Dog diabetes...issues controlling sugar?

[Critter]

Early this year my just turned 9yo female lab was diagnosed with diabetes. Came on suddenly (ironically I thought initially she was having a reaction as we treated her ear infection with a really strong, long acting combo med the vet prescribed). One day fine…next day drinking a ton and not able to hold it overnight (very housebroken - never issues). Blood sugar at vet’s was over 600!! They started her on a lower dose of insulin (Vetsulin) 17units 2x day. Instant improvement. Went back for glucose curve…turns out blood sugar only drops to 400s. Increase dose to 20 units 2x day. Repeat curve…same result, plus she hits the low point 9 hrs post insulin (not 6 which is what they wanted to see). She had developed a bit of a skin infection (she also has food allergies - on special diet…so this is not unusual)…vet puts her on antibiotics, thinking the infection could drive her sugar up. Seems reasonable…clear up infections, do some food modification (high protein, low carb, plus working with her allergy issues). She seems to be holding up other than not loving being stuck twice a day.

Then an accident in her crate…and the excessive drinking returns. Talk to vet…insulin increased to 23 units 2x day. Temporary fix…symptoms resolve. Then poor girl flooded her crate in urine…and went in the house (she doesn’t even alert us, which is totally not her)…just will lay at the water dish and drink without even getting up. Vet ups her to 26 units 2x day.
BTW her initial weight was 87 pounds (and a bit heavy)…now down to 78. Coat is dull. She just doesn’t look good to me…eats fine.
Have an appointment for another glucose curve tomorrow with the higher dose…plus an ultrasound and internal med consult. They aren’t sure if maybe a tumor or resistant to insulin…since she has been so hard to manage.

Any thoughts? Experiences? It doesn’t seem like this should be so hard to regulate…she is good about getting the shots (doesn’t love them, but it all goes in). Regular vet says most dogs are usually easier to manage.
Thanks.

[Angela_Freda]

My cat [about 11 years old] was Dx’d Diabetic earlier this spring, so that is my ‘expertise’ wrt this, beyond being a Vet assist for a few years a long time ago.

My cat is the wunderkind, he went into remission with 2 weeks on low carb food followed by just 4 doses of insulin.
BUT… he has had recurrances due to illness and then treatment. Like your Labbie, he had an ear infection that he managed without Diabetes issues, but then the meds did it.
Phhoey!
But 2 doses later [iirc] he was back off the juice [as they say] and doing well, though that ear infection is now untreated. It’s a high wire act without a net, this diabetes thing.

So what bloodwork, other than the BG have you done?
And I am curious, where do you prick for the BG testing on a dog? edge of ear like a cat? Where do you give the insulin? Is it sub cutaneous, as we do with cats, I would assume? OR intramuscular [like people, I think?]?

Please do update us, every story about a diabetic animal makes us all better able to treat our own diabetics… plus I have a 16 year old Labbie, so a fondness for all of them, sending big jingles for yours.

[horsenut_8700]

I would imagine there’s something else going on here. The last dog I saw who suddenly became a diabetic with uncontrollable blood sugar levels ended up being diagnosed as a brain tumor as the cause of the diabetes. Hopefully yours is a much better explanation!

[jetsmom]

My mom’s dog she had yrs ago couldn’t be stabilized using a certain type of insulin, but when switched to another type was stabilized. I know the more expensive type of insulin us what worked. (Not sure if it was derived from pigs or something else…)
maybe ask vet about type of insulin, and if it would be worth trying a different type.
Also, exercise variances can really affect numbers, as can stress.

[Angela_Freda]

Jetsmom makes a good point. In cats the best success towards remission [ie self regulating insulin for a diabetic cat such that cat does not need insulin injections] is with the longer acting insulins. For my cat we use Lantus Solostar pens.
That might be something to ask your Vet about.

