New member (diabetes and Cushing's) Trilostane

[TimTam]

Hi all, my 9 yo airdale cross (a guess) Shaggy has been diagnosed with Cushings. Its been a terrible rollercoaster ride. It all started with a clip, my groomer (has been sacked) managed to tear off one of his dew claws 2 days before Christmas. It never healed so he had to have it removed in January, as well as a strange growth on his face. He never really recovered from that. In May he started drinking heaps & finally had little accidents, which he had never done. He was lethargic too. The vet did blood tests, & he was hospitalised immediately - diabetes pancreatitis & suspected Cushings disease. Since then, he has been on insulin twice a day, antibiotics for the pancreatitis & a "hotspot" on his leg. We stabilised his diabetes, then he had another day in hospital for the Cushings test, which came back positive, but it was very hard cos his glucose went high, it had been very low til then. Ive had to increase his insulin, since starting Trilostane 45 mg last Friday for the Cushings. He is ok, but still lethargic, but improving with an increase in insulin. Ive been told that his diabetes will go with the Cushings treatment. Im not so sure. Apart from the heart ache of all this, its killing me to see him like this, a gentle soul who is getting fed up with all the needles, blood tests & poking. Our family decided that if we had to treat him for both, we just couldnt do it. The diabetes is a terrible tiedown & stressful, I have spent 5 weeks just crying every day for him. Im hoping & praying that the diabetes will go away. We can stretch the budget for the cushings treatment but not both. I actually asked vet on Saturday, after another rush trip as his glucose was too high, "am I doing the right thing here? Am I doing this for me or him?" She assured me it will be better, its just overwhelming now. Every article Ive read on Cushings, does not cover a diabetic Cushings dog, & what the long term prognosis is for them. Should I just put him out of his misery? I dont want to be one of those people who keep a dog alive in misery, just because it makes me feel bad. I love him to pieces, but this is really upsetting me. Ive probably all ready spent over 2 grand on him, should I keep going? I need help.

[Harley PoMMom]

Hi and welcome to you and Shaggy,

So sorry for the reasons that brought you here but sure glad you found us.

I was wondering if you could do us a favor and check your emailbox (or spam folder) for a communication from us. Once you respond to that email, your membership will be finalized, and anything that you post will become visible on the the forum immediately. Until that time, your replies must be manually "approved" by a staff member before they are visible to the public -- so there may be a bit of delay between the time that you write your replies and the time that you actually see them...Thanks!

A Cushing's diagnosis is very hard to confirm and then when non-adrenal illnesses are present, it can be a nightmare. Any kind of non-adrenal illness such as diabetes and/or pancreatitis can create false positives on all tests for Cushing's Disease.

We have a sister diabetes form and I really do suggest you join there also, the kind and friendly people there will help you with the diabetes...here's a link: http://www.k9diabetes.com/forum/index.php

It would be a great help to us if you could get copies of all tests that were done on Shaggy and post any abnormalities listed, here. This will enable us to provide you with better feedback, ok?

If Shaggy's diabetes was easily controlled before starting the Trilostane, then IMO a diagnosis of Cushing's is unlikely. Has there been any more episodes of pancreatitis and how was the pancreatitis confirmed?

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[mytil]

Hi and welcome from me too.

I have approved your membership so there is no need for you to do anything more. I have also renamed your title to indicated both cushing's and diabetes.

I am so very sorry you and your pup are going through this and we are all here to support you. Lori gave you a great site about diabetes. I do not have direct experience with both, but many here have and I know they will be chiming in shortly.

When you get the chance, please post the results of the tests that confirmed the cushing's.

Terry

[nibbles-mommy]

hi, my nibbles had diabetes and cushings. he was 15 yo at diagnosis. like it has already been mentioned, it's very difficult to diagnose cushings and when diabetes is involved it's best to wait until the diabetes is better controled then test for cushings because of the false positives. suchings is also a slowly progressivee disease so there isn't a rush to treat right now.

i'm a member at the site posted below, k9diabetes forum. the cushings treatment is alotmore expensive than diabetes. depending on where you live in the world and if shaggy is on humulin-n, you can get the insulin for $25 at walmart under their relion brand and also the syringes for around $12 for 100. if you're you're willing home test his blood sugar you could get a cheap meter at walmart and the test strips are cheap there also. testing at home would save money on the curves done at the vet because you could do that at home.

the type of diabetes dogs get doesn't normally go away. but it is very manageable.and your dog can live a long healthy happy life.

pop over to the k9diabetes forum when you get a chance. there are terrific, knowledgeable people over there just like here.

i am a little concerned with the increase of insulin when starting the vetoryl.. the reason the blood sugar would be higher and erratic with cushings is because of the high cortisol. but the cortisol should be lowering with the meds, hence less insulin.

[Jenny & Judi in MN]

Hi & Welcome. My Jenny has cushings and diabetes also and I can tell you that they can get to a point where you have your perky fun dog back!

I've never had to deal with pancreatitis with a dog but I've heard it takes a lot out of a dog. I think this may be playing into it.

