Confused about controlloing Toy Poodle Diabities

[zachariah]

For a long time we have struggled to control our toy poodles diabities. He is a 15 year old toy, weight 4.65 kg. Currently on LANTUS insulin using 3.25 IU twice a day. At almost totally random times his blood sugar levels will change drastically without warning either moving up or down. This will last for 12 to 48 hours and then go back to a normal controlled state. We have tried different insulin, dirt, shot locations, and tests. Nothing seemed to give us a steady controlled state. After much work with the vet and testing we have determined that his adrenal gland is enlarged, 25% larger than it should be. We suspect the gland is putting erratic level of adreniline out and this is what is making his blood sugar levels so erratic. The question is proving and what to do about it if we can. I was on the K9diabities forum and they sugggested this might be the place to ask about this issue. Anyone have some thoughts?

Thanks,

Zachariah

[lulusmom]

Hi Zachariah and welcome to you and Bailey.

Before we can provide you with meaningful feedback, we'll need more information so let me start the questions and see if we can't put the pieces of the puzzle together.

You mentioned that an enlarged adrenal was observed on imaging. Do you know if the other adrenal gland was normal? Were other tests done, such as bloodwork and/or urinalysis? If so, can you please get copies and post the results here? With respect to the bloodwork, we need only the abnormal values and please include the normal reference ranges. Cushing's and diabetes symptoms overlap so it's very difficult to figure out which condition is responsible. Is Bailey showing any symptoms like voracious appetite, hair loss or thinning, skin issues, panting or excessive drinking and peeing?

Dogs diagnosed with adrenal dependent cushing's have a functional adrenal tumor that randomly secretes excess amounts of cortisol. as well as any number of other adrenal hormones. If the adrenal glands are hypersecreting adrenaline, I would suspect that if Bailey has a tumor, it is a pheochromocytoma. Because secretion is so random, symptoms come and go. One of our admins, Kim, has first hand experience with this type of tumor and I'm sure she'll be by to ask questions and share her knowledge.

For those who would like to read Z's thread on k9diabetes, I've included the URL below.

http://www.k9diabetes.com/forum/showthread.php?t=3717

I'm sorry for the circumstances that brought you here but I'm glad the folks over at k9diabetes sent you to us. We'll do whatever we can to help you and Bailey figure things out and the more information you can give us, the better.

Glynda

[frijole]

Zacharia, Welcome from me! Like Glynda said I had a dog with an adrenal tumor called a pheochromocytoma. It is very rare but because you mentioned sporadic spikes it caught my attention like it did Glynda's. If there is a pheo involved there is high blood pressure during the episodes. Also there is obviously a tumor. So - can you look at the report from the ultrasound and tell if there was a tumor on one of the adrenal glands? When the spiking is occuring does your dog pant heavily, have all body shaking, feel warm/feverish (one or all of these)?

Hang in there - you answer questions and we'll ask more until we figure it out. ;):D Kim

[zachariah]

Thanks for the response. I will give you a better idea of case history and request further details from the vet. The enlarge adrenal was spotted yesterday and both blood and urine were taken then. I will request he provide me with the results after he get's them. We had not considered cushings before and during research I ran across the Urine Cortisol/Creatinine Ratio Test as a screen. Since they had a fresh sterile urine sample I asked him to get the screen run as well as a first step to see if it should be pursed further. Once he gets results and passes them to us I'll put up what I can.
In 2007 Bailey started having pancritis attacks. Over 2 years he had several with almost all of them involving eating something he shouldn't. In the third yeard he started urinating badely and became lethargic and very thirsty. The vet's diagnosed diabities based on symptoms and blood sugar reading in late 2009. Since then it's been a problem controlling the blood sugar. His weight has slow decreased from 5.1 kg to 4.65 kg.
From there he has shown increasing signs of weakness in his rear legs by having trouble jumping up on the couch. I built dog steps for him to get up but his weakness grew and now he cannot even use the steps. His incontence has also increased. He has also started sleeping a lot as well. At least up to 14 to 18 hours a day.
Part of this is age related. We say his age is 15 but there is a three year span it could be. HE was adopted from a rescue group and they told us he was 3 years old. A vet said his teeth and other indications showed he was 6 years old. This was in 2001. His actualy date of birth is unknown. When Bailey was rescued he was sent to another state to protect and hide him. His records from them showed a 3 month hospital stay to recover from the abuse that lead to his rescue. We never tried to back trace him after we saw that.
So 15 is the assumed age. The age is a factor as he is senile and has walked into the pool a few times so we have fenced in the area around his doggie door. There is possible brain damage as well in that he is doing excessive circling. HYe will walk in very small circles, always to his right whenever he stands up. Anywhere from 10 to 100 times before laying back down of wandering elsewhere in the house.
Don't know if that helped but there it is. When I get test results I'll post them. Thanks again for the response.

