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"Coal" is a 13 year old CM DSH. History: 1. Diagnosed via CT with cerebral ischemic infarction causing seizures in July 2005, been on Phenobarbital since then and fairly well controlled. Current dose is 16.2mg tabs, 1 in am and 1/2 in pm. 2. Started having intermittent diarrhea +/- bloody stools in July 2011. Increased frequency of diarrhea and large volume and projectile by July 2012 Initially he may have been getting in the other cats food (who was picky and changed food alot). Rarely vomited. Was on laxatone (not my reccomendation), and diarrhea would resolve temporarily with amoxi/metronidazole. Diagnostics: Multiple fecals: NSF 8/2012 CBC, Chem, T4, Hwab, UA attached Cobalamin: 1000 (290-1500pg/mL) Folate: 17.5 (9.7-21.6 ng/mL) PLI: 1.8 (0.1-3.5 mcg/L) TLI: 57.2 (12-82 mcg/L) Rads: Only abnormal finding was possibly thickened intestinal walls. No masses or obstruction noted. OA noted in elbows and spine. Ultrasound: Mild chronic renal changes without pyelonephritis or stones. Spleen normal. Liver enlarged, rounded, mixed echogenicity, no choleoliths or choleostasis. Stomach and small bowel have some loss of mucosal layering and distinction. No FB or masses. Pancreatic region is thickened and mixedd echotexture as with chronic pancreatitis. No lymphadenopathy. WDX: IBD +/- lymphoma, chronic pancreatitis Owner declined scoping or exploratory at this point. Treatment: Dewormed with profender Fortiflora daily Methylprednisolone 4mg 1 BID x 14 days, then 1 daily x 14 days, then 1/2 daily

So what do i do?

Was she previously a diabetic cat?

"Coal" is a 13 year old CM DSH. History: 1. Diagnosed via CT with cerebral ischemic infarction causing seizures in July 2005, been on Phenobarbital since then and fairly well controlled. Current dose is 16.2mg tabs, 1 in am and 1/2 in pm. 2. Started having intermittent diarrhea +/- bloody stools in July 2011. Increased frequency of diarrhea and large volume and projectile by July 2012 Initially he may have been getting in the other cats food (who was picky and changed food alot). Rarely vomited. Was on laxatone (not my reccomendation), and diarrhea would resolve temporarily with amoxi/metronidazole. Diagnostics: Multiple fecals: NSF 8/2012 CBC, Chem, T4, Hwab, UA attached Cobalamin: 1000 (290-1500pg/mL) Folate: 17.5 (9.7-21.6 ng/mL) PLI: 1.8 (0.1-3.5 mcg/L) TLI: 57.2 (12-82 mcg/L) Rads: Only abnormal finding was possibly thickened intestinal walls. No masses or obstruction noted. OA noted in elbows and spine. Ultrasound: Mild chronic renal changes without pyelonephritis or stones. Spleen normal. Liver enlarged, rounded, mixed echogenicity, no choleoliths or choleostasis. Stomach and small bowel have some loss of mucosal layering and distinction. No FB or masses. Pancreatic region is thickened and mixedd echotexture as with chronic pancreatitis. No lymphadenopathy. WDX: IBD +/- lymphoma, chronic pancreatitis Owner declined scoping or exploratory at this point. Treatment: Dewormed with profender Fortiflora daily Methylprednisolone 4mg 1 BID x 14 days, then 1 daily x 14 days, then 1/2 daily

How do i manage the diabetes in the face of pred or is there an affordable alternative treatment?

I am wondering if this patient is starting to develop kidney disease and is making the hypoadrenocorticism harder to manage?

Hi there I have a 17 year old MN DLH diabetic cat who was on fairly high dose insulin (Canninsulin) therapy (7.5 IU q 12 h) for years. Blood glucose curves and monitoring had been previously declined by the owners. The patient presented with seizures and apparent hypoglycemia four days in a row, which responded to corn syrup. The owner's did not give insulin for a 12 hour period and laboratory values returned with a blood glucose of 46 mmol/L and normal (326) fructosamine. The patient was decreased to 3.5 IU q 12 hours and a blood glucose curve revealed minimal changes in blood glucose (fluctuating values between 23 mmol/L and 15 mmol/L with no obvious nadir). We changed to 4.5 IU q 12 hours and asked the owners to test the blood glucose before giving insulin. Morning values ranged from 20-25 mmol/L but evening values ranged from 9-15 mmol/L. A recent glucose curve revealed a starting glucose reading of High (> 25 mmol/L) prior to morning (7:00 am) insulin, decreasing to 10.2 mmol/L at 6:00 pm. I am concerned as the seizures reported all happened immediately after the evening glucose measurement. Any suggestions? The patient also has marked renal disease. Thank you for your time

What is this cat's weight?

If so, has the glucometer been checked for accuracy?

Hi there I have a 17 year old MN DLH diabetic cat who was on fairly high dose insulin (Canninsulin) therapy (7.5 IU q 12 h) for years. Blood glucose curves and monitoring had been previously declined by the owners. The patient presented with seizures and apparent hypoglycemia four days in a row, which responded to corn syrup. The owner's did not give insulin for a 12 hour period and laboratory values returned with a blood glucose of 46 mmol/L and normal (326) fructosamine. The patient was decreased to 3.5 IU q 12 hours and a blood glucose curve revealed minimal changes in blood glucose (fluctuating values between 23 mmol/L and 15 mmol/L with no obvious nadir). We changed to 4.5 IU q 12 hours and asked the owners to test the blood glucose before giving insulin. Morning values ranged from 20-25 mmol/L but evening values ranged from 9-15 mmol/L. A recent glucose curve revealed a starting glucose reading of High (> 25 mmol/L) prior to morning (7:00 am) insulin, decreasing to 10.2 mmol/L at 6:00 pm. I am concerned as the seizures reported all happened immediately after the evening glucose measurement. Any suggestions? The patient also has marked renal disease. Thank you for your time

What stage of crd?

Is the urine free catch?

Hi there I have a 17 year old MN DLH diabetic cat who was on fairly high dose insulin (Canninsulin) therapy (7.5 IU q 12 h) for years. Blood glucose curves and monitoring had been previously declined by the owners. The patient presented with seizures and apparent hypoglycemia four days in a row, which responded to corn syrup. The owner's did not give insulin for a 12 hour period and laboratory values returned with a blood glucose of 46 mmol/L and normal (326) fructosamine. The patient was decreased to 3.5 IU q 12 hours and a blood glucose curve revealed minimal changes in blood glucose (fluctuating values between 23 mmol/L and 15 mmol/L with no obvious nadir). We changed to 4.5 IU q 12 hours and asked the owners to test the blood glucose before giving insulin. Morning values ranged from 20-25 mmol/L but evening values ranged from 9-15 mmol/L. A recent glucose curve revealed a starting glucose reading of High (> 25 mmol/L) prior to morning (7:00 am) insulin, decreasing to 10.2 mmol/L at 6:00 pm. I am concerned as the seizures reported all happened immediately after the evening glucose measurement. Any suggestions? The patient also has marked renal disease. Thank you for your time

Where is the owner injecting the insulin?

What time does the dog get the am and pm insulin/food?

Hi there I have a 17 year old MN DLH diabetic cat who was on fairly high dose insulin (Canninsulin) therapy (7.5 IU q 12 h) for years. Blood glucose curves and monitoring had been previously declined by the owners. The patient presented with seizures and apparent hypoglycemia four days in a row, which responded to corn syrup. The owner's did not give insulin for a 12 hour period and laboratory values returned with a blood glucose of 46 mmol/L and normal (326) fructosamine. The patient was decreased to 3.5 IU q 12 hours and a blood glucose curve revealed minimal changes in blood glucose (fluctuating values between 23 mmol/L and 15 mmol/L with no obvious nadir). We changed to 4.5 IU q 12 hours and asked the owners to test the blood glucose before giving insulin. Morning values ranged from 20-25 mmol/L but evening values ranged from 9-15 mmol/L. A recent glucose curve revealed a starting glucose reading of High (> 25 mmol/L) prior to morning (7:00 am) insulin, decreasing to 10.2 mmol/L at 6:00 pm. I am concerned as the seizures reported all happened immediately after the evening glucose measurement. Any suggestions? The patient also has marked renal disease. Thank you for your time

What is the diet?

Have the sodium concentrations been on the high end of the scale?

Hi there I have a 17 year old MN DLH diabetic cat who was on fairly high dose insulin (Canninsulin) therapy (7.5 IU q 12 h) for years. Blood glucose curves and monitoring had been previously declined by the owners. The patient presented with seizures and apparent hypoglycemia four days in a row, which responded to corn syrup. The owner's did not give insulin for a 12 hour period and laboratory values returned with a blood glucose of 46 mmol/L and normal (326) fructosamine. The patient was decreased to 3.5 IU q 12 hours and a blood glucose curve revealed minimal changes in blood glucose (fluctuating values between 23 mmol/L and 15 mmol/L with no obvious nadir). We changed to 4.5 IU q 12 hours and asked the owners to test the blood glucose before giving insulin. Morning values ranged from 20-25 mmol/L but evening values ranged from 9-15 mmol/L. A recent glucose curve revealed a starting glucose reading of High (> 25 mmol/L) prior to morning (7:00 am) insulin, decreasing to 10.2 mmol/L at 6:00 pm. I am concerned as the seizures reported all happened immediately after the evening glucose measurement. Any suggestions? The patient also has marked renal disease. Thank you for your time

Can you post the exact curve, including current dosage, time of administration?

The owner is using a glargine pen or syringes/bottle?

"Paris" is a 9 yr FS Daschshund, She presented for about a 1 month onset of worsening pu/pd. Now has progressed to urinating in the house. She has lost a little weight, and is now in ideal body condition. Her coat is normal, and she does not have a pendulous abdomen, no thinning of the skin, etc. She has started exhibiting signs of pica, eating O's t-shirts if on the floor, corners of rugs, towels, etc. She starts with licking, then progresses to chewing and eating whatever she was licking. She also seems more restless, anxious, nervous. TPR wnl. U/A: free catch: USG 1006, pH8, NO glucose, sediment quiet. A cystocentesis sample has been collected and submitted for culture and sensitivity (results pending). Blood CBC: mild leukopenia with neutropenia, (possible bands), eosinopenia. RBC and Plt counts wnl. Chemistry: mild decrease urea, mild increase ALT 148 U/L (10-100), marked increase ALP 1015 U/L (23-212), marked increase GGT 37 U/L (0-7). Abdominal u/s: liver, gallbladder, kidneys wnl. Adrenals both enlarged (I don't have measurements here) with normal cortices, ACTH stim (Idexx, in clinic): baseline cortisol 155 nmol/L, 2 hr post: 690 nmol/L (with supporting signs is consistent with Cushing's disease). We are running LDDS test today. I am posting this because I have not seen a case of HAC without the typical appearance...is there anything else I should be addressing here? I will post the LDDST tonight. thanks for your time!!! Comp: mild decrease urea, consistent with pu/pd. Mild increase ALT. Marked increase ALP (steroid induction with HAC, or cholestasis?). Marked increase GGT (cholestasis?). Diabetes insipidus doesn't cause ALP elevations, but HAC can, and it can lead to pu/pd due to interference with antidiuretic hormone. Recommend ACTH stim to rule in HAC (followed by LDDSt if positive to differentiate PDH and ADH). Rec abdominal u/s to evaluate liver, gall bladder, adrenals and kidney parenchyma. Get urine via cystocentesis at the time of u/s to send for culture /sensitivity. Pt does not have typical appearance of HAC, her coat is normal and abdomen not distended or pendulous. She does have pu/pd, anxiety/pica,panting.

Can you post the actual numbers for the entire cbc/chem screen?

What's the retic count?

A 13yr old, f/s dsh presented last week for exam prior to going to a kennel as the owners are moving and in limbo for a while. The cat had never been seen by our hospital before, but was previously diabetic and on Lantus insulin. Owners decided to stop insulin last summer and treat with diet (dry DM.) Physical was ok but I advised spot check bg which was over 400. Did cbc/chem/ua/culture. Bg over 400, glucosuria, all else ok. Advised cat medical board with us and start back on insulin and canned low cho food. So, I called lantus into a pharmacy for owner to pick up and bring to us for treatment while cat boarding. A few days later the owner brought in lantus with no box or prescription on bottle that looked slightly used. I asked the owner about the insulin and she told me it was the one they already had. She swears it has been refridgerated the entire time and is not 6 months old. I explained to the owner if she stopped insulin last summer, and this is the bottle she was using, it is 6 months old. Due to cost, owner wants me to use this insulin. I explained the 28 day exp after opening and our extending shelf life by refridgerating, but only 3 to 6 months. She still insists. Although it may be ineffective, will I hurt the cat by using this insulin? Am I better not to treat? Thanks,

How long is the cat going to board with you?

The owner is accurately measuring and then injecting the insulin?

A 13yr old, f/s dsh presented last week for exam prior to going to a kennel as the owners are moving and in limbo for a while. The cat had never been seen by our hospital before, but was previously diabetic and on Lantus insulin. Owners decided to stop insulin last summer and treat with diet (dry DM.) Physical was ok but I advised spot check bg which was over 400. Did cbc/chem/ua/culture. Bg over 400, glucosuria, all else ok. Advised cat medical board with us and start back on insulin and canned low cho food. So, I called lantus into a pharmacy for owner to pick up and bring to us for treatment while cat boarding. A few days later the owner brought in lantus with no box or prescription on bottle that looked slightly used. I asked the owner about the insulin and she told me it was the one they already had. She swears it has been refridgerated the entire time and is not 6 months old. I explained to the owner if she stopped insulin last summer, and this is the bottle she was using, it is 6 months old. Due to cost, owner wants me to use this insulin. I explained the 28 day exp after opening and our extending shelf life by refridgerating, but only 3 to 6 months. She still insists. Although it may be ineffective, will I hurt the cat by using this insulin? Am I better not to treat? Thanks,

Are you familiar with the recently-updated list of the carb contents of otc foods?

Is this canned or dry or both?

On Dec 12, I was presented with a 12-year-old, FS, DSH for weight loss, vomiting hair balls every other day, and localized alopecia (overgrooming). This cat is quite anxious and hides from other cats in the home. We did bloodwork (biochemistry, CBC, T4) at that time, but the only significant change was a moderate eosinophilia so the recent signs were attributed to possible stress and/or allergies. The owner started making changes in the home, using Feliway (feline pheromone spray) and feeding Hill's D/D. The cat was continuing to lose weight and was brought back in on January 25th, because her appetite was becoming poor and she was vomiting daily. She would show an interest in food, but did not ingest it herself. The owner was syringe-feeding at this point. On exam that day, her intestines felt "thickened" but there were no other significant findings. Repeat bloodwork was run with biochemistry, CBC, and spec fPLI. These yielded no significant results - possible IBD or neoplasia were discussed. On Jan. 25th, the cat was given an injection of Cerenia as well. After this the frequency of vomiting decreased, and over the next few days the cat started to eat more on her own. On Feb. 1st an abdominal ultrasound and urinalysis were performed. There were no significant findings on the abdominal ultrasound, but the ultrasonographer mentioned that early cholangiohepatitis could not be ruled out. The urinalysis indicated a relatively low USG (1.022) and a small amount of bacteria in the sample (1+, collected by cystocentesis). The cat is currently doing quite well - eating and drinking well, urinating normally. She still vomits occasionally, always hairballs, so I wonder if she is still overgrooming. At present, I would like to make some recommendations for the owner. Is a renal diet an appropriate place to start, or should we try to remain on the D/D food? If this is early renal disease and/or cholangiohepatitis, are there any other treatment recommendations I should be making? I would appreciate any feedback on this case. Thanks,

Where are the areas she is overgrooming?

Any chance that there is a house call option, for a bp at home?

On Dec 12, I was presented with a 12-year-old, FS, DSH for weight loss, vomiting hair balls every other day, and localized alopecia (overgrooming). This cat is quite anxious and hides from other cats in the home. We did bloodwork (biochemistry, CBC, T4) at that time, but the only significant change was a moderate eosinophilia so the recent signs were attributed to possible stress and/or allergies. The owner started making changes in the home, using Feliway (feline pheromone spray) and feeding Hill's D/D. The cat was continuing to lose weight and was brought back in on January 25th, because her appetite was becoming poor and she was vomiting daily. She would show an interest in food, but did not ingest it herself. The owner was syringe-feeding at this point. On exam that day, her intestines felt "thickened" but there were no other significant findings. Repeat bloodwork was run with biochemistry, CBC, and spec fPLI. These yielded no significant results - possible IBD or neoplasia were discussed. On Jan. 25th, the cat was given an injection of Cerenia as well. After this the frequency of vomiting decreased, and over the next few days the cat started to eat more on her own. On Feb. 1st an abdominal ultrasound and urinalysis were performed. There were no significant findings on the abdominal ultrasound, but the ultrasonographer mentioned that early cholangiohepatitis could not be ruled out. The urinalysis indicated a relatively low USG (1.022) and a small amount of bacteria in the sample (1+, collected by cystocentesis). The cat is currently doing quite well - eating and drinking well, urinating normally. She still vomits occasionally, always hairballs, so I wonder if she is still overgrooming. At present, I would like to make some recommendations for the owner. Is a renal diet an appropriate place to start, or should we try to remain on the D/D food? If this is early renal disease and/or cholangiohepatitis, are there any other treatment recommendations I should be making? I would appreciate any feedback on this case. Thanks,

Is she pruritic?

I presume that she has been dewormed appropriately; what diet is being fed?

On Dec 12, I was presented with a 12-year-old, FS, DSH for weight loss, vomiting hair balls every other day, and localized alopecia (overgrooming). This cat is quite anxious and hides from other cats in the home. We did bloodwork (biochemistry, CBC, T4) at that time, but the only significant change was a moderate eosinophilia so the recent signs were attributed to possible stress and/or allergies. The owner started making changes in the home, using Feliway (feline pheromone spray) and feeding Hill's D/D. The cat was continuing to lose weight and was brought back in on January 25th, because her appetite was becoming poor and she was vomiting daily. She would show an interest in food, but did not ingest it herself. The owner was syringe-feeding at this point. On exam that day, her intestines felt "thickened" but there were no other significant findings. Repeat bloodwork was run with biochemistry, CBC, and spec fPLI. These yielded no significant results - possible IBD or neoplasia were discussed. On Jan. 25th, the cat was given an injection of Cerenia as well. After this the frequency of vomiting decreased, and over the next few days the cat started to eat more on her own. On Feb. 1st an abdominal ultrasound and urinalysis were performed. There were no significant findings on the abdominal ultrasound, but the ultrasonographer mentioned that early cholangiohepatitis could not be ruled out. The urinalysis indicated a relatively low USG (1.022) and a small amount of bacteria in the sample (1+, collected by cystocentesis). The cat is currently doing quite well - eating and drinking well, urinating normally. She still vomits occasionally, always hairballs, so I wonder if she is still overgrooming. At present, I would like to make some recommendations for the owner. Is a renal diet an appropriate place to start, or should we try to remain on the D/D food? If this is early renal disease and/or cholangiohepatitis, are there any other treatment recommendations I should be making? I would appreciate any feedback on this case. Thanks,

What is her current weight?

Has the owner had the diet formulated by a nutritionist?

On Dec 12, I was presented with a 12-year-old, FS, DSH for weight loss, vomiting hair balls every other day, and localized alopecia (overgrooming). This cat is quite anxious and hides from other cats in the home. We did bloodwork (biochemistry, CBC, T4) at that time, but the only significant change was a moderate eosinophilia so the recent signs were attributed to possible stress and/or allergies. The owner started making changes in the home, using Feliway (feline pheromone spray) and feeding Hill's D/D. The cat was continuing to lose weight and was brought back in on January 25th, because her appetite was becoming poor and she was vomiting daily. She would show an interest in food, but did not ingest it herself. The owner was syringe-feeding at this point. On exam that day, her intestines felt "thickened" but there were no other significant findings. Repeat bloodwork was run with biochemistry, CBC, and spec fPLI. These yielded no significant results - possible IBD or neoplasia were discussed. On Jan. 25th, the cat was given an injection of Cerenia as well. After this the frequency of vomiting decreased, and over the next few days the cat started to eat more on her own. On Feb. 1st an abdominal ultrasound and urinalysis were performed. There were no significant findings on the abdominal ultrasound, but the ultrasonographer mentioned that early cholangiohepatitis could not be ruled out. The urinalysis indicated a relatively low USG (1.022) and a small amount of bacteria in the sample (1+, collected by cystocentesis). The cat is currently doing quite well - eating and drinking well, urinating normally. She still vomits occasionally, always hairballs, so I wonder if she is still overgrooming. At present, I would like to make some recommendations for the owner. Is a renal diet an appropriate place to start, or should we try to remain on the D/D food? If this is early renal disease and/or cholangiohepatitis, are there any other treatment recommendations I should be making? I would appreciate any feedback on this case. Thanks,

Is the cat grooming less?

Any seasonal component?

Got a cat on Pro Zinc and D/M diet with a totally greasy hair coat and large flake seborrhea! Skin changed demeanor when became diabetic! Any metabolic or shampoo thoughts? Thanx, br/

If the cat's diabetes is difficult to control, consider possible concurrent cushing's disease which can also cause haircoat changes, how does the cat's bloodwork look?

