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

[KarenC]

Hello everyone, new here

So my boy, Luke, was diagnosed with Diabetes back in May 2021. Since then his diabetes has not been under control and recently we upped his units of Vetsulin to 15 units 2x/day up from 10 units at his initial diagnosis. Each Glucose curve testing my vet increased his Vetsulin by a unit.

Back in October of 2021 he got a urinary tract infection. It was difficult to cure.....long courses of antibiotics. March of 2022 he had an ultrasound of his abdomen and they found suspicious areas in his bladder and debris or sand like debris. May of 2022 another ultrasound, still debris and no improvement in his bladder, more antibiotics and finally surgery to cut out the suspicious area and suck out the debris.

July 2022, diabetes still uncontrolled per glucose curve testing. Hair is coming out in chunks. We did see a little bit of this before he was diagnosed with diabetes but nothing like it is now. His hind legs are becoming weaker as well. So at the end of August we had another Glucose curve where we arrived at the 15 units 2x/day and then a week later we did the GI panel and low dose dexamethasone suppression test, endocrine tests...all kinds of blood tests!

It was found he is in the "gray zone" of Cushings (with clinical signs) most likely with the tumor on pituitary since none of his ultrasounds showed tumors on the adrenal glands. Then we find out he is super deficient on b-12 and EPI positive.

The poor guy can not catch a break here. I feel a bit overwhelmed with the conflicting diet needs of being a diabetic, which we have dealt with for a while, but now thrown the curve ball of the diet needs of the EPI dog.

A few days ago he was started on 12 mg of Melatonin and about 40 of Lignans to deal with his Cushing's. Vet order Cobalaquin and Pancreved which we hope to have by Friday and get him started on that.

I don't know how the Cobalaquin and Pancreved compare to what most others use for EPI but I hope they are adeauate, at least for now. HIs diet is currently Earthborn Holistic Lamb with Pumpkin. Totally grain free, pea and bean free, no potato and fortified with probiotics, b12 and other vitamins/minerals. He also gets a bit of wet food, all protein.

From the little I have seen so far I am understanding that diabetic dogs should only have 2 meals a day because a 3rd with no insulin could be worse for the overall glucose levels? As well as treats for the same reason? And then for EPI whatever he eats would also need the enzymes making the treat habit not a good one unless it is fortified with enzymes?

What have others experienced with a Diabetic who then developed EPI?

What might I expect when I start the enzyme treatment? Currently, his poops are fairly normal but he has had the random intestinal episode here and there over the past 15 months. Will the enzymes cause side effects at the start?

This is our boy, Luke. He is now a little over 9 yrs and he is a mixed breed. His top DNA contributors are Basenji and German Shepard (nothing like his appearance ) but he also has Boxer, Chow,. Collie and Cocker Spaniel in the mix.

[jilbert57]

Welcome to you and Luke. Wow he is handsome thank you for the picture. Will you please post the test results for the Tli, B12 and folate? Feel free to post all labs if you like it helps us.
Have you read the links on the forum yet?
I emailed the founder as she had a diabetic pup.
When starting enzymes more drinking hence more peeing can be expected.
There are 4 cornerstones of Epi:
ENZYMES
DIET
ANTIBIOTIC
B12
When those 4 come together the pup is on a good path. You have extenuating circumstances with Cushings and Diabetes so probably be more involved.

Jill

[KarenC]

Thank you, Jill!

Here are his recent labs that you specified results of:

Trypsin-like
Immuno-reactivity
(TLI)
a 1.3

Cobalamin
(B-12)
b 261

Folate 9.5

I forgot to mention that he hasn't lost much weight, if any over the past two months but possible between 1-2lbs. He had to be weighted many times as the vet said the scales needed to be calibrated and he has been hovering in the 53lbs range.

I have been combing thru the various links trying to absorb all that I can

[Olesia711]

Hi Karen,

Poor you and poor Luke.... this is a lot to deal with especially when it happens so close together..... but i will try to help you as best as i can.
For, the easy part. with the Cushings.... my non-EPI dog, Rico, had what your dog is dealing with, A-Typical Cushings. He too was on Melatonin, the Lignans from FlaxSeed Hulls ... not just flaxseed and they also put him on Lysodren. You didn't mention any Lysodren (mitodane)..... does your vet not think this is necessary? if it has not come up un conversation, i would definitely ask. My Rico lived for 16+ years.... 11 of them was with Cushings. The only food i avoided with him was organ meats.... did not give him any............. other than that, he ate what everyone else did.

