scott@vtx-cpd.com
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Hey.
Do you have any other results from the curve of this dog? What were the other values during the day.
The duration of Caninsulin is much more variable, so 3x daily dosing would be very unpredictable and cause a lot of cross-over with dose.
Although the Glargine response is very disappointing, there are some insulins that genuinely work better in some dogs than others. It is interesting that the owner does not report PUPD. Would this owner consider a BG sensor?
Scott 🙂
Sybil,
I think you sum it up so well “We need to worry about overstretched burnt-out cynical staff more than we worry about idiot breeders”.
I LOVE THAT!
Scott x
Hello everyone.
I have heard this so much. This is definitely a real trend after the lockdown puppy boom. I could not agree more with what you have said Ashley, it puts stress on all members of the team. And the most challenging issues with these cases… MONEY!
Ultimately this comes from the top down. I think the corporate managers have to make sure we on the ground have the power to manage these cases appropriately, without worrying we will create debt and do the wrong thing. Zoe… do you remember when I did that c section for a pound!
Jokes aside… as hard as it is in the moment… I always say over and over in my head:
“none of this is the dog’s fault”
Which helps.
Scott x
Sorry.
You are absolutely right! Totally the right dose. I mean that it can be challenging at smaller doses due to the difference in concentration.
Sorry to confuse you!
Scott 🙂
Thank you so much everyone for your answers. I summarised the imaging findings below.
The cardiac comments were really interesting. My thoughts about enlargement too. We did echo this dog and found the cardiovascular structures to be normal. No heart disease noted. I obviously had the benefit of that information!:
1. Diffusely within all of the lungs there is severe poorly defined increased opacity, forming ill-defined micro-nodular/miliary-like pattern with peribronchial cuffing.
2. The cardiovascular structures are wnl.
3. The mediastinal and pleural structures are wnl.
4. The visible cranial abdomen is unremarkable.Conclusions:
1. Severe diffuse predominantly unstructured interstitial to miliary/micronodular lung pattern Ddx pulmonary haemorrhage, haemangiosarcoma metastases (no obvious splenic mass/peritoneal effusion in cranial abdomen), non-cardiogenic pulmonary oedema (neurogenic cause), less likely lymphoma/granulomatous disease with absence of regional lymphadenomegaly, less likely parasitic such as angiostrongylus/eosinophilic bronchopneumopathy/pulmonary fibrosis with absence of lower airway signs.
So the cardiac size may have been a normal variant for this dog.
Hope this all helps.
Scott xxx
Hey.
I would totally agree, I think a longer-acting insulin is the way to go in this case. I wonder whether ProZinc may be the next choice (due to licensing and ease of dosing)? If ProZinc, I would start with 0.25IU/kg BID. If considering the insulin analogs glargine (0.3IU/kg BID) or detimir (0.1IU/kg BID) the main challenges are going to be dosing (less of an issue in dogs compared to cats). Main thing is not to dilute the insulin in any way. The nadir will still vary (especially in this patient). I would monitor as you are doing with BG curves and be super aware of the possibility of hypoglycaemia in the initial stages.
Hope that helps.
Scott 🙂
Thank you Magda and Michael.
I will see if we have any more thoughts before revealing the next bit!
Scott 🙂
Really interesting case!
Could you send the timings of the most recent BG curve results. When is the dog fed?
Scott 🙂
I knew that is what you meant!
Scott 🙂
Hey.
Yes, it is the Freestyle Libre 2.
Scott x
Hello.
Using the single value to increase dose can be challenging. A single blood glucose measurement is rarely useful in monitoring DM with the exception of finding a low result, always indicative of an overdose. Single glucose measurements may be sufficient when an owner believes the dog is virtually asymptomatic, the PE is unremarkable and serum fructosamine levels are between 360 to 450 mcmol/L. In such cases, glucose concentrations between 10 and 14 mmol/l around the time of the insulin injection are consistent with good glycemic control and additional blood glucose measurements are not usually necessary.
Hope you are having a lovely weekend.
Scott 🙂
Kerida,
Thank you so much for your kind words.
We really appreciate the support.
Have a lovely weekend.
Scott 🙂
Hello.
Hope you are well. Sorry for the delay in getting back to you. Overall, the pre insulin glucose and clinical signs might be a better way to go. The problem with the 6h post insulin, is that this one result can be very variable. Remember, the main issue normally in the initial stages of treatment is avoiding hypoglycaemia.
In the more stable patients, I would be happy to rely on the fructosamine and clinical signs. Again, there may be some use in the pre-insulin BG value if other monitoring is not possible. Ultimately, a BG curse will give you more information.
Overall, clinical signs really are the most important part of this. There is definitely not a one size fits all!
Hope that helps.
Scott 🙂
Kerida!
I am so excited that this all went well with the sensor!!!
I am really happy to help with the interpretation of the results too, let me know.
Scott 🙂
Hey Alice.
So sorry for the delay. I normally place BG sensors in cats behind the head at the back of the neck. Is that what you would normally do? I would then cover it with a bit of dressing around the neck like when we bandage in an oesophageal feeding tube. Does that make sense? I have popped a picture below:
Hope that helps.
Scott 🙂
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