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DM And Gymnema/Corn Silk

by rmtran - August 25, 2009

Hi Steve,

I have a 6 years old MC Chihuahua with recent dx of Diabetes Mellitus. The rDVM and our internist tried to control his BG with various approach without success.

When I first saw this dog 2 weeks ago, he was cold in extremeties and weak, his tongue pale lavender and his pulse thin; typical Yang Deficiency +/- Blood deficiency (Hair loss at caudal thigh and ventrum).
I placed him on Gymnema and Corn Silk (0.1 ml BID) for this 9 lbs dog.

Two weeks later, his body was HOT! The client did not change his diet (home cooked, chicken with lots of veggies including artichoke) nor the amount of insulin (Vetsulin 4.5 Unit BID).

His tongue was pink, and his pulse was choppy. His activity level has increased, but he started drinking more water. The client said that he started to sleep outside of blanket instead of inside.

I am wondering if Gymnema and Corn Silk has warm energetics, or his Yin Deficiency has uncovered with its use.

Which is likely true?

Thanks,

Rieko

by naturevet

August 25, 2009

Hi Rieko,

I have no good explanation for what you saw, but there's no denying it's there. So now I would look at either formulas like ZBDHW or Rehmannia Six; or especially at Qing Ying Tang.

The latter may seem an odd choice. All I can say is that I've used it where I see heat, stasis (i.e. a choppy pulse) and Yin deficiency, and have had animals experience an abrupt improvement in their response to insulin. I'd give it a try here.

I don't see a reason to stop the Gymnema, however.

Good luck,

Steve

by rmtran

August 27, 2009

Hi Steve,

I have a concern on this patient.

The client stataed that this patient was dragging right front leg time to time at the initial appointment. We thought that it could be diabetic neuropathy (although I usually see in hind limbs as dropped hock). I addressed it with acupuncture for the past two session (2 weeks apart), but the client stated that he is doing that on the other front limb as well, and he seems a bit weaker.

I do not recall any neuro problem such as neck pain.

Before I got your reply, I started this dog on Jian Tan Cha to tonify Yin and Qi; it obviously did not help much (the patient is on for past 3 days).

I will starting heat clearing formula, and I am recommending a neuro consult since it does not sound that good.
Out of your recommendation, QYT or ZBDH sounds better for this patient; LWDH may be too mild for this patient.

Just my curiosity: Is there a perticular formula that will address forelimbs rather than hind limbs?

Thanks a lot for your help.

Rieko

by naturevet

August 27, 2009

Hi Rieko,

I find over half of the dogs I see with forelimb lameness or weakness have neck chiropractic issues. Very few of them exhibit any neck pain. For now, I would obtain a chiropractic evaluation of the dog's neck. If there are no problems there, and the dog is not responding to QYT or ZBDHW, then hopefully there'll be sufficient changes in the case to help us figure out what to do next for the forelimbs.

Good luck!

Steve

by rmtran

August 27, 2009

Hi Steve,

I have a concern on this patient.

The client stataed that this patient was dragging right front leg time to time at the initial appointment. We thought that it could be diabetic neuropathy (although I usually see in hind limbs as dropped hock). I addressed it with acupuncture for the past two session (2 weeks apart), but the client stated that he is doing that on the other front limb as well, and he seems a bit weaker.

I do not recall any neuro problem such as neck pain.

Before I got your reply, I started this dog on Jian Tan Cha to tonify Yin and Qi; it obviously did not help much (the patient is on for past 3 days).

I will starting heat clearing formula, and I am recommending a neuro consult since it does not sound that good.
Out of your recommendation, QYT or ZBDH sounds better for this patient; LWDH may be too mild for this patient.

Just my curiosity: Is there a perticular formula that will address forelimbs rather than hind limbs?

Thanks a lot for your help.

Rieko

by rmtran

August 27, 2009

Hi Steve,

I do not know why this post was doubled...

Anyway, thank you very much for your advise, and I started Qing Yin Tang on this patient. I also recommended a neuro consult as well as chiropractic consult, if his legs are not doing well during my absence.

I am hoping that I can help this boy.
When I was at another clinic, I neutered him at 6 months old. I left the clinic, so did the client. She was looking for me a while, and found my brochure in front of the IMED office where she was referred to for DM. Here they are, Tim and his Mom are once again my loyal patient/client. I do not want to disappoint them.

Rieko

by rmtran

September 25, 2009

Hi Steve,

I continue to see this patient biweekly.