My Izzy, who was the EPI gal, lived to 15 years and battled the following:

14 years with EPI
8 years with Diabetes (that was WAY out of control for 2 years!)
8 years as an IMHA survivor
8 years with Hypothyroidism
10 years with central brain inflammation (Vestibular disease) that was treated in her 5th years, but her vision was forever "off" afterwards
She was also diagnosed with Rocky Mountain Spotted Fever tick disease in her 5th yer(even though she was on tick and flea meds)
She had a bout with Uveitus (eye inflammation) in her 6th year
And had juvenile incontinence her entire life (she was a lifer on PROIN)

I have always felt that because of EPI, her immune system was toast and was susceptible to all kinds of health "concerns"... BUT.... she was the happiest dog ever that battled it all and won....

SO..... i know you are frustrated and i am so sorry.... but EPI, Diabetes (this is a tough combo) and then toss in Cushings.... it is going to be a rocky ride in the beginning, but once you find the magic protocol for Luke, this all is manageable.

First... . ask the vet about Lysodren .. to better manage the Cushings and if your vet thinks it is needed now... and then put your focus on:
Diabetes #1 and EPi #2

Some tips:

YOu are correct. ONLY feed Luke 2 meals, breakfast and dinner with the same food, same portions of food and the same amount of insulin 12 hours apart (you have about at 30 minutes leeway. ) no inbetween meals, no treats.... use play, positive attention as a reward.

Food.... lower fat food often helps keep the diabetes in better control.... especially with EPI & diabetes. The one you are using now has 14% fat content..... it may or may not be jacking up his blood sugar. The fiber content is 5% which is a little high for most EPI dogs..... BUT.... if his poos are fine, then this dog food is fine for the EPI part of his health.

Overall the first focus needs to be on the blood sugar/ Diabetes.... if you have to use a food that is not ideal for EPI but is really working with the Diabetes, then the way to manage this is go with what works with Diabetes and just add more enzymes to compensate for the EPI condition.

Vets were amazed at how long my Izzy lived with all her health "concerns" and especially with the Diabetes..... our blood curves were AWFUL for 2 years... finally what worked for me, and then i started helping others with managing Diabetes and EPI ... was to feed about 80% of the meal with Homemade ingredients to keep the Diabetes in good control and 20% kibble cause that would keep the weight on. I will email you my cell phone # so that you can call me and we can chat.... as i know how overwhelming this can be .....

The Pancreved is the right kind of enzymes... but make sure your vet orders you the POWDER not tablets.... this makes a HUGE difference!

THe Cobalaquin is good B12, Dr. Steiner did studies with it, it works and TAMU promotes it and it has been used successfully with some EPI dogs to manage their B12. HOWEVER.... if Luke's B12 does not come up to a good high range (600's or above) with Cobalaquin... then just switch from Cobalaquin pills to Pet Factor B12 pills. Reason is because Cobalaquin is made with Cyanocobalamin B12 whereas Pet Factor is made with Methylcobalamin B12 and also has Folate and Intrinsic Factor in it. They are both the same dosage, but if Cobalaquin fails to perform as expected, Pet Factor will work. Some dogs do better on the Methylcobalamin with Intrinsic factor included. But they are both good.

Also. infection.... even out of control SID (small intestinal dysbiosis), a UTI, a tooth infection, ANYthing can jack up the blood sugar in Diabetic dogs

And last but not least when dealing with EPI + Diabetes.... this is a combo and unique health issue..... i know vet like to see the blood glucose with Diabetes in the 100's.. but when you have a dog battling EPI + Diabetes... this will most likely NOT happen... with this combination of health issues... your goal will be to get the blood sugar to be in a range below 250... if you can manage that ... Luke will be doing good.

It takes a LOT of work to find that balance but this Diabetes should be able to be managed with diet.
OR
You can work with your vet on using a combo insulin..... but this is VERY tricky and needs a qualified/experienced vet's guidance... you use a combo of short acting with intermediate acting insulin, or you use long acting insulin, with or without a combo..... it depends on the individual dog and what your vet thinks would be best.