Also, would you test for cushing's dz?

Got a cat on Pro Zinc and D/M diet with a totally greasy hair coat and large flake seborrhea! Skin changed demeanor when became diabetic! Any metabolic or shampoo thoughts? Thanx, br/

Liver/kidneys all okay?

How dehydrated is this kitty?

Hi there, I'm wondering if you guys could help me out with an unusual case we've had at the clinic this week? None of my colleagues has seen one of these in real life, so I'd love some input from you. Obie is a 10 year old MN bearded collie, 25kg. Owner works at a pharmacy. Obie has been itchy and on pred (through other vets) his entire life, presumptive diagnosis atopy. Was seen at our clinic 4 months ago and prednisone was scripted out for him - tapering dose starting at 20mg per day then reducing to lowest possible dose. He came back in yesterday for vomiting several times over the last 24 hours, the owners worried since the vomit had a small amount of frank blood in it. Owner reported that he was also PU, PD, panting, lethargic. He still had a good appetite. Feces normal. No pruritis! Turns out the owner had been giving him 20mg of pred daily for the entire four months since we'd seen him. Clinical exam pretty normal except dog slightly pot bellied, estimate 5% dehydrated & moderate muscle wasting over his entire body. Blood work (everything we can do in house): PCV 42% Glucose 24.8 ALP 1200 Total bilirubin 21 Urea, BUN, alt, albumin, calcium, amylase, all normal. WBC cannot be measured in house. Urine free catch: USG 1.026 BG 4+ ketones 2+ Blood 1+ Protein 1+ Otherwise dipstick normal We popped him on fluids for the day & used crystalline insulin IM hourly to get BG down to 15, then started him on caninsulin (0.25 IU/kg BID with meals) yesterday evening. We're also treating for possible gastric ulcer (ranitidine & sucralfate), weaning off pred (have halved dose to 10mg every day, and planning on halving dose again every 2 weeks). And put him on a course of amoxyclav in case occult UTI (urine culture not an option due to finances). I know we can't expect to get good control of the diabetes until the dog is off pred, especially since we'll be changing the pred dose every few weeks. We're planning on doing a curve every week from here, and also considering sending the owner home with urine glucose strips (instructing them to test every day, if they see ketones they need to come back in immediately, if they see no glucose on the dipstick they need to come back in for a curve in case the dog is too low). I've got a few questions about what we're doing, if that's OK. 1. Do you think that this steroid dose (just over 1mg/kg daily for four months) could be sufficient to cause or trigger the diabetes? 2. If so, do you think that the diabetes might go into remission when we can get him off the pred? 3. Does our plan for weaning off pred, and monitoring blood & urine glucose, sound sensible? 4. How long do ketones last in dog urine? Thanks!

How did the owner get this much pred to be able to give this dose for 4 months?

How many calories/meal does he currently get?

Hi there, I'm wondering if you guys could help me out with an unusual case we've had at the clinic this week? None of my colleagues has seen one of these in real life, so I'd love some input from you. Obie is a 10 year old MN bearded collie, 25kg. Owner works at a pharmacy. Obie has been itchy and on pred (through other vets) his entire life, presumptive diagnosis atopy. Was seen at our clinic 4 months ago and prednisone was scripted out for him - tapering dose starting at 20mg per day then reducing to lowest possible dose. He came back in yesterday for vomiting several times over the last 24 hours, the owners worried since the vomit had a small amount of frank blood in it. Owner reported that he was also PU, PD, panting, lethargic. He still had a good appetite. Feces normal. No pruritis! Turns out the owner had been giving him 20mg of pred daily for the entire four months since we'd seen him. Clinical exam pretty normal except dog slightly pot bellied, estimate 5% dehydrated & moderate muscle wasting over his entire body. Blood work (everything we can do in house): PCV 42% Glucose 24.8 ALP 1200 Total bilirubin 21 Urea, BUN, alt, albumin, calcium, amylase, all normal. WBC cannot be measured in house. Urine free catch: USG 1.026 BG 4+ ketones 2+ Blood 1+ Protein 1+ Otherwise dipstick normal We popped him on fluids for the day & used crystalline insulin IM hourly to get BG down to 15, then started him on caninsulin (0.25 IU/kg BID with meals) yesterday evening. We're also treating for possible gastric ulcer (ranitidine & sucralfate), weaning off pred (have halved dose to 10mg every day, and planning on halving dose again every 2 weeks). And put him on a course of amoxyclav in case occult UTI (urine culture not an option due to finances). I know we can't expect to get good control of the diabetes until the dog is off pred, especially since we'll be changing the pred dose every few weeks. We're planning on doing a curve every week from here, and also considering sending the owner home with urine glucose strips (instructing them to test every day, if they see ketones they need to come back in immediately, if they see no glucose on the dipstick they need to come back in for a curve in case the dog is too low). I've got a few questions about what we're doing, if that's OK. 1. Do you think that this steroid dose (just over 1mg/kg daily for four months) could be sufficient to cause or trigger the diabetes? 2. If so, do you think that the diabetes might go into remission when we can get him off the pred? 3. Does our plan for weaning off pred, and monitoring blood & urine glucose, sound sensible? 4. How long do ketones last in dog urine? Thanks!

Is the owner a pharmacist?

How many calories/day does he currently get?

Hi there, I'm wondering if you guys could help me out with an unusual case we've had at the clinic this week? None of my colleagues has seen one of these in real life, so I'd love some input from you. Obie is a 10 year old MN bearded collie, 25kg. Owner works at a pharmacy. Obie has been itchy and on pred (through other vets) his entire life, presumptive diagnosis atopy. Was seen at our clinic 4 months ago and prednisone was scripted out for him - tapering dose starting at 20mg per day then reducing to lowest possible dose. He came back in yesterday for vomiting several times over the last 24 hours, the owners worried since the vomit had a small amount of frank blood in it. Owner reported that he was also PU, PD, panting, lethargic. He still had a good appetite. Feces normal. No pruritis! Turns out the owner had been giving him 20mg of pred daily for the entire four months since we'd seen him. Clinical exam pretty normal except dog slightly pot bellied, estimate 5% dehydrated & moderate muscle wasting over his entire body. Blood work (everything we can do in house): PCV 42% Glucose 24.8 ALP 1200 Total bilirubin 21 Urea, BUN, alt, albumin, calcium, amylase, all normal. WBC cannot be measured in house. Urine free catch: USG 1.026 BG 4+ ketones 2+ Blood 1+ Protein 1+ Otherwise dipstick normal We popped him on fluids for the day & used crystalline insulin IM hourly to get BG down to 15, then started him on caninsulin (0.25 IU/kg BID with meals) yesterday evening. We're also treating for possible gastric ulcer (ranitidine & sucralfate), weaning off pred (have halved dose to 10mg every day, and planning on halving dose again every 2 weeks). And put him on a course of amoxyclav in case occult UTI (urine culture not an option due to finances). I know we can't expect to get good control of the diabetes until the dog is off pred, especially since we'll be changing the pred dose every few weeks. We're planning on doing a curve every week from here, and also considering sending the owner home with urine glucose strips (instructing them to test every day, if they see ketones they need to come back in immediately, if they see no glucose on the dipstick they need to come back in for a curve in case the dog is too low). I've got a few questions about what we're doing, if that's OK. 1. Do you think that this steroid dose (just over 1mg/kg daily for four months) could be sufficient to cause or trigger the diabetes? 2. If so, do you think that the diabetes might go into remission when we can get him off the pred? 3. Does our plan for weaning off pred, and monitoring blood & urine glucose, sound sensible? 4. How long do ketones last in dog urine? Thanks!

What's the normal value for bilirubin on this machine?

Were there any cystic lesions in the abdomen that would suggest that perhaps the ascites was a larger cyst that ruptured?

Hi there, I'm wondering if you guys could help me out with an unusual case we've had at the clinic this week? None of my colleagues has seen one of these in real life, so I'd love some input from you. Obie is a 10 year old MN bearded collie, 25kg. Owner works at a pharmacy. Obie has been itchy and on pred (through other vets) his entire life, presumptive diagnosis atopy. Was seen at our clinic 4 months ago and prednisone was scripted out for him - tapering dose starting at 20mg per day then reducing to lowest possible dose. He came back in yesterday for vomiting several times over the last 24 hours, the owners worried since the vomit had a small amount of frank blood in it. Owner reported that he was also PU, PD, panting, lethargic. He still had a good appetite. Feces normal. No pruritis! Turns out the owner had been giving him 20mg of pred daily for the entire four months since we'd seen him. Clinical exam pretty normal except dog slightly pot bellied, estimate 5% dehydrated & moderate muscle wasting over his entire body. Blood work (everything we can do in house): PCV 42% Glucose 24.8 ALP 1200 Total bilirubin 21 Urea, BUN, alt, albumin, calcium, amylase, all normal. WBC cannot be measured in house. Urine free catch: USG 1.026 BG 4+ ketones 2+ Blood 1+ Protein 1+ Otherwise dipstick normal We popped him on fluids for the day & used crystalline insulin IM hourly to get BG down to 15, then started him on caninsulin (0.25 IU/kg BID with meals) yesterday evening. We're also treating for possible gastric ulcer (ranitidine & sucralfate), weaning off pred (have halved dose to 10mg every day, and planning on halving dose again every 2 weeks). And put him on a course of amoxyclav in case occult UTI (urine culture not an option due to finances). I know we can't expect to get good control of the diabetes until the dog is off pred, especially since we'll be changing the pred dose every few weeks. We're planning on doing a curve every week from here, and also considering sending the owner home with urine glucose strips (instructing them to test every day, if they see ketones they need to come back in immediately, if they see no glucose on the dipstick they need to come back in for a curve in case the dog is too low). I've got a few questions about what we're doing, if that's OK. 1. Do you think that this steroid dose (just over 1mg/kg daily for four months) could be sufficient to cause or trigger the diabetes? 2. If so, do you think that the diabetes might go into remission when we can get him off the pred? 3. Does our plan for weaning off pred, and monitoring blood & urine glucose, sound sensible? 4. How long do ketones last in dog urine? Thanks!

How do the electrolytes look?

What site does the owner use to collect the bg's?

Hi there, I'm wondering if you guys could help me out with an unusual case we've had at the clinic this week? None of my colleagues has seen one of these in real life, so I'd love some input from you. Obie is a 10 year old MN bearded collie, 25kg. Owner works at a pharmacy. Obie has been itchy and on pred (through other vets) his entire life, presumptive diagnosis atopy. Was seen at our clinic 4 months ago and prednisone was scripted out for him - tapering dose starting at 20mg per day then reducing to lowest possible dose. He came back in yesterday for vomiting several times over the last 24 hours, the owners worried since the vomit had a small amount of frank blood in it. Owner reported that he was also PU, PD, panting, lethargic. He still had a good appetite. Feces normal. No pruritis! Turns out the owner had been giving him 20mg of pred daily for the entire four months since we'd seen him. Clinical exam pretty normal except dog slightly pot bellied, estimate 5% dehydrated & moderate muscle wasting over his entire body. Blood work (everything we can do in house): PCV 42% Glucose 24.8 ALP 1200 Total bilirubin 21 Urea, BUN, alt, albumin, calcium, amylase, all normal. WBC cannot be measured in house. Urine free catch: USG 1.026 BG 4+ ketones 2+ Blood 1+ Protein 1+ Otherwise dipstick normal We popped him on fluids for the day & used crystalline insulin IM hourly to get BG down to 15, then started him on caninsulin (0.25 IU/kg BID with meals) yesterday evening. We're also treating for possible gastric ulcer (ranitidine & sucralfate), weaning off pred (have halved dose to 10mg every day, and planning on halving dose again every 2 weeks). And put him on a course of amoxyclav in case occult UTI (urine culture not an option due to finances). I know we can't expect to get good control of the diabetes until the dog is off pred, especially since we'll be changing the pred dose every few weeks. We're planning on doing a curve every week from here, and also considering sending the owner home with urine glucose strips (instructing them to test every day, if they see ketones they need to come back in immediately, if they see no glucose on the dipstick they need to come back in for a curve in case the dog is too low). I've got a few questions about what we're doing, if that's OK. 1. Do you think that this steroid dose (just over 1mg/kg daily for four months) could be sufficient to cause or trigger the diabetes? 2. If so, do you think that the diabetes might go into remission when we can get him off the pred? 3. Does our plan for weaning off pred, and monitoring blood & urine glucose, sound sensible? 4. How long do ketones last in dog urine? Thanks!

If the dog is itchy, we're going to have to have a different plan for the pruritus...has he had a food trial?

Does this kitty have anyunderlying gi-related issues, which might be affecting his intestinal/colonic motility?

Hi there, I'm wondering if you guys could help me out with an unusual case we've had at the clinic this week? None of my colleagues has seen one of these in real life, so I'd love some input from you. Obie is a 10 year old MN bearded collie, 25kg. Owner works at a pharmacy. Obie has been itchy and on pred (through other vets) his entire life, presumptive diagnosis atopy. Was seen at our clinic 4 months ago and prednisone was scripted out for him - tapering dose starting at 20mg per day then reducing to lowest possible dose. He came back in yesterday for vomiting several times over the last 24 hours, the owners worried since the vomit had a small amount of frank blood in it. Owner reported that he was also PU, PD, panting, lethargic. He still had a good appetite. Feces normal. No pruritis! Turns out the owner had been giving him 20mg of pred daily for the entire four months since we'd seen him. Clinical exam pretty normal except dog slightly pot bellied, estimate 5% dehydrated & moderate muscle wasting over his entire body. Blood work (everything we can do in house): PCV 42% Glucose 24.8 ALP 1200 Total bilirubin 21 Urea, BUN, alt, albumin, calcium, amylase, all normal. WBC cannot be measured in house. Urine free catch: USG 1.026 BG 4+ ketones 2+ Blood 1+ Protein 1+ Otherwise dipstick normal We popped him on fluids for the day & used crystalline insulin IM hourly to get BG down to 15, then started him on caninsulin (0.25 IU/kg BID with meals) yesterday evening. We're also treating for possible gastric ulcer (ranitidine & sucralfate), weaning off pred (have halved dose to 10mg every day, and planning on halving dose again every 2 weeks). And put him on a course of amoxyclav in case occult UTI (urine culture not an option due to finances). I know we can't expect to get good control of the diabetes until the dog is off pred, especially since we'll be changing the pred dose every few weeks. We're planning on doing a curve every week from here, and also considering sending the owner home with urine glucose strips (instructing them to test every day, if they see ketones they need to come back in immediately, if they see no glucose on the dipstick they need to come back in for a curve in case the dog is too low). I've got a few questions about what we're doing, if that's OK. 1. Do you think that this steroid dose (just over 1mg/kg daily for four months) could be sufficient to cause or trigger the diabetes? 2. If so, do you think that the diabetes might go into remission when we can get him off the pred? 3. Does our plan for weaning off pred, and monitoring blood & urine glucose, sound sensible? 4. How long do ketones last in dog urine? Thanks!

Can we use atopica?

What?

Hi, I have an 8 year old 10.7 kg MN scottish terrier who is currently on 5 mg TID diazepam for scottie cramp and 30 mg phenobarb BID for seizures who we diagnosed with pituitary dependant cushing's disease in May. His LDDST results had a cortisol level of 161 nmol/Lat 0 hour, 28 nmol/L at 4 hours, 41 nmol/L at 8 hours. We started him on 40 mg of vetoryl SID. Rechecked ACTH stim 2 weeks later and his cortisol was at 175 nmol/L and he was still very PU/PD se we increased him to 50 mg SID. Recheck ACTH stim about 6 weeks later and his cortisol is 246 but PU/PD had improved so we left him at 50 mg vetoryl SID. Owner now reports profound increase in drinking - 2-3 times normal. Repeated bloodwork and his ALP has increased from 606 to 989 U/L, USG 1.010 with quiet sediment, blood glucose normal and cortisol is 138. So we tried dividing his dose of the vetoryl and it made no difference. Could this be diabetes insipidus or are we just being too cautious with his vetoryl dosing. I have also discussed abdominal ultrasound to see if there is anything else going on in the abdomen. Thank you,

Does the dog have typical clinical signs of cushing's (panting, hair loss, potbelly, etc)?

Any thoracic rads?

Hi, I have an 8 year old 10.7 kg MN scottish terrier who is currently on 5 mg TID diazepam for scottie cramp and 30 mg phenobarb BID for seizures who we diagnosed with pituitary dependant cushing's disease in May. His LDDST results had a cortisol level of 161 nmol/Lat 0 hour, 28 nmol/L at 4 hours, 41 nmol/L at 8 hours. We started him on 40 mg of vetoryl SID. Rechecked ACTH stim 2 weeks later and his cortisol was at 175 nmol/L and he was still very PU/PD se we increased him to 50 mg SID. Recheck ACTH stim about 6 weeks later and his cortisol is 246 but PU/PD had improved so we left him at 50 mg vetoryl SID. Owner now reports profound increase in drinking - 2-3 times normal. Repeated bloodwork and his ALP has increased from 606 to 989 U/L, USG 1.010 with quiet sediment, blood glucose normal and cortisol is 138. So we tried dividing his dose of the vetoryl and it made no difference. Could this be diabetes insipidus or are we just being too cautious with his vetoryl dosing. I have also discussed abdominal ultrasound to see if there is anything else going on in the abdomen. Thank you,

Giving trilostane with a meal and doing stim 4-6 hours post pill?

Which kind of diet is this dog taking (brand and quantities)?

Hi, I have an 8 year old 10.7 kg MN scottish terrier who is currently on 5 mg TID diazepam for scottie cramp and 30 mg phenobarb BID for seizures who we diagnosed with pituitary dependant cushing's disease in May. His LDDST results had a cortisol level of 161 nmol/Lat 0 hour, 28 nmol/L at 4 hours, 41 nmol/L at 8 hours. We started him on 40 mg of vetoryl SID. Rechecked ACTH stim 2 weeks later and his cortisol was at 175 nmol/L and he was still very PU/PD se we increased him to 50 mg SID. Recheck ACTH stim about 6 weeks later and his cortisol is 246 but PU/PD had improved so we left him at 50 mg vetoryl SID. Owner now reports profound increase in drinking - 2-3 times normal. Repeated bloodwork and his ALP has increased from 606 to 989 U/L, USG 1.010 with quiet sediment, blood glucose normal and cortisol is 138. So we tried dividing his dose of the vetoryl and it made no difference. Could this be diabetes insipidus or are we just being too cautious with his vetoryl dosing. I have also discussed abdominal ultrasound to see if there is anything else going on in the abdomen. Thank you,

Using cortrosyn/synacthen?

Maybe they don't scoop so very often?

Hi, I have an 8 year old 10.7 kg MN scottish terrier who is currently on 5 mg TID diazepam for scottie cramp and 30 mg phenobarb BID for seizures who we diagnosed with pituitary dependant cushing's disease in May. His LDDST results had a cortisol level of 161 nmol/Lat 0 hour, 28 nmol/L at 4 hours, 41 nmol/L at 8 hours. We started him on 40 mg of vetoryl SID. Rechecked ACTH stim 2 weeks later and his cortisol was at 175 nmol/L and he was still very PU/PD se we increased him to 50 mg SID. Recheck ACTH stim about 6 weeks later and his cortisol is 246 but PU/PD had improved so we left him at 50 mg vetoryl SID. Owner now reports profound increase in drinking - 2-3 times normal. Repeated bloodwork and his ALP has increased from 606 to 989 U/L, USG 1.010 with quiet sediment, blood glucose normal and cortisol is 138. So we tried dividing his dose of the vetoryl and it made no difference. Could this be diabetes insipidus or are we just being too cautious with his vetoryl dosing. I have also discussed abdominal ultrasound to see if there is anything else going on in the abdomen. Thank you,

Are you looking at pre and post stim cortisol concentrations or just one or the other?

Is the dog obese?

Hi Everyone- Hoping for some insight on a challenging case. 8yr intact female Pit Bull. Never health issues except very small mammary nodule noted on PE by previous vet >1yr ago and has not changed in size. Diagnosed 1/22/13 with Diabetes (Glu 463mg/dl, rest of chem/cbc WNL) with pu/pd symptoms having only been going on for ~2weeks. 65# (mildly overweight). Started on Humalin-N and w/d. Over weekend first stopped eating w/d, then bland diet (rice/hamburger), then started vomitting. No known FB or toxin. Recheck 2/3/13 Chemistry panel WNL except hyperglycemia (463mg/dl), mild hyperphosphatemia, low normal K & Cl. CBC showed mild anemia (HCT 36.8%) and mild leukocytosis (WBC 20.88 K/ul) (mild neutrophilia,monocytosis).SNAP 4DX all negative, SNAP cPL Abnormal. Started treatment for pancreatitis (Convenia, Metoclopramide, Amoxi, Previcox, NPO then Iams Intestinal Plus canned). 2/4/13 Brought back to clinic first thing this morning due to sudden decline. Continued vomiting, ataxic. Glucose=706mg/dl. Don't have blood gas so started treating for suspected DKA. Started LRS IV for first few hours (along with Metoclopramine IV, Buprenorphine IV), then start Humalin-R IM protocol hourly, rechecking glucose q2hr. Despite insulin injections, glucose steadily climbing all day and continued vomiting. 2p started measuring as "High" on our glucose meter (>750). Starting around 4:30p, slight abdominal distention (abdominocentesis yielding no sample). Recheck CBC (HCT 27.6%, WBC 26.3K/ul) and Chem: extreme hyperglycemia (GLU=1235mg/dl), azotemia (BUN 110mg/dl, Cr 4.2mg/dl), mild increases in ALT, AST, ALKP. Lytes--mild hyponatremia (1235mmol/L), normal K (3.7mmol/L), mild hypochloremia (93mmmol/L). Dog is still able to lift head up and look around, but making no moves to get up, still dark bile vomitting, and starting to show increased respirations. Money is an issue for owner so had declined transfer to referral center this morning. Phone messages in to internal medicines at referral center and university. Any and all suggestions please!!!