This blog is written by a DVM and has good info about diabetes in cats… can some of it be carried over to dogs? Not sure. But worth asking your Vet for sure.

http://catinfo.org/feline-diabetes/

[Critter]

Not much info…vet did an abdominal ultrasound and everything looks normal. Her blood sugar went down to 320s…which is actually the most controlled it has been. They didn’t want to switch brands yet…instead they increased her dose to 30 units twice a day. They also did chest xrays to make sure no tumors in that region…as well as urine culture to rule out UTI. Waiting on those results. This is a dog who does not exercise…not a normal lab. Her happy day is to lay in the front yard, watching everyone. She’s not stressed…other than the medical issues, she has a pretty cushy life and no big changes to her routine (unless at the vets, and even there she is not that stressed…everyone always gushes about how sweet and good she is). She has always been non-active…three throws of a ball was her max…she would bury it or lay on it, so you couldn’t throw it anymore!

Vets want to keep increasing her dose to the max…then try a different brand if she is symptomatic again. Not sure I agree…but they have the degree/experience and she did she the internal med specialist today. The only other thought was Cushings…but the plan is to test that next if the higher dosing doesn’t work. Meanwhile…I will be buying a bottle of insulin a week!! Ugh…good thing she’s cute!

[Megaladon]

I know of a few dogs that had a Fructosamine test done, sent to a veterinary college. I don’t know exactly what it shows but maybe that is another route? I understand your frustration, most cats get like a max of 2 units of insulin or like Angela Freda’s cat, can come right off, but my boy is on 6 units am and pm!! Good luck to you, it’s going to be a bit rough at first figuring out what her body needs, but I think you’ll be okay!

[Angela_Freda]

What does a fructosamine test show?

The level of fructosamine in the blood is a reflection of glucose levels over the previous 2-3 weeks. … Both fructosamine and A1c tests are used primarily as monitoring tools to help people with diabetes control their blood sugar.

I looked it up cause the testing of BG is frustrating… given that what you test that minute may change drastically in an hour… unless you test every hour… or do a curve every day… Diabetes Tx really is treatment by the blind in a lot of ways.

[HappyTalk]

See if you can get him on a Continuous Glucose Monitor (CGM). I did this for my diabetic dog through Ohio State University. He had a sensor implanted that recorded the glucose level every 5 minutes. It also had a warning tone when his glucose dropped below 100. The data went to a device worn on his collar that resembled a pager. I also had to keep a log as best as I could of his activity throughout the day. At the end of five days, the sensor was removed and the data downloaded to a computer program. It showed that he was becoming almost hypoglycemic at 4 am almost every morning! As he got fed and his insulin at 6 am/pm this was very surprising. It was surprising how quickly his blood glucose could drop. We also had to calibrate the device three times a day via blood testing ( pricking for a blood drop)

The whole thing was surprisingly affordable.

[Critter]

So the past two mornings I’ve done the urine test…no glucose in her urine. They want her to have just trace, to make sure she isn’t too low. So we are dropping the insulin again (per vet) and will see how that goes. They mentioned a 24 hr glucose curve…I asked about the CGM…but they said it wasn’t proven/reliable in dogs yet (which seems odd to me, as it is used in people quite often and the principle is not much different).
I’m starting the wonder if I should just do a consult at U Penn…I’m paying just as much at this vet, and they just seem to be not as good at the diagnostics. They’ve also mentioned the Fructosamine test, but haven’t done that yet.

[Angela_Freda]

So you’re not doing a Blood Glucose test? Interesting. I have no idea how that compares with a urine test.
I think many Vets, like many seasoned diabetes ‘parents’ get comfortable with how much guesswork is involved in this thing. At least that is what I have found when we’ve been in a dicey situation with Meow… things seem dire to me, and everyones’ being very calm and blasé :eek:

A consult with U Penn would be interesting. I have a friend who works there.

