Possible Cushing's Diagnosis for Babydog, also Diabetic

[MegMere]

Hi. I want to introduce myself and give my brief story. I have a black lab/german shepard mix (adopted pound pup) that I've had for 9 years. When I adopted her she was just under a year old. Her name is Babydog and she got very sick about 3 weeks ago. She had vomited and had also had diarreaha about 6 places in the house plus there was a pool of almost pure blood in one spot. I discovered this about 5 am and since I live near a university with a top rated vet school I took her there. They kept her for about 4 days; she had pancreatitis and I was told was also diabetic and dehydrated. However, they said she was doing very well and so finally I went and picked her up. They told me to give her 10 unit insulin injections twice a day and then take her to her vet for a glucose curve test after a week. I did this and my vet said that her insulin was not good. That it is in the 400 range. So over the last week I've been told to switch to a different insulin, changed her food and now it appears that she is not responding to the insulin at all. So after 2000 dollars for the initial er trip and 4 days in a row now taking her to the vet, it is being suggested to me that if when they test her today that if her insulin is not better that she could have cushings disease. My dog still has energy. Besides that one incident she does not urinate in the house. I'm beginning to feel so defeated. I am not able to afford more mounting vet bills only to be told that what was originally diagnosed is now not what's wrong. Plus she seemed to be doing well when she first came home from the vet school. Apparently she was responding to the insulin when they gave it to her because they had her levels regulated. Do you think my vet is the problem or am I not doing something right? I've stayed on schedule with all of her shots although she hates getting them. It's breaking my heart and now I get to apparently start over with an entirely new illness that I'm not familiar with if she does indeed have cushing's disease.
Advice??
Thanks!

[Roxee's Dad]

Moderators note: You'll notice there is a delay from the time you post until it shows up on the forum. You will need to go to your e-mail and confirm your account. Until then, your post will remain in moderation until approved by a staff member.

Hi,
I wanted to welcome you to K9cushings, glad you found us but am sorry for the circumstances. This is a wonderful group of people willing to share their knowledge and experience. The others as I affectionately call them will be by to help you sort through this.

Can you post what test were performed to diagnose the diabetes and cushings? Please be aware, there is no one reliable test to properly diagnose cushings and please be aware that cushing's is not a death sentence. With proper diagnosis and treatment, our cush pups go on to live long healthy and happy lives.

The others will be by to help, please gather all the diagnostic information, your vet should be happy to provide it.

You should also visit our sister site:
http://www.k9diabetes.com/forum/index.php

It is a wonderful resource for dogs with diabetes, They will welcome you with open arms and helpful information. I am also aware of a recall of certain type of insulin used in treating dogs with diabetes. You should be able to find out more information there. We have quite a few members that are members of both site as their pups have both diabetes and cushings.

So take a deep breath, read our resources and information section, ask all the questions you want. We are here to help you and Babydog.

[Squirt's Mom]

Hi and welcome to you and Babydog! :)

What an ordeal you two have been thru lately! Bless your hearts.

First and foremost, IF Baby does have Cushing's, it is not a death sentence...altho two years ago when Squirt and I got here you sure couldn't have made me believe that! :p I was a complete and total basketcase then! :eek: A friend here described me as a woman who had stuck her finger in a light socket and her hair was standing all on end...she kindly left out the part about bugged-out eyes and flying slobber. :o But it does get better, I promise. Today I rarely slobber more than once a month. :p

In all seriousness, you and Babydog are in good hands here. We will help you sort through all of this as best we can...and there is a great deal of experience here with pancreatitis and diabetes as well as Cushing's and other related conditions.

Cushing's is a very slow progressing condition, taking years to do irreparable damage. So take a deep breath, hold it a sec and let it out slowly. Let's take this one step at a time.

True Cushing's is caused by elevated cortisol in the body. We all need some cortisol to help us function properly. Cortisol is one of the fight-or-flight hormones and we need it to deal with stress. Now, anytime the body is under stress of any kind, extra cortisol is released to help us cope. The same is true with dogs...they need some cortisol to function when dealing with stress.