He is finallyon QYT, and his front limb is better (no more dragging). However, the glucose level remains variable.

He also started to have erhythema with small epidermal collarettes at ventrum, that makes me think of Damp settling at ventrum. The client mentioned that he used to have anal sacculitis, which has pretty much resolved since acupuncture was started. His signs of Blood deficiency remains: Thin, somewhat wiry pulse, pale dry tongue, thinning of hair at caudal thigh and ventrum, hyperkeratosis of nare. I dispensed Si Wu Tang to be used with Qing Yin Tang, but wanted to check with you before I tell the client to start it.

My other thought for this patient was SMS with Dang Gui. I opted not to use SMS at first, because this dog did not seem to have much to drain at the first visit (a lots of blood deficient signs with coldness).

Now I see some Damp, so I thought that may be better than QYT + SWT.

Thanks for the imput as always,

Rieko

by naturevet

September 25, 2009

I also wonder whether SMS plus DG is a better choice. But I've also seen diabetic dogs (not cats) destabilize on SMS - I think, anyway. So let's see what happens. If your dog gets more Damp on SWT, we'll know that a move to SMS plus DG is more likely to be helfpul, not harmful.

S

by rmtran

September 26, 2009

Thanks, Steve.

I decided to get SWT back and dispense SMS with Dang Gui.

Would it be ok to mix more than 20g of Dang Gui into 100g of SMS if less effect of draining is desired here?

Rieko

by naturevet

September 26, 2009

That should be fine. But to do more than that would imply Blood deficiency signs are quite obvious. If they are, then no problem. I've used up to 35g before where the Blood deficiency effects are present.

S

by rmtran

October 3, 2009

Hi Steve,

As you suspected, this dog started to drink more and wake up the client three time in the middle of night to go potty in a few days with SMS with DG.

The client plans to discontinue, and see if it stops, then re-start with smaller dosage.

I told her that it is likely that we go back on the plan with SWT (never given yet), if he becomes PU/PD again on it.

I am wondering if SMS has so much draining effect that makes him PU/PD. His glucose level was not much different (the client does glucose curve at home).

Apart from this, I have a thought about why this dog became so hot after start taking Gymnema tincture. It contains alcohol, which is hot in energetics; could it be a reason for him to become ataxic and hot? Only 0.15 ml or so twice daily, but he is 9 lbs Chihuahua; it is like a taking shots every day, isn't it?

Another question: This patient continues to have keton in his urine (50% of the time). Is this normal if he is on mainly protain based diet? It improved some after incorporating complex carb. The client home cooks chicken and other veggies along with artichoke (that supposedly improves insulin sensitivity).

Thanks for your imput!

Rieko

by naturevet

October 6, 2009

Hi Rieko,

It appears to be the Huang Bai that can have a de-stabilizing effect on diabetics. From a TCM perspective, if it is problematic, it is because it is too cooling for the patient. So it suggests the patient needs Qi or Yang tonification. In that case, Bu Zhong Yi Qi Tang may be helpful. We have some IDDM cases in dogs that are beginning to not need their insulin, which I find amazing.

As for Gymnema, the Corn Silk drains Damp. So if a patient is Blood or Yin deficient, they could become hot on it. BZYQT has Blood tonification properties as well as Qi tonification properties, so it would be my next pick if the Si Wu Tang does not pan out.

Good luck!

Steve

by rmtran

December 14, 2009

Hi Steve,

It has been a while since I continue to treat this patient every 2 weeks.

I ended up using just Dang Gui (small amount) and Gymnema/Cornsilk for this little guy for a while, and he gradually developed more Blood deficiency signs.

He continues to seek for warmth (although his body does not feel that cold any longer).
Tongue-pale lavender
Pulse-very thin and wiry
He has superficial dermatitis at abdomen that gradually gotten worse; erhythema, epidermal collarettes.
His abdomen and caudal thighs are still bold, and his nose crusty, and his pads are dry.

This patient was never been on Si Wu Tang (the cient returned before using it); I dispensed BZYQT today in hope of better glycemic control. This client is an ophthometrist, and she started to give Vetsulin four times daily! She think that it helps this patient to be energetic (1 Unit BID between 4.5 Unit BID).

My question: Does insulin acts as Qi tonic here?

Another strange thing is that the patient develops polydipsia with cooked salmon (no salt added), and I cannot figure out why; any idea?

Thanks!

Rieko

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