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Dr. Ellie
Dr. Ellie, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 305
Experience:  emergency and critical care resident
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I have a dog that has diabetes her sugar has been low weeks?

Customer Question

I have a dog that has diabetes her sugar has been low for 3 weeks? so low she had seizures? we have all kind of blood work done everything came back good? now sugar is every high and staying high. we have change insulin? She on a strict diet? she is nine years old she wt. 12 and half pounds she has been a diabetes for about 6 years? I have a very good vet? we thought finally we got it under control for about a week now is staying very high. do you have any input on what u might think the problem is that I have missed?
Submitted: 3 months ago.
Category: Dog Veterinary
Expert:  Dr. Ellie replied 3 months ago.

Hi there!! I am eager to help answer your questions about your dog's diabetes today, but please allow me a few minutes to read through your question thoroughly and gather some information for you. I appreciate your patience, I will be with you shortly.

Very Sincerely,

Dr. Ellie

Customer: replied 3 months ago.
ok that fine I hope u know something we r missing?
Customer: replied 3 months ago.
sorry u will have to email I have to go back to work
Expert:  Dr. Ellie replied 3 months ago.

I am working on a thorough response right now, you will be able to access it when you log on to the website and can read it at your leisure.

Expert:  Dr. Ellie replied 3 months ago.

I am unable to call as I am at work right now, but I am happy to opt out so that your request is re-submitted and another expert that is available for phone calls can get in touch with you. Please feel free to let me know if you still need further assistance.

Dr. Ellie.

Customer: replied 3 months ago.
I don't mind u Dr ellie u calling me I don't wont to pay other 28.00 to talk?
Expert:  Dr. Levinson replied 3 months ago.

Hi there, are you still looking for some information?

Expert:  Dr. Ellie replied 3 months ago.

I am unable to call, as I am currently working (I work very long shifts at an emergency hospital) but I am happy to help out via chat. That way I can continue to care for the patients I have in the ICU while I'm helping you :)

One of the first things that I think of when a diabetic dog has a consistent blood sugar that is too high is that the insulin may be bad. I know this may sound basic so please don't be offended but I want to review proper handling of insulin with you before moving on to the more complicated stuff. I find it helps to start at the beginning so that we don't make things more complicated than they need to be. Is that OK?

Customer: replied 3 months ago.
This is new insulin just had it about 2 weeks the name is ***** ***** she gets 4 units in the morning and she gets 4 at night? She was at one time getting 8 units two times a day till it drop so low that she was having seizures and she was taking Humulin n that's when we switch to the new one. So this insulin is not old?? She had a shot of antibiotics with that I'll kind of blood work and blood work came back good she don't have Cushing's disease so there's a problem somewhere for the sugar to be high? 4/3 weeks it was low now it is high and I mean, they don't even register on my meter? Me and my vet which he is very good and been very concerned have done everything possible to see what we could do it while this is happening I was just wanting your input maybe you might know something? We have not try??
Customer: replied 3 months ago.
My insulin stay in the refrigerator if I go anywhere I put it in a bag with an ice pack?
Expert:  Dr. Ellie replied 3 months ago.

Thank you for getting back to me about that. It sounds like the insulin storage and handling is appropriate which is good. I just want to make sure that you are rolling the insulin and not shaking it. But, now that part is done we can move on to other reasons for high blood sugar in diabetics. Different insulins have different dosing so you can't necessarily say that one unit of vetsulin is the same as one unit of the humulin. It sounds like his insulin needs have changed and the key is to find out why and treat the underlying cause. Things that can increase insulin needs include bushings disease, infection (typically a bladder or kidney infection due to the blood in the urine), additional snacks throughout the day that were not previously part of her diet, other hormones (is she spayed?), etc. Once that is ruled out, you have to look for what is called a symogi effect. This happens when the blood sugar drops too low causing counter regulatory hormones to be released in large quantity resulting in a spike in blood sugar. Testing for this requires a serial blood glucose curve. This is performed by monitoring glucose every 1-2 hours throughout the day (usually a 12 hour period but can also be a 24 hour period) to look for the peak and trough glucose levels. Here at my hospital, we are 24 hours so we can perform a 24 hour glucose curve to get a complete picture of what is happening over time. If we can identify a symogi effect, the insulin dose can be adjusted to prevent such a drastic drop and the tendency of the body to make a drastic correction. Because management of diabetes can be complicated, some people choose to see an internal medicine specialist until the insulin dose is stable then follow up with their general practitioner from there. Since you are seemingly having issues after she did well for so long, it may be worth it to discuss the possibility of a referral to an internist with your general practitioner to trouble shoot the situation.

