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Dr. Joey
Dr. Joey, Board Certified
Category: Dog
Satisfied Customers: 5007
Experience:  15 yrs in practice, specialist canine/feline medicine
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We have an 11 year old male, weight 10.5 kilos In March he

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We have an 11 year old male ***** *****, weight 10.5 kilos
In March he had to have an emergency gall bladder removal (mucesole) and was like a new dog for a few weeks.
He started drinking and peeing a lot and was diagnosed with diabetes in May.
Since then we have never been able to get it under control. The vet thinks he has cushings disease and is on 40mg of Vetoryl twice a day and 22 units of insulin twice a day and still his glucose readings are over 40.
He has been checked for thyroid (all OK), infections (had 4 weeks of antibiotics just in case), he has had chest x rays and scans looking for any other problems ( scan showed enlarged liver and adrenal glands which was expected) the last thing has been to change his insulin from porcine to bovine based. (about 3 weeks now). Should we be asking for a second opinion? or does this happen sometimes?
PS: he is also blind now.
Kind regards

Hello I am Dr. Joey. Thanks for asking your question and trusting me to help you and your pet today. I am a licensed veterinarian with over 16 years of experience. I am so sorry to read Paddy is going through this.

Gall bladder issues this severe are typical with Cushing's syndrome. In the more advanced stages of the disease developing diabetes is also possible. I do hope your veterinarian counseled you that when a Cushanoid develops diabetes that regulation can be difficult. This has to do with the high amount of circulating cortisol secondary to Cushing's syndrome causing insulin resistance (this means even though we give insulin, the cortisol prohibits it from getting into the cells and working), which means getting these dogs treated well is tough. Sometimes if and when we get good control of the Cushings syndrome the diabetes regulation improves. Overall it sounds like your vet is looking for all the right things that could also lead to some level of insulin resistance as well.

A few things to think about:

-Are you moving the insulin injections around on the dog's body (giving in different locations) every day?
- Have you reviewed with your vet to be sure you are neither OVER- nor UNDER-shaking the insulin.
-Are you ONLY feeding at mealtimes, when the insulin is given, using a MEASURING CUP and the amount fed is what your vet recommends? (sometimes when we see our pet's weight falling off we panic and start really over-feeding the dog---which means we have to chase after them with an ever-increasing amount of insulin) You may want to do a nutritional consult with your vet to ass how many calories/day does he currently get and what should he weigh.

- IF not already done, then a urine culture is really a good idea (via cystocentesis, even if the sediment is quiet)---If you get a negative, reculture every 4-6 months for the long haul. If a positive culture comes back, then we treat this for 4 weeks, then culture when OFF the antibiotic for 1 week to ensure cleared, then repeat culture 1 month later; then once every 4-6 months.

I am at a point I need to know what questions you have. I hope that the information I provided has been helpful.

Please let me know if for any reason you need further clarification, have more questions, or were expecting a different type of answer.

If you received all the information you needed, then kindly submit a rating.

Customer: replied 7 months ago.
Thank you very much for your reply, it is good to confirm that our vet is doing all the right things.
I have two queries, 1) we always inject in the scruff of the neck, where else could we inject and why does it make a difference.
We have had no advice regarding diet. Paddy has allergies so it is difficult. We cook his food ourselves and he has carrots, swede, chicken and pasta. He is fed morning and early evening. If he needs a treat we give raw carrot and the occasional sliver of cheese (handy for hiding tablets in) His weight has changed very little.

Excellent that it sounds like you are being consistent with his diet. Are you following receipts for dogs that are diabetic? If you need recipes I believe there are some in Donald Strombeck's book: Home-Prepared Dog & Cat diets the Healthful Alternative (Click here to see on amazon). You may want to review the amount you feed with your veterinarian. Carrots are great treats.

You can also discuss the culturing of the urine with your vet.

Let me know if you have any further questions. If not, please do not forget to submit a rating

Dr. Joey and other Dog Specialists are ready to help you
Customer: replied 7 months ago.
Thank you for your help, it is very reassuring. I will be submitting a 5 star rating.

Thank you!! Keep me posted.