Home Testing Made Easy!

With the help of a sweet friend, I got Beignet’s first Freestyle Libre sensor on this afternoon. She seriously didn’t flinch in the slightest. It definitely hurt my heart to shave the application site though. The sensor is supposed to stay on for 14 days. If you scan the sensor with the reader device or your cell phone (app must be installed) about 3 times a day – you get 24 hours of readings! After the sensor is applied you must wait 1 hour before you are able to use the device. There is a 10 day Freestyle Libre which was the original model – it takes 12 hours after application for the sensitive to be ready to be used.

I’m super excited about this option. I have several family members that are always too nervous to home test when they keep her for me. This alleviates that issue completely. Saturday Bennie is due for a curve. I will still use my AT2 for the curve so that I can compare readings further. Below I posted our very first Freestyle Libre reading – as you can see it is very close to our AT2 read! Since the Freestyle Libre tests interstitial glucose and not blood glucose, I will have to do a lot of cross checks before I am able to fully use and appreciate our readings. Interstitial glucose readings will be slightly delayed compared to blood glucose readings. That means for example if she eats, her blood sugar will go up as her body absorbs the sugars in her food. It just takes longer for the sugar to be absorbed into interstitial tissue. Once we figure out the differences for Beignet this will probably do a great job of making sugar checks much faster and also giving us much more data since we will have day and night readings!

The cost of the Freestyle Libre is ~$80 for the reader (a 1 time purchase) and ~$60 for each 14 day sensor (so equivalent to 2 vials of AlphaTrak2 stripes a month). A prescription is required. Initially your vet has to call in 2 prescriptions – 1 for the reader and 1 for the sensors.

https://www.freestylelibre.us

We will post updates soon!

~Devoted Doxie Mom

Beignet with her 1st Freestyle Libre sensor.
The Freestyle Libre sensor is only slightly larger than a quarter.
Beignet’s very 1st Freestyle Libre reading crosschecked with her AlphaTrak2.

Click pic above to get your own FreeStyle Libre case just like Beignet’s pink one pictured above!  Great for anyone as clumsy as I am!

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We Love Our Vet Crew!!!

Bennie snuggling with her favorite human, Dr. Brad Everson, during a recent visit.

When you get a life changing diagnosis like diabetes, initially you may be in a fog of sorts. Even as a (human) medical professional, the thought of taking care of a diabetic pet was unfathomable – there are so many differences between the care of humans and animals. Knowing you have an AMAZING vet to get you through this journey is key! Long before her diagnosis, Beignet formed a special bond with her vet, Dr. Brad Everson at Southern Hills Animal Hospital in Shreveport, LA ( http://www.sohillsvet.com ). She gets so incredibly excited when she realizes we’ve pulled up. She adores everyone on staff, but no one quite as much as her Dr. Brad. The joke amongst the staff is that Dr. Brad is her boyfriend😂. She will literally sneak out of an exam room to look for him in his private office if she doesn’t see or hear him. She will cry and moan if she hears him in the next room, completely jealous he’s in a room without her.

Bennie has spent quite a bit of time at Southern Hills since her diagnosis in January 2018. Even at her sickest, she is always happy to be there. If she spends the day, I don’t even get so much as a tail wag because she is never ready to leave. From the moment she walks in the door she has everyone from receptionists to everyone in the back, ready to give her tummy rubs. She’s also good at getting everyone in the waiting room to rub her tummy as well. We just can’t say enough about how much we love our vet team!!!

When it comes to having a diabetic pet, you need to think of yourself as part of a TEAM with your vet. Hopefully everyone has a vet like, Dr. Brad, that they can work seamlessly with. He is always patient, answering the LISTS of questions I bring in each visit. He encouraged me to home test, letting me know Bennie would be hopefully regulated far quicker and more accurately if I was willing to home test. Having had several diabetic pets himself, he empathized with our set feeding and insulin schedules. He has time and time again gone above and beyond for my sweet girl. He truly loves her as much as she loves him. He is typically on the floor rubbing her tummy or holding her while she showers him in doggy kisses while he fills me in on everything I need to know.

