Hello. Wire Fox Terrier w/ Diabetes and Cushings...

[Munchie's Mama]

Hi. I've already posted a few times on the Diabetes board. Now that I know that my Munchie also has Cushings, I will post here as well. Munchie is a 10 year old Wire Fox Terrier. He'll be 11 next month. He's the joy of my life. :) I discovered on Saturday morning that he has Diabetes. He was exhibiting symptoms so I checked him with my own meter, (I'm a type II diabetic also) and discovered that he had a sugar over 400. When I got down to the emergency vet, she told me she suspected that he had Cushings as well. She went over some of the symptoms, and he fit them to a t. So she ran a ACTH Stim test. The results came back yesterday: Pre sample=11.2 Post=28.3
Needless to say, he has it. We started him on insulin on Saturday (9 U every 12 hours) I haven't seen it drop below 400 yet. We will see our regular vet tomorrow, and I'm assuming he will start Munchie on Trilostane or something similar. I hope after that, he can stop suffering so, and be happy once again. He's so weak in his hind quarters, he can hardly get around. It breaks my heart to watch him. I understand it's a rough road to treat both of these diseases, but I'm hopeful. I've read good things about Trilostane. I'm so thankful for both of these boards. I have gathered some very valuable information. I will update you on Munchie's progress. :)

[littleone1]

Corky and I want to welcome both you and Munchie. I'm sorry to hear that Munchie has both diabetes and cushings.

You have found a wonderful group of very caring, supportive, and knowledgeable people that have a lot of experience. Some of their fur babies also have both diseases.

Others will be along that can offer information when treating both diabetes and cushings.

Terri

[lulusmom]

Hi and welcome to you and Munchie.

I just finished reading your thread at k9diabetes.com and for those members would would like to do the same, here's is a handy link:

http://www.k9diabetes.com/forum/showthread.php?t=2676

I see that some of the members on K9diabetes already mentioned to you that the acth stimulation test is less likely to yield a false positive result than other tests; however, if any dog were to have a false positive result, it would be a dog with uncontrolled diabetes. A post stimulated cortisol of 28 ug/dl is most definitely consistent with cushing's but given the circumstances, additional testing should be done, not only to validate the acth stim test, but to determine which form of cushing's Munchie has. An abdominal ultrasound is usually done to differentiate. Does your vet have any plans to run additional diagnostic tests before starting treatment with Trilostane? I am assuming that your vet did a complete blood chemistry and urinalysis, right? Can you please post only the abnormal blood and urine values and include the normal reference ranges?

Cushing's and diabetes share some of the same symptoms so what additional symptoms associated with cushing's has convinced your vet that Munchie has cushing's? Voracious appetite, panting, thinning of coat, skin issues, pot belly? You mentioned on k9diabetes that Munchie is overweight and that you think he has a pot belly. With an overweight pet, it is very difficult to tell if a pot belly is due to the weight issue or if it being caused by the factors typical of cushing's such as, enlarged liver and abdominal fat deposits due to cortisol's effect on fat metabolism. It is known that uncontrolled cushing's predisposes a dog to diabetes; however, I believe obesity is a much higher risk factor for diabetes.

As others on k9diabetes have already mentioned, getting the diabetes under control takes priority. Because nonadrenal illnesses, and most certainly diabetes, can cause transient elevations in cortisol, it is also important that you try to get the diabetes under control before testing for cushing's. Cushing's is difficult enough to diagnose without throwing diabetes in the mix so it can be a slipperly diagnostic slope, especially for a general practitioner. I would highly recommend that you consider consulting with an internal medicine specialist before starting any treatment for cushing's. I have two dogs with cushing's, both with other conditions, and they treat with a specialist who is highly trained and experienced with all endocrine disorders. You pay more for the experience but quite often, a specialist will save you money in the long run. If you let us know what city you are near, we may have a member who can offer you a name.....or you can try to find a specialist in your area using this link: http://www.acvim.org/websites/acvim/index.php?p=3

I'm sure sorry for the reasons that brought you here and to our sister forum, k9diabetes, but I'm really glad that you found all of us. In my opinion, you now have the best of both worlds and between us all, we'll get Munchie on the right track. He's a lucky boy to have one smart cookie for a mom so he's way ahead of the game.

