Diabetic for over a year now has EPI (and more)

Epi4Dogs Foundation Inc.’s mission is the advancement of science and education relating to EPI (Exocrine Pancreatic Insufficiency), yielding useful insights and positive outcomes in better managing EPI in dogs and cats. Our goals are to support and/or collaborate with veterinary EPI research and researchers, and to promote EPI awareness by educating the general public, pet owners, pet organizations, rescue and shelter organizations, veterinary schools and veterinarians.
Barb
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Re: Diabetic for over a year now has EPI (and more)

Post by Barb » 10 Oct 2022, 19:09

All I can say is I have so much admiration for you and Olesia, dealing with these concurrent conditions in your pups. There are so many things to balance and keep track of. They are so lucky to have such caring and knowledgeable people taking care of them. Thank you both for sharing your experiences and your knowledge. So many others can benefit from your generosity.

I will continue to follow your thread and hope Luke continues to improve.

Barb

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Olesia711
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Re: Diabetic for over a year now has EPI (and more)

Post by Olesia711 » 10 Oct 2022, 19:24

thanks Barb :)
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

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KarenC
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Re: Diabetic for over a year now has EPI (and more)

Post by KarenC » 13 Oct 2022, 18:30

Thank you so much! I do believe that at some point someone else will also be in the same position and if reading thru our experiences helps then I will post as much as I can :) Sometimes, that is all it takes to help ease our fears. Every little nugget of someone's experience could be the piece of the puzzle someone needs.

As for Luke....well his BCG did not go well and his numbers were high. 586 at the start and 412 by the end. However, he gained 6 lbs so we know the enzymes and b12 part is working now and will continue that course to keep his EPI managed. I decreased his food amount by a little because he has never been this high in weight and I don't want him to get too overweight.

We have increased his insulin to 17 units and will go back for another BCG in November and my regular vet did mention something about that to me awhile ago- the Libre. I must remember to bring this up again when he goes for his annual in November. Also, we do have the blood test kit for at home but we have such a hard time getting the blood from him that we end up poking him so much he gets irritated by the process.

They are also going to do his Cushing test again and see how the supplements are working. It may just be the Cushing's interfering now. And it may not be, we shall see. From researching more it does seem like the Cushings could be affecting his glucose levels. He has been panting a lot at night, kept me up a lot! Also the intense licking can also be a sign of his Cushing's from some things I found in research. He was really frightened on his initial visit when I thought he had an infection, i guess because it was a place he had never been. He was better when he went for the BCG. But his next BCG will be with his regular vet.

The local vet was ok but she wanted me to try the RC diabetic food. I am still reluctant to try that but will if it's a last resort. I did so much food research and I just don't get how that stuff costs so much when it's filled with so much junk (seemingly). Olesia, what did you do for food for the diabetes? DId you try the prescrip diets?

I know it hasn't been that long since his diagnosis, I just want him to feel better but I need to be more patient too :)

I will update as things go and hope that is ok. Thank you for reminding me about the glucose patch, Olesia!
Luke, Basenji/Shepard/Spaniel/Collie mix. DX-Diabetes 5/2021, DX-EPI & Cushings 9/2022, DX-Hypothyroid 10/22

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Olesia711
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Re: Diabetic for over a year now has EPI (and more)

Post by Olesia711 » 14 Oct 2022, 10:07

fisrt of all, if you and your vet cannot get his Diabetes under good control.. talk to your vet about "trying" a long acting insulin. I get Clinician's Brief's about various Canine health issues.... and this came up in one of their tutorials.... i will post the info here (in red) for you to share with your vet (if needed- -but please know this has to be with your vet's approval and guidance) :

