My pal Jessie, schnauzer, diabetes

[frijole]

Hi friends. My mom and stepdad's schnauzer Jessie is about to undergo testing. She was a finicky eater up til about a year ago and she started eating like a cush dog. She has been heavy for more than that. I don't know her weight yet. But she is short and wide. :p

I know that a thyroid test was done last year and was negative. (probably the T4 and not the Free T). I do not know of any blood panels that have been done in the past. (yet..am gathering facts from my stepdad)

I babysat her for 3 weeks just a bit ago and watched her like a hawk to see if anything was out of the ordinary and other than the appetite of a cush dog I saw nothing. Her energy level was good.

Within the last week she started peeing in the house. They just told me today that she is drinking a ton of water all of a sudden and peed again in the house. I explained the similarities between cushings and diabetes. They are scheduling a blood panel to be done to rule out or confirm diabetes. I assume that will happen on Monday.

I have firsthand knowledge of cushings but haven't dealt with diabetes. I hope it is one or the other and not both. We don't have any specialists within 6 hrs driving distance.

I'm open to advice and prayers for our little one. I'm not sure I have a photo but I'll get one and add it. Thanks guys! Kim

[littleone1]

Hi Kim,

I'm sorry that Jessie is going through this. I don't have any experience in dealing with diabetes. I wish that I had some advice to offer, but unfortunately, I don't.

My thoughts and prayers are with all of you.

[lulusmom]

Hi Kim,

I think a blood chemistry panel is the first step. If diabetes is ruled out, you might want to think about doing a UC:CR. Can you help your folks do the collection if need be?

If it turns out that Jessie does have cushing's, how lucky for the whole family that you are well versed and can bring much calm to a highly emotional situation. ...not to mention how lucky you are to have all of us here to help you out. :D

[Harley PoMMom]

Hi Kim,

I am not an expert when it comes to diabetes, but Natalie is. Here is a post from her to a new member about checking for diabetes.


Hi Carol,

My experience comes from the diabetes side. Something you could do quickly and easily to check the possibility of diabetes is to buy urine test strips that check for glucose and do a quick urine test at home. I believe they are commonly known as ketodiastix or diastix. You don't want to use ketostix as those do not check for sugar. There are also reagent strips that check multiple parameters - those would work as well.

They are generally available at a pharmacy and are not very expensive.

That would help answer the diabetes question. And then the additional specific test results would make it easier to look at the overall picture.

I too would go with the specialist in your shoes just because they deal with more complicated problems on a daily basis.

Natalie

Hope this helps alittle. My thoughts and prayers are with you, Jessie, and his family.

Love and hugs,
Lori

[frijole]

Hi Kim,

I think a blood chemistry panel is the first step. If diabetes is ruled out, you might want to think about doing a UC:CR. Can you help your folks do the collection if need be

If it turns out that Jessie does have cushing's, how lucky for the whole family that you are well versed and can bring much calm to a highly emotional situation. ...not to mention how lucky you are to have all of us here to help you out. :D Yes, lucky me. :p:D I mean, them. My gal Annie is next to be tested...I think she is atypical. Just based on other's stories.. Don't have the strength to update her thread tonight. :(

[lulusmom]

Well be here when you get your strength back, sweetie.

[frijole]

Lori, I remembered reading that thread. Trust me, my stepdad is better off paying for the blood panel then trying to figure out what test to buy and then doing it. Visual is fun though.

Glynda, I never had the UC:CR test done. Never knew about it til after Haley was dx-ed and reading here for years. Can all vets do it? ha. Wonder why it wasn't done? I'll try to find the link for it. 3 days worth of early morning pee? :confused::):D:p:p Sigh.

Appreciate the luv for Jessie - she is a nice dog and loves to come over and play. I will check back tomorrow - gotta run as I have an early a.m. appt. Thanks to all!!! Kim

[lulusmom]

I never did a UC:CR with Lulu either because the IMS took one look at her and dived right into the big gun testing. :D Dr. Bruyette mentioned collecting pee for three days here but I just listened to one of his audio and he said that the 3 day pooling is standard in Europe but it's not done here in the states. Just plan on collecting one specimen. I don't know of any vet that can't do a UC:CR or that doesn't have a lab that can do it.

[Harley PoMMom]

Harley had a UC:CR done and so did my other Pom. I did talk to my vet about the 3 day pooled samples and she did agree that this is a better way.

