Alex never had an accident in the house and was easily trained except for some chewing that went on 
during the puppy stage. The usual items chewed were throw pillows and shoes. However, the bedclothes
were another issue. We have a king-sized bed and that was an expensive period of time. After we got
through this period Alex was an exemplary example of a fine mutt, always well-behaved and loving, 
with one exception. My mom, shown with Alex, was staying here recouping from a broken arm and 
her minister came to visit. I had to actually put Alex in the bedroom....he didn't like this man one 
little bit and made it totally obvious to everyone....especially the minister! 

About four years ago I noticed a drastic change in his coat and behavior and had repeatedly 
asked about possible thyroid problems but was told he was fine. This last spring, when I took the
gang (4) in for their usual heartworm check, I again asked about thyroid problems and told the 
vet that I suspected that he may be diabetic. I was simply told there was not a problem and he 
was fine. We go to a local veterinary clinic where there are always a number of vets on hand.

I have been diabetic most of my life but went undiagnosed until 1989. Thus said, I know 
personally the symptoms of uncontrolled blood sugars. On the morning of June 5th, 2002 I awoke 
to the sound of running water. Half-asleep, I thought it was my husband in the bathroom but when 
I reached over I found him to be still lying in bed. I awakened Roger and we went to check out the
noise. There was Alex in the hallway, peeing a lake while in a daze. That did it! Alex had the typical 
symptoms of uncontrolled diabetes and was even staggering. We made sure we got him to the vets
that day and I insisted Alex be checked for diabetes. His blood sugars were over 600 with a 
blood test and his ketones showed "Large" on the Keto-Diastix. He was started on 14 units of 
Humulin N on the 7th of June. After only a week and a half, looking at Alex's curve, it was
apparent that the N was not providing the needed duration. It was also becoming painfully 
apparent that, in my opinion, vets do not get enough of an education covering diabetes.
I am not faulting vets, but I will fault vet schools because, in my opinion, they do not 
provide a good education covering this disease and how to control it. I started looking for 
information concerning pet diabetes on the internet and that is how I found the Queenie website. 
Although I knew plenty about human diabetes, I did not know how much 
of that knowledge could be applied to dogs. 

After three weeks I started voicing my objections to the standard protocol of diabetes 
treatment in animals. Alex was still running an easy 500-600+ most of the time and we had 
upped the N considerably. This would have been totally unsatisfactory if Alex had been 
a human and I was especially concerned since I had learned that dogs can form cataracts 
so quickly. I made an appointment to see one of the owners of this practice to discuss the situation 
and gave her information on the insulins I currently use, Lantus and Humalog. We looked over 
all the bg values and patterns, which clearly showed that the N had not worked over this period
and, further, it wouldn't, at least not at this time and not in this dog.  We could not increase the
dosage much more due to the risk of hypoglycemic incidents, something I desperately wished
to avoid. Dr. Yvonne Nadler agreed and we set off to find research using Lantus in animals.

The new Lantus that came out in 2001 is for basal insulin needs only. The body has 
two kinds of insulin needs, basal and bolus so to speak. The pancreas puts out a small amount 
of insulin all the time and this is called the basal. When a person or animal eats, extra insulin 
is needed to cover the rise in glucose from the meal and this is called a bolus. The normal pancreas
runs this operation very smoothly and efficiently, keeping blood glucose in a range of about 70-150. 
The diabetic's pancreas cannot preform this feat for various reasons. The other insulin is called
Humalog and came onto the market in 1996. The Humalog is used to cover the postprandial rise 
from meals and works consistently and efficiently. It is normally taken at mealtime, starts to 
work in 5 minutes and peaks at two hours, at which time the action of the insulin drops 
dramatically. In order to keep sugars within normal range using these two insulins together, you 
need to use the Lantus to cover the basal insulin needs and the Humalog to cover meals.

Once the correct dosage of each insulin is found, the resulting curve is beautifully flat. Also, there is 
less chance of hypoglycemic episodes with both of these newer insulin types. The Lantus has a relatively 
flat profile to it with only a slight peaking action about 8 hours after injection, therefore, less lows if at all.
With Humalog, using a ratio of units to carbohydrates, you can cover a meal nicely and the insulin gets in 
there, does its job and then gets out, also resulting in less hypoglycemic incidents if the ratio is matched well.

Dr. Yvonne Nadler and I discussed using the Lantus and Humalog in Alex and I provided her
with information covering Lantus. We had a very real problem in that we couldn't get our hands on 
much information using the Lantus in animals. She knew quite well the action of the rapid-acting Humalog
as they use this insulin under emergency situations to quickly reduce high glucose levels but was not
familiar using it to cover meals. It was a joint decision to give this combination a try though we were 
flying a bit blind when we first started. Dr. Nadler also stated that she would in no way give this
a try under normal circumstances but since we were doing home blood testing and I was
familiar with this protocol and both insulins we were going ahead with the "experiment" 
rather than leave Alex in his present condition, mostly uncontrolled and not feeling well.

Because of a few problems encountered, and lack of knowledge concerning the use of Lantus
in animals, I made an appointment with my endocrinologist for some help. Dr. D. filled in the blanks in
about two minutes! He stated that as far as he was concerned we had made an exceptional choice in 
insulins and that we should have changed earlier. He was in a rush as he had had an emergency 
and was way behind schedule but as he was running out the door....he added that we had a 
real problem with the food! Well, we do, but that has been taken care of by turning to 
home-cooking rather than using any commercial dog foods. 

It has now been three months since Alex was first diagnosed and it has been an extremely
frustrating time in trying to regulate a dog that has turned out to have food allergies or intolerances
that affect his glucose. With the use of the Lantus and Humalog or the Regular, Alex is regulated 
quite nicely and we are at the point of fine-tuning any small problems. The rapid-acting Humalog 
wasn't producing quite enough duration to cover Alex's glucose metabolism and we have temporarily 
changed to using Regular, a short-acting insulin used to cover foods also. Though an older, more
unpredictable insulin type, the Regular provides longer duration. Once we get the food down a little better
we are going to try to go back to the Humalog simply because it has a more predictable activity profile.

Alex has now gained back a little over 6 pounds of the 13 he originally lost. He is no longer moping 
around, hiding in a cool place in the bathroom. Alex's tail is up, ears perked, greeting friends 
and family once again, and he has a bounce to his steps that I haven't seen in a long, long time. He is 
also now back in the family room during the evenings, or by my side most of the day. He's pretty much
back to normal and we knew that for sure when we went back to the routine battle of Alex wanting to 
go for rides in the car! He doesn't behave 100% well when you go to leave....he wants to go with you!
And further.....it's great to have that battle back!

Diabetes is a continuing battle, whether it be in humans or animals,
and though there is no cure, it can be controlled.
If one insulin doesn't get the job done, another one or combination of insulins
will, in most cases. I'm very lucky that I have a vet who is honest, cares about the pets and clients, 
and was willing to give the Lantus/Humalog combination a try. It is absolutely wonderful to be 
working together for the benefit of a pet, Dr. Nadler with her expertise as a vet, and my years 
of experience being a diabetic and knowing first-hand how many of these various insulins act. 
Together we're working to get the job done and I sure owe Yvonne a big thank-you for listening 
and trying something new when the standard therapy didn't work. Dr. D., my endocrinologist, 
gets another thank-you from me as he shared information he knew concerning the use of Lantus in dogs.
Sharing knowledge and experiences truly works wonders, just like on the Queenie site. Thanks also go
to many on the website who helped me with my questions, and you know who you are. 

Margo Hupe
 
Alex had successful cataract surgery!