'The true Soldier fights not because he hates what is in front of him, but because He loves what is behind him.' -G. K. Chesterton

15 June 2010

Canine Diabetes Mellitus

Time for a Trooper update. I also want to document our journey so if anyone out there finds themselves in our shoes you'll have a starting place and an idea of what's involved.

First the weasel words. Trooper has Insulin dependant Canine Diabetes Mellitus. He's also
14 1/2 years old, mostly blind, a little deaf with a bad thyroid, allergies, no testosterone production and an artificial hip. This is our story, his and mine and I'm doing things the way that seems best to me from my Vet recommendations and what I've learned through research and trial and error. Please educate yourself and seek advice and treatment from a reputable Veterinarian. I am neither a Veterinarian nor a medical professional. My advice is based on my experience. Your mileage may vary.

All things considered Trooper is doing well. He's responding to the insulin and has gained some more weight. He's slowed down considerably but still manages to get around. His eyesight has stabilized but he's sprouting some skin growths that are probably cancerous. We're going to have them removed by freezing (he can't take any more surgery) when he stabilizes but otherwise I'm not overly concerned.

This is his medicine cabinet. I think I need one of those little grandpa pill containers. Insulin, Syringes, Joint Care, Hydroxazine, Levothyroxine, Prednisone and Rimadyl. Add in eye goop and Iodine for his skin growths and our medicine regimen is full.

Lu made a log so we can keep track of what he gets and when he gets it as well as food and testing. I try to keep pretty meticulous records so if something comes up I can more easily diagnose the problem. Have I mentioned how lucky I am to have Lu around? She's a real peach.

Shots. I was most concerned about the twice daily injections but that fear was unfounded. I got good info from the Vet and thankfully Trooper is very stoic. The shots don't seem to bother him at all. The syringes are incredibly thin. 30 gauge and very, very sharp. I've stuck myself a few times and they went in almost without sensation. No pain. They are one and done. Don't reuse syringes. The easiest place for me to stick is on Trooper's neck. The skin and flesh are thick and I can easily find the skin behind the fur.
Insulin must be mixed but do it gently. Follow the directions and your vet's recommendations. The insulin will bubble badly if you shake it vigorously. Also, mix exactly the same way every time. Consistency is key to insure he's getting the same dose every time. Otherwise he'll yo yo, the tests will be inconsistent and you'll have a harder time getting the dosage correct.

A word of caution on filling the syringe. You must be certain all air bubbles are out of the syringe. If you get a vein the insulin will still work but if there's a bubble it can kill your dog. My syringes come with a small gap between the plunger and the base of the syringe. I start by depressing the plunger all the way. I insert the needle and do a partial draw. I flick the needle body with a finger nail and watch to make sure all air bubbles rise to the top. I press the plunger and expel the air and insulin completely. I do another draw 1 unit past the dose and then press the plunger again until I get to the correct dosage. Now we're ready. Get trained by your Vet and practice before you do your first injection. When you're ready be confident and sure handed. A word on units. Be sure you go over this with your Vet. It's easy to miss read the unit markings and give too much or too little and either can have catastrophic results.

I have Trooper lie down and get settled I grab a handful of loose flesh and expose the skin underneath. Trooper handles the procedure without complaint. Seriously, he's under absolutely no stress. I wish I was more like him.

When we're both ready and I've picked the injection site i make a quick stab at a shallow angle and press the plunger to the stop. In this photo I'm pinching, lifting up and pulling forward. The injection is going in toward the head, below the pinch and into the meaty part of his neck flesh while not into the muscle. I was trained to do subcutaneous but intra-muscular is also acceptable.

Trooper doesn't need a treat afterward and sometimes he'll get up immediately after and go find a place to catch a nice nap. Still, a juicy tidbit makes the medicine go down more easily. If you have a sensitive dog I recommend you have someone hold the treat where he can see it and give it immediately afterward with plenty of praise. Lu and I are ready in case Trooper should decide he's had enough of the needles. The one in my other hand is for sister Chrisi. Can't leave her out. Anything Trooper gets she gets. Except the shot of course.
Have a sharps container handy. Most pharmacy's will take used needles for disposal. Do not throw them in the trash. Sooner or later you'll have a line of junkies at your house stretching around the block.

Diet is critical. We chose a quality brand dog food (the same he's been eating in fact) as opposed to making our own. We get good and consistent nutrition and don't have to deal with the effects of changing his diet. If you're a dog owner you know exactly what I'm talking about. I limit treats to hard biscuits, again a quality brand. I feed 1 cup of dry mixed with 1/4 cup of canned at injection times. He should eat when the injections are given. Afterward I put 1 to 2 cups of dry in his bowl for between meal snacking. Food should be available when the dog is hungry. Again, consistency is the key. Monitor the dog to see when he's eating and how much and modify your feeding accordingly. With Trooper, he eats only when he's hungry and neither of them is a food thief. Food can stay in the bowls all day.

