Diabetes control in an unhandleable dog

Re: Diabetes control in an unhandleable dog

Thomas Johnson — Tue, 14 Jan 2014 14:26:42 GMT

[quote user="Mark Holmes"]Recently had a client with a dog I just couldn't stabilise, always hyperglycaemic. I swore he was giving injections. Several bouts if DKA later it was euthanased and owner returned 13 bottles (10ml bottles) of unopened caninsulin.

[/quote]

What I really struggle to understand is why people keep spending money on consultations and medications if they're not doing what they're advised or using the medications they're given!

Re: Diabetes control in an unhandleable dog

Martin Atkinson — Tue, 14 Jan 2014 13:12:50 GMT

[quote user="Mark Holmes"] I swore he was giving injections.[/quote] Did you ever demonstrate the injection technique or get him to show you his?

It is amazing the ways clients can contrive to defeat your best efforts. I had one client who had 4 dogs over the years and each time she said she had £2000 to spend after which the dog would have to be put to sleep because she wouldn't be able to afford to keep it, and it was. We were sympathetic after the first but the sympathy was running a bit thin after the third. The fourth dog fortunately outlived her and when her relatives cleared her house they found and brought in for disposal year's worth of unused medication, probably spanning all four dogs!! Her initials fittingly spelled ODD. There's nowt as queer as folk.

Re: Diabetes control in an unhandleable dog

Bob Russell — Tue, 14 Jan 2014 13:02:46 GMT

Worst case scenario get a dose that minimises the symptoms to the owners satisfaction. Have a good chat with the owner regarding spaying, risks of concurrent disease etc.

We have the full range of diabetics. Minimal intervention through to home glucose curves and good control. Up to the temperament of owner and patient. One patient is fat as butter, not spayed and minimal supervision. Pretty much down the seeing patient just enough to keep the DC at bay but hardly satisfactory. Owner seems happy with things especially as I 'cured' an 'inoperable' tumour on a foot a couple of years ago!

Re: Diabetes control in an unhandleable dog

Mark Holmes — Tue, 14 Jan 2014 12:53:43 GMT

Recently had a client with a dog I just couldn't stabilise, always hyperglycaemic. I swore he was giving injections. Several bouts if DKA later it was euthanased and owner returned 13 bottles (10ml bottles) of unopened caninsulin.

Re: Diabetes control in an unhandleable dog

Martin Atkinson — Tue, 14 Jan 2014 12:07:59 GMT

I broadly agree with most of the above, but don't bust a gut over it, its not your fault/problem, you can only do as much as the animal or the owner allows. Just explain to them how you are limited by the circumstances and will never achieve ideal control and they have to expect problems may therefore occur.

We once had clients who were incapable of injecting the dog because it tried to bite them when they tried to do anything with it. It was fine with us, we even hospitalised it twice to perfectly stabilise it but each time it went home it became symptomatic again but they wouldn't admit until the end that it was because they weren't injecting it. They elected to have it euthanased, even though it wasn't that bad clinically even untreated, because 'it wasn't fair to hurt it with the injections'!!

You can't win 'em all.

Re: Diabetes control in an unhandleable dog

Hannah Wynne Richards — Tue, 14 Jan 2014 08:56:50 GMT

Neuter and daily urine dipstick.

Wynne

Re: Diabetes control in an unhandleable dog

Suzanne Kelly — Tue, 14 Jan 2014 00:18:30 GMT

I agree with everyone else, spay it. If the O is a VN is she not able to take blood herself? I find buster collars brilliant for fearful dogs that hate being muzzled. Get the O to buster collar train it and then blood sample from the saphenous with the dog distracted at the front end.

Good luck with it,

Suzanne

Re: Diabetes control in an unhandleable dog

Busybee — Mon, 13 Jan 2014 23:15:49 GMT

[quote user="Michael Woodhouse"]A single Jumbone shouldn't affect stability - did you consider it causing pancreatitis?[/quote]

Good point Michael, thanks! There have been no other signs of pancreatits though.

[quote user="John Flynn"]If she's recently been in heat, then that could easily be what's unsettled things.[/quote]

Again, certainly a good idea.

[quote user="John Flynn"]Oh, and if they're flush with cash[/quote]

I wish.....

[quote user="Mark Holmes"]Spay her, don't rely on blood glucose post a2 sedatives and extreme stress can cause hyperglycaemia as in cats. Consider euthanasia if QOL deteriorates. Can owners inject ok?[/quote]

Spaying with pre-op bloods seems to be the way forward. At present, owner seems able to inject ok (ex-vet nurse) with the dog distracted with food. TBH I would be worried about asking her to BG curve the dog at home though.

Re: Diabetes control in an unhandleable dog

Mark Holmes — Mon, 13 Jan 2014 22:53:19 GMT

Spay her, don't rely on blood glucose post a2 sedatives and extreme stress can cause hyperglycaemia as in cats. Consider euthanasia if QOL deteriorates. Can owners inject ok?

Re: Diabetes control in an unhandleable dog

John Flynn — Mon, 13 Jan 2014 20:34:39 GMT

Oh, and if they're flush with cash, those special diabetic diets can make a real difference...

Re: Diabetes control in an unhandleable dog

Andrew Kent — Mon, 13 Jan 2014 20:32:28 GMT

I would monitor this dog entirely on clinical signs and urine, there is no real problem doing so in dogs. However without being neutered you will never achieve stability and so especially in this context get the dog neutered ASAP before spending any more time on stabilisation.

Re: Diabetes control in an unhandleable dog

Gillian Mostyn — Mon, 13 Jan 2014 20:27:33 GMT

I would sedate for blood profile to rule out other problems, such as renal issues (I also think Christmas treats likely to be a red herring) but if ok I would put on best-guess insulin, monitor via behaviour and urine, and if QOL poor then PTS.

Re: Diabetes control in an unhandleable dog

Clive Ansell — Mon, 13 Jan 2014 19:20:58 GMT

Guess/estimate a bid dose, then ga it and measure fructosamine in a month or so.

Agree about her spayed too.

Re: Diabetes control in an unhandleable dog

John Flynn — Mon, 13 Jan 2014 19:14:12 GMT

I think your idea of spaying her (before?) her heat is a good one. If she's recently been in heat, then that could easily be what's unsettled things.

If the owners can inject her, they might be able to do marginal ear vein pricks? Of footpad pricks or any other way of getting blood samples for a glucose curve at home?

Re: Diabetes control in an unhandleable dog

Michael Woodhouse — Mon, 13 Jan 2014 19:11:56 GMT

You can't treat the dog safely.

Either 'guess' a dose as best you can based on pu/pd or give up and PTS when QOL deteriorates. Had to give up on a cat once who hated the injections.

A single Jumbone shouldn't affect stability - did you consider it causing pancreatitis? ACP sandwich and some bloods?

Best of luck, but be careful.