Out of control Diabetes in Dogs:
10-13-22 Clinicians brief

A 7-year-old spayed miniature schnauzer is presented for marked lethargy, vomiting, polydipsia, and polyuria. Physical examination reveals severe dehydration and thin body condition. Laboratory results show severe hyperglycemia (glucose, 653 mg/dL; reference range, 70-120 mg/dL), azotemia (creatinine, 5.2 mg/dL; reference range, 0.6-1.4 mg/dL; BUN, 63 mg/dL; reference range, 8-29 mg/dL), hyponatremia, hypochloremia, low bicarbonate, glucosuria, and ketonuria. Diabetic ketoacidosis is diagnosed, and insulin therapy is initiated to treat fluid deficit and acidosis. Treat with: Short-acting insulin IV CRI. Short-acting insulin IV CRI is preferred, but other effective insulin replacement approaches are also available. Selecting an insulin protocol for a systemically ill dog with dehydration and acidosis should include consideration of the pharmacologic formulation, which determines availability of insulin to tissue. Short- and ultrashort-acting insulins are rapidly absorbed after SC, IM, and IV administration, immediately lowering glucose activity.1 Although regular insulin is frequently recommended as a short-acting insulin for early management of complicated diabetes, recent studies also support use of newer, ultrashort-acting insulins, which are rapidly cleared from blood, thereby allowing more predictable glycemic control in dogs.1-3 These formulations can be ideal for precise control of glycemia, including during diabetic crises (eg, diabetic ketoacidosis, concurrent acute inflammatory illness [eg, pancreatitis]).

Intermediate- and long-acting insulins should be avoided in critical patients because many factors can alter the pharmacokinetic profile of insulin given SC or IM.4

Intermittent administration of short-acting insulins could also be useful in this patient. Treatment for diabetic ketoacidosis (ideally insulin administered via CRI) should maintain blood insulin at an effective concentration until hyperglycemia is controlled and ketosis is resolved; however, a short-acting insulin may be administered frequently (eg, SC or IM every 1-4 hours, depending on the protocol) when CRI is impractical or unavailable. Administration every 8 to 12 hours is ineffective for achieving treatment goals because of the brief duration of activity of regular and other short-acting insulin formulations.

2. A 6-year-old, 17.6-lb (8-kg) spayed terrier crossbreed with a one-year history of inconsistently controlled diabetes is evaluated using an interstitial glucose monitoring device (Figure). NPH (9 units every 12 hours) is currently being administered. Overall control is assessed as fair. The owner reports that mild clinical signs, including polydipsia and polyuria, occurred throughout the monitoring period.



FIGURE Glucose curve data from interstitial glucose monitoring. The black line represents the 10-day average glucose concentration.

Treat with: Using a longer-acting insulin. A longer-acting insulin (including traditional long-acting [eg, detemir, protamine zinc, glargine] or intermediate-acting [eg, lente] formulations) should be considered to minimize the 2 hyperglycemic peaks.6 The duration of NPH may be too short, as glucose in this patient begins to rise several hours before a meal and insulin administration.

Alternate strategies (eg, dose increase, more frequent injections) can also be considered. Although increasing the NPH dose may prolong the hypoglycemic effect, onset and peak effects can be altered, resulting in an unacceptable glucose nadir.9


With regards to Diet..... i personally had to feed my Izzy approx 80% home-made food (this REALLY got the Diabetes under great control!!!)... but after a few weeks she started losing weight... so then i had to add about 20% kibble which is concentrated... so that was the magic formula for us that kept her Diabetes in control, kept the weight maintained and kept her EPI well managed.
THe home-made diet was composed of mostly low fat meat/fish and the rest was sweet potatoes and acceptable cooked veggies.... along with bone meal and a quality doggie vitamin. The kibble was a low fiber kibble (grain free).

hope this helps a little!
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

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KarenC
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Re: Diabetic for over a year now has EPI (and more)

Post by KarenC » 16 Oct 2022, 13:08

Thank you for this :D

I have such a long list of things to discuss now with my vet at Luke's next visit.

I was thinking of adding some fresh sweet potato to his food. He also loves broccoli. I could cook up the sweet potato, mash it and add some chopped broccoli. That would make it nice and easy to prep ahead of time and add a dollop or 2 to his food. He would love that. I feel like, right now anyway, maybe his EPI is managed.

But, I will be switching to Wonderlabs(already ordered) when he finishes up his bottle of Cobalaquin. It seems fine enough to use but Wonderlabs is obviously, highly recommended and much more cost effective at this time.

Cost is definitely a factor now with all of his meds and supplements.