[lulusmom]

Dr. Bruyette's lecture notes can be found on his VCA website. If you go to Lecture Notes and clink on the link Hyperadrenocorticism and page down to the UC:CR, you'll see that a single morning sample is indicated. This is a great resource for more than just cushing's.

http://vcawla.com/

[k9diabetes]

Hi Kim,

Is Jessie a mini Schnauzer? Diabetes is extremely common in mini Schnauzers. My list is unofficial but they are at the top for the breed I see most often, followed closely by Min Pins. I'm actually starting to wonder if the selective breeding that develops these mini breeds is at the heart of how common diabetes is among them.

High triglycerides are really common too and can skew the test results.

I'll be interested to see what you find out!

Natalie

[Harley PoMMom]

And Dr Bruyette's post can be found here: :)


Yes. The same would apply when looking at urine cortisols in the initial diagnosis of Cushings. Ideally 3 morning pooled urine samples collected by the owner at home and refrigerated.


Dave

[frijole]

Hi Kim,

Is Jessie a mini Schnauzer? Diabetes is extremely common in mini Schnauzers. My list is unofficial by they are at the top for the breed I see most often, followed closely by Min Pins. I'm actually starting to wonder if the selective breeding that develops these mini breeds is at the heart of how common diabetes is among them.

High triglycerides are really common too and can skew the test results.

I'll be interested to see what you find out!

NatalieYes Nat, mini schnauzer. My aunt's mini has diabetes. So between the two of us we can help them. Your comment on the trilycerides - are you saying if they have high levels they might not have diabetes but it would appear they do? Sorry, my knowledge is limited to cushings. :p and in particular pituitary.

Thanks! Kim

[Squirt's Mom]

Hey Kim,

Man! Your folks are so lucky to have you along on Jessie's journey! I know she is in good hands with you on her side. Plus like Glynda said, she also has all of us, too, right there with you.

Big hugs,
Leslie and the girls - always

[k9diabetes]

The high triglycerides can skew some results on the a blood panel. I don't think the glucose is one...

But they can make the blood sugar difficult to control.

Natalie

[Franklin'sMum]

Hi Kim,
Thoughts and prayers from us here to Jessie. Good luck with everything and please keep us posted
Jane, Franklin and Bailey xxx
________
Paxil lawyers (http://www.classactionsettlements.org/lawsuit/paxil/)

[frijole]

Thanks. I'm going over with a list of instructions just to be safe.


Fast the dog
Collect urine
Do blood panel
If diabetes don't waste $ yet on cushings tests yet
If not diabetes start with ldds test
If they do a thryoid test do a Free T4 in addition to Free T

Did I miss anything? Thanks! Kim

[Harley PoMMom]

I had the Free T4 by ED done on Harley...but now I wish I would of had a full thyroid panel done and sent to Dr Dodds. I like the fact that she takes in consideration of the breed, sex, and age of the dog.

Love and hugs,
Lori

[frijole]

Good thing I went over with the list because he wouldn't have fasted the dog or got a urine sample. When he called the gal at the counter said "bring her in on Monday". So... since he did fast her and bring in a specimen they did testing.. I don't know which tests they all did.

But she is diabetic. Her bs level was 450! I am thinking that is fairly high? That's all my mom emailed me. I'll get more details later. I hope she is easy to control because my stepdad is the "dog" person and he is afraid of needles. :o

I'll post more once I get info. Kim

[acushdogsmom]

If they do a thryoid test do a Free T4 in addition to Free T

Did I miss anything? Thanks! KimI think the test you want is the "Free T4 by equilibrium dialysis" - also sometimes called "Free T4 by EQD" or "Free T4 by ED". :)

There may also be a "Free T4" test (without the EQD), but I'm not sure if it's the same thing as a Free T4 by EQD, and it's the equilibrium dialysis test that you want to get done.

P.S. There's also one called total T4, I think, but I don't think there's one that's called just "Free T". ;)

[frijole]

I think the test you want is the "Free T4 by equilibrium dialysis" - also sometimes called "Free T4 by EQD" or "Free T4 by ED". :)

There may also be a "Free T4" test (without the EQD), but I'm not sure if it's the same thing as a Free T4 by EQD, and it's the equilibrium dialysis test that you want to get done.

P.S. There's also one called total T4, I think, but I don't think there's one that's called just "Free T". ;)

:eek: WOW. No wonder I can never remember this. I am going to write it all out for when I take Annie in.