How long ago was her last heat cycle?

Are the owners administering the insulin properly?

Hi Everyone- Hoping for some insight on a challenging case. 8yr intact female Pit Bull. Never health issues except very small mammary nodule noted on PE by previous vet >1yr ago and has not changed in size. Diagnosed 1/22/13 with Diabetes (Glu 463mg/dl, rest of chem/cbc WNL) with pu/pd symptoms having only been going on for ~2weeks. 65# (mildly overweight). Started on Humalin-N and w/d. Over weekend first stopped eating w/d, then bland diet (rice/hamburger), then started vomitting. No known FB or toxin. Recheck 2/3/13 Chemistry panel WNL except hyperglycemia (463mg/dl), mild hyperphosphatemia, low normal K & Cl. CBC showed mild anemia (HCT 36.8%) and mild leukocytosis (WBC 20.88 K/ul) (mild neutrophilia,monocytosis).SNAP 4DX all negative, SNAP cPL Abnormal. Started treatment for pancreatitis (Convenia, Metoclopramide, Amoxi, Previcox, NPO then Iams Intestinal Plus canned). 2/4/13 Brought back to clinic first thing this morning due to sudden decline. Continued vomiting, ataxic. Glucose=706mg/dl. Don't have blood gas so started treating for suspected DKA. Started LRS IV for first few hours (along with Metoclopramine IV, Buprenorphine IV), then start Humalin-R IM protocol hourly, rechecking glucose q2hr. Despite insulin injections, glucose steadily climbing all day and continued vomiting. 2p started measuring as "High" on our glucose meter (>750). Starting around 4:30p, slight abdominal distention (abdominocentesis yielding no sample). Recheck CBC (HCT 27.6%, WBC 26.3K/ul) and Chem: extreme hyperglycemia (GLU=1235mg/dl), azotemia (BUN 110mg/dl, Cr 4.2mg/dl), mild increases in ALT, AST, ALKP. Lytes--mild hyponatremia (1235mmol/L), normal K (3.7mmol/L), mild hypochloremia (93mmmol/L). Dog is still able to lift head up and look around, but making no moves to get up, still dark bile vomitting, and starting to show increased respirations. Money is an issue for owner so had declined transfer to referral center this morning. Phone messages in to internal medicines at referral center and university. Any and all suggestions please!!!

Have you taken any radiographs to look for pyometra?

What about phosphorous?

Hello, A collegue of mine saw a 7 year old FS DSH cat yesterday for acute onset of lethargy and acting abnormally. The little girl is an inside/outside cat although has not been outside for the last several months due to our cold winter. No known ingestion of any toxins, no plants in the home, no medications or supplements, has not been to see us since she was spayed at 6months of age. Vaccines not up date, no deworming. Owner describes an acute onset of lethargy starting 72 horus prior to presentation. The cat became lethargic, was not eating or drinking, no vomiting or diarrhea and progressively became worse, culminating in a ventroflexed neck and generalized weakness. On PE generalized weakness, wide based stance and signficant ventrolfexion of the neck was noted. A grade 1 systolic heart murmur was present but otherwise PE was unremarkable. The following tests were run; 1) CBC- unremarkable 2) biochem - BUN 20.2mmol/L - creat 299umol/L - amylase 2465U/L - glucose 11.9mmol/L - phos 0.8mmol/L - potassium 2.4mmol/L 3) T4- wnl 4) FIV/FeLV - wnl 5) UA- SpGr 1.044, ph 5, Protein 2+, RBCs 3+, glucose 4+, no ketones The cat was started on IV fluids with 20meq/L KCl as well as oral potassium supplementation of tumil K. Clinically she seems to be doing a bit better but when I took over and re-ran her lytes this am, her Potassium was still 2.7mmol/L The concern that we have is the owner has very limited funds beyond this point and I dont have a clear picture of what may have caused this. There has been no history of PU/PD, wt loss, change in appetite etc that would make me think diabetes and currently stress is our thought. With the specific gravity chronic renal disease does not seem as likely although we would like to look at a Urine protein/creatinine ratio to help. Any thoughts? currently I would like to look at urine protein/creatinine ratio, fructosamine, poss ACTH stim and an abdominal US but currently these tests cannot be afforded.

Can you check the cats blood pressure?

Do you have a c02 level or an ability to measure blood gases?

Hi all, I would apreciate some help here: I have a Male pers 16yold cat, who was not diabetic and didn´t have renal disease in last octobre, that presented yesterday night for anorexia of 2 days, not drinking enough not urinating enough. PE- depressed,12%dehydrated , hypotense, 80bpm very weak pulses, 50rpm, pelvic 1/2full blader, 34ºC. his BG was to high to be mesured and he had glucose and ketones on is 1025 density urine He was re-hydrated trough the night with ringer Lactate and re-warmed. BW from this morning came: Phosf-17.6; Na+:125.1; K+:6.8; Cl-:98.3 glucose- 559,4 Htc-23.7 BUN422.7 Creat-4.8 ALT-253 We started CRI 0.045 IU rapid insulin in 250ml NaCl 0.9% 10ml/h) this morning, and until now (8hours) I still get Hi glucose measurements. But he is more responsive and HR 110bpm; but still polipneic because of compensation of metabolic acidosis I think. I know the important is to correct the electrolyte and acid-base disturbances but I have no means to measure HCO3.. He is still 7% dehydrated, and I stoped ringer. Will I be able to decrease his blood glucose with these electrolyte changes? Can I add dextrose to the same bag of NaCl 0.9 and insulin? what should be my main concern now? Thanks Barb

The elevated potassium is of more concern to me - is this animal urinating?

What's the tot protein and bumin level?

Hi all, I would apreciate some help here: I have a Male pers 16yold cat, who was not diabetic and didn´t have renal disease in last octobre, that presented yesterday night for anorexia of 2 days, not drinking enough not urinating enough. PE- depressed,12%dehydrated , hypotense, 80bpm very weak pulses, 50rpm, pelvic 1/2full blader, 34ºC. his BG was to high to be mesured and he had glucose and ketones on is 1025 density urine He was re-hydrated trough the night with ringer Lactate and re-warmed. BW from this morning came: Phosf-17.6; Na+:125.1; K+:6.8; Cl-:98.3 glucose- 559,4 Htc-23.7 BUN422.7 Creat-4.8 ALT-253 We started CRI 0.045 IU rapid insulin in 250ml NaCl 0.9% 10ml/h) this morning, and until now (8hours) I still get Hi glucose measurements. But he is more responsive and HR 110bpm; but still polipneic because of compensation of metabolic acidosis I think. I know the important is to correct the electrolyte and acid-base disturbances but I have no means to measure HCO3.. He is still 7% dehydrated, and I stoped ringer. Will I be able to decrease his blood glucose with these electrolyte changes? Can I add dextrose to the same bag of NaCl 0.9 and insulin? what should be my main concern now? Thanks Barb

If he is urinating, how much?

When was this last upc?

Hi all, I would apreciate some help here: I have a Male pers 16yold cat, who was not diabetic and didn´t have renal disease in last octobre, that presented yesterday night for anorexia of 2 days, not drinking enough not urinating enough. PE- depressed,12%dehydrated , hypotense, 80bpm very weak pulses, 50rpm, pelvic 1/2full blader, 34ºC. his BG was to high to be mesured and he had glucose and ketones on is 1025 density urine He was re-hydrated trough the night with ringer Lactate and re-warmed. BW from this morning came: Phosf-17.6; Na+:125.1; K+:6.8; Cl-:98.3 glucose- 559,4 Htc-23.7 BUN422.7 Creat-4.8 ALT-253 We started CRI 0.045 IU rapid insulin in 250ml NaCl 0.9% 10ml/h) this morning, and until now (8hours) I still get Hi glucose measurements. But he is more responsive and HR 110bpm; but still polipneic because of compensation of metabolic acidosis I think. I know the important is to correct the electrolyte and acid-base disturbances but I have no means to measure HCO3.. He is still 7% dehydrated, and I stoped ringer. Will I be able to decrease his blood glucose with these electrolyte changes? Can I add dextrose to the same bag of NaCl 0.9 and insulin? what should be my main concern now? Thanks Barb

Has his body weight changed?

Does he in any way look like he has cushing's?

Hi all, I would apreciate some help here: I have a Male pers 16yold cat, who was not diabetic and didn´t have renal disease in last octobre, that presented yesterday night for anorexia of 2 days, not drinking enough not urinating enough. PE- depressed,12%dehydrated , hypotense, 80bpm very weak pulses, 50rpm, pelvic 1/2full blader, 34ºC. his BG was to high to be mesured and he had glucose and ketones on is 1025 density urine He was re-hydrated trough the night with ringer Lactate and re-warmed. BW from this morning came: Phosf-17.6; Na+:125.1; K+:6.8; Cl-:98.3 glucose- 559,4 Htc-23.7 BUN422.7 Creat-4.8 ALT-253 We started CRI 0.045 IU rapid insulin in 250ml NaCl 0.9% 10ml/h) this morning, and until now (8hours) I still get Hi glucose measurements. But he is more responsive and HR 110bpm; but still polipneic because of compensation of metabolic acidosis I think. I know the important is to correct the electrolyte and acid-base disturbances but I have no means to measure HCO3.. He is still 7% dehydrated, and I stoped ringer. Will I be able to decrease his blood glucose with these electrolyte changes? Can I add dextrose to the same bag of NaCl 0.9 and insulin? what should be my main concern now? Thanks Barb

Is the bun really 422.7 or is that a typo?

If so, which one?

I'm hoping to get a little advice in managing this case. I currently work at a military clinic, so we are restricted with what we can manage (but I will keep pushing until the tell me no). Because the couple travel, multiple veterinarians have treated her. Olivia is an 11yr FS Dachshund (24 pounds) She presented to our clinic in November 2011 for annual exam. We were allowed to perform senior lab work which showed the following abnormalities: AST 82 (15-66) ALT 333 (12-118) ALKP 1723 (5-131) GGTP 54 (1-12) Gluc 175 (70-138) Potassium 5.8 (2.6-5.5) Na/K ratio 26 Patient was referred to clinic out in town for futher workup. ACTH stim tests were performed and Olivia was diagnosed with hyperadrenocorticism. At this point, I can only give you brief information as the clients traveled north. she was started on insulin in April and Vetoryl was initiated at 30mg qd. Weight 27 lbs She had multiple bg curves that veterinarians continued to increase her insulin (Humulin N) In September she presented to another veterinarian who again increased her insulin to 12 Units BID, continue Vetoryl 20mg qd, Denosyl, Marin, and Pancreatic Plus tabs. November 2012 - Clients traveled south and brought Olivia back to us for suspect UTI Urine culture (free catch) - Klebsiella Pneumoniae U/A - glucosuria 3+ WBC >50 RBC 4-10 Rods - 51-100 At this time, owner was only giving 11U BID insulin (p weighed 20.4) and vetoryl 30mg qd. Client was upset at all the costs over the year and Olivia was still showing clinical symptoms. We treated with a course of antibiotics, but glucosuria still present at time of recheck. After discussing at length and trying to piece the puzzle together I remembered attending a CE course that stated pets that were both diabetic and cushings syndrome to give Vetoryl BID. My current plan that I had initiated in January was Vetoryl 10mg bid and lowered insulin to 9 1/2 u bid (client has seen some improvement over the month). So we are coming up to the month of changes and I was going to restim her (no where had I seen any of the vets check her after starting the Vetoryl). I got my hands on a bottle of cortrosyn. It has been a while since reconstituting it and storing it and I have found different suggestions. What is the best way to reconstitute and store? If anyone has had any luck in managing this type of case, please help. Last concern is that clients head back north in a couple of months!

Do you have any information about how the cushing's was diagnosed and how long this was done before she became diabetic?

Did high fiber diets help at all?

I'm hoping to get a little advice in managing this case. I currently work at a military clinic, so we are restricted with what we can manage (but I will keep pushing until the tell me no). Because the couple travel, multiple veterinarians have treated her. Olivia is an 11yr FS Dachshund (24 pounds) She presented to our clinic in November 2011 for annual exam. We were allowed to perform senior lab work which showed the following abnormalities: AST 82 (15-66) ALT 333 (12-118) ALKP 1723 (5-131) GGTP 54 (1-12) Gluc 175 (70-138) Potassium 5.8 (2.6-5.5) Na/K ratio 26 Patient was referred to clinic out in town for futher workup. ACTH stim tests were performed and Olivia was diagnosed with hyperadrenocorticism. At this point, I can only give you brief information as the clients traveled north. she was started on insulin in April and Vetoryl was initiated at 30mg qd. Weight 27 lbs She had multiple bg curves that veterinarians continued to increase her insulin (Humulin N) In September she presented to another veterinarian who again increased her insulin to 12 Units BID, continue Vetoryl 20mg qd, Denosyl, Marin, and Pancreatic Plus tabs. November 2012 - Clients traveled south and brought Olivia back to us for suspect UTI Urine culture (free catch) - Klebsiella Pneumoniae U/A - glucosuria 3+ WBC >50 RBC 4-10 Rods - 51-100 At this time, owner was only giving 11U BID insulin (p weighed 20.4) and vetoryl 30mg qd. Client was upset at all the costs over the year and Olivia was still showing clinical symptoms. We treated with a course of antibiotics, but glucosuria still present at time of recheck. After discussing at length and trying to piece the puzzle together I remembered attending a CE course that stated pets that were both diabetic and cushings syndrome to give Vetoryl BID. My current plan that I had initiated in January was Vetoryl 10mg bid and lowered insulin to 9 1/2 u bid (client has seen some improvement over the month). So we are coming up to the month of changes and I was going to restim her (no where had I seen any of the vets check her after starting the Vetoryl). I got my hands on a bottle of cortrosyn. It has been a while since reconstituting it and storing it and I have found different suggestions. What is the best way to reconstitute and store? If anyone has had any luck in managing this type of case, please help. Last concern is that clients head back north in a couple of months!

Since having diabetes/cushing's is a hemorrhage of money, i really try to get the owners on board with generating the curves at home...any chance of this?

What was his urine specific gravity?

Hi - Dyna is a 4 year old s/f lab. She grabbed a KFC chicken wing during the superbowl. She started vomiting on Monday morning. This morning she presented lethargic and not eating with a 103.4 temp, a tense belly, WBC of 15,500, normal chemistries except K+ a little low at 3.3. Serum was not lipemic. First set of rads showed lots of gas - not a blockage pattern and no chicken bone. We put her on iv's for a few hours and retook the lateral rad - the gas had been moving, but it looked more like there was ascites. Dyna did not feel any better, so we took her to surgery - thinking that she might have peritonitis from a poke from the chicken bone. I didn't tap her abdomen as her spleen was very elongated - I didn't think I could avoid it. So I went in. There was ascites - not tons, but a lot. It looked like pus, but the cytology had a high amount of WBC, but not TMTC. No sign of the chicken bone, no obvious puncture. Intestines looked irritated, but were moving well, etc. The distal end of the right limb of the pancreas - about 1/3rd to 1/2 of the limb was affected - it was very firm and thickened, about 4 cm thick. The omentum had been attached to it - that area was thick and discolored - black in some spots, brown in others. The area right alongside the duodenum was OK. The distal ileum had some white stripes - like stretch marks. The mesentery was connected to the mesentary of the pancreas. There was yellow thin fluid oozing from part of the damaged pancreas. Wasn't sure what to do, but it looked pretty ugly - so I removed with finger fracturing and suturing. I separated the good pancreas from the bad with suture. I also removed the ugly omentum and sutured up the hole I made. I flushed the abdomen with a few liters of fluids. Her liver looked normal. Her spleen was elongated, but no masses. I didn't leave her abdomen open. ' Post-op her WBC was down to 5,000. Platelets went from 275K to 199K. I didnt recheck her protein after sx. I assume this is necrotizing pancreatitis. The biopsy will go out tomorrow. But could the pancreas get that severe in 48 hours? Was the chicken bone a red herring- or did it push her pancreas over the edge? She's had cerenia, famotidine, cefazolin, buprinex. What can she expect the next few days? Thanks -

Maybe it was the sauce that tripped things up?

How many calories per meal does she currently get?

Muffin is a 22-lb mixed breed spayed female dog. She appears to be an unregulated diabetic and I am trying to figure out what the best next steps are for this patient. This is a long history involving four of my colleagues so I am myself trying to sort through the patchy history: 7-12-12 Lethargy, inappetance. Bloodwork: Severe elevation in liver values (ast, alt=3196, alp, ggt, total bilirubin), glucose=78 Urinalysis: 3 proteinuria, bilirubinuria, hematuria Abdominal rads: hepatomegaly, cystoliths Chest rads: bronchial pulmonary pattern Initiated convenia, ursodiol, denamarin 7-26-12 Abdominal ultrasound: billateral nephrolithiasis, cystic urolithiasis, bilateral adrenomegaly, buliary mucocele with suspected focal peritonitis 8-3-12 Dex suppresion test: cushing's highly unlikely (mild elevation in cortisol pre-dex, normal 4th and 8th hour post-dex) 9-10-12 recheck bloodwork: liver values are normal. Mild elevation in total protein, globulins hyerkalemia 6 (3.6-5.5), sodium 146. Mild elevation in cholesterol, triglyceride, platelets. Remainder, including glucose, within reference intervals. 10-22-12 Bloodwork: Mild elevation in total protein and globulin, mild hypercalcemia, mild hyperkalemia, thrombocytosis Mild elevation in cholesterol, triglyceride, platelets. Remainder, including glucose within reference intervals. 10-29-13 ACTH stim- values within reference range 12-3-12 Presented for hesitation to jump and otitis externa Initiated rimadyl and mometamax 12-13-12 Presented for wheezing Received convenia Bloodwork: mild elevation alkphos, hypergycemia glucose=576 hyperkalemia, hyponatremia, hypochloremia, mild leukocytosis, mild anemia normal tp and globulin Urinalysis: glucosuria, ketonuria (++ ) Initiated 4 units Humulin N BID, w/d diet 12-17-12 Spot check blood glucose six hours post AM insulin=625 Insulin dose decreased to 3 units nph BID 12-20-12 8 hour post insulin (3 units)=563 Insulin dose decreased to 2 units humulin N BID 12-29-12 Inconsistent appetite; presented to ER for possible seizure. Blood glucose 500 at ER. Suspect unlikely hypoglycemic seziures II/VI systolic heart murmur hr=141 Blood pressure 160/119 Blood glucose 528 (not in record how many units are being given) Patient will not eat w/d Offered referral; declined 12-31-12 No more seizures PUPD, losing weight, on 2 units humulin N BID Prescribed doxycycline 1-2-13 admitted for glucose curve; receives multiple meals per day pre-insulin bg=586 Patient refused food for glucose curve so curve was rescheduled Owner reports eating well at home and no more seizures since last visit 1-3-13 Returned for curve; ate and received 2 units humulin N at home at 7:15am 10am bg=631 12pm bg=537 2pm bg=517 4pm bg=632 Insulin dose increased to 4 units humulin N BID 1-21-13 spot check 6 hour post insulin =450 Insulin dose increased to 5 units humulin N BID 2-2-13 spot check 4 hour post insulin =474 owner feeding whatever patient will eat; patient is a picky eater and is increasingly refusing food maintaining weight Bloodwork: mild elevation in alp, mild azotemia with usg=1040, mild hyperkalemia, hypercholesterolemia and hypertriglyceridemia urinalysis: glucosuria 3 Recommend increase insulin dose to 6 units BID and return for glucose curve in one week Discussed referral, owner declines Initiated tramadol for presumed osteoarthritis Problems: 1. diabetes mellitus, poorly regulated 2. history of possible cholangiohepatitis 3. history of elevated globulins and total protein, resolved 4. urolithiasis, asymptomatic 5. Two seizures, appears to have resolved 6. Plump adrenals on ultrasound 7. Heart murmur Plan: 1. Perform glucose curve in one week 2. Discuss consistent feeding and giving insulin at time of feeding; however sometimes patient will not eat! 3. Urine culture And if owner wants to proceed with diagnostics, 4. Test for tick borne diseases, lepto 5. Consider repeating an abdominal ultrasound, thoracic rads 6. cPLi Questions: 1. Any suggestings with modifying the insulin dose? The high values on 1-3 make me concerned that the patient was receiving too much insulin, but the day prior blood glucose was high in the morning pre-insulin as well. A 12-hour curve perhaps may be helpful? 2. Owner is now feeding anything that the patient will eat. It is very difficult for the owner to give the patient any medications! I will stress the importance of consistency of feeding and administering insulin, but what if she just cannot feed the dog two meals a day? The patient was prescribed w/d but refuses to eat it. 3. Anything else you would add to the plan for him?

