lived 19. From k9diabetes forum, I got to know we were using a u-100 syringe for pet insulin, when we should have been using a u-40 one.
During this crisis, I urged vet to change Ben's insulin and we switched to one intended for humans (Insulatard). For the time being Ben's diet is regulated (he is eating kibbles for diabetics from another brand and he likes them) and he is getting his insulin twice a day, 5 iu each time. The problem is that Glucose levels go from 26 in the morning, to 14/17 in the afternoon, and again 20 sth in the evening. However, since starting with Insulatard sugar levels never exceed the 26 - 29, and we have gone down to 14 and once even 7. For reasons of geographical location, I am still waiting for a pet glucometre I have ordered from the US and am keen to start home testing to see exactly what is happening during the day.
Now after this long background information, I am coming to the point of my post here, which is the recent results that my vet communicated to me after he tested for Cushing's. However, these tests were taken on the second day of Ben's DKA - when we were really in the eye of the storm.
I do not have the paper with me (vet still has it), but these are the figures communicated over the phone:
TLI +50 Ig/L - values above + 35 indicating pancreatitis or renal insufficiency. The latter is a new occurence, as all previous blood tests showed normal kidney functioning. Ben is having normal blood tests tomorrow to check on kidneys.
Urea normal. Creatinine slightly below normal.
Urine Cortisol: Creatinine ratio 80
LDDS 126.7, 121.9, 15.3 (I hope I got the last figure right)
Alkaline phospatases were high and neurophiles (hope I got the name right) were abnormal too.
Fair enough - We have unregulated diabetes (though not sure if it is unregulated due to failure to find the right dosage and frequency of insulin injections) and we have the blood tests pointing to Cushing's. On the outside, Ben has velvety fur, he is energetic and lively, peeing and drinking subsided to normal levels (sleeps whole night through). There is no pot belly or any skin problems. He is still hungry, but it might be understandable given that he does not get anything outside his feeding time, and he gets only 60 g of kibbles in the morning and the evening.
Coming to my query:
Vet is saying that the course of action now is to stop the insulin and start treatment for adrenal Cushing's and then see what results this will have.
At this point I asked my vet if he knows if the adenoma is adrenal or in the pituitary gland, but he doesn't know.
Ultrasound is unavailable where I live and there are no specialists on Cushing's. Vet said we could so the HDDS, but we will have to stop insulin for two days before the tests.
From your experience,
a) is it wise to do a HDDS and stop insulin, risking another DKA
b) I do not want to second guess the vet (normally he is good and experienced - though he admitted that he doesn't get much cases of canine diabetes), but would it be advisable to ask for a new set of tests? He seemed reluctant when I hinted at it, saying that he always suspected Cushing's from the beginning, there are the alk ph tests, and the urine ratio tests...
c) if insulin is stopped during Cushing's treatment, what if it isn't Cushing's after all? Will there be irreversible side effects?
d) if I delay starting the treatment for two weeks (to get enough time to do my insulin curve properly), will there be any consequences? In other words, does the disease progress rapidly?
Many thanks for any advice you can give me.
Vanessa
Ben: Cross-breed, 8kg, Male, Neutred, around 10 years
Diabetes - diagnosed in DEC 2015
Insulatard x 2, 5 iu each time
High-fibre pet food for diabetics (60 gr / meal x 2)
Thank you for allowing me to join this forum as I am in dire need of information. I have been referred here by the k9diabetes forum.
To start with, let me introduce Ben. Ben is a 10-year old cross-breed, but looks like a toy Manchester Terrier. He weighs 8kg (weighed 10 kg in Dec 2015 when he was diagnosed with diabetes and had lost weight rapidly over the 6 weeks before his diagnosis as he was overweight) and is about 35 cm tall (therefore, not really a toy-sized dog).
We were noticing that Ben was drinking enormous quantities of water and also peeing frequently. We started having house incidents, he had to go out around 3 times / night to pee, and every time there were huge puddles. Ravenous appetite (but he always liked his food). Before his weight loss, he might had fat deposits on neck and shoulders, but he was fat all round.
