Diabetic dog...when to say enough?

[Critter]

I realize no one can answer this for me…but I feel like I need to talk this out somehow.
I have a 10yo lab…about 1.5 years ago she was diagnosed with diabetes (sudden onset polyuria/polydipsia…glucose over 650 when we went to the vet). She was started on insulin right away, and we did blood sugar curves. Lots and lots of them…every curve was still to high and her nadir was very delayed. They kept upping her dose…we were at 30 units Vetsulin 2x day. Then she went hypo…luckily, I have hypoglycemia, so I recognized it pretty quick and squirted some plain cake frosting on her gums. Perked right back up. Vets then dropped her insulin way down, symptoms got bad again, more curves, you get the idea. A few months ago she went blind pretty much overnight. She has some vision, but will walk into things occasionally. Insulin got upped a bit and she stabilized. I had asked about trying other brands of insulin, and was told no.

She’s been pretty stable on 22 units for awhile. Last week she starting drinking a lot again…she will just lay at the water bowl. Her sugars mid shot are 350-400…which is not good, but is about as regulated as the vets can get her without sending her into hyper/hypo swings. Also last week she had a few days of vomiting. That’s an issue, as then I have to worry about getting some food into her because of teh insulin. She was also not moving around much and not too happy. It looked a bit like pancreatitis…it did settle down. We upped her insulin to 23 units twice a day, and she has perked up a bit.

I am just at a loss of how long we keep doing these yo-yo events. Up the insulin and have a hypo episode (which we may not be home to catch)…or low insulin and she has no quality of life. I am also worried as later this summer I am away a few weeks…I have a vet tech friend who can come and do her shots 2x a day. But, if she vomits or has a hypo, my dad is not capable of making any decisions or providing care (he can let her in and out to pee/poo, and that’s about his limits of pet care).

Add to that she has an old cruciate ligament injury and is on aspirin daily just to get around (I know aspirin is not the best…but she vomits up all the other doggie pain meds, so this has worked and she tolerates a very low dose).

Last week when she was pretty bad looking, I starting thinking it might be getting time to consider euthanasia. This week, with her perking up with the increased insulin, I am not so sure. She is continuing to lose weight…90 lbs (heavy when diagnosed) to 72 now (looks lean, but not ribby yet)…but it won’t be long at the rate she is losing.

I also feel guilty thinking of euthanasia…I lost my heart horse in November to founder. I did everything I could until I couldn’t stand to see him suffer any more, and his light seemed to dim. I feel like I should try harder for my lab. She’s not my heart dog, though I do adore her and she is a great dog (I lost my heart dog 2 years ago to kidney failure/sepsis, and did all kinds of treatments, she was 14)…so I feel guilty that I am thinking about “giving up” sooner with this dog.

When her sugar is being stable, she’s old, blind and lame, but she’s happy. When it’s fluctuating, which happens often, she’s not. If I go to the vet’s they just want to run 24 hour blood sugar curves and keep playing with the insulin (we’ve run so many curves and they tell us nothing different). I just don’t know and don’t want her to suffer like she was last week.

Ugh! Thanks for letting me have some “talk therapy”.

[Critter]

Forgot to also mention that she is done with the twice a day injections. She’s good, but we have a squirmy standoff every time now. And I’ve had my friend the vet tech watch to make sure I am not causing issues…and she’s says I am doing it correctly (when she does it, the same squirmy process happens).

[jherold]

Id say its time. You’ve done your best. Love her and let her go.

[MsM]

It doesn’t sound like a good quality of life. Certainly you need to let go before you travel. Intellectually I would say let her go while she is stable, but I know emotionally I would have difficulty with that. At the very least, perhaps speak to your vet that the next time she has an issue will be her final visit.
I had my blind dog PTS and just under13 yo. I felt guilty as it wasn’t an emergency situation, but he had multiple problems and his QOL sucked much of the time. It was difficult but it was right.

[GoodTimes]

I think you’ve pretty much answered your own question. I’m not sure if it’s what you want to hear or not, and my heart is breaking for you, but it sounds like it’s time. If she got bad while you were at work, or out getting groceries, or when you’re travelling you would feel so much worse then knowing you did everything for her. She doesn’t know what’s going on. Give her the best day ever and then let her go.

[Angela_Freda]

They say a day earlier is better than a minute too late, but that’s easy to say and harder to do.
I’m in a similar boat with my cat… he was in remission for a year after diabetes diagnosis and just 4 insulin injections and now we just can not get him controlled… He’s not suffering, but I would prefer he not ever suffer.
The problem seems to me to be that we can not see the future.

Jingles for your Labbie.

[Rain]

@MsM

I Intellectually I would say let her go while she is stable, but I know emotionally I would have difficulty with that.

