EPI with Diabetes

Sometimes when a dog has Diabetes + EPI, the owner struggles to find the right balance to manage both conditions. Although the following is not quantified veterinarian research, as i have listed for many of these "other" conditions, it is real-life examples from actual members of epi4dogs who ARE managing both Diabetes + EPI and or struggling.  These are actual posts (re-printed here with their permission) of what worked for their Diabetic + EPI dog. Hopefully these examples might help someone else.

Please check out this wonderful support group for diabetes dogs:  http://www.k9diabetes.com/ 

Olesia's experience in dealing with concurrent conditions Diabetes + EPI

 June 2016 (EPI + Diabetes diet has been altered to better suit her Diabetes):


1/3 cup over cooked old fashioned oatmeal
1/3 cup "no fat" cottage cheese
1/3 cup baked, mashed, skinned sweet potato
1/2 cup minced baked white chicken breasts
1/2 cup Annamaet Lean & Grain Free kibble
2 tsps of EnzymeDiane porcine pancreatin 6x with each meal 

I also give daily:
1 VetriScience Dog PLus Vitamin
1/4 tsp porcine bone meal
 ... and other meds for other health concerns that she has.....



JUNE 2014

Hi Jennifer..... i have an EPI dog who was diagnosed with Diabetes AND Low Thyroid last Feb.  OMG managing the Diabetes has ben HELL!


First... please do join the K9-Diabetes group they will help you with lots of tips and tricks.

But 2nd.... has your vet checked for Low Thyroid.... if your baby has EPI.... then there is a possibility that Low Thyroid is also part of the issue.... we are seeing more and more of these 3 conditions show up concurrently....and Low Thyroid or any Thyroid imbalance will really skew the diabetes. 


Are you able to do curves at home?  If not, ask your vet to teach you how, watch the video on k9-global for assistance (fantasic video!) and if you are dealing with concurrent conditions,,, do tighter blood curves,,, but only do for 2 full days... no need to do 3 days in a row.


Also my Izzy's numbers were in Mia' range she was running from 180- 600 .. very scary!!!!!!!


What i have learned is that i now can "control" Izzy's diabetes because i did so many blood curves and i recorded the effect of EVERYTHING... one at a time and then i proofed it too....For us, this is what i found out.


1. We can only feed Izzy twice a day 12 hours apart to get a routine and balance with the BG.

2. i learned which foods she can eat and which sky-rocket her BGs. Foods with fat sky-rocket her BGs.  For example i cannot feed chicken legs (too fatty) but i can feed baked chicken breast. I can feed slices of LEAN pork loin.... quite a bit actually.. but she cannot have any regular prok meat.  Izzy also does well with baked and mashed sweet potato but not white potato and no rice, and she can eat free range hard boiled egg,  but not store bought eggs. ..... and she can have tuna fish.  I also use (because of the EPI + Diabetes) Annamaet LEAN grain free food mixed in with the lower fat concentrations of Taste of the WIld... this is what works   for us.

3. I have to TIME Izzy's daily exercise and we can only play at certain hours (for use it is an hour after she hits her nadir.

4. I also discoverted that interrupted sleep at night will cause her BGs to be high in the morning!!!!!

5. ANY infection.... OMG... that is another BG spike.

6. Izzy also had the rebound effect going on..... the more she spiked, the more i increased her insulin.... and then she was fine for a few days and then started spiking again... it was not the tru Symorgi effect but rather a wierd rebound effect.... so i had to find the "happy" dose... not too low but not to high either and keep it consistent... dont' change all the time.



... and her meds for other health concerns.................. 
... and her meds for other health concerns.................. 

Tara's suggestions for Greg with Tasha's EPI + Diabetes 1/2013

 Tara with Ruby... response to Greg with Tasha.. recently diagnosed with EPI +Diabetes:

1. Aww Greg, I know it is so hard to see them that skinny. That was my way of evaluating Ruby initially too. Ruby did put some weight on about 6 mos. into her diagnosis, but because of her problems with megaesophagus complicating the picture I cut her to one meal a day and she has stabilized with weight loss. She is skinny, but she is happy and healthy for a dog with as much going on as she has.

It sounds as though you are considering putting Tasha down because her weight hasn't increased and the numbers are still high. I know such a decision for you would be heartbreaking, but I want to be sure you are making that decision while having realistic expectations. I won't lie to you having a dog with EPI and diabetes does get trickier, but it is one hundred percent doable.

Can you answer some questions for me? I still haven't had a chance to review your thread.

How is Tasha acting? It sounds as though she is eating which is a good sign as to her overall wellbeing.

What food is Tasha on? I recently reduced Ruby from roughly 4% - 2% fiber and it made a huge difference in Ruby's stool.

What insulin dose and type of insulin is she on?

The way the insulin works initially is that there is a big excess of BGs (blood glucose) that the insulin works gradually to clear. Because dog's are generally started out on a smaller dose then they will probably need, that can take some time. When I said that dogs can do wonderfully after insulin is started I didn't mean days...more like weeks. There have been dogs that basically couldn't walk that after a few weeks on insulin are putting their front feet on the counter at the vets to ask for their treat....and that dog was one of the other ones at k9diabetes that also has epi.

I want to say something and need you to know I am not coming from a judgmental or angry place. I believe if you can do this Tasha can do this. I don't know how she is feeling and I am sure she doesn't feel great, but I think watching her is killing you. You are used to seeing a vibrant healthy fleshed out Tasha, which may not happen for a bit and wanting the numbers to come down, which may also take a bit. Most dog's don't have our preconceived notions about stuff like that, they just feel crummy and go lay down.