Do you think the owner could learn to generate the curves at home?

I assume that this one doesn't have concurrent epi?

Muffin is a 22-lb mixed breed spayed female dog. She appears to be an unregulated diabetic and I am trying to figure out what the best next steps are for this patient. This is a long history involving four of my colleagues so I am myself trying to sort through the patchy history: 7-12-12 Lethargy, inappetance. Bloodwork: Severe elevation in liver values (ast, alt=3196, alp, ggt, total bilirubin), glucose=78 Urinalysis: 3 proteinuria, bilirubinuria, hematuria Abdominal rads: hepatomegaly, cystoliths Chest rads: bronchial pulmonary pattern Initiated convenia, ursodiol, denamarin 7-26-12 Abdominal ultrasound: billateral nephrolithiasis, cystic urolithiasis, bilateral adrenomegaly, buliary mucocele with suspected focal peritonitis 8-3-12 Dex suppresion test: cushing's highly unlikely (mild elevation in cortisol pre-dex, normal 4th and 8th hour post-dex) 9-10-12 recheck bloodwork: liver values are normal. Mild elevation in total protein, globulins hyerkalemia 6 (3.6-5.5), sodium 146. Mild elevation in cholesterol, triglyceride, platelets. Remainder, including glucose, within reference intervals. 10-22-12 Bloodwork: Mild elevation in total protein and globulin, mild hypercalcemia, mild hyperkalemia, thrombocytosis Mild elevation in cholesterol, triglyceride, platelets. Remainder, including glucose within reference intervals. 10-29-13 ACTH stim- values within reference range 12-3-12 Presented for hesitation to jump and otitis externa Initiated rimadyl and mometamax 12-13-12 Presented for wheezing Received convenia Bloodwork: mild elevation alkphos, hypergycemia glucose=576 hyperkalemia, hyponatremia, hypochloremia, mild leukocytosis, mild anemia normal tp and globulin Urinalysis: glucosuria, ketonuria (++ ) Initiated 4 units Humulin N BID, w/d diet 12-17-12 Spot check blood glucose six hours post AM insulin=625 Insulin dose decreased to 3 units nph BID 12-20-12 8 hour post insulin (3 units)=563 Insulin dose decreased to 2 units humulin N BID 12-29-12 Inconsistent appetite; presented to ER for possible seizure. Blood glucose 500 at ER. Suspect unlikely hypoglycemic seziures II/VI systolic heart murmur hr=141 Blood pressure 160/119 Blood glucose 528 (not in record how many units are being given) Patient will not eat w/d Offered referral; declined 12-31-12 No more seizures PUPD, losing weight, on 2 units humulin N BID Prescribed doxycycline 1-2-13 admitted for glucose curve; receives multiple meals per day pre-insulin bg=586 Patient refused food for glucose curve so curve was rescheduled Owner reports eating well at home and no more seizures since last visit 1-3-13 Returned for curve; ate and received 2 units humulin N at home at 7:15am 10am bg=631 12pm bg=537 2pm bg=517 4pm bg=632 Insulin dose increased to 4 units humulin N BID 1-21-13 spot check 6 hour post insulin =450 Insulin dose increased to 5 units humulin N BID 2-2-13 spot check 4 hour post insulin =474 owner feeding whatever patient will eat; patient is a picky eater and is increasingly refusing food maintaining weight Bloodwork: mild elevation in alp, mild azotemia with usg=1040, mild hyperkalemia, hypercholesterolemia and hypertriglyceridemia urinalysis: glucosuria 3 Recommend increase insulin dose to 6 units BID and return for glucose curve in one week Discussed referral, owner declines Initiated tramadol for presumed osteoarthritis Problems: 1. diabetes mellitus, poorly regulated 2. history of possible cholangiohepatitis 3. history of elevated globulins and total protein, resolved 4. urolithiasis, asymptomatic 5. Two seizures, appears to have resolved 6. Plump adrenals on ultrasound 7. Heart murmur Plan: 1. Perform glucose curve in one week 2. Discuss consistent feeding and giving insulin at time of feeding; however sometimes patient will not eat! 3. Urine culture And if owner wants to proceed with diagnostics, 4. Test for tick borne diseases, lepto 5. Consider repeating an abdominal ultrasound, thoracic rads 6. cPLi Questions: 1. Any suggestings with modifying the insulin dose? The high values on 1-3 make me concerned that the patient was receiving too much insulin, but the day prior blood glucose was high in the morning pre-insulin as well. A 12-hour curve perhaps may be helpful? 2. Owner is now feeding anything that the patient will eat. It is very difficult for the owner to give the patient any medications! I will stress the importance of consistency of feeding and administering insulin, but what if she just cannot feed the dog two meals a day? The patient was prescribed w/d but refuses to eat it. 3. Anything else you would add to the plan for him?

I don't think you need any tick titers...she already was treated with doxycycline, wasn't she?

This sounds like a very complicated case and one which might benefit from a referral, is that possible?

Muffin is a 22-lb mixed breed spayed female dog. She appears to be an unregulated diabetic and I am trying to figure out what the best next steps are for this patient. This is a long history involving four of my colleagues so I am myself trying to sort through the patchy history: 7-12-12 Lethargy, inappetance. Bloodwork: Severe elevation in liver values (ast, alt=3196, alp, ggt, total bilirubin), glucose=78 Urinalysis: 3 proteinuria, bilirubinuria, hematuria Abdominal rads: hepatomegaly, cystoliths Chest rads: bronchial pulmonary pattern Initiated convenia, ursodiol, denamarin 7-26-12 Abdominal ultrasound: billateral nephrolithiasis, cystic urolithiasis, bilateral adrenomegaly, buliary mucocele with suspected focal peritonitis 8-3-12 Dex suppresion test: cushing's highly unlikely (mild elevation in cortisol pre-dex, normal 4th and 8th hour post-dex) 9-10-12 recheck bloodwork: liver values are normal. Mild elevation in total protein, globulins hyerkalemia 6 (3.6-5.5), sodium 146. Mild elevation in cholesterol, triglyceride, platelets. Remainder, including glucose, within reference intervals. 10-22-12 Bloodwork: Mild elevation in total protein and globulin, mild hypercalcemia, mild hyperkalemia, thrombocytosis Mild elevation in cholesterol, triglyceride, platelets. Remainder, including glucose within reference intervals. 10-29-13 ACTH stim- values within reference range 12-3-12 Presented for hesitation to jump and otitis externa Initiated rimadyl and mometamax 12-13-12 Presented for wheezing Received convenia Bloodwork: mild elevation alkphos, hypergycemia glucose=576 hyperkalemia, hyponatremia, hypochloremia, mild leukocytosis, mild anemia normal tp and globulin Urinalysis: glucosuria, ketonuria (++ ) Initiated 4 units Humulin N BID, w/d diet 12-17-12 Spot check blood glucose six hours post AM insulin=625 Insulin dose decreased to 3 units nph BID 12-20-12 8 hour post insulin (3 units)=563 Insulin dose decreased to 2 units humulin N BID 12-29-12 Inconsistent appetite; presented to ER for possible seizure. Blood glucose 500 at ER. Suspect unlikely hypoglycemic seziures II/VI systolic heart murmur hr=141 Blood pressure 160/119 Blood glucose 528 (not in record how many units are being given) Patient will not eat w/d Offered referral; declined 12-31-12 No more seizures PUPD, losing weight, on 2 units humulin N BID Prescribed doxycycline 1-2-13 admitted for glucose curve; receives multiple meals per day pre-insulin bg=586 Patient refused food for glucose curve so curve was rescheduled Owner reports eating well at home and no more seizures since last visit 1-3-13 Returned for curve; ate and received 2 units humulin N at home at 7:15am 10am bg=631 12pm bg=537 2pm bg=517 4pm bg=632 Insulin dose increased to 4 units humulin N BID 1-21-13 spot check 6 hour post insulin =450 Insulin dose increased to 5 units humulin N BID 2-2-13 spot check 4 hour post insulin =474 owner feeding whatever patient will eat; patient is a picky eater and is increasingly refusing food maintaining weight Bloodwork: mild elevation in alp, mild azotemia with usg=1040, mild hyperkalemia, hypercholesterolemia and hypertriglyceridemia urinalysis: glucosuria 3 Recommend increase insulin dose to 6 units BID and return for glucose curve in one week Discussed referral, owner declines Initiated tramadol for presumed osteoarthritis Problems: 1. diabetes mellitus, poorly regulated 2. history of possible cholangiohepatitis 3. history of elevated globulins and total protein, resolved 4. urolithiasis, asymptomatic 5. Two seizures, appears to have resolved 6. Plump adrenals on ultrasound 7. Heart murmur Plan: 1. Perform glucose curve in one week 2. Discuss consistent feeding and giving insulin at time of feeding; however sometimes patient will not eat! 3. Urine culture And if owner wants to proceed with diagnostics, 4. Test for tick borne diseases, lepto 5. Consider repeating an abdominal ultrasound, thoracic rads 6. cPLi Questions: 1. Any suggestings with modifying the insulin dose? The high values on 1-3 make me concerned that the patient was receiving too much insulin, but the day prior blood glucose was high in the morning pre-insulin as well. A 12-hour curve perhaps may be helpful? 2. Owner is now feeding anything that the patient will eat. It is very difficult for the owner to give the patient any medications! I will stress the importance of consistency of feeding and administering insulin, but what if she just cannot feed the dog two meals a day? The patient was prescribed w/d but refuses to eat it. 3. Anything else you would add to the plan for him?

Did the mucocele ever get removed?

Using pens or a bottle of glargine?

Muffin is a 22-lb mixed breed spayed female dog. She appears to be an unregulated diabetic and I am trying to figure out what the best next steps are for this patient. This is a long history involving four of my colleagues so I am myself trying to sort through the patchy history: 7-12-12 Lethargy, inappetance. Bloodwork: Severe elevation in liver values (ast, alt=3196, alp, ggt, total bilirubin), glucose=78 Urinalysis: 3 proteinuria, bilirubinuria, hematuria Abdominal rads: hepatomegaly, cystoliths Chest rads: bronchial pulmonary pattern Initiated convenia, ursodiol, denamarin 7-26-12 Abdominal ultrasound: billateral nephrolithiasis, cystic urolithiasis, bilateral adrenomegaly, buliary mucocele with suspected focal peritonitis 8-3-12 Dex suppresion test: cushing's highly unlikely (mild elevation in cortisol pre-dex, normal 4th and 8th hour post-dex) 9-10-12 recheck bloodwork: liver values are normal. Mild elevation in total protein, globulins hyerkalemia 6 (3.6-5.5), sodium 146. Mild elevation in cholesterol, triglyceride, platelets. Remainder, including glucose, within reference intervals. 10-22-12 Bloodwork: Mild elevation in total protein and globulin, mild hypercalcemia, mild hyperkalemia, thrombocytosis Mild elevation in cholesterol, triglyceride, platelets. Remainder, including glucose within reference intervals. 10-29-13 ACTH stim- values within reference range 12-3-12 Presented for hesitation to jump and otitis externa Initiated rimadyl and mometamax 12-13-12 Presented for wheezing Received convenia Bloodwork: mild elevation alkphos, hypergycemia glucose=576 hyperkalemia, hyponatremia, hypochloremia, mild leukocytosis, mild anemia normal tp and globulin Urinalysis: glucosuria, ketonuria (++ ) Initiated 4 units Humulin N BID, w/d diet 12-17-12 Spot check blood glucose six hours post AM insulin=625 Insulin dose decreased to 3 units nph BID 12-20-12 8 hour post insulin (3 units)=563 Insulin dose decreased to 2 units humulin N BID 12-29-12 Inconsistent appetite; presented to ER for possible seizure. Blood glucose 500 at ER. Suspect unlikely hypoglycemic seziures II/VI systolic heart murmur hr=141 Blood pressure 160/119 Blood glucose 528 (not in record how many units are being given) Patient will not eat w/d Offered referral; declined 12-31-12 No more seizures PUPD, losing weight, on 2 units humulin N BID Prescribed doxycycline 1-2-13 admitted for glucose curve; receives multiple meals per day pre-insulin bg=586 Patient refused food for glucose curve so curve was rescheduled Owner reports eating well at home and no more seizures since last visit 1-3-13 Returned for curve; ate and received 2 units humulin N at home at 7:15am 10am bg=631 12pm bg=537 2pm bg=517 4pm bg=632 Insulin dose increased to 4 units humulin N BID 1-21-13 spot check 6 hour post insulin =450 Insulin dose increased to 5 units humulin N BID 2-2-13 spot check 4 hour post insulin =474 owner feeding whatever patient will eat; patient is a picky eater and is increasingly refusing food maintaining weight Bloodwork: mild elevation in alp, mild azotemia with usg=1040, mild hyperkalemia, hypercholesterolemia and hypertriglyceridemia urinalysis: glucosuria 3 Recommend increase insulin dose to 6 units BID and return for glucose curve in one week Discussed referral, owner declines Initiated tramadol for presumed osteoarthritis Problems: 1. diabetes mellitus, poorly regulated 2. history of possible cholangiohepatitis 3. history of elevated globulins and total protein, resolved 4. urolithiasis, asymptomatic 5. Two seizures, appears to have resolved 6. Plump adrenals on ultrasound 7. Heart murmur Plan: 1. Perform glucose curve in one week 2. Discuss consistent feeding and giving insulin at time of feeding; however sometimes patient will not eat! 3. Urine culture And if owner wants to proceed with diagnostics, 4. Test for tick borne diseases, lepto 5. Consider repeating an abdominal ultrasound, thoracic rads 6. cPLi Questions: 1. Any suggestings with modifying the insulin dose? The high values on 1-3 make me concerned that the patient was receiving too much insulin, but the day prior blood glucose was high in the morning pre-insulin as well. A 12-hour curve perhaps may be helpful? 2. Owner is now feeding anything that the patient will eat. It is very difficult for the owner to give the patient any medications! I will stress the importance of consistency of feeding and administering insulin, but what if she just cannot feed the dog two meals a day? The patient was prescribed w/d but refuses to eat it. 3. Anything else you would add to the plan for him?

Is she still on urso?

Has the owner's glucometer been checked for accuracy?

Mily is a 2 yo female spayed Shepherd-Rottie cross. She presented, having been diagnosed with end stage renal disease at another hospital. Vet there recommended euthanasia and owner was unwilling to give up. She has been losing weight for 4 months and has gone from around 90 to just under 72 pounds in that time. At 72 lb, this dog is grossly underweight. She was somewhat lethargic at home, and sometime cries as if she is in pain. Yet, in the office, she is still playful and wanting to fetch and catch toys. She is bright and alert. Urinalysis was WNL except for some blood, a few leukocytes, and SG at 1.012. Numerous SG tests have all been from 1.010 - 1.012. Bun from other hospital was wnl and cre was slightly elevated. I started her on ringers, 1 liter per day IV on day one and, since I was unable to agree with the diagnosis of end stage renal disease, after I started her on the fluids, I also challenged the SG with desmopressin which yielded no response. Blood panel performed on day three was wnl except for cre of 1.8 (0.5 - 1.5) and slight elevation of total protein 8.2 (5.5 - 8.1) and minor increase is leukocytes 16.1 (6-13.5). Also insignificant elevation of monos plus her standard SG of 1.011. Her RBC's are 6.91, so she is not demonstrating the anemia I usually see with end stage kidneys. Abdominal radio-graphs are unremarkable except for a very large spleen and very little contrast because nearly all the body fat is depleted. I cannot even see the kidneys except as faint shadows. Owners have very little money, and I am wondering if this dog has Addison's. Being able to do an ACTH test is financially unlikely and I would like feedback regarding simply starting her on Prednisolone at doses therapeutic for Addison's (0.22 mg per kg) and Florinef, at 0.01 mg/kg bid and seeing how she responds. How long does it take for a dog to respond to treatment if she has Addison's? If the treatment works, can we then back into the diagnosis?

How much lepto do you see there?

Can you characterize the vomit and frequency?

Rex is a 2005 neutered male dsh that was was diagnosed with diabetes March 2012. Since then he jumped around to different vets and has not been properly regulated. He went into the EC for DKA a few months ago. He was put on DM wet and dry and 2.5 IU glargine BID. The owners have been doing some research themselves and have started keeping really good records and put him on a new diet over the last month or so. I have attached their notes (blood glucose curves). The blood glucose seems to start out mildly high before the insulin dose in the AM and then either not drop much at all or even increase or drop to being almost hypoglycemic after 4 hours, and then increasing a day later into the very high range. The glargine is only a month old. The owner’s have switched Rex to almost 0% carb diet... only canned food in the last few days. His physical was normal except for severe dental tartar. He only had a few teeth left and the owner told me he had a dental less than a year ago. The last blood drawn was done in August of 2012 and looks like the cat potentially had stage 1 kidney. A thyroid level was not done. Would it be prudent to run and chem, CBC, and a T4? What about a fPLI? I did a thio which was neg and sent a UA out which was normal except for sg of 1.020 and 4+glucose. What would you recommend I do next and would you recommend dropping the insulin? Is is blood glucose curves suggestive of a somogyi effect? Thanks,

I'm guessing the client is making these decisions, correct?

The owner moves the injections around on his body every day?

Hello, Feb 4/13: I saw a 11 year old spayed female cat (BW=3.93kg) with a several week his of decreased appetite, and occasional vomiting. Drinking and urinating increased. The owners only feed dry food, they say the cat will not eat canned food. Bowel movements are daily or every other day. The Chemistry panel showed slightly elevated creatinine: 143 umol/L. The urinalysis showed USG of 1.026. This was consistent with CRI stage 1. The owner declined further diagnostics at this time. I put the cat on Mirtazapine 15mg 1/4 tablet every 3rd day. Feb6/13: The cat returned to the clinic. The owner was concerned the cat was still not eating well. On physical exam the cat had mild pain in the cranial abdomen. The cat had gained weight (BW=4.00kg). Radiographs of the abdomen were unremarkable. The snap feline pancreatic lipase test was abnormal. The diagnosis of pancreatitis was made. I gave the cat: Buporphine 0.015mg/kg SQ Ceia 0.1ml/kg SQ Convenia 0.1ml/kg SQ 200ml NaCl 0.9% subcutaneous fluids Prednisolone 5mg PO SID for 30 days, then gradually taper The owner is to encourage eating and drinking at home. If the cat is not eating and drinking well at home, they are to return to the clinic for fluid therapy. Questions: 1) I am concerned about putting the cat on Prednisolone when there is mild al insufficiency present. What do you think? Should the Prednisolone be discontinued or tapered faster? 2) Any other suggestions? Thank-you, really appreciate the ade! (and so does the cat!) :)

Was a urinalysis, culture or sediment exam run, at all?

Can you post your us images?

Hello, Feb 4/13: I saw a 11 year old spayed female cat (BW=3.93kg) with a several week his of decreased appetite, and occasional vomiting. Drinking and urinating increased. The owners only feed dry food, they say the cat will not eat canned food. Bowel movements are daily or every other day. The Chemistry panel showed slightly elevated creatinine: 143 umol/L. The urinalysis showed USG of 1.026. This was consistent with CRI stage 1. The owner declined further diagnostics at this time. I put the cat on Mirtazapine 15mg 1/4 tablet every 3rd day. Feb6/13: The cat returned to the clinic. The owner was concerned the cat was still not eating well. On physical exam the cat had mild pain in the cranial abdomen. The cat had gained weight (BW=4.00kg). Radiographs of the abdomen were unremarkable. The snap feline pancreatic lipase test was abnormal. The diagnosis of pancreatitis was made. I gave the cat: Buporphine 0.015mg/kg SQ Ceia 0.1ml/kg SQ Convenia 0.1ml/kg SQ 200ml NaCl 0.9% subcutaneous fluids Prednisolone 5mg PO SID for 30 days, then gradually taper The owner is to encourage eating and drinking at home. If the cat is not eating and drinking well at home, they are to return to the clinic for fluid therapy. Questions: 1) I am concerned about putting the cat on Prednisolone when there is mild al insufficiency present. What do you think? Should the Prednisolone be discontinued or tapered faster? 2) Any other suggestions? Thank-you, really appreciate the ade! (and so does the cat!) :)

Repeat usg after the weight gain on repeat exam?

Anyone have any thoughts?

Hello, Feb 4/13: I saw a 11 year old spayed female cat (BW=3.93kg) with a several week his of decreased appetite, and occasional vomiting. Drinking and urinating increased. The owners only feed dry food, they say the cat will not eat canned food. Bowel movements are daily or every other day. The Chemistry panel showed slightly elevated creatinine: 143 umol/L. The urinalysis showed USG of 1.026. This was consistent with CRI stage 1. The owner declined further diagnostics at this time. I put the cat on Mirtazapine 15mg 1/4 tablet every 3rd day. Feb6/13: The cat returned to the clinic. The owner was concerned the cat was still not eating well. On physical exam the cat had mild pain in the cranial abdomen. The cat had gained weight (BW=4.00kg). Radiographs of the abdomen were unremarkable. The snap feline pancreatic lipase test was abnormal. The diagnosis of pancreatitis was made. I gave the cat: Buporphine 0.015mg/kg SQ Ceia 0.1ml/kg SQ Convenia 0.1ml/kg SQ 200ml NaCl 0.9% subcutaneous fluids Prednisolone 5mg PO SID for 30 days, then gradually taper The owner is to encourage eating and drinking at home. If the cat is not eating and drinking well at home, they are to return to the clinic for fluid therapy. Questions: 1) I am concerned about putting the cat on Prednisolone when there is mild al insufficiency present. What do you think? Should the Prednisolone be discontinued or tapered faster? 2) Any other suggestions? Thank-you, really appreciate the ade! (and so does the cat!) :)

Any chance of posting the radiographs and or lab results?

