13 y/o Boston Terrier, Molly Megan MCQ, Cushing's, Diabetes (help please, crisis)

[ladysmcq]

My name is Judy Neely, I live in Missoula Montana, I have a 13 year old Boston Terrier name Molly Megan MCQ, she goes by Meg, megan was diagnosed with cushing in 2007 along with our Precious Promise also a Boston Terrier and Megs long time Companion.. for one year I treated them both holistically until I was backed into a corner and had to treat or watch them deteriorate quickly... I joined the other cushings group and read and researched about Trilostane and Lysodren all hours of the night and day, I finally bit the bullet and started treating with Trilostane, but no vets here in our city knew much about Trilostane, even the internist.. they all wanted to start high, I would not even think of going over 10 mg to start...

Promise did not respond to it, and from the use of it quickly declined, her cushings was Pituitary, we lost Promise on Oct 13 2008, she was 11 years old.. and a Champion agility dog, our best friend and family member... it was a hard blow for Meg and I.. little did I know that Promise was guiding Megan around, due to failing vision... another family member McKinsie stepped right up to the plate and became Megans guide dog and comfortor as megan was very depressed from the loss of Promise,

Megan was than diagnosed with Diabetes and Meg got stim test every three months, was getting trilostane 10 mg once daily, her stim test got better and better, and she did also. her sugar has been under control and she has been on the same dose of Trilostane 10 mg since 2008 with very little problems..but I have been watching her carefully..

her last 4 stim test she has been running her pre's very low I thought 1.6 1.9 2 and her Post mostly 2 .6 or 2.4 or 2 my vet said all the super chems panels were good and they were she was getting better and better... but I could tell she wasnt herself and the other day she was staggering , drooling, and didnt look good, I checked her sugar and it was 251, but didnt look like that was the problem and i gave her 5mg of Pred right away, called the vet and told him and he said that was good thinking, and said to bring her in for a stim test in the morning...

she improved, in a few hours and was much better, I did not give her the trilostane the next day or the next...her stim test came out pre 3.8 and her post 5. the vet said it was good so keep on with what I was doing...I told him I thought it came up because she had Pred, he didnt seem to think so...but I do..he also said he didnt know from here on how to treat Meg as far as dosage, but said to out her back on the 10 mg of Trilostane... I did not...I restarted her on 5 mg of Trilostane after two days of being off. becasue I did not know what to do or have anyone to guide me other than the good Lord...so here i sit not knowing what to do next and if I should have left her off the trilostane for a longer period of time....she did start hanging out at the water bowl, and quit it after I restared her back on the 5 mg...of Trilostane...I dont know where to go from here...and my vet doesnt either,..

so I am trying to find a knowledgable vet that has dealt with Trilostane to help us...I think the trilostane builds up and she was close to crashing and I caught her before it happened...any advice ...feedback...thoughts...help will be appreciated, maybe who I could contact to talk to...or??????

Meg is my very breath...without her I am nothing.... I need her in my life, she is my most treasured little person...she is what makes me get up in the morning...she is a light to many but her light shines the brightest in my life....could anyone help us....God Bless all who have loved ones with Cushings...Judy and Megan..

[littleone1]

Hi Judy,

Corky and I want to welcome you and Megan.

Corky is also my baby and is a Boston Terrier. He is being treated with Trilostane, and has been doing well with it. He started on 20mg a day with once a day dosing, and is now up to 40mg a day, with twice a day dosing. He has an adrenal tumor. He hasn't had any setbacks from being on the Trilo, and it will be a year on Sunday since he's been taking it. Trilostane usually lasts about 8 hours.

I'm very lucky, as his IMS is very experienced in using Trilostane. You might want to try to find an IMS with experience in treating Cushings.

Others will be along that have much more experience than I do. Hang in there. There are so many knowledgeable, caring, and supportive members here.

Terri

[frijole]

Judy, I am bumping this up so someone that has used trilo will see it and respond.

I used lysodren but have read here for over 4 yrs so ... based on that... I think you did the right thing by giving the prednisone. That and the skipped dosage(s) are probably why you are seeing a higher result.

I know that maintaining levels of 1 to 5 are the goals with lysodren but I know that many here believe that dogs on trilo can certainly be managed at higher levels. So I would stick to the lower dose and ignore the vet! :o It would be nice if you could find an IMS doc for your vet to "listen to". Are there any vet schools near you?

You seem to be doing a wonderful job. I hope I helped a little bit. Kim

[labblab]

her last 4 stim test she has been running her pre's very low I thought 1.6 1.9 2 and her Post mostly 2 .6 or 2.4 or 2 my vet said all the super chems panels were good and they were she was getting better and better... but I could tell she wasnt herself and the other day she was staggering , drooling, and didnt look good, I checked her sugar and it was 251, but didnt look like that was the problem and i gave her 5mg of Pred right away, called the vet and told him and he said that was good thinking, and said to bring her in for a stim test in the morning...

she improved, in a few hours and was much better, I did not give her the trilostane the next day or the next...her stim test came out pre 3.8 and her post 5. the vet said it was good so keep on with what I was doing...
Hello and welcome from me, too!

I'm so sorry that you're feeling so worried about Meg, but very glad that you have started posting here. You've given us a lot of information, which is great. But I do still have a few questions for you -- the answers may help us sort out what is going on with Meg.