Glynda

[Munchie's Mama]

We are seeing our regular vet tomorrow. The emergency vet did a chem panel and a ua. She faxed the results to our vet, so I'll get them from him and post the results. Munchie's trembling, panting, and very weak hind quarters led the vet to the thought of Cushings. She did mention a abdominal ultrasound would be a good idea. Our vet is very good, and I'm assuming he will know the best course to take. However, I live near Denver and I'm not opposed to talking to a internal medicine vet near me to get more ideas and opinions. So if anybody knows of one around here, please feel free to post any information. I would be most grateful. I will update when I learn something new. Thanks for the help and advice. :)

Thanks for the link. There's a internal medicine specialist listed who's at the hospital I took Munchie to on Saturday.

[Munchie's Mama]

Hi. Munchie my 10 yo Wire Fox Terrier began dosing with Trilostane Friday evening. 60 mg daily. He slept most of the day today. He seems very lethargic, and weak in the rear end. I read something on here about cortisol withdrawal and it makes a lot of sense. I'm thinking he is going through that very thing. I was quite encouraged when he seemed very interested in his dinner and ate all of it. It just made me nervous to see him so tired, but reading about withdrawal put me at ease. I'm hoping it only lasts a couple of days and then he will seem more like himself. :)

[littleone1]

Hi,

Corky went through cortisol withdrawal when he first started taking Trilostane. He started acting lethargic after his second dose. I talked to Corky's IMS and she told me not to give him the next morning dose until I saw how he was acting in the morning, and to call her first. Since he was so much better in the morning, she said that I could give him his next dose.

That's a good sign that he ate all of his dinner. If you see that he is still acting lethargic in the morning, call your vet. Do you have Prednisone in case you would have to give it to Munchie?

I'm hoping that Munchie will be better in the morning.

Terri

[labblab]

Hello and welcome from me, too!

I am sorry to hear that Munchie is feeling poorly, but hopefully he will be perking up soon. Can you tell us how much he weighs? Initial trilostane dosing is determined on the basis of weight, and we have learned over time that many specialists and now the manufacturers of Vetoryl themselves (Dechra) are recommending that dogs be started at relatively low doses so as to minimize the severity of potential issues such as cortisol withdrawal. Even though Dechra's published dosing literature speaks of an initial range between 1-3 mg. per pound, their U.S. technical representatives are verbally recommending that dogs be started at the lowest end of the formula: at 1 mg. per pound, and then working upwards from there over time if dosing increases are warranted. So depending upon Munchie's weight, he might feel better starting off on a lower dose. Here's a link to those published recommendations:

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

However, I do realize that since he has also been newly diagnosed with diabetes, your vet may be anxious to bring his cortisol down more quickly. In that vein, we have found that many specialists recommend that diabetic dogs be dosed twice daily rather than once daily in order to keep their endocrine systems more evenly balanced throughout a 24-hour time period. In that situation, the daily total is basically divided in half and administered at 12-hour intervals (as opposed to doubling the recommended daily dose). In terms of consultation, it is great if there is a specialist at the emergency hospital near you. However, if by any chance you live north of Denver, you might even consider consulting with a team at the CSU vet school in Fort Collins. As the others have already said, in complicated situations such as the combination of diabetes and Cushing's, expert advice can be really helpful.

Marianne

[addy]

Hi,

I can't really help with technical info but wanted to stop by and tell you welcome.

You now have two forums that can help give moral support and have vast knowledge of both diabetes and Cushings.

I am sorry you need us but glad you are here.

Hugs,
Addy

[Munchie's Mama]

Sad news about Munchie. He had a terrible reaction to the Trilostane. Nausea, vomiting, trebling, bloody diarrhea. So we stopped the pills immediately, upped his dosage of insulin to 12 units, and he's on Amoxicilin for the bloody diarrhea. I'm very disappointed that the Trilostane had this result. I guess it's back to square one for treatment of Cushings. He's 44 pounds and was given 60 mg once a day. Could that have been too much??

