Newly diagnosed diabetes & cushings HELP!!!

[Yoyobear81]

Hello, my name is Gayle and my baby is Tyler (Westie was 19lbs, now 13) Diagnosed with cushings September 2011....we did not initially treat due to high costs and the fact he did not show any symptoms apart from increased drinking and urination (vet agreed side effects could be worse than the disease and as he was eating and playing as normal, would be ok in the meantime) fast forward to 2013.....he had developed a slight pot belly during 2012 which dissappeared....drinking and urination increased A LOT (we ended up having a water dish in our bedroom and he would then potty on pee pads in his crate- I am lazy lol) He started losing weight...quickly, we took him in for bloodwork last week (think my hubby and I were in denial) now 13lbs and positive diagnosis for diabetes. Phew. He was hospitalized on Wednesday morning and we are going in first thing tomorrow to meet with the vet. We knew the cushings would make it difficult to regulate the diabetes but they now have him up to 13units of insulin and #'s are still in the 6/700's. Now it looks like we are going to have to talk about trilostane. My husband has a bad taste in his mouth about treating the cushings as the costs my vet told us back in 2011 were crazy (thousands of dollars which btw we unfortunately do not have) I am a member of the K9diabetes forum and was directed here when i posted his latest update. I have seen lots of posts describing freezing cortrosyn to save money and also using compounded trilostane. What am I looking at money wise by doing this? Do we have to do the ACTH tests if we start him on a very low dose and moniter how the insulin is accepted? Feel like we are over a barrel now as we have already spent $1200 (which we dont have) just to get to this point....my head is spinning....been an emotional wreck all week trying to get my head round money/insulin/cortisol and the fact that I might lose my baby :( Any help would br greatly appreciated...like I said, seeing the vet 1st thing in the am and want to make sure I know all the questions I need to ask and am as clued up as I possibly can be. Most important, would love some info on prices so I can get a general idea of what we're looking at....sorry for the novel, I'm a mess right now :( Thanks again

[Concernedmom]

Hi Gayle
Wanted to say welcome to the site. So sorry to hear about Tyler. You have definitely come to the right place for information. There are so many people that know a lot about cushings and the treatment. I can tell you what I paid for Trilostane when I was buying it. We would buy 30 mg tablets and it cost me $55. My pup was taking 1 pill a day. My first diagnostic ACTH test cost me $171 for the cortrosyn and $99 for the lab test and every Acth test thereafter was $99 just for the lab test because the cortrosyn was frozen 3 more times. I got a total of four (4) test from my vet. You also need to do electrolyte tests along with ACTH tests but I can't remember what I paid. I hope this helps. At least it gives you an idea of what some of the costs will look like but every vet charges different prices for lab work and medication. I'm sure the rest of the gang will be on to welcome you and give more detailed information as they are more knowledgable with cushings. Take care and try to hang on

[Yoyobear81]

Thanks for the quick reply :) Can I ask u how long a pack of tablets would last you? Was this the compounded or was this from the vet?

[doxiesrock912]

Yoyobear,

I'm not sure where you're from but Beacon Pharmacy compounded 90 20mg tablets at a total cost of $105.

[Yoyobear81]

I'm in Orlando, FL :) Thanks for the info :)

[Harley PoMMom]

Hi Gayle,

Welcome to you and Tyler from me as well. So sorry for the reasons that brought you to us but glad you found your way here.

I am providing some links that may answer a few of your questions and I hope they will help.

About compounding pharmacies: http://www.k9cushings.com/forum/showthread.php?t=385&highlight=compounding+pharmacies

Money saving tip on diluting/freezing cortrosyn: http://www.k9cushings.com/forum/showpost.php?p=69247&postcount=61

This next post is from one of our Administrators, Marianne, to another member which she provides details about using a pre ACTH stim for monitoring:
Sharon, changing the subject ;), we staffers have been wracking our brains trying to think of ways to help you with Norman's treatment cost. One suggestion we've thought about is the possibility of sometimes performing baseline cortisol readings instead of full ACTH stimulation tests to assess the appropriateness of Norman's trilostane dosing. Baseline cortisols still require a blood draw and analysis, but you are spared the cost of the stimulating agent. I do not want to give you false hope that you will be able to totally discontinue ACTH testing. But you may be able to reduce the number of ACTH tests that are needed.