It sounds as though she has been treated successfully with trilostane since 2008. But recently her stim tests have been lower? Can you please tell us how her stim tests were running during those first two years of treatment? On the face of it, a "post" result of 2.4 or 2.6 really isn't considered too low according to the trilostane treatment protocols with which we are most familiar -- especially as long as Meg's chem panels were also looking good. But if this represents a big drop from her earlier tests, then perhaps it is a level that is too low for her comfort. So any additional info that you can give us about her previous testing history will be helpful.

Also, you noted that her blood sugar during this episode was 251, which I believe is high? How has Meg been doing, generally, as far as her diabetes? I know that it can be very confusing at times to try to unravel the symptoms or problems that are being caused by each disease on its own...

It is true that prednisone will skew the outcome of a stim test. However, as long as the test was run more than 24 hours after Meg was given the prednisone, the results are probably a pretty trustworthy indication of her natural cortisol level. Since it turned out to be 5 -- coupled with the fact that she was already starting to drink more water again -- that does seem to indicate that she needs to be taking trilostane rather than not. It also makes me wonder whether her diabetes might have played some role in her earlier discomfort.

So any additional info you can give us about Meg's previous stim testing history and diabetes management will be greatly appreciated! Also, how much does Meg weigh?

Thanks so much in advance,
Marianne

[k9diabetes]

Hi Judy,

I can't help much with your immediate question but wanted to say hello - I lived in Missoula for a number of years so double hello! :) And also I wanted to invite you to the sister site to this one for dogs with diabetes, www.k9diabetes.com (http://www.k9diabetes.com). There is a forum there as well, www.k9diabetes.com/forum (http://www.k9diabetes.com/forum). I administer the diabetes site but also check in here periodically.

Do you have a vet who is willing to work with you on this?

I would suggest that your veterinarian get in touch with Dr. Feldman at UC Davis, author of many of the protocols for treating Cushing's disease. UCD should be willing to consult with your vet and provide some guidance.

Also, if you go through the reference section here, those protocols and other articles and guidelines are provided there and you can print them up for the veterinarian to review.

I hope you have a vet who likes a challenge and is willing to become an expert, maybe with a nudge from you!

Natalie

[ladysmcq]

Natalie,

thank you for your reply, I do belong to the diabtes group but am not sure if it is the one that your telling me about, will check your hyperlink out...I do have a vet that likes a challenge, and takes pride in his knowledge, and has done a lot of research due to my nudging him..but sometimes is a bit arrogant, not often but I will suggest Dr, Feldman to him and see if he will look into it for me...if not I will try and contact him....I will also look up the referance section as you suggested...thank you again former Missoulian...smile....Judy and Megan

[ladysmcq]

thank you Kim, everything said helps, yes you did, thank you for replying..The closest vet school in in Spokane Washington, 3 and a half hours away from me, but could call, am not sure how familiar they are with Trilostane and treating Cushings...will try and get my vet to call some of the Dr.s that the list has suggested...we have and internist here in town that worked at Perdue, but he hadnt treated any dogs with Trilostane three years ago, and wanted to start Meg at 120 mg when I first started talking to him...in which I knew than and there, he wasnt knowledgable about it...but he at least will confer with others, so he might be my only hope here in town....thanks again for suggesting a IMS..Judy and Megan

[ladysmcq]

Hi Judy,

Corky and I want to welcome you and Megan.

Corky is also my baby and is a Boston Terrier. He is being treated with Trilostane, and has been doing well with it. He started on 20mg a day with once a day dosing, and is now up to 40mg a day, with twice a day dosing. He has an adrenal tumor. He hasn't had any setbacks from being on the Trilo, and it will be a year on Sunday since he's been taking it. Trilostane usually lasts about 8 hours.

I'm very lucky, as his IMS is very experienced in using Trilostane. You might want to try to find an IMS with experience in treating Cushings.

Others will be along that have much more experience than I do. Hang in there. There are so many knowledgeable, caring, and supportive members here.

Terri

Hello Terri,
another BT Lover, so glad to know you. Thasnk you for your advice, and we do have and internist here in Missoula, but has not used Trilostane a lot, but will check back with him the first of the week and see if he will contact some of the people that this list is suggesting for me to contact,..he is a very good internist, and concerned about the dogs...he just made me a bit nervous when we first started out using Trilostane as he had not treated a dog with it, and wanted to start out High instead of low, and I am a firm believer to start low and slow. am glad to have found this group, I would have never known it was available without Elly and Augi's help...they showed me the way, God Bless them...and thank you all and everyone for helping me..Judy and Megan..

[ladysmcq]

Hello and welcome from me, too!

I'm so sorry that you're feeling so worried about Meg, but very glad that you have started posting here. You've given us a lot of information, which is great. But I do still have a few questions for you -- the answers may help us sort out what is going on with Meg.

It sounds as though she has been treated successfully with trilostane since 2008. But recently her stim tests have been lower? Can you please tell us how her stim tests were running during those first two years of treatment? On the face of it, a "post" result of 2.4 or 2.6 really isn't considered too low according to the trilostane treatment protocols with which we are most familiar -- especially as long as Meg's chem panels were also looking good. But if this represents a big drop from her earlier tests, then perhaps it is a level that is too low for her comfort. So any additional info that you can give us about her previous testing history will be helpful.

Also, you noted that her blood sugar during this episode was 251, which I believe is high? How has Meg been doing, generally, as far as her diabetes? I know that it can be very confusing at times to try to unravel the symptoms or problems that are being caused by each disease on its own...