[acushdogsmom]

Pretty good explanation here:

http://www.marvistavet.com/html/body_hypothyroidism.html


TESTING FOR HYPOTHYROIDISM

One would think testing for hypothyroidism would be simple: a blood test of the T3 or T4 level could be checked and if it is low, the patient is hypothyroid. Unfortunately, the situation is rarely so simple.

Measurement of “T3”: If T3 is the active hormone, why can’t we just test blood levels of T3? Due to assorted compensatory mechanisms, T3 levels often fluctuate into the normal range in even truly hypothyroid dogs. This means that T3 values are virtually useless in diagnosing hypothyroidism.

Measurement of “T4”:The T4 level (also called the “total T4” level) is measured commonly and is included in many routine screening blood panels. It would seem that a low T4 would indicate hypothyroidism and a normal T4 would indicate normal thyroid function. Unfortunately, it isn’t that simple. Dogs on certain drugs (most notably phenobarbital and potassium bromide (both seizure medications), prednisone or other corticosteroids, non-steroidal anti-inflammatory drugs, propranolol (a heart medication), clomipramine (a behavior drug), or sulfa class antibiotics) or with illnesses other than thyroid disease often have depressed T4 secretion. These dogs will have low T4’s but are not hypothyroid. This means a normal T4 indicates normal thyroid function but a low T4 may or may not indicate hypothyroidism. There is also a “grey zone” where T4 results are considered not definitively normal and not definitively abnormal. In short, T4 alone is not adequate to make a diagnosis of hypothyroidism


Free T4 – As mentioned, T4 is the precursor hormone which is not active but it converted by body tissues into T3 which is active. T4 exists in two froms: the form which is carried around bonded to a blood protein (this is called “bound T4”) and T4 floating around loose in the bloodstream (called “free T4”). Only free T4 can enter cells and be converted to T3 and the concentration of free T4 corresponds to thyroid hormone activity where it counts (i.e. at the tissue level). Free T4 levels are less subject to fluctuate into a falsely low range in response to non-thyroidal diseases or drugs than is a total T4 level.

Free T4 levels are typically 1000 times smaller than total T4 levels plus tests for free T4 have to work in such a way so as not to convert bound T4 into free T4 and thus interfere with results. Because of these two issues, it is somewhat difficult to test for free T4 and the only acceptable way to do this is by a method called “Equilibrium dialysis.” At this time most labs offer equilibrium dialysis free T4 but it is important to realize that a free T4 level on a lab report is not an equilibrium dialysis free T4 unless it specifically says so. (Equilibrium dialysis free T4 is sometimes notated “fT4(ED)”).

[frijole]

Per my stepdad the only abnormality in the panel was the glucose. No cushings. Just the 450 reading on the glucose.

He showed my stepdad how to give the shots and sent him home with her. Said to come back in one week. Is this normal? Guess I expected them to keep her and get her levels normal.

Get this - he gave her vetsulin which even I know from reading here has been discontinued/recalled. I think he is trying to use up what he has. I told my stepdad and he said he is getting an rx and will ask for a different kind. Lord.

I will research the vetsulin in a minute... just got home. Kim

ps she is on 6 units but don't ask me if that is per day or per dose. i am just quoting him.

[AlisonandMia]

Here's a link to some Vetsulin info - the latest I believe: http://vetsulin.com/vet/Vet_ProductAlert.aspx

Got this from K9D and there's lots of other info there, of course.

Good luck!

Alison

[frijole]

Thanks Alison. I searched here and found lots of links and I am seething at the vet for prescribing this to a new patient. I will be phoning him tonight and sending him the links to read. All about the money no doubt. Grrr. Kim

[AlisonandMia]

It seems that some of them have somehow been able to remain ignorant of the Vetsulin situation. Others seem to be very convinced of the superiority of Vetsulin (because it is a pork insulin) over NPH that they are very loath to relinquish Vetsulin and so have started new patients on it despite being advised not to. And some may even be in some sort of denial and believe that this glitch with Vetsulin will only be short-lived and it will come back before their supplies run out - which is very, very doubtful - and looking more doubtful every day. NPH is very good and actually often better for some dogs as well as being a heap cheaper and there seem to be quite a few vets that have always used it as their first-line insulin.

For months now the makers of Vetsulin have been saying that old patients need to be transitioned to NPH and new patients should not be started on Vetsulin as once the supplies dry up they will need to go through the palaver of switching anyway.

