Healer -- or deadly weapon?

Thank heavens for sinus headaches.

I never thought I’d have a reason to say that, but a nagging pain in my head combined with a friend’s fatigue may have saved Frankie’s life.

Frankie’s insulin problems: Some background

I’ve written about this many times before, so I’ll just recap.

Frankie’s diabetes had been well regulated on a canine-oriented insulin called Vetsulin. Then Vetsulin was taken off the U.S. market and I started mail-ordering the equivalent drug directly from a Canadian pharmacy — until there was a run on the pharmacy’s supplies. With the help of the ever-generous Karen Friesecke of Doggie Stylish, I was able to nab the saved-for-Canadian-dogs supplies, though getting the fragile drug through the mail via UPS was nerve wracking, not to mention expensive.

Fast forward to this past June. Frankie and I came back from my trip to San Diego and he had two hypoglycemic — low blood sugar — attacks out of the blue, one in the middle of the night, and one after breakfast. This hadn’t happened in years and it’s very scary. It’s not good for high blood sugar to be left untreated, but it takes weeks or months without insulin to lead to serious health effects; skipping an injection or two is no big deal. In contrast, a dip in blood sugar as a result of getting too much insulin can lead to convulsions, coma and even death within a matter of hours.

Although I suspected the problem with the insulin might be a result of my traveling with it and having it degrade, I nevertheless thought it might be time to switch to a more easily obtainable human variety, Humulin, to which  lots of diabetic dogs successfully transitioned after Vetsulin was taken off the market.

A month of anxiety

The vet had suggested I start out with a very small amount — 1 ml as opposed to the 3.5 ml that I’d been giving Frankie of the Caninsulin — and go up from there gradually. By testing Frankie’s urine — a far less accurate measure than blood testing but one that’s worked for me in the past — I raised his insulin in tiny increments over the first few weeks whenever the sugar content tested high. He had his first hypoglycemic attack when I reached 2.5 ml. Luckily I was home and caught it right away; a tablespoon of high sugar Karo syrup and a small meal was an instant cure. Another hypoglycemic incident followed about a week later at a lower level of insulin, at which point I began obsessing about leaving Frankie with a caretaker when I went away for a weekend.

I prepared needles with an even smaller amount of insulin in advance. All was okay, and I began to relax.

Until last Thursday night. Another food writer friend and I had gotten semi-last minute invitations to a tequila dinner at a nice resort.

Good tequila, good food, and good friends are some of my favorite things in the world.

Aside from Frankie.

The near catastrophe

I was looking forward to the event, but Thursday was hectic, with a midday meeting and a sinus headache I couldn’t relax long enough to get rid of. I still wanted to go, though — if tequila wouldn’t cure a headache what would? — but then my friend canceled and the host said maybe we should all convene another time.

I thought of saying I was feeling well enough to come on my own but then thought… nah. It would be a late night and I probably should take it easy because I had a lot to do the next day.

I never thought about a problem with Frankie. His blood sugar had tested high before dinner, so I went up from 1 3/4 ml to just slightly under 2 ml of insulin.

I lay down to watch TV after dinner — something I don’t usually do, i.e., the laying down part — so I didn’t really look at Frankie when he came wandering out of “his” room, though I saw him emerge. He went back in so I figured he was just checking to see if I was there, as he sometimes does. It’s very sweet.

About half an hour later, at 7:15, he came out again and I thought he might need to go out, so I got up — and saw he was staggering and shaking.

I gave him Karo syrup but, for the first time, he was almost too out of it to take it in. And he didn’t try to gobble up the food as he has always done. It took much longer than ever before until he — literally — bounced back and went bounding out of the room.

All I could think about was “What if I had gone to that dinner?” I wouldn’t have been home for another 3 hours, minimum.

I can’t bear to contemplate that, though of course I keep going there, over and over.

The new course of action

I called the vet the next morning.

I had been planning just to make an appointment for a glucose curve which would determine what time of day the sugar levels dropped and for how long — maybe the insulin lasted longer than 12 hours in Frankie, I thought — but when I explained what had been happening, my vet asked, “So can you still get that insulin from Canada?” She said one in ten dogs have trouble making the shift and Frankie seemed to be that one.

