Cushings and Diabetes (12 y/o Rat Terrier) - Trilostane

[FatFred]

My 12 yr old Rat Terrier, Fred, has been taking Vetoryl for 4 years with good results. Today he was at the vet because I thought perhaps the dose needed tweaking. It turned out he's diabetic and I had to start injecting insulin tonight. My question is has anyone else had this experience? None of the vets have ever had this occur with a patient so they called the Vet School for advice. Even there the information seems limited. The questions are is there any contraindication with use of insulin and Vetoryl. And, has Cushings caused diabetes in other dogs.
Thank you for reading. Nancy

[mytil]

Hi Nancy and Fred --- and welcome to our site.

Great job with your pup - 4 years and going :)

We have many here with this combination and I am sure they will pop in shortly. I do not have any direct experience with these two, but some think this is a connection between the two in some dogs (sorry to sound vague).

In the meantime here is a great site for diabetes - http://www.k9diabetes.com/forum/ (our sister site).

How much Trilo are you currently giving (and the tweaked amount as well).

Keep us posted
Terry

[FatFred]

Hi Terry,
Thanks for the reply and the link - I will definitely check that out. He is currently on 60 mg e/o day. Originally it was every day and eventually stabilized enough to cut back. I don't have the results of yesterday's stim test yet so the dose hasn't changed. I carried him in because of a significant increase in urination, thus the stim test. The vet noticed his little "part" seemed irritated so tested for UTI which was negative and led to the glucose test.
So here we are - I know nothing about diabetes and got a crash course last night in giving injections. I can do it but I'm not going to like it - and neither is Fred. It's a good thing love concurs all.
Nancy

[Jenny & Judi in MN]

Hi Fred: My Jenny also has both Cushings & Diabetes. We used Lysodren but I second the invitation to come on over to the diabetes forum, lots of help over there!

There are many people who have noticed their dogs became diabetic after taking prednisone but I've never heard of a correlation between Cushings causing diabetes.

The cortisol levels can definitely affect how much insulin is needed though. My 7 pound poodle has needed anywhere from 7 units per shot to 1 unit per shot depending on where we were at with her Cushings maintenance.

The diabetes is very manageable, and if you can home test blood sugar much less costly to handle with maintenance also.

Judi

[Jenny & Judi in MN]

Nancy: somewhere on this site is an article where they recommend going to twice daily dosing with the Trilo vs. once since the insulin and feeding will be twice a day now too. Let me see if I can find it but it is something you may want to talk over with your vet.

My Jenny got overdosed with Lysodren and is now on prednisone cause her cortisol is low. Her blood sugar is much more stable with small doses at every meal.

If you warm the insulin in the syringe between your fingers it can help make the shot less uncomfortable. Also, what size needle are you using? the vets give huge ones sometimes and for smaller dogs, the smaller needle seems to work better. We get one that only goes up to 30 units and has half unit markers on it at Wal Mart. Walmart also has the NPH insulin for $25 per bottle.

edited: page 7 of the vetsulin article about diabetes & cushings talks about twice a day dosing to keep the insulin level

http://www.vetsulin.com/PDF/20585.pdf

[FatFred]

Hi Judy, your information has already been helpful. Fred has cried out with both shots today but I didn't know to warn it in my fingers. I'll be trying that in the morning. I have a lot of reading and learning to do and will definitely visit the diabetes forum.

My needles are super fine 29 gauge for 30 units or less. The med is Novolin 3 units every 12 hours. We are going back to the vet next week for a glucose curve to see if this dose needs to be adjusted. She said they will teach me to test at home when they get him stabilized. This has been a lot to absorb and everything I read is more scary. But we eventually learned to deal with Cushings and we can do this too. Thanks so much for the support.
Nancy

[frijole]

Love the photo of Fat Fred at work :D

Just letting you know my mom's dog has diabetes and if I can give shots you can too. :p:p:p

My aunt is a nurse and her dog has diabetes and she taught us about rubbing the syringe between your fingers to warm it up. She said she switches up the locations she gives the shots in (left side then right side) and after giving the shot she rubs the area (like a quick massage) - don't know why but the dogs seem to like it.

Diabetic dogs are harder to keep regulated (cushings) so like Judi suggested you might need to tweek your dosing. Hopefully your vet has worked with this combination before.

Good luck! Kim

[lulusmom]

Hi Nancy

When was the last time Fred had an acth stimulation test and can you please post the results of that test? The goal of treatment is to stabilize the dog on an effective dose and once that dose is established, the dog stays on that dose for life or until symptoms and an acth stimulation test dictate otherwise. Vetoryl has a short half life and it's enzyme blocking abilities start to wear off after 8 hours so some dogs have to switch to twice daily dosing in order to see complete resolution of symptoms. Therefore adequate control with every other day dosing would be questionable, unless appropriate testing was done to confirm.

