My best friend (8 y/o Lab) Diabetic, Cushing's - Trilostane

[ozzysmom]

My beautiful 8yrs. Old Lab has been diagnosed diabetic and Cushing’s. I am devastated. I feel so helpless and angry that his regular vet didn’t pick up on the fact that he was showing signs of Cushing’s. I never even heard of the disease until last summer because Ozzy tore his Achilles tendon and the orthopedic vet found that Ozzy had a pot belly and his fur wasn’t growing back from the operation. Last week Ozzy’s glucose levels were off the charts. He couldn’t hold his urine for more than 15mins. He would urinate while he slept. We thought he had a bladder infection so we brought a urine sample to the orthopedic vet. He was shocked at Oz’s glucose levels and told us to get him to an internist. We got him in two days later. This vet did a full test on a new urine sample – no infection but very high glucose. I told her what the pervious vet suspected. She was more inclined that Ozzy was diabetic but could see that Ozzy has a pot belly and poor hair growth. Next day we brought him back for the ACTH test. She also prescribed insulin 10mg twice a day. We went through the weekend injecting him. He did show improvement. On the Mon. Oct. 31th, I tracked her down and was told yes, the ACTH confirmed Cushing’s. She ordered trisolane – 45mg twice a day. I should receive by the end of the week because it is coming from across country. I am so worried to say the least. I read so many sad stories and one vet even told me perhaps we should consider putting Ozzy down!!!! I want the best for my wonderful friend. I have concerns with the dosing schedule because two night of the week, my husband and I are not at home for the 7:00 p.m. shot. Can anyone tell me how they have handled a diabetic/Cushing’s dog? I just love him so much and want the best for him. Thanks in advance.

[Squirt's Mom]

Hi and welcome to you and Ozzie,

First, I want to send you to our sister group, k9diabetes. They are the experts in this area and I know they will be able to help you tremendously with his diabetes. You can find them at -

diabetes info
http://k9diabetes.com/forum

Get registered with them asap. ;)

We have several members here who deal with both conditions and I am sure they will be along soon to share their experiences with you.

As for the vet who said to put him down, phooey on them! Both conditions can be and are coped with by many people and the dogs do just fine. It is not uncommon at all for both to show up in a pup so you just ignore that nonsense!

It would help us a great deal if you could get copies of the tests he has had done and post the actual results here, including the units of measurement and normal ranges for each value. Don't worry about those that are normal, just post the abnormal results. Post all the info you have on the tests for Cushing's, tho - LDDS, HDDS, ACTH and/or ultrasound.

Also, can you tell us how much Ozzie weighs? This will help us make sure the dose prescribed is correct. We are here to help you every way we can tho we are not vets. We have lived with Cushing's in our own lives, tho, and have learned a great deal which we are more than willing to share.

The most important thing for you to know right now is that you and Ozzie are not alone on this journey. We, and k9diabetes, will be with you all the way.

Hang in there!
Hugs,
Leslie and the gang

[ozzysmom]

Thanks Leslie for getting back to me so fast. I will get his test results a.s.a.p. As for his weight, he is currently 93lbs. What I forgot to mention yesterday was that Ozzy takes quite a long time to urinate. He is much better than before the insulin but he not peeing normally. I am so frighten to lost my big boy, I just start to cry just thinking about it. This morning, he ate well but just wanted to sleep. He also is sticking to me like glue. He seems to know that I know that he is sick and that we are trying to make him better, sounds crazy but it’s true. You are such a wonderful group of people and are doing an extremely important service. I wear my emotions on my sleeve and when people ask me what is wrong and I tell them, they generally look at me like "is that all!" Wow. I will keep in touch.

[Polkaroo]

My Bazil was Cushingoid and Diabetic. She lasted a year longer than anyone expected. She passed away this past May.

The Cushings Diabetes combo is a tough one. Until the Cushings is under control, the diabetes likely won't be stabilized. It will take a lot of hard work and likely a few tears before you are out of the woods.

Diet is a huge thing for the diabetes. Can I ask what are you feeding him?

Let the Trilostene do it's job and once his levels come down, you should see improvement on the diabetes side too.

