Case:Miss Molly

Miss Molly:Canine
Female Silky terrier
Born	Jun-1996
Dx	Dec-2005
Oral meds	:
Regulated	Not-yet
Regulated between 100 and 250
Remission	Not-yet
Insulin	Levemir (basal) Humalog (bolus)

Update 8/11/09

Molly has been on Levemir for over 1 year with very good results.

Molly continues to do very well on Levemir and Humalog. Better than she did with the Lantus and using about 1/4 the amount of Lantus she was on. (She was on Lantus and Humalog for about 2 and 1/2 years). Molly has Atypical Cushing's, Adrenal tumor, spleen tumor, asthma (on Flo-Vent with inhaler which has some steroid), Mitral valve is thickening and we are watching her Parathyroid and calcium levels. One of the parathyroid is larger than the other 3 but not large enough for surgery. We are also monitoring her kidneys and liver and doing wellness checks. We do occasional fructosamine tests and the results have been "normal" or "well-controlled". We also take her bg's ourselves everyday. This is great news because we know that although her blood glucose fluctuates with her adrenal hormone issue's, we have her in a good range most of the time.

With all of Molly's other health issues besides DM we are very grateful. She is coming up on her two year anniversary since her cataract surgery and is doing very well with her sight also.

She did very well on a nine day trip and 6 hotels for our son's wedding and only had one day of low bg's and some diarrhea but bounced back. She was so happy having all of her people in one place again.

Molly was 13 on 6/11. We are very grateful and enjoy every precious moment with her.

Update 3/29/09 Molly was changed from Lantus to Levemir in mid- 2008.

Molly continues to do really well on Levemir since her change from Lantus. The dose is remaining the same...we do have to adjust up or down about 1/4 unit. Her fructosamine test have her in the "well-regulated" range again.

*Only try Levemir with a vet backing you up and start very very low. We started Molly at 1/4 of the amount of Lantus she was getting and lower than our vet suggested, this proved to be the correct thing to do for Molly. This is such a new insulin for canine's and needs to be approached very carefully. One reason we were able to attempt this change is because we do Molly's curves and check her bg's ourselves. We also consult our vets and do regular blood work with Molly.

Humalog, a Rapid insulin is still being used for her meal bolus. Some may not need this but Molly does.

We were able to reduce the amounts of both insulins: Lantus and Humalog after changing to Levemir by more than 1/2 of her TDD.

She continue's to see well following her cataract surgery Sept. 07. She developed KCS and will always be on drops but it's such a blessing and we are very grateful.

She is still on the same food and weighs about 13.6 lbs give or take a few ounces.  :-) We have lessened the amount from 1/2 cup to 1/3 cup on the advice of her holistic vet.

Molly will be 13 in June.

'''Update Molly 7/27/08

CHANGED FROM LANTUS TO LEVEMIR'

We have some good news to share. We changed Molly to Levemir about 5 weeks ago.

For the first time since being diagnosed 12/24/05, we can say that Molly's fructosamine tested "normal".

Her fructosamin test until this point were all "well-regulated" on Lantus and Lantus did a very good job for over 2 and 1/2 years. We found as time went on that we had to keep increasing the Lantus to maintain control.

We do see some highs and lows not reflected in the fructosamine test but less with the Levemir and Humalog than with the Lantus and Humalog.

We got her fructosamine test back today and her results were "Normal". Thanks Lord! (lots of prayers answered :-)

This is the first "normal" she has had since diagnosed over 2 and 1/2 years ago. She has been in the "well-regulated" range.

The range is 175 -345 for normal and Molly was 325

Our vet is really happy. :-) We are super grateful.

(Ranges are: Normal 175-345 Well-regulated < 450 and poorly regulated >600)

We will keep trying to achieve better numbers but to be honest we are thrilled with these and if she stays here we will be happy.

(Molly has Atypical Cushings, a tumor in her left adrenal gland, a tumor on her spleen, asthma, a mitral valve thickening). She also had cataract surgery 9/07 and is seeing very well.

She was on Lantus and Humalog. She is still on Humalog for her meal bolus.