Yes. I let my Goldie go at 13 yrs when he was stable (but gradually going downhill) and I still have guilt 6 years later. Practically speaking, “a day too early” is better, but it does not prevent the guilt. However, had I waited until he was CLEARLY suffering, I’d also feel guilty. There is no simply no way to match our hearts with our heads in terms of “the right time.”

From a 3rd party perspective, I’d say you HAVE tried your best. Clearly you are going above and beyond, and I would not say you are “giving up.” My personal opinion is that it is time. Your pup does not like the injections, and she probably feels crappy most of the time, even when her insulin is balanced (or whatever the proper terminology is). In 3 months, she will feel worse than she does not, and be skinnier. I am not saying today is the day, but at any point in the coming weeks/months, you would be doing the right thing.

[Sswor]

@Angela Freda

They say a day earlier is better than a minute too late, but that’s easy to say and harder to do.

Yes, it is soul crushing.

My most recent, I [very almost nearly] followed this advice. He had liver disease, poly cystic, pre-cushings-like syndrome, and ultrascans 30 days apart showed one of his adrenal glands increased in size 4x. It was dumping LOADS of adrenaline into his system at the slightest provocation. He was beside himself with emotion–fear, anxiety, manic excitement. It was the very end of June and the 4th was on its way. I knew I could not let him suffer through another fireworks “event”. Not to mention, one of the too numerous to count" cysts could burst at any time and bleed out causing death. It could have happened when I was not at home and he would have died a horrible, terrifying death, alone. I could not let that happen. I picked a quiet day, a day I could take off and stay with him. I made an in-home appointment. Vet was going to come after her daily rounds. I gave him the best day ever, all the while tick tock, vet coming. I nearly cancelled that appointment 500x during those hours but knew I could not. She came. He lost it, reeled, staggered, and collapsed as she climbed the porch. She let him go quietly and swiftly while I held him and poured out my heart to him. It was heart shattering–for me.

In hindsight I have no regrets. The others? I waited too long and am haunted by their memories. I cry periodically out of the blue for them, even a decade later. This most recent guy was my forever heart dog. We had a love affair to cross the ages. I remember him fondly. I did the right thing. No regrets. He needed me to provide that very last act of kindness and love for him. I came through, I didn’t let him down.

Life is a journey and every dog we have teaches us how to be a better dog owner for the next. That is the only way I can make sense of the ones I let go too long, and was too late for.

Best of luck to you, OP. I am so very sorry.

[Angela_Freda]

@Sswor we put Emma our Lab to sleep last month, she was 16.5 and had been waxing and waning from decent days to not as decent days… and she started to decline, losing control of her bladder and bowels that last day.

Like you, I almost cancelled the appt. several times… but the begging I was doing in my head was ‘I want her back’ and that wasn’t going to happen. Sometimes you can not fix what’s broken. So we do the next best thing we CAN do.

So we had a great last day, she got to go out in the snow with her dad, she ate yummy treats in the car sitting with her head in my lap the whole way there… and she was nearly gone after the pre-anesthetic was in.
I miss her, but I would miss her if we’d had another 16 years too. No matter, there’s no scenario in which I would not be left wishing I had her back., even if for just one more day

We had her since she was 3 months old and she never wanted for anything, never knew being lost or afraid or hungry, or cold, or abused… she was truly one of the lucky ones.

[Sswor]

@Angela Freda I too had crazy fantasies during those final hours of waiting for vet to arrive–of scooping him up and running away, from the fear, from the illness, from the disease. Just taking him and fleeing. But you cannot run from these things. You must face them and be fearless for your loved pet. You are their guardian, their protector, their custodian. These stories are heartbreaking, but full of love. Waiting too long is a nightmare that can be difficult to avoid. Be brave, OP. You can do it. It is kind.

[2tempe]

OP - Just hugs. It sucks, but as others have said you seem to know the answer.

[Saskatoonian]

I just got off this roller coaster in January, with my 14 year old GSD mutt. I second that making the decision is soul crushing, but would add that, at least for me, the only thing worse would have been to wait too long, til she was in worse shape; til it was an emergency and it couldn’t happen quietly at home. It breaks my heart to read all you’ve done for her, and that you’re still feeling guilty about considering euth, but it helped me to have people around me who’d gone through it before, so maybe this thread will help you. If it helps to have a stranger say that it sounds like time, well, it does, to me. The only comfort to me was to do it right, peacefully after so much steak for so long that she didn’t want any more, and that she died in my arms. Hugs. I’m so sorry.

[hoopoe]

I worked in vet clinical over 20 years, Never had a client come back and say , we were too hasty.

This sounds like an unhappy situation for all concerned. When she is “normal” she is an old worn out dog, but she still wags her tail. When she is bad she is a sick old dog.

Pets are for loving and feeling loved. They bring joy and peace. Do you feel these?

If you brought her to me and said “its time” I would agree. I think you have done everything and more.

