Diabetic/referral advice

Re: Diabetic/referral advice

Emma P — Fri, 04 Feb 2011 22:33:15 GMT

Thank you all for your thoughts and suggestions. I have now calmed down and am able to look at the situation as a more rational person! Malcolm is now on 3iu BD and has perked up a lot. Had some initial vomiting which seems to have stopped. Eating, P/U and P/D but not wanting walkies. Not his normal self but much improved.

Have now had rational discussion with vet. She is concerned that he may also have Cushings - which is def possibly (although no prev symptoms). He has had severe atopy since 18 months old - tested strongly positive to all outdoor and indoor allergens except fleas. Also food allergic to beef. Management of this - due to no effect with artrevetrin as been preds (hence the diabetes no doubt) - esp over the summer months. As he is highly sensitive even most topical worsen the skin disease. She agrees liver enzymes levels are not entirely due to preds/diabetes - last dose back in November.

Currently due to blood sample prep skin is bad - lesions over b/s site. He reacts to clippers - developing severe clipper rash even with light clip. Am slowly getting him used to the lip *** technique but essentially checking urine glucose BD.

Due to atopy vet is concerned that we will get a severe reaction to ultrasound gel so currently postponing ultrasound whilst trying samples of different gels to find least reactive. He will rip his skin apart without the steroids - on antihistamines - and has been for years, but minimal effect.

Still have concerns that there is some cancer process but have to except what I can expect from my boy. Hope that skin has improved by beginning of next week so can repeat full bloods - has had convenia and trying to cover active lesions as much as possible. Will let you know the next lot of results - hopefully will see some liver improvement. What ever the thought of trying to manage severe atopy, diabetes and some liver disease is hard. i know it will impact on his lifespan and all I want is for my little man to be happy.

Re: Diabetic/referral advice

Susan Jackson — Fri, 04 Feb 2011 19:15:17 GMT

I forgot to say if you are using canisulin there is helplines and vets from intervet that you can ring and speak to about managing him. They are very nice and happy to discuss anything with you. How's he doing now?

Re: Diabetic/referral advice

Honeybadger — Fri, 04 Feb 2011 14:19:43 GMT

I hope your little man is improving. What did you decide to do?

Re: Diabetic/referral advice

zara — Wed, 02 Feb 2011 17:05:44 GMT

Went on a CPD evening with BVNA on diabetes.

Try calling Intervet see what they say, as their talk on diabetes was very good.

Sorry cant help otherwise

Re: Diabetic/referral advice

Steph Worsley — Wed, 02 Feb 2011 00:00:47 GMT

Don't think I have seen them this high in a diabetic without a concurrent problem alongside.

Referral places are happy to give advice to vets, it's a bit hard for them to give advice to nurses unless you know a referral vet (odd I know, but its to do with sucession as a lot of primary vets can get a bit annoyed if you go behind backs.)

If you want referral now then your vet is obliged to refer you if you request it, as it is your right to request referral at any time you want it.

I personally would probably wait and retest say on thurs (if in house bloods are still off the scale then get referred for imaging and full workup)obviouslyy if he deteriorates then refer sooner

Re: Diabetic/referral advice

Sal the 1st — Tue, 01 Feb 2011 22:42:57 GMT

have seen raised liver enzymes with pancreatitis in dogs which have decreased as the condition improves and have seen high values in diabetics which have decreased as the animal stabilises on insulin, and have also seen extremely high liver enzymes on an already diagnosed diabetic yorki which on further investigation was found to have Cushings. (and I am not saying your dog has Cushings but might be something to look out for). Personally if it was mine I would give the insulin a couple of days, but I understand your concern - I am the same if one of mine is ill, Is there anybody you could talk to at the refferal centre used by your practice ?

Re: Diabetic/referral advice

Phrin Vernon RVN — Tue, 01 Feb 2011 22:41:34 GMT

If you are worried I would always suggest ringing a refferal centre - most of them give telephone advice quite freely, and it will help you to know you are doing the best you can.

There are lots and lots of fantastic GP vets out there, but if it was my animal I would be on the phone to the local referral place asap - no offence to GP vets at all, lots if not most of them are bloody ace, but if it was my animal I would call them and at least get their opinion so much as they can give it without examining the animal.

Re: Diabetic/referral advice

Susan Jackson — Tue, 01 Feb 2011 21:13:19 GMT

I'm not sure but I remember something about the liver enzymes being high due to the high sugar levels or lack of insulin I can't remember what exactly. Should come down but yes have to wait few days for insulin to work.

Someone may be able to give you more details but I'll have a look for you and get back if no one has answered this.

Re: Diabetic/referral advice

sarahjune84 — Tue, 01 Feb 2011 21:12:09 GMT

sorry i cant really help but a few years ago i went on a cpd course on diabetics and the speaker was Grant Petrie, he was really good and said if anyone every had problems with a case then to get in contact with him. I cant find my notes at the moment with his details but if you googled him I bet you could track him down and speak to him and he could advise you on the best plan of action.