We got to a point with Lantus where she was taking a total of 7 and 1/2 units a day (4 a.m. 3 and 1/2 p.m.) that's a lot for Molly. She started at about a total (TDD) of 2 and 1/2 units a day. We were also having to increase her Humalog to bring that postprandial rise back down. Now she is taking 1 and 1/2 units a.m. and 1 and 1/4 units p.m. (Levemir).

We were able to cut her Humalog about in half too.

She has not had any adverse reaction to Levemir. I believe it also does not sting like the Lantus. We do see occasional highs and lows. I really think this is due to Molly's Atypical Cushing's.

The main thing to remember is that Levemir takes so much less insulin than the the NPH regulars or Lantus. We started with 1 unit and slowly worked up. In Molly's case we still need to use Humalog for that postprandial rise, but it take less of the Humalog also.

Molly now weighs 13 lbs. Our vet is very happy about her weight, I hope she levels here though because of her cruciate knee problems.  :-)

lots of blessings,

Peggy and Poppa and Miss Molly

PREVIOUS INFORMATION ON MOLLY:

Molly was diagnosed on Christmas Eve day 2005.

Molly has been on Lantus for her basal insulin and Humalog for her meal bolus for over two years. She has been well-regulated according to her fructosamine tests for the past two years with one exception, right after she had cataract surgery and was on steroid eye drops. We discontinued the steroid a month early and her bg's are returning to good ranges again. We just celebrated her 2 year Anniversary since being diagnosed with DM. :-)

Molly's story:

Molly has asthma and allergies. One allergy is pork, this ruled out Vetsulin/Caninsulin as an option. She was started on Humulin N. The problem we encountered was Molly's reluctance to eat a full meal in the morning.

At the time of diagnosis she went totally off dog food. She was on Science ID for 9 years. We tried every dog food we could find in our area, we even mixed chicken in with it and still she refused. We decided to go with a home cooked diet using the standard 50% meat, 35% veggie's, and 15% fiber. (The mainstay being ground turkey or chicken, baby food meat, green beans, squash, cottage cheese and oatmeal). The only complication we had initially was that Molly was not a veggie kind of girl. We also discovered that white rice and brown rice sent her blood glucose soaring. Molly's food also includes C-Biotic by Wysong supplement and Milk Thistle, 1/2 capsule twice a day. (3/4/07) We have added a little Add-Life by Wysong to her food and Shasha's Blend for her knee's (seems to be helping a lot). We have added Prozyme, a pancreatic enzyme supplement. Molly also takes Denosyl. Welactin has been added to Molly's food.

With the help and encouragement of some wonderful people I have listed below we learned how to do Molly's blood glucose test at home. They also educated us about insulin and food. Needless to say they have my undying gratitude and due to their experience and knowledge have saved Molly's life.

We found a vet with more experience with Diabetes. He changed Molly's insulin to Lantus once a day.

Lantus was not giving us 24 hour duration. The board suggested and the vet concurred that 2x a day every 12 hours would be good. Lantus for Molly begins in 1 to 2 hours, peaks at 5 to 6 and is out of her system in about 11 hours per injection. The advantage to this was that her morning injection did not have to be early, allowing Molly to have her morning meal about 11 a.m.. It was difficult at first but she now will eat a small morning meal and her main evening meal about 6:00.

The Lantus was doing a very good job serving as her basal insulin but we still had the postprandial rise.

It was suggested Humalog to cover her meals. This proved to be, in my opinion a stroke of genius! Of course I knew nothing about Humalog. With their help I learned. The Humalog, given after her meals is a very rapid insulin. For Molly it starts in 10 to 15 minutes, peaks at about 2 hours and is out in 3 to 3 and a half. This allows us to cover that postprandial rise without overlapping the Lantus peak times. We have had occasions when the Humalog was not needed but most of the time it is.