There are also a few dogs out there who really, really need Vetsulin for some reason (allergy or other immune issue usually) and you'd think it would be best if the remaining supplies of Vetsulin be stockpiled for those pets and all the others use NPH.

From what I've seen at K9D, BG of 450 at diagnosis is actually pretty good and it looks like they caught it early. BG levels in the 600's (or even higher) and a very sick dog is not unusual at all.

Alison

[frijole]

I think the vet is trying to use up his supply. :p He did say that he'd probably (hee hee) have to switch. My stepdad was impressed I knew about vetsulin. I agree it would make more sense to save it for those who need it...

Glad to hear 450 is good. And to be honest - it is because of this board and what happened to my aunt's schnauzer that I knew to push him to go in. He would have stalled and it would have been worse. So thanks to all who taught me.

Jessie is lucky to have all of you on her side.

[AlisonandMia]

Switching can be a bit of a performance - involves cutting the dose by around 20 - 30% in a well-regulated dog and then increasing the dose (of NPH) as necessary so it can mean that a previously well-controlled dog has to go through period of poor regulation. Better to start on the NPH in the first place, IMO. Almost invariably they end up on more or less the same dose of NPH as they were on Vesulin.

Just one other question - has the vet recommended twice daily insulin or are they starting with one shot a day? They sometimes do that (and it is more likely to be satisfactory(-ish) with Vetsulin than NPH) with squeamish and overwhelmed owners at first to get let them get comfortable with giving injections before moving to two shots a day. That could be one reason to start with Vetsulin under the present circumstances.

Some vets also still think that Vetsulin can be used as a once-a-day insulin (it was originally promoted as such) and actually try to use it that way all the time. That's something that occasionally works - but very, very rarely as most do need two shots a day.

Alison

[frijole]

twice a day Alison. I know this because they are bringing her over tomorrow night and I get to give her my first shot. :eek:

[BestBuddy]

Hey Kim,

Sorry to be so slow to jump in but my life is a but hectic at the moment.

First the Vetsulin issue, if it is going to be in short supply then starting with NPH is much better. I used Caninsulin (our Vetsulin) for over 4 years and was really happy with it. The FDA has issues with Vetsulin but our Caninsulin is still available and all the people I have contacted have said we will have no problem and supply is assured.

NPH is cheaper and much easier to obtain and I think if I am honest with myself it was easier to keep Buddy in good/safe BG ranges.

When I made the change from Caninsulin to Vetsulin I didn't adjust the dosage and one night I gave 4 units of Caninsulin and the next day I started with 4 units of NPH. Buddy didn't skip a beat.

As for food you need to feed something that Jesse will eat every day without a problem and as time goes on maybe then you can look at making small adjustments just to fine tune things. Something that is low in fat and sodium and medium protein with lots of fibre is perfect. I added Benefibre to the food to add some extra.

The injections...well I used a product called inject ease (google it) and it made the injections so easy for someone who had a needle phobia (me). There are lots of little tricks but they can be learned on the way.

Jen

[frijole]

I posted on k9D but fyi Jessie had her one week test.. not good. She started out at 450 and after one week at 6 units 2 x daily (she is 23 lbs) today she was at 590.

Here is the quote from my mom so I dont leave anything out.
After the curve test today and with Jessie's BS at 590 he increased the insulin to .8 2 times a day. They told Pete to give the dog only half of the dose of insulin if she won't eat. She wouldn't eat this a.m. and Pete gave her the shot thinking she'd eat. Well she didn't. So, I guess she went all day without eating. They had her down at the clinic from 8-3. She goes back a week from today to check the dosage again.

:( I am worried. They love her to death but what was he thinking? I worry...alot.

[littleone1]

I'm so sorry Kim. I really don't know anything about diabetes in our furbabies. I wish I could help. My thoughts and prayers are with you and your family. I really hope that everything will improve.

[BestBuddy]

Ok because Jessie has been so high giving the insulin without food probably wouldn't have hurt BUT it is really important to feed first.

You have to try and convince them that it can cause a serious problem if Jesse gets too much insulin especially without food to balance it. Good luck with that.

I have said this many times and I will say it again (sorry) but Buddy's specialist said that 99% of the diabetic dogs he treated ended up on the same number of units as weight in kg. Jess at 23lb is just over 10 kg so maybe the magic number for her will be a little higher than the 8 she is getting at the moment.

It is important to go slow so you don't overshoot the perfect number so maybe another week and if things are not good enough another small increase.

