Dog Veterinary

Ask a dog vet and get answers to your dog health questions

Ask a Dog Veterinarian,
Get an Answer ASAP!

This answer was rated:

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>
Show More
Show Less
Ask Your Own Dog Veterinary Question
Answered in 1 hour by:
3/11/2018
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 35,473
Experience: University of California at Davis graduate veterinarian with 45 years of experience
Verified

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.

Ask Your Own Dog Veterinary Question

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.

Ask Your Own Dog Veterinary Question
Hi,
I'm just following up on our conversation about your pet. How is everything going?
Dr. Michael Salkin
Ask Your Own Dog Veterinary Question
Customer reply replied 5 months 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: 35,473
Experience: University of California at Davis graduate veterinarian with 45 years of experience
Verified
Dr. Michael Salkin and 87 other Dog Veterinary Specialists are ready to help you
Ask your own question now
Customer reply replied 5 months 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.

Ask Your Own Dog Veterinary Question
Customer reply replied 5 months 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.

Ask Your Own Dog Veterinary Question
Customer reply replied 5 months 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.

Ask Your Own Dog Veterinary Question
Was this answer helpful?

How JustAnswer works

step-image
Describe your issueThe assistant will guide you
step-image
Chat 1:1 with a dog veterinarianLicensed Experts are available 24/7
step-image
100% satisfaction guaranteeGet all the answers you need
Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 35,473
35,473 Satisfied Customers
Experience: University of California at Davis graduate veterinarian with 45 years of experience

Dr. Michael Salkin is online now

A new question is answered every 9 seconds

How JustAnswer works:

  • Ask an ExpertExperts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional AnswerVia email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • 100% Satisfaction GuaranteeRate the answer you receive.

JustAnswer in the News:

Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.

What Customers are Saying:

It was so professional, so personally concerned (as we were) and you answered all of our questions. George and I are so happy that I found "JustAnswer" on my Google search -- you are now in my "Favorites" list! And, yes we do love our kitty - she makes our life complete!

Bev & GeorgeBoca Raton, FL

Wonderful service, prompt, efficient, and accurate. Couldn't have asked for more. I cannot thank you enough for your help.

Mary C.Freshfield, Liverpool, UK

This expert is wonderful. They truly know what they are talking about, and they actually care about you. They really helped put my nerves at ease. Thank you so much!!!!

AlexLos Angeles, CA

Thank you for all your help. It is nice to know that this service is here for people like myself, who need answers fast and are not sure who to consult.

GPHesperia, CA

I couldn't be more satisfied! This is the site I will always come to when I need a second opinion.

JustinKernersville, NC

Just let me say that this encounter has been entirely professional and most helpful. I liked that I could ask additional questions and get answered in a very short turn around.

EstherWoodstock, NY

Thank you so much for taking your time and knowledge to support my concerns. Not only did you answer my questions, you even took it a step further with replying with more pertinent information I needed to know.

RobinElkton, Maryland

< Previous | Next >

Meet the Experts:

Dr. Debbie

Dr. Debbie

Dog Veterinarian

904 satisfied customers

Companion animal veterinarian practicing for over 10 years.

Dr. Andy

Dr. Andy

Medical Director

16,499 satisfied customers

UC Davis graduate, emphasis in dermatology, internal medicine, pain management

Dr Scott Nimmo

Dr Scott Nimmo

Dog Veterinarian

10,818 satisfied customers

BVMS, MRCVS. { Glasgow UK }

Dr. Gary

Dr. Gary

Dog Veterinarian

10,089 satisfied customers

DVM, Emergency Veterinarian, BS (Physiology)

Dr. Bruce

Dr. Bruce

Veterinarian

9,808 satisfied customers

15 years of experience as a small animal veterinarian

Dr. Scott

Dr. Scott

Veterinarian

9,615 satisfied customers

15 years of small animal, equine and pocket pet medicine and surgery.

Rebecca

Rebecca

Dog Veterinarian

8,947 satisfied customers

More than 30 years of companion animal practice.