My advice for anyone going through this is to have a vet you can trust and work with. Don’t make changes to your pet’s care without consulting your vet. If you want to change insulin or other medications, discuss these changes with your vet as they may have reasons for the medications they have prescribed for your pet. Be patient. Your dog will not be regulated in days or weeks. If you don’t feel you are getting correct information get a second opinion or request to see an Internal Medicine specialist veterinarian. This may require you to travel. However, they typically will allow you to send them home testing results and blood glucose curves and give you advice between visits via phone or email. Plus I think the goal of most vets and vet specialists is to get you to the point that you are comfortable making your own insulin changes, etc if you home test. If you don’t home test, your vet will always manage your dosing based on your dog’s blood sugars in their office. Thankfully if needed, Southern Hills has an Internal Medicine Specialist, Dr Treadwell, on staff if we were to need her.

Just wanted to post this Ode to Dr. Brad! I can’t even list the ways he has gone over and above for us! He actually told me when Bennie was just 2yo that he suspected she would end up having IBD when she got older, so at least I was somewhat prepared for that diagnosis. We ❤️ the Southern Hills team and the quality of care we always know we will get! When my dogs went for their ProHeart shots, Dr. Brad’s newest partner, Dr. Tori Torres, saw us. She had taken the time to review Beignet’s whole chart when she saw us on her schedule so she would be up to date and prepared for any questions I might have on Bennie’s care which really impressed me! Another partner, Dr. Brown, discovered Bennie’s dry eye diagnosis. So thankful for our Southern Hills crew!! The best of the best!!!

-Devoted Doxie Mom

Bennie with Ms. Bonnie that runs the kennel area at Southern Hills. Bonnie always makes sure my diva gets extra spoiled on all the days she is sick enough to spend the day with Dr. Brad. And she always comes to our exam room to get her snuggles if we are just in for a quick visit. Bennie trying to tell Ashley to rub her tummy instead of posing for yet another pic.Bennie giving kisses to LJ, one of her many besties at Southern Hills.

Making sure she gives everyone a turn to give her some love!

Beignet does NOT like sharing snuggles with Andouille!

An Eye For An Eye….

Pictured above is our 3rd vet specialist selfie of 2018. Beignet and I just made our first 6 hour round trip visit to see Dr. John Warren at Veterinary Eye Institute in Plano, Texas (http://www.veterinaryeyeinstitute.com/meet-our-doctors/john-r-warren/ ). When Beignet got diagnosed with diabetes, all I could focus on was that she was only 7 years old and could soon be blind due to this diagnosis. Was she going to be able to beat diabetes? Of course I just assumed as a physician she would be the best controlled diabetic my vet has ever seen (and yes Bennie decided that wasn’t going to be the case…). Was her perfect control going to be soon enough to prevent diabetic cataracts? I sure hoped so.

The doctor in me immediately thought I needed to do all the preventative precautions for a diabetic. However we had a few obstacles. First there are very few vet specialists in our area. Secondly, Beignet threw me a major ball when she became extremely ill just weeks after her diagnosis. Worries over her eyes after a 6 week struggle for her life were just a distant memory.

Dr. Warren said it is always best to see a vet ophtho as soon as possible after a diabetes diagnosis. They can guide you through what to expect. Work with you on preventative care options. And also diagnose cataracts and other eye conditions that may already be present. Depending on the source, 50-70% of dogs diagnosed with diabetes develop cataracts during the first year after their diagnosis. Beignet has 4 more months until her 1 year anniversary so we hope that we beat those odds. However all diabetics will eventually get cataracts. My almost 12yo nondiabetic has early lenticular cataracts from old age now. My understanding is that diabetic cataracts respond better to surgery than nondiabetic cataracts, so at least there’s that if I can afford surgery when our time comes.