Jenny

[frijole]

Terri, thanks for the warm thoughts. :)

Jen, thanks I passed that on to my mom. Good to know. My aunts dog developed pancreatitus real bad when diagnosed and was near death. So the vet kept him and got him stable at 15 units prior to releasing him so my aunt didn't have to deal with this.

Kim

[frijole]

Heh guys - my mom's dog that has diabetes was walking on 3 legs yesterday (Easter) and so they took her to the vet (the one I fired) today. My mom obviously doesn't know the details since she never goes to the vet but she emailed me that "he thinks she has a snapped ligament..like an ACL..I think that's what he said. He's giving her a shot each week for 4 weeks...hoping that will help...won't cure it."

WTH? I know some of you have dealt with similar issues.... can you help me direct my poor step dad and this idiotic vet? (Sorry but the guy is a complete idiot)

Thanks
Kim

[frijole]

HELP... this vet is such an idiot. He didn't even tell them to keep her off her leg and there are about 20 steps from the porch to go potty.. I told my mom that was out of the question!

He also is 'guessing' that it is an acl because he didn't do an xray because he'd have to put her out... well no kidding.

My mom said 'well she is 11 yrs old and not in the best of health'. She is a very feisty loving overweight diabetic dog.

I know poor Deb has been thru this twice. Anyone? I'm clueless on ACL injuries aside from what I see in football. :o Kim

[Harley PoMMom]

Oh Kim,

So sorry to hear about Jessie. I don't know hardly anything about ACL tears but found this article: Ruptured Anterior Cruciate Ligament (ACL). (http://www.peteducation.com/article.cfm?c=2+2084&aid=474) Hope this helps.

Keeping you all in my thoughts and prayers.

Love and hugs,
Lori

[lulusmom]

Sorry Kim but everything I know about ACL tears and ruptures is what I've read. From what I understand, if it is an ACL rupture, surgery is usually the only choice and the longer you put it off, the more certain that arthritis will be bad at some point in the future. I was under the impression that a vet can manipulate the knee and figure out if it is the ACL. In any event, you are right, this vet doesn't sound very sharp. If Jessie were mine, I would have already scheduled an appointment with an orthopedic surgeon.

[StarDeb55]

Kim, an x-ray won't show the actually injury. What it will show is a change in position between the tibia & the knee. What the absolutely diagnostic sign for an ACL rupture is found on physical exam, called "drawer sign". When the lower leg is manipulated back & forth, I think it's the knee that slides back & forth like a drawer being opene & closed. "Google" to make sure. I'm guessing that the injection is either an anti-inflammatory or a steroid. They can try conservative management meaning absolutely no walks, no playing, basically crate rest for at least 6 weeks. The only sure cure is surgery. Actually, the type of surgery that Chew had can be done almost any time, even months after the injury according to Chew's surgeon. The surgery is called TPLO, & it isn' cheap, about $3200. There is a cheaper surgery where suture material or monofilament line is used to replace the torn ligament. This one is what Barkley had years ago. Chew's surgeon said that this surgery is old school, he still does occasionally, but it has fallen out of favor.

http://www.veterinaryspecialty.com/ACLTears.aspx

Hope this helps.

Debbie

[frijole]

As always you guys are awesome. I sent my mom the links and the info. Its funny because she 'doesn't like dogs' but every time something goes wrong my mom gathers the info to pass on to my stepdad. I think he feels he needs her blessings before spending the money. I told them to take her to my current vets because one of them is an orthopedist and they have the equipment and skills to get this done and it is obvious the current vet is guessing and to not tell them to rest the leg is insane.

Hugs to you all. Kim

[Squirt's Mom]

Hi Kim,

This group helped me tremendously with Crys and her problems.

http://pets.groups.yahoo.com/group/ConservativeManagement/

Hope things go alright for little Jessie!

Hugs,
Leslie

[StarDeb55]

Kim, I was in a hurry when I posted this morning, forgot one thing. If they choose conservative management, this means, potty breaks are on a leash with somebody taking Jessie outside, no freedom whatsoever. No sleeping on beds or couches, no jumping, anything. I will admit that I let Chew sleep on the bed, but I knew he would be ok as he just doesn't get up in the middle of the night unless he's sick or something really bad. I trusted him that much & I was right. If Jessie can be trusted, it might be ok, but until your folks know for sure, restrictions have to be put in place.

Debbie