Also monitor output. Yep, you can't overlook anything. I test his urine every morning before the meal and injection. Consistency has become our byword. I watch his leavings for texture and frequency. One problem for Trooper, and it is probably as much a function of his age as his Diabetes, is gas. If he's not eliminating regularly or if it's becoming too firm I'll modify his diet. It usually means a night lying on the floor with him, rubbing his belly and talking soothingly as he pants heavily. This is where the log comes in. I know exactly what he's eaten, how much and what treats. Trooper hates it but table scraps are strictly off his menu as are the more spicy treats like pigs ears (his absolute favorite) and anything that tends to plug him up. Like cheese.

At the risk of driving it into the ground, consistency is absolutely key. For me, that consistency is maintained by monitoring everything and the log book. I tend to spend as much time with Trooper as I can and most days that's 24 hours. Luckily I'm retired so I have that time to spend. Lu has been invaluable as anytime I'm not there she is and Trooper both loves and trusts her. If you're single make a good friend or two. Help can can literally be the difference between a comfortable life and a painful death. Insulin must be given at precise 12 hour intervals with food and if you're working or just human schedules can be a problem.

When we started down this road I was concerned that I'd be overwhelmed. With Lu's help (and the DO when she was visiting (Thanks sweetie) and Trooper's stoic acceptance and trust in me it has been a lot easier than I could have hoped. Again, consistency helps here as well. I don't have to remember, I have it written down and I do the same things the same way at the same time every day. Dogs tend to like routine and it lowers both your and his stress levels.
There are pitfalls to be aware of, primarily Hypoglycemia and Ketoacidosis.
Hypoglycemia is too little blood sugar and can be caused by too much insulin, a missed or late meal or a vomited meal. Monitor at all times. If you think you might have missed an injection but can't remember don't give one. Lack of insulin makes Trooper feel sick but an overdose may kill him. We have syrup and honey immediately available in case of hypoglycemia. Rub some on the dogs gums, do not pour it into his mouth, and monitor. Call your Vet or an animal hospital.
Canine Ketoacidosis is a condition that is triggered by chronic (severe) diabetes. It is caused by the body breaking down fats in the body for energy when there isn't enough glucose available. It requires immediate Veterinarian intervention. In fact in my opinion both conditions merit such intervention. Don't mess with this stuff. I urine test for glucose and ketones every morning and log the results.
Here's a typical day for us.
7:40 am and the alarm goes off. I get up and rouse Trooper. We go out for a pee and urine test. Back inside and I fix the morning meal and morning meds. Chrisi joins us by this time because she's The Princess after all and 7:40 am is for the peasants. Meal done and we sit for eye goop and lesion treatment. I have Trooper lie down and prepare his injection. Precisely at 8:00 Trooper gets his first shot of the day. Afterward he usually goes off to bed and if it's been a rough night I join him. Otherwise I get on with my schedule. I refill food bowls with 1-2 cups of dry and top off water. If I have errands this is a good time. I don't stay away long and usually Lu will baby sit for me. I clean the yard (every day) and analyze leavings. I've become quite the poop expert. I watch his food and water intake throughout the day. By evening everyone is pretty well settled. 7:45 pm and I fix the evening meal with evening meds. More eye goop and Iodine. I prepare his evening injection. 8:00 pm on the dot he gets his second and last shot of the day. This may be followed by a treat if he's in the mood. Dry food in the bowl for night time snacking, a check of water bowls and usually he's done for the night.
Lu and I tend to sleep with an ear cocked for certain sounds. Trooper has gas occasionally and when he does he pants heavily. That means a night on the floor, cuddled with him, rubbing his belly and talking soothingly until he gets relief. He also sleeps hard enough that he gets lost in a dark room. We keep lights on in the house and outside every night but he's pretty groggy when he wakes up at 0 dark thirty. We've both shot out of bed from a dead sleep many times upon hearing him bumping into things and panting. He also can't always make the door outside so we've placed throw rugs and carpet runners in strategic locations to catch the accidents. It's a fact of life and one we don't obsess over. Besides, Lu can awaken from a sound sleep at the drop of a poop and insists that clean up is under her sole purview. I do so love that woman. She also frequently takes the morning routine after a particularly tough night for me and the boy.
Diabetes, especially in an old dog and coupled with other medical conditions, can be challenging but it's not overwhelming. Just get educated, have a good Vet (one who is very well versed in Diabetes), have a plan, monitor and log everything and be consistent. After a lifetime of training for and implementing killing and police skills I've found a joy in tending to Trooper. I'm a pretty fair nurse. Who would have guessed? Also, don't get stressed out. If you need a break take it just make sure you've got someone you trust to take over. Trooper is well attuned to my moods and if I'm stressed or in a bad mood it affects him as well. Lu and I still ride and I get to the gym as often as I can.
I've added some good links to the warrior Roll but there are a lot of great places out there to get information, helpful tips and inspiring stories. If anyone who reads this has any questions or needs some support or advice please contact me. Lu and I will help in any way that we can even if it's just to hold your hand.
As for Trooper, Lu and me, we've found a happy place and we're coping just fine. I'm overjoyed that I still have my best friend and I'm determined to make his final days as easy and happy as I can. I owe it to him and it's a true labor of love.
Thank you my friends for your advice and support. It has meant the world to Trooper, Lu and me.


JihadGene said...

It's like having family. Hell, my dogs ARE family! Great Post!!!

Six said...

Thanks Gene. Yeah, he's definitely family. When he goes, and it's coming, I'm going to be a bag of broken glass.