If you ever need to chat with someone who has been through this combo, PM me anytime! :D

[ozzysmom]

Hello Polkaroo's Mom, I feed Ozzy a special food which he was on since birth. It is called Blackwood and is made in small batches. I have him on the low-fat one now. I also give him green beans, pumpkin and carrots. I am very careful what I give him to eat but he is also a true Lab and will steal food when he can. I see you are from Ontario, Canada. I lived in Montreal for thirty years. My parents are now in Ottawa. Getting pretty cold up there now I guess. Thanks for your concern.

[Jenny & Judi in MN]

Hi Ozzys Mom:

My Jenny was diagnosed with diabetes in May and her vet did not notice her Cushings until I asked about her pot Belly around July 4th also.

There have been cases of diabetics testing positive for cushings when they don't really have it but your boy does sound like he has the symptoms.

My second vet, who is handling Jenny's 2 major illnesses, told me that once we get both issues under control she could have some good years left. It was a very emotional summer for me though and I totally understand and sympathize with how overwhelmed you are feeling.

I have found so much support and knowledge on these 2 forums.

It took a long time to get Jenny's blood sugar down to where we wanted it but she is finally there. We are in the maintenance phase on her Cushings but it is a hit or miss thing as she is in the 15% group with an adrenal tumor and we are not going to have it surgically removed.

There are lots of good tips and helpful people on the diabetes forum so please come over. Did they check for ketones in the urine? That can be very dangerous.

hang in there, it is manageable. hugs, Judi & Jenny

[Polkaroo]

I'm in Ottawa LOL!

You may want to stop the pumpkin and carrots. Both are high in natural sugars. Anything green is best except green peppers and peas (again both are high in sugar). Green beans have tons of glucose reducing properties. He needs lots of fibre too. Broccoli is good and celery is a great "free" treat (i.e. it won't affect anything). Low fat, high fibre is the way to go so you are good there.

I too was going to ask about his ketones? Are you checking his blood sugar at home? You may also want to get a pack of ketone strips to test his urine at home too. The sooner you catch problems when they happen, the better your chances of avoiding disaster. :)

[ozzysmom]

How funny, my parents are in Stittsville. Thanks for the advice on the carrots & pumpkin. Will stop. I had the urine and blood test results faxed over today. Have to say I have no idea what all this means but here we go: Urine Cortisol 12.9, Creatinine 17.2, Cortisol/Creatinine 234. MA 10.9, Protein 6.2, Cholesterol 342, CPK 1401, specific gravity 1.035, glucose 3+. No traces of bacteria.
Blood. ACTH
Sample 1 – 7.6
Sample 2 – 23.5

I have more info. but it will take a lot of space. Started the trilo. today. He is very sleepy, still is eating well but takes forever to empty his bladder. This morning, he had an accident, that is the first time since last week. Ozzy is looking very thin but doesn’t look like he unhappy. Thanks again everyone, it is all very confusing.

[Polkaroo]

Ok this is too weird. I live in Stittsville. Just move out here last year.

[ozzysmom]

:(Poor fella isn't feeling well at all. Thankfully, he is eating well and drinking but still taking a very long time to empty his bladder. He is also showing signs of weakness in his hind legs. Has anyone else experienced this?:confused:

(MODERATOR NOTE - I have merged your latest post about Ozzie with his original thread. We like to keep all the info about each pup in their own thread. This way it is easy to look back through the history if needed. I also changed your title a bit to reflect his treatment.)

[ozzysmom]

Hope Farfalle is doing well today.!

[ozzysmom]

As of this Monday, he is going downhill. He is having problems with his hind legs, very weak. Still drinking water and he can't go through the whole night. We have to take him out every 3 hours. Very sad to see him like this.The vet thinks maybe the trilosane is causing the weakness since he has not been getting better. She was concern about his weight loss, although he eats very well. I have changed his food to a more high protein kind to put some pounds back on him. They did try to do a blood curve but for some reason couldn't get a good reading. I do urine tests every second day, I have not seen any changes. It seems that the glucose just wouldn't go down! She did tell me the results from the ACTH but I can't remember right now but she did say they dropped quite a bit. I go again in 10 days for another test. I think Ozzy will be put on a very low dose at that time. I just feel that we are missing something here that will have a huge impact on his health. Any suggestions. I also posted on the diabetes for dogs forum.

(MODERATOR NOTE - I have merged your latest post about Ozzie with his original thread. We like to keep all the info about each pup in their own thread. This way it is easy to look back through the history if needed. I also changed your title a bit to reflect his treatment.)

