My family has a yellow Labrador Retriever that we have raised from a puppy. His name is Benny and he does everything that an energetic Labrador Retriever will do. He loves to run/walk with us, chase balls that we throw for him, and he absolutely loves swimming and being with our children. Benny has always been very energetic and has been a training partner for my wife and me at various times. We have two dogs, Benny and Sonny. Sonny is a 2-year old Labrador mix that we adopted from a shelter and has a wonderfully talkative personality and entertains us daily! But, back to Benny.
Benny is now almost 12 years old and was diagnosed with hypothyroidism about 4 years ago. Hypothyroidism is a result of low thyroid hormones. Thyroid hormones are necessary to control a dog’s metabolism and a few of the key symptoms of hypothyroidism are weight gain and lethargy. A good resource for understanding the background of hypothyroidism and symptoms is here: https://pets.webmd.com/dogs/hypothyroidism-in-dogs.
Benny has been successfully treated for his hypothyroidism with Levothyroxine, also known as L-Thyroxine, which is a thyroid hormone that is available in a pill form that we put in his food twice a day. Your veterinarian will recommend the right dose. I have to say that it has been very easy to give the medicine, once you get past the shock of realizing that your pet will require prescription treatment for the rest of his life. We just put the Levothyroxine pill, as prescribed by our veterinarian, in a small piece of cheese or in a piece of food with his meals. It is well worth it! Benny rebounded within a few months and became his active self again after being a bit sluggish. Amazingly enough, his dosage has been constant for the past 4 years without any noticeable side effects.
In the past 3-4 months, my wife and I noticed that Benny began having some trouble with his morning runs/walks. He has never had any problem going at least a mile or two every morning, sometimes 3 miles or so. Recently, Benny has slowed to where we could only take him on short walks each morning which he still enjoys. Something was wrong though, and we noticed that he had some hind-leg weakness when he was getting up from laying down. We gave Benny Rimadyl as prescribed, but it wasn’t seeming to provide much of a response.
I took Benny to the vet, as I have before when I noticed changes that do not appear to be part of the normal ageing process. Maybe this was normal ageing, but I was still concerned. My vet understood and explained that he has neuropathy in his hind legs, which is degenerative and happens often in older dogs as nerves become less responsive or damaged. I requested a blood test because I just wanted to have the comfort that it wasn’t anything else that was causing him to slow down. It was clear to me that his legs were weaker, and I noticed his voice was slightly changing when he barked. My vet explained that he probably had something called laryngeal paralysis. More on that degenerative disease later.
It was a Sunday afternoon and my vet graciously called me following a Saturday blood draw to let me know that Benny’s bloodwork looked good, except for one thing that he was surprised to find. Benny’s blood glucose level was 507 mg/dL. This is several times the normal blood glucose range for dogs which is 70 – 140 mg/dL. It was clear to him that Benny had diabetes. Dogs only have one type of diabetes and that is type-1 diabetes. Their pancreatic beta cells (pancreatic islet cells) have somehow lost their ability to make and release insulin as part of the metabolic process to control blood glucose. Blood glucose then rises to unhealthy levels that can result in many other conditions. Some dogs develop cataracts that can lead to blindness. Benny was definitely drinking more water lately, but he always did so I wasn’t sure this was not normal. Excessive drinking of water is a key symptom of diabetes though. For other symptoms and a good overview go to this link: https://www.petmd.com/dog/conditions/endocrine/c_dg_high_blood_sugar.
After talking with my vet that Sunday afternoon, he prescribed NPH Insulin, also known as isophane insulin. NPH stands for “Neutral Protamine Hagedorn”. NPH Insulin was developed by Nordisk and first marketed in 1950, so it has been around for over 65 years. This is a human insulin product that is intermediate-acting that we will need to give Benny by injection every 12 hours, right after he is fed. The NPH insulin that our Vet prescribed is U-100 insulin which describes the concentration. U-100 insulin means that there are 100 units of insulin per millilitre (ml) of liquid. U-100 is the most common concentration of insulin. There are other insulin concentrations available as well, such as U-500 insulin which is 5-times more concentrated on a per ml basis of liquid.