You have mentioned that food cost is a concern and that you hate needles. I imagine a big part of the equation is the fear of whether or not you can afford a diabetic dog as that is forefront on most people's mind when they get this diagnosis. There are the best possible ways to do this disease and then there are all the other ways that people sometimes need to come up with, due to finances, dog's biting them, schedules or even fear of needles.

I hope you can give it a bit of time to let the dust settle and get more information. It is such an individual decision and I know most folks would have put my Ruby down or more likely not been able to keep her alive, but that is from the megaesophagus not the diabetes and epi.

I get the sense you want to make this decision in private and respect that, but if there are any questions I will check back often and will private message you with my phone number.

I will hold you and Tasha in my thoughts.




Hi Folks, I wanted to give an update as I know how we worry about "our" dogs.


Greg and I were able to talk on the phone. He was feeding multiple meals to try to help with the weight gain. Multiple meals are the right approach for weight gain in an epi dog, but not in a diabetic dog. The insulin Tasha is on is supposed to work with food being fed twice daily when injections are given. Because she was being fed outside of the 2 meals he wasn't making any headway with the numbers.

Unfortunately when the BG numbers are elevated nutrition isn't able to get into the cells of the body. So by feeding her multiple times a day that was raising the numbers at a time when the insulin would have otherwise been lowering her numbers, and high numbers means no absorbtion.


.......A disclaimer here: the above info applies to when starting the regulation process and most often to maintain regulation. However, all dogs are different and throw their own different kinks into the regulation process. There are many different ways to fix all of these kinks, but until you know what the kinks are they are hard to fix. The very standard approach of two meals and two injections with no variation, and then a 12 hr. curve to see how the food and insulin are balanced are how you find the kinks and then fine tune your approach....after finding the correct insulin dose........


Since we talked he had a vet appt. and the numbers have come down from the mid 500s to the high 400s. Greg reports that she seems a bit more like herself. The vet has increased the dose from 7 to 9 units.


I'm not sure Greg has found the right enzymes amount for Tasha. Sometimes the poops are good and then other times not. There were switches between food when she wasn't eating, so that could have messed things up.

I will need to defer to you folks on the enzymes as I don't have much experience beyond Ruby with that.

I believe he was feeding a canned Pedigree to get her to eat and then was giving her Pro Plan dry with the pedigree as a topper. Through the switches in food the enzymes amount stayed the same.

I suggested he use tuna water from a can of tuna soaked in water .....not oil, as a topper and check in with you folks on how to tweak the enzymes. Hopefully with her going back to the dry kibble things will sort itself out on that end.


Greg believes home testing isn't an option for them due to Tasha's temperament and his fear of needles. Also making things difficult is his region is recovering from Frankenstorm Sandy. His vet is practicing out of a trailer and doesn't have the ability to house a dog for a day long curve. I suggested doing a drive by, where he goes to the vet every 2 hrs. to have the test done.





Hi Greg, Glad to hear there was some progress in the numbers. As she gets further from the multiple meals the insulin dose should be able to whittle those highs more and more.


Usually we work a little slower with the increases, doing 1 unit at a time for a dog Tasha's size. We talked a lot about what you are capable of doing right now on a number of fronts. Taking that into consideration and that she was still close to the 500s there will probably be room for this increase.


However, I hope on Saturday the vet won't rely on just a spot check to evaluate for another increase. The profile of NPH insulin suggest that most dog's will have their lowest BG (blood glucose) number at 6-8 hrs. and many dogs follow that profile. I have also seen dogs that don't follow that profile and have their lowest reading at 2 hrs. or even at 12 hrs.


Insulin dosages should always be based on the low number. The lowest I am comfortable with is 100 for a regulated dog and 150 for an unregulated dog. Some dog's can drop substantially with exercise. The way you describe Tasha when she was healthy makes me think she could be one of those dogs and that 150 would give you a bit of a cushion.


I have heard of vets saying a 70 is okay for dogs. The experience that the vets don't have that many folks at k9diabetes do is that we test a lot to see how different things affect the numbers. There is a Newfoundland who drops just getting out of bed in the morning. Therefore a bit of a cushion is good for a healthy active dog.


My fear with another spot check is on a two unit increase you may miss her low point, catch when she is on the rise and raise by too much. When dogs are first diagnosed there can be all sorts of things going on as the body struggles to find a balance again. If the body is used to having higher numbers the liver may panic in response to a lower number and shoot out stored glucose. I call these false highs, and it is one of the reasons I don't raise a dose based on a spot check. Say Tasha is a dog that has her lowest point at 4 hrs. and she goes to a 100 and her liver panics because it isn't used to being there. It releases glucose shooting her up to 400 when the spot check is done at 6 hrs. If an increase is done then it could continue the cycle and eventually make things worse.


Here is a link that gives some good info regarding the above:



If a curve is run you rule out the possibility of this happening and you will see when Tasha typically has her low point (nadir) to better time spot checks in the future.

I hope this all makes sense as it can be a lot to take in initially.

If you have any questions don't hesitate to call before 3:00 or after 8:00.




Tara & Ruby  13 yr. old Boston Terrier who just keeps going against all odds! 

EPI: 3/4 tsp. 8x pacreatin from Enzyme Diane w/ 3/4 c. Honest Kitchen Embark & 1/4 c. Origen

Megaesophagus: Needs to have mostly Honest Kitchen consistency as anything else won't make it down, Fed upright and remains up for 1/2 hr.

Diabetes: .5 units Levemir 2x daily, .05 units Humalog 2x daily

 5. Hi Greg, Can you tell me what formula Pro Plan Tasha is on? I would like to help you figure out how much you should be feeding her for weight gain.


