Autumn, Cushings and/or Diabetes

[Autumn]

Hello
I just signed on to K9 Diabetes Forum and was kindly referred here with my questions. This is long but I sincerely appreciate any input/advice. I will be discussing this in more detail with my vet tomorrow. Thank you in advance!

My dog is going to be 6 years old next month. When she was 4 years old, I had taken her to a vet for regular check up, who looked at her and said oh maybe a Cushing dog..... without any testings at all. She is a Dachshund mix, medium size dog but has that Dachshund round appearance but she is not pot bellied as pictures on line show of Cushing dogs. Our dog was also very over weight at this time. I finally found the vet we go to now and we have been very happy here. At that time, he said no cushings.

In January, she started drinking water excessively and going out at night to relieve herself. I took her to the vet and they diagnosed Diabetes. She is now 29 pounds and currently on 12 units of Vetsulin 2xs a day. She has been hard to regulate.

Since she has been treated for diabetes, we see a marked difference in her. She is a rescue dog and has always been very nervous. Now she seems happier and is no long over weight. She is a mellow dog, sleeps a lot but comes running whenever I say time for walk Walks with a bounce in her step.

She recently was tested for Cushings due to being resistant to insulin. I do know, her last blood sugar number when checked was 255, this was 4 hours after injection and breakfast. How do I get information as to how many units of Vetsulin for 30 pounds is considered resistant?

She was there all day for the ACTH Stimulation. I made a mistake....She had the dexamethasone suppression test. The Dr.called and confirmed Cushings.

The Dr. said, the Cushings is what has led to her having Diabetes.

She had a UTI and was on clavamox at the time of the ACTH Stimulation test. I read that a UTI could raise Cortisole levels. She has had 2 UTIs since January. Also, one in the fall.

I do have confidence in my vet. He has been wonderful. I do not want him to think I question his diagnosis. However, I do not want to put my dog on the Trilostane unless we are 100 percent certain. I read this can be dangerous.

If she does have Cushings and I don't treat her immediately , I hurt her. I want to do the right thing for my girl. If I don't treat her immediately I could be risking her to go blind from no treatment due to high blood sugar levels?

Should I have another test done or would that be putting her through another test unnecessarily. The more I read, the more confused I become as Diabetes can have similar symptoms as Cushings. Could she have had Cushings at the very young age of 4, as the first vet thought just by looking at her.

As you can tell, I'm confused and very worried about doing the right thing. Thank You for taking the time to read and respond!

[labblab]

Welcome! I know that others will be by shortly to offer their support and advice. I just wanted to let you know that I have deleted a second "duplicate" thread that you had posted. I am guessing that you posted the second thread because there was a delay in your seeing THIS thread appear on the forum. I am also guessing that this is because you have not yet completed your registration process. When that happens, your posts are "held" for approval by a Moderator prior to being released for public viewing.

You should have received an email sent to the address with which you registered with us...once you respond to that email, your registration will be complete. So please go back and check your emailbox (and also any spam folders) to see whether you have a confirmation email awaiting you. :)

Marianne

[Autumn]

Hello
Thank You for the welcome. :)
I did make the mistake of posting before completing registration in email. Thank you for fixing this.

[frijole]

Hello Autumn (is that your name?)

Glad you found us. We have seen very young pups with cushings so while it isn't common it does happen. If you could - get a copy of the exact test that was done to diagnose cushings and the numbers on it.
You are smart to want to confirm the diagnosis prior to starting any medication.

The best thing you can do is to read up and get educated on the disease so that you can understand the vet, ask questions and "be your dog's voice" thru this. You are off to a great start. If you go to our Reference thread there is a ton of information including info for dogs with both diabetes and cushings. YOu aren't alone so read, ask questions and keep us posted!

Kim

http://www.k9cushings.com/forum/showthread.php?t=190

[Autumn]

Hi Kim
Thanks for the welcome. Actually, Autumn is my dog's name. ;)

It's a lot to take in. You are right. It's time to research and learn. I will be discussing with my vet with more information and knowing what to ask. I will get the numbers on the ACTH test and post them here tomorrow.

Also, after advice and reading of the forums, I'm now thinking that we should attempt to regulate her blood sugar more first. Then retest Autumn when she is better regulated BG and free of UTI.

Thanks so much! :)

[Dollydog]

Hi Kim and welcome,
We deal with Cushings and Diabetes at our house....I haven't started up Lady's thread here yet....but I'll get to it!
Being free of the UTI and trying to regulate her blood sugar first is a good idea. But IF your dog has Cushings it will be impossible to regulate the diabetes.
We had Cushings first....excessive drinking, urinating and eating were Lady's only symptoms. She has had problems for the last 6 years with skin infections on different parts of her body. She's on Trilostane and NPH.
Hope you get some answers soon,
Jo-Ann & Lady :)

[Wylie's Mom]

Hi Autumn's Mom? Dad?,

I just wanted to Welcome you:)... Unfortunately, I can't give much input in your situation, since Diabetes is in the picture. But, since your vet has mentioned Trilostane... I agree with you that you do want a definitive diagnosis before treatment with Trilo (or Lysodren, for that matter). If later, you do get a definite dx, and decide to use Trilo, I wonder if you should consider having Autumn's estradiol (hormone) levels checked through the Univ. of Tenn, Knoxville (UTK) first. Trilostane is known to increase this hormone level and can cause issues similar to regular cushing's. Maybe someone else can give their opinion on this:confused:.