I wasn’t happy, needless to say, but I was relieved that I had “permission” not to keep trying something that so clearly wasn’t working. I have half a bottle left of Canadian insulin and I’ve ordered five more, enlisting Karen’s help to get it to me.

I wish that wasn’t the case and that Frankie had been able to make the switch. And I worry that the Canadian supplies will dry up entirely. But I’ll deal with that if I have to.

As anyone who takes care of pets or infants knows, it’s frightening to have the life of a loved one who can’t communicate with you in your hands. It’s doubly scary when the medicine you think you’re administering carefully has the power to do so much harm.

Surely insulin can’t be the only drug that behaves this way, though. I’m interested: Does anyone else deal with this kind of delicate balance in taking care of a pet?

30 thoughts on “A Close Call — and a Change of Medical Course”

  1. I’m so relieved for your and Frankie’s sake. That’s probably the best headache you’ve ever gotten.

    I’ve only experienced a small taste of what you’re going through with Frankie. My dog Christie had Cushing’s disease which we treated by suppressing the adrenal function with mitotane (a toxic poison used in chemotherapy). However, if Christie experienced any type of stress, we needed to immediately give her steroids to counterbalance the adrenal glands that weren’t allowed to do their job.

    The problem came when we started having seizures. And upon coming out of the seizures, her strange behavior led to violent fights between Christie and her sister Agatha. I’d say a bloody dog fight counts as stress and it as always a horrible balancing act.

    Unfortunately the vet did not prescribe tequila for my stress and I’m sure those several months took years from my life.

    You’ve taken on a big challenge with such grace and smarts. I hope what you share is helpful to other people facing similar trials with their own pets.

    1. Wow — what you went through with Christie sounds far worse than what I’ve been experiencing. Dealing with seizures must have been terrifying; I can’t even imagine.

      Grace and smarts — I dunno. I feel like I’ve been bumbling through. But I’m glad it doesn’t show. And I would be doubly glad if anything I wrote were to help others cope with the difficulties of dealing with a pet’s illness.

  2. What a relieve, this was a close call indeed. In particular scary that you were only up to a 2ml doses, when the original was around 3,5ml. Do I understand correctly what the vet mentioned – this brand/type of insulin will never have worked out for Frankie, despite the doses? And now that the vet can rule out this type of insulin I hope it can give the vet a clue what other types there are left that could work for Frankie?

    I followed your blogs on Frankie’s insulin “quest” and I cannot think of any medication that is as difficult to manage as insulin. Viva’s Cushings disease is also managed by adapting the doses, but the intervals are a lot longer, not measured in hours like insulin. And there are not all the problems between with brands/types. There is no difference in quality like with insulin coming from the same bottle/package over time. And last but not least, these types of emergencies cannot occur. You see it coming if the doses is not correct in between the quarterly blood tests, leaving ample time to react.

    TG there was still Vetsulin left. We furiously hope for you and Frankie, you’ll find the right insulin in time. Hugs from Kenzo & Viva.

    1. Thank you for your good wishes, Leo, and I appreciate the hugs from Kenzo and Viva (even if Frankie wouldn’t).

      Yes, I understood from this vet — who was not my regular vet; he was on vacation — that this type of insulin would not have worked out for Frankie no matter how much I fiddled with the doses, that he was the 1 in 10 that didn’t respond well to this type of insulin. I am going to have to go back and do some more research to see if we tried any others on Frankie initially, but I don’t believe that there are other types that work as well for dogs as Vetsulin/Caninsulin and Humulin. Humulin used to be the primary one used for dogs until Vetsulin came on the market, and– being made from pigs– it was considered more compatible with canine anatomy than human insulin.

      I wish Vetsulin would come back on the market because it does seem to work well for many canine diabetics, but in the meantime… And at least I can say I tried, that I wasn’t just stubbornly sticking to what I thought worked without making an attempt to switch over.

  3. I had a diabetic kitty on a human insulin that was discontinued so I know the feelings you must have felt when your dog’s insulin was discontinued. I was lucky I was able to buy enough to last her life time (she died a few years ago) and I ended up with half a bottle – which I believe is still in my fridge.