When you say you are giving her 1 1/2 -2 cups at each meal, is the amount varying because she won't finish it all? Or is it because you are giving her different amounts? To the best of your ability you want to keep the amounts the same.


We don't her to be hungry, but in the case of a diabetic animal it isn't that simple. Dogs can get very hungry when their bgs are either too high (because the nutrition isn't getting into the cells) or too low (because the dog senses the low bgs and wants to eat something to bring the numbers back up).


If you were going to add more food,  I would rather it be added to the breakfast and evening meal equally. As I understand it you took what she was being fed at multiple meals and then split that between two meals. If you now increase the amount it will likely increase her requirements for insulin therefore driving the numbers higher. If you do that at this point don't be alarmed if the numbers on Saturdays vet visit are higher.


 If you do add more food to the meals you could still do the curve on Saturday, evaluate and increase if needed. You usually wait 3-5 days after a dose increase to allow the increase to fully settle in. As what you would be changing in this case is the food amount you wouldn't need to wait to run the curve.


I know the curve is problematic, but it will give you so much information and we won't be walking around in the dark.


I am back to work the next 3 days, but will check in on you and feel free to reach out via private msg.





Hi Olesia, I wanted to pass along some info in regards to the SIBO/ antibiotics. Infection usually does raise the bg numbers, some dogs will have elevated numbers in relation to antibiotics, but not all.


On a more curious note, I was convinced Ruby had SIBO and was treating her for it for a long time and not having any success getting rid of the tummy rumbles. Then I heard someone on k9D talking about how her dogs belly would grumble when her bgs were shifting quickly. So I got out my meter and stopped treating for SIBO. Sure enough for Ruby that is what it is. It can actually be a good thing as now I know when she is rising or falling guickly and I can test to see what to do.






#1-Posts for Wizzie the EPI'r with Diabetes

Please feel free to read this thread that has multiple experiences and suggestions regarding dealing with an EPI + Diabetic dog....


1.   from Alison


We have had Wizzie for 12 years now and managed many health problems along the way (epilepsy, EPI, arthritis, incontinence).

I would say that despite this long list of conditions requiring daily medication that he has been very healthy happy and active.

However that all changed when we put him in kennels for the first time in June.  He was not the same dog when we got him back and got sicker and sicker.  Unfortunately the symptoms of diabetes were the same as those of an overdose of his epilepsy medication (KBr) as he had lost weight we presumed it was the EPI and weight loss making him pee all the time and wobble all over the place. The vet agreed and told us lower the medication and  to phone in a week.  Well after the week we realised he had lost a kg in body weight and took him back to the vet. 



So after two days on insulin he was loads better.


But getting his diabetes under control is proving more difficult than any of the above conditions.  We have been trying for about 6 weeks now.


He has three meals a day for the EPI, he is on caninsulin twice a day.  He seems to do well for a while perks up then a few days later start going hyper glycaemic again.


Anyway I was wondering about getting a home glucose monitor if anyone has used one - which would you recommend.


Vet is being brilliant and only charges us £12 each time we go in for glucose test (my husband is out of work and I am on 10% pay cut!!!!!) so I would need to really know it was the right thing to do beofre buying one.


Since the EPI diagnosis he has been on Burns Lamb and brown rice.  He does well on this for both EPI and epilepsy.  It may not be the best for diabetes though as relatively high in carbohydrates.  But changing his diet I don't think is an option as changes in salt will really affect his epilepsy medication and of course his EPI.  the enzymes are Pancreatic enzyme from Pfizer.  One tub for £55 last about three months so not too bad.

He is a terrible scavenger so spends most of his time outside with a muzzle on - a good tip to other EPI dog owners, you really don't want them eating that dead rabbit....


He has been seizure free for over three years and I don't really believe he is epileptic anymore but best not to change things now - at 14 he doesn't have that much time left with us,  so we'll continue with the KBr...



2.   from Mellon Collie :
Hi Alison We also have to contend with EPI and diabetes in our 2 year old collie. Our main problem is giving her injections as she is needle phobic. It took a couple of really bad weeks before we won that one. We have not resorted to blood sugar testing as she is so phobic but I sure it would improve her control. I am glad your vet is so helpful. Mine us very helpful but also very expensive -£84 for her last blood test and I cannot get them to do B12 levels. I am in Essex. Do email me if you need support although we are still quite new to this too. You will find incredible support on this forum. Good luck. Jacqui --


2 year old border collie. At 5 months began to ge ill. EPI diagnosed at 9 months. Started on panzyme and gained 2 kg in 2 weeks. Poos settled from 14 puddings a day to about 4 x 75% normalish and tail returned to happy waving. Has been well and happy for 18 months but has now been diagnosed with diabetes.


3. from Tara and Ruby

Hi Alison, sorry you are needing to add one more disease. My dog has Epi, diabetes and megaesophagus, so i feel your pain.

First let me say it can take awhile to achieve regulation so try to be patient. But if you are seeing truly hypoglycemic episodes that needs to be addressed right away. Hypo events can actually cause seizures and I would hate for that to start up her epilepsy again...besides being dangerous.

Being willing to home test will speed the regulation process along, help in your understanding of the disease and understanding of how the diabetes manifests in your dog, as it is very dog individual.

Some basic guidelines are:

* to start slow. I have seen many dogs overdosed early on or had their dosages increased too rapidly.

*Stay at a dose for 3-5 days before increasing, as you get closer to the target numbers you want to slow down and let the dose settle in for a bit longer

*Do small increases - 1/4- 1/2 unit for small dogs, 1/2 - 1 unit for larger dogs, again this would depend on the numbers. Really high numbers might warrant a larger increase.