We went to our vet with these symptoms. He ran blood tests and told us it was diabetes and potentially Cushing's. Blood glucose level was 32 at the time. We started on an insulin for pets, with a minimum dose with the intention of going up gradually. Also changed diet to kibbles for diabetics - Ben only had those kibbles for the first few days. We then had to soak kibbles in broth, add chicken, removed kibbles and gave chicken broccoli, barley, oats - to cut a long story short, come mid-Feb Ben was not eating, we (unwisely) stopped insulin and Ben had a severe case of Diabetic Ketoacidosis, from which he thankfully recovered after 5 days on a drip of IV fluids. Before this glucose levels never seemed to budge (we got 36 and once even HI) and the lowest we got was a short-lived 19. From k9diabetes forum, I got to know we were using a u-100 syringe for pet insulin, when we should have been using a u-40 one.
During this crisis, I urged vet to change Ben's insulin and we switched to one intended for humans (Insulatard). For the time being Ben's diet is regulated (he is eating kibbles for diabetics from another brand and he likes them) and he is getting his insulin twice a day, 5 iu each time. The problem is that Glucose levels go from 26 in the morning, to 14/17 in the afternoon, and again 20 sth in the evening. However, since starting with Insulatard sugar levels never exceed the 26 - 29, and we have gone down to 14 and once even 7. For reasons of geographical location, I am still waiting for a pet glucometre I have ordered from the US and am keen to start home testing to see exactly what is happening during the day.
Now after this long background information, I am coming to the point of my post here, which is the recent results that my vet communicated to me after he tested for Cushing's. However, these tests were taken on the second day of Ben's DKA - when we were really in the eye of the storm.
I do not have the paper with me (vet still has it), but these are the figures communicated over the phone:
TLI +50 Ig/L - values above + 35 indicating pancreatitis or renal insufficiency. The latter is a new occurence, as all previous blood tests showed normal kidney functioning. Ben is having normal blood tests tomorrow to check on kidneys.
Urea normal. Creatinine slightly below normal.
Urine Cortisol: Creatinine ratio 80
LDDS 126.7, 121.9, 15.3 (I hope I got the last figure right)
Alkaline phospatases were high and neurophiles (hope I got the name right) were abnormal too.
Fair enough - We have unregulated diabetes (though not sure if it is unregulated due to failure to find the right dosage and frequency of insulin injections) and we have the blood tests pointing to Cushing's. On the outside, Ben has velvety fur, he is energetic and lively, peeing and drinking subsided to normal levels (sleeps whole night through). There is no pot belly or any skin problems. He is still hungry, but it might be understandable given that he does not get anything outside his feeding time, and he gets only 60 g of kibbles in the morning and the evening.
Coming to my query:
Vet is saying that the course of action now is to stop the insulin and start treatment for adrenal Cushing's and then see what results this will have.
At this point I asked my vet if he knows if the adenoma is adrenal or in the pituitary gland, but he doesn't know.
Ultrasound is unavailable where I live and there are no specialists on Cushing's. Vet said we could so the HDDS, but we will have to stop insulin for two days before the tests.
From your experience,
a) is it wise to do a HDDS and stop insulin, risking another DKA
b) I do not want to second guess the vet (normally he is good and experienced - though he admitted that he doesn't get much cases of canine diabetes), but would it be advisable to ask for a new set of tests? He seemed reluctant when I hinted at it, saying that he always suspected Cushing's from the beginning, there are the alk ph tests, and the urine ratio tests...
c) if insulin is stopped during Cushing's treatment, what if it isn't Cushing's after all? Will there be irreversible side effects?
d) if I delay starting the treatment for two weeks (to get enough time to do my insulin curve properly), will there be any consequences? In other words, does the disease progress rapidly?
Many thanks for any advice you can give me.
Vanessa
Ben: Cross-breed, 8kg, Male, Neutred, around 10 years
Diabetes - diagnosed in DEC 2015
Insulatard x 2, 5 iu each time
High-fibre pet food for diabetics (60 gr / meal x 2)