Gus (maltese), Age 6, Diagnosed with Diabetes and Cushings

[Mick938]

Gussie is 19 lbs and has maintained his normal energy level and appetite to date. I took him in 2+ weeks ago because of excessive drinking and urinating that had been noticeable for a few days prior to going in. At this point, no adverse affects to the meds and still "normal" although he still drinks and urinates more than normal, but not quite as much as before going in.

I'm on Day 11 of Vetoryl (30mg once a day) and about Day 15/16 of Humulin (now 8 "units" twice a day). When initially diagnosed with diabetes, glucose was in 600s. After 3 days of humulin at 5 units, glucose down to 300s. Then ldds and hdds tests came back and vet put us on Vetoryl based on Cushings diagnosis. Couple days after Vetoryl and a move to 6 units of insulin, glucose was back up to high 400s. Now we're up to 8 units of insulin twice per day and still in the 400s, now on day 11 of the Vetoryl.

Some other resources I've seen have been cautious about the simultaneous Cushing/diabetes diagnosis, saying Cushings is tough to identify when other issues are present. Also that there can be false positives for Cushings-related tests when the dog is diabetic. I also saw a post specifically noting that in such instances, diabetes should be treated first, then re-assess for Cushings.

My concern is that we saw quick glucose results early with small insulin dose and no Vetoryl. Since Vetoryl and the Cushings diagnosis, we're not seeing any drop in glucose, despite increasing insulin units. Is there any information out there about these two meds (Vetoryl/Trilostane and Humulin/insulin) somehow not working well together.

My fear is that we're headed down a road of continuing to increase units of meds when there's a chance that maybe he's only diabetic at this point. I'm talking to the vet again today/tomorrow, but I wanted to get some outside input if possible. Thanks in advance.

[k9diabetes]

I'm cautious about Cushing's diagnoses in general because it is challenging to accurately diagnose. It is usually best done with a couple of different tests and obvious symptoms as well. And then there's proper interpretation of the results of the tests, which doesn't always occur unless an internal medicine specialists is involved or the vet has a lot of experience dealing with Cushing's disease.

I am especially very cautious about a Cushing's diagnosis made when diabetes is already present because the diabetes seems to be able to generate a false positive on the LDDS.

With blood sugar of 600, I would say the diabetes diagnosis is solid.

If you could post all of the results from Gus' Cushing's testing - the HDDS, LDDS, blood panel for elevations of liver enzymes - the good folks here could advise whether they think the test results themselves suggest Cushing's disease.

The suggestion to tackle the diabetes first is partly because of the concern about how accurate the Cushing's tests may be in the presence of diabetes but also related to the fact that diabetes can be lethal if left untreated for very long while the Cushing's disease causes life-threatening problems only if left untreated for years. So there's generally no rush to treat the Cushing's.

A lot depends on whether your dog visually screams "I have Cushing's disease!" ;) If yes, then it makes more sense to start treating it right away.

One potential problem with Vetoryl is that it can elevate some other hormone levels that can cause Cushing's like symptoms and raise blood sugar. If your dog isn't handling the Vetoryl well, then I imagine any inflammation or allergic type response might also elevate the blood sugar. Also, an allergy to the insulin could drive blood sugar higher. It's rare but does occur sometimes with NPH.

There's no reason you couldn't try dropping off the Vetoryl now and tackle the blood sugar first while you work out whether the Cushing's diagnosis seems accurate.

I don't know whether that could be done cold turkey (isn't that an odd phrase!) or whether should be tapered off as I'm a diabetes person rather than a Cushing's person. We would love to see you at the sister forum to this one for diabetes: www.k9diabetes.com/forum (http://www.k9diabetes.com/forum)

Natalie

[Mick938]

Thanks for the input. I'll try to get the full tests to date on Friday and post ASAP. I'll also join the diabetes forum. As you suggested, I'm comfortable that diabetes is an accurate diagnosis, my concern is with the Cushing's and the general uncertainty that surrounds that diagnosis - especially when diabetes is already in play.

Thus far, the only physical symptom of Cushing's that we've seen was the frequent drinking and urination, which I believe is also attributable to the increased blood sugar/diabetes.

I'm not going to jump to conclusions yet, but my gut is telling me that the Cushing's diagnosis might be a little premature. I'm going to call the vet shortly to discuss my concerns on that front. This site/forum is an amazing resource, by the way. Great work!