In the desire to ease the cost/demands of trilostane monitoring, Dr. Audrey Cook at Texas A & M University has been designing research to explore whether baseline cortisols, on their own, can reliably predict safe and appropriate trilostane treatment control. Her results are only preliminary, and she cautions that more research needs to be done. But her initial results suggest that as long as a dog's baseline cortisol falls within a specific optimal range and the dog is doing well clinically, a vet may be able to assume that the trilostane dose being given is safe and effective.

However (and this is a BIG "however"), she recommends that any dog with a baseline reading that falls outside a specific optimal range should still proceed to a complete ACTH stim test before making dosing changes. The ACTH would also be recommended any time a dog is not doing well clinically. Here's a link to the complete study:

http://www.2ndchance.info/cushings-monitorcortisollevel.pdf

Baseline cortisol monitoring may not be a good option for Norman right now since his clinical signs are still not under control and he is still so new to treatment. But a bit further down the road, baseline cortisol monitoring may give you some relief from ongoing ACTH costs. You may want to tell your vet about this study, and your vet may even wish to contact Dr. Cook directly to see whether there have been any recent updates to this research. After hearing about your specific situation, Dr. Cook might be able to give your vet some monitoring suggestions.

I know how anxious you are to see improvement with Norman. But I do encourage you to try to be patient and give him at least a couple more weeks to stabilize on this current dose of trilostane. At that point (and after maybe talking to Dr. Cook), your vet may feel that a baseline cortisol reading can be helpful in assessing how well he's doing on that dose. But I think he needs to have some time to adjust before you consider yet another dosing change. Even if this current dose is still too low, you won't know how much of an increase is appropriate until you can judge the maximal effect of the dose he's already taking. Does that make sense? I hope so! :o

Marianne

I am happy that you have joined our K9diabetes sister site, the wonderful and knowledgeable people there will definitely be able to help with Tyler's diabetes.

I was wondering if you could get copies of all tests that were done on Tyler and post any abnormalities that are listed. We will be especially interested in the test/s that were performed to confirm the Cushing's diagnosis.

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

Love and hugs,
Lori

[Simba's Mom]

Welcome to Tyler and you, cute name and dog! This is a great place for info and encouragement, hang on this ride has ups and downs but we are here for you!!!

[Yoyobear81]

Thanks so much Lori! Some great stuff here :)

[goldengirl88]

Hi Gayle:
Just wanted to stop by and say hello to you and Tyler. Hope you figure things out, and that Tyler does well. God Bless you both.

[molly muffin]

Hello and welcome to the forum.

How as Tyler this morning? What happened with the vet visit? I'm so glad you found us an our sister site k9diabetes. Wonderful people over there too. We'll all try to help as much as we can. Lori and the others have got you off to a good start.

I hope things were looking better this morning and BG was better.

Sharlene and Molly Muffin

[Wally P's Mom]

Hello and Welcome to the Group:

My doxie, Fritz was diagnosed with diabetes on 11/30/12 and in January of this year, cushings.

This is my first go around with both conditions. You are not alone. The initial costs are high, but for Fritz, his scripts are spread out and some of the meds get filled monthly and others once every three months.

For some advice on costs savings, call the chain pharmacies in your area and shop around. There are some chains that offer discount cards if you don't have insurance. Also, just read the motor club magazine and believe it or not there was an article that mentioned some lady that used the motor clubs drug discount on her dog.

For us, we use a discount card at a chain pharmacy just because of location.

I found a mail order service for his test strips that costwise compares to what I pay for my husband's and he has insurance.

It is a huge think to wrap your head around, but with patience and prayer, you can do this.

Marge

[Yoyobear81]

Hi guys sorry I haven't been back for a few days, we got him home on monday and his blood glucose has been going down alot....was 55 this morning so I am actually now decreasing his insulin.....gave him 13u just now and he was on 15u a few days ago. I ordered the trilostane but wondering know if we should hold off starting him on that as we only got it because his bg wouldn't budge.....any thoughts on this? Thanks guys! Also, he's got a lot more energy and his drinking and urination has decreased immensely :)

[frijole]

THere's no rush to treat cushings - I'd let the change in insulin take hold and get him stable before trying anything new. If you introduce a new med now you won't know for sure if it's the diabetes or the new med. My two cents, Kim

[Yoyobear81]

Thanks Kim, yeah that sounds right......definitely don't want to complicate things further.