[Squirt's Mom]

Hi Sweeite,

If your vet did not give you Prednisone, please call asap and get some....don't ask, TELL them. ;) It is not an option when dealing with either Trilo or Lyso. It is used in cases like this when the pup seems to have crashed - meaning the cortisol is too low. Pred is inexpensive and your vet should have no problems giving you a few tablets for Munchie. The things you mentioned are in keeping with the cortisol dropping too low. This can also make the electrolytes too low which is dangerous. Please call your vet asap and get some pred. If they are closed, call an ER clinic and see if they can get you some - they will probably have to call your GP vet for approval.

Keep a close eye on him. If he does not improve he will need to be seen asap.

Keep in touch and let us know how he is doing, 'k?

Hang in there!
Hugs,
Leslie and the gang

PS. Has Munch ever had colitis? The blood in the diarrhea is very familiar as my Trink has colitis. Other conditions can also produce blood in the feces....Squirt used to get Spirochetes which would give her bloody diarrhea if we didn't get hold of it quickly.

[labblab]

Oh, I'm so sorry about Munchie. And yes, I do believe it is possible that the 60 mg. was too much for him. Per my earlier reply, I believe that the manufacturers of Vetoryl would be verbally recommending a daily dose closer to only 40 mg. Do keep updating us as to how he is doing, OK?

Also, even though Leslie is exactly correct that prednisone is recommended when cortisol levels have dropped too low, you would want to make sure that any vet with whom you consult right now about his condition (for instance, an ER vet) is aware that Munchie is diabetic. Because steroids like prednisone can raise blood sugar levels, and so I believe you would want to make sure that anybody who is supplying you with prednisone is aware of his diabetes and would take that into account in making the determination as to whether prednisone is advisable or necessary for him right now. It may be the case that just discontinuing the trilostane is the better option.

Marianne

[addy]

Sending hugs your way and hoping Munchie is okay.

I am hoping someone will be along to comment on the dose of Trilostane. Dechra (manufacturer) recommends 1mg per pound. Unn. Cal. Davis I believe recommends an even lower dose. Perhaps your vet was taking in to consideration the diabetes and wanting to try to quickly control the Cushings?

Hugs,
Addy

[littleone1]

I'm sorry to hear that Munchie is not doing well. I'm sending positive thoughts and prayers that Munchie will be feeling better very soon.

[Munchie's Mama]

Thanks for all of your good wishes. Munchie is sound asleep in his bed. I took his sugar before bed and it was 379!! To me that is wonderful because it's the first time since he was diagnosed that I've seen it below 400. Maybe we're finally making some progress. As for Trilostane, I think it's leaving his system pretty quickly. I was nervous when our vet suggested 60 mg, because I remember the article on here about the 1 mg per pound. I should have listened to my instincts, instead of assuming the dr. knows what's best. I don't know how we will treat the Cushings now. I'm very leery about Trilostane, even at a smaller dose. Any how the antibiotics seem to have helped his diarrhea, and he ate all of his dinner of scrambled eggs. :)

[Munchie's Mama]

Hi Sweeite,

If your vet did not give you Prednisone, please call asap and get some....don't ask, TELL them. ;) It is not an option when dealing with either Trilo or Lyso. It is used in cases like this when the pup seems to have crashed - meaning the cortisol is too low. Pred is inexpensive and your vet should have no problems giving you a few tablets for Munchie. The things you mentioned are in keeping with the cortisol dropping too low. This can also make the electrolytes too low which is dangerous. Please call your vet asap and get some pred. If they are closed, call an ER clinic and see if they can get you some - they will probably have to call your GP vet for approval.

Keep a close eye on him. If he does not improve he will need to be seen asap.

Keep in touch and let us know how he is doing, 'k?

Hang in there!
Hugs,
Leslie and the gang

PS. Has Munch ever had colitis? The blood in the diarrhea is very familiar as my Trink has colitis. Other conditions can also produce blood in the feces....Squirt used to get Spirochetes which would give her bloody diarrhea if we didn't get hold of it quickly.