    Anyway. I’m posting to ask if you ever considered testing Frankie’s blood sugars through his blood at home. I did with my kitty for years using a human glucometer.
    it is definately more accurate then urine – which only shows when it spills over, not the nuances of the immediate readings of the blood. I’ll confide that it is scarey the first time you try to make your pet bleed on purpose, but it gives you so much more control over this disease. You can even do your own curves at home

    1. Thanks very much for this, Connie. I have thought about blood testing but it can be tough with a small dog — oddly, according to a diabetes expert I interviewed for a story recently, it can be easier with cats — and I have to admit that I just haven’t wanted to go that extra step of getting blood from Frankie twice a day in addition to giving him shots when — in the case of Vetsulin — urine testing worked fine. But if it comes to a choice of worrying about hypoglycemia and testing, I’ll definitely do it. But I’m trying to give both of us a more stress free life!

    1. Thanks, Rox. It’s so frustrating to know there’s a product out there that worked well and that I can’t get it without jumping through a lot of hoops. I’ll grant that there were problems with the product — that’s why it was taken off the market! — but I was fortunate never to experience them, at least not until the June experience, and since the other two bottles in the same batch were/are fine, I’m fairly certain it had to do with temperature control (or lack thereof) while I was traveling.

  4. My Pekingese, Stanley, has IVDD. His back is aging faster than he is. Two emergency back surgeries in 3 years, one dental surgery, and a course of steroids for his back…not to mention Erchilia, colitis…you name it. His walking is impaired and come to find out he has another bad disc giving us problems. He’s only 8, and I’m constantly on guard: is he walking differently? Is the disc about to blow? Is he going to end up in a wheel chair? Not to mention that if the paralysis travels up his spine he could die from respitory issues, or need to be put down. It’s scary and extremely stressful-a constant guessing game. Not to mention expensive.

    One thing we have tried with Stanley is setting up a live stream camera (livestream.com or ustream.com). When we used livestream we were able to check on Stanley from our cell phones while we were out, make sure he was OK. That might be a good option for you, so you can keep an eye on him while you’re out. I’m happy to fill you in more on how we set this up. It gave me peace of mind while we were out. I actually started it because our downstairs neighbors smoked in the house, and I wanted to make sure they didn’t burn the house down with Stan in it!!

    1. Wow, Erin — I’ve never heard of IVDD and that sounds EXTREMELY difficult to deal with. Diabetes pales in comparison. Seriously. People say to me “I could never do that” when it comes to Frankie’s treatment – and I’m sure you get that with Stan’s — but the fact is when you love a family member you can and you do.

      I guess I’ve gotten used to Frankie being well regulated. If it comes down to it, I will try blood testing — and maybe a camera too! Right now I’m still hoping to return to a routine that’s easier to cope with.

      1. If you need any tips about setting up a Frankie cam, I’m happy to share! Frankie is lucky to have such a dedicated person. So many dogs get surrendered due to medical issues.

        1. Thanks, Erin — no luckier than Stanny is. And good luck with your new blog! I’ll be looking forward to reading about Stanny’s adventures.

    1. Thanks, Amy. I hope so too. I will do the blood testing if necessary, but at this point I’m not ready to give up on meds that give me a modicum of freedom. I can’t imagine getting a pet sitter to deal with that!

  5. Thank goodness for sinus headaches. I’ve known and loved many dogs with many chronic health issues, but never diabetes. I can only imagine your fear and frustration, especially at not being able to get the medication that actually WORKS for Frankie. I hope your Canadian connection keeps the Caninsulin coming. You’re so right about how scary and heart wrenching it is to love and care for creatures, human and not, who are not able to tell us where it hurts. Frankie is one lucky pup to have you.

    1. Well, now I’m already thinking I should have been blood testing and setting up a Frankie-cam — and that it’s not too late! But seriously I can’t imagine most dog people I know NOT doing what I do. I wish I didn’t have to but I’m sure you would do the same for Sadie, and I’m sure that’s true of pretty much everyone who comes here, even if they think they couldn’t.