I immediately picked up my NPH insulin prescription at my local Walmart, which seemed to have reasonable prices along with the syringes. The syringe needles are typically 31-gauge for NPH insulin U-100, which means that they are very narrow needles and do not cause much if any pain when giving the injection near his front shoulders or back area just below the neck. Needle gauges are based on the diameter of the needle. A 31-gauge needle, for example, has a nominal outer diameter of 0.01025 inches or just over 1/100th of an inch. The higher the gauge, the smaller the needle diameter. The lower the gauge number, the wider the needle diameter.
I began giving Benny his injection of NPH insulin the next day starting at 15 Units every 12 hours, right after he is fed, or sometimes while he is still finishing his food. It is better to wait until after your dog has finished his food to give the injection, especially if he is a picky eater. This 15-Unit insulin dose was the starting dose recommended by my vet. The dosage is based on the weight of the pet and the amount of insulin needed to reduce the blood glucose to a more normal range over time. My vet would like Benny’s blood glucose levels to be in the 70-180 mg/dL range for as much of the day as possible. We keep honey available and dog treats, should his blood glucose get too low, so we can quickly reverse any signs of hypoglycemia and take him to the vet. For a better understanding of hypoglycemia, check out this link: https://www.petmd.com/dog/conditions/endocrine/c_dg_low_blood_sugar.
Typically, the starting amount of NPH insulin prescribed by our vet is 0.25 – 0.5 Units per kg (kilogram) of weight, but lower and higher starting doses are certainly possible. One kg is 2.204 lbs. Benny is 87 lbs so his weight in kilograms is 39.47 kg (87 lbs / 2.204 lbs/kg = 39.47 kg). 15 units of an NPH insulin dosage is 0.38 Units per kg of weight. To get that number, take 15 Units divided by 39.47 kg and that equals 0.38, which is within the recommended starting range by my vet.
It is important to be very consistent with feeding diabetic pets on a relatively set schedule and to make sure that the meal portions are close to the same each time. This is sometimes difficult, but we do the best we can. It is also better, in my experience, to limit the treats between meals, but sometimes I end up giving one small treat that will not raise his blood glucose very much, like a partial egg white from a hard-boiled egg.
In the past week or so, I also purchased the AlphaTrak 2 pet blood glucose monitoring system because I wanted to track Benny’s blood glucose levels myself. I looked at a few pet blood glucose monitors and settled on this one just based on reading recommendations from other pet owners online and reviewing the AlphaTrak 2 instructions prior to purchasing. The test strips are where the manufacturer really makes their money, that is clear. When I received the AlphaTrak 2 from Amazon the next day, I read the quick-start guide first, then loaded the lancet device (do not push lancet too far into the lancet device, half-way in works for me and I use setting 4 or 5 on the lancet device) and made sure to enter the code on blood glucose strips bottle into the purple blood glucose reader. I used the calibration solution first to check accuracy and it seemed accurate. I also tested it on myself just to make sure I could do it successfully before trying it on Benny.
Below are some of Benny’s initial blood glucose readings. Note that I moved away from feeding any dog food on July 12th which appears to have helped.
|Benny Bankosky||Initial Blood Glucose Reading 507 mg/dL on 7/7 at Vet, weight was 87 lbs.|
|Date||Insulin Dosage||Time||Blood Glucose Results||Notes|
|9-Jul||15U||5pm||N/A||Fed (2 sausages, 1 hard-boiled egg and 1/2 cup dog food)|
|10-Jul||4:30pm||504 mg/dL||Received AlphaTrak 2 system. Took 3 blood glucose readings consecutively (avg. glucose)|
|10-Jul||15U||6:30pm||Fed (2 sausages, 1 hard-boiled egg and 1/2 cup dog food)|
|11-Jul||15U||6:30am||380 mg/dL||Fed (2 sausages, 1 hard-boiled egg and 1/2 cup dog food)|
|11-Jul||15U||6:30pm||Fed (2 sausages, 1 hard-boiled egg and 1/2 cup dog food)|
|12-Jul||15U||6:30am||347 mg/dL||Fed (3 sausages, 2 hard-boiled egg, no dog food)|
|12-Jul||15U||6:30pm||222 mg/dL||Fed (3 sausage patties and 2 hard-boiled eggs, no dog food)|
|13-Jul||15U||6:30am||179 mg/dL||Fed (3 sausage patties and 2 hard-boiled eggs, no dog food)|
I don’t know for sure if the blood glucose readings are accurate, but we will get an accurate blood glucose check in two weeks at the vet. It took a few days for Benny’s blood glucose levels to come down, as you can see above. Benny was weighed again on 7/18/18 and is 86.6 lbs.