What I didn’t realize with my focus on cataracts was the next most common eye disorder in diabetics, Keratoconjunctivitis Sicca (aka dry eye). After a bout with corneal ulcers, Beignet received this new diagnosis weeks ago. Having the same diagnosis, I have some idea of what she’s been going through. However my dry eye doesn’t involved nasty snot pouring from my eyes all the time (thankfully). Beignet can at times not open her eyes. She blinks repetitively. I’m constantly having to clean her eyes and apply drops. If your diabetic dog has mucus discharge of any color from his/her eyes, please have your dog tested for dry eyes or better yet, see a vet eye doctor if you haven’t already. When Beignet saw Dr. Warren, she still had ZERO tear production in either eye. She has to do a month of once daily steroid drops along with a compounded 3 time a day immmunosuppressant drop that will hopefully stimulate tear production. If dogs fail therapy they can transplant a saliva gland from the mouth to the eye which causes nonstop tearing. We hope we don’t have to resort to this….

We will be traveling back to see Dr. Warren in a month. Please pray that her eyes are responding to treatment. We are feeling a little defeated at the moment. I keep thinking – what next?? Before 2018, we had minimal issues. So far, it’s been diabetes followed by chronic pancreatitis followed by suspected jejunal inflammatory bowel disease followed by a new heart murmur and now this. You can see with all that, why we aren’t the perfectly controlled diabetic I initially thought she would be (although is there even such a thing???). Her eye issues require more time than anything else. And for the record her heart issue was insignificant. Despite it all except for the 6 weeks in February/March and this past month this sweet baby has been nothing but happy no matter what she had to deal with. I’m hoping we get back to that fun loving, tummy rub obsessed, tail wagging, loves everyone happy girl again!

To end, my advice is even if you have to drive, get your dogs eyes checked! Even if you can’t afford cataract surgery, getting established might improve you dog’s long term outcomes. And what if your dog has treatable dry eye, like Bennie or another easily treatable condition? Not treating can lead to vision loss. I definitely don’t think a $125 visit was at all unreasonable especially in that it was the nicest vet office I’ve ever visited. Just wish he was a little closer!!!

~Devoted Doxie Mom

Addendum : A lot of diabetic dog owners go ahead and start lubricant eye drops when their dog is diagnosed to hopefully prevent their dog from getting dry and becoming more susceptible to corneal ulcers. Here is the type many use pictured above. Click on the pic to purchase.

Although it was recommended that Beignet not use just drops.   Instead, Dr. Warren insisted she use the GenTeal Tears Severe Gel (not to be confused with the version for nighttime that’s a step up from this which we were told not to use). You can purchase the gel by clicking on the pic ABOVE

There is no set brand of eye wash you have to use. It’s best to use a dog version of an eye rinse though or sterile water whereas the GenTeal brand of dry eye products are actually made for humans but okay to use on pets. I’ve posted a link to our favorite sterile eye wash below. Click on the pic to purchase.

Should We Be Enticed by Entyce??

Anyone else ever had to offer their diabetic a literal buffet to try to entice them to eat in order to get that all too important insulin injection done??? For Beignet, add in the diagnoses of chronic pancreatitis and suspected jejunal Inflammatory Bowel Disease (IBD). If we have a flare of either, then meal time becomes an absolute nightmare🤯🤦‍♀️😭! When Bennie was hospitalized with the internal medicine service at Texas A&M Vet school, I was told to offer her different wet and dry options until she hopefully decided to eat something. That plan doesn’t work for Beignet at all. Thankfully they sent us home with something that did help – the new dog appetite stimulant, Entyce®️ (capromorelin).

