Test Results question (Rex) 11 y/o yellow lab - Diabetic - possible Cushing's

[Debs]

Hi, I got the following numbers from the LDDS test. Can you tell me what they mean?

1.5
1.2
1.7

Rex is an 11yr old yellow lab, 70lbs, diagnosed with diabetes in Nov. 2011, on 25 units of insulin 2xday, WD diabetic dry food, but his BG varies so much, for no reason.

Today BG
6:00am - 334
8:30am - 318
11:00am - 223
2:00pm - 197
6:00pm - 157

Definitely not a normal diabetic curve. He changes from acting like he's still 4 years old to not wanting to get out of his crate within hours. Any input is appreciated! Deb

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[mytil]

Hi and welcome to our site.

To answer your question about the LDDS numbers you posted, can indicate a positive for Cushing's. BUT, that in and of itself does not offer a diagnosis of Cushing's. Were additional tests performed? (ACTH, UC:CR, ultrasound for example).

What symptoms did your boy have that prompted the look towards Cushing's? I ask this because diabetic symptoms are similar.

I do not have direct experience with diabetes. However, there are many here who have both conditions and will say that it can be difficult (although not impossible) to get both regulated. Here is a great sister site for diabetic dogs - http://k9diabetes.com/ and the forum is a great place.

Keep us posted
Terry

[mytil]

Here is another link you will find useful - http://www.k9cushings.com/forum/showthread.php?t=190

[Debs]

Hi Terry, thanks for your reply. We've been having a difficult time controlling his diabetes, varying BG for no reason, and he's been very lethargic. Unfortunately this would explain a lot, so I'll be doing a lot more research!

[lulusmom]

Hi and welcome to the forum.

Uncontrolled diabetes can cause false positives on the LDDS so unless our boy has more of the usual symptoms we see with cushing's, there is no way to confirm a diagnosis at this time. Any number of conditions can cause lethargy, including diabetes. More common symptoms associated with cushing's are voracious appetite, excessive drinking and peeing (this is also a very common diabetes symptom), loss or thinning of coat, skin issues, panting and loss of muscle mass, usually with pronounced weakness in the hind end. Are you seeing any of these?

When was the diabetes diagnosed? Can you please post the results of any bloodwork and urinalyses that were done? With respect to bloodwork, we need only see the abnormal values and please include the normal reference ranges.

As Terry already advised, we have a sister site www.k9diabetes.com and I highly recommend that you join there. The owner of that site is also an administrator here so I'm hoping she will drop in and share her opinions as to what may be going on with Rex.

I'm sorry you've found it necessary to reach out to us but I'm glad that you found us. We're here for you and once you get registered over at k9d, you'll definitely find that you have the best of both worlds at your disposal.

Looking forward to hearing more about Rex's medical history.

Glynda

[labblab]

Welcome from me, too! As Glynda has said, Cushing's diagnostics can be very challenging with a diabetic dog and we will definitely be anxious to hear more about Rex's history and symptom development. However, for what's it worth, the ACTH stim test probably would be a more trust-worthy diagnostic for Cushing's in Rex's case than the LDDS. Both tests can return "false postives" in the face of nonadrenal illness such as diabetes, but the ACTH is less likely to do so. So if it were me, I believe I'd request an ACTH prior to moving forward towards Cushing's treatment.

Marianne

[Debs]

Unfortunately I typed a long post that was lost and I don't have time to re-do it. I'll get all of Rex's test results and try to post again later. I did see how to not lose the post next time!

[Debs]

I just received the ACTH test results for Rex:

2.4
24.4

Between this and the LDDS, it looks like he has Cushings. I'm trying to understand all of this. The Vet wants to start treatment, which I'm sure we will do, but I need some time to digest. Going for a walk, will do research and be back later.

[addy]

We are here for you. It is a lot to think about and can be overwhelming, I know.

(((hugs)))))

addy

[labblab]

Aside from the difficulty in controlling glucose levels, does Rex exhibit other symptoms consistent with Cushing's?

If you and your vet do decide to move forward with treatment, I'm guessing that you may end up treating with trilostane (brandname version of the drug is Vetoryl). If so, you'll find lots of helpful information on this thread:

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

Also, even though many dogs treated with trilostane are dosed only once daily, there is strong reason to believe that twice daily dosing is a better option for diabetics:


In diabetic patients with hyperadrenocorticism, twice-daily dosing is absolutely recommended to avoid large fluctuations in serum cortisol concentrations.

