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I am in Canada, and the Humulin N is quite cheap here, $20/bottle.

I had Bella on samE, milk thistle, urosodiol, Vit e etc when she was first diagnosed with CAH and diabtetes. She went off her food, and was eating less than half her meals. that was when my vet gave up. I took her down to WSU to specialist, and he said to take her off everything and get her eating again. It worked, and she had not missed a meal since. 2 wks ago I just added back the samE, and so far so good. Before anytime I have added anything back, her bgs just rocket up AND down. So I am planning to just wait and few more weeks and then add back the milk thistle.

She is really touchy on the food. I had her on a kind of hybrid diet for diabetes and liver. Currently I feed her 2X/day
1/3 cup brown rice, 1/3 cup chicken breast, 1/3 cup veggies...mostly carrots and green beans. she also gets a calcium supplement, omega 3s and now the samE . A few days ago I tried to add a tbsp of cod back, and she couldn't tolerate it. So I think I am stuck with this diet right now, and am still trying to adjust the insulin to match up.

2 wks ago, I had her scheduled for dental, as it was thought that might be part of the trouble. However, she had other ideas. She had a reaction to the preop and we nearly lost her. So that is it for her as far as surgery is concerned.

As to the bg...............the fun part.

She just does her own thing, I struggled for the pbetter part of this yr thinking that I HAD to manage her with 2 shots per day. Can't be done. then I got thinking that a normal dog's pancreas certainly supplies insulin more than twice per day, so..........

On 2 shots per day: If she is at 360 in the morning and i give her 4 1/2 U she will stay above 270 or so all day, if I give her 5U she will drop to
under 90 by noon, and any snack to ensure against hypo, she will rapidly go up over 300 agian

Now I give her what she appears to need: a typical day ( if there is such a thing)

5 am 270 food & 4U
8am 180 snack & 1-1.5U
12pm 140
2pm 120
4pm 200
5pm 270 food & 4U
8PM 180
10PM 160 snack & 1U
12 130
5am 270 etc.

But every 3 days or so, she will go up after breakfast to 300 and just stay there or climb slowly. I don't know why, but if she looks like that is what she is doing that day, I just give her one more unit , wait an hour, and if that doesn't work, then I give her another and wait and see. that way I can keep her under 270 and not let her get near 90. Last night at 10pm, I checked her before bed, she had been in the 160 range for the last 4 days, and she was 90!! So I just keep checking and adjusting. Luckily now she will eat, even when she is half asleep, so that is a lot better than it used to be. I know this sounds strange, but believe me, it is just her. She doesn't get any extra treats, I measure and weigh her food, and she gets exactly the same amt of exercise (since she is blind she goes out on a lead so that part is easy.)

I am not sure whether she meatabolizes the insulin differently from one day to the next, or whether the food digestion is the problem. if I could change her diet a bit it ight help, but every time I try, she gets diarrhea or won't eat, no matter how slowly you try.

The good news is she is feeling really really good, doesn't drink excessively or anything. My vet thinks she is perfect weight, I would like another pound or so, but so far this seems to be where she is best.

Confused in Canada, Joan

Marianne,

I fired the first vet for sure. The specialist is at WSU, 4 hrs away. He helped by taking her off supplements, said to give her 5U bid, and feed wd.
for starters, she hated wd almost as much as I did. I called him to see what to give her if she didn't eat, and the vet student said "thats what he said, giv eher the 5U. Now I was a newbie then, but I am not a natural blond if you know what I mean.

Main trouble is I live in a small town (2 vets) and next good one is 2.5 hrs away. She is a great surgeon, but can't give too much help with the diabetes. so I have been doing it on my own. So far so good, at least she is alive and moderately well. Her ALT and ALP are still extremely hi, but no bilirubin, amylase problems etc. Hopefully the samE will help.

This is all keeping me busy as 8 of our pugs are rescues. 5 are handicapped, and now Bella .............

Thanks for all the help and thoughtfulness.

Okay, so here goes a brief (relatively speaking) description of how I got here.

I rescued Bella as a blind senior (10) pug in June/08. In sept she went off her food, after ultrasound and biopsy she was diagnosed with Chronic active hepatitis. Supposed to be moderate enough to be reversible. So we went to 4 meals per day and multiple supplement for liver health. She did quite well till Jan/09. About this time she went deaf, miserable as she was blind as well, vet prescribed prednisone, worked for her hearing for sure but................ Went off her food again, took her back to vet who didn't think it was serious, but did a blood panel at my insistence. Ketoacidosis!!! Great, so much for not serious. IV fluids here at home for 3 days, and now we have a diabetic with CAH.

Vet told me to test urine ( I already used chemstrips to test my handicapped pugs on a sweekly basis as lots of UTIs) and give her 5U Caninsulin bid.
So 2 days later, I find negative glucose in urine, phone vet to see what dose of insulin, and she says give 5 anyways. I go and purchase glucometer, and test and adjust myself. 5Units bid at that time would have killed her!

By Feb she is off and on again with her food so much, our local vet tells me to "try and enjoy your last days with your pet and don't force her to eat or take meds" I fire vet!!!!!!!!!!!! down to WSU for another ultrasound etc. he says it is more unregulated diabetes than liver. Great!! On his advice we take her off all the supplemtns, and darned if she didn't start eating again! However, on the caninsulin, her bg would go up and down like a yo yo.
She would drop more than 100 right after a shot of any amt and then skyrocket. Most dogs will rebound if they drop more than 90/hr, but with her she will rebound if she drops more than 55!!! So more fun.

I switch her to Humulin, and it was like night and day! At least she now has a curve, instead of a huge "V"!

Now on 2 meals per day, her digestion acts up, and she has diarrhea or indigestion and won't eat. So I found (probably incorrectly) that I had to find a diet and number of meals/day that she would tolerate and would actually eat. With feeding more times, she pretty much had to have more insulin injections. Toyed with the idea of R, or glargine and R combined, but had so much trouble with the caninsulin, sort of scared to try.

Now i can pretty much keep her between 140 and 250 if I check often and adjust. I know it isn't ideal..............

So I think you are right about the rice, I will decrease it slowly, need to replace it with something. Used to feed her a bit of whole grain pasta, but not much better results. Can't feed her too much protein because of the liver issue. Tried egg whites, not good. Tried oatmeal...not too bad. Tried yogurt....horrible.

On the veggies, I can cut down on carrots, add more green beans she likes those. She can't take sweet potatoes, celery, broccoli. Any ideas what to add for veggies?

I looked up the merrick, I don't think it will work for her with the CAH. Can't take red meat because of the ammonia build up. I do add a bit of cod to her chicken, and if I do it very carefully she is alright with that. I really have a thing re canned food. That stuff is 81% water. With the home cooked, I can adjust her ingredients exactly. I guess I just haven't done a very good job of it yet.

Hope I didn't lose everyone thru all this, thanks for sticking with it.

Hoping to hear suggestions, if I haven't scared everyone off already.

Pug hugs Joan