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My Lhasa apso (12 yrs 3 mnths, female, intact, 9.3 kg) is…

Second opinion] <p>My Lhasa apso...
Second opinion] <p>My Lhasa apso (12 yrs 3 mnths, female, intact, 9.3 kg) is suffering from diabetes and is on Lantus. (She ha sbeen on lantus since feb 5. Her glucose curve is not coming up right and has severe fluctuations. she had an incident of hypoglycaemia on 27th February where her glucose levels went down to 30 - a teaspoonful of honey and some sugar syrup supplemented by some food recovered her - since then she was on one unit of Lantus at night and 2 units of lantus in the day - however, on the third day her glucose levels went down to 55 again - and we skipped the dose and gave only one unit next morning (her glucose levels were 239 that morning). In six hours it had climbed up to 258 but by 6.30 in the evening (10 hrs after her meal and insulin) it went upto 349, and at 8.15 pm before her dinner it was 330 (we gave her two units of lantus) but by 6 hrs of meal it climbed to 555. Next day onwards that is yesterday morning, evening and today morning we have given 2 units in the morning, evening and then today morning - and her glucose levels went down to 55 by the end of the day today - glucose curve for today was as follows - before meal and insulin in the morning 258, two hours after meal 302, six hours after meal 191 (gave her a snack of steamed chicken as her usual glucose level at that time is between 260 and 270), 8 hrs after meal 131 (gave her chicken soup and a biscuit), 10 hours after meal - 83 (gave her sugar syrup and a treat), 12 hrs after meal - 55. we gave her food and in 30 minutes it shot up to 230. we have now given her 1 unit of lantus. We have done an ultrasound which is typical of a diabetes patient. Her reproductive organs do not show any abnormality. There is high glucose in her urine but does not indicate any infection. My queries are: 1. Is it normal for a dog to get hypoglycaemia even if the dose given is not even .5 units of body weight? 2. Is lantus a safe insulin for her or would you recommend another one. We are scared through the day and night. 3. how can we avoid so much fluctuation? I would be really grateful if you could pls help me on the earliest. Warm regards, ***** *****</p>
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Answered in 1 hour by:
3/11/2018
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 33,340
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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You're speaking to Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

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I'm sorry to hear of this with your Lhasa, Ritu. I reviewed the entire history and saw that it would be very difficult to assess the efficacy of her protocol due to frequent and intermittent feedings in response to spot glucose measurements. To answer you directly...

1) Glargine insulin is usually initiated at 0.25 - 0.5 units/kg subcutaneously every 12 hours - 2.3 - 4.6 units for her twice daily. Hypoglycemia isn't expected at doses of 1 or 2 units (0.1 - 0.2 units/kg for her) but it's possible in mildly diabetic patients.

2) If she's mildly diabetic you're likely to be seeing the swings from low to high due to overdosing (the Somogyi effect). Hence, another insulin should be considered. Glargine should be used in poorly controlled diabetic dogs where NPH and zinc (Lente) insulin are ineffective because of problems with too short a duration of insulin effect.

3) Stop giving this insulin and speak to your vet about initiating an NPH or lente insulin for at least 5 days and then perform a glucose curve at home without supplemental feedings until the curve is completed in 12-24 hours. Initial dosing of the NPH or lente insulin is usually 0.25 units/kg twice daily with equal sized meals at the time of insulin injection.

Please respond with further questions or concerns if you wish.

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Hi,
I'm just following up on our conversation about your pet. How is everything going?
Dr. Michael Salkin
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Customer reply replied 1 month ago
Dear Dr Salkin,Many thanks for enquiring about my pet.Mishti has been off insulin for a week. And in the last three days, we have been doing a glucose curve for her (10th/11th/12th March) without giving her insuin. Readings for which have been as follows:7 am: 352/345/343
10.30 am: 413/414/363
2.15 pm: 335/336/285
4.15 pm: 323/299/277
8.20 pm 280*/418/351 (*She had just half her meal on day one - and I had supplemented with a bowl of soup in the afternoon)
She has now been advised to give a 30X70 insulin – to be given one hour after the meal morning and evening. As she has seen tendency for hypoglycaemia even with one unit of Lantus – I have requested the vet to start with one unit morning and evening, which he has agreed to for 5 days. The dose would have to be increased to 2 units if she does not respond at all.
My queries are:
a. What do you have to say about above readings?
b. Can I try to give her four meals in a day, instead of 2 – three small meals at 8.30 am, 12.30 pm and 4.30 pm and one full meal at night and give one unit of insulin at that time and not give insulin during the day or would that be a bad idea?
c. Why am I advised to give insulin one hour after the meal?
d. Do you think I need to give her any other supplements?Best, ritu

a. She's diabetic but not egregiously so. The insulin dose is too small. Good work obtaining those values!

b. You can give as many meals daily as you wish as long as you keep her daily caloric intake the same; otherwise, it will be impossible to regulate her.

c. Insulin can be given in close proximity to eating. There's nothing sacrosanct about giving it an hour after a meal. I suspect that her vet is worried that if a meal isn't fed prior to insulin she's more likely to become hypoglycemic. It doesn't work quite that way.

d. I'm not aware of any supplements of value for diabetics.

Please continue our conversation if you wish.

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 33,340
Experience: University of California at Davis graduate veterinarian with 45 years of experience
Verified
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Customer reply replied 1 month ago
dear dr Salkin, Many thanks for your able guidance. Would be really grateful if you would be kind enough not to close this thread. Would always want to approach you only, for your able guidance and detailed response.Best, ritu

Thank you for your kind accept. I appreciate it. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

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Customer reply replied 1 month ago
Dear Dr Salkin,Thanks again. have put her on one unit of 30X70 since yesterday - there is very little change in her readings from when she was off insulin. We would watch for today and increase the dose if required from tomorrow.Meanwhile, her urine report shows infection - leucocytes 1+ . Vet here has suggested to repeat the test tomorrow and medication would commence post that. Is there a medicine that we can give her to keep infections away? I am told till the time there is glucose in her urine - there is all the likelihood of infections.

A UTI is very common in our diabetics but we mustn't rely on the findings of leucocytes on a Dipstix pad which is notoriously inaccurate. Urine sediment showing bacteria and/or elevated numbers of either leucocytes or red blood cells indicate a UTI. Glucose in her urine indicates that her blood glucose exceeded 180 mg/dL - the level at which for glucose spills into the urine. it doesn't indicate a UTI.

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Customer reply replied 1 month ago
Dear Dr Salkin,We did a lab test for her and it indicated leucocytes of 1+. Hence, the concern about UTI. We are repeating the test today and would seek your able advice post that.Best regards,ritu

Ritu, the 1+ as measured on a Dipstix pad isn't likely to be accurate. The urine sediment needs to be microscopically reviewed to see if there really are more than 5 white blood cells per high power view...which would be significant. In any event, I'm pleased to review whatever you can post for me.

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Dr. Michael Salkin
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