Pancreatitis puts the system under a great deal of stress and will cause the cortisol to rise naturally. So you want to be sure it is under control before starting any Cushing's specific testing. Otherwise, the results could easily be skewed and you wouldn't know any more than you did before the test and would have wasted money...or worse, treatment would start based on a skewed test. :eek: Lori is our resident pancreatitis expert and I am sure she will along soon to share with you.

BG levels can also react to stressors, making it difficult to regulate. Untreated Cushing's can make BG difficult to regulate, too, and that is probably why your vet is thinking along those lines. Please do join our sister-list at K9Diabetes.com...they will be able to help you a great deal!

It is always a bit harder when dealing with multiple issues, but Baby's are not insurmountable based on what we know so far. I know it seems that way right now, but things will get better as you get more answers and learn more about the various conditions she is, or may be, developing. Several of our members deal with multiple issues and the pups are doing just great! I am sure the same will be true for Baby in no time!

Educating yourself is the best thing you can do for Baby. You are her first and last defense, her only voice, her advocate. The more you know, the stronger you will be in these roles. So read in the Resource section and read the treads here. Ask lots of questions then read some more. Gotta keep that mind busy, ya know! :p

For now, the most important thing for you to know is that you and Babydog are not alone on this journey. You have walked into the most amazing bunch of folks you will ever meet and we will be with you every step of the way. Never hesitate to ask questions as that is how we all learn...there is no such thing as a dumb question. If we don't know the answer, we will help you research. If you just need to talk, someone is always around to listen. We are a little family here, of which you and Babydog are now a part. So try to relax, gather as much info as you can on Baby to share with us, and remember there are a whole bunch of folks standing by your side now.

I am so glad you found us and look forward to learning much more about the both of you in the time ahead.

Hugs,
Leslie and the girls - always

[MegMere]

First I want to thank everyone for welcoming me to your community. I am so worried about my Babydog and it's nice to know that there are people out there that love animals and consider them "one of the family" too.
I do have some of the results from when she was initially admitted to the emergencly clinic as stated in my introduction.
Initial diagnostics:: PCV 56% TS:7.6 g/dl Lactate:2.2 mmol/L Blood Pressure: 138 mmHg
Serum chemistry: ALP 135 U/L (H), glucose: 420 mg/dL (H), Cholesterol:297 mg/dL (H)
Complete Blood Count:HCT 60.9% (H), lymphocytes: 0.793x10^3 cells /uL
Total WBC count within normal limits.
Abdominal radiographs:Some sections of small intestine are stacked on top of each other and have sharper than normal turns. Abdominal ultrasound was recommended.
Abdominal Ultrasound: Pancreas mildly enlarged in size and hypoechoic, there is a corresponding area of hyperechogenicity in the mesentary. These findings are consistent with pancreatitis. A small splenic nodule of unknown clinical significance was also present on the ultrasound.
Urinalysis-USG:1.043 pH: 8.0, urine protein 113.4 mg/dL, glucose:3+, keytones: trace
the Next day 2-27
NOVA (chemistry) elevated glucose, potassium within normal limits
2-28
NOVA (chemistry) Glucose 275 mg/dL, potassium within normal limits

This was from her initial emergency room documentation. I don't really understand it but all I know is she got better came home and after going for her recheck at my regular vet he says her glucose curve has been in the 400 to 500 range everytime they test her.
Any information would be helpful. Thanks again for taking the time to view my post.
With the most sincere gratitude,
MegMere

[frijole]

Hi MegMere - glad you found us. We have several members who have dealt with diabetes and cushings and I am sure one of them will respond when they see your posts.

I know just from reading here that sometimes dogs have both diseases, but we see a fair number that simply have diabetes and "cushing like symptoms" but not really cushings.

Those with experience with diabetes can better coach you on what to ask your vet and they can perhaps tell you if your vet is on track or not. I do know that alot of members have used specialists when multiple diseases are expected because frankly they have more experience (normally).

Hang in there! I am glad you found us. Kim

[Harley PoMMom]

Hi and welcome from me and my boy Harley too! I was wondering if your vet was treating Babydog's diabetes with Vetsulin?

Love and hugs,
Lori

[littleone1]

Hi MegMere,

Corky and I would also like to welcome you and Babydog. I'm sorry that I can't offer any advice, as I haven't had any experience with diabetes. We do have several members that have been treating both Cushings and diabetes. I'm sure that they will be able to give you some good advice.