I'll email you privately.

[KarenC]

Thank you, Olesia!

First, I have to say, WoW! What you and Izzy had to endure is mind boggling. What a great dog she was and more so, what a great human who took care of her. I am grateful for you and Izzy for being able to bring forth your knowledge and experience with all of this!

Yes, the Pancreved is in powder form. I should have both that and the Cobalaquin on Friday so this wknd will be the start of dealing with the EPI.

I believe my vet, who has been conferring with another internist, wants to see how he responds to the Melatonin and Lignans and we are to bring him back in for blood work again in 2-3 months.

One change we need to make is his feeding. I feel stupid for not realizing this before but he (and his humans)were in such routine along with other various reasons for feeding him smaller meals 3 times a day. So I think to start I can feed him a little more at breakfast and dinner and skip the lunch. His weight has been pretty stable along with his poos. So that's a plus.

Having all these issues at the same time makes it hard to know what symptom is from what and until now, we always thought it was the diabetes but they are all so similar.

So, for over a year now we have been on a good schedule with feeding and insulin and I will adjust (as mentioned above) to feeding only twice. And while he doesn't get treats often it seems like those will be cut out for now. This is the first step for us. Then we integrate the enzyme powder into the meal routine along with giving him the B12.

Trying to work out a plan in my head to make it feel simple. It seems simple enough but epi and diabetes require some opposite things and I hope finding the balance between the 2 isn't too much of a struggle.

I have gotten your email and I appreciate your time so much! I feel like I am forgetting some things but there is a lot to process at the beginning stages.

-Karen & Luke

[Olesia711]

hi Karen,

it IS a lot to process all at once...and my heart goes out to you....... but once you understand what to prioritize and why, and then address things accordingly... it helps you get a grip on things..... it is just a lot to process all at once.

two things that will help tremendously with the diabetes management (and EPI) is to keep a record of what you are doing for and with Luke.
for example make an ongoing template that lists the day and the hours of the day

record how much insulin you are giving at what time.
record what food (ingredient and portions) that you feed.
record blood sugar levels
record activity (what time, what kind (like walking, playing ball or frisbee) and duration (like 10 , 30 minutes)
record what meds are being given (name, dose)
record poo eliminations (texture, color, volume, frequency/time)
record any regurg, vomiting, etc.
record any unusual happenings like guests visiting, trip to the vet (things that can be stressors)

what you will begin to notice is what could be triggers for high blood sugar spikes AND it will also show you when Luke's nadir is ( lowest point of blood glucose levels / same time.)... which will help with diabetes insulin dosing and type, if you are dealing with a Somogyi effect (when insulin lowers your blood sugar too much, it can trigger a release of hormones that send your blood sugar levels into a rebound high.)

And keeping a record/journal will also really help you manage EPI.

thanks for letting me know you received my email

[KarenC]

Hello,

I wanted to come back to this and sort of update things a bit. We started Luke on the enzymes and B12 about 2 weeks ago and so far things seem ok on that end. His poop before this was good and it is still good now. He hadn't lost much weight, maybe 1-2 lbs before this all started. So neither weight nor his poop were clinical signs of the EPI, I think.

He gets about 2 cups dry with 1/3 can. I started with 3/4 tsp of the enzyme (pancreved) sprinkled over the dry, add water and incubate for 20-30 minutes. When it is ready I give him all his meds/supplements in a spoon of can and add more can food to the enzyme & dry mix. He gobbles it up fine and I follow that with a bit of unsalted broth to wash it down (keep his mouth washed of enzyme particles).

We started feeding him twice a day (previously he got a lunch which he still looks for) because that is the best course for the diabetes.

So I guess my first question is....he has not gained any weight on this new regiment. Should I increase the enzyme amounts to 1 tsp? Is this how we judge how to adjust the dosages? Just not sure on that

As for his Diabetes, we were testing and things looked like they improved, i was encouraged by glucose readings around 250! He is also on 12 mg of melatonin a day and 40-60 HMR lignans a day for the Cushings. No adverse reactions were noticed since he started all of this.