*Always base increases on a curve which is testing right before food, then every 2 hrs. after up to dinner time. Things should be consistent for three days prior to curving

* Base the dose on the lowest number rather then the high

* It is a good idea to weigh the food, rather then measuring cups, so that the amounts are consistent

* It is best not to exercise your dog until you see the trends. Some dogs are known to drop by 100 points with exercise.

I am an avid home tester. Mostly because Ruby has been pretty hard to regulate. I don't know if she would be this way without the Epi or if the enzymes wreak havoc with her food rise.

She spikes about 300 points with food. We have recently found an approach that works which I will explain soon.

To your original question, there are two ways to go about home testing. There is an animal validated meter (Alpha Track) which runs about $100 and then strips are about $1 each. I have that to run comparisons, but most times now I use the walmart meter called Prime. The meter was $18 and 50 strips cost $10. The readings are always lower then the AT (Alpha Track), but they are consistent. When I got the Prime I ran enough test at different ranges so I got a handle on how to convert the readings. You could do the same thing by bringing your meter to the vets and comparing it to their animal meter, just use the same drop of blood. You would want to do this comparison in each of the hundreds (100s, 200s, 300s and so on)as the comparisons seems to change. I will say that the lows are the closest between the two meters. Not all human meters are that good. The midle of the road cost wise and very reliable (though still a human meter so will read a bit lower then animal meter) is the One touch ultra 2

There are a fair amount of videos on youtube that show how to home test. The forum I belong to for the diabetes is k9diabetes. I have been on a few forums and it, like this one, is one of the best. Good information and friendly non judgemental people.

Most home testers test twice daily at the "fasting", right before meals. Anything below 100 and I would decrease the dosage, although with as new as you are at this I would suggest running the numbers a little higher until you get familiar with the trends.

So, back to the EPI and diabetes. I think due to the predigestion from the enzymes Ruby has a huge food rise. At this point she is on a long acting insulin, which differs from your insulin. Have you seen a profile of your insulin? The midday meal will be spiking her up without much insulin to balance it. I imagine you are feeding 3 x daily in an effort to put weight on? Unregulated diabetes makes it hard for the cells to absorb nutrition, so I would work on getting the numbers regulated and I think feeding 3 x a day may be working against you....That being said some people do have to have another meal or snack added in, but this approach is usually arrived at later.

Do you have a curve from the vet that I could look at? I would be happy to tell you what I see.

If your dog has had hypoglycemic episodes it can take up to 3-5 days for the numbers to level out again. Here is one of my favorite links for diabetes.


I hope I haven't overwhelmed you. The learning curve is pretty steep with diabetes, but home testing will be a huge help.

I am in a busy week at work but will check in nightly. If you need to reach me sooner you can send a private message through the forum and it will be forwarded to my email.



Tara & Ruby  13 yr. old Boston Terrier who just keeps going against all odds! 

EPI: 3/4 tsp. 8x pacreatin from Enzyme Diane w/ 3/4 c. Honest Kitchen Embark & 1/4 c. Origen

Megaesophagus: Needs to have mostly Honest Kitchen consistency as anything else won't make it down, Fed upright and remains up for 1/2 hr.

Diabetes: .5 units Levemir 2x daily, .05 units Humalog 2x daily


4.  from Alison

He gets three meals a day but they are at 7 30 am, 6pm and 8pm due to being at work.   He goes hyper glycaemic not hypo.

The caninuslin peaks at 8 hours post injection, so at first with one dose a day he was getting the insulin for his first meal but  by the time 2nd and 3rd meals came along he had no insulin left so was always hyper.  After another night of no sleep (I am insomniac) Wizzie was wanting out hourly until about 2am then Iwould not get back to sleep, I spent the whole night thinking about it and emailed the vet and said it is not working we need to change.  SO now we are on two doses a day.


We have not done a curve yet as the vet understands it would be expensive for us.  But I am tihnking the way round this would be to get a home monitor, so when I have a bit more time I will look at the options outlined above - thanks!

I don't think they have another patient with both EPI and diabetes (let alone epilepsy!)


I also tihnk one thing we are doing wrong (vet and us) is change the dose as soon as a bad reading is obtained, I think we need to wait a bit longer.


5. from Ashley:

So sorry you have to go through this on top of everything else Wizzie has to deal with. Jewels(14 years old) was recently diagnosed with Diabetes in July of this year. She has had EPI since June 2011. We are also on Caninsulin 2x a day 3 units per injection. We have been slowly doing increases with her to try and get numbers under control. It can take quite a while like Tara said to get it under control. We have stable numbers with Jewels but they still run a bit higher then I would like. So we are working with smaller increases of 1/4-1/2 unit after a curve just liek Tara suggested. Our vet suggested we start out with 3 units per meal unless she was under a certain number and then we were not supposed to give her any. But by the time the next meal came around her numbers had shot wayyy up because of not having that injection. But afer some good advice we lowered her dose right down to 1  1/4 units and worked our way up(which we are still doing) At the beginning Jewels was still in the "honeymoon" phase so she was still producing a little bit of insulin herself and thats where we would get those low numbers once in a while. But as of now her numbers are still on the higer side. With all the stuff going on with Wizzies body you may never get a perfect set of numbers becuase there is so much playing into it. Especially with the EPI affecting the pacreas as well, but we should be able to get them to a manageable number. 