Customer: replied 3 months ago.
We have done all that? She has be spayed? She has all kind of blood work they check for everything?
Expert:  Dr. Ellie replied 3 months ago.

Without seeing what blood work was done, I cannot say that a complete work was performed however it sounds like it was more thorough than most. Have you ever had a blood glucose curve performed where the dog stays at the vet for the day or overnight and has blood sugar check hourly or every 2-4 hours throughout the day?

Customer: replied 3 months ago.
I have she has been there 4 time all day? In the beginning it was on the low side so we got that under control finally doing good for about a week then it started for now over a week being high and she's been to vet twice and monitor all day long? On her blood work they tested for about 25 different things the cushions disease which she did not have everything turned out good on the blood work? She had a shot of antibiotics that lasted 2 weeks but now she's back on some antibiotics just in case she has an infection somewhere? I know I am grasping at straws but I have can't figure out the life of me why this keeps happening to her? Like I said I have a very good vet but he's been staying on top of it? There's not too many vet that you can text and let him know what's going on with her so I do stay in touch with him about every day or night? She stay at the vet Tuesday all day her sugar was went down a tad but then it went right back up? She was there all day Thursday and he kept a check on it every 2 hours and it was on the high side all day? I am giving her 4 units of insulin in the morning 4 units of insulin at night? And I check her sugar off and on all day? It just breaks my heart but I can't get this under control and I hate to see her go through all this. By the way she's a miniature schnauzer she weighs 12 and a half pounds? I know my vet has done everything possible and checked everything I just don't understand I just don't understand!! They first vet that I took her to put her on eight units in the morning 8 units at night? And she really didn't do well on that it would get too low then I would have to back down on the units. Her name is ***** *****'s had cataract surgery in both eyes this little baby has been through a lot but she's tough. I'm just wanted to get this sugar under control. Thanks
Customer: replied 3 months ago.
I'm going to do as you suggest I'm going to get up and check it about 2 in the morning because that's when your sugar drops is at night? Then I'm going to check it in the morning at 6 right before I feed her? I fed her at 6 at night I check her sugar then. About 11 that night I give her a little something to eat?
Expert:  Dr. Ellie replied 3 months ago.

Different insulins wil have different dosages so 1 unit of her old insulin is not necessarily equivalent to 1 unit of the new insulin. Sometimes, dogs need an alternate dosing schedule such as once a day insulin or a lower second dose instead of the same dose twice daily. Unfortunately, there is a lot of guesswork that goes into getting a diabetic dog well regulated if they are not straightforward as it sounds like your dog is not. It sounds like your vet has done a good job so far, but it sounds like it may be time to get a specialist involved. An internal medicine specialist is trained in managing all sorts of chronic and complicated conditions such as diabetes mellitus and may be able to see what we are missing. Since your dog has had a thorough work up and is still difficult to regulate, there is clearly a piece we are missing. The other key with diabetic management is consistency and regimented routine. Eating at non-mealtimes can throw of fate blood sugar because there may not be enough insulin in the system to work on the new glucose that the liver will make from the nutrients in the food. The reason that we recommend giving animals insulin with meals is that under normal circumstances the pancreas would release insulin after eating to help the cells use the glucose made from the meal that was just eaten. when there is no glucose, the cells cannot use this glucose and the blood sugar becomes high. If you are giving your dog a snack without insulin on a regular basis this may be contributing to her increase in blood sugar. I recommend cutting out the snack and seeing if this helps keep her sugar more steady.

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