[Critter]

I’m just doing urine tests…the vet is doing the blood glucose. I hadn’t bought a meter for her yet…as we’ve had to keep going back to the vet since it’s not stabilized.
We dropped her back down, and she now has low levels of glucose in the urine.
But the vet called and she does have a UTI. So they are hoping that is messing with the curve. Two weeks of antibiotics. This poor girl is always having an infection and going on antibiotics…I asked about doing prophylactic abx, like with do with people with poor immune systems…but they are too worried about abx resistance. Which I understand…but this dog will finish the abx…and in another month we will need to put her on them again.

[Angela_Freda]

@Critter

I’m just doing urine tests…the vet is doing the blood glucose. I hadn’t bought a meter for her yet…as we’ve had to keep going back to the vet since it’s not stabilized.
We dropped her back down, and she now has low levels of glucose in the urine.
But the vet called and she does have a UTI. So they are hoping that is messing with the curve. Two weeks of antibiotics. This poor girl is always having an infection and going on antibiotics…I asked about doing prophylactic abx, like with do with people with poor immune systems…but they are too worried about abx resistance. Which I understand…but this dog will finish the abx…and in another month we will need to put her on them again.

That’s interesting. I wonder why the difference in protocol, ie you have to go to Vet, and after being shown how to, I was sent home to do it myself.
Maybe it’s cats vs dogs? OR Vet to Vet?

My cat had an ear infection [we think, presented with one dilated pupil, BP was fine], put him on ABs and that threw him for a loop. Really and truly change is not their friend.
Someone over on the other thread here about diabetic cats mentioned feeding their cat food with cranberries and something else w/cranberries in it too, I wonder if something that would be an option for your Lab wrt UTIs? If there’s an herbal way to keep them rare? Will the UTIs get less frequent if the sugar level goes down, ie the sugar affords the bacteria a more fertile place to grow?

[Critter]

They gave me a rx for a meter…I just hadn’t picked it up yet, as they’ve been insisting they need to keep doing the curves. I figured once we had her more stable, I would get the meter…but that hasn’t happened yet. They say the UTI is linked to the diabetes.

Here is the odd part…they had us up her dose…urine glucose initially high. Then 2 days negative…so we dropped her back to 26U. First day urine glucose was trace…then 2 days max glucose (>1000). So I increase her to 28U…first day urine glucose >1000…then negative. Drop to 26U…still negative. It doesn’t seem like her dose matters…some days it is way high and other days way low. She looks just fine…activity level is consistent and diet is consistent. Guess we need to go to the University for the second opinion.

[Angela_Freda]

Critter, how is your Labbie doing?

[Critter]

Up and down. Apparently the vet’s rapid increase was too much…we had dropped her (per vet) back to 24 twice a day because of so many negative AM sugars. I did get the meter…negative by urine strips varied from 117 to 290s on the meter. Then one night last week she wouldn’t eat dinner (so not like her)…so I waited (did not give her insulin). I checked her sugar it was >250. Two hours later she was vomiting and looking pretty horrible. I decided to check her sugar and it was 44!!! So she went hypo fast…I had some vanilla cake frosting that you shoot out of the can…shot that in her mouth and in a few minutes she perked up. Took a day or two to get her sorted out again…vet thinks somygi effect. So we dropped her insulin way down and are monitoring again. Poor pup…I thought she was about done when she had the hypo crash:(

[DrBeckett]

In her original blood work, did she have an elevated Alkaline Phosphatase? If she possibly has Cushing’s that can make controlling the BG very difficult. I’m sure they would have thought of that, though.

[Critter]

All her initial labs were perfect, except the blood sugar. They said we could do more detailed testing for cushings, but that we might have false positives and that they didn’t think it was worth it. But I still wonder if that might be an underlying issue, since she is so hard to manage. And we are super rigid about diet/activity, so I know that she’s not spiking/dropping from environmental reasons. It could be that the antibiotics cleared up the UTI and she now needs a lower dose…but she had been on antibiotics only 2 months prior. Now that she’s on the lower dose, she is back to excessive drinking.

[Angela_Freda]

Yikes Critter, that is SO scary! Good thing you had a monitor and could get a BG reading.
Jingles for some relief for you guys soon!