But for now, we'll wait for those test results ;).

-Susy

[Autumn]

Hi Kim, Jo-Ann & Lady and Susy :)
Thanks so much for your replies and information . We appreciate it so much. It's been very stressful. I think taking it slow is the way to go. Check into getting her blood sugar regulated. I learned today she is not near the numbers to be considered resistant yet.

I'm going to read the Reference thread and learn a lot more so I can make informed decisions. I sure have a lot to learn. LOL

I'll be back with the results.

If she has both, I hope it's ok, Joann and Lady, to ask you many questions. :)

I hope all your dogs are doing well! :)

Anna and Autumn

[gpgscott]

Hi Anna, welcome to you and Autumn.

Please do work through the resources. And then before comencing a lot of diagnostics please come back and muse with us.

There are way too many pups put through too many tests without need.

Scott

[jrepac]

Cushings can certainly bring on diabetes as a complication; and the cushings makes it very hard to control the BS levels. My vet keeps close tabs on my Aussie's glucose level, which has occassionally been on the high side in the last year. Luckily, I control her diet and give her some supplements that seem to be helping.

But, read up first, and I'd say clear the UTI. No need to rush, but if the ACTH is positive, that is a pretty strong indicator of Cushings.

Good luck,

Jeff

[Squirt's Mom]

Hi Anna,

A belated welcome to you and Autumn! :)

You have been given some great input so far as usual. The most important thing that has been said is, take your time to be sure you are dealing with Cushing's BEFORE starting any treatment for it. The waiting game is truly unnerving at times :eek: but we will be here waiting with you.

I have some links for you on Cushing's in general and a few on elevated sex hormones that need to be taken into consideration if you are looking at Trilo is a possible treatment.

Keep in touch!
Hugs,
Leslie and the girls

K9C Resource section:
http://www.k9cushings.com/forum/forumdisplay.php?f=10

Kate Connick*
http://www.kateconnick.com/library/cushingsdisease.html

PowerPoint Presentation
http://talkoftheinternet.com/etvma1/hac-3-13-07.ppt

Long Beach Animal Hospital*
http://www.lbah.com/canine/cushings.htm

Drs. Foster and Smith*
http://www.peteducation.com/article.cfm?c=2+2097&aid=416

Newman Veterinary*
http://www.newmanveterinary.com/CushingDiag.html

Cushing’s signs and pics*
http://www.newmanveterinary.com/CushSignFrame.html

BMD Health Library*
http://www.bestbeau.ca/bmd_health_links_4.htm
(scroll down to see Endocrine Diseases)

Mar Vista Animal Medical Center*
http://www.marvistavet.com/html/cushing_s_disease.html

Vetstream*
http://www.vetstreamcanis.com/ACI/February08/VMD2/FactSheet052.asp

Atypical Cushing’s*
http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=485128&sk=&date=&pageID=1

http://www.vetcontact.com/en/art.php?a=132&t=

UT Panel
http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php


Canine Hyperadrenocorticism, Diabetes Mellitus, or Both?
http://www.vet.uga.edu/vpp/clerk/Zwicker/

[Wylie's Mom]

Hi Anna,

The good thing is that Autumn is very young... if you are ovewhelmed with the reference materials (I was at first:eek:), feel free to post your questions here, on your thread;).

-Susy

[ladysmom06]

Hi Anna,

Welcome to you and Autumn.

Here is a copy of a reply I posted to you on your thread on the diabetes forum.

We dealt with both cushings and diabetes. Lady was first dx with cushings but was also diabetic at that time - the vet we were seeing missed the diabetes. She saw another vet who wanted to treat the diabetes first and get that under control - she wasn't sure she had cushings bc the tests can give a false positive in unregulated diabetics. When we couldn't get her diabetes regulated after 4 months the vet repeated all the cushings test and then sent us to an IMS. Lady had most of the symptoms of cushings - the tests were all positive. We then started treating the cushings and in a matter of weeks we were finally able to start regulating her diabetes. We didn't start the cushings treatment until 7 months after we started treating the diabetes. My point is you have time if Autumn does have cushings. I would try and get the diabetes regulated first and IF you can't get it regulated then I wouild look at the tests for cushings. Also I would look into getting another opinion. Lady was seen by her regular vet and also an IMS. I see that you have joined the cushings forum - lots of info and very caring people there too.

Good luck to you and Autumn and hugs to the two of you.

Luv,
Lynne and Angel Lady 7/98-3/09

[Autumn]

Hi :)
Thanks so much for the replies. The reading can become overwhelming, LOL :eek:. I'm learning a so much on the forums and thank everyone so much for their information and welcome. Everyone is very kind.