[frijole]

I'm sorry to hear this. In order to offer advice we really need to know what the reading was on the acth test that was done. If it is low you should not be giving trilo. Low is a 1 or less.

Am I right that Ozzy is eating normal amounts but is losing weight? Have you done a full blood panel? that would help determine if something else is going on. Kim

[ozzysmom]

I really feel incompetent because I do not remember the number the vet gave me re: the ACTH. I know that is was getting close to normal because she lowered his dosage from 45mg to 35mg 2x a day with the warning to watch him closely. He is eating very well, I can’t get enough food in him but yet he is not gaining. I have also changed his food to a high protein, low carb kind so he can put some pounds on. His water intake has decreased but still he drinks a whole bowel at a time. During the night, we must get him up twice so he can pee otherwise he has an accident. For some reason his glucose isn’t going down. We have gone from 10 units to 30 units in three weeks. It seems that the 2 conditions are fighting each other. What am I missing? His next ACTH is in 2 weeks which will be his 3rd.

[frijole]

Don't feel incompetent.. you are new to this as we all were at once time. It is simple - CALL the vets office and get the numbers or better yet drive over and get copies of all the tests done to diagnose the cushings and then post the info for us to read.

Question - is this vet a regular vet or a specialist? I ask because dealing with the combination of cushings and diabetes is tricky and we've learned that IMS vets (internal med specialists) are better trained to handle these cases. It is not easy so don't blame your vet at all.

We really need to know the results of the tests to help you. That will tell us whether the cortisol has gone too low. The excess water intake could be due to either the diabetes or the cushings. But do keep on giving water - don't withhold it! If need be buy diapers or pet pads to get you thru this bump in the road.

I am no diabetes expert but from your description it sound like it is the bigger issue right now. Have you posted on the k9diabetes forum? If the acth test shows cortisol is close to 'normal' then the issue is with the diabetes. So please get the numbers. Call or drive over tomorrow and get back to us ok? Kim

[Skye]

why are you not removing adrenal tumor?

[ozzysmom]

I was told not to have this kind of operation due to the poor results. I will call the vet tomorrow and get the ACTH results and post them. The vet is my only option right now because he is too weak to go to the university which is 45 mins. away. Ozzy hates being in the truck, he gets so stressed. I was told this vet has had experience in dealing with diabetes/cushing's dogs. I just feel we are missing something. I will post the information I get from the vet and hopefully you all can give me some insight. Thanks again for taking time on Thanksgiving and helping me through all this. It is much appreciated.

[k9diabetes]

Hi Ozzysmom,

Although his current insulin dose is on the high side of average, it's not excessively high. He could easily need 40 or 50 units per injection to regulate.

Have you already stopped the Trilostane?

If not, I think it should be done immediately. I have seen severe weakness in other dogs sensitive to it and especially in dogs who might not actually have Cushing's disease.

Then his insulin dose should be increased.

Sounds from K9D that you might be taking him to the vet, maybe tomorrow?

Natalie

[frijole]

I was told not to have this kind of operation due to the poor results. I will call the vet tomorrow and get the ACTH results and post them. The vet is my only option right now because he is too weak to go to the university which is 45 mins. away. Ozzy hates being in the truck, he gets so stressed. I was told this vet has had experience in dealing with diabetes/cushing's dogs. I just feel we are missing something. I will post the information I get from the vet and hopefully you all can give me some insight. Thanks again for taking time on Thanksgiving and helping me through all this. It is much appreciated.

I re-read your thread and I can't see where you indicated that your dog has an adrenal tumor... did I miss it? How was the tumor diagnosed? The acth test can't distinguish whether it is pituitary or adrenal cushings.

You are LUCKY that the university is 45 mins away. I had to drive 5 hrs to the closest one to get help for my dog. Hopefully the local vet has the experience needed - but if an emergency arises you have an option that is close enough. Thanks for getting us the test results. Hang in there, Kim

[BestBuddy]

Hi,

I think your insulin dose has been too low from the start. I know you need to be careful and start slow but at Ozzy's size the original dose was not going to make much of a dent in his BG numbers in my opinion. It doesn't sound like you have been getting any good BG numbers with Ozzy and until you can get the numbers down I would stop the trilo and then start again when you have a handle on the diabetes.

I wish vets would not pick a number of insulin units for a dog and say we don't want to go over that......it is not a contest and the insulin is not a score, there is no right or wrong dosage just the correct one for your dog.