Here's the source for that quote:

http://www.dechra-us.com/Files/dechraUSA/downloads/Case%20Studies/Clinicians%20Brief-trilostane.pdf

Current inital dosing recommendations from both Dechra (manufacturer of Vetoryl) and other sources are to begin with no more than a total daily dose of approx. 1 mg. per pound. So for Rex, this would translate into a dosing schedule of 30-40 mg. twice daily (Vetoryl comes in 10 mg. and 30 mg. capsules; compounded versions of trilostane can be ordered in any dosage strength).

When you have the chance, do look through this posted info and then check back with any questions, OK?

Marianne

[Debs]

I'm having a very had time deciding whether to treat or not. I could really use a conversation with anyone that has experience with a diabetic & cushings labrador. It doesn't look like the odds are very good that he'll feel any better, and he's going downhill very quickly, so I need to make some decisions. Is it better to treat the diabetes aggressively and let him get out and do the things he loves, hiking, walks, playing ball, swimming, or start Vetoryl and hope it doesn't kill him or make him sicker? Will he still just lay around feeling miserable? Am I jumping the gun on quality vs quantity? I realized last night that I never thought about this part of having a dog, somehow I figured death would just happen, never that it was something I may have to control. I'm so upset.

[labblab]

I can surely understand how upset you are feeling right now. There is nothing worse than watching our dogs in pain or in decline, and not knowing how best to help them!! If only they could talk...:o

Once again, though, I strongly encourage you to join our sister forum devoted to dogs with diabetes:

http://www.k9diabetes.com/forum/

You'll definitely have the chance to talk with other folks who are dealing with diabetes, and some who are dealing with both diabetes and Cushing's.

I am still really hoping that you'll tell us more about Rex's symptoms aside from the lethargy and difficulty controlling his glucose level. Is he acting abnormal in other ways that are consistent with Cushing's? I'm afraid it's hard to advise you without knowing more specifics about Rex's condition and behavior.

Marianne

[Debs]

Im so sorry, all of the information you wanted was in the post that didn't work. He has a voracious appetite, and is more persistent than he's ever been over food/treats. He drinks excessively but this is a symptom of both diseases, his fur was thinning on his tummy, but doesn't seem to be now, no skin issues, he does pant more, and he has worsening neuropathy in his hind end, but this is also a symptom of both diseases, especially when his BG is high (over 200).

Blood tests results out of norm:

11-14-11(diagnosis of diabetes)
ALP 192 (20-150)
TBIL .7 (.1-.6)
BUN 25 (7-25)
CA 11.8 (8.6-11.8)
GLU 548 (60-110)

11-21-11
ALP 254 (20-150)
ALT 251 (10-118)
BUN 27 (7-25)
GLU 323 (60-110)

11-18-11
ALP 164 (20-150)
BUN 27 (7-25)
GLU 549 (60-110)
TP 8.7 (5.4-8.2)

11-21-11
LDDS
1.5 ug/dl Baseline
1.2 ug/dl 4 hour post
1.7 ug/dl 8 hour post
ref range (1.0-4.0 ug/dl)

3-21-12
Fructose
343 (200-375)

Today his BG was 255 at 6am 330 at 10am. This weird trend of rising BG when it should be going down is why I suspected something else was going on. He just wants to stay in his crate or at my feet and sleep which is not his normal behavior. Hope this additional information helps. Also, does anyone have an idea how much an ultrasound costs? Is is worth getting one? Thanks! Deb

[k9diabetes]

Rex is an 11yr old yellow lab, 70lbs, diagnosed with diabetes in Nov. 2011, on 25 units of insulin 2xday, WD diabetic dry food, but his BG varies so much, for no reason.

Today BG
6:00am - 334
8:30am - 318
11:00am - 223
2:00pm - 197
6:00pm - 157

Definitely not a normal diabetic curve. He changes from acting like he's still 4 years old to not wanting to get out of his crate within hours. Any input is appreciated!

Hi Deb,

I'm the administrator of the Diabetes forum that other members have referred you to - www.k9diabetes.com (http://www.k9diabetes.com) and www.k9diabetes.com/forum (http://www.k9diabetes.com/forum).

With Rex weighing 70 pounds, 25 units of insulin per injection is a pretty typical amount for a dog his size so he is not resistant to insulin, one of the symptoms that comes with Cushing's disease. And his blood sugar comes down to very reasonable levels at least at times.

Those things make Cushing's unlikely.

There are many many things that can lead to erratic blood sugar - pretty much any other illness or inflammatiion or infection. And there are several conditions that can cause the hind leg weakness as well.

My gut instinct just from the little bit you have written is that there is something else entirely that's causing these problems for Rex and I would invest any time and money on a thorough checkup for him.

I think x-rays of the chest and abdomen and an abdominal ultrasound would be a very good next step. It also would be helpful to have an electocardiogram of his heart rhythm to check and see if there might be problems there. Not aiming to prove or disprove Cushing's but to look without any preformed ideas about what might be wrong.

