“I Think My Vet Has Given Up” | Ask Dr. Joi

By Dr . Joi Sutton|2017-10-13T10:46:08-04:00Updated: October 12th, 2017|Pet Care, Pet Diabetes, Pet Newsletter|10 Comments
  • Cairn Terrier Lying in Field of Flowers

I get some great questions from clients. They inspire me with article ideas and keep me in tune with diabetic pet owners. I enjoy interacting with our readers, and sometimes the questions are worthy of a newsletter. I bet if one person has this question and takes the time to write me, there are likely lots of folks with a similar question. Today’s question is about chronically high blood glucose levels in dogs.

I have a ten year old Cairn Terrier. Last October he was diagnosed with diabetes and pancreatitis. He was put immediately on insulin injections and started at 3 units 2x a day. Well, we never got his sugar under control. He got as high as 12 units 2x day. Eight weeks ago he was changed to Vetsulin. He was started at 3 units 2x a day, and he is already up to 8. The lowest I’ve gotten his sugar to is 484. He eats a prescription diet. His urine test strip was 500. He went completely blind a month ago. He eats and drinks and pees ok. He was checked for Cushing’s disease, and that was negative. I don’t know what else to do. Should I go back to a homemade food? I think the diet he is eating now is not working. What else could be causing his sugar to be so high? Thank you so much. I’m at a loss, and I think my vet has given up.

First of all, let’s go back to the basics. I don’t know what all you have done, and sometimes little things like timing of meals or giving mid-meal snacks can make a huge impact on diabetic regulation. Here are some links about basic diabetes knowledge and my typical recommendations.

Back to Basics for Diabetic Pets | Part 1

Back to Basics for Diabetic Pets | Part 2

Back To Basics For Diabetic Pets | Part 3

Back To Basics For Diabetic Pets | Part 4

Read these and see if there are any blaring things you do that could adversely affect his control. I’m a proponent of consistent good habits. A “routine” is your friend when it comes to diabetes control for your pet.

Next, if you fear your vet is frustrated or has “given up”, consider seeking a veterinary internist. I seriously doubt your vet has given up, but at times we do get frustrated when a disease gets the better of us! We vets go through 8 years of college to get the letters “DVM” behind our names. Vet internists go through an additional 4 years of training for the extra letters behind their names. Internists thrive on the hard-to-manage diabetic or other difficult medicine patient. They rejoice over patients that make us general practitioners want to pull our hair out. Most large cities have a specialty veterinary hospital that would have an internist who could set you on the right track. Often, they look for underlying infection or concurrent disease that could cause insulin resistance. Two of the most common sources of infection in diabetic pets are urinary tract infections (so a urine culture is in order) and oral infection from dental disease. If there is doubt regarding oral infection, a dental cleaning with full mouth dental X-rays is in order. I’m glad your vet already tested him for Cushing’s disease. Your vet might also re-test for pancreatitis as pets can have chronic, smouldering pancreatitis.

As far as food is concerned, a specialty diet is actually a really good choice for a diabetic dog as the right formula will be high in complex fiber and low in fat. The low fat bit is particularly important as you say your pet had pancreatitis. I’m sure your sweetie would love some home cooking regardless. There are lots of good food choices for a diabetic dog, but the real key is to feed equal portions/calories every 12 hours and try your best to avoid mid-meal snacks unless you suspect or identify hypoglycemia.

You mention urine glucose. Are you testing his blood glucose at home too with a blood glucose meter? Let me tell you, home blood glucose curves make all the difference for diabetes regulation. By running glucose curves at home you eliminate stress hyperglycemia that commonly occurs when a pet spends the day at the vet clinic. And, it saves you a ton of money by checking the repeat blood glucose samples at home rather than paying your vet and his staff to do it. A glucose curve means you check the blood glucose every 2 hours from one injection until the next, twelve hours later. My twist is that when it falls below 150 mg/dl you should check hourly until it starts to rise again so you know where it truly bottoms out. They call this low point the “nadir” of the curve. Blood glucose curves tell us how long a particular insulin lasts in your pet and also if we should increase or decrease the dosage.

As far as being blind, that is likely from diabetic cataracts. Diabetic cataracts commonly occur in diabetic dogs and rarely in diabetic cats. Good glucose regulation can delay or prevent them, but once they form we are looking at surgery to remove the lenses to restore vision. A vet ophthalmologist could help you with this. First I’d consult an internist as your initial question was about getting his diabetes under control. We use oral supplements like alpha lipoic acid to help prevent diabetic cataracts. Hopefully soon there will soon also be a topical cataract preventative for dogs called Kinostat. Kinostat is still awaiting FDA approval as I write this. Diabetic pets are also prone to other ophthalmic conditions, so I am always pleased when diabetic pet owners go to the ophthalmologist early.