The only thing I have noticed is that he started licking his sheath. It got bad, very intense licking and biting like it was itchy. Some hair loss there and red marks, possibly some sort of bump but maybe that was always there. I made a quick appt at a local vet (not his regular vet) because they had an appt and it was close. I thought maybe he had an infection. They did a urinalysis and it was clear. They suggested I consult my regular vet about his insulin and sent me home with some wipes for the itching.....

However, his glucose was sky high! Over 1000. I was in shock because I thought he was doing better with that. He has a glucose curve scheduled in 10 days.

So, I guess my next question is whether or not anyone has experienced some sort of reaction to enzymes with their dog?

I did call my vet right away and she wants me to stop the enzymes for the wknd. We also drove out to my vet this morning and they gave him a Cytopoint injection and refilled his Apoquel. She will call me on Monday after she consults with another doc on his insulin. So that stays the same for now. She wants his licking/itching to get under control and I guess see if the enzymes could be the issue...

It's a lot of information and I feel a bit disheartened thinking we might be lucky and things were going well. But Luke has never been typical. So just seeking more advice now that we are a few weeks into this.

I know the diabetes must come first. My mind is just back to swirling all of this around until it makes sense again.

Thanks!
Luke & Karen

[Olesia711]

Karen, I am so so SO sorry i missed this post.........i just didn't see it. My apologies!

But OMG....BGs at 1000 ???? YiKES! I have never seen BGs that high and to answer your question, i have never heard of enzymes causing BG to sky rocket like that either.

Since it has been so many days since you posted this, i sure hope things have been resolved.

If when you see this, i hope you can post an update for us.........

[KarenC]

No worries, Olesia! I wrote a wall of text and the questions were lost, no doubt Plus I know a lot of us southern states were dealing with hurricane Ian (us included!) so it's been a busy time for sure.

However, since then, my regular vet gave him a cytopoint injection and we got him back on Apoquel. She had him off the enzymes for the wknd until she consulted with the endocrinologist on Monday. After that he went back on enzymes. So that was a week ago today. He still goes to lick the sheath some but it has much improved and the licking is less.

The local vet that saw him for that thought glucose was coming out as he peed and causing the itching. I asked my regular vet who consulted with an endocrinologist and both said they had never heard of this. Or that it could cause such an intense reaction. This local vet gave me such a weird reaction when telling me about the glucose level. It was like shock but yet...not an emergency and he only offered that i call my regular vet.

Luke has a blood glucose curve scheduled for tomorrow at this local vet. More for convenience since our regular vet is about 90 mins away. I am a little worried but mostly because Luke was so scared at that initial visit. I have never seen him so scared going anywhere for the first time and wonder if his result was from his fear kicking in hard. He must have been so stressed.

His pee strip glucose results are still showing us at home in the 250 range. Before his EPI they were always in the 500 range.

Almost a month now on enzymes and b12 and he is doing ok as far as that goes. Poops are still good and weight seems stable tho it seems he may have a worsened acid reflux so will bring that up at his next visit with his regular vet. He seems to...cough a lot more too, or it sounds like, kinda like a hacking noise.

Thanks so much for checking in. I will update with anything else but hopefully it's only to report good news. I still am hopeful that managing the EPI will regulate his diabetes. Or at least help it some. If not, then managing the Cushings in a better way will be next.

[Olesia711]

Hi Karen,

First, thank you so much for being so understanding.... i appreciate it but felt so bad that you went almost 10 days without a response....

Glad they started him back on the enzymes... PHEW!
And OMG... i too have not heard of this "The local vet that saw him for that thought glucose was coming out as he peed and causing the itching." but over the years, i have learned never to say never.... you'd be amazed at things that happen or what the causes are that were not expected nor typical and sometimes even touted as "can't happen!"

But if he gets so nervous,,, yes that to can contribute to a rise in BGs. Can you have a conversation with your vet (if you are comfortable with this) and have them teach you how to test blood at home so that you can do BG curves at home so he doesn't get so stressed???? but if this freaks you out... the other option is to ask the vet if he can wear a diabetic patch that would monitor his blood glucose.... it is called a FreeStyle Libre here is some info on it from one vet clinic:
https://chfa.net/resources/blog/390-dia ... and-rapids
unfortunately the pee strips do help but they don't give the full or accurate picture of what is going on ....