When they initially prescribed it, I had questions. I had heard the sugar content was high and that it could potentially interfere with insulin. I’m not sure if it has now been studied in diabetics, but it had not been back in March. Our vet team listened to my questions and concerns, and said that I was absolutely correct in that its use is currently controversial. However, they said it was far more important that Beignet start eating (she had been very ill for ~4 weeks at this point) and that she would only be on the medication once daily for 4 days. So basically in the grand scheme of things, potentially having a few days of a higher sugar was a small price to pay if she overall improved. We’ve used Entyce®️ several times since March for flares. I only noticed her blood sugar increasing with our last round back in June. I’ve seen others post that their dogs increase every time. It takes about 1-2 hours for it to kick in on Bennie. So if I don’t know she’s not going to eat, its not as helpful day 1 of a flare if I want her to remain on her regular insulin schedule. I personally wouldn’t use this for the overly picky diabetic, but more for illnesses like pancreatitis and IBD. If your dog is in the latter category, its something you can potentially discuss with your vet. Since it is new, many vets are not using just yet. Our vet said we should always have Entyce®️ and Cerenia®️ on hand in case of a flare. We spilled some of our prescription from Texas A&M, so Dr. Brad ordered us a new bottle which was the first prescription they had dispensed from Southern Hills Animal Hospital (although they have used it on hospitalized patients with great results). Just sharing this to reiterate that this is a new product with a lot of promise for our diabetics with pancreatitis and/or IBD, but is something you may have to do a risk/benefit discussion with your dog’s vet if needed. Since we had some on hand, he had me give a one time dose to Andouille, my other dachshund, who refused to eat after having a procedure under anesthesia. It worked great for her as well! Hope this info helps since I left out info on Entyce®️ on my pancreatitis post!!

-Devoted Doxie Mom

The Panic of Pancreatitis

Is there anyone who’s heard ‘pancreatitis’ and not freaked out a little? And if you didn’t freak out, maybe its because you truly just didn’t know much about it. I will review what pancreatitis is, how its diagnosed, how its treated, the prognosis, how to prevent pancreatitis and our personal pancreatitis journey with not 1 but 2 doxies.

First you might be wondering what your dog’s pancreas has to do with diabetes. The pancreas is an organ that has both endocrine (think insulin production) and exocrine (think digestive enzymes for fat and protein breakdown) functions. So since the pancreas has endocrine functions it is most definitely involved in diabetes. Pancreatitis can be acute or chronic. It can be mild or subclinical, it can also be severe. Pancreatitis can cause diabetes. Its also said that diabetes can cause pancreatitis.

Here’s a little breakdown of how pancreatitis happens: Pancreatic ‘juices’ get secreted ➡️ Other enzymes get activated ➡️ Damage to the exocrine pancreas occurs (Ex. Bleeding, swelling, inflammation, breakdown including fat breakdown, etc) ➡️ The body mounts an inflammatory response ➡️ Enzymes and inflammatory substances spread throughout the body ➡️ General inflammation spreads throughout the body affecting multiple organs. So with all this potentially going on, you can see how even just one episode of pancreatitis could cause permanent changes to your dog’s pancreas.

SYMPTOMS of pancreatitis can be vomiting, anorexia/hyporexia (not eating at all versus decreased appetite), dehydration, fatigue, weakness, pain, depression, diarrhea, fever, high heart rate, breathing difficulties, shock, etc. My non-diabetic dachshund was diagnosed with pancreatitis years ago and her only symptom was that she wasn’t sleeping well. She was constantly up and down, because she was unable to get comfortable due to pain.

You may never know the CAUSE of your dog’s pancreatitis. Many cases are idiopathic, or cause unknown. Here are some potential causes:

    Diet and nutrition are important triggers. Generally this is a high fat/low protein diet. There are typically an increase in cases around the holidays when dogs tend to get into table food they shouldn’t. Always ensure your dog can’t get to food or your trash! It can happen with just one ‘meal’ of fatty table scraps. Also certain prescription diets such as those that help dissolve bladder stones.
    Hypertriglyceridemia is when there is excess fats circulating in the dog’s blood (typically >500mg/dL).
    Trauma
    Hyperadrenocorticism
    Obesity
    Surgery – although this is now thought to be caused by decreased perfusion to the pancreas during anesthesia
    Drugs/Toxins
    Infections
    Hypercalcemia
    Associated illnesses

Any dog can be affected by pancreatitis. It is more common in middle aged to elderly dogs. It is more common in females. Research from necropsies are beginning to show far more dogs are affected than anyone originally thought. Certain breeds are known to be more predisposed to pancreatitis. Those include: Schnauzers, Poodles, Cocker Spaniels, Yorkshire Terriers, Dachshunds, etc.

