“I Think My Vet Has Given Up” | Ask Dr. Joi

I get some great questions from clients. They inspire me with article ideas and keep me in tune with diabetic pet owners. I enjoy interacting with our readers, and sometimes the questions are worthy of a newsletter. I bet if one person has this question and takes the time to write me, there are likely lots of folks with a similar question. Today’s question is about chronically high blood glucose levels in dogs.

I have a ten year old Cairn Terrier. Last October he was diagnosed with diabetes and pancreatitis. He was put immediately on insulin injections and started at 3 units 2x a day. Well, we never got his sugar under control. He got as high as 12 units 2x day. Eight weeks ago he was changed to Vetsulin. He was started at 3 units 2x a day, and he is already up to 8. The lowest I’ve gotten his sugar to is 484. He eats a prescription diet. His urine test strip was 500. He went completely blind a month ago. He eats and drinks and pees ok. He was checked for Cushing’s disease, and that was negative. I don’t know what else to do. Should I go back to a homemade food? I think the diet he is eating now is not working. What else could be causing his sugar to be so high? Thank you so much. I’m at a loss, and I think my vet has given up.

First of all, let’s go back to the basics. I don’t know what all you have done, and sometimes little things like timing of meals or giving mid-meal snacks can make a huge impact on diabetic regulation. Here are some links about basic diabetes knowledge and my typical recommendations.

Back to Basics for Diabetic Pets | Part 1

Back to Basics for Diabetic Pets | Part 2

Back To Basics For Diabetic Pets | Part 3

Back To Basics For Diabetic Pets | Part 4

Read these and see if there are any blaring things you do that could adversely affect his control. I’m a proponent of consistent good habits. A “routine” is your friend when it comes to diabetes control for your pet.

Next, if you fear your vet is frustrated or has “given up”, consider seeking a veterinary internist. I seriously doubt your vet has given up, but at times we do get frustrated when a disease gets the better of us! We vets go through 8 years of college to get the letters “DVM” behind our names. Vet internists go through an additional 4 years of training for the extra letters behind their names. Internists thrive on the hard-to-manage diabetic or other difficult medicine patient. They rejoice over patients that make us general practitioners want to pull our hair out. Most large cities have a specialty veterinary hospital that would have an internist who could set you on the right track. Often, they look for underlying infection or concurrent disease that could cause insulin resistance. Two of the most common sources of infection in diabetic pets are urinary tract infections (so a urine culture is in order) and oral infection from dental disease. If there is doubt regarding oral infection, a dental cleaning with full mouth dental X-rays is in order. I’m glad your vet already tested him for Cushing’s disease. Your vet might also re-test for pancreatitis as pets can have chronic, smouldering pancreatitis.

As far as food is concerned, a specialty diet is actually a really good choice for a diabetic dog as the right formula will be high in complex fiber and low in fat. The low fat bit is particularly important as you say your pet had pancreatitis. I’m sure your sweetie would love some home cooking regardless. There are lots of good food choices for a diabetic dog, but the real key is to feed equal portions/calories every 12 hours and try your best to avoid mid-meal snacks unless you suspect or identify hypoglycemia.

You mention urine glucose. Are you testing his blood glucose at home too with a blood glucose meter? Let me tell you, home blood glucose curves make all the difference for diabetes regulation. By running glucose curves at home you eliminate stress hyperglycemia that commonly occurs when a pet spends the day at the vet clinic. And, it saves you a ton of money by checking the repeat blood glucose samples at home rather than paying your vet and his staff to do it. A glucose curve means you check the blood glucose every 2 hours from one injection until the next, twelve hours later. My twist is that when it falls below 150 mg/dl you should check hourly until it starts to rise again so you know where it truly bottoms out. They call this low point the “nadir” of the curve. Blood glucose curves tell us how long a particular insulin lasts in your pet and also if we should increase or decrease the dosage.

As far as being blind, that is likely from diabetic cataracts. Diabetic cataracts commonly occur in diabetic dogs and rarely in diabetic cats. Good glucose regulation can delay or prevent them, but once they form we are looking at surgery to remove the lenses to restore vision. A vet ophthalmologist could help you with this. First I’d consult an internist as your initial question was about getting his diabetes under control. We use oral supplements like alpha lipoic acid to help prevent diabetic cataracts. Hopefully soon there will soon also be a topical cataract preventative for dogs called Kinostat. Kinostat is still awaiting FDA approval as I write this. Diabetic pets are also prone to other ophthalmic conditions, so I am always pleased when diabetic pet owners go to the ophthalmologist early.

Do chat with your vet about a referral to a vet internist. And keep your chin up.

Have a question or comment? Post below or email me at [email protected]. I always enjoy hearing from my readers!

NOTE: Consult your veterinarian first to make sure my recommendations fit your pets special health needs.