It is true that prednisone will skew the outcome of a stim test. However, as long as the test was run more than 24 hours after Meg was given the prednisone, the results are probably a pretty trustworthy indication of her natural cortisol level. Since it turned out to be 5 -- coupled with the fact that she was already starting to drink more water again -- that does seem to indicate that she needs to be taking trilostane rather than not. It also makes me wonder whether her diabetes might have played some role in her earlier discomfort.

So any additional info you can give us about Meg's previous stim testing history and diabetes management will be greatly appreciated! Also, how much does Meg weigh?

Thanks so much in advance,
Marianne

Hi Marianne,

thank you for taking interest in Megan, and responding to my post. Megs earlier Stim tests were much higher, I just looked at all of them since we started doing then in 2008, and they were up in the higher levels, 6 7 9 and 10 post, 4, 5 7 pre, it wasnt until Dec of 2009 that they started dropping really low, now the other Cushings list I belonged to and posted these lower numbers all considered those to be very low, and to watch her carefully...and from what I had researched thought that to be true also...

a 251 Glucose level is good for Megan, as she used to run in the 500s and 600, so to get them down to those levels was good, however since I started cooking her the evening meal of Brown rice, green beans and Chicken breast, they really have come down and stayed lower, the night I gave her pred and it was 251, the vet said to take it one hour after giving her her insulin , which I did and it had come down to 181, I have not seen her act like that when her sugar was somewhat high....the next day however after she had the pred, her glucose on the chem panel was up to 535..which is the highest it has been in over a year and a half...but she had eaten breafast, only had her insulin on board about and hour, and had Pred, so that was expected..

Megan weighs 28 pounds...the stim test done the next day it had not been 24 hours....it had been more like 14 hours....after the pred was given....

in the previous stim test and Super Chem panels, the numbers for the labs just got better and better, but the cortisol levels are getting lower and lower..and at one time we had the Sodium go very low and the Potassium go high and the ratios there were dangerous, and that got my vets attention quickly....she also had Pancreatitis....however we got that cleared up and that was several months ago, and she has been fine ever since....

Diabetes and Cushings is like chaseing your tail...its complicated, I have been blessed with her doing better than I expected ...and still being with me...and for that I am so grateful...I know it cant go on forever but I want it too, and my vet said he isnt ready to quit....even if he did, I would never quit and do everything I could do for her and than some...When you post how can you put the dogs picture on your post...or are you not allowed to do that...thank you for your help...Judy and Megan...

[ladysmcq]

Hello and welcome from me, too!

I'm so sorry that you're feeling so worried about Meg, but very glad that you have started posting here. You've given us a lot of information, which is great. But I do still have a few questions for you -- the answers may help us sort out what is going on with Meg.

It sounds as though she has been treated successfully with trilostane since 2008. But recently her stim tests have been lower? Can you please tell us how her stim tests were running during those first two years of treatment? On the face of it, a "post" result of 2.4 or 2.6 really isn't considered too low according to the trilostane treatment protocols with which we are most familiar -- especially as long as Meg's chem panels were also looking good. But if this represents a big drop from her earlier tests, then perhaps it is a level that is too low for her comfort. So any additional info that you can give us about her previous testing history will be helpful.

Also, you noted that her blood sugar during this episode was 251, which I believe is high? How has Meg been doing, generally, as far as her diabetes? I know that it can be very confusing at times to try to unravel the symptoms or problems that are being caused by each disease on its own...

It is true that prednisone will skew the outcome of a stim test. However, as long as the test was run more than 24 hours after Meg was given the prednisone, the results are probably a pretty trustworthy indication of her natural cortisol level. Since it turned out to be 5 -- coupled with the fact that she was already starting to drink more water again -- that does seem to indicate that she needs to be taking trilostane rather than not. It also makes me wonder whether her diabetes might have played some role in her earlier discomfort.

So any additional info you can give us about Meg's previous stim testing history and diabetes management will be greatly appreciated! Also, how much does Meg weigh?

Thanks so much in advance,
Marianne

Marianne,

I also forgot to mention that Megan is blind with Cateracts, but has been nominated on doggy space for a chip in to help with expenses for her eye surgery so she can see again, megan gets along very well, and has no problem navigating the house or the outside, with her own special seeing eye dog and companion, along with her Mom to help her if she needs it...Judy and Megan..

[labblab]

thank you for taking interest in Megan, and responding to my post. Megs earlier Stim tests were much higher, I just looked at all of them since we started doing then in 2008, and they were up in the higher levels, 6 7 9 and 10 post, 4, 5 7 pre, it wasnt until Dec of 2009 that they started dropping really low...
__________________________________________

Megan was than diagnosed with Diabetes and Meg got stim test every three months, was getting trilostane 10 mg once daily, her stim test got better and better, and she did also. her sugar has been under control and she has been on the same dose of Trilostane 10 mg since 2008 with very little problems..but I have been watching her carefully..

her last 4 stim test she has been running her pre's very low I thought 1.6 1.9 2 and her Post mostly 2 .6 or 2.4 or 2 my vet said all the super chems panels were good and they were she was getting better and better...

Hi again, Judy.

Thanks so much for all the additional information. First off, I am not a vet, but I do agree with your decision to reduce Meg's dose to 5 mg., at least for the time being. Since you had given her a trilostane break for a few days and she was starting to drink excessively again, it seems as though it was reasonable to start back at a reduced dose.