Blood test results for Molly in the beginning:

In the beginning Molly's blood work was not good she had low MCV range 58-79), Platelets were slightly increased. 533, (range-170-400). Total Protein was high, 7.7 (range 5.0 to 7.4), Albumin 4.8, (Range 2.7 to 4.4). Cholesterol 646. (Range 92-324). BUN was 42, (Range 6-25). Creatinine 2.1 (Range 0.5-1.6). Calcium 11.7, (Range 8.9- 11.4). Lipase, 980, (Range 77-695). Potassium 6.9, (Range 3.6-5.5). Triglyceride 497, (Range 29-291). Osmotality, Calculated, 323, Range 277-311). Magnesium 2.9, (Range 1.5-2.5).

Her values improved in March/06 but she was still high in Urea and Creatinine. Her latest blood work shows everything normal with the exception of her blood glucose and that was because it was before her insulin injection.

Molly's Thyroid, normal. Addison's and Cushing's test's negative. Ultrasound of abdomen, the doctor said " her organs did not look like the organs of a diabetic" , the only thing she saw was on the outside of her left adrenal gland, it was different around the egdes, our vet said it could just be the way she is made. Sterile urine test, negative. Latest ultrasound Oct. 06. Slight change in liver, normally seen in diabetic patients, left adrenal gland remains the same.

Ophthalmologist check on 4/19 showed cataracts but the kind from aging, not from diabetes. Diagnosis: Incipient & immature cortical cataract. Tonometry 10mmHg 12mmHg July's visit, 18 mmHg and 17 mm Hg. Opthamologist check 10/26/06. Some changes from last visit. Little specks in the eye getting a little larger and some lines coming out from them. These are age related not diabetes related. (see update after cataract surgery).

Senior Wellness blood work 12/06 all normal with exception of blood glucose. Molly usually goes low at the vet's so I decreased her Lantus by 1/3 the night before. When I took her to the vet her bg was 225 and when we got home after the vet fed her a little food her bg was 125.

Molly is a Silky terrier weighing 11.6 lbs. Her typical daily dose of insulin's are: Lantus 2x twelve hours apart, Morning dose 2 units Lantus. Humalog post meal. Depending on how much she eats and how high her blood glucose is she requires between 1/2 to 3/4 units of Humalog, per meal, rarely requiring a full unit. We have discovered with allergy/ asthma season that it is taking about 1/4 to 1/2 more units than before.

Molly was on Albuterol for her asthma for years. She has been on Flo-vent with the aid of an inhaler , it is working so much better for her. This is the first time in years (2006) that we have been able to get through the allergy season without prednisone and bronchial dilator shots. We are so grateful to a great vet we have now.

3/20/07 We suspect that the Flo-Vent may have influence her diagnosis of Atypical Cushings 12/06. The IMS is still working with other endocrinologist to get to the bottom of it. Her most recent test had some adrenal hormone's elevated and some were lower. This is puzzling to her endocrinologist.

Molly is playing more and getting bossy again and that is music to our ears! Her sense of humor is back. She tries to slip off to bed before her evening shot. She is great about the bg testing, she doesn't like it but tolerates it well.

Update 12/06 Molly has celebrated her 1st Anniversary since being diagnosed. This year has been a tremendous learning experience for our whole family.

Molly has been diagnosed with Atypical Cushing's. She was tested twice for Cushing's and the result's were negative. Her ultrasound spotted a node on her left adrenal gland. We are taking her to a specialist in MI to obtain more information. We are located in Canada. Our thanks to our vet here for going the extra mile. She helped us to do a full adrenal panel and send it to UT Knoxville, USA. Our deepest gratitude to Dr. Oliver and his staff.

Note* (Molly also has asthma and requires Flo-Vent inhaler 3 times a day. She has had two ultrasounds one in April and one in October where they found a node/blemish, on her left adrenal gland).

2/17 Update: Preliminary report from Internal Specialist:

The doctor said her ultrasounds were reviewed by their ultrasonagraphers and "at this time, they have confirmed the presence of the hypechoic area on left adrenal gland. Both adrenals are otherwise within normal echo limits."

He said, "Many of the hormones and drugs have a steroidal configuration and, hence, there is the possibility of some cross reactivity in the assays that are used to try to assess and understand her overall hormonal milieu."

