Cushing's and Diabetes

[exist]

Hello everyone,

I originally created a thread regarding my dog http://www.k9diabetes.com/forum/showthread.php?t=3414&page=1 over at K9Diabetes where CarolW recommended K9cushings.com.

My sister and I have been trying to learn as much we can on Cushing's and canine diabetes. We feel all we have learned is treatment is extremely hard and that the prognosis is not good. However, after speaking with everyone at k9diabetes, we feel learning from people who share the same experience is much more valuable.

My dog Peanut was recently diagnosed with Cushing's and diabetes. It started late last week, when Peanut began to have excessive thirst and urination. It got to a point where his water bowl was always dry no matter how many times we filled it. He would even drink out of toilet bowl, which he has never done.

We took him to the vet and was told he has diabetes and Cushing's. They also said having both will make it hard to treat Peanut. Per vet's order, we have begun treatment for the diabetes first. So far, the animal hospital began to regulate him for most of Wednesday. We are currently giving him a 4 unit injection of Lantus twice daily. After discussing it with the helpful people over at K9diabetes, we are going to push for using NPH.

Are the drugs for Cushing's similar, as in a difference in efficacy? We read over some of the side effects and warnings of the 3 common drugs, which is pretty frightening. Also, after discussing it over at k9diabetes, we have learned that the Cushing's diagnosis may not be accurate. The vet is convinced Peanut has it. When the time for treatment comes, should we reject it and ask for more testing?

Having both diabetes and Cushing's, is the prognosis as bad as we have read? Or does it depend on several factors such as treatment and response? From what we have read, it seemed diabetes alone is treatable and manageable. But does having diabetes with Cushing's guarantee Peanut's quality of life will be poor?

I can't think of any other questions but I feel that there is so much more to ask and learn. Any information you feel I should know is truly and greatly appreciated.

[mytil]

Hi and welcome to our site.

I am sorry your Peanut is having these troubles.

I am wondering what tests your vet performed to be so quick to say your Peanut has Cushing's.

When you can post the actual results of the Cushing's test - That way we can all offer more opinions as to treat or not to treat.

Are there any other symptoms Peanut is exhibiting? i.e. excess hunger, thinning coat ....? I know excess thirst is a big symptom of diabetes.

Keep us updated
Terry

[Cyn719]

Hi and welcome to the forum

I am so sorry Peanut is having these issues but so glad you came here. The members here are fantastic and very knowledgeable. They will ask many questions but this will help them see the whole picture. Test results, abnormal bloodwork, the breed of Peanut, weight any history will help if you could post this. And yes Cushings does cause excessive thirst also. like Terri said the results of what the vet did to come to this conclusion is important. We are always here for you and Peanut. The experts will be by to give their advice. Hang in there:)

Hugs

[jmac]

Hello, and welcome from me and Hannah as well. I am sorry you are going through such a scary time right now. I know I was majorly overwhelmed with just the Cushing's diagnosis, so I can't imagine how you must be feeling.

First of all, you are in good hands on this forum, and I'm sure on the diabetes one as well. These wonderful people will help you get through this. I was also overwhelmed when I read about Cushing's medications and treatment and I came here feeling really sad and grim about the prognosis. Within a few days, however, I was feeling so much better after learning from members that the medications can be wonderful and dogs with Cushing's can live for years with successful treatment. Hannah has very minor symptoms so we are not treating Cushing's at this point, but I feel much more comfortable about doing so if we get to that point.

I don't have a lot of knowledge about diabetes, but I think it makes sense to treat that first, especially because that could be the reason for the excessive thirst. It would really help us if you can post the test results that led your vet to suspect Cushing's. Then the helpful and knowledgeable people here can advise you on what to do.

We are here to help you as much as we can, and to be your support system as you go through this difficult time. You are doing the right thing by getting educated and asking questions. Please let us know how we can help.

Julie & Hannah

[exist]

Hello,

Thanks for the warm welcome! The vet did an annual senior wellness exam. These are the results that were outside the range:

ALK. PHOSPHATE: 1,100 (HIGH - 10-150 U/L)
CK: 396 (HIGH - 10-200 U/L)
GLUCOSE: 534 or 634, the ink was faded (HIGH - 50-125 mg/dL)
CHLORIDE: 96 (LOW - 105-115 mEq/L)
SODIUM: 135 (LOW - 141-156 mEq/L)
B/C RATIO: 42.0 (HIGH - no range given)
NA/K RATIO: 25 (LOW - 27-40)
ANION GAP: 26 (HIGH - 12-24 mEq/L)

CBC Standard:
NEUTROPHIL SEG: 82 (HIGH - 60-77%)
LYMPHOCYTES: 11 (LOW - 12-30%)
EOSINOPHIL: 1 (LOW - 2-10%)
AUTO PLATELET: 81 (LOW - 164-510 K/uL)
PLATELET COMMENT:
-Large platelets present
-platelets clumped
-appear slightly decreased

I am not sure what lead the vet to diagnose Peanut with Cushing's. Natalie over at k9diabetics informed me that elevated alk. phosphate can also be due to the diabetes. Except for the distended stomach, I don't think he is showing any signs of cushings physically (I.e. thinning hair, skin problems). Does this test give any results indicating Cushing's?