But just to back up a bit. In terms of trilostane treatment in general, the two protocols with which we are most familiar both agree that an ideal "post" stim result should fall between approx. 1.5 - 5 (and the "pre" result is typically of little interest or concern). From what we have read, Dr. Feldman at UC Davis really prefers that dogs remain within that range. Dechra (the manufacturers of brandname Vetoryl) also considers that an ideal range, but are "OK" with results ranging as high as approx. 9 as long as all symptoms are well controlled. So according to these protocols, Megans earlier "post" stims of 6-10 would have been altogether higher than UC Davis would prefer, and would have been in the higher third of Dechra's acceptable range. That is why I said earlier that, on the face of it, her more recent "post" stim results of 2-3 would not be considered too low, especially coupled with the fact that her Chem panels were showing steady improvement as her "stim" tests were declining into the ideal range. That would imply that her lowered cortisol levels were beneficial in terms of internal organ function as well as outward symptom control.

Where things get sticky, though, is what the testing trend was. Did it just keep getting lower and lower each time? In other words, were the most recent post "stim" results in the order of 2.6, then 2.4, then 2.0 after having already fallen steadily from 10? If so -- and since Meg was remaining on the same dose of 10 mg. -- then I do think a dosage adjustment should have been made earlier and that you are right that the cumulative effect of that dose was likely leading to a crash.

I think you have reason to be optimistic, though. It sounds as though the trilostane has been doing a good job of controlling her symptoms during these past two years, and perhaps all you need is just a dosing adjustment (which you have already started on your own by dropping her to the 5 mg.). How long has she been taking that dose? How does she look to you?

Another resource that I can offer to you and your vet is the U.S. office of Dechra. They have veterinarians on staff who serve as technical consultants. I have spoken with one of their vets myself, Dr. Tim Allen, and I believe he'd be happy to consult with you and your vet about possible dosing changes for Meg. Here's the contact info for Dechra:

http://www.dechra-us.com/Default.aspx?ID=365

And here's a link to a thread on our "Important Information" forum that will discuss the dosing protocols of both Dechra and UC Davis in much more detail:

http://www.k9cushings.com/forum/showthread.php?t=185

Hope this additional info may help.

Marianne

[Franklin'sMum]

Meg is my very breath...without her I am nothing.... I need her in my life, she is my most treasured little person...she is what makes me get up in the morning...she is a light to many but her light shines the brightest in my life....could anyone help us....God Bless all who have loved ones with Cushings...Judy and Megan..

Hi Judy and welcome to you and Meg :)

I have nothing to add to the info and advice you've already received, but just wanted to tell you how much I love your description of your little girl, and how much she means to you :D.
With your love and determination, and the help of the groups, I'm sure you'll find the guiding light to help you both :)

Jane, Franklin and Bailey xxx

[labblab]

One more quick thought -- just wanted to make sure that your vet also checked Meg's sodium and potassium levels again at the time that he ran the ACTH test? Since she ran into a problem with those levels once previously, you'd want to know that they were still OK.

Marianne

[ladysmcq]

Hi Judy,

I can't help much with your immediate question but wanted to say hello - I lived in Missoula for a number of years so double hello! :) And also I wanted to invite you to the sister site to this one for dogs with diabetes, www.k9diabetes.com (http://www.k9diabetes.com). There is a forum there as well, www.k9diabetes.com/forum (http://www.k9diabetes.com/forum). I administer the diabetes site but also check in here periodically.

Do you have a vet who is willing to work with you on this?

I would suggest that your veterinarian get in touch with Dr. Feldman at UC Davis, author of many of the protocols for treating Cushing's disease. UCD should be willing to consult with your vet and provide some guidance.

Also, if you go through the reference section here, those protocols and other articles and guidelines are provided there and you can print them up for the veterinarian to review.

I hope you have a vet who likes a challenge and is willing to become an expert, maybe with a nudge from you!

Natalie

Hi Natalie,

I reread your post to me again this evening, and got much more out of it than last night...to tire I guess, but I did wrte down the name of this Dr Feldman, where he was at and would like to review the information in the referances you did refer to about treament of Cushings..and i guess it sunk in about the sister site for Diabetes, and I definately will be visiting that site also...and spend some time there...it looks very informative...hopefully i can find a better diet for Meg, I dont think her diet is the best...I try for it to be,, when I fed her kibble twice a day her glucose was always high, but I only feed her solid Gold Kibble with some wellness Salmon in the morning, and home cooked in the evening..brown rice, green beans and Chicken Breast, will give pumpkin, or cottage cheese, yogurt, oatment .eggs at differant times. I do try and give very small snacks, as with human diabetics you dont go all day without eating...I dont see why a dog is any differant when you have diabetes....

thanks for the invite and the information..it is much appreciated...Judy and Megan

[Squirt's Mom]

Hi Judy and welcome to you and Megan! :)

When I read your first post it brought tears to my eyes because I fully understand your feelings for Megan. My Squirt means the same to me - she is the light of my world, my salvation, my hero, and I cannot imagine life without her. She has taught me so very much and continues to do so every day.

You have found the very best place to learn about Cushing's. The experience and knowledge found here is astounding and the support is incomparable. Our sister site is just as amazing for diabetic babies so you and Megan are in good hands now. You are no longer alone on this journey - we will be with you every step of the way.

I am glad you found us and look forward to learning more about the both of you in the times to come.

Hugs,
Leslie and the girls :D - always

[k9diabetes]

Hi Judy,

Does her blood sugar do okay with the snacks?