He might benefit from being seen by an Internal Medicine Specialist as they are focused on more complicated cases like Rex's. That would probably be your best investment in terms of cost - to go straight to an IMS who can perform more advanced diagnostics.

I know how worried you are... have been there with an aging diabetic dog who had heart problems and eventually cancer. A very good veterinarian can help you put Rex's quality of life in perspective so you can make informed decisions... it's always very difficult and painful but demonstrates your love for Rex.

Natalie

[Debs]

Thanks for your input Natalie. I'm not sure that you saw the LDDS and ACTH test results on Rex. We know he's not insulin resistant, just that it's not working correctly.

(Meter corrected numbers)
Yesterday
6am - 255
10am - 329
3:40pm - 352
4:30pm - 259 (after a 1/4 mile walk)
6:00pm 288

This morning he was 353 at 6am

Our vet consulted with WSU and they both think we should try vetoryl.

I would so like to talk to someone that has had a labrador around the same age that has been through this so I have some idea what to expect.

Thanks for taking the time to weigh in!

[k9diabetes]

I just realized you have posted quite a bit of diabetes information at CSG.

The blood sugar numbers you posted there do not look anything at all like Cushing's disease. I wouldn't even consider a Cushing's diagnosis or treatment at the moment.

Instead I would go for x-rays and abdominal ultrasound to see what might be going on with Rex because my strong feeling is that there is something else bothering him.

Natalie

[Jenny & Judi in MN]

As an owner of a diabetic cushings dog who has been hanging out at both forums for almost a year now, I would listen hard to Natalie's gut instinct if I were in your shoes. I know you love your dog and he is your dog but I've seen her be right more often than not.

Plus Cushings is normally a pretty slow moving disease, if Rex even has it.

Hang in there and keep us updated. It is so hard to worry and hope you are doing the right thing. Judi

[nibbles-mommy]

My dog Nibbles was also diagnosed with cushings and diabetes. He was diagnosed with cushings first a few months prior to diabetes. I didn't treat him until the diabetes because the vet said it would be difficult to regulate his sugar with uncontrolled cushings. I was leery of the cushings diagnosis because he, like your baby didn't really present out-right symptoms. I treated with trilostane for 9 months. After the 9 months, his appetite was nonexistent, which we know is very important for diabetics and his hind area was really failing. I took him off the trilostane (vetoryl) and his appetite improved but not his legs. So obviously something other than cushings caused the weakness. The vet thought it to be disc issues, or spinal related. After stopping the trilo (vetoryl), his sugar was very regular and between 150-300 most of the time. I really wish I had gone with my gut and just treated the diabetes alone first since cushings is slow moving.

Good Luck!

[lulusmom]

Hi Deb.

I just reviewed your thread on CSG and I would have to agree with Natalie. The curves you posted between 4/6 and 4/13 are not typical of the numbers you would see for a diabetic dog with elevated cortisol. One thing that jumped out at me on the bloodwork done on 11/21/11 was that there was a marked increase in ALT from the prior bloodwork done three days before. Depending on what the ALT was on 11/18/11, the increase in just three days could have been more than twofold, which should have been a concern. We usually see moderate to severe elevations in ALP and very mild to no elevations in ALT so Rex's liver enzyme pattern is not what we see in a cushdog. Unfortunately, the LDDS was also done on 11/18 and as the glucose was also high on that day, I would be suspicious of a false positive result.

Has Rex had a more recent blood chemistry done? Do you know where Rex's bg was on the day your vet did the acth stim test? False positive acth stim test results are less likely than the LDDS in the face of non adrenal illness or stress, but it can still happen. If Rex does have cushing's, neither the LDDS or acth stim test tells us if it is adrenal or pituitary based disease. I would therefore second Natalie's suggestion that you have an abdominal ultrasound done to check the adrenal glands as well as check the surrounding organs for any signs of trouble.

Glynda

[Debs]

Thank you all so much for taking time to review all of the information. It's meant a lot to me to have such a wonderful group of caring supporters who know how much my fur child (only child) means to me.

Rex will be having an ultrasound tomorrow. I agree that this was the most appropriate move forward and hopefully it will shed more light on the best direction for his care. I will post again when I know more. Deb

[Debs]

I don't have an official report yet, but the sonogram didn't find anything. Rex's adrenal glands were a "different" shape, but not noticeably enlarged, although they want to measure, and strangely his liver wasn't enlarged, even with the diabetes. I'll wait for the report, but at this time have decided not to proceed with treatment for cushings. We'll up his insulin and keep monitoring. I will update as things progress. Thanks so much, the support, input, understanding and compassion from this group is amazing! It's definitely made everything easier for me! Hugs, Deb