Thanks again!
Luke, Basenji/Shepard/Spaniel/Collie mix. DX-Diabetes 5/2021, DX-EPI & Cushings 9/2022, DX-Hypothyroid 10/22

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Olesia711
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Re: Diabetic for over a year now has EPI (and more)

Post by Olesia711 » 16 Oct 2022, 20:32

My diabetc dog did great with a little cooked, mashed, skinned sweet potato.... and a little broccoli sounds great too... just don't over-do on the broccoli cause too much can give them gas... some other veggies that i used were carrots, squash, and green beans :)

Keep us posted!
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

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KarenC
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Pet name: Luke
My name: Karen

Re: Diabetic for over a year now has EPI (and more)

Post by KarenC » 18 Oct 2022, 07:14

Always when I think things are getting to a stable place......the unexpected happens.

Sunday night about 3 or 4 am Luke suddenly woke up jumped off the bed. I sat up and thought he was going to vomit somewhere. But when he got on the floor he seemingly fell over on his side, like if a cow tipped and their legs just stuck out stiffly. He made some loud noise but then righted himself soon after, laying on his belly as usual. I talked to him till he wagged his tail.

After the shock of the event we all fell asleep for an hour till the alarm went off. Normally we take the dogs out right away. He did not want to go.....that seemed strange. I then discovered he actually vomited on the bed which is why i think he jumped up suddenly. I also discovered he had urinated either during the fall over event or just after.

My first thought was some kind of seizure. Not good! But it was really hard to know if this was. Not all seizures involved trembling and the like.

Called the vet and luckily they had a cancellation so we were able to get him in yesterday. Along with this episode he has been hacking/coughing alot. I am pretty sure he is having reflux and I was going to post and ask about this wondering if anyone experiences a cough with the reflux? Maybe because of irritation.

Anyway.....He had blood taken, urinalysis and x-rays with radiologist consult. His x-ray shows 2 areas of concern which the radiologist believes is pneumonia. We are thinking aspiration pneumonia. Something he never had and it started when we started the enzymes and the hacking got progressively worse.

Waiting on blood and urinalysis results.

We start a prescrip of antibiotic and a nebulizer today and started him on sucrolfate for the reflux. I may post separately for other experiences with reflux.

Of course, we are hoping he did not have a seizure and it some weird mistep in his confusion and now treating pneumonia.

Another adventure in our journey.......
Luke, Basenji/Shepard/Spaniel/Collie mix. DX-Diabetes 5/2021, DX-EPI & Cushings 9/2022, DX-Hypothyroid 10/22

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Olesia711
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Re: Diabetic for over a year now has EPI (and more)

Post by Olesia711 » 18 Oct 2022, 12:31

ahhh geez.........so sorry to hear this.... however.... i posted on your other thread and will continue to post there to keep everything in one place..............
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

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KarenC
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Pet name: Luke
My name: Karen

Re: Diabetic for over a year now has EPI (and more)

Post by KarenC » 20 Oct 2022, 10:07

Just wanted to post here with an update on the "And More" part.....and keep the reflux thread more specifically about reflux issues.

I couldn't have imagined when he got diagnosed with EPI and how overwhelming all of that was that just a short time later we would add to his list of diagnoses but now we can add Hypothyroidism to his list.

His recent blood work showed very low Thyroid and T4 levels.

I haven't seen many posts of other dogs with EPI plus a handful of other issues.

The positive from his recent bloodwork was that everything else looked good, his glucose was even down to a 200! Amazing for him. I hope that trend will continue. Because I am not sure how much more he can handle.....
Luke, Basenji/Shepard/Spaniel/Collie mix. DX-Diabetes 5/2021, DX-EPI & Cushings 9/2022, DX-Hypothyroid 10/22

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Olesia711
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Re: Diabetic for over a year now has EPI (and more)

Post by Olesia711 » 20 Oct 2022, 15:07

ahhh...i can shed some light on this! my Izzy, who also had EPI + Diabetes (plus she dealt with a whole list of other issues).............ANYWAY.... she too was diagnosed with Low Thyroid ......when these dogs have other underlying immune issues...... they often also develop low thyroid as a result of the body having issues.... it is not that they developed yet another stand-alone health condition... but rather that this new health condition is the body just saying "hey, things are out of whack here, so this thyroid is reacting this way........."

Not sure if how i am explaining it makes sense or not... but i hope so.
in short... this happens a lot with these immune-compromised dogs..............thank goodness it is an easy management... give Synthroid or Levothyroxine daily :)
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

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