If so, can you post results?

Hello, Feb 4/13: I saw a 11 year old spayed female cat (BW=3.93kg) with a several week his of decreased appetite, and occasional vomiting. Drinking and urinating increased. The owners only feed dry food, they say the cat will not eat canned food. Bowel movements are daily or every other day. The Chemistry panel showed slightly elevated creatinine: 143 umol/L. The urinalysis showed USG of 1.026. This was consistent with CRI stage 1. The owner declined further diagnostics at this time. I put the cat on Mirtazapine 15mg 1/4 tablet every 3rd day. Feb6/13: The cat returned to the clinic. The owner was concerned the cat was still not eating well. On physical exam the cat had mild pain in the cranial abdomen. The cat had gained weight (BW=4.00kg). Radiographs of the abdomen were unremarkable. The snap feline pancreatic lipase test was abnormal. The diagnosis of pancreatitis was made. I gave the cat: Buporphine 0.015mg/kg SQ Ceia 0.1ml/kg SQ Convenia 0.1ml/kg SQ 200ml NaCl 0.9% subcutaneous fluids Prednisolone 5mg PO SID for 30 days, then gradually taper The owner is to encourage eating and drinking at home. If the cat is not eating and drinking well at home, they are to return to the clinic for fluid therapy. Questions: 1) I am concerned about putting the cat on Prednisolone when there is mild al insufficiency present. What do you think? Should the Prednisolone be discontinued or tapered faster? 2) Any other suggestions? Thank-you, really appreciate the ade! (and so does the cat!) :)

Bp and rest of physical exam normal?

Does the dog look cushingoid to you?

Toasty is a 13 1/2 yr fs 100% indoor cat. She lives with a house mate who is also geriatric and the owner just acquired an adult cat from the shelter in late Dec. 2012. Toasty presented on 1/7/2013 with a history of acting dull, not interested in anything would eat if owner broughtthe food to her same with water. Not grooming really just not wanting to be bothered or interact. PE revealed a 2 lb weight in 18 mos. dilated pupils, increased heart rate with a murmur. Lungs WNL Abdomen-soft non painful and no masses or thickening appreciated. Retina appeared normal, no hemogghages or detachment noted. Could not get a urine at that time. We performed a Chem/ CBC and T4 also checked her Blood Pressure The average was 180/120. Also did a Quantitave Feline Specific Lipase. CBC was normal. CHEMs: normal except for an albumin of 2.6g/dl and ALKP of 127U/L (14-111) T4 4.0 (0.8-4.7) fSpecLipase 2.7 3.5ug/L unlikelyto have pancreatitis. While I was waiting for all the blood work I did a trial of amlopidine @ .625mg q24 hours. I spoke to the owner 2 days later and she reported a change in Toasty"s behavior, ie walking and doing her routine Toasty things. I cautiously was happy and her BP was rechecked but it was the same, however she was betteer. I also told the owner we should revisit the T4 and do a FreeT4( is that necessary). She has been up and down with heer appetite but is better than she was. I realize her thyroid may be at the bottom of the hypertension but am reluctant to start meds with her being borderline or until I get the free T4. I also discussed other possibilities for the waxing and waning... but in general she is better. Discussed U/S to rule out any neoplasia in abdomen etc, Is there anything I need to pursue? Does amlopidine work quickly if hypertension is an issue? It didn't seem that the BP was that high but that is the only medication I gave her. Coincidence or real. It's been about 3 weeks and she is still acting okay with ocassioally getting quite, but eating. Owner also wondering if new cat was / is an issue? Thanks in advance,

Anything else?

Was there glucose in the urine?

Toasty is a 13 1/2 yr fs 100% indoor cat. She lives with a house mate who is also geriatric and the owner just acquired an adult cat from the shelter in late Dec. 2012. Toasty presented on 1/7/2013 with a history of acting dull, not interested in anything would eat if owner broughtthe food to her same with water. Not grooming really just not wanting to be bothered or interact. PE revealed a 2 lb weight in 18 mos. dilated pupils, increased heart rate with a murmur. Lungs WNL Abdomen-soft non painful and no masses or thickening appreciated. Retina appeared normal, no hemogghages or detachment noted. Could not get a urine at that time. We performed a Chem/ CBC and T4 also checked her Blood Pressure The average was 180/120. Also did a Quantitave Feline Specific Lipase. CBC was normal. CHEMs: normal except for an albumin of 2.6g/dl and ALKP of 127U/L (14-111) T4 4.0 (0.8-4.7) fSpecLipase 2.7 3.5ug/L unlikelyto have pancreatitis. While I was waiting for all the blood work I did a trial of amlopidine @ .625mg q24 hours. I spoke to the owner 2 days later and she reported a change in Toasty"s behavior, ie walking and doing her routine Toasty things. I cautiously was happy and her BP was rechecked but it was the same, however she was betteer. I also told the owner we should revisit the T4 and do a FreeT4( is that necessary). She has been up and down with heer appetite but is better than she was. I realize her thyroid may be at the bottom of the hypertension but am reluctant to start meds with her being borderline or until I get the free T4. I also discussed other possibilities for the waxing and waning... but in general she is better. Discussed U/S to rule out any neoplasia in abdomen etc, Is there anything I need to pursue? Does amlopidine work quickly if hypertension is an issue? It didn't seem that the BP was that high but that is the only medication I gave her. Coincidence or real. It's been about 3 weeks and she is still acting okay with ocassioally getting quite, but eating. Owner also wondering if new cat was / is an issue? Thanks in advance,

Is she simply an atypical presentation for hyperthyroidism?

If so, has the glucometer been checked against your in-hospital serum chemistry machine?

10 yr old lab mix m/c. Seen 3 weeks ago..very acut pu/pd..no weight loss. Previous history od hindlimb weakness/pain? Now Hyperglycemia, glucosuria. Started on Walmart brand insulin. Only 5 units bid. Dog started constantly whining after starting insulin treatment. Rechecked 1 week later, still hyperglycemia. Owner claimed dog was getting worse with constant whining, falling down in rear. I increase insulin dose to 7 units bid...dog started whining more to the point that the owner was unable to sleep...looked like he wanted to cry. S I took dog in last night....gave xanex. Buprinex. And ace to get her to quiet down..stopped insulin. This morning was whining unceasingly, blood work still normal..glucose 500. Still weak in rear, dose of tramadol made her so worse...weak all 4 limbs, even knuckling. I am beginning. To think this is neurological....but can' t relate to the diabetes. Any ideas?

I haven't seen insulin cause constant whining/crying...does the owner truly think this only began after the insulin started?

Great that you cultured the urine : ) can you post the ultrasound images?

10 yr old lab mix m/c. Seen 3 weeks ago..very acut pu/pd..no weight loss. Previous history od hindlimb weakness/pain? Now Hyperglycemia, glucosuria. Started on Walmart brand insulin. Only 5 units bid. Dog started constantly whining after starting insulin treatment. Rechecked 1 week later, still hyperglycemia. Owner claimed dog was getting worse with constant whining, falling down in rear. I increase insulin dose to 7 units bid...dog started whining more to the point that the owner was unable to sleep...looked like he wanted to cry. S I took dog in last night....gave xanex. Buprinex. And ace to get her to quiet down..stopped insulin. This morning was whining unceasingly, blood work still normal..glucose 500. Still weak in rear, dose of tramadol made her so worse...weak all 4 limbs, even knuckling. I am beginning. To think this is neurological....but can' t relate to the diabetes. Any ideas?

What exactly does the complete neuro and orthopedic exam look like?

If so have you ever tried giving insulin before the morning meal to "maybe" help blunt the post-prandial rise in the blood glucose concentrations?

Hello, I have a 12 year old NM cat that suffers from constipation and has megacolon. He has hyperglycemia of 282. UA: sp gravity 1.057 (1.015-1.060). pH 6.5 (5.5-7). Protein 2+ (Neg), Glucose 3+ (Neg), Ketone negative, Bilirubin 1+ (neg), Blood 2+(neg), Urine sediment inactive. Microalbuminuria 4.1 2.5. Should I diagnose this cat with diabetes based on this or should I also run a Fructosamine? Thanks!

Is the owner describing pu/pd?

Can you palpate a thyroid nodule?

Hello, I have a 12 year old NM cat that suffers from constipation and has megacolon. He has hyperglycemia of 282. UA: sp gravity 1.057 (1.015-1.060). pH 6.5 (5.5-7). Protein 2+ (Neg), Glucose 3+ (Neg), Ketone negative, Bilirubin 1+ (neg), Blood 2+(neg), Urine sediment inactive. Microalbuminuria 4.1 2.5. Should I diagnose this cat with diabetes based on this or should I also run a Fructosamine? Thanks!

Any weight loss?

Is relion a brand?

Hello, I am hoping for some help with a diabetic patient of mine. Chloe is a 8 year old English Setter, and she became diabetic at the tender age of 5.5 years. She has been relatively well controlled, and as she is a mental wreck when she comes to the clinic, the owners do glucose curves at home. The saga really begins in Jan 2012, and I will try to summarize as succinctly as possible: Jan 2012: Skin problems with hair loss on tail and caudal thighs, with bacterial dermatitis on the inner thighs. Dry skin overall; treated with antibiotics and fish oils. Resolved slowly (dermatitis) but the hair loss remained about the same, maybe a little better. Feb 2012: Dental performed in the clinic, no significant occurrences. April 2012: Wellness exam, rabies vaccine and Dist/Parvo titers were done. Chloe's skin was still dry but the other signs had cleared up, though her fur was still thin. October 2012: Urinary tract infection (diagnosed via urinalysis, not culture). At-home glucose curve showed decent control. Treated with antibiotics and pet improved. Nov 2012: Pet ate some weird things (soap, donut, etc) and had gastroenteritis, seemed to be improving, and then was rushed to the e-clinic one night for presumptive vestibular disease. Bloodwork revealed elevated liver enzymes, ALT 613 (10-100), AP 1030 (23-212), GGT 13 (0-7), Lipase 1980 (200-1800). Followup testing for Cushings was recommended. An LDDS test was performed and was within normal limits. We recommended that an abdominal ultrasound be performed, but the owners opted to wait and recheck the liver values. Dec 2012: Recheck bloodwork showed much improvement in the liver values; all back to normal except AP 235. A fructosamine was also run and was high 724 (222-348). At that time I recommended that the owners do a full glucose curve at home to assess if insulin dose needed to be changed. I have yet to get this info from them as Chloe also developed diarrhea in early January and the owners are now focused on this. January: Pet began having bouts of apparent colitis (sometimes fresh blood seen), responsive to metronidazole. Fecals have been negative, and an ultrasound was performed. The liver looked funny, so an FNA was done, but just showed fat infiltrate secondary to DM. No other abnormalities were seen. I don't know why, but I am at sort of a loss for what to do next. The owner does not want to pursue exploratory and biopsies if it can be avoided...anyone have any great advice for curing diarrhea in a diabetic? Thanks for the help!

So it sounds like it's primarily large bowel diarrhea?

Is chronic pancreatitis suspected or is there steatorrhea?

Hello, I am hoping for some help with a diabetic patient of mine. Chloe is a 8 year old English Setter, and she became diabetic at the tender age of 5.5 years. She has been relatively well controlled, and as she is a mental wreck when she comes to the clinic, the owners do glucose curves at home. The saga really begins in Jan 2012, and I will try to summarize as succinctly as possible: Jan 2012: Skin problems with hair loss on tail and caudal thighs, with bacterial dermatitis on the inner thighs. Dry skin overall; treated with antibiotics and fish oils. Resolved slowly (dermatitis) but the hair loss remained about the same, maybe a little better. Feb 2012: Dental performed in the clinic, no significant occurrences. April 2012: Wellness exam, rabies vaccine and Dist/Parvo titers were done. Chloe's skin was still dry but the other signs had cleared up, though her fur was still thin. October 2012: Urinary tract infection (diagnosed via urinalysis, not culture). At-home glucose curve showed decent control. Treated with antibiotics and pet improved. Nov 2012: Pet ate some weird things (soap, donut, etc) and had gastroenteritis, seemed to be improving, and then was rushed to the e-clinic one night for presumptive vestibular disease. Bloodwork revealed elevated liver enzymes, ALT 613 (10-100), AP 1030 (23-212), GGT 13 (0-7), Lipase 1980 (200-1800). Followup testing for Cushings was recommended. An LDDS test was performed and was within normal limits. We recommended that an abdominal ultrasound be performed, but the owners opted to wait and recheck the liver values. Dec 2012: Recheck bloodwork showed much improvement in the liver values; all back to normal except AP 235. A fructosamine was also run and was high 724 (222-348). At that time I recommended that the owners do a full glucose curve at home to assess if insulin dose needed to be changed. I have yet to get this info from them as Chloe also developed diarrhea in early January and the owners are now focused on this. January: Pet began having bouts of apparent colitis (sometimes fresh blood seen), responsive to metronidazole. Fecals have been negative, and an ultrasound was performed. The liver looked funny, so an FNA was done, but just showed fat infiltrate secondary to DM. No other abnormalities were seen. I don't know why, but I am at sort of a loss for what to do next. The owner does not want to pursue exploratory and biopsies if it can be avoided...anyone have any great advice for curing diarrhea in a diabetic? Thanks for the help!

(e.g. increased frequency, urgency, tenesmus, mucous as well as the fresh blood?) no vomiting or anorexia or weight loss?

How would you handle this case?

Hello, I am hoping for some help with a diabetic patient of mine. Chloe is a 8 year old English Setter, and she became diabetic at the tender age of 5.5 years. She has been relatively well controlled, and as she is a mental wreck when she comes to the clinic, the owners do glucose curves at home. The saga really begins in Jan 2012, and I will try to summarize as succinctly as possible: Jan 2012: Skin problems with hair loss on tail and caudal thighs, with bacterial dermatitis on the inner thighs. Dry skin overall; treated with antibiotics and fish oils. Resolved slowly (dermatitis) but the hair loss remained about the same, maybe a little better. Feb 2012: Dental performed in the clinic, no significant occurrences. April 2012: Wellness exam, rabies vaccine and Dist/Parvo titers were done. Chloe's skin was still dry but the other signs had cleared up, though her fur was still thin. October 2012: Urinary tract infection (diagnosed via urinalysis, not culture). At-home glucose curve showed decent control. Treated with antibiotics and pet improved. Nov 2012: Pet ate some weird things (soap, donut, etc) and had gastroenteritis, seemed to be improving, and then was rushed to the e-clinic one night for presumptive vestibular disease. Bloodwork revealed elevated liver enzymes, ALT 613 (10-100), AP 1030 (23-212), GGT 13 (0-7), Lipase 1980 (200-1800). Followup testing for Cushings was recommended. An LDDS test was performed and was within normal limits. We recommended that an abdominal ultrasound be performed, but the owners opted to wait and recheck the liver values. Dec 2012: Recheck bloodwork showed much improvement in the liver values; all back to normal except AP 235. A fructosamine was also run and was high 724 (222-348). At that time I recommended that the owners do a full glucose curve at home to assess if insulin dose needed to be changed. I have yet to get this info from them as Chloe also developed diarrhea in early January and the owners are now focused on this. January: Pet began having bouts of apparent colitis (sometimes fresh blood seen), responsive to metronidazole. Fecals have been negative, and an ultrasound was performed. The liver looked funny, so an FNA was done, but just showed fat infiltrate secondary to DM. No other abnormalities were seen. I don't know why, but I am at sort of a loss for what to do next. The owner does not want to pursue exploratory and biopsies if it can be avoided...anyone have any great advice for curing diarrhea in a diabetic? Thanks for the help!

Has a fecal flotation been negative?

How heavy is the dog now and what is her bcs?

Hello, I am hoping for some help with a diabetic patient of mine. Chloe is a 8 year old English Setter, and she became diabetic at the tender age of 5.5 years. She has been relatively well controlled, and as she is a mental wreck when she comes to the clinic, the owners do glucose curves at home. The saga really begins in Jan 2012, and I will try to summarize as succinctly as possible: Jan 2012: Skin problems with hair loss on tail and caudal thighs, with bacterial dermatitis on the inner thighs. Dry skin overall; treated with antibiotics and fish oils. Resolved slowly (dermatitis) but the hair loss remained about the same, maybe a little better. Feb 2012: Dental performed in the clinic, no significant occurrences. April 2012: Wellness exam, rabies vaccine and Dist/Parvo titers were done. Chloe's skin was still dry but the other signs had cleared up, though her fur was still thin. October 2012: Urinary tract infection (diagnosed via urinalysis, not culture). At-home glucose curve showed decent control. Treated with antibiotics and pet improved. Nov 2012: Pet ate some weird things (soap, donut, etc) and had gastroenteritis, seemed to be improving, and then was rushed to the e-clinic one night for presumptive vestibular disease. Bloodwork revealed elevated liver enzymes, ALT 613 (10-100), AP 1030 (23-212), GGT 13 (0-7), Lipase 1980 (200-1800). Followup testing for Cushings was recommended. An LDDS test was performed and was within normal limits. We recommended that an abdominal ultrasound be performed, but the owners opted to wait and recheck the liver values. Dec 2012: Recheck bloodwork showed much improvement in the liver values; all back to normal except AP 235. A fructosamine was also run and was high 724 (222-348). At that time I recommended that the owners do a full glucose curve at home to assess if insulin dose needed to be changed. I have yet to get this info from them as Chloe also developed diarrhea in early January and the owners are now focused on this. January: Pet began having bouts of apparent colitis (sometimes fresh blood seen), responsive to metronidazole. Fecals have been negative, and an ultrasound was performed. The liver looked funny, so an FNA was done, but just showed fat infiltrate secondary to DM. No other abnormalities were seen. I don't know why, but I am at sort of a loss for what to do next. The owner does not want to pursue exploratory and biopsies if it can be avoided...anyone have any great advice for curing diarrhea in a diabetic? Thanks for the help!

When she's on metronidazole, does the diarrhea completely resolve and then recur as soon as it's stopped?

If he really felt like he *had* to feed her at 3:30am, why not just a little snack and then resume 8 and 8 feedings rather than skipping 8 am and then further disrupting her schedule by feeding her at noon?

Gizmo is a 12 1/2 year old Fsp DSH. She is a new patient. She was previously diagnosed as Diabetic and was maintained on 1 unit of Caninsulin BID. In July it was decided that she was in remission based on a low fructosamine level and her insulin was discontinued. She presented yesterday for pu/pd, weight loss (4lbs) and lethargy. She was pyrexic, 40 degress celcius, mildly dehydrated but as per her owner was still eating and drinking well. Blood results are attached. We couldn't collect any urine so it is still to come. The glucose is elevated so she is diabetic again and this fits with the pu/pd and weight loss. Her TP and globulins are moderately elevated and her K+ is a little low. So in addition to diabetes I have on my list of rule outs - infection, inflammation and tumor. FIP? but she is an older cat so less likely. Multiple myeloma? - need protein electrophoresis. Tumor - xrays and/or ultrasound. Infection - antibiotic trial. On a relative basis how high are her protein and globulin levels? For her age her teeth are not bad. She has mild periodontal disease and at least one neck lesion. There are no other obvious signs of infection but I haven't rules out a UTI yet. I was just wondering if there was anything else to consider in this case. Thanks, ☼

Over what time period?

Ps: if you have time could you perhaps complete the diabetes treatment survey?

Hi, This is a 13yo 19lb FS DSH (12-13lb ideal). Diagnosed w/ DM in December (500+ glucose) & concurrent UTI. Started 12/24 on Lantus at 2 units BID as she was only 325 on the day we started her. Changed to DM food; does not like canned and will not meal feed. We have been raising her insulin dose one unit at a time weekly based on curve data in house (very mellow). She is now at 7 units and barely falling below 300. Owner is seeing a slight improvement in PU/PD, but none noticed at all until we got to 6 units. She has lost 1.5lbs in 6 weeks though. Am I being too chicken going up only one unit at a time? Would you suggest a different approach or even a different insulin since I just don't seem to be getting anywhere? Owner coping okay but I'm feeling like I'm not accomplishing anything here. My Lantus cats usually respond much better than this. Injection technique & insulin handling is good. This is her second DM cat & she's a great caretaker. A few recent curves are below. I'd love some advice on managing this kitty! 2/8/13 2/1/13 1/25/13 7am 7 units 6 units 5 units 8:30am 401 429 289 11am 359 489 276 2pm 304 356 316 5pm 289 333 519 The columns looked better before I posted, sorry if it's hard to read! ☼

When you diagnosed the uti, did you use 6-8 weeks of the 'smallest gun' antibiotic that would work, then are you culturing the urine now that the antibiotics have stopped?