I also use an at home meter(accu-check compact plus) It holds a drum of 17 strips so I dont have to insert one each time. I was also able to purchase a bulk amount of strips so we have stuck with this meter. The one touch ultra is a good meter(one my vet uses) but the srips are quite expensive so I have kept with this one for now. I am also in a financial bind right now as we are in the middle of moving to a whole new city and need to get settled with jobs. A good place to get the strips if you go for a brand name meter is amazon. They are quite a bit cheaper for them. I noticed Tara suggested the Prime meter from Relion but they only sell that is the US and I noticed that you live in Scotland(on your profile) So I dont know what type of generic meter they sell there as I live in Canada and cant really help there. 


As for the food, if its working I would keep to the same food for now. I have kept to the same food for Jewels as well because it is working for both my EPI dogs. I know some brands are labled as "low glycemic" but those brands usually have grains in them and I have been doing grain free becuase thats been working for the EPI. So you kind of have to make a sacrifice for one ailment or another I find. I have been doing low glycemic wet food with her grain free kibble becuase she has now become a very picky eater so at least one aspect of it is low glycemic. 


Tara has been my diabetic savior for Jewels. She has been so wonderful and helpful through all of this, she is very knowledgeable about diabetes so anything Tara has to say I would trust in her advice. 


Sorry for babbling on! Hope all goes well with Wizzie and keep us updated

Diabetes + EPI

 The caregivers of diabetic animals who home test do become experts of the day to day....for their animal at least. As with EPI, diabetes is very animal specific.


The k9diabetes is an open forum for anyone to read, but you need to join if you want to post. It is a great resource and you can find a lot of info in the home page links or on the forum. I also use the diabetesindogs wikia page or the petdiabetes wikia, as most of those entries are from caregivers who have made a fine art of regulating their animal and are sharing what they have learned along the way. Feel freee to PM me whenever you have a question. Through my struggle with Ruby, as she has been very hard to regulate, I have learned a lot of what works and what doesn't (can't believe I am still learning) and I am happy to share what was given to me so freely.


You know I went back and reread my post and want to explain something that might confuse folks. As Alison said she was getting 10s and 20s and then I said I got a low of 29??? The difference is the different units of measurements as Alison and I are in different countries.


So for her 10 mmol/l, I would multiply by 18 to come up with a US number of 180 mg/dl. To translate my 29 mg/dl number to Alison's measurement it would be divided by 18 to get a 1.6 mmol/l. Way too low

#2-Posts for Wizzie the EPI'r with Diabetes  

Posts for Wizzie the EPI'r with Diabetes6. from Tara and Ruby:

Hello again Alison,

I think getting the home meter will make a huge difference for you. The spot checking that is happening is only telling you what the number is at that particular moment. What I am concerned about is in your initial post you said that after 2 days on insulin he was so much better, but now is being hard to regulate.

So....this is just guess work, but here is what I am afraid may be happening. When the body senses the bgs (blood glucose) falling either too low or too quickly the liver will shoot out stored glucose. This may happen if the BGs fall more then 100 points in an hour. It can also happen when the numbers are not necessarily dangerous, but the body perceives them to be because it is so used to being high. The technical name for this is Glycogenolysis. Here is a link that explains it:


Then of course there is full blown rebound when the body is very much in danger, liver shoots out glucose and can take days to recover with the numbers shooting from too low to high and back again until the body stabilizes.

So, my concern is that some of these spot readings that you are seeing could very well be highs that are actually a bounce back up from either a dangerous low or a perceived low.

This is why getting a curve is so crucial. It is also why it is very ill advised to do increases without a curve or based on one bad reading.

Also pure speculation on my part, but I can see a scenario where the first few days he was on the insulin it started to bring the numbers down. Then possibly as the numbers came down and the insulin didn't have as much glucose to clear he started going too low and thus started a vicious cycle. Even if you are seeing too high numbers each time you spot check there is a very real possibility this is occurring, especially if increasing the dose isn't seeming to bring the numbers down.

When you talk about the insulin peaking at 8 hrs. I assume you are getting this information from an insulin profile. The guidelines in the profile are just that, guidelines. You may find once you do a curve that your particular dog processes the insulin very differently. Ruby tends to use up her insulin quickly due to her food rise so the peaks nevelone ER happened whe the profile said it should.

I have been at this for over a year and am very active on the k9diabetes forum. Due to that continuing education and being an avid tester I now use a fast or rapid acting insulin to handle her food rise. This approach does take a fair amount of knowledge and testing, but it may be something to look at if you can't get her regulated on the food she is on with the one insulin. I am not familiar with the food, but know there are a few people on the k9diabetes forum who feed Burns. They might also have suggestions of which meters would be good to purchase where you live.

I have tried just about every insulin and approach out there.The approach we are using now is used by only one other caregiver that I know of, but I am having great success with it. I feed Ruby once a day. Dose her Basal/long acting insulin twice daily ( the dose is smaller in the morning when she doesn't eat) and the dinner meal is covered one of the long acting shots and usually R insulin.

Thankfully even with the megaesophagus she is able to eat 3/4 the amount in one meal that she used to eat in two. I don't worry about the decrease in food because as her numbers are better she will in turn gain weight.