Because dogs process insulins somewhat differently than people and because we don't generally do an insulin regimen the way people do (people use a basal insulin and then a faster acting insulin to cover meals), a dog may not have any insulin to go with a snack later in the day. So I wondered how the snacks affect her curves.

How have her curves looked prior to this episode? Do you test blood sugar at home?

Although it probably sounds dull, with a dog like Meg whose diabetes is complicated by Cushing's disease, I would probably aim for as much consistency of diet as possible. Same meal breakfast and dinner and same ingredients in each meal. Maybe pick a diet you're happy with and has some variety in ingredients and feed that at both meals.

Only because the content of the diet has such a big effect on blood sugar. If what's in her food is shifting around, her blood sugar may do the same.

And the picture is complicated enough without adding in changes of food.

But I'm jumping ahead of things! ;) Could be she's perfectly regulated on her nicely varied diet and snacks - one of the those bomb-proof dogs who regulates easily. Something I'm not personally familiar with as our dog was always a challenge. 8)

Natalie

[ladysmcq]

.Megans Glucose is all over the place. up and down. last night going up to 485 one hour after insulin peaks at midnight, 213 before breakfast, 285 mid afternoon, 435 early evening..She is not being fed any differant, she gets the same food every day, knowing change will affect the glucose level I do not change her diet, but need to research a diabetic diet for a cushings dog..that is more beneficial and healthier for her..I tried to find that on the Diabetes list but unable to acess the files on that subject, they were locked and closed ..
Now I am beginning to wonder if it was her glucose rather than over control on the trilostane, we have and appt on Thursday with the Missoula IMS, he could not get us in before than..I believe her diabetes needs to be treated now..she has been on 10 units of Humulin N 100 for a long time and wonder if they can become resistant to the insulin, or is it not good insulin it has only been open about 10 days..she has been steady like a rock, and it started about the time I got the new bottle of insulin...I can only get 27 or 28 days on the bottle of insulin as she will immediately start urinating too much at the end of that time frame...the ex date is good, but something is not right..and she is really feeling it..I did talk with the internist here today and he said, concentrate on getting the cortisol level in place and than worry about the blood glucose, but I am very concerned about the b/g also and do not want it to get any higher. he said it would kill her, but it wasnt and answer that was satisfactory to me..as it can....everything is out of balance .i dont know where we are or what to do, as there are not enough knowledgable vets here to help her...I don tknow if she needs her insulin adjusted , or a new bottle of insulin, or if she needs a dose adjustment with the trilostane or not...she is scareing me to death....will call primary in am..get a new bottle of insulin and .go from there...on a wing and a prayer...Judy and Megan

[AlisonandMia]

If the problems started with a new bottle of insulin then I'd think the first suspect would have to be bad insulin (sometimes something has happened during shipping and handling). Many people with diabetic dogs find that when things go "off" trying a new bottle of insulin is a good first step. If that doesn't help then you start looking at other things like infections, cortisol, getting hold of elicit food etc.

How are you storing the insulin - is your fridge as cold as it should be? Sometimes, particularly in warm weather, things can get a lot warmer in the fridge door than you would ever suspect, particularly if the fridge is opened and closed frequently. We've had milk go off within a day due to that little problem.

Alison

PS: With her bg running on the high side it is probably a good idea to be checking her urine for ketones with ketodiastix or a similar product.

[k9diabetes]

Hi Judy,

It's a real catch-22 when you have diabetes in the mix. If the Cushing's isn't controlled, the diabetes won't be either. And it seems her cortisol levels have been changing a lot recently, which is likely to change how much insulin she needs. More insulin for higher cortisol levels and less insulin for lower cortisol levels like you saw on the stim tests.

Can you catch me up a bit on her diabetes regimen and monitoring?

By the way, I approved your membership at the diabetes forum and we could review it there if you'd rather. If you log in, you should be able to see everything at the forum. We see dogs on all kinds of different diets.

As far as her diabetes...

When was the diabetes diagnosed?

Was she always on NPH or did she use Vetsulin for a while?

When you say 10 units, is that 10 units per injection and two injections a day?

How often do you monitor her blood sugar?

Was it well regulated prior to these changes in her cortisol levels?

Was her curve fairly flat or were there large differences between the highest and lowest blood sugar?

Bad bottles of insulin are a distinct possibility. They can be left on a loading dock in the sun or kept in a too-cold refrigerator. So if there is a sudden loss of blood sugar control with a new bottle, it's wise just to buy a newer one, perhaps from a different retailer, and see if that helps.

It may be that her cortisol levels are more than enough to explain her changing blood sugar.

Also, Trilostane is fairly short acting and I have always figured that the timing of the Trilostane could play a part in blood glucose regulation. Such as if the Trilostane is given only once a day there might be higher cortisol and thus blood sugar levels 12-24 hours later. No factual basis for that idea. Just seems like a possibility when you are injecting insulin twice a day but giving Trilostane only once. As I understand it, the cortisol levels are more controlled during the hours immediately after it is given.

If you can fill me in some more, I will try to help sort out the blood sugar issues.

Natalie

[k9diabetes]

I see some people who can't get more than about 28 days from a bottle of NPH and some who seem to manage to use it longer. It's hard to say what all the differences might be. There are so many steps between manufacturing and your use of it - transportation, unloading, storage at the pharmacy, the conditions inside your particular refrigerator if you refrigerate it.

Seems like the longest life does come from refrigerating it.