< Previous | Next >

Related Dog Veterinary Questions
Nicole, We communicated several weeks ago about Maggie. She
Hi Dr. Nicole, We communicated several weeks ago about Maggie. She ended up with a 3 day stay in an emergency vet hospital for pancreatitis, diabetes and renal failure stage 3. The pancreatitis and re… read more
Dr. Nicole
Dr. Nicole
Veterinarian
Doctor of Veterinary Medicine
927 satisfied customers
Salkin, This is in reference to my dog Mishti, my 12.3 years
Dear Dr Salkin,This is in reference to my dog Mishti, my 12.3 years old intact female Lhasa apso. I had written to you about her before also. On your advice and on the advice of her Vet here - we had … read more
Dr. Michael Salkin
Dr. Michael Salkin
Veterinarian
DVM
35,473 satisfied customers
My Lhasa apso (12 yrs 3 mnths, female, intact, 9.3 kg) is
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 fluctua… read more
Dr. Rachel
Dr. Rachel
Doctor of Veterinary Medicine
1,081 satisfied customers
I have a 6 1/2 year old diabetic female Doberman. We were
I have a 6 1/2 year old diabetic female Doberman. We were giving her insulin 16 units twice a day. Last fall she started peeing everywhere and we took her in and they did the glucose curve for 4 days … read more
Scott Perry
Scott Perry
Veterinarian
Doctor of Veterinary Medicine
3,182 satisfied customers
12 year miniature schnauzer. Just can't control her diabetics.
12 year miniature schnauzer. Just can't control her diabetics. She's an angel, just can't let her go. She's on pig insulin. 1 and one unit, am and pm after meals. Just don't know what to do.… read more
Expert
Expert
Associate Veterinarian
Doctor of Veterinary Medicine
1,049 satisfied customers
My dog is diabetic, when first diagnosed my vet kept her for
My dog is diabetic, when first diagnosed my vet kept her for about a week to determine her insulin dosage, which was four units of Lantus. That seemed to help her for awhile, but the excessive drinkin… read more
Dr. Gary
Dr. Gary
Dog Veterinarian
Doctoral Degree
10,089 satisfied customers
my dog is almost 11, large-- around 100 lbs. she was diagnosed
my dog is almost 11, large-- around 100 lbs. she was diagnosed with diabetes in october last year. we worked with our vet to get her blood glucose # XXXXX but it's been expensive and not entirely succ… read more
Dr. Gary
Dr. Gary
Dog Veterinarian
Doctoral Degree
10,089 satisfied customers
Our 10 year old Siberian Husky, Chloe, was diagnosed with diabetes
Our 10 year old Siberian Husky, Chloe, was diagnosed with diabetes in December. It has been very hard to regulate her glucose levels. We have been taking her to the vet 4 times a week for glucose test… read more
Dr. Gary
Dr. Gary
Dog Veterinarian
Doctoral Degree
10,089 satisfied customers
I have an insulin dependent cat and I had a brain fart this
I have an insulin dependent cat and I had a brain fart this morning and gave the cats insulin to my dog. She is a 13 lb healthy spayed female. I gave her 7 units of lantus insulin She is now at the Ve… read more
Dr. Loretta
Dr. Loretta
Large and small animal Veterinarian
Doctoral Degree
22,387 satisfied customers
Hi Dr. Denise, I still feel that i am not satisfied with
Hi Dr. Denise, I still feel that i am not satisfied with Nadal's Blood Glucose count. I wish to bring it down in the 200 range atleast. Do you have any recommendations? I changed his food to one cup r… read more
Denise Colgrove
Denise Colgrove
Relief veterinarian
Doctoral Degree
6,383 satisfied customers
My dogs sugar does go up and down, I am checking it daily
My dog's sugar does go up and down, I am checking it daily with a urine test. When it shows a neg. am't of insulin for two days, I decrease it by one unit. But then the next day he is showing sugar in… read more
CriticalCareVet
CriticalCareVet
Veterinary Specialist
Doctoral Degree
57,087 satisfied customers
Our Yorkie has been diagnosed with diabetes and has been on
Our Yorkie has been diagnosed with diabetes and has been on Humilin Insulin (about 5 units) after each meal which is Hills W/D canine diabetes formula. He seems to have been very well regulated until … read more
Dr. Scott
Dr. Scott
Veterinarian
Doctoral Degree
9,615 satisfied customers
I just had my dogs blood sugar level checked today; shes
I just had my dog's blood sugar level checked today; she's been diabetic for about six months. It registered at 222, and the vet is keeping her insulin the same, 10 units twice a day. I looked this up… read more
Dr. Loretta
Dr. Loretta
Large and small animal Veterinarian
Doctoral Degree
22,387 satisfied customers
lab mix: lost 36 lbs and now weighs 55 lbs...gain weight..local vet
HI there, live in Cayman Islands - my lab mix diagnosed about 4 months ago with Diabetes. He has lost 36 lbs and now weighs 55 lbs. He cannot gain weight and yesterday the local vet switched him to Ve… read more
Dr. Scott
Dr. Scott
Veterinarian
Doctoral Degree
9,615 satisfied customers
dog: According to her glucose curve that I have done today at 5am
hI. My dog is diabetic and currently has 7units of insulin at 5am and then 7units at 5pm. According to her glucose curve that I have done today at 5am before insulin it was HI at 10am it was 9.2, at 1… read more
Rosie_MRCVS
Rosie_MRCVS
Veterinary Surgeon
Bachelor's Degree
798 satisfied customers
My dog is diabetic but we are still trying to figure out the
My dog is diabetic but we are still trying to figure out the right insulin dosage for her. She has been on 18 units of NPH (twice daily) but today we went to the vet for a glucose check and her blood … read more
Dr. Lee
Dr. Lee
Veterinarian
Doctoral Degree
4,959 satisfied customers
We have a XXXXX XXXXX who was diagnosed with diabetes in May.
We have a XXXXX XXXXX who was diagnosed with diabetes in May. He was very acidotic at the time and had IV therapy for 2 days to save him. He was started on Vetsulin 3 unit 2 t a day. We did a insulin … read more
Dr. Scott
Dr. Scott
Veterinarian
Doctoral Degree
9,615 satisfied customers
my dog was diagnosed with diabetes in Feb. She was placed
my dog was diagnosed with diabetes in Feb. She was placed on Vetsulin, 3 units 2 x per day. Everything was fine until May when she was retested, Vetsulin was increased to 4 units 2 x/day. 3 weeks late… read more
Dr. Scott
Dr. Scott
Veterinarian
Doctoral Degree
9,615 satisfied customers
Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Show MoreShow Less

Ask Your Question

x