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Willow71

Willow71

Member Since 2017
Getting worried that Willow is going downhill again. She has been back from a stay at the vets for two days for DKA and sore tummy - possible inflammation again in pancreas/gallbladder. We have been instrudted to give her 1 U Actrapid as needed when BG over 14 - every 2-6 hrs), in addition to the 2.5 U of Caninsulin twice a day. She has also been on potassium supplements for a few days. Her BGs appear to be very slowly coming down but are still in the early 20's. The other day i accidently gave her a whole metronidazole tablet which the vet said was okay - we only had these as an "incase" we start them option. The thing is later that day her levels for BG were a lot better at at least 16. Yesterday she ate pretty well but was getting a bit fussier and didnt want water in her food so we reduced the water (we do this to help with her hydration since she often gets a bit dehydrated). Today she has eaten small amounts of low carb but not much so we gave her her favourite food whoch is of course higher carb but is a gd indicator with how well she is. She did eat it at least. She definitely doesnt seem very bright today though.
Anyway I decided Id start her on metronidazole 1/4 tablet twice a day as on the prescription as she seemed to improve when she had the accidental dose the other day (could be coincidence but when she has had other antibiotics she has improved every time).
I also had Cerenia for nausea so gave that and I believe it has anti-inflammitory properties too? I also gave her the pain med the vet had prescribed for a few days - Buprenorphine. I had not given this last night as vet had said gave for a couple of days but now Im wondering if not giving this last night has contributed to her feeling worse.
Ive been filling in her spreadsheet since back from the vets the other day. As you can see today she was 22.2 BG and I did blood ketones as couldnt get urine and these are up again at 6.8 though they do tend to go up and down.
Ill monitor and if needed will take her to the ED vet again but hoping to avoid it as it stresses her out so much. But if I suspect DKA Ill definitely be heading up there.
She unfortunately doesnt tolerate subcut fluids well at home but I might syringe abit of extra water throughout the day via mouth.
The issue with willow seems to be a lack of response to insulin even with increases and the rapid acting one and the vets think this could be due to inflamed pancreas that she had but also they are wondering about her gallbaldder - tests previously for pancreatitis was positive.
Any comments suggestions would be appreciated. (The info is in the World spreadsheet column)
 
I suggest you try raising her dose carefully. She has to get out of those high numbers. The fast acting insulin is a complicating factor. If you weren’t using that you could raise the dose in 0.25 u increments every 3-4 cycles until you start seeing yellow and blue.
 
I think she needs 3 U. I might look at raising her Caninsulin. She had increased a few days before the vet stay from 2u to 2.5u then just on the ActRapid for a day at the vets...then they got her back on the caninsulin 2.5 the next day. It's been 4days back on caninsulin but with ActRapid too. I might increase her Caninsulin tomorrow morning. It's hard doing .25 increases as the syringes don't even have half units. Not sure if I can get U40 syringes with smaller markings here in Australia?
 
Her blood ketones have gone up as far as 15 once. I think she had a vet stay that time. She had ketones in th Euronext as well that time. She has had blood ketones around 7 before and they have come back down - I think we gave subcut fluids that time. I'll keep a close watch on them today. Going to try and catch a wee to check if they are coming through in the urine.
 
With the ketones that high, how often do you test for them? I know you said she doesn’t tolerate sub q fluids at home. HERE’S a video on giving them, maybe there are some suggestions to make it easier for you.
 
I’ve just tested her again two hrs later and her BGs are still 22.3 and ketones the same but at least not increased. Though st least only up .01. She won’t eat the normal low carb food so the higher carbs given today aren’t the best thing for her but better than not eating. I’ve just given her an appetite stimulant so I can hopefully give her her low carb food later. I don’t usually give her the higher carbs anymore and she’s on the sensitive stomach food usually.
 
Oh, you poor things. Where are you in Australia? I'm on the Gold Coast but from Melbourne originally.

It does seem to me that Willow might have something else going on. My thoughts are either...

1. Gallbladder issue. If treated, no more pain, appetite will return and maybe BG will decrease.

2. Pancreatitis. There is a specific test for just this I think. It is a painful condition and if Willow does have that, they can fix it and again, no more pain, better appetite and more responsive to the insulin.

3. Recurring DKA and some sort of insulin resistance.

4. Some other underlying infection no one can find. If having an antibiotic seemed to make her feel better, that would imply it did SOMETHING, but to what exactly?

They NEED to know if there is something going on, and if so, what it is!

They can't just keep sending her home and then the ketones are still there and the BG is still high so they get worse. This is similar to my Dweezil all over again.

They used the Actrapid on Dweezil in the hospital too (I didn't know you could use it at home!) and even that didn't do that much. Still low 20s (pinks). I don't know why they didn't keep him on it until his BG went lower.

I think keep using the Actrapid as often as needed (meaning once she gets to 14+ use it again) alongside the 2.5 units of Caninsulin, and if you can get her to stay mostly even just below 14-ish for a few days AND she's eating, those hideous ketones SHOULD go away.

Then you can raise the dose of Caninsulin to 3 units.

Nope, we can't get half marked syringes here annoyingly, but you can from online US pet shops, but just make sure they're the right ones for the Caninsulin / Vetsulin.

Also, does Willow ever eat the Fancy Feast low carb options many people use here? There is a good variety, even in Australia.

Maybe her food is keeping her high.

It is so hard to know.
 