  6. Wow, very scary stuff, so sorry the new insulin didn’t work out!

    It seems to me insulin is the one that is most sensitive because the disaster can be so immediate. Other hormones, such as cortisol levels (in both Cushing’s and Addison’s) or thyroid hormone levels also need to be balanced carefully but I haven’t experienced (thankfully) or heard of the imbalance causing such immediate dire danger. The effect is more long term problem, though of course extreme overdose could be just as dangerous. This is not likely to happen with careful administration and problems can be caught and dealt with.

    One other drug that can lead to immediate life-threatening situation are NSAIDs. And sometimes the effect can be very acute, whether the dog has been on the meds for a while or even taken it just once. Jasmine got very ill suddenly after being on Previcox for couple weeks, with no warning signs prior that. I read stories of dogs who died after getting just one or two pills! I read a story of a dog who’s insides virtually “exploded” with bleeds which were popping up faster than the emergency surgeon could take care of.

    Of course severe allergic reaction could prove deadly with any drug one’s dog might be allergic to.

    1. Thanks, Jana. And I hear you about NSAIDs. Though I know that diabetes is hereditary, I find it difficult to avoid thinking that the three weeks I had Frankie on NSAIDs for a back problem were what pushed the predisposition towards the disease over into pancreatic failure; there is no proven link but there IS a correlation and given the types of situations you describe it seems like a reasonable theory… if I could go back I would never have given Frankie those pills.

        1. Yes –I started noticing his drinking and peeing a few months later, and it takes a little while before diabetes gets to the stage where the symptoms become obvious.

  7. I know I already shared my horror and relief with you on Twitter, but just wanted to comment here officially. I am SO glad that you were there Edie and not out with your friend. I know that you have mentioned worrying about leaving Frankie alone and going out, so this must have been quite a scare, especially considering you hadn’t planned on being home. Perhaps your body knew something your brain did not (thus the sinus headache).

    So very thankful that you know someone like Karen who can help you out. I am so very sorry for the scare, but grateful you were there and that you an get more insulin. I imagine you are not the only dog owner wondering what you would or will do without the dog insulin available. How frightening. 🙁

    1. I’m neither religious nor superstitious (well hardly) but I did think there might have been something that kept me from going out that night. I’m always humbled by the generosity of people I’ve never met like Karen — not to mention the support that you and my other virtual friends give me!

  8. Do you mean units? Not mls? mls are much larger than units. Each syringe should be 1/10 of a ml, and from there, there should be 30ish units in a syringe. mls are going to be way too much, esp w/a dog transitioning over. (and it’s humulin-n, right? not humulin-r, the short acting one?)

    I am sorry you had a rough time with it! I guess I got lucky and Buzz started on the humulin-n, so I will never knew how well he could’ve done on vetsulin…

    1. Yes, Erin, you’re right of course — it’s units, not mls! I always think of them that way in my head for some reason, but it’s incorrect. Still, the point is the same: if I had been giving Frankie 3.5 mls of Caninsulin and then reducing his dosage by half, not 25% as I heard was typical with the Humulin — and yes, it’s Humulin-N that we were on, not R — he should not have been reacting with hypoglycemia.

      Many dogs react great with Humulin-n; it’s what was used before Vetsulin came on the market. I’m just unlucky that Frankie is the one in 10 that has real problems with it.

  9. Hi Y’all,

    I’m catching up, or at least trying to, after a HECTIC week!

    Golly days, I wouldn’t wish any kind of headache on anyone, but in your case it was a blessing. Having had a Basenji who became diabetic I know how frustrating it is maintaining the balance.

    Later she started hating the needles and trying to avoid me when I tried to catch her urine.

    Finally one evening she demanded to go with us to the barn to feed. To this day I can see her trotting down the shedrow her tail wagging over her back and suddenly falling over. She must have died instantly from heart failure because she was dead when we reached her. She was 12 years old, the youngest any of our dogs have crossed the rainbow bridge.

    Whenever I read about your trials and tribulations with Frankie, I feel for you. It is so difficult having any pawed one with a serious health problem, especially diabetes. Whatever kept you home that night, call it Fate or whatever you want, it kept Frankie safe. I know the stress it puts on you though.

    BrownDog’s Human

    1. I can’t tell you how much this message means to me — you’ve got me tearing up! — from someone who’s been through it. Thank you for your kind and sympathetic words, BDH.

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