I wish you and Babydog the best, and hope everything goes well for both of you.

Terri

[BestBuddy]

Hi and welcome,

What insulin are you using? 10 units seems like a small amount for a lab sized dog. Buddy was only 11lbs and getting 4-5 units which was the right amount for him. An average (remember all dogs are different) would be 1/4 to 1/2 unit per lb. How much does Babydog weigh?

Jenny

[MegMere]

Hi and welcome,

What insulin are you using? 10 units seems like a small amount for a lab sized dog. Buddy was only 11lbs and getting 4-5 units which was the right amount for him. An average (remember all dogs are different) would be 1/4 to 1/2 unit per lb. How much does Babydog weigh?

Jenny

Hi Jenny,
Babydog weighs about 68lbs. The insulin was Humulin I think? Today the vet told us to stop the insulin and so tomorrow I'm taking her in for one more glucose curve to see if she's actually diabetic or not. It's strange b/c when she left the er vet hospital at the university she was diagnosed as diabetic with pancreatitis but now her insulin doesn't appear to be doing anything and I guess that's why the vet now suspects cushings. However, she is still very active, doesn't urinate in the house and isn't weak in her legs. I just don't know what to think. Hopefully her test tomorrow will provide some answers.
Thanks for responding.

[MegMere]

Hi and welcome from me and my boy Harley too! I was wondering if your vet was treating Babydog's diabetes with Vetsulin?

Love and hugs,
Lori

Hi,
No, Babydog has not been treated as yet with Vetsulin.
Thanks for responding.

[Harley PoMMom]

Inflammatory destruction of the pancreas, as in pancreatitis, can bring about temporary or permanent diabetes in dogs.

http://www.marvistavet.com/html/body_diagnosing_diabetes.html

Also, looking at Babydog's USG 1.043 : Elevated cortisol makes the kidneys go into overdrive and our cush pups pee buckets; therefore our cush pups HAVE to drink more water to keep up with the kidneys output. So, in most cases our cush pups have a low USG. The (USG) Urine Specific Gravity test tells your veterinarian how concentrated the urine sample is. On Harley's lab report from Anitech Diagnostics, his USG taken 2/26/10 was 1.009 (R.R. 1.015-1.050).

Since the pancreatitis showed up on the ultrasound and Babydog was hospitalized for it also, was a cPLI or a cPL test done to confirm? Since she is part Shepherd/Lab, she might have IBD too...just a thought.

Keeping you both in my thoughts and prayers.

Love and hugs,
Lori

[rhodesian46]

Question? Was the diabetes diagnosed the same time as the pancreatic attack? If Babydog was diagnosed the same time then why take her off the insulin for a day? Her blood glucose was 275.That is high. Her USG( urine specific Gravity) was with in range for a dog. A dog that is diagnosed with insulin has a low USG. THey are drinking lots of water and there urine is like water.
As far as your vet thinking along the line of Cushings:I don't understand. Your dog is on 10 units. A relatively low amount for a dog that size. With Humulin you can go 1/4-1/4 per lb of body weight. So if your dog weighs 60 # then 30 units could be administered 2 x a day if her Bg' s warrant this. Of course weekly curves would need to be done when doing an increase. With your size dog most vets will increase 2 units at a time then wait 5-7days to do a 12 hour curve and decide whether to increase again. You have plenty of room to go. I would not test for Cushings at this time. My concern right now is whether your vet has experience with either diseases. Please make sure and don't be afraid to ask how many diabetic dogs he is treating and Cushings dogs as well. It is your right as as an owner to have these answers. Also get all test results and vet notes and keep in a file in case you need these say for an emergency.

BTW did you know that you could get a generic form of Humulin N from Wal MArt It is their brand Relion Novolin N and it is 1/2 the price( around $23 a bottle) It is the same as Humulin.

You can cut costs by home testing. I did this with my Siberian Husky SHe had Cushings,diabetes and hypothyroidism.

Would you mind posting some reference ranges for the results you posted. MAybe post the whole chem panel.

Marianne

[k9diabetes]

Hi and Welcome!