DIAGNOSING pancreatitis whether acute or chronic can be very tricky! I was shocked to discover Beignet had chronic pancreatitis. How could I have not known she had it??? In humans, lipase and amylase elevations typically give you your diagnosis but do not determine severity of disease. Amylase shows elevations within 5-8 hours of symptom onset and returns to normal by day 3-4 and reaches a maximum 12-72 hours after symptom onset. Some research supports only checking lipase in humans due to it being elevated both in the early and late stage. Lipase elevates within 4-8 hours of symptom onset, peaks at 24 hours and returns to normal within 8-14 hours. In humans, both amylase and lipase can also increase with other disorders. I feel its important to understand a little about human diagnosis to help us understand dog diagnosis. Below I will go through each diagnostic option in dogs:

  • CBC & Chemistry Profile: These are extremely important to evaluate the dog for systemic complications, but are NOT useful to diagnose pancreatitis. In a dog with pancreatitis, you may commonly find signs suggestive of nonspecific inflammation, a decrease in platelet count, an increase in neutrophils with a left shift, increased BUN and creatinine, increased liver enzymes, increased bilirubin, etc. Although amylase and lipase are on the Chem profile, they are described below.
  • Amylase: Has very poor sensitivity and specificity. Very limited as a measure of pancreatitis diagnosis. Possibly given the human info above, its already potentially normalized by the time the dog presents to their vet.
  • Lipase: This is generally on most in-office metabolic panels. Lipases are something released from multiple organs including the pancreas, liver, stomach, endothelium etc). A serum total lipase is NOT specific for pancreatitis. An article online from Texas A&M Vet School said it could miss up to 86.4% of pancreatitis patients. Lipase can be increased by steroids, cancer as well as diseases of the kidney, GI tract, and liver. Also there is an increase in false negatives in pancreatitis patients due to hemolysis, lipemia and icterus (jaundice). Beignet has never had an elevated amylase or lipase.
  • Serum Pancreatic Lipase Immunoreactivity (PLI): The Spec cPL®️ specifically tests for pancreatic lipase and has rare false positives. In office rapid cPL tests are available, but generally cPL tests are send out tests for most vets. This test is how we got Beignet’s diagnosis of chronic pancreatitis. http://vetmed.tamu.edu/gilab/service/assays/pli. Be aware that many GI conditions can cause mild pancreatic inflammation. This in turn can increase your cPL test. Sometimes a repeat cPL maybe needed to help determine if the dog has a primary or secondary pancreatitis.
  • Trypsin-like Immunoreactivity (TLI): This is the diagnostic test of choice for EPI as it tests exocrine pancreas function. It is not very sensitive for pancreatitis though.
  • Abdominal X-ray: This is more important to help excluse other diagnoses in your vet’s differential diagnosis (the diagnoses your vet is ruling in or out including pancreatitis). Findings in pancreatitis will be nonspecific.
  • Abdominal CT or MRI: Very insensitive in cats and never truly evaluated in dogs. Probably not worth what this would cost you.
  • Abdominal Ultrasound: Highly specific for pancreatitis, but just seeing an enlarged pancreas with fluid accumulation around it is not enough to give you the diagnosis. With newer high resolution ultrasounds, occasionally pancreatic nodular hyperplasia could be misinterpreted as pancreatitis. When it comes to an ultrasound, consider the expertise of the ultrasonographer (who maybe your vet), quality of the machine, and the level of suspicion of your ultrasonographer. When Beignet was sick, my vet told me his ultrasound machine was older and if we wanted to do one locally, he would send us to do one on a better machine. We were going to a vet school, and chose to wait to do one there done by their radiologist. I was able to see chronic changes quite easily on the entire left side of Bennie’s pancreas on her ultrasound😢. Contrast enhanced ultrasounds have improved diagnostic evaluations but aren’t routinely done.
  • Pancreatic Cytology or Histopathology: This can give you a definitive diagnosis. FNA (fine needle aspiration) of the pancreas has been reported to be safe. But sometimes the disease is very localized, so a normal FNA does not exclude pancreatitis. Biopsy on the other hand can increase a dog’s risk of pancreatitis as compared to FNA. If pancreatitis is severe, a dog’s anesthesia risk is much greater. An exploratory lap or FNA may be too risky in severe pancreatitis.