In my opinion any time you decide is the proper time

I would also wonder if there is a secondary issue beyond diabetes causing these insulin dysfunctions. Has she been screened for cancer? Xrays ultrasound. Might that information support your decision making. Have you consulted with an internal medicine specialist? Doing these things will assure you have the solid information you need for informed decision making

I am sorry for your grief. Stacked upon the loss of your horse makes it more difficult. You have my utmost sympathy and support

[Critter]

Thank you all for the support and sharing your stories. I think I am also trying to avoid reliving the loss of my gelding from a few months ago…I very nearly told the vet to stop when she came to euthanize him…but he was suffering and and 25, and he gave me so very much for 21 years…he did not need to suffer.

When my lab was first diagnosed with the diabetes…we did xrays and ultrasounds to rule out other issues, all negative, though they couldn’t rule out everything. She was seen by an internal medicine specialist at the practice. The only thing I didn’t do was take her over to the teaching hospital for a third opinion…the vet clinic we use is a pretty large practice with specialists that are there on certain days. It was the specialist that had increased her dose significantly…which then caused the rebound hypos. I haven’t consulted with them recently other than her routine insulin refills…in part because we did so much in the beginning, and we never got any answers about why she was so hard to regulate. She does have some tumors…one on her belly we did have biopsied and was said to just be a lipoma.

I guess part of me feels that 10 is not that old…though I realize it is getting up there for a lab. I worry that making a decision to put her down because I worry what might happen while I am away for 3 weeks…well that’s a lot of ifs. If she was fine, I would feel guilty saying goodbye when it wasn’t warranted…but I would feel worse should something bad happen and she have to suffer while I wasn’t there to make decisions for her.

I guess I am just struggling…the last two animals I had to make this decision for were my heart dog and heart horse…and as Angela Freda said…another 14 or 25 years with each of them would not have been enough. I know I made the right decision for both of them to end their suffering with sudden diseases…but it doesn’t lessen the guilt of not being able to fix them either.

I don’t think today is the day…but I don’t think it will be long either. I am also facing another goodbye coming soon with my old mare…she’s 28 and I know her days are numbered as well. I’ve had her since she was a yearling. She’s been struggling getting up and down this winter, so that just makes me feel like there is too many goodbyes lately.

[khall]

Prepare yourself and her and pick a day, coming from having to make the choice unexpectedly to being able to plan it out, it is way easier to have it planned out. You are giving her one last gift of ending her pain. When I have done this in the past, yes I was sad, but I am usually relieved that the worrying is over.

[Angela_Freda]

I know many don’t like Facebook, but this was posted there a few days ago, and it helped me…

‘Grief, I’ve learned, is really just love.
It’s all the love you want to give but cannot.
All that unspent love gathers up in your eyes, the lump in your throat, and in that hollow part of your chest.
Grief is just love with no place to go’

[Alex_and_Bodie_s_Mom]

@Angela Freda

I know many don’t like Facebook, but this was posted there a few days ago, and it helped me…

‘Grief, I’ve learned, is really just love.
It’s all the love you want to give but cannot.
All that unspent love gathers up in your eyes, the lump in your throat, and in that hollow part of your chest.
Grief is just love with no place to go’

Angela, that’s lovely, I’m crying reading it.

OP - My heart breaks for you, having to face this so much in such a short span of time. I know we can say ‘a day too soon rather than a moment too late’ all we want, but the fact is, we’re the ones who have to make that call, make that impossible wait, hold that lead rope - or that head in our laps. All we can do is trust that we’ve done right by them while we’ve had them.

I did wait too long for one of my mares last year. I should have put her down months earlier than I did. But she had good says where she rallied . . . and bad days when she didn’t. I regret not putting her down sooner, and even so, I hung up on the vet when I was trying to make the appointment. But she was ready to go and had been telling me so for a while. I was just too blind to see it.

[Current_Options]

sending PM

[sisu27]

I’m so sorry. It’s such a hard decision.

I had my dog of a lifetime soulmate PTS in the early stages of CHF from DCM. I had waited too long before. I owed him so much I swore I wouldn’t do that again. He was 9.

We gave him a great day. I almost changed my mind while we waited for the vet to show up. They had some emergencies and were hours late. Which was hard but I am also grateful for those extra hours.

I dont regret it. I wonder if we could have got his meds right and had more time but I still think I did the right thing for him. I miss him terribly. It’s been a year and a half and I mourn his loss ever day. I have a new pup who I love but nothing could fill that void.

I promise you I feel so much guilt for the ones I didn’t give that same kindness. I was selfish and childish thinking that it could be fixed eventually. DCM kills and I wish it didn’t take me 4 to fully grasp that.

I wish you clarity and peace with this decision.

[Amelia]

Just hugs. I’m not the one to give advice because I can’t make it for my little dog yet. I just keep telling myself I’ll know when it is time–and I hope you do as well.