I hope this helps, Tara


 7. from Ann and Maddie

Thanks Tara for answering my PM

I have just checked the foods and don’t know whether this is of any help but this is the food Alison currently uses it is rice based


this one is heavy in rice and lower in oats but low fiber 2.2 %

Burns do also produce a diabetic dog food which is probably the one on the K9( forum )

There food is usually on par with the like of Hills etc but cheaper !!!!! Which is this one


The second food is higher in fiber but and it’s a big but its is mostly oat based so …….its one of the better fibres see fiber section




8.  from Ashley:

I started testing out on the teenie tiny vein on her ear(as recommended from my vet) and that was such a pain literally for jewels and I. It was so hard to find that I had to stab her so many times I just could do it anymore so I finally found this linke:


http://www.k9diabetes.com/bgtestvideos.html (Hope its ok to post this here)


So now I test her on the little carpal pad(the little one on the front paw that does nothing haha) Ive tried the lip one but not always easy and if they move the blood gets wiped off instantly. If wizzie has eblow callouses that is a great spot to test. I tested my shephereds just to see the difference from Jewels to them and used the elbow. So easy and the blood comes easy as well. The little carpal pad you may have to squeeze a bit to get enough blood but it doesnt really bother Jewels too much. And yes I use the lancing wand on her pad becuase it is so thick. I actually used it on every area but her ear as it was so thin. 


You could ask you parents to get you something. I got my monitor from my diabetic friend who had an extra and I just bought the strips. You can also check out the meter websites and most meter companies will give you a coupon for a free meter if you purchase the strips. You can also buy the online, from any pharmacy or drugstore. If you plan on using the coupon you will have to purchase it from a store. But if your parents can get it for cheaper or free I would go that route. I now purchase my strips off of a man who has diabetes and gets 3 packs of strips a month but only uses 1 so he sells me the other 2. But amazon is another great option for test strips as they are usually around 50% off the normal price(well the ones for the accucheck anyways) 



Mom to Jewels 13 year old Jack Russell Terrier diagnosed with EPI June 29 2011. Weight 15lbs(heaviest was 19.8lbs) (9.2lbs at time of diagnosis). On 1/2 tsp of enzyme diane powder per 1/2cup meal(usually 2x a day), 100mg tylosin 2x a day, 2 units of caninsulin 2x a day, using accu-check compact plus meter. New mom to Thor 18 month old German Shepherd(became part of our family on April 09 2012) diagnosed at 8 months. 63lbs upon arrival 77lbs as of today! On 2 tsp. of pancreatin 6x us powder  from enzyme diane per meal(2 cups of food) 

Also mom to 6 year old German shepherd Jackson, and 3 year old husky Mya, 1 1/2 year old kitten Shelby, and 4 ball pythons(Skittles, Storm, Rogue & New baby hatchling!!)



9. from Alison:

OkAY - Wizzie woo is doing really good at the moment, he enjoyed his senior walk yesterday.  So hopefully he will do okay with this dosage he is on now (been about 1 week).


I am decided on  a home meter and think I will get the accu check aviva nano meter, which I have sourced for £8.95.

50 strips from ebay about £15

and fast clix lancets, 200 for £13 (ebay again).

Unless anyone says no don't use that one, I will go ahead this evening and buy all that.  And look forward to better more informed control over his diabetes.  I will check it against my vets one as advised.

best wishes to all



10. from Ann and Maddie:

Just reminded me re B12 and also Olesia i think what Kathy posted on another  thread re b12  and diabtes should be included there this what she wrote i hope she doesnt mind me quoting it here but i think it is important..


The B12 is in the form of methylcobalamin, a better form of B12 and definitley the form you want to use with a diabetic dog. It's the specific form of B12 that is used for brain and nervous system function, immune system regulation, peripheral and diabetic neuropathy.

Here is the link


I order a year supply at a time.



11. from Tara and Ruby:

Posts: 60

Hi Alison, I have to rush to work, but just wanted to mention a few things.

I don't have any experience with that meter, but have heard that smaller meters in general ( I am assuming the nano means smaller then a full sized model?) are not as reliable.

I posted a question over at K9d to see if anyone else has experience with it. I won't be able to check that thread till tonight though.

Might be a good idea to get your pup ready for testing by doing some dry runs without the meter. The thing some dog's hate is the clicking sound of the lancet.

While you are out it would be a good idea to get some Ketostix (US name) to measure ketones. These should be monitored when the BGs run high for awoke and can be very dangerous very quickly. Also some people have better success using a thicker size lancet to get blood. The thickness can depend on where you decide to test. Just hoping to save you an extra run to the store

Also I would be hesitant with the 1/2 hr. dog walks as some dog's can have a big drop with exercise. At the least I would have the dog walker watch him closely and carry biscuits and honey or some kind of fast acting sugar. I am glad he enjoyed it yesterday, but the snack in the morning may have kept him from dropping too low which may be a concern if he walks for a 1/2 hr. today without the snack.

All these things will be much easier for you to navigate once you have the meter. I know it can initially seem like you can't even sneeze without affecting the BGs.


Running late now but I will get back on tonight about diet (won't be much help there ) and b12 , have some good suff from Kathy.


Hey There, One response so far.


Hi Tara,

I used the Accu Check Aviva Nano to begin with for Alfie and didn't find it very reliable. When checking it with the vets it was as much as 100 points out, sometimes higher than the vet but sometimes lower.

I use the One Touch Ultra and found it much better, I have an Optium Xceed as well which is really good. There is not much difference in the price of strip on both those meters over here.


12.  from Ashley and crew!

Here are 2 pictures of the size difference of the meters. Even though mine says compact it is actually not small at all as it holds the drum of 17 strips in it. I have had pretty good success with this one. Not a lot of jumping around on numbers. It has a memory feature so if i am out and forget to write down the BG for that test I can look back and see. I also love how I dont have to keep extra strips with me as the drum holds 17 and automatically dispenses it when I turn it on to test. The thing I like about this one as well is that you can control how deep the lancet goes. I have to have it on 5 for jewels as her carpal pad is thicker than a lip or elbow. But you can change it from a 1-5. I dont have any experience with any other meters but this one has been pretty decent. It has been pretty close with my vets as well. Im sure there will be other responses from the K9D forum as well. Everyone seems to use different meters but I would go with the one that has the most positive "reviews"

This is mine..... the Accu Check Aviva Nano you are talking about



 Written and re-printed with permission of Frankie with her dog Zip , April 13, 2012

Hi Tara - Yes, I use a powdered enzyme - Pancrea Powder Plus, from Butler Labs. We can get powdered enzyme from Diane's Enzymes too - which many on this site do for quite a bit less $ - but I'm a big chicken to change what is working for Zip. 