Right now, we are not confident with the Cushings diagnosis as we need to get to the point where she is proven insulin resisitant. She's not near her level of units of insulin to be considered resistant.

Plus I was not to aware of the possible false positive due to the diabetes not yet controlled. All this information makes it possible to make the right treatment decision. It's good to know we have time to re-evalute the situation. If in the future, she is still diagnosed with Cushings, we will feel comfortable and confident to treat her.

Thanks! :)

[Autumn]

Good Evening :)
I have Autumns test results from the Low Dexamethasone Suppression Test. And do not have a clue what it means ;)

First, I read the dog should be fasting for 8 hours before this test. Audy was told ok to have breakfast/injection. I'm thinking this is due to her diabetes, ?

Report states a false negative can occur under stress. My dog is always stressed at the vet and this day she was a nervous wreck. Possible false negative with other illness like her diabetes and also had a UTI at the time.
Thanks!
It says 3 samples
Tube Labeled Pre 10
Tube Labeled Post 2
Tube Labeled Post 6

Cortisol pre 10.8
Cortisol 2 2.1
Cortisol 3 5.9 Ug/dl

Any input what this means is greatly appreciated.
Anna

[lulusmom]

Hi Anna,

Thanks for posting the results of the LDDS. I do believe that those results are consistent with pituitary dependent cushing's (PDH). I am providing a link to some good information on the LDDS. If you scroll down to Case 3 and click on answer C. The dog has PDH, I think you'll have your answer.

http://veterinarymedicine.dvm360.com/vetmed/Medicine/ClinQuiz-Interpreting-low-dose-dexamethasone-suppr/ArticleStandard/Article/detail/580093

Does your vet plan on doing an abdominal ultrasound to check out the adrenals and surrounding organs?

Glynda

[AlisonandMia]

Those results would be consistent with PDH - except that with the diabetes and the UTI and the fact that Autumn is very stressed at the vets the LDDS test is probably not very reliable in her case and this could well be a false positive.

A huge number of diabetic dogs will test positive for Cushing's on an LDDS test because of the physiologic stress of the diabetes. The same applies for dogs that have any other non-adrenal illness (a UTI in Autumn's case). We've also seen more than a couple of dogs that have tested positive on an LDDS test because of being very stressed out at the vets!

With a diabetic the preferred Cushing's test is the ACTH stim test which is significantly less likely to be skewed by stress although chronic stress (like having diabetes) can result in a borderline positive result sometimes.

The standard thing with a diabetic dog that is thought to possibly have Cushing's is to give regulating the diabetes a really good shot including taking the insulin dose up to the point where insulin resistance is proven and also any other reasons for difficulty in regulating the BG like infections the insulin not suiting the particular dog etc. are ironed out before considering Cushing's treatment. If you can get good regulation of the diabetes and good response to insulin then that just about rules out Cushing's.

We have seen quite a few cases here where a diabetic dog was "diagnosed" with Cushing's by a GP vet (often using the LDDS test) and when the dog was seen by an Internal Medicine Specialist the Cushing's was "undiagnosed" (at least for the time being) and the diabetes addressed first. In almost every case it turned out that there was no Cushing's present and any problems with diabetes management were overcome.

The problem is that many of the signs and symptoms of Cushing's overlap although the onset of the symptoms with diabetes is often far more sudden whereas Cushing's very often comes on quite gradually - and to add to the confusion diabetes is very likely to result in false positives on Cushing's testing.

Don't worry about the fasting thing - that is one thing that doesn't affect the validity of the test as such. The reason for the fasting is that sometimes if a dog has eaten, some fat from the meal can turn up temporarily in the blood and make the sample impossible to "read" for cortisol. If they could use the sample and get a reading then not fasting won't have affected anything.

Alison

[k9diabetes]

The test results do look like Cushings but I still want to caution that the results may still be skewed by stress and by the presence of diabetes and a UTI when the test was done.

I believe that an ACTH test would be considered more accurate under these circumstances... Cush folks please confirm that.

Plus Autumn is showing blood sugar as low as 200 on less than 1/2 unit per pound of insulin and I don't think has never even had a curve done to see where her regulation is.

So whether Cushings is truly in the picture remains questionable to me.

Natalie

[k9diabetes]

Ah, Alison, you were confirming my statement while I was typing it! ;)

Natalie

[Autumn]

Thanks!
Very grateful for these two forums for all the support and information you all share. We are better off taking our time and getting her blood sugar regulated. I sensed a small urgency to treat her and it's not time yet, if it is ever necesary. We can always retest later. Also, excellent information that the preferred Cushing's test is the ACTH stim test! I couldn't get an answer with this.

Thanks again! Have a great day!

[k9diabetes]

Hi Anna,

I'm linking your two threads together... here is a link to your thread at the diabetes forum! :)

http://www.k9diabetes.com/forum/showthread.php?t=951