Cody Lee is an 8 year old neutered male Lhasa Apso who was diagnosed with
diabetes one month before his 7th birthday. Just a few weeks before, he had received an
overdose of a long-acting steroid which never should have been given in the first place.
He became acutely ill within a few days of the injection and progressively got worse over
the next few weeks. His weight dropped from 24 to 16 pounds in less than 1 month. On June
3, 1997 he was admitted to the ICU of a university veterinary hospital with a diagnosis of
steroid-induced diabetes, ketoacidosis, and acute pancreatitis. Cody was extremely ill and
remained in the ICU for 10 days. On the third day, I was approached with how he wasn't
improving and if he didn't get better by the end of the weekend I would be faced with some
serious decisions. I was also told that as ill as he was, even with the most invasive of
approaches he had a very high chance of not surviving. I cannot even put in to words how I
felt, I have never in my life cried so much. I felt my whole world was coming apart---I
couldn't eat, work, or sleep.
On that Monday, Cody had stabilized but he still would not eat. Before making any
decisions about further invasive procedures or euthanasia, they wanted him to spend the
night with me at home and see if I could get him to eat. They were comfortable sending him
home with me because as a nurse, I could manage all his medications, injections, and IV's.
I was terrified, but the vet had confidence that I would be able to manage.
When we got home, Cody was very upset (he even bit me), but he finally started eating. He
looked quite a bit better the next morning. We went back to the hospital in the morning
for monitoring, and the vet decided I should care for Cody at home. I came back on Friday
with a dog they barely recognized--one who was alert and happy and playful. Cody was not
100% yet, but he was a far cry from the almost comatose dog of just a few days before.
As far as getting Cody's diabetes regulated and monitoring him - he was pretty regulated
when I got him home from the ICU. He was sent home on 6 units NPH twice a day and his bg
curve was great. About 3 weeks later, I suspected maybe his bg was too low. Cody wasn't
acting hypoglycemic, I just had a "feeling" something wasn't right. Cody had a
check-up with the vet and I told him of my concerns and he didn't really believe Cody
could be hypo and still be so alert, but he agreed to do a bg curve and all the tests were
in the 50's! Since then Cody's insulin dose is adjusted as needed based on a combination
of urine and home blood glucose monitoring. Cody remembers his days in the ICU, and
becomes severely stressed if he stays at the hospital. This stress causes his bg to be
falsely elevated, so the vet decided it would be better for Cody if I continued to monitor
Cody's bgs at home. Cody also gets a fructosamine test every 3 months. This shows us how
well the diabetes has been controlled, on average, for about the past 3 weeks.
Since being diagnosed, Cody has had several periods where his diabetes was unregulated. He
had to be put on a diet because his weight was increasing, he has undergone dentistry and
antibiotics for gingivitis, he has experienced Somogyi rebound (hyperglycemia caused by
too much insulin), he has had a urinary tract infection, superficial infections, and a
change in appetite. All of these things influenced his diabetes regulation. For the most
part I was able to keep his bg pretty well controlled, but it requires home blood
monitoring, urine monitoring (twice daily minimum), as well as frequently insulin dose
As for Cody's diet, we have several things to consider: diabetes, problems with bladder
stones, and preventing the pancreatitis from flaring up again. His diet since June 97 was
Hill's WD twice a day at the time of injection. I fed him mostly dry kibble, but usually
gave his breakfast portion as 50% dry 50% canned food so that I was sure he ate before I
left for work. I usually feed him and give his insulin injection at the same time unless
something unusual is happening. For example, if his bg is low I feed and wait 30 minutes
before giving the injection (and adjust the insulin dose depending on how low his bg is).
If his bg is high I inject first and feed 30 minutes later. He has recently been switched
to Eukanuba Glucose Control diet but it is still too soon to see how that will work.
When Cody was first diagnosed with diabetes, even though I have advanced nursing
experience, I felt scared over managing Cody's diabetes. I have a good relationship with
Cody's vet, and I called the vet with questions about almost every little thing. My vet
gave me very complete answers and explanations, and gave me guidelines in order to make
decisions on my own. Now, I make most of the day to day decisions by myself but when
problems occur I defer to the vet for instructions. I like to think of us as a team but I
also think I have a pretty good understanding of when to be led.
In ending I just want to say that Cody is more special to me than I can ever hope to
describe in mere words. He has taught me that there is a being beyond those precious eyes
and this has effected my outlook on all animals. Cody has gone through an awful lot in his
life, much more than seems fair for such a lovable dog. He is now a diabetic and will
require insulin therapy forever. But the most important thing is that through it all he
has remained a lovable and happy dog who continues to bring joy to me and anyone else
fortunate enough to be near him.
After two years of successful management of his diabetes,
Cody passed away in October 1999, due to complication from liver
disease. Your friends on the diabetes mailing list will miss you Cody.