Since she's such a big dog, vetsulin can be a bummer, as it only has 40 units in a ml (although if she takes as little vetsulin as she takes of nph, maybe not?

Lucky me get this as a transfer this morning. 5y F (intact) diabetic dog 20kg dog in resuce group sent to foster home 2 days ago told pet is diabetic but manage with food feed high carbohydrate diet so pet off insulin not sure how long at least 2 days presented to our service early this morning (4am) for seizures and vomited several time yesterday Temp 103.5 dehydrated 8% rotary nystagmus seizuring at presentation multiple large mammary tumors enlarged vulva bloodwork performed wbc 21.89 mon 1.53 neu 18.88 rbc 4.91 hct 33.97% PLt 1099 Alb 2.3 ALkp 167 BUN 96 Phos 9.3 Cre 1.9 Glu > 700 Na > 170 TP 10.7 Glob 8.5 could not do more diagnostics without consent from rescue group gave 7.5mg Valium IV at presentation, bolused 400ml Plasmalyte then maintained at 100ml/hr; patient continued to paddle intermittently gave 84.5mg Phenobarbital IV also started with Regular Insulin 5 U IM q 4 hours pending BG values I take over the case this morning (8am) and pet still has nystagmus panting heavily, heart rate 180, vocalizing starting to paddle gave another 7.5mg Valium IV have been trying desperatley to get in touch with owner with no luck pet lateral recumbancy not responsive BG still > 700 machine will not read gave insulin rechecked electrolytes and Na is improving is now 171 Cl 138 Since Na is improving I was going to continue with the Plasmalyte 100ml/hr continue checking BG and giving insulin Thought about giving another dose of Phenobarbital IV to help with seizure activity ANy other thoughts or suggestions? Thanks ☼

What is causing the fever and the leukocytosis?

What should he weigh?

Lucky me get this as a transfer this morning. 5y F (intact) diabetic dog 20kg dog in resuce group sent to foster home 2 days ago told pet is diabetic but manage with food feed high carbohydrate diet so pet off insulin not sure how long at least 2 days presented to our service early this morning (4am) for seizures and vomited several time yesterday Temp 103.5 dehydrated 8% rotary nystagmus seizuring at presentation multiple large mammary tumors enlarged vulva bloodwork performed wbc 21.89 mon 1.53 neu 18.88 rbc 4.91 hct 33.97% PLt 1099 Alb 2.3 ALkp 167 BUN 96 Phos 9.3 Cre 1.9 Glu > 700 Na > 170 TP 10.7 Glob 8.5 could not do more diagnostics without consent from rescue group gave 7.5mg Valium IV at presentation, bolused 400ml Plasmalyte then maintained at 100ml/hr; patient continued to paddle intermittently gave 84.5mg Phenobarbital IV also started with Regular Insulin 5 U IM q 4 hours pending BG values I take over the case this morning (8am) and pet still has nystagmus panting heavily, heart rate 180, vocalizing starting to paddle gave another 7.5mg Valium IV have been trying desperatley to get in touch with owner with no luck pet lateral recumbancy not responsive BG still > 700 machine will not read gave insulin rechecked electrolytes and Na is improving is now 171 Cl 138 Since Na is improving I was going to continue with the Plasmalyte 100ml/hr continue checking BG and giving insulin Thought about giving another dose of Phenobarbital IV to help with seizure activity ANy other thoughts or suggestions? Thanks ☼

Could she also have a uti or pyometra or could this be related to neoplasia?

I have thought about medullary washout, but how could i gradually restrict a abetic cat without making her sick?

Lucky me get this as a transfer this morning. 5y F (intact) diabetic dog 20kg dog in resuce group sent to foster home 2 days ago told pet is diabetic but manage with food feed high carbohydrate diet so pet off insulin not sure how long at least 2 days presented to our service early this morning (4am) for seizures and vomited several time yesterday Temp 103.5 dehydrated 8% rotary nystagmus seizuring at presentation multiple large mammary tumors enlarged vulva bloodwork performed wbc 21.89 mon 1.53 neu 18.88 rbc 4.91 hct 33.97% PLt 1099 Alb 2.3 ALkp 167 BUN 96 Phos 9.3 Cre 1.9 Glu > 700 Na > 170 TP 10.7 Glob 8.5 could not do more diagnostics without consent from rescue group gave 7.5mg Valium IV at presentation, bolused 400ml Plasmalyte then maintained at 100ml/hr; patient continued to paddle intermittently gave 84.5mg Phenobarbital IV also started with Regular Insulin 5 U IM q 4 hours pending BG values I take over the case this morning (8am) and pet still has nystagmus panting heavily, heart rate 180, vocalizing starting to paddle gave another 7.5mg Valium IV have been trying desperatley to get in touch with owner with no luck pet lateral recumbancy not responsive BG still > 700 machine will not read gave insulin rechecked electrolytes and Na is improving is now 171 Cl 138 Since Na is improving I was going to continue with the Plasmalyte 100ml/hr continue checking BG and giving insulin Thought about giving another dose of Phenobarbital IV to help with seizure activity ANy other thoughts or suggestions? Thanks ☼

Do you have blood gas capability?

How much does the dog weigh?

Lucky me get this as a transfer this morning. 5y F (intact) diabetic dog 20kg dog in resuce group sent to foster home 2 days ago told pet is diabetic but manage with food feed high carbohydrate diet so pet off insulin not sure how long at least 2 days presented to our service early this morning (4am) for seizures and vomited several time yesterday Temp 103.5 dehydrated 8% rotary nystagmus seizuring at presentation multiple large mammary tumors enlarged vulva bloodwork performed wbc 21.89 mon 1.53 neu 18.88 rbc 4.91 hct 33.97% PLt 1099 Alb 2.3 ALkp 167 BUN 96 Phos 9.3 Cre 1.9 Glu > 700 Na > 170 TP 10.7 Glob 8.5 could not do more diagnostics without consent from rescue group gave 7.5mg Valium IV at presentation, bolused 400ml Plasmalyte then maintained at 100ml/hr; patient continued to paddle intermittently gave 84.5mg Phenobarbital IV also started with Regular Insulin 5 U IM q 4 hours pending BG values I take over the case this morning (8am) and pet still has nystagmus panting heavily, heart rate 180, vocalizing starting to paddle gave another 7.5mg Valium IV have been trying desperatley to get in touch with owner with no luck pet lateral recumbancy not responsive BG still > 700 machine will not read gave insulin rechecked electrolytes and Na is improving is now 171 Cl 138 Since Na is improving I was going to continue with the Plasmalyte 100ml/hr continue checking BG and giving insulin Thought about giving another dose of Phenobarbital IV to help with seizure activity ANy other thoughts or suggestions? Thanks ☼

Have you checked for ketones?

What is the current bcs?

I am having a very difficult time managing a diabetic patient. Nikki is a 12 year old FS Min Pin, wt 12 lbs, BCS 3.5/5. She is fed W/D dry BID. She has been on treatment from the ophthamologist for kcs, diabetic cataracts with lens induced uveitis, and mineralized keratopathy. Her current treatment is tacrolimus, diclofenac, and pred acetate (they were very hesitant to put her on the steroid but her uveitis warranted it).. The owner does at home glucose curves, and prints out periodic 24 hour reports for me, Nikki is currently on 6 units Humilin N insulin BID. Her glucose levels start at 500+ prior to insulin, then have a nadar around 130 at 6 to 8 hours during the day, and back up to almost 500 again at 12 hour mark. In the evening her nadar hits about 6 hours and is high 100's.. She always climbs back to high 400's or even 500's in 12 hours. She had a dental done in September with extractions, so mouth is fairly clean.. Recent UA no sign of infection, but oddly glucose was negative at 2 to 3 hours post morning insulin. She had full blood panel in Sept, which showed ALT 106, Alk Phos 1226. We did a fructosamine last week, and it was 530. I'm not sure if this is a somogyi effect, as the glucose doesn't seem to go low enough to stimulate gluconeogenesis, and clinically she doesn't ever seem to act weak, although her mom says when glucose is high she is lethargic. She is currently PU/PD, but per owner only since starting back on the steroid drops 1 month ago. Even before going on steroids she had same unusual swings in her curve, but owner says she was not PU/PD. Do I need to change insulin, change frequency, or what? Eye treatment is probably going to change as quickly as they can get the uveitis under control. Any advice would be appreciated! Also, the owner is using One Touch by metronic? to monitor at home. Thanks so much, ☼

Has the owner's glucometer been checked for accuracy?

Were there any elevations in her liver values that would support hyperthyroidism?

I am having a very difficult time managing a diabetic patient. Nikki is a 12 year old FS Min Pin, wt 12 lbs, BCS 3.5/5. She is fed W/D dry BID. She has been on treatment from the ophthamologist for kcs, diabetic cataracts with lens induced uveitis, and mineralized keratopathy. Her current treatment is tacrolimus, diclofenac, and pred acetate (they were very hesitant to put her on the steroid but her uveitis warranted it).. The owner does at home glucose curves, and prints out periodic 24 hour reports for me, Nikki is currently on 6 units Humilin N insulin BID. Her glucose levels start at 500+ prior to insulin, then have a nadar around 130 at 6 to 8 hours during the day, and back up to almost 500 again at 12 hour mark. In the evening her nadar hits about 6 hours and is high 100's.. She always climbs back to high 400's or even 500's in 12 hours. She had a dental done in September with extractions, so mouth is fairly clean.. Recent UA no sign of infection, but oddly glucose was negative at 2 to 3 hours post morning insulin. She had full blood panel in Sept, which showed ALT 106, Alk Phos 1226. We did a fructosamine last week, and it was 530. I'm not sure if this is a somogyi effect, as the glucose doesn't seem to go low enough to stimulate gluconeogenesis, and clinically she doesn't ever seem to act weak, although her mom says when glucose is high she is lethargic. She is currently PU/PD, but per owner only since starting back on the steroid drops 1 month ago. Even before going on steroids she had same unusual swings in her curve, but owner says she was not PU/PD. Do I need to change insulin, change frequency, or what? Eye treatment is probably going to change as quickly as they can get the uveitis under control. Any advice would be appreciated! Also, the owner is using One Touch by metronic? to monitor at home. Thanks so much, ☼

E.g. has one curve been done in the hospital where we compare numbers on the owner's machine vs those on a machine that we know to be accurate in-house?

What's the cat's pcv?

I am having a very difficult time managing a diabetic patient. Nikki is a 12 year old FS Min Pin, wt 12 lbs, BCS 3.5/5. She is fed W/D dry BID. She has been on treatment from the ophthamologist for kcs, diabetic cataracts with lens induced uveitis, and mineralized keratopathy. Her current treatment is tacrolimus, diclofenac, and pred acetate (they were very hesitant to put her on the steroid but her uveitis warranted it).. The owner does at home glucose curves, and prints out periodic 24 hour reports for me, Nikki is currently on 6 units Humilin N insulin BID. Her glucose levels start at 500+ prior to insulin, then have a nadar around 130 at 6 to 8 hours during the day, and back up to almost 500 again at 12 hour mark. In the evening her nadar hits about 6 hours and is high 100's.. She always climbs back to high 400's or even 500's in 12 hours. She had a dental done in September with extractions, so mouth is fairly clean.. Recent UA no sign of infection, but oddly glucose was negative at 2 to 3 hours post morning insulin. She had full blood panel in Sept, which showed ALT 106, Alk Phos 1226. We did a fructosamine last week, and it was 530. I'm not sure if this is a somogyi effect, as the glucose doesn't seem to go low enough to stimulate gluconeogenesis, and clinically she doesn't ever seem to act weak, although her mom says when glucose is high she is lethargic. She is currently PU/PD, but per owner only since starting back on the steroid drops 1 month ago. Even before going on steroids she had same unusual swings in her curve, but owner says she was not PU/PD. Do I need to change insulin, change frequency, or what? Eye treatment is probably going to change as quickly as they can get the uveitis under control. Any advice would be appreciated! Also, the owner is using One Touch by metronic? to monitor at home. Thanks so much, ☼

How long since she's had a urine culture?

Are the gi signs still a problem for joey?

Can a cat with chronic tubulointerstitial nephritis (or any cause of staged CRD) concentrate it's urine to 1.055 after being given desmopressin? ☼

Is this for a specific case you're working up?

Are you comfortable assessing for retinal disease?

Hello, I would love some input on a case I have. I have a 7 yr FS Schnauzer that I diagosed with diabetes and DKA in May 12/12. We treated her in clinic and placed her on Caninsulin. At that time she had ALP 889 (20-15), BG 23.6. CBC WNL. U/A - 1.035 sp gravity; chem strip leuko neg, nitrate neg, urobilinogen norm, protein 2+, pH 5, blood neg, ketone 4+, bilirubin neg, glucose 4+. Urine sediment NSF. cPLI - indicates pancreatitis. Owner declined urine culture and was given one dose Convenia. Tried to get her on low fat diet RC, but owner was feeding combo of RC low fat cans and RC mature consult dry. Did present 11/9/12 for not eating, but ate readily when came into clinic. Did urine chem strip: leuko neg, urobilinogen norm, protein 2+, pH 5, blood neg, ket neg, glucose neg, urine sp gravity 1.040 and BG 15.1 - continue 10 units Caninsulin BID. Early in December, she refused to eat her RC food and owner switched to Beneful without telling us (I suspect she had a pancreatitis flare up). She then presented to us again Jan 14/13 in DKA again. Below are her BG curves and bloodwork from most recent DKA. I have spoke to the owner about testing fasting triglycerides, radiographs bladder (r/o stones and protein in mulitple U/A), culture urine and progress to urine protein creatinine ratio if negative. I highly suspect she has hyperlipemia, pancreatitis flares ups and am concerned about stones etc. Owner is limited financially (she is off work) and is have liver and pancreas issues of her own! Orginally would not eat any low fat diet, but was able to get her on G/D (did Hills consult), but have since been able to switch her back to RC low fat only. After last DKA was given one dose Convenia. However, when Convenia was wearing off switched to 20 days Clavaseptin based on internist recommendation from Royal Canine internist when I called about diets (she doesn't like Convenia). My questions are: 1) Should I switch to Detemir? My understanding is to start at 0.1 units/kg BID. Can I start this imediately after the last Caninsulin dose? 2) Is it okay to use Dolpac in diabetic dog to deworm since esosinophils were elevated? 3) If Caninsulin is not lasting long enough, human Novalin NPH will not help will it? I just ask because ower was asking about cheaper insulin options. Note: did talk to the owner about insulin resistance and how this can make it very hard to control diabetics unless underlying source is found! Note: curves start at 8 am and BG taken every 2 hrs May 5/12 5 units Caninsulin at 7:30 am/pm 8 am 30.7 10 am 21.6 12 am 18.7 2 pm 18.4 4 pm 24.5 6pm 29.1 Increased to 8 untis BID, by my associate June 14/12 Four readings taken by my associate 23, 14.4, 15.9, 22.0 - increased to 10 units BID July 3/12 8 am 28.9 10 am 12.8 12 pm - 7.9 2 pm - 7.5 4 pm - 27.9 6 pm 27 left on 10 units BID Jan 24/ 13 6 units Caninsulin (dose she went home on after discharged from hospital with DKA. 6:15 am at home before insulin 30.4 6:35 am - got 6 units Caninsulin 8:34 am - to high to read 10:34 am - 24.3 12:30 pm 31.5 2:30 pm - 32.9 4:30 pm - 30.2 DKA in Jan 14/13 bloodowrk ALP 338 ( 20-150), AMY 3885 (200-1200), TB 13 (2-10), BG 25.2. CBC - mild elevation HgB, MCHC, mild decreases monocytes and mild elevation in eosinophils. U/A: sp gravity 1.050, leuko neg, nitrte neg, urobilinogen norm, protein 3+, pH 5, blood 2+ ketones 2+, bilirubin 1+, glucose 4+. Sediment - possible cast. She is coming in for a BG curve tomorrow and I will post it tomorrow pm. I was trying to save this as a draft and post everything tomorrow, but I couldn't get it to save and I didn't want to have to write the entire hx again tomorrow! Sorry about that. Thanks so much for an input you may have! ☼

Was this last curve done at home?

Any chance the owners could do at home?

Hello, I would love some input on a case I have. I have a 7 yr FS Schnauzer that I diagosed with diabetes and DKA in May 12/12. We treated her in clinic and placed her on Caninsulin. At that time she had ALP 889 (20-15), BG 23.6. CBC WNL. U/A - 1.035 sp gravity; chem strip leuko neg, nitrate neg, urobilinogen norm, protein 2+, pH 5, blood neg, ketone 4+, bilirubin neg, glucose 4+. Urine sediment NSF. cPLI - indicates pancreatitis. Owner declined urine culture and was given one dose Convenia. Tried to get her on low fat diet RC, but owner was feeding combo of RC low fat cans and RC mature consult dry. Did present 11/9/12 for not eating, but ate readily when came into clinic. Did urine chem strip: leuko neg, urobilinogen norm, protein 2+, pH 5, blood neg, ket neg, glucose neg, urine sp gravity 1.040 and BG 15.1 - continue 10 units Caninsulin BID. Early in December, she refused to eat her RC food and owner switched to Beneful without telling us (I suspect she had a pancreatitis flare up). She then presented to us again Jan 14/13 in DKA again. Below are her BG curves and bloodwork from most recent DKA. I have spoke to the owner about testing fasting triglycerides, radiographs bladder (r/o stones and protein in mulitple U/A), culture urine and progress to urine protein creatinine ratio if negative. I highly suspect she has hyperlipemia, pancreatitis flares ups and am concerned about stones etc. Owner is limited financially (she is off work) and is have liver and pancreas issues of her own! Orginally would not eat any low fat diet, but was able to get her on G/D (did Hills consult), but have since been able to switch her back to RC low fat only. After last DKA was given one dose Convenia. However, when Convenia was wearing off switched to 20 days Clavaseptin based on internist recommendation from Royal Canine internist when I called about diets (she doesn't like Convenia). My questions are: 1) Should I switch to Detemir? My understanding is to start at 0.1 units/kg BID. Can I start this imediately after the last Caninsulin dose? 2) Is it okay to use Dolpac in diabetic dog to deworm since esosinophils were elevated? 3) If Caninsulin is not lasting long enough, human Novalin NPH will not help will it? I just ask because ower was asking about cheaper insulin options. Note: did talk to the owner about insulin resistance and how this can make it very hard to control diabetics unless underlying source is found! Note: curves start at 8 am and BG taken every 2 hrs May 5/12 5 units Caninsulin at 7:30 am/pm 8 am 30.7 10 am 21.6 12 am 18.7 2 pm 18.4 4 pm 24.5 6pm 29.1 Increased to 8 untis BID, by my associate June 14/12 Four readings taken by my associate 23, 14.4, 15.9, 22.0 - increased to 10 units BID July 3/12 8 am 28.9 10 am 12.8 12 pm - 7.9 2 pm - 7.5 4 pm - 27.9 6 pm 27 left on 10 units BID Jan 24/ 13 6 units Caninsulin (dose she went home on after discharged from hospital with DKA. 6:15 am at home before insulin 30.4 6:35 am - got 6 units Caninsulin 8:34 am - to high to read 10:34 am - 24.3 12:30 pm 31.5 2:30 pm - 32.9 4:30 pm - 30.2 DKA in Jan 14/13 bloodowrk ALP 338 ( 20-150), AMY 3885 (200-1200), TB 13 (2-10), BG 25.2. CBC - mild elevation HgB, MCHC, mild decreases monocytes and mild elevation in eosinophils. U/A: sp gravity 1.050, leuko neg, nitrte neg, urobilinogen norm, protein 3+, pH 5, blood 2+ ketones 2+, bilirubin 1+, glucose 4+. Sediment - possible cast. She is coming in for a BG curve tomorrow and I will post it tomorrow pm. I was trying to save this as a draft and post everything tomorrow, but I couldn't get it to save and I didn't want to have to write the entire hx again tomorrow! Sorry about that. Thanks so much for an input you may have! ☼

Is the owner capable of generating the curves?

I don't see the comparison numbers?

