Insulin resistant diabetic dogs

Re: Insulin resistant diabetic dogs

Hanna Bennett — Tue, 22 Dec 2009 20:57:03 GMT

[quote user="Laurence Webb"]They used to give you a free gucometer if you bought one from them and also sent them you old human one. Is there a deal on buying them then?[/quote]

not sure, opened the post the other day and there was something from them about a deal, didn't read too closely as most of the guff was aimed at selling us sevoflo. but there was definitely a deal on about buying something and getting one free again.

Re: Insulin resistant diabetic dogs

Rob Loxley — Mon, 21 Dec 2009 23:55:49 GMT

Do a urine culture, check for dental disease/other common causes of resistance. If you're at the point of insulin resistance (are you quite, being on 15iu BID for 10kg dog??) and sufficiently suspicious of Cushing's and adrenal/pituitary scans are out, why not do a trilostane trial (with informed consent). Would need to monitor blood sugar level closely as could go hypo etc.

Re: Insulin resistant diabetic dogs

Laurence Webb — Mon, 21 Dec 2009 23:31:02 GMT

They used to give you a free gucometer if you bought one from them and also sent them you old human one. Is there a deal on buying them then?

Re: Insulin resistant diabetic dogs

Hanna Bennett — Mon, 21 Dec 2009 19:28:08 GMT

and i think Abbot are doing a deal on Alphatrack glucometers

Re: Insulin resistant diabetic dogs

Laurence Webb — Mon, 21 Dec 2009 16:46:22 GMT

Well, although the Alphatrack is more economical on the long run, it may well be easier to get an owner to buy the Woodley one as the inital price of the Alphatrack is a bit off-putting. The Woodley one would be enough for an owner to do a glucose curve with and then you could tell them to buy more strips as required

I suspect it would also depend on how much monitoring you think will be required as to how long it would take to get through the strips. The Alphatrack certainly works out as the best one to use in-clinic. For owners may be more down to psychology as to which one to sell them - low initial cost with higher on-going costs vs high inital cost with lower ongoing costs

Re: Insulin resistant diabetic dogs

Rudolph — Mon, 21 Dec 2009 13:40:15 GMT

I'm impressed by your research!! I use the Woodley one as a back-up or to loan out to clients and I have an Alphatrak for use in-house, which I bought when it was launched some years ago.

Good spot with their prices, though. I'll pay more attention next time a "too-good-to-be-true" offer comes along.

Re: Insulin resistant diabetic dogs

Laurence Webb — Mon, 21 Dec 2009 12:04:03 GMT

I've just been pricing the glucometers up and the Alphatrack, whilst more expensive initially, works out more competative over time.

The Woodley g-pet is £9.50 for the glucometer + 10 test strips but then is about £1.00 per test (ie the macine is effectively free). The Alphatrack is £83.08 for the inital kit, but comes with 50 test strips. Extra test strips are then just under 50p per test.

So by the time you've done 116 tests the Alphatrack is cheaper. It's also available via NVS which, at the moment, the Woodley one isn't.

Re: Insulin resistant diabetic dogs

Laurence Webb — Fri, 18 Dec 2009 21:55:42 GMT

Thanks!

Re: Insulin resistant diabetic dogs

Rudolph — Fri, 18 Dec 2009 18:24:52 GMT

It's Woodley equipment. Bargain!

Re: Insulin resistant diabetic dogs

Laurence Webb — Fri, 18 Dec 2009 17:48:19 GMT

Related, but slightly off topic, can someone remind me who it is that is selling handheld glucometers for animals on a special offer at the moment. I remember seeing an advert to buy them for £10 in one of the vet papers but, in a fit of tidyness, I've thrown it out.

Re: Insulin resistant diabetic dogs

Clare Hogston — Wed, 16 Dec 2009 15:11:22 GMT

The alkp was only marginally raised at 252 (our ref 0-130)- I would normally expect a higher value with cushings.She came in today for a repeat acth stim.Her fructosamine is 472, but she has put on 0.4kg, and the last few days has been less thirsty.I questioned the owner about insulin handling and storage etc and volume given- which all seems to be ok. The comment about insulin going intradermal rather than subcutaenous was something I was wondering-variable absorption could explain her varaible thirst.The 2x glucose curves performed - the insulin was injected by one of the nurses, but from an open bottle the owner bought in.Her last curve- the glucose was 24.2 on admission and the lowerst it dropped was 22- so thats resistance allright! I don't know how much stress will affect things in dogs cf cats.