[lulusmom]

Hi Zachariah,

Thank you for providing more information on your precious Bailey. It sounds like he had a really tough life before finding love with you. Bless you for rescuing him.

I'll look forward to seeing test results and in the meantime I do want to mention that results of a UC:CR done in vets office is probably not going to be reliable because the leasts amount of stress will cause transient excess cortisol, resulting in possible false positive result. Urine specimens for this test should be a free catch at home, preferrably the first pee of the day and before meds and meal. I also want to mention that it's quite possible that Bailey has an expanding pituitary macroadenoma that is causing the extreme lethargy, inability to walk, disorientation and circling to the right. Has your vet discussed the possibility with you? How is Bailey's appetite?

http://www.compendiumvet.com/Media/PublicationsArticle/PV_30_01_33.pdf

Glynda

[zachariah]

His appetite is very good but he is on a restricted diet. He gets 1/2 a can of Hills WD morning and evening just before his insulin shot. We make sure he eats before giving the shot. He has a habit of eating anything he can get or find though. Strangly enough he has a taste for watermelon and has sneaked up and stolen pieces from my wife's plate. So it has been a real battle to keep him away from extra food and other things that mess up is blood sugar levels. He is very smart and sneaky. This summer we caught him getting out into the yard to nibble at fallen fruit from a few of the trees. He found a way to open the bottom of the screen door just enough for him to squeeze through, get the fruit, and then sneak back into the porch. When his mind isn't wandering due to age he is very smart. His doggie door leads to a fenced area that does not include the fruit trees.
The vet does suspect something is wrong in his brain but we have not been able to determine what. Getting an MRI done requires ansteseia for an extended period. We've decided the risk to him is too great and anything we could find out from it we could not do anything about. So why take the chance.

[zachariah]

The vet contacted us about the blood work on Bailey. He will not give me the actualy values of the results but was quiet happy to discuss the implications. By what he said his liver enzymes are slightly elavated but not significantly. His kidney is fine. The urinanalysis shows no infections or other problems. The only unusualy result was high phosphous levels but not high calcium levels.
We then went on to discuss cushings as a possibility. HE says it is unlikely as Bailey does exhibit some of the symptoms but none of the most common symptoms. The tests and results give no clear indications that do indicate cushing either. So he really does not want to follow that line right away.
The mosly likely cause of the high phospous is a possible tumor. I suspect this is because he does exhibit signs of damage to is nervous system. Basically continoious circling to the right and he fails reaction tests to check responses on is right side.
A big point is that due to Baileys age the best diagnostic tool, an MRI, is very risky for him. They would need to sedate him for a 6 to 8 hour period to get the MRI done. Around here none of the vets have an MRI and use the ones in the human hospitals when schedules allow. Given Bailey is 15 going on 16 that long sedated is very risky. So we and the vet agree it is not a good thing to do without a lot more reason than we have.
I did ask about the enlarged andrenal glands and their impact on the blood sugar level but he does not think they are a major problem. He refers to them as only slightly enlarged. Not too sure how to take that comment as previously he stated they were enlarged and that was why he wanted further tests.
So we are back to square one again. We love the little guy but this is driving us crazy trying to figure it out. Thanks All.