Keeping in the box to shelter from light and storing the bottles upright inside the box so the insulin doesn't get stuck to the rubber stopper. Most of us keep it on the door rather than inside the fridge itself to avoid having it get too cold. And then very careful mixing before drawing it up - no shaking, lots of gentle rolling - to keep the bottle as evenly mixed as possible when you withdraw the dose.

Might check the temperature of the refrigerator if it's kept there.

But some of the issue may be handling before it gets to you. Only thing you can do then is try a different pharmacy. Some do seem to do a better job of caring for it than others.

Natalie

[Franklin'sMum]

Hi Judy and Megan,

I tried to find that on the Diabetes list but unable to acess the files on that subject, they were locked and closed ..

If you mean the padlock icons or the words thread closed, on the left side of the pages, that just means that no new posts can be added, but the posts themselves are viewable :)

Jane, Franklin and Bailey xxx

[ladysmcq]

Thank your for all the responses to my concerns regarding Megan, my 13 year old Boston. I didnt know how to answer all the questions in the replys, I am so overwhelmed with trying to figure out what is going on with Meg. Megs last ACTH test seemed to be in a good range, and I may have panic and was off course on what was happening..with her...symptoms of over control of Cushings and diabetes look similier, and since I had not had any real issues with diabetes I got scared and treated her , with Pred thinking she was going to crash, when it may have well been her high glucose...I did check her Glucose before I thought over control with the trilostane, her Glucose was 251. I called the vet right ater the predisone and he agreed it probably was a good idea, and to come in in the am for another Stim test..., neither he or I picked up she had a ranging UTI...because she didnt show any indication of it..as with diabetes and cushings you urinate a lot, but not when on Trilostane if it is in control..I didnt pick up on it until a few nights ago when she urinated and her urine looked milky..and cloudy..I became suspicious than...and the next morning she urinated pure blood, I called the vet and took a UA in and they didnt keep it correctly and they couldnt use it....but the vet perscribed Zenquin 25 mg one daily for three weeks...by that evening her urine was free of blood. her blood sugars are still bouncing all the wall, I have been taking them 3 to 4 times a day, and they are in the 2 and 300s and once went up to 485, but mostly running in the 2 and 300s..I am at a loss of what is wrong...she does have a broken tooth, that the vet looked at, and said it wasnt bothering her..but how can you be sure she doesnt have and infection from that also...

I talked with the internist and he wanted to order the Ciprofloxen, said it was what he treated with..but after reading all the side effects I was terrified to put her on it....and kept her on the zenquin, I will check for ketones, as have the sticks...to be honest I dont know if the insulin was bad or not..but it did clump and being a nurse I know how to handle insulin and when to discard and when to keep...she can only go 27 to 28 days on a bottle of insulin, no longer and i change it every 28 days or one day earlier..my fridge is fine and it is kept on the door and not on the shelf of the fridge. I get my insulin from one of the drug reps, as he gives me samples and the price is right...its free, and he is kind enough to give them to me, I talked to him about them and he said they may have gotten to warm or something with the temp when he was carrying them around one day...but in any event I threw them away and went and bought a new bottle immediately...

Meg had cushings for one year when she became diabetic, we could see it coming, as her glucose kept rising, and than there it was, and she was started on insulin, very low dose, until we reached it up to what it is now..so guess she had been diabetic two years, and has been on 10 units of Humulin N 100 bid...(2xs a day..) I had and appt with the internist on Thursday but he called and said to wait a few days and see how she feels before bringing her in, because he felt the trip would stress her , too much, and reschedual, in which I will do at the first of the week to see him..he isnt as concerned about her diabetes as the level of cortisol, he said get the cushings under control and than worry about the sugar...but according to the ACTH test it looked very much under control and that the diabetis was out of whack...This evening two hours before her dinner and insulin her glucose was 345, I have a call in to my primary vet in hopes tomorrow he may adjust her insulin...or whatever....I am not sure, I am about to go over the edge...from worry about her...I dont now if my diet is right for her and if she is getting the right amount of food for the insulin she is taking..or is it her age, the cushings... or the UTI.
.Meg is my very heart,and soul, without her I cannot survive, she has been my best friend for 13 years, It is and honor caring for her, she is not a burden..God made her just for me and Blessed me with her life as a gift, and I am not willing to give her up, so if all of you could keep Megan in your prayers, that we can find out what is going on and get her diabetes under control....When you think of the word and emotion LOVE..she is what it is all about ...she is a glimpse of the kind of LOVE people look for all thier life and cannot find...she has given me more love than you could ever have in a lifetime...I would lay down my life for her...we share the same heartbeat....Judy and Megan.

Moderator's Note: I have combined your update thread with Megan's original thread. We usually prefer that all posts concerning a pup be kept on one thread as it makes it easier for other members to refer back to the pup's history, if needed. Debbie

[ladysmcq]

Hi Judy,

It's a real catch-22 when you have diabetes in the mix. If the Cushing's isn't controlled, the diabetes won't be either. And it seems her cortisol levels have been changing a lot recently, which is likely to change how much insulin she needs. More insulin for higher cortisol levels and less insulin for lower cortisol levels like you saw on the stim tests.

Can you catch me up a bit on her diabetes regimen and monitoring?

By the way, I approved your membership at the diabetes forum and we could review it there if you'd rather. If you log in, you should be able to see everything at the forum. We see dogs on all kinds of different diets.

As far as her diabetes...

When was the diabetes diagnosed?

Was she always on NPH or did she use Vetsulin for a while?