Hello, I would love some input on a case I have. I have a 7 yr FS Schnauzer that I diagosed with diabetes and DKA in May 12/12. We treated her in clinic and placed her on Caninsulin. At that time she had ALP 889 (20-15), BG 23.6. CBC WNL. U/A - 1.035 sp gravity; chem strip leuko neg, nitrate neg, urobilinogen norm, protein 2+, pH 5, blood neg, ketone 4+, bilirubin neg, glucose 4+. Urine sediment NSF. cPLI - indicates pancreatitis. Owner declined urine culture and was given one dose Convenia. Tried to get her on low fat diet RC, but owner was feeding combo of RC low fat cans and RC mature consult dry. Did present 11/9/12 for not eating, but ate readily when came into clinic. Did urine chem strip: leuko neg, urobilinogen norm, protein 2+, pH 5, blood neg, ket neg, glucose neg, urine sp gravity 1.040 and BG 15.1 - continue 10 units Caninsulin BID. Early in December, she refused to eat her RC food and owner switched to Beneful without telling us (I suspect she had a pancreatitis flare up). She then presented to us again Jan 14/13 in DKA again. Below are her BG curves and bloodwork from most recent DKA. I have spoke to the owner about testing fasting triglycerides, radiographs bladder (r/o stones and protein in mulitple U/A), culture urine and progress to urine protein creatinine ratio if negative. I highly suspect she has hyperlipemia, pancreatitis flares ups and am concerned about stones etc. Owner is limited financially (she is off work) and is have liver and pancreas issues of her own! Orginally would not eat any low fat diet, but was able to get her on G/D (did Hills consult), but have since been able to switch her back to RC low fat only. After last DKA was given one dose Convenia. However, when Convenia was wearing off switched to 20 days Clavaseptin based on internist recommendation from Royal Canine internist when I called about diets (she doesn't like Convenia). My questions are: 1) Should I switch to Detemir? My understanding is to start at 0.1 units/kg BID. Can I start this imediately after the last Caninsulin dose? 2) Is it okay to use Dolpac in diabetic dog to deworm since esosinophils were elevated? 3) If Caninsulin is not lasting long enough, human Novalin NPH will not help will it? I just ask because ower was asking about cheaper insulin options. Note: did talk to the owner about insulin resistance and how this can make it very hard to control diabetics unless underlying source is found! Note: curves start at 8 am and BG taken every 2 hrs May 5/12 5 units Caninsulin at 7:30 am/pm 8 am 30.7 10 am 21.6 12 am 18.7 2 pm 18.4 4 pm 24.5 6pm 29.1 Increased to 8 untis BID, by my associate June 14/12 Four readings taken by my associate 23, 14.4, 15.9, 22.0 - increased to 10 units BID July 3/12 8 am 28.9 10 am 12.8 12 pm - 7.9 2 pm - 7.5 4 pm - 27.9 6 pm 27 left on 10 units BID Jan 24/ 13 6 units Caninsulin (dose she went home on after discharged from hospital with DKA. 6:15 am at home before insulin 30.4 6:35 am - got 6 units Caninsulin 8:34 am - to high to read 10:34 am - 24.3 12:30 pm 31.5 2:30 pm - 32.9 4:30 pm - 30.2 DKA in Jan 14/13 bloodowrk ALP 338 ( 20-150), AMY 3885 (200-1200), TB 13 (2-10), BG 25.2. CBC - mild elevation HgB, MCHC, mild decreases monocytes and mild elevation in eosinophils. U/A: sp gravity 1.050, leuko neg, nitrte neg, urobilinogen norm, protein 3+, pH 5, blood 2+ ketones 2+, bilirubin 1+, glucose 4+. Sediment - possible cast. She is coming in for a BG curve tomorrow and I will post it tomorrow pm. I was trying to save this as a draft and post everything tomorrow, but I couldn't get it to save and I didn't want to have to write the entire hx again tomorrow! Sorry about that. Thanks so much for an input you may have! ☼

How much does she weigh?

Could you send a picture?

Hello, I would love some input on a case I have. I have a 7 yr FS Schnauzer that I diagosed with diabetes and DKA in May 12/12. We treated her in clinic and placed her on Caninsulin. At that time she had ALP 889 (20-15), BG 23.6. CBC WNL. U/A - 1.035 sp gravity; chem strip leuko neg, nitrate neg, urobilinogen norm, protein 2+, pH 5, blood neg, ketone 4+, bilirubin neg, glucose 4+. Urine sediment NSF. cPLI - indicates pancreatitis. Owner declined urine culture and was given one dose Convenia. Tried to get her on low fat diet RC, but owner was feeding combo of RC low fat cans and RC mature consult dry. Did present 11/9/12 for not eating, but ate readily when came into clinic. Did urine chem strip: leuko neg, urobilinogen norm, protein 2+, pH 5, blood neg, ket neg, glucose neg, urine sp gravity 1.040 and BG 15.1 - continue 10 units Caninsulin BID. Early in December, she refused to eat her RC food and owner switched to Beneful without telling us (I suspect she had a pancreatitis flare up). She then presented to us again Jan 14/13 in DKA again. Below are her BG curves and bloodwork from most recent DKA. I have spoke to the owner about testing fasting triglycerides, radiographs bladder (r/o stones and protein in mulitple U/A), culture urine and progress to urine protein creatinine ratio if negative. I highly suspect she has hyperlipemia, pancreatitis flares ups and am concerned about stones etc. Owner is limited financially (she is off work) and is have liver and pancreas issues of her own! Orginally would not eat any low fat diet, but was able to get her on G/D (did Hills consult), but have since been able to switch her back to RC low fat only. After last DKA was given one dose Convenia. However, when Convenia was wearing off switched to 20 days Clavaseptin based on internist recommendation from Royal Canine internist when I called about diets (she doesn't like Convenia). My questions are: 1) Should I switch to Detemir? My understanding is to start at 0.1 units/kg BID. Can I start this imediately after the last Caninsulin dose? 2) Is it okay to use Dolpac in diabetic dog to deworm since esosinophils were elevated? 3) If Caninsulin is not lasting long enough, human Novalin NPH will not help will it? I just ask because ower was asking about cheaper insulin options. Note: did talk to the owner about insulin resistance and how this can make it very hard to control diabetics unless underlying source is found! Note: curves start at 8 am and BG taken every 2 hrs May 5/12 5 units Caninsulin at 7:30 am/pm 8 am 30.7 10 am 21.6 12 am 18.7 2 pm 18.4 4 pm 24.5 6pm 29.1 Increased to 8 untis BID, by my associate June 14/12 Four readings taken by my associate 23, 14.4, 15.9, 22.0 - increased to 10 units BID July 3/12 8 am 28.9 10 am 12.8 12 pm - 7.9 2 pm - 7.5 4 pm - 27.9 6 pm 27 left on 10 units BID Jan 24/ 13 6 units Caninsulin (dose she went home on after discharged from hospital with DKA. 6:15 am at home before insulin 30.4 6:35 am - got 6 units Caninsulin 8:34 am - to high to read 10:34 am - 24.3 12:30 pm 31.5 2:30 pm - 32.9 4:30 pm - 30.2 DKA in Jan 14/13 bloodowrk ALP 338 ( 20-150), AMY 3885 (200-1200), TB 13 (2-10), BG 25.2. CBC - mild elevation HgB, MCHC, mild decreases monocytes and mild elevation in eosinophils. U/A: sp gravity 1.050, leuko neg, nitrte neg, urobilinogen norm, protein 3+, pH 5, blood 2+ ketones 2+, bilirubin 1+, glucose 4+. Sediment - possible cast. She is coming in for a BG curve tomorrow and I will post it tomorrow pm. I was trying to save this as a draft and post everything tomorrow, but I couldn't get it to save and I didn't want to have to write the entire hx again tomorrow! Sorry about that. Thanks so much for an input you may have! ☼

It's hard to know what to make of that jan 24th curve...how close was that to when she was sick?

Are the medic director and non-vet upper management aware of this issue?

Trill is a 9 year old F Yellow Lab. I diagnosed her with diabetes about 4 weeks ago. She is scheduled to be spayed in 4 days. Her owner couldn't afford to spay her earlier. She is due to come into heat anytime now. I have read up on previous posts which suggest that spaying the dog may put diabetes into remission but this appear to be lined with estrus and diestrus. Trill was anestrus when her diabetes developed so does mean that the diabetes will likely not go into remission. Also we have waited at least one month to spay her from the time the disease was diagnosed. I will have her owner monitor her carefully regardless. She has purchased an Alphatrac and also has urine sticks. Thanks, ☼

How much insulin is she on right now and what does she weigh?

I'm concerned that if the bilirubin is truly elevated (was there hemolysis or lipemia in the sample?

"Henry VIII" is a 13 1/2-year-old neutered male domestic longhair with a history of various forms of eosinophilic granuloma complex that have recurred since 2001. Steroids worked well previously, but he became diabetic in 2008. Due to his owners' financial concerns, he has been on NPH insulin since his initial diagnosis (they didn't want to use glargine due to its cost.) This summer he developed a rodent ulcer and we tried Atopica, but while taking it he became hypoglycemic and ended up at our local university, where they recommended stopping the Atopica because they thought it may have decreased his appetite. His lesions were well-controlled at that time, so no further treatment was done. Fast forward to January of this year. Henry presented January 2 with bilateral linear granulomas. I tried Tritop and cefpodoxime, and we started him on a food trial with Hill's d/d venison. Owner called today to report that his lesions are no better and that he seems to be "obsessed" with chewing and licking the lesions. Any suggestions? Owner asked about steroids, which I obviously want to avoid, but this is a quality of life issue for this cat. Thanks in advance for your help!p /y University of Minnesota Class of 2000 Burnsville,MN

So is he on insulin now?

Is he losing weight or remaining stable?

Hi, Another post here for my own personal cat. She was a good sam kitty 14 yrs ago with frx pelvis, and both rear limbs frx. The left rear limb had an IM pin placed in femur and rt. rear limb was amputated. She is a 14 yr old DSH with hyperthyroidism diagnosed 2 months ago and controlled with Methamizole, probable IBD controlled with diet, and allergic to dust mites and grasses--controlled with desensitization injections. She has significant arthritis in the stifle and tarsal joints of the remaining limb. 3 to 4 yrs ago she started having trouble with allergies and received a depo injection and became hypergylcemic. It resolved when the depomedrol wore off. Before she received her desens. shots (6 months ago) she was extremely pruritic and arthritic and was receiving prednisolone. She became hypergycemic again and it again resolved when prednisolone was withdrawn. I had her on Tramadol and Gabapentin. I placed her on Metacam 2-3 times per week in addition to Tramadol 50 mg 1/4 tab bid and Gabapentin 50mg sid to bid (higher doses make her extremely lethargic). Not surprisingly she is now in early renal failure bun-93 and crea 1.6(down from 2.2 with subq fluids). In the last two weeks I withdrew the metacam. She began to go down hill, not moving, and not eating even with cyproheptadine and meds for nausea. We were considering euth. so I decided to give her a shot of Dexamethasone--she perked right up , started eating and moving. About when dex would be wearing off she started to go down hill again and I gave her a 5mg pred for two days and again she perked right up again. At this point bloodwork is ok bun-93, creat-1.6 and t4-1.5. i believe she is not moving or eating well more likely due to pain and not renal disease at this point. The tramadol and gabapentin alone just aren't cutting it. So my question is--should I play with fire and use the Metacam, or should I play with another type of fire and use Prednisolone(Medrol) or Budesonide and hope she doesn't become diabetic? I forgot to mention she has also been received Adequan injections and Laser therapy. Thanks for your help. ☼

Have you posted previously on vin about this cat?

Whenever you have hypernatremia, knee jerk to the quetsion of why not enough water?

Saw a 11 yr CM DSH on Saturday for weight loss, sagging head, and decreased appetite. Last seen in June for lameness, weight was 2# more. PE unremarkable aside for possible intestinal mass in mid-abdomen (though I cannot be sure it wasn't a fecal ball, it difficult to keep it between my fingers long enough to palpate well). Rads showed mild, diffuse interstitial pulmonary pattern, subjective cardiomegaly (though no concerns for heart dz on PE), poor peritoneal detail. Bloodwork - pmn 9374 (2500-8500), AST 1160 (10-100), ALT 193 (10-100), K 3.2 (3.4-5.6), CPK 146060 (56-529). No history of trauma and I don't remember the blood draw being overly difficult. Ideas aside from toxo?

Any chance of posting the rads, here?

What is the current potassium value for this patient?

Saw a 11 yr CM DSH on Saturday for weight loss, sagging head, and decreased appetite. Last seen in June for lameness, weight was 2# more. PE unremarkable aside for possible intestinal mass in mid-abdomen (though I cannot be sure it wasn't a fecal ball, it difficult to keep it between my fingers long enough to palpate well). Rads showed mild, diffuse interstitial pulmonary pattern, subjective cardiomegaly (though no concerns for heart dz on PE), poor peritoneal detail. Bloodwork - pmn 9374 (2500-8500), AST 1160 (10-100), ALT 193 (10-100), K 3.2 (3.4-5.6), CPK 146060 (56-529). No history of trauma and I don't remember the blood draw being overly difficult. Ideas aside from toxo?

Can you post full labs?

Can i see her actual ultrasound report?

Saw a 11 yr CM DSH on Saturday for weight loss, sagging head, and decreased appetite. Last seen in June for lameness, weight was 2# more. PE unremarkable aside for possible intestinal mass in mid-abdomen (though I cannot be sure it wasn't a fecal ball, it difficult to keep it between my fingers long enough to palpate well). Rads showed mild, diffuse interstitial pulmonary pattern, subjective cardiomegaly (though no concerns for heart dz on PE), poor peritoneal detail. Bloodwork - pmn 9374 (2500-8500), AST 1160 (10-100), ALT 193 (10-100), K 3.2 (3.4-5.6), CPK 146060 (56-529). No history of trauma and I don't remember the blood draw being overly difficult. Ideas aside from toxo?

Any chance a t4 was run?

Does the owner note on the curve when he gets exercised?

Saw a 11 yr CM DSH on Saturday for weight loss, sagging head, and decreased appetite. Last seen in June for lameness, weight was 2# more. PE unremarkable aside for possible intestinal mass in mid-abdomen (though I cannot be sure it wasn't a fecal ball, it difficult to keep it between my fingers long enough to palpate well). Rads showed mild, diffuse interstitial pulmonary pattern, subjective cardiomegaly (though no concerns for heart dz on PE), poor peritoneal detail. Bloodwork - pmn 9374 (2500-8500), AST 1160 (10-100), ALT 193 (10-100), K 3.2 (3.4-5.6), CPK 146060 (56-529). No history of trauma and I don't remember the blood draw being overly difficult. Ideas aside from toxo?

Bp?

Is the dog making good amounts of urine?

Saw a 11 yr CM DSH on Saturday for weight loss, sagging head, and decreased appetite. Last seen in June for lameness, weight was 2# more. PE unremarkable aside for possible intestinal mass in mid-abdomen (though I cannot be sure it wasn't a fecal ball, it difficult to keep it between my fingers long enough to palpate well). Rads showed mild, diffuse interstitial pulmonary pattern, subjective cardiomegaly (though no concerns for heart dz on PE), poor peritoneal detail. Bloodwork - pmn 9374 (2500-8500), AST 1160 (10-100), ALT 193 (10-100), K 3.2 (3.4-5.6), CPK 146060 (56-529). No history of trauma and I don't remember the blood draw being overly difficult. Ideas aside from toxo?

Hr?

Do you have a cbc and chem screen that you can post?

Saw a 11 yr CM DSH on Saturday for weight loss, sagging head, and decreased appetite. Last seen in June for lameness, weight was 2# more. PE unremarkable aside for possible intestinal mass in mid-abdomen (though I cannot be sure it wasn't a fecal ball, it difficult to keep it between my fingers long enough to palpate well). Rads showed mild, diffuse interstitial pulmonary pattern, subjective cardiomegaly (though no concerns for heart dz on PE), poor peritoneal detail. Bloodwork - pmn 9374 (2500-8500), AST 1160 (10-100), ALT 193 (10-100), K 3.2 (3.4-5.6), CPK 146060 (56-529). No history of trauma and I don't remember the blood draw being overly difficult. Ideas aside from toxo?

Urinalysis?

How much does this guy weigh?

Saw a 11 yr CM DSH on Saturday for weight loss, sagging head, and decreased appetite. Last seen in June for lameness, weight was 2# more. PE unremarkable aside for possible intestinal mass in mid-abdomen (though I cannot be sure it wasn't a fecal ball, it difficult to keep it between my fingers long enough to palpate well). Rads showed mild, diffuse interstitial pulmonary pattern, subjective cardiomegaly (though no concerns for heart dz on PE), poor peritoneal detail. Bloodwork - pmn 9374 (2500-8500), AST 1160 (10-100), ALT 193 (10-100), K 3.2 (3.4-5.6), CPK 146060 (56-529). No history of trauma and I don't remember the blood draw being overly difficult. Ideas aside from toxo?

How much does the cat weigh now?

The owner is using u40 syringes?

Just a quick question about using Proin (phenylpropanolamine) in a dog with suspected mitral insufficiency. Today I was presented a castrated male shetland shepdog about 15 yrs. of age for more frequent urinary accidents in the house. His past history is that he has been on enalapril and vetmedin for suspected chronic mitral insufficiency for quite some time. He has been for some time having the intermittent lapse of house training but the owner now says for the last two weeks it has been just about daily. He seems to be doing complete voiding as usually very large volumes and not just little dribbling. He is often found to be sleeping in a wet bed also. The other day, the owner witnessed him just standing in the kitchen urinating, only about an hour after she took him out and he did nothing outside, and he was acting as if he was not even aware that he was doing it. I discussed possible cognitive disfunction, CRI, UTI, cushings, diabetes, etc, etc.....the owner would not allow us to run any bloodwork or take radiographs but authorized us to run a urinalysis at least. The owner was crying and I suspect they are likely going to be electing to euthanize very soon if they can't get some control on his urinations.....they are ing to treat him if it is a bladder infection but not much else it seems.....explained that there are so many reasons he could be doing this and that the bloodwork and rads would be extremely helpful. Again refused work up! If they won't let me do bloodwork and rads I can't imagine that they persue a echo work-up either. I feel so bad because the dog is so BAR, happy and looks great for a 15 yr. old, that I hate to just give up so quickly on him, but my hands are essentially tied by these owners. Pending UA....may be put on antibiotics, but could I use Proin as a last ditch effort to help this dog hold his urine a little better despite his cardiac situation and current "control" with enalapril and vetmedin. Thank you so much for any help/advice...I know you do not have much to work with!!!! ☼

Do you have any chest films on the dog?

Do you know if the dog or owners were on any glucocorticoid type drugs?

Hi, I have a question about a cat with diarrhea. The cat was received from a cat shelter last year in June. He developed eosinohilic granuloma on one of his foot pads (diagnosed by histohologic examination by a hologist). He also developed this on both caudal thighs, his hard palate. He was put on oral prednisolone. The foot pad, thighs were okay after 1 wk, the hard palate was doing much better. 1.5 wk later his lips and another foot were involved. The owners were also given him hypoallergenic food in combination with fresh meat. I discussed trying to see whether he had food allergy or not. He got a second prednisolone therapy (oral). After a while multiple foot pads and his left caudal thigh were having eos gr again. While during the prednisolone therapy everything was fine. He was put on oral ciclosporine (Atopica, 25 mg SID). He was doing fine on the ciclosporine. We did not measure a toxoplasma titer before we started the ciclosporine, nor did we test him for FIV/FeLV. One month later he was seen for a soft tissue swelling dorsally from his right carpus, for which he got an injection of cefovecin (Convenia) and an injection of dexamethasone). One month later he was seen by a colleague because of diarrhea. Aparantly the cat had diarrhea already previously of starting the ciclosporine (not mentioned earlier by the owners), and the diarrhea got worse since the ciclosporin (also not mentioned earlier by the owners). He investigated a native rectal sample (cotton tail sample) and saw very many rods and also inflammatory cells. The colleague gave the cat an injection of vit B12 and put him on oral clindamycine for possible entero-toxoplasmosis (50 mg BID, 5.8 kg bodyweight). Two weeks later I saw the cat, the diarrhea was the same. So the cat was already having softer stool before the ciclosporine, but the diarrhea was got worse on the ciclosporine (smelling like rotten eggs), hypoallergenic food did not make any difference. Sometimes he was walking with a more curved back (dorsally). Otherwise no complaints. One of the other cats which also is on oral ciclosporine did also develop diarrhea on this medication, but the stool was getting normal again over time on hypoallergenic food. I discussed the options. The owners chose to test the IgM toxo titer and in the mean time put the cat on oral clavulanated amox in combination with a medication against diarrhea which also contains a probiotic. This clindamycine was stopped. As up to this date no improvement on this medication. Toxoplasmosis: IgM 1:16 (1:16) (remark: the sample was hemolytic, results should be interpreted with caution). I called the lab, they told me the result was borderline. It still could be enteric Toxopl. The advise was to send in a stool sample of 3 consecutive days to look for Toxoplasmosis. When the result would be positive, the the cat has indeed active Toxoplasmosis. When the result would be negative, it would be advised to send in a blood sample for Toxoplasma titers IgM as well as IgG. And to repeat this after a couple of weeks to see if the titers would rise. -Do you agree that this still could be Toxoplasmosis looking at this titer? Or can I conclude that Toxoplasma is no issue in this cat? -Do you think the hemolytic sample was of any influence of the result? -Do you think that a stool sample for investigation of Toxoplasmosis would be wise? -Do you agree also checking the IgG titer? I thought this is of no use, as a positive titer only means the cat has been in contact with Toxoplasma in the past. Or is a rise in IgG titer of any use (so talking 2 samples with a couple of weeks apart)? -Was the clindamycine dose a little bit to low for enteric Toxo? Thanks in advance, ☼

Also, is the diarrhea small intestinal or more consistent with large bowel disease?

Was this stim run using cortrosyn, and the samples submitted to a commercial lab?

