Maltese dog, Episodes, Won't sleep nights, Very clingy

New symtptoms:  (See recent relevant medical history below) In early Dec. 2010, my 10 year old Maltese male began scratching at the bed in the middle of the night. He usually sleeps and prefers to be in his own bed, in the bedroom.  He was shivering severely and his body was very cold, including paw pads.  It was Not cold in the house.  Picked him up and warmed him up and after a fairly short amount of time he was then panting.  After this, the entire next day he followed me Everywhere, tail drooping, hanging down.  Very unusual for this Maltese as he is usually a Very Happy dog.  He was extremely needy and wanted to be held and stroked constantly.  After approx. 24 hours his behavior seemed to change back to normal, and I thought it had passed.  I called his vet who is treating him for the diabetes, explained his symptoms and the vet offered no diagnosis.  His symptoms occurred again after several days, but without the trembling and cold body.   I took his temperature; it was between 100 and 101, so basically normal.  I took him to another vet hoping for a diagnosis, but again no diagnosis offered.  These symptoms have now occurred again on Dec. 17 - Dec. 18.  PLEASE HELP.  We are exhausted and don't know what to do.  He doesn't wimper and although it would seem by his behavior that he is in pain he doesn not groan or cry out.  He has to be coaxed to eat when he has these symptoms but he usually will east something - bits of chicken breast, or hypoallergenic biscuits.  His symptoms seem to begin and get worse from approx. 12 Midnight to 9AM the next morning.    

Recent Medical History: My 10 year old male Maltese was diagnosed with diabetes in the Summer 2010.  He's now fairly regulated and is on 11 units of Humulin injections 2X a day.  In Nov. 2010 he had a tumor removed from his belly that came back from the pathologit diagnosed as a Grade 2, mast cell tumor.  The good news, there was no metastasis anywhere else in his body, from tests for bone marrow, lungs, urine, etc.

You help would be appreciated.

[Jaybay]

Since a physical problem seems to have been ruled out, then you have to consider a mental/ behavioral issue.  Trembling that is unrelated to room temperature or fever is most likely from anxiety.  It's a normal response for dogs who need to release tension and have no other way of doing it.  

One thing in particular to be aware of is to not give him affection when he has these spells.  I know, I know - it's so hard not to do that because it's what we humans expect if we're upset.  Dogs, however, only have the idea reinforced that there really IS something to be worried about when we give them affection at the wrong time.  If you treat him as you would a human child, he will continue with the behavior.  

Since the symptoms happen at night, try giving him more structured exercise during the day.  Go on two walks a day - increase the time slowly if he's not used to regular exercise.  If the walk is all about your dog leading you and doing whatever he wants to do, that needs to change.  If your dog currently thinks he's the pack leader, he's going to be under a whole lot of stress thinking he has to maintain that position.  Never forget the old maxim: a tired dog is a good dog.  And a tired dog is also a happy dog.  

Aside from physical exercise, dogs need mental exercise.  You could start by hiding high-value treats in your home or yard and make a game out of having him find them.  Although he's a small dog, having a "job" on the walk is also a form of mental exercise.  Once he's in good physical shape you can add a coat with pockets for more weight like books or anything else that adds weight and bulk.  Even a pulling a tiny cart will give him a job and tire him out.  

It's really pretty simple.  Reward the behavior you want with praise and affection, and withhold affection from behavior you don't want.  Affection given at the wrong time only makes things worse.  Believe me, I know how difficult it can be.  One of my dogs was been terrified of thunderstorms.  The more I tried to comfort as I would a human child,  the worse she got.  Once I stopped giving her cuddles and affection and allowed her the time to deal with her fears on her own, she got over it - and pretty quickly.  

If none of these techniques help, then I strongly advise that you hire a veterinary behaviorist to evaluate both his behavior and your reaction to it.  Anything you learn in that process can be applied to all dogs in your life, and also make your relationship with your dog so much more rewarding.  It's all about learning to communicate and understand your dog's body language and basic mental and physical needs.  Go for it!  :-)