When you say 10 units, is that 10 units per injection and two injections a day?

How often do you monitor her blood sugar?

Was it well regulated prior to these changes in her cortisol levels?

Was her curve fairly flat or were there large differences between the highest and lowest blood sugar?

Bad bottles of insulin are a distinct possibility. They can be left on a loading dock in the sun or kept in a too-cold refrigerator. So if there is a sudden loss of blood sugar control with a new bottle, it's wise just to buy a newer one, perhaps from a different retailer, and see if that helps.

It may be that her cortisol levels are more than enough to explain her changing blood sugar.

Also, Trilostane is fairly short acting and I have always figured that the timing of the Trilostane could play a part in blood glucose regulation. Such as if the Trilostane is given only once a day there might be higher cortisol and thus blood sugar levels 12-24 hours later. No factual basis for that idea. Just seems like a possibility when you are injecting insulin twice a day but giving Trilostane only once. As I understand it, the cortisol levels are more controlled during the hours immediately after it is given.

If you can fill me in some more, I will try to help sort out the blood sugar issues.

Natalie

Diabetes diagnosed one year after Cushings diagnosed.
has always been on Humulin N 100
Started out on 5 units bid, than 7 than 8 an on up...she has been on 10 units of Humulin n for about a year now...have had no trouble until the UTI came along, and I got afraid about her Cortisol level...she has never had a UTI that we know of...at the beginning I checked her Glucose all the time, drew blood out of her vein...it ran very high in the beginning, but than leveled out, and since she was checked very three months for the stim tests and didnt show any signs of diabetes giving problems I only did random checks...and they were good for her...

I look at insulin very closely as in the hospitals and Dr offices it is thrown out every 28 days...and it just something as a nurse you always check...and look for that the layman does not always think to, many good bottles of insulin have been thrown out if there is any kind of doubt...

I am hearing some on the list say treat diabetes first and than worry about the cortisol and my internist says treat the cushings and than the diabetes...the other cushings list, there are so many differant opinions that is is enough to make you throw your hands up in the air and want to run as far away as you can....

you sort of have to step back in the quietness of a corner and collect your self, say a few prayers and come out fighting again....and never give up.

in the town of Missoula Montana we are not blessed with a great deal of medicine in the realm of vets...I think the internist and my primary vet are the m most knowledgable..however my primary vet states he is not all that knowledgable about the trilostane but does research and has been good working with me, at almost anything I want to do...but once in a while his weird personality quirks come out...and you want to stuff him in the garbage...can...but to me and Megan has been nothing but attentive, and certainly long suffering regarding a 5000 dollar vet bill....that we only pay monthly on....God bless him...for that...Megan was nominated on doggy space for a chip in from her doggy space friends, and that will go for her cateract removal or for part of her vet bill....God Bless them...as far as her cost of health care, that isnt the issue..she is...it aways gets paid off....some day....and every dollar I put on it is for her...and she is worth every penny.....God Bless all on this list that deal with loved one with these diseases...Megan and Judy

[ladysmcq]

One more quick thought -- just wanted to make sure that your vet also checked Meg's sodium and potassium levels again at the time that he ran the ACTH test? Since she ran into a problem with those levels once previously, you'd want to know that they were still OK.

Marianne

her Potassium and Sodium was good when the stim tests. were taken.....he watches that and nothing was out of order that I know of...it would seem he would look at that....but labs were more improved every time...he never said anything I trust he must have looked for that....I will double check....Judy and Megan

[zoesmom]

Hi Judy and Meg -


but I could tell she wasnt herself and the other day she was staggering , drooling, and didnt look good, I checked her sugar and it was 251, but didnt look like that was the problem and i gave her 5mg of Pred right away, called the vet and told him and he said that was good thinking, and said to bring her in for a stim test in the morning.....

Just now reading thru your thread for the first time. And Meg has many things going on. But my first thought was ......staggering and drooling did not sound like too low cortisol. Those are not the symptoms we'd expect to see. As far as the blood sugar, I know that is closely connected to the how the cortisol levels are running but I have no idea if staggering/drooling would be related to her erratic glucose levels.

But what did cross my mind, however, was some sort of poisoning. Not necessarily 'poison' per se, but things that are toxic to dogs. Is there any chance she could have gotten into something she shouldn't have? Here it is, many days later, so if that did happen, it could have been just enough to be mildly toxic to her with staggering and drooling. There are just so many possibilities of things that can affect dogs in that way that I'd be really suspicious of that.

That's not to say that she didn't need that lower dose of trilostane since you also say she'd been acting off lately and her acth test numbers have been coming down steadily. Again, I don't want to comment on the diabetes aspect. I DO think the 5 mg. of trilo makes sense, given what you said about the pred and the subsequent acth test.

But I just have a gut feeling that maybe there were two different things going on. Cush and diabetes parents always tend to look to the obvious in such situations. But it's not always the obvious. It does sound like she's had the general blahs a bit longer and that could have been because she needed slightly less trilo and/or that her insullin played a role. But unless the diabetes people feel like staggering and drooling is connected to diabetes, I'm thinking something toxic may have caused that. If you do a web search of 'staggering and drooling in dogs', you'll see that all sorts of hits come up related to various kinds of toxic or poisonous ingestion.