Do chat with your vet about a referral to a vet internist. And keep your chin up.

Have a question or comment? Post below or email me at [email protected]. I always enjoy hearing from my readers!

NOTE: Consult your veterinarian first to make sure my recommendations fit your pets special health needs.

About the Author: Dr . Joi Sutton

Dr. Joi Sutton is a 1993 graduate from Oregon State University. She has practiced both in emergency medicine and general practice. Dr. Sutton has done extensive international volunteer work though Veterinary Ventures, a nonprofit organization that takes teams of veterinarians to undeveloped countries for humane medical care. She also runs a small animal practice in South Florida. Connect with Dr. Joi on LinkedIn


  1. DEBORAH VERA December 15, 2017 at 10:26 pm - Reply


    • Dr . Joi Sutton December 17, 2017 at 8:01 am - Reply

      We don’t often use urine glucose in assessing diabetes control these days. Back before we had such great blood glucose meters, say 15 to 20 years ago… (before we could get a blood glucose reading on such a tiny amount of blood that it was feasible for owners to check blood glucose at home) vets would use urine glucose as a tool. Now we may occasionally have owners check urine for ketones, but we rely on blood glucose to asssess degree of diabetes regulation. This is a fantastic question. The threshold in the kidneys is somewhere around 250 to 300 mg/dL in dogs and cats. That means that if the blood glucose is below this range, there will be no sugar in the urine. So you see it is crude relative to blood glucose.

  2. Janey Phillips October 13, 2017 at 10:39 am - Reply

    We had similar trouble regulating our 11 year old Westie, who has been diabetic for 2 and 1/2 years. For that matter we still lose control periodically! Long story short, the Alpha Trak 2 blood glucose monitor made/makes the difference. We finally figured out that our dog was having somogyi rebounds, and that giving him higher doses because of high blood glucose values was worsening the control problem. He has never manifested signs of too low blood sugar, would just rebound, so only doing periodic curves with the meter showed us what the dose should be. We have him on a moderate calorie measured prescription diet so that he always gets the same calorie amount. We can see cataracts in his eyes but he can still see well enough to catch a tossed ice chip, and the veterinary opthalmologist has him on a medication for dry eyes. We always test blood glucose before each meal and I have testing supplies ordered on autoship. In the long run, if you want to give your diabetic pet a long and happy life, testing expense is worth the money.

    • Dr Joi November 7, 2017 at 10:07 pm - Reply

      I’m very glad you went to the vet eye doctor.

  3. Laurie Whin October 12, 2017 at 5:02 pm - Reply

    My cat had pancreatitis and my vet tried putting him on Prednisone/or Prednisalone? Very quickly he got diabetes, which I believe was insulin resistance due to the medication. I decided that purchasing the special glucose monitor for pets-you can’t use the human type because it measures differently- was the way to go as we tried to find the right dosage for him. The urine test is only for screening since it does not accurately correlate with blood glucose levels. To make a long story short, the glucose monitor turned out to be a life saver for him. Once we got him established on the correct dose of insulin, I would occasionally do a random glucose level-especially if he was acting a little bit off. My vet also wanted me to repeat the glucose curve periodically-every 4 weeks I think. Doing this testing at home, I discovered that his glucose levels were gradually becoming more like normal. One day I just thought to check it just before administering his next dose. His blood sugar was only 110! So, had I given him his usual dose of insulin, it might have killed him.
    I just wanted to share my own testimony regarding using the home glucose monitor. They may seem expensive, but not compared with having the curves run at the vet clinic. I used the AlphaTrak 2, sold on this website. It is easy to use, requires a very small size drop of blood, and has very good reviews about ease of use and accuracy.

    • Dr Joi November 7, 2017 at 10:06 pm - Reply

      Great job, Laurie!

  4. Linda October 12, 2017 at 12:52 pm - Reply

    When my cat was diagnosed, it took some time to get his glucose regulated. He now uses human insulin, The Lantus Pen. Have you tried changing up the type of insulin he’s using?

    • Dr Joi November 7, 2017 at 10:06 pm - Reply

      Lantus is a very good choice for diabetic cats.

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