[Harley PoMMom]

Natalie is correct that the elevation in the ALP could solely be from the diabetes. Dogs with diabetes also can have a pot-bellied appearance.

Here is a link to a blog from a renown Cushing's expert, Dr Peterson, about diabetes and cushing's in a dog:http://endocrinevet.blogspot.com/2012/01/q-diagnosing-cushings-disease-in-dogs.html?utm_source=dlvr.it&utm_medium=facebook

Love and hugs,
Lori

[mytil]

Thank you for posting the blood panel results. Lori is correct the ALK PH can be elevated due to diabetes. It looks like to me, his electrolytes are low (Sodium, Chloride)....the other one is Potassium shown as NA/K RATIO. This could also be a side effect of diabetes. I must admit that is as far as I know about diabetes, but many here are dealing with both.

FYI on Cushing's testing - Here is a link that describes the testing for Cushing's - it is an easy read and http://www.kateconnick.com/library/cushingsdisease.html - it is found in our Resources section - http://www.k9cushings.com/forum/showthread.php?t=180.

The distended belly could also be excess fluid build up....(just a thought to pass by your vet).

Terry

[exist]

Hello everyone,

Thank you for the articles. Everyone on both sites have been so helpful and a big part of what my sister and I have learned. It would have been overwhelming trying to learn about both diabetes and Cushing's on our own.
Unfortunately, whether it is because of the doctor or us, there isn't enough communicating. I just created a post about this issue over at k9diabetes but want to leave it here as well to get input as well as making it somewhat of an update of what is going on. It's kind of long, sorry.

After discussing the direction we believe Peanut's treatment should be going and the progress made so far, my sister and I have decided to seek a different doctor. Taking the advice everyone at k9diabetes/k9cushings have given us and information from research, we feel the current vet is not aggressive enough in treating Peanut. An enormous red flag is the lack of communication. After diagnosing Peanut and regulating his bg for a whole day, she has not really discussed what our next step is except to give Peanut his insulin shots. She hasn't given us much information like:

-how treating diabetes is going to be affected by Cushing's and vice-versa
-more information about Cushing's since she diagnosed him with it
-diet: I have read Cushing's means less fiber while diabetes means more. I think such information is important to know.
-conflicts, prognosis, anything more than "it's hard to treat both. It takes commitment." how so? What should I expect? What are the warning signs treatment isn't working and we need to bring him in. What adjustments need to be made?
-what we should/shouldn't do ( exercise, any important physical signs, etc.)
-testing his levels at home
-what we should expect by our next visit AND when our next visit is
-any other important information
-discussion/explanation of his test results, bg curve, ketones...

Half the information is either from k9diabetes/cushings or from the nurses/techs at the hospital after learning what to ask here. We realize a lot of what happens next is also very much our responsibility. And in hindsight, we should have been more aggressive in questioning her as well. But given that this is all new and overwhelming for us, I feel she should have somewhat discussed the game plan until the next appointment, and more importantly, given us a next appointment.

Another major concern is her treatment method. I realize she is the expert and possesses a vast amount of knowledge compared to my sister and I. But it seems she is a minority of vets who believe Lantus works the best. From everything we have learned here to articles and studies by her peers, the majority prefer to use NPH. The longer Peanut's bg is high, the worse he becomes..After bringing up the issue, I hoped she would at least try to find out more about NPH.

We plan on making an appointment with the current vet one last time to address our concerns. But unless she makes us feel completely certain that she will work with us, it will probably be the last visit.

So we are seeking new doctors. We read that working with an animal internist is better than going to a regular vet. We weren't aware there were different types of vets. Is there a website, like human doctors, where vets are ranked and reviewed in each city? If not, is there at least a site or service that can direct me to an internist?

Sorry for the long post...I just needed to explain (vent) my frustrations with the doctor. Maybe its not her and I'm just not giving the effort I need to, I don't know. But it is clear both sides are not on the same page. Any suggestions? Or is our course or action the right one to take?

Thank you!

[jmac]

Hi there,

I think you are wise to seek another opinion and and internal medicine vet is more experienced with Cushing's and other diseases than regular vets. I like my regular vet very much, but also made an appointment to see an IM vet to get her opinion as well, and my dog does not have a complicated case. My regular vet agreed that it was a great idea. I think it's great to get a second opinion at this point, especially from a specialist. Many times they can work together and you can even have tests done at the regular clinic.

There is a website where you can search for specialty vets. I'll post it below.

http://www.acvim.org/websites/acvim/index.php?p=61

Julie & Hannah