Hi, I have a question about a cat with diarrhea. The cat was received from a cat shelter last year in June. He developed eosinohilic granuloma on one of his foot pads (diagnosed by histohologic examination by a hologist). He also developed this on both caudal thighs, his hard palate. He was put on oral prednisolone. The foot pad, thighs were okay after 1 wk, the hard palate was doing much better. 1.5 wk later his lips and another foot were involved. The owners were also given him hypoallergenic food in combination with fresh meat. I discussed trying to see whether he had food allergy or not. He got a second prednisolone therapy (oral). After a while multiple foot pads and his left caudal thigh were having eos gr again. While during the prednisolone therapy everything was fine. He was put on oral ciclosporine (Atopica, 25 mg SID). He was doing fine on the ciclosporine. We did not measure a toxoplasma titer before we started the ciclosporine, nor did we test him for FIV/FeLV. One month later he was seen for a soft tissue swelling dorsally from his right carpus, for which he got an injection of cefovecin (Convenia) and an injection of dexamethasone). One month later he was seen by a colleague because of diarrhea. Aparantly the cat had diarrhea already previously of starting the ciclosporine (not mentioned earlier by the owners), and the diarrhea got worse since the ciclosporin (also not mentioned earlier by the owners). He investigated a native rectal sample (cotton tail sample) and saw very many rods and also inflammatory cells. The colleague gave the cat an injection of vit B12 and put him on oral clindamycine for possible entero-toxoplasmosis (50 mg BID, 5.8 kg bodyweight). Two weeks later I saw the cat, the diarrhea was the same. So the cat was already having softer stool before the ciclosporine, but the diarrhea was got worse on the ciclosporine (smelling like rotten eggs), hypoallergenic food did not make any difference. Sometimes he was walking with a more curved back (dorsally). Otherwise no complaints. One of the other cats which also is on oral ciclosporine did also develop diarrhea on this medication, but the stool was getting normal again over time on hypoallergenic food. I discussed the options. The owners chose to test the IgM toxo titer and in the mean time put the cat on oral clavulanated amox in combination with a medication against diarrhea which also contains a probiotic. This clindamycine was stopped. As up to this date no improvement on this medication. Toxoplasmosis: IgM 1:16 (1:16) (remark: the sample was hemolytic, results should be interpreted with caution). I called the lab, they told me the result was borderline. It still could be enteric Toxopl. The advise was to send in a stool sample of 3 consecutive days to look for Toxoplasmosis. When the result would be positive, the the cat has indeed active Toxoplasmosis. When the result would be negative, it would be advised to send in a blood sample for Toxoplasma titers IgM as well as IgG. And to repeat this after a couple of weeks to see if the titers would rise. -Do you agree that this still could be Toxoplasmosis looking at this titer? Or can I conclude that Toxoplasma is no issue in this cat? -Do you think the hemolytic sample was of any influence of the result? -Do you think that a stool sample for investigation of Toxoplasmosis would be wise? -Do you agree also checking the IgG titer? I thought this is of no use, as a positive titer only means the cat has been in contact with Toxoplasma in the past. Or is a rise in IgG titer of any use (so talking 2 samples with a couple of weeks apart)? -Was the clindamycine dose a little bit to low for enteric Toxo? Thanks in advance, ☼

Is the cat eating a canned or dry kibble?

What to do?

Thought I would share with fellow veterinas my experience with a new product called Flexicult Vet. Its an in-house culture and sensitivity system that is used for urine. Results are obtained in 24 hours using five commonly administered antibiotics used in canine and feline UTI's. Normally I use the services of a reference lab, but this fills a void in our practice of offering culture and sensitivity for half the cost. This does NOT take the place of a complete C & S but creates a new area of service where economics are an issue. Discussion with a couple of university docs have been favorable but can't be published or promoted. I would enjoy your comments. Thanks! Dr. ☼

Can you tell me your experience with this product?

How much does she weigh and how many calories are in a can of this diet?

I have a 9yr old King Charles MN. He had normal labwork and a dental 2 weeks ago (5 extractions). Went home on Carprofen and Clindamycin. He was back for his recheck today. The owner said he had been panting a lot lately (the last 2 months or so) but forgot to mention it at his visit 2 weeks ago. He seems to pant more at night, so much that she has to wear ear plugs. No other clin signs. His exam today was boring. He did pant off and on in the room. After one bit of panting his gums did look slightly hyperemic then when I looked again later they were normal color. No murmurs, lungs sound wnl. No upper airway referred noise. Pulse equal and synchronous. No fever. No pain on neck, back, extremity palpation. His BCS is 7 of 9. No signs of Cushing's. USG was 1.038, boring sediment, all chems/cbc/lytes wnl. We did chest rads and the radiologist read them out as completely normal. Liver wnl on rad too. I am thinking next steps are thyroid panel? LDDS even though no other signs? Behavioral? Any input would be appreciated. Thanks ☼

Any dental radiographs done?

What time are you fedding this dog in relation to the insulin?

Hello, I have a DSH 8 year old male cat . he is eating and active. for the 5mths he has had a leucopenia of 4.2 total wbcs,pcv of 27%,plasma protein of 7.4g/dl,hb=13.2,g/dl,rbcs=6.74,mcv=40.1mchc=48.8,mch=19.5,moderate platelets,no blood parasites,heinz bodies found, serum biochemistry=albumin=21.6g/ltotal protein=28.3g/dl .all other values are normal. i think the cat may have an intestinal lymphoma. i want to give him vit b12 and put him on 20mgs depo-medrol as he is difficult to pill and give him liquid febendazole for 5 days. please advise on further diagnostics,differentials,treatment. thanks

Is there any previous labwork on this kitty?

Could this be somehow related to systemic disease (ie, poorly controlled diabetes)?

Hello, I have a DSH 8 year old male cat . he is eating and active. for the 5mths he has had a leucopenia of 4.2 total wbcs,pcv of 27%,plasma protein of 7.4g/dl,hb=13.2,g/dl,rbcs=6.74,mcv=40.1mchc=48.8,mch=19.5,moderate platelets,no blood parasites,heinz bodies found, serum biochemistry=albumin=21.6g/ltotal protein=28.3g/dl .all other values are normal. i think the cat may have an intestinal lymphoma. i want to give him vit b12 and put him on 20mgs depo-medrol as he is difficult to pill and give him liquid febendazole for 5 days. please advise on further diagnostics,differentials,treatment. thanks

Finally, what type of diet is he eating?

Did you do a rel exam?

Hello, I have a DSH 8 year old male cat . he is eating and active. for the 5mths he has had a leucopenia of 4.2 total wbcs,pcv of 27%,plasma protein of 7.4g/dl,hb=13.2,g/dl,rbcs=6.74,mcv=40.1mchc=48.8,mch=19.5,moderate platelets,no blood parasites,heinz bodies found, serum biochemistry=albumin=21.6g/ltotal protein=28.3g/dl .all other values are normal. i think the cat may have an intestinal lymphoma. i want to give him vit b12 and put him on 20mgs depo-medrol as he is difficult to pill and give him liquid febendazole for 5 days. please advise on further diagnostics,differentials,treatment. thanks

Do you have a t4, plain rads and a u/a?

Is samson still constipated?

Good morning, I'm looking for a little advice on my diabetic patient who belongs to an MD: "Sarah" is a 9 year old 9 Kg F/S Australian Terrier who was diagnosed with diabetes on 12/24/2012. 6 months prior to that she had a right adrenalectomy due to tumor. She was on oral prednisone post-op at a dose of 0.14mg/kg, and her resting cortisol levels were still low. After her Diabetes diagnosis, her resting cortisol level was checked again, and was a bit improved (was 1.6 , range is 2.-6.0) With the improvement, the specialist lowered her prednisone dose in hopes that this would help in her Diabetes management. She is currently on 0.07 mg/kg oral prednisone once daily, She was started on NPH on 12-24-12 at 2.5 units BID. Her mom checks BG at home with Abbot Alphatrak. Her levels were always "high" =too high to register. We continued increasing the insulin and she is now on 7units q. 12 hr NPH. Her last BG curve shows very short duration of insulin: See below. My question is whether to forge ahead with continuing NPH increases or change to Detemir BG curve 2/13/12: 7:30 a.m =530 mg/dL (prior to food and insulin/then fed and given 7 units NPH) Eats Iams Senior dry with green beans. 9:30 = 508 11:30 =621 1:30=591 3:30=558 thank you for your help --☼

Hmmm...can i see a few of the previous curves as well?

Could you first tell us what the insulin concentrations were and the blood glucose values at the exact time of those insulin values (+ reference ranges)?

Good morning, I'm looking for a little advice on my diabetic patient who belongs to an MD: "Sarah" is a 9 year old 9 Kg F/S Australian Terrier who was diagnosed with diabetes on 12/24/2012. 6 months prior to that she had a right adrenalectomy due to tumor. She was on oral prednisone post-op at a dose of 0.14mg/kg, and her resting cortisol levels were still low. After her Diabetes diagnosis, her resting cortisol level was checked again, and was a bit improved (was 1.6 , range is 2.-6.0) With the improvement, the specialist lowered her prednisone dose in hopes that this would help in her Diabetes management. She is currently on 0.07 mg/kg oral prednisone once daily, She was started on NPH on 12-24-12 at 2.5 units BID. Her mom checks BG at home with Abbot Alphatrak. Her levels were always "high" =too high to register. We continued increasing the insulin and she is now on 7units q. 12 hr NPH. Her last BG curve shows very short duration of insulin: See below. My question is whether to forge ahead with continuing NPH increases or change to Detemir BG curve 2/13/12: 7:30 a.m =530 mg/dL (prior to food and insulin/then fed and given 7 units NPH) Eats Iams Senior dry with green beans. 9:30 = 508 11:30 =621 1:30=591 3:30=558 thank you for your help --☼

Do you know if she's on novolin or humulin?

Special stains?

I take care of an 11 year old MC German Shorthair Pointer who is diabetic and hypothyroid. His diabetes has been difficult to control as he is very anxious and it is difficult to get good glucose curves. His owner can not do them at home. His hypothyroidism is well-controlled. He had been drinking excessively and when we checked his glucose and urine his glucose levels were high so we increased his insulin by 1 unit. I believe he is on 26 Units BID (sorry, I am at home). After increasing by one unit he became weak and stumbly so we decreased back down to 26 units again. After discussion with the owner, we elected to try a course of clavamox for 2 weeks to see if infection was playing a role. He seemed more energetic and perky but still drank excessively. I had the owner bring him back in for an exam. His blood glucose as soon as he arrived was 360. His blood pressure was 130. After the exam we collected urine by free catch and the glucose was 1000. He has many skin nodules (~25). I removed a subcutaneous MCT earlier this year. The rest all aspirated as fat. I sent out a cbc/chemistry panel/fructosamine level. 2/13 2/11 7/10 AlkP 491 (10-150) 609 930 Glucose 427 (60-125) Ca 12.9 (8.2-12.4) wnl wnl Fructosamine 360 (260-378) 629 350-400 good glycemic control The owner was not home to know if he was stressed earlier in the day. He eats w/d with some treats. I was thinking of testing for Cushings (do a urine cortisol to creatinine ratio to screen). I thought maybe the AlkP went down with the better glucose control but something is still underlying. I also recommended an iCa level and abdominal ultrasound. Should I not be trusting the fructosamine level? It seems more reliable in this anxious patient. Any other thoughts? Thanks, ☼

Is he on humulin or novolin nph?

Exposure to urban wildlife reservoirs?

I take care of an 11 year old MC German Shorthair Pointer who is diabetic and hypothyroid. His diabetes has been difficult to control as he is very anxious and it is difficult to get good glucose curves. His owner can not do them at home. His hypothyroidism is well-controlled. He had been drinking excessively and when we checked his glucose and urine his glucose levels were high so we increased his insulin by 1 unit. I believe he is on 26 Units BID (sorry, I am at home). After increasing by one unit he became weak and stumbly so we decreased back down to 26 units again. After discussion with the owner, we elected to try a course of clavamox for 2 weeks to see if infection was playing a role. He seemed more energetic and perky but still drank excessively. I had the owner bring him back in for an exam. His blood glucose as soon as he arrived was 360. His blood pressure was 130. After the exam we collected urine by free catch and the glucose was 1000. He has many skin nodules (~25). I removed a subcutaneous MCT earlier this year. The rest all aspirated as fat. I sent out a cbc/chemistry panel/fructosamine level. 2/13 2/11 7/10 AlkP 491 (10-150) 609 930 Glucose 427 (60-125) Ca 12.9 (8.2-12.4) wnl wnl Fructosamine 360 (260-378) 629 350-400 good glycemic control The owner was not home to know if he was stressed earlier in the day. He eats w/d with some treats. I was thinking of testing for Cushings (do a urine cortisol to creatinine ratio to screen). I thought maybe the AlkP went down with the better glucose control but something is still underlying. I also recommended an iCa level and abdominal ultrasound. Should I not be trusting the fructosamine level? It seems more reliable in this anxious patient. Any other thoughts? Thanks, ☼

Sometimes it's possible for the owner to be taught to generate curves at home....do you have any idea of what the difficulty is that the owner is having with this?

Does that interrupt the behavior?

History: Henry is a 9 1/2 year old yorkshire terrier that was diagnosed with diabetes mellitus in early 2011. He has been stable on lantus insulin for the last 12 months at 3 IU twice daily. The last curve was conducted in May 2012 and was the following; 9am 12mmol/L 11am 9mmol/L 1pm 7.3mmol/L 3pm 6.2mmol/L 5pm 6.6mmol/L Urinalysis; USG 1.040, ditpsick +++ glucose, ketones -ve pH 6.0 Culture -ve The dog was again seen on the 31st of Jan for a recheck. His weight was 5.75kg clinical examination was largely unremarkable however he was noted to be somewhat pote bellied with sparce hair coat over the dorsum. The liver was slightly enlarged and rounded on palpation. BG curve was as follows: 10am 14.8mmol/L midday 13.6mmol/L 2pm 17.5mmol/L 4pm 17.4mmol/L 6pm 17mmol/L He was subsequently increased to 4 IU BID. Upon recheck today the owner noted the dog to have any increased appetite and slightly loose faeces. There had been no notable change in drinking. His weight had dropped to 5.25kg BG curve: 9am 16.2mmol/L 11am 9.2mmol/L 1pm 12.3mmol/L 3pm 10.9mmol/L 5pm 10.7mmol/L To me this appears to be a much improved curve however the clinical picture appears to have worsened. Am I better to leave this dog on 3 IU BID or does he need further increase on dosage? Any suggestions would be much appreciated

Is the urine being regularly cultured?

Doxycycline hepatopathy?

Please, I need a help with this case. Male neutered diabetic dog (poodle), 12y, presented with vomit and loss appetite. He is on lantus insulin and his blood glucose values are under control. In ultrasound examination liver was enlarged and there is a biliary calculi in common bile duct (1.03 x 0.67 cm), with partial obstruction. His blood values: AST 5970 (6.2-66), ALT 3850 (5-82), BUN 84 (22-60), creatinine 1.0 (0.5-1.9). He was treated with metronidazole, methoclopramide, low fat diet, pain control. Now he is ok, eating well. My doubts: should we operate this dog, since he is doing well? There are medical options to dissolve stone? Low fat diet is a good option for long term, considering diabetes? I am planning to check blood values again. I´m worried to add ursodiol in this case. He has other microcalculi and biliary sludge. Thanks for any help.

How is the dog feeling at this point and what is the bilirubin level?

The parvo puppy with no money: what would you do?

I am working with a newly confirmed addisons that has been having elevation in glucose with each recheck since confirmation last week. With the last check his glucose is up to 250 with Na 126, K 6.8. I was not suprised to see a slight elevation but not this high. Do we have a possible concurrent diabetes going on? We are working on getting his electrolytes in normal range. Should we also be getting his glucose down? Help !! ☼

What does he weigh and how much pred are you using?

Off-topic a bit: what types of diseases do you routinely diagnosis via the wellness ultrasounds?

I am working with a newly confirmed addisons that has been having elevation in glucose with each recheck since confirmation last week. With the last check his glucose is up to 250 with Na 126, K 6.8. I was not suprised to see a slight elevation but not this high. Do we have a possible concurrent diabetes going on? We are working on getting his electrolytes in normal range. Should we also be getting his glucose down? Help !! ☼

What were the original electrolyte levels (actually the whole chem screen) and the acth stim results?

Why is there a yeast issue?

I am working with a newly confirmed addisons that has been having elevation in glucose with each recheck since confirmation last week. With the last check his glucose is up to 250 with Na 126, K 6.8. I was not suprised to see a slight elevation but not this high. Do we have a possible concurrent diabetes going on? We are working on getting his electrolytes in normal range. Should we also be getting his glucose down? Help !! ☼

Did you use cortrosyn?

Interesting case ...other then the proteinuria and inc alp (was the dog fasted for the chol?) does the dog have any clinical signs of cushings?

I am working with a newly confirmed addisons that has been having elevation in glucose with each recheck since confirmation last week. With the last check his glucose is up to 250 with Na 126, K 6.8. I was not suprised to see a slight elevation but not this high. Do we have a possible concurrent diabetes going on? We are working on getting his electrolytes in normal range. Should we also be getting his glucose down? Help !! ☼

I take it you're using florinef (given that percorten works so much more reliably in correcting the 'lytes)...what dose did you start with and what dose are you giving now?

How about glipizide and acarbose?

My ient is a diabetic 6yr F(S) min schnauzer. She receives 7units of NPH insulin twice daily. Yesterday, her glucose curve indicated quite an elevated 8am blood glucose of 495. But, as the day went on... 10am (450), 11am (350), 1pm (175) 3pm (135), 5pm (120). I told owner to only give 5 units of NPH last night. But, I believe that I need to adjust this. Its far too high in the morning, and seems to be too low in the evening. Should I increase the am dose to 8 units and leave pm dose, or lower pm dose a little? I'd appreciate some advice Thanks, ☼

When does she get the insulin/food?

Is this diagnosis of prostatic neoplasia solely based on mineralization on abdominal ultrasound?

Hi! I was hoping for some input on a case. Casey is a 14 yo F/S DSH. I first saw her in September 2012 for weight loss and PU/PD. Owner reported she used to weigh around 12 pounds, at presentation she was 8 pounds with a BCS 5/9. PE that day showed numerous live fleas and thyroid glands palpated enlarged. Otherwise exam was unremarkable. Labwork at that visit was as follows: CBC: Eos 5.17 (H) suspect from the fleas Chem Panel: ALP 136 (H), otherwise WNL UA: USG 1.020, otherwise NSF TT4: 7.4 (H) BP: 130 mm Hg Methimazole 2.5 mg BID was started along with flea prevention (Comfortis). Owner failed to come in for scheduled rechecks for 2 months. On that visit (two months after treatment was started) he reported that Casey was doing well, no concerns. She had gained 0.2 lbs, exam was WNL. Recheck labwork that day was as follows: CBC - WNL Chem Panel: ALP 150 (H), ALT 136 (H), otherwise WNL TT4: 5.2 (H) I attributed the liver value elevations to the still unregulated thyroid disease. Methimazole was increased to 3.75 mg PO BID She came back three weeks later and a recheck TT4 was 2.3. Owner reported no concerns and she had gained another 0.1 lbs. Owner was to continue 3.75 mg methimazole BID and we were going to recheck her again in 3 months. She just represented to me last week with a new primary complaint of hair loss. Owner has been finding clumps of hair all over the house and her haircoat is thinning symmetrically along her dorsum. Owner has not witnessed her overgrooming. They did admit they had lapsed on flea control for both the cat and the dog in the house. Owner reported no other concerns. On exam she had lost 0.28 lbs since her last visit (3 months ago). She has symmetrical alopecia along her dorsal mid-thoracic to lumbar region. The hair easily epilates and does not appear to have short/stubbly hairs like I tend to see with overgrooming. The underlying skin is WNL. No evidence of fleas. Rest of exam was WNL. Diagnostics that day included: Skin cytology/Skin scraping - NSF CBC - WNL Chem Panel - ALP 213, ALT 150, Gluc 315 TT4 - 2.7 While we were waiting on the above tests the owner was sent home with Revolution and they were instructed to restart the dog on flea preventative as well. Once I got that initial labwork back I had her return the next day and got the following: Repeat BG - 308 UA - +500 glucosuria, 1.022 USG, otherwise WNL Fructosamine 417 (Normal 142-450) I sent her home with canned Purina DM diet to start transitioning her over to that day while we were waiting on the fructosamine (which I just got today). So, that's where I'm at. My first question is trying to figure out if this is consistent with DM. Her fructosamine was normal (although high normal) so could this just be stress hyperglycemia/glucosuria or is she an early diabetic? I was considering transitioning to canned Purina DM and rechecking a blood glucose unless someone tells me to start insulin therapy. If I try just diet how long would you wait prior to checking her again? Next, I was concerned that her liver values have gone up a bit. I have seen some hyperthyroid cats where the values never normalize but I haven't had them go up. Would this warrant further workup (AUS?) immediatly or should we continue monitoring? The owner is reporting a normal attitude, normal appetite, no C/S/V/D and no changes in urinary/drinking habits. Her hairloss is still the owners primary concern which I'm a bit stumped on. I've never seen a cat with symmetrical hairloss that was not from overgrooming/pruritic skin dz. I've started her on Revolution topically. I've read about telogen defluxion secondary to any systemic illness and have seen some pictures of cats with Cushings disease. Any other thoughts on this? I appreciate any input! Thanks, br/

Are the hair tips squared off on the trichogram (which would be consistent with self-barbering) or not?

Here is a link to some previous discussions with photos: http://beta.vin.com/members/search/search.plx?b=1&s=doc0004261208+doc0003649003+&st=4&is=1&id=1 does your cat look like this?