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Dr. Drew
Dr. Drew, Veterinarian
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Experience:  Small Animal Medicine and Surgery
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My Lab is diabetic and takes insulin twice a day. 13 UNITS

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My Lab is diabetic and takes insulin twice a day. 13 UNITS TWICE DAILY
Last night, she ate at 10, then had thrown up this morning (sometime during the night).
She continued to throw up between 7:00 & 9:30 a.m., so I took her to the vet and she received a Reglan shot.
Tonight, she is still vomiting clear water and white foam, 10 hours post injection.
She missed her insulin shot this morning because she didn't eat, but if she doesn't eat tonight, I still can't give it to her tonight, either, if I understand correctly, so her last injection would have been last night at 10:00.
It's Friday night, and she hasn't eaten / won't eat, and hasn't had any insulin since last night at 10:00, (24 hours at 10:00 tonight.
Should I wait a full 24 hours before contacting the vet again ((in the morning at 10)) or wait until morning and see what happens.
She keeps on drinking water, but it's not going down, just coming back up as clear water and white foam.

My basic question is "If she won't eat, she isn't supposed to have insulin, but she hasn't 'improved' and stopped vomiting as expected. How long should I wait on the Reglan to work, or to call the vet?
I want to be safe, but week-end appointments are expensive! I want to 'do the right thing' for my dog' without being paranoid!!

Thank you so very much for your insight. I'm distraught about whether or not I'm wanting to call the vet too soon, or being so worried.
Submitted: 1 year ago.
Category: Dog
Expert:  Dr. Drew replied 1 year ago.
Hello, thanks for your question today! I am Dr. Drew, and I am a licensed veterinarian. I'll be happy to help you in any way I can.

Reglan (metoclopramide) typically will take effect within 1-2 hours, and is essentially gone from the bloodstream within about 6 hours after injection. Since 10 hours have passed, I suspect that there is no significant amount of this drug still in her system.

I rarely withhold all insulin from diabetic dogs; even if they do not eat, most will require at least *some* insulin (usually 1/3 to 1/2 of the usual dose). The big concern is that a diabetic dog who goes without insulin for very long, may develop Ketoacidosis, a condition where the metabolic functions in the body begin to shut down, largely due to the lack of insulin's many functions.

It would be reasonable to try to give something to settle her stomach, since the Reglan clearly didn't do very much. A dose of pepto-bismol liquid may be useful, 1mL per 10 pounds of body weight, or you could give Bonine (meclizine), which is a motion sickness medicine for people, sold in any pharmacy, 25 mg every 12 to 24 hours.

Certainly if there is no improvement by the morning, Chessie needs to be re-evaluated. Diabetic patients must not be allowed to go very long when not feeling well.
Customer: replied 1 year ago.

In my panic to write, pay, and contact you correctly, I forgot to tell you something!


 


The vet to say she gave Chessie the Reglan injection that should last, and she gave me 2 Cerenia tablets 60 mg. each for Saturday and Sunday .... just in case, since it's the weekend.



1st - I was under the impression I probably wouldn't need them, and that they (Cerenia tablets) were for tomorrow & Sunday for emergencies, .......... but wondering if I should give one of them tonight? Will it hurt anything?


 


2nd - How much food would be considered 'enough food', and how long would she have to hold it down without vomiting, to be able to give her her full injection?


Thank you!!


 

Expert:  Dr. Drew replied 1 year ago.
Cerenia would be a very good idea to give at this point. It's a very safe product, so you may as well give a dose.

I'm not aware of any long-lasting Reglan product that is available. There is an injectable Cerenia, which lasts 24 hours, but Reglan does not last very long at all.

I'd consider at least 1/3 of her usual amount of food to be the minimum required for a full dose of insulin to be given. If vomited up within 2 hours, it's likely that very little was absorbed.
Dr. Drew, Veterinarian
Category: Dog
Satisfied Customers: 16460
Experience: Small Animal Medicine and Surgery
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