As far as the Honest Kitchen - I loved the 'numbers' of that food, (carbs to protein ratio)  but Zip wasn't digesting it at all. And not just the vegetables - I found over time that he wasn't digesting hardly any of it. I also liked that it was flakes and came in contact with the enzyme more than whole kibble. But even longer incubation didn't change Zip's ability to digest it. We tried Zeal, Holistique Blenz, Hund & Flock, then the Merrick BG Buffalo.

My Kennel owner, Lisa (Friendly Grove in Olympia, WA) worked with me too to get a good food. I also liked Solid Gold's numbers (protein - carb ratios) but  Merrick's BG seemed to work best for Zip and  that is 'easiest' for me to control - and that makes me feel confident about his treatment/diet.

To meet Ruby's Mega needs, you could do like we do:  My husband and I (I'm a woman with the nickname of Frankie)  *grind* Zip's kibble before adding the enzyme and incubating.

To do this I use a Cuisinart Food Processor - with a sharp blade - and grind it until it is like coarse sand. We grind a tupperware tub full (about 4 quarts worth?) and keep it tightly lidded. Then we measure out a cup full (which is equal to about 1 1/2 kibble). I put 1 tsp of the Pancrea Powder on the 1 cup of ground kibble, mix it, add 1/3 cup warm water, mix well, and let it incubate for 30 minutes.  It becomes soupy - so would be perfect for your little girl's needs.

I also make 'bones' for Zip this way, but add less water and let incubate for 30 mins. Then I make/roll a tube of food on wax paper - like you do for refigerator cookies - but thinner - then cut into 1/4 inch slices and place on a parchment paper lined cookie sheet - and bake at 350 degrees until done...then turn them over, put back in the oven, turn the oven off, and let sit for a few hours or overnight. You probably can't give Ruby crunchie snacks, but this might be helpful for other EPI Moms and Dads.

About B12:  I give Zip sub-Q injections of B12 every two weeks - depending. I can now tell when he needs some as he goes off his feed and acts weird. Doesn't have changes to his poops, but is just 'different'. I do not know it influences his BG at all.

Mini Glucose Curve: While we were getting Zip's food and BGs under control and during switching of food - , we checked his BG at 7 am (fasting), at 2 p.m. (which was his usual peak) and again at 6 p.m prior to his evening meal. From that chart I could see his response to the different foods. *Q* do you take Ruby's BGs? Sounds like you might and that is wonderful if you do. Zip is not cooperative with me doing that. lol 

The biggest lesson I've learned is that if EPI is controlled and they are getting the nutrition they need on a regular timed basis and the 'normal' amount of insulin - then you shouldn't worry too much. There is no way to perfectly control Diabetes and keep the numbers within the recommended levels. There are just too many factors that play into it and too many hours in the day for it to go up and down.  

The Fructosamine Level Test - I use this as my guide now - along with mini-BG curves.  It tells you the *average* BG from the last 2 -3 weeks. It is like the human A1C test, but has a shorter average. That is what I now use for Zip. Here is a chart that gives the Fructosamine Levels with corresponding BG:  

Well - I can't get it to paste in a format that's readable.  Here is the link so you can see and read it. 


One thing at a time: The other important thing (that some very wise person on this forum told me) is: to change only one thing at a time. Then examine the results and record it on your spreadsheet. That's the thing that kept me sane while figuring this out. 

Zip turns 8 in two weeks! He has had EPI for 4 years and Diabetes for the last 2 years. He is doing great and is a happy camper. 

Please ask me anything - I'll answer as best I can and share what I've learned. If you ever want to talk - either private email or on the phone, let me know. I'm happy to do either.

God will Bless you as you care for this precious gift of Ruby. 




Frankie and Zip


Written and re-printed with permission of Frankie with her dog Zip , April 13, 2012

HI Tara and Ruby,

EPI *and* Diabetes can be overwhelming at first – but I promise you it does settle down to a routine.

I think it is important to realize Ruby’s BG will rise and fall under many circumstances: stress, illness, extra exercise, etc. You can have a Fructosamine level test done to see what Ruby’s *average* BG is from the past 2 to 3 weeks. It is helpful to measure the changes you are making to her diet and exercise plan. (See below for a ***chart that explains.)


My Zip started with EPI and then a couple of years later he became diabetic. Zip is an Australian Cattle Dog (ACD). His EPI came from a case of severe pancreatitis.


My research said that EPI must be controlled first, then the Diabetes.



Zip’s EPI was well controlled with Pancrea Powder Plus – but his food was too high in carbs and too low in protein….and his BG was in the 600s. The Vet and I worked very closely while increasing his insulin while changing his food. And I kept a spreadsheet of everything I could think of and shared it with the Vet. I can email you my chart privately if you think it would help.


Also, it takes awhile to get to the correct level of Insulin. You want to go slowly so they don’t go hypo, which is life threatening. I’m not a patient person so this was hard for me. I wanted Zip’s BG to normalize quickly.


I’m not going to give you all my details but here are some of the highlights.