Jenny

[ozzysmom]

No, Ozzy was never diagnosed with an adrenal tumor. I was warned by his orthopedic vet (who is amazing) and by another vet not to have this operation done, to the point that they said they wouldn’t have it done to their own dogs. Both felt that the trilosane will be the best approach. Today is the 2nd day of the trilo so we will see. Last night he couldn’t climb the stairs. He is also developing a cataract in his left eye which I knew was going to happen. His right eye is already blind due to a detached retina. I will post the information from the vet when I see her. I will push for more insulin and tell her what you all have mentioned. All of you are very special because you give a lot of information and comfort to people going through this for the first time. Thank you so much

[frijole]

ok... thanks... I was/am confused what operation you were talking about because there is no operation involved in treating cushings (only removing adrenal tumors). Glad you found us. Good luck! Kim

[ozzysmom]

I have Ozzy's lab test results.
On Oct. 27th. The 1st ACTH test (no medication) 93 lbs.
Cortisol sample 1 - 7.6
Cortisol sample 2 - 23.5 (2hrs. later)
Glucose - 371

On Nov. 16th after 10 days on 45mg trilosane 2x per day. 83 lbs. I gave him his insulin 20 units and trilosane 45 mg @ 7:00 a.m.
Cortisol sample 1 - 1.4, Glucose - 382 (10:00 a.m.)
Cortisol sample 2 - 2.9 (2hrs. later), Glucose - 383 (11:00 a.m.)
Glucose - 404 (3:30 p.m.)

after this test he was put on 25 units insulin and dropped down to 30mg 2x per day trilosane. Any suggestions.

[k9diabetes]

According to the following resource, a post-diagnostic cortisol level of 22 would be in the borderline range.


Post stimulation values between 17-22 ug/dl, are considered borderline, and those of higher than 22 ug/dl are consistent with a diagnosis of HAC.

https://listserv.tamu.edu/cgi/wa?A2=ind0203&L=cushings-pets&P=R19896&D=1&H=0&O=D&T=1

That would put Ozzy's result, with uncontrolled concurrent diabetes, at just barely above the borderline level. I would question whether he has Cushing's disease at all then unless he just visually screams Cushing's dog and it is confirmed by other tests.

Looks to me like he just needs more insulin. He is responding to what he's been given so far or you wouldn't see blood sugar down into the 300s and 400s.

He may have some other issue - spinal cord problems, arthritic inflammation - that are causing his leg weakness and lowering his cortisol level with Trilostane would actually make those kinds of problems worse. This was the case with Yunee's dog Harry, who has some neuropathy and arthritis in his back. On Trilostane his weakness and problems walking got worse.

I don't recall now how long it took Harry to bounce back after being taken off of Trilostane. Ask Yunhee (HarrysMom) at K9D about that.

His cortisol level might rebound off of Trilostane or it might not.

The other thing about diabetics is that having high blood sugar for a long time makes their body somewhat resistant to the effects of insulin.

Once you start injecting them with insulin and the blood sugar has been brought down, their bodies become more sensitive to it and you get more kick from the same number of units.

It could be that Ozzy is somewhat resistant now but will recover from that once his blood sugar is down another 100 points or so.

I still think a neurologist consult would be good. It really makes a huge difference because they can tell so much more from the tests than the average GP vet.

Our diabetic dog one day just couldn't stand up. We took him to our GP vet, who is better than most. He did the basic neuro tests and some looked like vestibular syndrome and some didn't. So he got us in to the neurologist a few hours later and the neurologist confirmed that it wasn't vestibular syndrome. Instead, it was something in the brain. In his opinion, a TIA - mini stroke. Our dog couldn't stand up because he was terribly dizzy - the vestibular system was being affected. But he started to slowly recover over a few hours. Those kinds of fine distinctions really need to be made by a specialist.

I'm not convinced that Ozzy's problem is neuropathy. I think he could have some other back or spinal problem.

I would also push for more insulin. If the vet refuses to raise it, you will have to find someone who doesn't put an artificial limit on how much insulin they can have. It would be entirely within normal limits for him to need as much as 1/2 a unit per pound. Some dogs just need more than others.

I am anxious to see how he does over the next couple of days. I am so hoping that his cortisol level will rebound and he will feel better. I know how worrying and scary this all is.

Natalie