Hi Leslie,
Munchie seems to be better this evening. He hasn't vomited or had diarrhea in several hours. He ate his dinner and tolerated his Amoxicillin alright. I think the bloody diarrhea was a result of the Trilo. It is one of the most common side effects according to the package insert. My vet didn't offer us any Prednisone at all, which leads me to the conclusion that he may not be very up to date on treating Cushings. Perhaps I should consult a Internal Med specialist. I will keep watcing Muncher closely, and if I don't like how he seems, I will take him back in. Thanks for your helpful advice and good wishes. Take care.:):)

[k9diabetes]

I think an IM is an excellent idea. There has been the idea that Trilostane is "safer" than lysodren for treating Cushing's but I believe that vets are finding, as it gets more use, that it too can be problematic for some dogs.

Which isn't really surprising. It is a powerful drug and not as much is known about it as the alternative, Lysodren. I think, if I had a dog diagnosed, I personally would try Lysodren first and I would work with an Internal Medicine Specialist, as well as read as much as possible about treatment myself.

Both are very powerful drugs. And both need a skilled veterinarian to administer them.

I think even just revisiting the Cushing's diagnosis would be worthwhile. It is very very difficult to accurately diagnose Cushing's in a newly diagnosed diabetic and I think it's better to work the blood sugar for a bit and then consider additional diagnostics to make sure the Cushing's disease actually exists.

The high blood sugar may simply be that the insulin dose is low, which it should be in the beginning.

I'm relieved to know that he's feeling better! That quick exit from the system is definitely one advantage to Trilo in cases like this.

Natalie

[addy]

Hi,

Just a note from me- I asked my Internal Medicine Specialist last summer about providing prednisone if we load Zoe and she said she does not do that. She said she has treated a lot of dogs. So it is not always that they don't have experience with the disease.

I plan on revisiting that with her. Not sure how far I'll get:rolleyes:


Hugs,
Addy

[Munchie's Mama]

I am so frustrated right now!! Yesterday for a brief time I had my Munchie back again. When his cortisol level was down, his sugars came down and the old Munch was back. Barking, playing in the back yard with his toys. BUT, now that the Trilo has gotten out of his system, he's panting, cannot walk very well, blood sugar is off the chart. I think Trilo can help Munchie but at a smaller dose. 60 mg was way too much and made his cortisol fall too low. But when the cortisol level started back up, on the way, old Munchie was back. How do I make my vet understand that we need to start out SMALL and work our way up??? To him 60mg is a small dose. According to new studies, 60 mg is huge for a dog of Munchie's size (44 pounds). I've read everything from .33mg per pound of body weight to 1mg per kg of weight. Why can't my vet understand that??? I have left a voicemail with a IMS vet at the hospital we went to when Munchie was first diagnosed. I am PRAYING that he is in the loop and understands the need for a smaller dose. If my regular vet gets pissed that I spoke to another vet, that's too damn bad. This is my dog's life we're talking about. He can be well again, I saw it yesterday for myself. Thanks for letting me vent here. I'm heartbroken that Munchie is once again debilitated by this damn disease. :(

[labblab]

Perhaps your vet would be willing to speak with the technical representatives at Dechra's U.S. office headquarters in Kansas (Dechra is the manufacturer of brandname Vetoryl). In presentations at conferences and in verbal conversations, Dechra has revised their published dosing recommendations to reflect an initial dosing formula of no more than 1 mg. per pound. And given Munchie's response to the 60 mg. dose, they might recommend starting even lower for him.

Several of us have spoken directly with Dr. Tim Allen at Dechra. He is an IMS himself, and is really nice and really helpful. I know he would be happy to speak with either you or your vet about Munchie's situation. Here's the contact information for Dechra:

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

Marianne

[Munchie's Mama]

Thank you very much for the info. I will contact them today.

I spoke to Dr. Allen. He agreed we should probably start at a lower dose and perhaps work our way up to 60 mg eventually. SO, we are going to start all over again at 10 mg. I can pick them up tomorrow. In the meantime, my vet said I could divide up a 60mg capsule into 4 piles of powder and give my dog one of the piles sprinkled onto his food. BUT in the package insert it specifically states not to do this. Maybe I should just wait until tomorrow. Thanks for your help. :)

[Harley PoMMom]

I would definitely wait until tomorrow when you get the 10mg capsules. Opening the capsules up is really not an advisable thing to do.