In my experience, pressing the blood glucose lancet device against the front leg elbow gently where there is a bare skin spot was the best place to get a small drop of blood from Benny. Others have recommended the ear or pad that is not walked on and is a little higher on the leg away from the paw. The elbow is probably less sensitive, due to nerve damage from laying down over the years. He doesn’t really even move when I use the lancet device and I try to relax him first by petting him for a minute.
After a few days of treating Benny with NPH Insulin and monitoring his blood glucose levels, he regained some strength and energy. The insulin and subsequent blood glucose reduction have definitely improvedBenny’smood and he is more active. I play with him gently as he is still recovering, but now the wheezing and difficulty getting air in his lungs have gotten worse.
When Benny goes outside even for a few minutes and exerts himself, I have been hearing a wheezing sound that appears obstructed. He has recently struggled to breathe with minimal physical activity, which is highly concerning. My vet previously said that he thought that Benny was experiencing laryngeal paralysis. Laryngeal paralysis is a condition where the arytenoid cartilages of the larynx lose their ability to open and close, which obstructs breathing. The presence and position of the laryngeal cartilages reduce inspiration volume, so it is essentially like breathing through a straw. No one wants to do that for long, it is exhausting.
Benny’s breathing was getting worse and my vet prescribed Doxepin, a tricyclic antidepressant that has been used previously in dogs for treating skin disorders due to anxiety. There are no clinical studies available on Doxepin to treat laryngeal paralysis, but many dog owners have reported a marked decrease in wheezing or obstructed breathing, which allows dogs to be more comfortable with minimal exertion.
Benny started taking a 50 mg dose of Doxepin twice daily. We started to see a little improvement within 24 hours. We have now been on the treatment for only a few days and his breathing has definitely improved. That doesn’t mean that he can run or play, the Doxepin just makes breathing a little easier while walking around and going to the bathroom. One notable side effect that we have seen after starting Doxepin, is that Benny’s pre-meal blood glucose readings have increased by around 30 – 50 mg/dL without any other changes in his meal schedule or insulin dose. This started right after the first dose and we are hoping that the readings will decline without needing our vet to adjust his insulin dose. We are monitoring this closely though.
Two days ago, we met with an experienced veterinary surgeon and tentatively scheduled laryngeal paralysis tie-back surgery for Benny for next week. This is a procedure, based on my understanding, that our surgeon will make an incision through the side of the neck to pull back and suture one of the laryngeal cartilages, so the airway remains partially open on one side. The opening doesn’t need to be very wide to improve breathing, it just needs to reduce the air resistance to breathing. It is hopefully a surgical procedure where we can take Benny home the same day or next day unless there are any complications. There is a chance that Benny cannot have the procedure if they find other issues in pre-op or during surgery.
Our surgeon said that 80-90% of dogs do well with the laryngeal paralysis surgery if it proceeds as planned and the goal is to open the airway a little to allow for better breathing. Initial recovery is about 6-8 weeks, with minimal activity. There are risks, most prominently asphyxia pneumonia which is a result of food or water getting into the lungs and causing a bacterial infection, due to the permanent partial opening of one of the laryngeal cartilages. Benny’s food will likely need to change to meatballs, so he doesn’t literally inhale them. I was told that Benny should not swim in the future since his laryngeal cartilages will not function normally and he may inhale water that can lead to a serious infection. Retrievers skim the water with their mouth open while swimming, so water can enter and cause an infection. We hope that he can breathe more easily overall if the surgeon goes forward.
I hope that you found my experience useful if your dog has any of these diseases/conditions. I am learning as I go like everyone else. We all want the best for our pets and there is no doubt they are part of our family. I have had dogs for most of my life and if you can allow them into your lives and treat them well, they will give you their heart.
Brent Bankosky, MS, MBA