If your dog has joined us in the pancreatitis club, you maybe curious about TREATMENT options:

  • Aggressive fluid treatments with electrolyte replacements if needed.
  • Remove any potential causes.
  • +/- Gut rest. Recommendations on this vary. Definitely will be done if the dog is vomiting despite anti-nausea medications. Beignet required it.
  • Nausea medications: Cerenia and ondansetron are potential options
  • Pain medications
  • +/- Antibiotics: these have questionable value so are not routinely recommended.
  • Reglan (metoclopramide) for improving gastric motility. It can help with nausea but should not be used as the dog’s anti-nausea medication in pancreatitis. I read that it could decrease blood flow to the pancreas potentially. Bennie was put on this for gastric emptying and it was increased from twice to three times a day when she was hospitalized at a vet school.
  • Reflux medications. Many dogs are put on them but I haven’t seen them listed as parts of treatment. Bennie was put on omeprazole but advised to stop after a week due to potential issues with long term PPI use. However she may have been put on this more for her suspected IBD than her pancreatitis.
  • Food: May require a permanent food change. Generally <10% dry matter fat, but Ultra Low Fat diets are what we will see being recommended in the future. Stay tuned for an upcoming post with all my dry matter fat calculations. Do not use the fat percent on your dog food label (unless Hill’s, who often has the actual dry matter fat values on their labels) but instead put the information into a calculator like this one http://fnae.org/dmb.html. Know that these values are minimums and typically the food contains ~3% more fat than what you calculate. You can always contact the company to ask for the actual value. Early nutritional support is a key component of successful treatment in humans with pancreatitis.
  • Plasma transfusions maybe needed in severe cases of pancreatitis.
  • If a dog isn’t responding, prednisone, prednisilone, or cyclosporine maybe given. Cyclosporine for a dog with diabetes is preferred as it has less of an impact on insulin resistance. There is not a lot of data on its use in chronic cases.
  • Entyce – a newer appetite stimulant maybe needed to get your dog to eat. Since I forgot to originally add this, I will post about Entyce in an upcoming blog.

To PREVENT pancreatitis, keep your dog at their recommended, ideal weight. Avoid feeding foods high in fat. Work on a weight loss plan for your dog if they are overweight. Discuss any medications your dog is on with your vet to determine if they potentially increase your pet’s risk.

Your dog’s PROGNOSIS depends on the severity of disease. Risk factors for poor outcomes include: hypothermia, acidosis, low calcium and failure of 1 or more organs. Chronic pancreatitis typically has better outcomes, but may eventually cause diabetes (like in Bennie) and/or other diseases that affect the dog’s quality of life. There are many dog’s like Beignet that have an upset tummy here and there, but aren’t very ill. So even with a visit to the vet, no one is aware that the dog is actually having a mild pancreatitis flare. Chronic pancreatitis maybe associated with intestinal or liver inflammation.

This went a little longer than I initially intended. My information is more to give a better understanding of pancreatitis and should not replace the care and advice of your vet team. My information comes from my own personal medical knowledge and reading various articles over the past months. Texas A&M vet school has many great articles on pancreatitis. The Merck Manual online also has some great reading on dog and cat pancreatitis. Hopefully if you experience an acute flare your dog does well! I will tell Bennie’s story in a future post.

-Devoted Doxie Mom