I'm also not sure what the vet would need to test to rule out something toxic and any lingering after effects/damage. I would guess probably general labwork - blood and urine - to make sure things like the kidneys, etc. are ok. One other thought is that maybe she had something stuck in her throat. My last dog drooled a lot when that happened. She also had a horrible episode of drooling one night that sent us flying to the emer. clinic at midnight and they came up with nothing much. I don't know for sure but I think she may have cracked a molar that night as the drooling continued for awhile (tho'much less severe) and then she woke up one morning with an abscessed molar. She drooled so bad that first night that she saturated several towels that I'd put underneath her mouth and she didn't look good. Sue

[k9diabetes]

Staggering is a very common symptom of low blood sugar in dogs. And I would think drooling is possible as well. There's a lot of variety in how dogs react and it's not all that unusual for them to show no sign whatsoever. I've heard about two dogs just in the past few weeks who weren't obviously in distress who turned out to have blood sugar of 27.

Whether she went low would depend on when that blood glucose level was taken. If it was very long after the prednisone was given or if it was long enough after a hypoglycemic event that caused rebound, the blood sugar would already be on the upswing so a 251 reading wouldn't necessarily mean the blood sugar wasn't low earlier.

Now that I know you're a nurse, I know you are familiar with a lot of this stuff. It can be a little difficult to go cross species, though, as dogs absorb insulins, tolerate high blood sugar, and tolerate diabetes differently than people do. Most of it is good news for dogs. They can often make NPH last 12 hours or more, don't often need a faster acting bolus insulin, suffer from far fewer side effects of having high blood sugar, and can tolerate higher levels of blood sugar without discomfort. They develop almost none of the nasty consequences of Type 1 diabetes that people do. Mainly cataracts and a tendency toward UTIs.

I'm more familiar with canine than human diabetes... UTIs very commonly throw a dog's blood sugar completely out of whack. It's the first sign to many folks that their dog has a UTI - they see the blood sugar suddenly go out of regulation.

So I think the best first step for Megan is to treat the UTI as you are so it's no longer a factor in her blood sugar.

And then see whether her blood sugar stabilizes significantly from elimination of that variable.

You may have to wait until she's done with the antibiotic as we see a lot of dogs whose blood sugar bounces around or goes higher from the antibiotic.

You are treating the Cushing's disease and it seems like you are getting her cortisol levels back to a good level, which will also help the blood sugar.

If her blood sugar is hovering mostly in the 200s, that's decent enough that you don't have to worry about her. You can give the antibiotic time to really wipe out the infection and clear her system and see where she's at.


you sort of have to step back in the quietness of a corner and collect your self, say a few prayers and come out fighting again....and never give up.

I think you've hit the nail on the head. None of what I see happening with Megan is a threat to her survival. Maybe to your sanity! ;) But she should be fine.

You're working on sorting out her cortisol, her blood sugar's not all that bad (I know some people who are still trying to get blood sugar as good as hers in their dogs), and the antibiotic is tackling the UTI. And now you know that she responds to a UTI with higher blood sugar so next time it happens you can check for that.

When she's had time to get back to "normal" (no seriously! LOL), you can do a curve and see where her blood sugar is at.

Natalie

[ladysmcq]

thanks for your thoughts regarding Meg and your welcome comments, Meg is blind and maps her way around the house only...most other times it is another Boston that I have that guides Meg to places and I am pretty much around to help her out, and get her outside and other places I know she likes to be...it wasnt a lot of drooling and not heavy...but one of the side effects of the Trilostane is drooling and staggering...and you take them off of it immediately if you see that...and it clears up usually in several hours....she did clear up and was better that evening as the trilostane was wearing off....there is nothing in my house for her to get into, in which she has never done in any time of her life...get into things....the toxic thought to me was the trilostane...also she had a raging UTI in which I didnt know about....and she is much better now...it has turned colder here now and I have noticed some shivering a bit when going outside....that is also another side effect of Trilostane....with the diabetes and cushings its sort of like chasing your tail.... so am hoping i can get and appt in a few days to see the internist and see how her cortisol level turns out and than maybe do some insulin adjustment...as hard as I have to say this..Meg is 13, only for a month....and , I can hardly say it...but age could be a factor also....I dont even want to think that....but every day with her is a bonus and a blessing...right now...she is stable...but I touch her every moment to see if she responds....I would know in a heart beat if something is not right.....thanks for your help and thoughts....Judy and Megan..

[ladysmcq]

oh Iforget to mention...she does have a broken tooth.. its the canine one...I point it out to the vet all the time and he said it would be a risk to take it out, and he wouldnt do it...it hasnt looked like it was bothering her..but looking at it today...it starting to get red around her gum...so ma going to have it looked at again by the internist...but will not risk anesthesia ...my vet didnt think it hurt her...but how do you know...??? it could casue the little bit of drooling I suppose....she doesnt do it a lot...Judy and Megan

[ladysmcq]

Natalie,Thanks for all the reassurance..., about her blood sugars...I think she is feeling better...I feel really horrible for not picking up the UTI before I did, but she never ever had one and wasnt looking for that when I saw her urine and knew immediately that is what she had...she does have cateracts and is blind from them....and me trying to guess everything that might be going on with her, makes me feel just as blind as she is....at times.....she will be on this antibiodic for three weeks.....do they put dogs on a maintance dose of antibiodics, like people that have chronic UTI'S??? i need to go to the diabetic sight and see if I can get a top diabetic diet for her....but one that will be compatible with Cushings also....I am not sure I am feeding her correctly...and want her to have every advantage she can have.......Judy and Meg

[mytil]

I just wanted to check and see how Meg is doing.

Terry