Re: Insulin resistant diabetic dogs

Rajat — Tue, 15 Dec 2009 20:45:04 GMT

Sounds like insulin resistance and agree with all other comments that check and dbl check clients actions.. I referred a client once who was not referigerating insulin despite it being on the label and being told that during our long diabetes chat...felt silly after for not checking she hadnt forgotten its meant to live in the fridge!

In addition to other tests (17-ohp, repeat acth stim and CSL definitely a good idea excellent endocrinology service) I would definitely do a urine culture by cysto...obviously after the dog is off any abs for a few days. DM would predispose it to UTIs as would Cushings and I try to check it in every such case where costs etc allow...

I wouldn't rule out a change in Insulin to Lente if none of the above works. Adrenal imaging may be helpful if an ultrasonographer can help but TBH if all else fails and your clin suspicions remain high you could try her on vetoryl empirically.. Obviously not without risk but neither is raging DM!:)

Ps- how much was the rise in ALKP?

Cheers

Raj.

Re: Insulin resistant diabetic dogs

James Allsop — Tue, 15 Dec 2009 17:25:22 GMT

I agree - would definately check owner compliance especially with the variable polydypsia.

Cushings in my experience can sometimes be very frustrating and can take several ACTH stim and /or LDDS tests to finally be convincing.

Re: Insulin resistant diabetic dogs

Laurence Webb — Tue, 15 Dec 2009 09:37:13 GMT

...and then there's the story of the owners who were shown how to give injections by demonstrating on an orange. Failure to control the diabetes was eventually traced down to the fact that they were carefully injection insulin into an orange each day before feeding it to the dog.

Can't remember when I first head that one, but it's been doing the rounds for some time.

Re: Insulin resistant diabetic dogs

Utlendigur — Mon, 14 Dec 2009 23:21:37 GMT

I must admit I tend to start with basics - are the owners storing, measuring * and injecting the insulin properly? Is it kept in the fridge (but not frozen), are they rolling it to mix (not shaking it), are they getting injections subcut (rather than intradermal). Would usually rule these out by doing a curve using fresh bottle with injection given by vet or nurse. Are you getting any dip on the glucose curve? Does the dog look clinically cushingoid (coat, pot belly etc)? Must admit it sounds suspicious for cushings. May also be worth checking for hypothyroidism?

* It may sound simple to us doing it every day but we have had two cases you couldn't make up. One owner injecting air because they didn't realise you had to up-end the bottle, and another owner whose friend when looking after the diabetic dog phoned OOH in a panic "We need another bottle of insulin, this one doesn't work" - doesn't work??? - again not enough sense to turn the bottle upside down!

Re: Insulin resistant diabetic dogs

Clare Hogston — Mon, 14 Dec 2009 20:53:13 GMT

I'm not sure my scanning sklils are up to visualising adrenals! This dog had a normal bile acid stim test and a uniform appearing echogenicity- but I realise that doesnt = no disease!

I use idexx labs and speaking to the pathologist there- they suggest the acth stimtest is the one less affected by the unstable diabetic state.

Thanks for your comments.

Re: Insulin resistant diabetic dogs

listhestar — Mon, 14 Dec 2009 20:19:29 GMT

[quote user="Laurence Webb"]

[quote user="listhestar"]

Can always ask them to look for 17-hydoxy something (sorry mind blank moment)

[/quote]progesterone

If you're experienced at ultrasound you could measure the adrenals. I saw them once on a course...not sure I've convincingly found any myself though.

[/quote]

Thanks :)

Re: Insulin resistant diabetic dogs

Laurence Webb — Sun, 13 Dec 2009 22:44:35 GMT

[quote user="listhestar"]

Can always ask them to look for 17-hydoxy something (sorry mind blank moment)

[/quote]progesterone

If you're experienced at ultrasound you could measure the adrenals. I saw them once on a course...not sure I've convincingly found any myself though.

Re: Insulin resistant diabetic dogs

listhestar — Sun, 13 Dec 2009 18:54:25 GMT

[quote user="Clare Hogston"]ACTH stim and LDDST test were performed [/quote]

Which lab did you use- I find some labs aren't so good with the ACTH (don't know why)? I use Cambridge for all endocrine work. Can always ask them to look for 17-hydoxy something (sorry mind blank moment) as that can show up cushings sometimes before cortisol levels.

Good luck

Lisa

Re: Insulin resistant diabetic dogs

Martin Jones — Sun, 13 Dec 2009 18:42:19 GMT

Cushings. Alternatively, the possibility that the auto-immune destruction of the b-cells is progressing quickly, thus increasing insulin dose required quite rapidly.

But Cushings. Possibly Type 2 - is it very fat? Does it have a fatty liver?

Cushings. Possibly some ADH issues - you could try it on ddavp tablets for a few days if you really feel you've ruled everything else out.

Cushings.