He also said that whether there is sufficient evidence to conclude that she has AC "in light of her diabetes and her medications is still a question for which I do not yet have an answer of confidence ". He is continuing to work on this and will get back with us.

Molly was also diagnosed with cruciate knee ligament damage in both knee's. Our regular vet referred us to an orthopedic surgeon and we consulted with our holistic vet. After much research and considering the recouperation time was 3 months for each knee, we opted to try the holist way first. She had three sessions (the vet said may take 5) of acupunture and natural medicine into her knee's. She was put on Shasha's Blend (which I would highly recommend to anyone needing help with joint pain). We are happy to report that she is not limping. We have also learned that this has to do with Atypical Cushing's.

Update: 2/14/07 Molly's appointment at MSU went well on 1/25. The left adrenal gland does not have a tumor. They called it a blemish or just the way she is made. We are waiting to hear from them on the rest of their evaluation.

The good news is that all of her blood work is normal with the exception of her blood glucose and she is fighting a UTI at the moment.

Update 2/14/07, Molly is over the UTI (E. coli) after 4 weeks, two rounds of Baytril. We found Baytril/or the UTI increased her blood glucose on the average 70 points. Molly still negative for UTI 3/20/07.

Update 5/8/2007

Molly continue's to be "well regulated" according to her fructosamine tests on Lantus for her basal insulin and Humalog for her meal bolus.

Her recent ultrasound shows that the growth on the adrenal gland is growing. Aspiration is not an option because it is so close to the aorta. The good news is that they do not think, from the ultrasound, that it is malignant.

Next ultrasound is scheduled for August. Please pray for her.

Flo-vent is helping her Asthma but could be influencing the tests that showed Atypical Cushings in Dec. 2006.

We have started her on Prozyme, a pancreatic enzyme to aid her pancreas.

8/1/07 UPDATE

Molly is doing pretty well. Her ultrasound shows no more growth on the adrenal tumor! Thank you for the prayers, they were answered. The growth on her spleen is about the same too. The ultrasound of her heart shows airway disease in keeping with her asthma and allergies and a thickening of her mitral valve. We are watching her for a heart murmur. Molly is 11 now so this is in keeping with an aging canine. The radiologist again commented that her organs look good and her liver does not look like a dog with diabetes. She did see a little speckling or something with the pancreas probably due to the mild pancreatitis but nothing to worry about. She said pancreatitis leaves scarring that can be seen on the ultrasound.

She has had one bout of mild pancreatitis and a bout of gastroenteritis in the last couple of months. Her weight has dropped about 6 ounces and we are working at getting it back up to her usual 11 lbs.

Her blood work has all been normal and great with the exception of the lipase during the mild pancreatitis.

She was also given the all clear for her cataract surgery. She has about 20% of her sight left. We have been told that she will be totally blind within about 6 months. She is scheduled for surgery on Sept. 13th, please pray for her (again :-)

At the moment she is not receiving any medications for the Atypical Cushing's. We are seeing the holistic vet and have Lignan's for her but we are suspicious that one that she was on could have caused the tummy upset.

We did try a diet change through a nutritionist and had a comparison done on the home cooked food we feed her. Ours is fine and we give her supplements. (Home cooked diets should have supplements/vitamins). :-) Molly has Balance IT, Prozyme, C-Biotic, Denosyl, Welactin, Milk Thistle. These are working well with her food. Please check with your vet if you want to try them.

Her bg's continue to be good, and well controlled on the fructosamine test but again, she has highs and lows that aren't reflected.

Update 9/23/07

Molly had cataract surgery (with lens implants) on 9/13/07 at Michigan Veterinary Specialist. She is doing really well so far. Her surgeon said that her blood pressure was up and down during the surgery. Her follow-up visit was 9/18/07. She had the stitches on her eye lids removed (no collar necessary). He said he thought she would do good but she was doing excellent.  :-) We are so grateful to everyone for their prayers, encouragement, shared knowledge and support. She goes back in about one month for her re-check. Please continue to pray that she keeps doing well. Molly's Poppa and I highly recommend MVS and Dr. Dan Lorimer to anyone seeking cataract surgery for their furbaby. He and his staff have been wonderful. http://www.michvet.com/ (A special thank you to Mary Ann and Aini for their help and guidance).