1. This is what I learned about how food works on Diabetes’ BG.

a. Just like in humans carbohydrates (carbs) cause a spike in BG very quickly after eating. After spiking the BG then crashes if you eat only carbs.

b. Protein eaten with the carbs: BG rises smoothly and does not go as high and then starts to decline.

c. Add some fat to the Carb/Protein intake and the BG level rises continues on an even level for around 4 hours or so before declining. (at which point theoretically you feed again and the BG continues at a steady state).

The ratio of Carbs to Protein for humans is: no more than 2 Carbs per Protein. Better is one to one ratio with some fat.


So, I researched all the grain-free dog foods (better for the EPI) I could find to find a high protein to carb ratio. I tried a couple ‘raw’ foods – dehydrated but raw when rehydrated. ZIP couldn’t digest it. Tried some grain-free foods with fruits and berries dried within it – again, Zip couldn’t digest. I finally settled on Merrick’s Before Grain Buffalo and Zip has been on that since (with a few change-ups of a similar food like.


Being consistent with feeding and insulin is important. Try to feed at the exact same time and same amounts – to include treats. Try to give her the same exercise each day. If she has more exercise than normal she can have treats to off set.


As I mentioned before, I kept a spread sheet of when and what Zip ate, how much insulin, and then would record his BGs. The vet and I adjusted the insulin to bring him to an acceptable curve.


Best to you and your baby. Please contact me if I can be of any help to you.

Frankie and Zip




Written and re-printed with permission of Sue with her dog Claire August 14, 2011

Talked to Dr Stewart again today.  She posted Claire's recent problems on the Veterinary Information Network (VIN), and was offered the following info:

What we're seeing in Claire is very common in EPI/diabetic dogs, and we'll probably never have real good control over the diabetes.   (Not sure how many times I need to hear that before I accept it, but I'll always keep searching to make it better for her)

Most of these dogs "appear" to have a good handle on the EPI, good stools, maintain their weight, but they wonder if something doesn't upset the EPI, which in turn throws the diabetes out of control for no apparent reason.  None of them felt I should change to a Rx enzyme, they did caution about buying in such a large quantity.  Where are you storing them, how often are they opened and exposed to the air, how consistent is the temp where I'm storing them. 


I held onto one of the plastic containers that her original Rx enzymes came in.  We fill that up and then I tightly wrap the remainder in plastic bag and then put them into a ziplock brown bag that protects from light. I then store them in a cupboard. The temp in my house fluctuates a lot because we don't have central air.  It has been a very hot summer??  So, in the future I will probably only buy 1/2 the amount.  I just purchased enzymes shortly before Claire was having all these problems.  I went with the 8x, because the 6x weren't available.  That concerns me now........and I'll need some help from you guys in figuring out how much to give.  I like the way Diane packs these now, two smaller bags.


To get her back on track they said to continue with small increases in insulin and wait 5-7 days before changing again.  Stop checking her levels every day, owners tend to check far more than necessary, see a couple bad numbers and start making adjustmens to soon which starts it snowballing all over again.  (Ah.............even a longer waiting game, but I will do as they tell me)


Thats about it from them............I told Dr S. about the bad breath being gone...............She said they sometimes use Tylan powder to treat gingivitis.  Claire's teeth don't look bad but I've not had them cleaned and I probably won't. I just about fell apart the day of her cataract surgery, I don't want her put under again..............ever..............(lol) So that may have solved the mystery of the nice fresh breath she has.


I know this is an EPI forum, but I also know there will be others who join with EPI/diabetic dogs.  Some of you folks are really on top of storing all this info and my hope is, as new pups and owners join who are dealing with both, maybe we can give them a huge head start.



Sue and Claire


I would love to see a tab directed towards the diabetic/EPI dog.  Feel free to use any of the info I supply.

Forgot to mention this in previous post.  Asked Dr S. about adding probiotics............She suggested I wait a couple weeks before doing so.  She doesn't feel she'll need them initially and we should avoid any and all changes we can.  Pretty much what you said.....................





  Written and re-printed with permission of Vickey with FoMoCo  August 16, 2011

Hi Sue and Claire, very interesting posts. The scary thing with having a EPI/diabetic dog is when you give them there insulin (of course after they eat) and then they get sick, then you have a real threat of insulin shock! And it is even scarier when you have a job and are not there to see or know what it happening. So I can really sympathize with you. The beath thing is interesting as I can always tell if FoMoCo's sugar is high she has sweet breath, but when normal it is well "dog breath". So I will be interested in seeing what happens now that she has started on Tylan. I do check her glucose level twice a day since we started the enzymes. I do make adjustments but the are up or down on her dose by 1/4 unit. So it is a very small change but then they are very small dogs. I do it mostly because I do not want to go to work and worry about her if she is running a little low, I back off a fraction to lower the risk of her going into insulin shock while I am not there. I have now gone from feeding her every 4 hours to every 6, and it has cut down on the peaks in her sugar. I will watch it for a while and if she remains stabile, I will back off on her testing. But if I make a change in food etc. I will monitor it again twice a day just before I feed and give her the insulin for as you know every change can affect their sugar level. Hope some of this helps. So glad you Claire is feeling better, I love the good days and hate the bad!


Hi Sue and Claire,  Vicky and FoMoCo ~

Very very interesting.... glad Claire appears to be feeling better.... and that IS interesting that they use Tylan for gingivitis ... well... i guess bacteria is bacteria!  And getting Claire back on track with "small increases in insulin and wait 5-7 days before changing again." again very interesting.

 Vickey..... and that is also very interesting... "sweet breath" = high sugar, normal doggie breath=all is well. AND.... i find that real interesting that feeding her every 6 hours has cut down on the peaks in her sugar... is this because by going just a few hours longer without food allows for the sugar to drop a little more?


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