Thank you - I agree we need to know what else is going on because something is definitely stopping her from stabilising and making her not very responsive to insulin - even the ActRapid one. Tonight her BG was at least under 20 - it was 19.3..... Interestingly we have started the metronidozale antibiotic today. Im going to insist she stays on it for full course and then a standard antibiotic for quite a while until we get her well properly. Her ketones in blood are at 5.6 so slightly down - I managed 15mls of subcut water earlier so I will try that again soon. We attempted to go to the ED vet but they had several emergencies that were critical and said noone would see her for at least an hour or we could just have her wait there - we chose to bring her home, got some food into her and gave her 3U of Caninsulin - Ive decided Im going to do the increase tonight but will monitor her carefully. We will go back to the vet if we feel she needs to.
I might try to get fancy feast for variety. She is on Royal canin sensitive wet food which is low carb low allergy.
BTW I'm on the Central Coast NSW.
 
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She's down to 15.2 tonight! Not sure if it's the extra Caninsulin but you wouldn't think it would change so quickly. I am suspecting that the metronidazole might be working...and maybe the extra Caninsulin.? Either way I'm happy we finally have a number in the yellows!
 
Willow71 said:
She's down to 15.2 tonight! Not sure if it's the extra Caninsulin but you wouldn't think it would change so quickly. I am suspecting that the metronidazole might be working...and maybe the extra Caninsulin.? Either way I'm happy we finally have a number in the yellows!
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Well that’s good news. I am glad you tried 3 tonight.
 
That yellow is promising. Give this dose again this AM and tonight and then go up if numbers are still high. Keep your SS updated and post for dosing advice. If something else is going on you can dose around it until it’s uncovered and treated. I wouldn’t give the fast acting insulin at the same time though.
 
Kris & Teasel said:
That yellow is promising. Give this dose again this AM and tonight and then go up if numbers are still high. Keep your SS updated and post for dosing advice. If something else is going on you can dose around it until it’s uncovered and treated. I wouldn’t give the fast acting insulin at the same time though.
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Hi yes I'm hopeful the increase may be helping but also suspect the metronidazole. I'm updating her spreadsheet regularly as I test.
 
Yes I’m glad we raised the insulin and gave the metro. Her BGs are 14.3 currently but she has had bits of higher carb food as that’s all she will eat today. At least it’s still in the yellow numbers. Her blood ketones have increased again to 7.2. I’ve given another 15 ml approx subcut fluid so hoping this helps. Also just a half dose pain med as she’s been a bit wobbly today due to being unwell and I don’t want to make her too unsteady. Hopefully she will be feeling a bit better in the morning
 
Willow71 said:
Yes I’m glad we raised the insulin and gave the metro. Her BGs are 14.3 currently but she has had bits of higher carb food as that’s all she will eat today. At least it’s still in the yellow numbers. Her blood ketones have increased again to 7.2. I’ve given another 15 ml approx subcut fluid so hoping this helps. Also just a half dose pain med as she’s been a bit wobbly today due to being unwell and I don’t want to make her too unsteady. Hopefully she will be feeling a bit better in the morning
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When there are ketones in the picture you can feed higher carb food to allow a higher dose of insulin to be given. Let her eat whatever appeals - the high BGs and the ketones are far more serious.
 
This 15 is excellent news. And while eating the higher carb food too.

So...we can establish that her body CAN respond and get into lower numbers. And that the antibiotic MAY be fixing SOMETHING we're not sure about.

What I'm wondering is how her ketones have risen after that BG of 15 and lower ketone reading earlier. Shouldn't they have kept going down? Why have they risen, especially if she's eating and higher carb food? Does she just need more fluids and more time at lower numbers?

I'm not sure how to handle giving regular Caninsulin twice a day as well as the ActRapid when needed. I guess that's not such a worry until / unless her BG starts getting quite a bit lower. We don't want to give AM caninsulin, then wait 3 hours, see numbers still above 15 so give ActRapid and then both insulins work suddenly at the same time to give a hypo result. I know this is highly unlikely, but does anyone know if this could happen?
 
Yes I haven’t given any fast acting today. She was 18 BG this morning and then 18 again three hours later. She would only eat high carb food but I got 25mls subcut fluids in this morning as well. The blood ketones were 6.2 ... hopefully slowly reducing. I’ll give more subcut fluids in a few hours. Not sure how often to give but I’m thinking it was every 4-6 hours maybe for fluids?
 
Willow71 said:
Yes I haven’t given any fast acting today. She was 18 BG this morning and then 18 again three hours later. She would only eat high carb food but I got 25mls subcut fluids in this morning as well. The blood ketones were 6.2 ... hopefully slowly reducing. I’ll give more subcut fluids in a few hours. Not sure how often to give but I’m thinking it was every 4-6 hours maybe for fluids?
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I can't advise about fluids but I recommend not lingering at the 3u insulin dose very long. Give it again tonight and then bump it up to 3.5 u tomorrow AM. Normally we'd say bump up by 0.25 u but this is a special case where ketones are lurking. Keep testing for them. Feed her whatever she wants to eat. Hold off on the fast acting insulin.
 
You could split the fluids to twice a day. So if you are told to do 100 ml, you can do 50 in the morning and 50 in the evening. Just make sure the ones from the previous session have been absorbed so you aren't over hydrating.
 
We had to say goodbye to our precious baby girl Willow today. Such a hard decision to make but we had to let our Willow go... her little body was shutting down so we did what was the best thing for our baby girl.
 
Willow71 said:
We had to say goodbye to our precious baby girl Willow today. Such a hard decision to make but we had to let our Willow go... her little body was shutting down so we did what was the best thing for our baby girl.
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Oh no! I'm so so sorry! I know you tried everything you could. Rest in peace
 
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