You've sure been hit with a lot of news in a short amount of time! No doubt it all feels really confusing right now!

It seems like some of the advice given is at odds with each other... there seems to be a question about whether she's truly diabetic and at the same time concern that she's insulin resistant and so has Cushing's disease.

As others have mentioned, both pancreatitis (by impairing the function of the pancreas in producing insulin) and Cushing's disease can cause high blood sugar. And it's not uncommon for a dog to have more than one of those disorders at the same time. Or to have diabetes alone. Or to have diabetes and one or more of those conditions! Yikes, huh?

So this will take some slow and careful investigation to sort out.

I can say that I would put Cushing's disease at the bottom of the list at the moment unless she is visibly showing signs of Cushing's disease. It's the least time critical to treat and is very hard to accurately diagnose with a dog who may have pancreatitis and/or diabetes at the same time.

If your 68 pound dog has never been on more than 10 units of NPH insulin, then no one can say that she is resistant to that insulin.

If you don't give anywhere near enough insulin, you really don't see a response from the blood sugar. It looks like shooting water. As the dose goes up, though, and starts to approach a functional dose, the blood sugar will start to drop. Your dog could easily need 20 to 30 units of insulin. And if there is still some lingering pancreatitis, she could need more from the inflammation and stress.

So until she has been tried on a lot more insulin, it's impossible to know if she is resistant to insulin. In fact, I would say that if the curve already showed blood sugar down into the 400s, it probably will work well for her when more is given. If she wasn't responding to the insulin, the blood sugar levels would usually be much much higher.

I am sure they are being conservative with the dose right now because they are not certain she's truly diabetic.

As far as Vetsulin, you don't want to use it because at the moment it is under an FDA alert and is not being produced. Supplies are rapidly drying up and maybe already be exhausted. The manufacturer is asking that ALL newly diagnosed dogs be started on another insulin.

Chances are very good that NPH will work just fine for your dog if they determine that she is actually diabetic.

I want to invite you to join this site's sister forum for canine diabetics, www.k9diabetes.com/forum (http://www.k9diabetes.com/forum). It looks a lot like this forum and all works the same way.

We can show you how to home test her blood glucose, which will save you a ton of money versus doing curves at the vet and you will be able to see for yourself how her regulation is coming along.

We also have a ton of injection tips because most dogs don't hate the shots and sometimes it's just a matter of a few tips like putting the bevel on the syrinfe facing up and warming the insulin in the syringe before injecting.

I really wouldn't worry about Cushing's disease right now. Work first on getting the diabetes question sorted out. You can tell a lot about whether a dog has Cushing's based on how she responds to the insulin.

Hang in there. This first part is the worst part. Eventually, with diabetes, it becomes about as stressful to deal with as brushing your teeth! :)

Natalie

www.k9diabetes.com (http://www.k9diabetes.com)
www.k9diabetes.com/forum (http://www.k9diabetes.com/forum)

[Franklin'sMum]

Hi MegMere, and welcome to you and Babydog,

I'm so sorry Babydog is having these issues and that you're feeling lost and confused, but please don't give up hope. This is truly an incredible group of caring and knowledgeable people.
I noticed your second post mentioned a nodule on the spleen... When things have settled down with Babydog a little, it may be a very good idea to have another abdominal ultrasound to check that splenic nodule again.

A small splenic nodule of unknown clinical significance was also present on the ultrasound.
MegMere
Leslie (Squirt'sMom) can tell you more, but Squirt had been diagnosed with Pituitary Cushings, every test came back as positive for pit. cushings, and at the second u/s the sonographer found a tumor on Squirt's spleen. After having the tumor removed (or a spleenectomy, sorry Leslie, my memory fails me) Squirt has now repeatedly tested negative for true cushings, and has Atypical Cushings (which is an elevation in one or more of the intermediate steroid/sex hormones) and from what I understand, a lot easier to treat.
That second ultrasound saved Squirt's life, so you may want to consider having another U/S done, before doing cushings blood testing on Babydog.

Hoping you get Babydog's diabetes figured out,
Jane, Franklin and Bailey xxx
________
Vaporizer volcano (http://volcanovaporizer.net/)