Update 10/19/07

Molly had her one month check up after cataract surgery. She is doing excellent. We couldn't have hoped for better results. Thanks to everyone for their prayers and support and help during this time. She is still having eye drops 2x a day and returns in two months. We highly recommend Dr. Lorimer and his staff, they have been wonderful.

(Nov.2007) Molly's latest ultrasound:

There are some changes in her liver, slightly enlarged. The tumor in her adrenal gland looks slightly larger, not much but a bit. The spot on her spleen remains the same. The radiologist saw some thickening in her intestines and around the top of her tummy. Thyroid looked normal (we had what we think now was a false-positive hyper-thyroid test result). We think these changes are in part due to the steroids she has been on following cataract surgery/higher bg's. With the bg's now coming down considerably we are hoping and praying that her organs will bounce back too. Please continue to pray for her and pray that the Atypical Cushing's is not moving into full Cushing's.  :-)

1/4/08

Molly had very high bg's due to the steroid eye drops Prednisolone Acetate. We had to stop the drops a month early. She continues on Flurbiprofen 2x a day. We see some cloudiness in the center of her eyes. They say it's a normal part of the healing process. Her pressures are good. We take her back next week and I will update her progress. We are extremely pleased with the doctor and staff at MVS and highly recommend them to everyone.

1/7/08 Molly's cataract surgery follow-up visit went great! She is doing really well. Pressures were great and she is down to flurbiprofen 1x a day for the next 4 months then back for a recheck. Dr. Lorimer said we can breath easy now.  :-) He is a wonderful surgeon and we highly recommend him (Michigan Veterinary Specialists). Our thanks to Dr. Dan Lorimer, Kim, his tech and the entire staff for giving our Molly her sight back.

We also want to thank everyone for their prayers and support. :-)And a special thanks to Mary Ann and Aini for their recommendation and lending their experience and ear.  :-)

Blood work update 1/23/08

Molly had her routine blood work and basically it's really good news.

She is finally back to "well-regulated". Her ALT ,ALK, Lipase, etc. all normal. Her cholesterol is high,

10.34 on scale of 2.54 to 9.50. Her MCH is low 17 range 21-27 and MCV low 50 range 62-78.

If we can get her bg's down a little more I think she will be doing pretty well.

Her holistic vet said, her liver values are well in normal range (huge relief her ultrasound showed liver slightly enlarged after surgery and steroid drops). He also said there is no indication of excessive cortisol effects from the adrenal tumor. Yippee!!!

Her thyroid was normal TSH, T4 and FT4. (she had a test at the IMS that said she was hyperthyroid). I think we got a false positive. Ultrasound of her thyroid also was good.

We increased her Milk Thistle after surgery and I think that and Denosyl has really helped

Molly has been on Lantus and Humalog for over two years and doing well.

Update 4/7/08 Molly had her 6 month eye exam following cataract surgery. We have been so blessed. She is doing great. No problems. She is on flurbiprofen 1x a day and goes back in 6 months. We are go grateful she is doing so well.

Dr. Lorimer and his staff at MVS in Southfield and Auburn Hills, MI are the best. We are very grateful to them.

We really need to acknowledge the wonderful people that have helped with Molly's care and regulation, especially Natalie, Chris' mom, Margo, Angel Alex's and Angel Hooper's mom, Denise, Angel Bogie's and Molly's mom, Terry, Angel Missy and Naddie's and Quincey's mom, Helen, Angel Missie's and Angel Honey's mom, and so many others I wish I could list all. A special thank you to Angel Chris, Angel Alex, Angel Bogie, and Angel Missy, because of your wonderful love and your beautiful spirits you moms are honoring you and saving lives every single day. Thank you, does not say enough. We are also blessed with two great vets here in Canada (one is holistic and works with our vet and a radiologist that is monitoring Molly) and would like to thank them for their patience and help in co-ordinating Molly's care.

Miss Molly and her Momma and Poppa

October 2006.