Cost of diabetes:

1. Are you using NPH insulin? Walmart sells the exact same stuff under the name Humulin for $25 per bottle. Syringes are also cheaper at Walmart

2. Curves. You can test your dog's blood sugar yourself, give the vet the results and save $100 or so instead of having to leave the dog at the vet for this. are you on our K9diabetes.com forum?

For me, the diabetes has not been as expensive as the cushings. But they are both very very overwhelming.

Please try to hang in there. If your dog is lethargic I wonder if the blood sugar is too low or high. Do you have results of any curves done at the vet?

hugs, Judi

[TimTam]

Thank you for your replys & words of encouragement. Im in Australia, so no Walmart. Ive requested the copies of all the tests done, so I can give you more info. Half the time I have no idea what theyre talking about re tests results, so it IS very overwhelming, but Im trying hard to educate myself. At the moment, Shaggys glucose reading is extremely high, so his insulin has been increased again to 5 iu, he was on 3 iu. The vet seemed to think the Cushings had been triggering a false low reading? he had been stable, thats why they pushed for the Cushings test. The test was no insulin in the morning, & then he was given a dose of cortisone? Due to the lack of insulin, his glucose spiked again. Its slowly lowering. Shaggy is holding his own, can still jump on couch & bed, but hair is falling out in clumps, & his skin is very itchy. I do the glucose testing at home (chasing him round with a kidney dish) so thats really not an issue, if Im worried, I take a sample to vets for proper testing. But Ive got to the stage where I can tell by his symptoms whether he is peaking or dropping glucose. The reason why the vest suspected Cushings diabetes originally was due to his swollen belly, excessive drinking & "accidents" & his liver enzyme tests, over periods of 3 weeks was incredibly high. If I remember correctly it was 1600. Anyway, thanks again, Im calmer again today, & I will have a look at the diabetes site, though Ive done alot of reading on diabetes. Even the vet says though, a Cushings / Diabetic dog is extremely hard to stabilise. The Pancreatitis hasnt been mentioned since 1st diagnosed. Too many other problems. he was given a drip antibiotic overnight to flush the toxins out, then the antibiotics but since then, havent thought about it. I will ask that question as well tomorrow. Thanks again, I feel like a have more direction now.

[Harley PoMMom]

The reason why the vest suspected Cushings diabetes originally was due to his swollen belly, excessive drinking & "accidents" & his liver enzyme tests, over periods of 3 weeks was incredibly high.

Shaggy's clinical symptoms, such as his pot-belly, excessive drinking/urinating and elevated liver enzymes, can be associated to just diabetes. Here is a link to Dr. Mark Peterson's blog about this. Dr. Peterson is a world-renowned specialist in endocrinology of the dog and cat. Q & A: Diagnosing Cushing's Disease in Dogs with Diabetes Mellitus (http://endocrinevet.blogspot.com/2012/01/q-diagnosing-cushings-disease-in-dogs.html)

Getting copies of Shaggy's test results and posting them here will be really helpful to us in providing more meaningful feedback.

Please remember you are not alone on this journey as we will be walking every step with you.

Love and hugs,
Lori

[k9diabetes]

Hi and welcome to you, both here and at K9D - I approved your registration there last night.

From what you have described so far, I question the Cushing's diagnosis more than the diabetes diagnosis. It is extremely difficult to accurately evaluate Cushing's disease in a newly diagnosed diabetic and especially one with pancreatitis as well. The tests can be thrown off by those other health problems.

And diabetes has the potential to be fatal if not treated properly while Cushing's disease does damage only over a long term of no treatment. So it is best to tackle the diabetes first and worry about Cushing's disease later. How Shaggy's diabetes responds to insulin can help tell you whether he actually has Cushing's disease or not.

I've been involved with forums for dogs with diabetes and Cushing's for eight years and I don't recall ever seeing a dog whose diabetes went away after Cushing's treatment. And never have I seen that happen when the blood sugar goes very high, as it sounds like Shaggy's has. Diabetes that is coming strictly from Cushing's disease would tend, I think, to show only moderate increases in blood sugar.

So if you have to choose one to treat for now, it must be the diabetes. Which is much less expensive to monitor since you can check blood sugar at home.

It is typical for a diabetic dog's blood sugar to go sky high after a Cushing's test. The test stimulates the release of cortisol - Cushing's is too much cortisol - and there is a nearly direct link between cortisol levels and blood sugar levels. Our dog, when tested for Cushing's, had significantly higher blood sugar for a full 48 hours after a stim test.

There are lots of other things going on with Shaggy that could be affecting his blood sugar....

Inflammation - from pancreatitis - raises blood sugar.

Some antibiotics raise blood sugar.

He could also have previously had some remaining insulin producing ability that is now gone, so would require more insulin. That period where they still have some insulin-producing ability is called "honeymooning" and can last quite a while but basically always ends in dogs because after some time all of the cells that produce insulin fail.

http://www.k9diabetes.com/dogdiabeteshoneymoon.html

The main website has lots of information, plus there is a page of links to additional information: www.k9diabetes.com (http://www.k9diabetes.com).

Please do join us at the diabetes forum too and we can help you sort out what's happening with Shaggy's blood sugar and how likely a Cushing's diagnosis seems to be.

Natalie