Love and hugs,
Lori

[Munchie's Mama]

We re-started Munch on Trilo last night. 10mg instead of 60mg. He still threw up during the night a little bit. This morning he seemed rather weak and dopey. However, after his insulin shot kicked in he devoured his breakfast and seems very bright and with it. I'm praying the sensitivity to Trilo is temporary and once his body gets used to it he'll be alright. I'm very grateful we have a vet who was willing to listen to me and to do a little research and agree that a smaller dose to start is advisable.

[Squirt's Mom]

Hi,

How is Munchie doing today? Did you continue with the Trilo? If so, how did he handle it?

Let us hear from you!

Hugs,
Leslie and the gang

[Munchie's Mama]

He's adjusting to the 10 mg Trilo very well. His sugars have come way down. At bedtime last night it was actually 250. I could hardly believe it!! Compared to where he was that's great. He doesn't vomit at all now. He's still weak in the rear, but improving. Yesterday, he played with his tennis ball a little bit. He has stopped drinking so much water, no more accidents inside, and hardly any panting. I know his symptoms will probably return and we'll end up increasing the dose. For now I'm just enjoying my happier, more comfortable dog. Thanks for asking about him. :)

[Harley PoMMom]

It's wonderful that Munch's system has adjusted so well to the 10mg of Trilostane!

You're doing a great job! Keep us posted, please. ;):)

Love and hugs,
Lori

[labblab]

Congratulations!! What super news on this Mother's Day! :)

And you never know, this dose of trilostane may very well continue to hold Munchie's symptoms in check. Even if not, now that you have the 10 mg. capsules, you'll be able to make dosing changes much more easily.

Keep up the good work, and please give Munchie a bit pat for me.
Marianne

[Squirt's Mom]

:D Glad to hear that Munch is doing so much better with this lower dose! :D That is great news!

I hope you find this is going to work for him for quite some time to come and you see many, many more days of your happier, more comfortable baby.

Hugs,
Leslie and the gang

[Munchie's Mama]

Thanks for the kind words everyone!! It is VERY much appreciated. May all of our furbabies continue to thrive and be with us for many years to come.
Hugs and pats to all
:):)

[littleone1]

This is such good news about Munchie. I hope everything continues to go well.

[addy]

I am so happy to hear Munchie is doing better. You are doing an amazing job.

Hugs all around,
Addy

[Munchie's Mama]

Quick update on Munchie. His cushing's symptoms returned, and his sugars started to go up again. We have gone to 10mg Trilo twice a day. He appears once again to be in control. His sugars are 160-300 range. The cushings symptoms seem to have disappeared again, except for the rear end weakness. I hope this improves with time. We plan on doing a stim next week to see where we are. :)

[addy]

Glad to hear things calmed down again for Munchie. Will be anxious to hear stim results next week. Crossing everything I can for you. You are doing so well handling both diabetes and Cushings. You are really doing a good job.

Hugs,
Addy

[Squirt's Mom]

Sounds like you have had your hands full but you are doing a great job dealing with both conditions! I am glad Munchie is back on track and things are going good for him again.

Keep up the good work and let us know what you learn from the ACTH. :)

Hugs,
Leslie and the gang

[Munchie's Mama]

Munchie continues to do well. Sugars in the 90-200 range. The only stubborn symptom that bugs him is his hind quarters weakness. He is on 10mg Trilo twice a day, plus 13U insulin twice also. We will do another stim test after our finances settle down later on in the month. Hubby had to get a different job, and my workman's comp stopped. So we were kind of scrambling for a little while there. :)

[addy]

So glad you posted as I have been thinking about Munchie. Glad to hear he is doing well. The hind leg weakness can take a bit to figure out.

Hugs,
Addy

[Squirt's Mom]

Good to hear from you again, especially with good news! :) That is wonderful that Munchie is leveling out with his sugars and cush signs, too.

You are doing a great job, Mom! Keep it up!

Hugs,
Leslie and the gang

[Munchie's Mama]

Update on Muncher: Munchie had a stim test about 10 days ago. His numbers are down from where they were:
Pre: 3.6
Post 10.4
We've gone to 10 mg Trilo x2 in the A.M.
and 1 10 mg in the P.M. so 30 mg daily total. Of course now his sugars are way high again from the injection. I guess it takes quite awhile for the sugars to calm down again. We will do another stim in 3-4 weeks. He still battles with rear end weakness, but it's better than it was. :)