One of the functions of cortisol is to regulate blood sugar and if a dog with cushing's is not well controlled, continued high blood glucose can cause diabetes that can be permanent or secondary to cushing's. If it is secondary to cushing's, getting the dog's cortisol regulated quickly may eliminate the need for insulin completely or in the case of permanent diabetes, will eliminate problems with insulin resistance. I'm not saying high cortisol is what caused Fred's diabetes but it should have been ruled out by your vet.

It would help us greatly if you could explain the circumstances leading up to cutting Fred's dosing back to every other day and how your vet determined if that dosing regimen was effective in maintaining cortisol at therapeutic levels throughout every 24 hour period.

Sorry for all the questions but the more we know about Fred, the better able we'll be to provide more meaningful feedback. I'll be looking forward to seeing the results of your boy's last acth stim test.

Glynda

[GabbySue]

I only want to add one thing with giving the insulin injection,

DO NOT RUB THE SITE!!!! I am a nurse too and this is a big No No...

Warming the syringe between your fingers first will help, the other is to tap gently on the skin in the area first where you are giving the injection, this causes the muscles to relax and not tense which will also help lessen the pain. I give these shots about million times a day(it seems that way) as more than 1/3 of my patients are diabetics.

Also once opened the insulin vials do not need to be kept refrigerated, no matter if they are or aren't they are only good for 28 days. We only keep the unopened vials in the fridge.

Hope this helps,

Tiffany

[FatFred]

I think one difference in giving shots to dogs vs people is dogs wiggle a lot. I've given 9 shots so far and don't have a set technique yet. I watched the videos in the diabetes forum and those dogs sit so still! I think it's a pretty sure bet I haven't hit the same spot twice.

Regarding the Cushings - I don't have the lab values from the stim tests. I know many of you have that information but I've never asked for it. Fred was diagnosed in 2008 and it took over a year of frequent testing to find a dose that both controlled the Cushings and that he could tolerate. That's how we arrived at the 60mg e/o day. The most recent test was done last Thursday and they called over the weekend to say the results were fine. Until a few weeks ago he was asymptomatic so when he started urinating excessively I carried him in for a stim test. And that led to the diagnosis of diabetes.

I have an appointment Thursday for the glucose curve and I'm going to ask questions about some of the things I've read here.
Thanks again for the help. My husband is appreciative too - he's been reading the responses.

[molly muffin]

Wow, congratulations on being able to get through this since 2008! I'm am heartily impressed and hopeful.

I'm sure you will be getting plenty of replies from others who have gone through the cushings and diabetes jointly.

I am not one of those knowledgeable enough on that though, so I'll welcome you to the forum and tell you this is a wonderful place, full of really supportive people who have all been there, done that.

Hugs and belly rubs for Fred

Sharlene and Molly muffin

[FatFred]

Hi Sharlene, I see Molly muffin was just diagnosed. The first year was a big learning curve for me and also expensive! I think Fred went undiagnosed for quite a while. We got teased a lot because he was so fat and the vet was always suggesting I was overfeeding him. Then we moved and the new vet diagnosed him on the first visit and it was confirmed by the stim test. His hair was falling out, he panted with every breath, needed to go out about every 30 minutes - in addition to looking like a football. Most of those issues decreased over time until this diabetes thing popped up. My point with all of this is I guess little dogs are tough and he's a happy boy. I hope you haven't had to go through all of that with Molly muffin. Nancy

[lulusmom]

Hi Nancy,

I realize you don't have copies of the last acth stimulation test but if you would please call your vet's office with pen and paper in hand, they should be happy to give you the pre and post numbers. It's only two numbers but they are the most important numbers you can post for us right now. I've lost count of the number of times a member posted that their vet said the acth stim test was fine or normal but once they posted the actual numbers, they were not fine nor normal for a cushdog. While waiting for the results from you, can you confirm that the acth stimulation test was done within 4 to 6 hours after Fred's dose of trilostane, given with a meal?

I apologize for being persistent but I think it's very rare that a cushdog with well controlled cortisol is diagnosed with diabetes two years down the road. That coupled with the fact that Fred is on a very unorthodox treatment regimen of every other day dosing, it's difficult to dismiss high cortisol as the causative factor for the diabetes.

Glynda

[molly muffin]

Hi Nancy,

Well, I can say it is definitely expensive and we're only a few months into the journey. We'll survive though and now I know why I'm working. Molly has that belly alright, we thought it was a love of treats and the fact that everyone wants to rub it, which she loves, didn't make us think it was anything indicating a problem.
We aren't going through too many symptoms yet. The IMS thinks that would come with more time.
Oh gee, Glynda is right, those results make all the difference, the actual numbers I mean. Not that I understood them so much, but others on here sure do.
I agree, those little ones are just resilient.
:)

Hugs,
Sharlene and Molly muffin