Advice re diabetic dog, please

Re: Advice re diabetic dog, please

Bob Russell — Mon, 02 Jun 2014 17:11:55 GMT

As an aside, if you have a dog on lente that becomes unstable check that the insulin is what it says it is! Our wholesaler was sending out PZI with lente bar codes! Hopefully now corrected!

We checked the bar code, not the box (inexperienced staff member) and this slipped through the net. Fortunately the owner picked up on it before opening the bottle. Red faces all round!!

Re: Advice re diabetic dog, please

Rob Davis — Mon, 02 Jun 2014 16:52:32 GMT

[quote user="Alison Skipper"]We're worried that going back to Caninsulin will go back to the very rapid metabolism which meant he wasn't in the normal range for very long with that either.[/quote]

Would TID caninsulin be a possibility for the owner - we have one dog on TID and this seems to suit him much better.

Re: Advice re diabetic dog, please

Alison Skipper — Fri, 30 May 2014 19:09:51 GMT

Sorry, of course I mean mmol not units! Thank you all for the input. We have thought about whether we are overdosing - the nadir is more usually around 5 but has hit 1 on occasion - he has never had a visible hypo, though, and we have previously gone back to 2 units and built it up again for exactly this reason and found he needs to reach this sort of dose to have any time on the curve within the normal range at all. We're worried that going back to Caninsulin will go back to the very rapid metabolism which meant he wasn't in the normal range for very long with that either. But if we were treating the dog rather than the numbers we would be very pleased with ourselves because his weight is stable and he looks really well in himself. Thanks again to everyone for the suggestions.

Re: Advice re diabetic dog, please

Martin Atkinson — Fri, 30 May 2014 18:24:00 GMT

[quote user="Alison Skipper"]glucose was up around 20 and completely flat for about 6-7 hours after the insulin before dropping over a couple of hours to a nadir which ranges between 5 and 1 units but only lasts a couple of hours[/quote] I presume you mean a nadir of between 5 and 1 mmol/l not units? Anything less than 5 mmol/l as a nadir is very suspicious of overdosing. In this case you may have a chronically overswinging dog and need to be thinking about reducing dose not increasing - very urgently. If it really goes down to 1mmol/l I'm surprised it hasn't crashed already! I would recommend an immediate reduction in dosage of 50% and start again on Caninsulin as there is too much danger of dosage accumulation on PZI. I second Glargine if you're finding it difficult to stabilise but I really think you should start with basics again first.

Re the possible HAC I find ACTH stimulation test a bit unreliable and would prefer to do a LDDS test especially after a non-diagnostic ACTH stim test not that we have a lot of choice to do that in the first place at the moment

Re: Advice re diabetic dog, please

Claire Fisher — Fri, 30 May 2014 07:50:34 GMT

[quote user="Nicola Lawlor"]

They were also convinced the dog was cushingoid from history/other lab results and eventually we did something with hydroxyprogesterone measurements instead and that finally got the diagnosis. .

[/quote] The 17-OHP protocol is the same as for an ACTH stim and can be run on the same samples so if the lab still have them you could ask them to run the test without having to get any more blood.

Re: Advice re diabetic dog, please

Linda Filshie — Fri, 30 May 2014 00:07:21 GMT

Not polyphagic, not PUPD, weight stable and lots of energy? Sounds like a reasonably controlled diabetic and not particularly cushingoid to me. I would aim to treat the dog and not the lab results.

That said, I do think your nadir is too low. Just a few thoughts: Did you do the curve with fresh insulin you administered yourself? Have you checked for a UTI? And as PZI can also induce antibodies might it be worth a switch to glargine?

Re: Advice re diabetic dog, please

Nicola Lawlor — Thu, 29 May 2014 21:53:05 GMT

I would follow the cushings concern further at this point as you are still suspicious. We had a really difficult cushingoid case a while back now that was repeatedly normal on ACTH stim, normal on dex testing and eventually went to a referral centre in our desperation. They were also convinced the dog was cushingoid from history/other lab results and eventually we did something with hydroxyprogesterone measurements instead and that finally got the diagnosis. Dog has responded really well to vetoryl and symptoms that we were concerned about have resolved. ACTH stim still used to monitor the dog (when available!) and no issues with getting monitoring results that rule out addisons at least.