Cooper - diabetic and cushings

[charansuri]

Hi everyone,

I am new to this board. It's been stressful month or so for us and I am happy to find this forum where I can find some support and advice.

Cooper is 8 years old miniature Schnauzer. He used to be one of the most hyper-active, curious, always-smiling dog in our household (he has 2 buddies). He weighs around 19 pounds now. He used to be around 23 lbs during his healthy days.

In May of 2012, he got sick, drinking lots of water, peeing often and becoming dull and less active. The vet diagnosed for diabetes. Since then we have been giving him insulin shots. A month ago, he was at 10 units. We have had several Glucose monitoring done on him in a year time and kept adjusting his insulin dose. He also went blind quickly and now gets 3 eye drops every day.

Truth be told, when we started on insulin, he did pretty well. But, he had phases when he would go down, start drinking more water, peeing more again which lead the vet to keep increasing the insulin dose.

His insulin was increased to 10 units in May 2013 and by June he started drinking more water again. We took him to the vet (new doctor at the clinic) and told her that we keep increasing his insulin and its not making much of difference. She suspected Cushing's because his body was getting resistant to insulin and the main vet ran tests, spoke to his specialist friends and confirmed he has Cooper has Cushing's. The main vet has been the family vet for years.

We started him on Vetoryl, 10 mg capsules last Friday. Since he is diabetic, the vet started him on low dose, twice a day (10 mg in the morning and 10 mg in the evening). His insulin reduced from 10 to 8 units. Past 4 days, Cooper did amazingly well and we thought he was getting back to his old self.

But, as of Wednesday (5 days since we started him on Vetoryl), he pooped in his crate in the afternoon (never does that!) and vomited all of his dinner just an hour ago. He got 10 mg Vetoryl and 8 units of insulin, twice. I don't plan to give him any more Vetoryl starting today. It's July 4th and the vet is closed. I have an appointment with vet to check his Glucose on Monday but I am going to take him in on Friday since this new development.

I am just feeling very low and depressed at this point. I feel like it's back to square one and feel very helpless. I was so hopeful he was getting better, but this is a major set back... he is laying on his dog bed now. I hope stopping Vetoryl will make him feel little better, at least till I can take him back to vet.

We are expecting a baby in a month and I really wanted to get Cooper's health under control before the baby arrives. I am just too stressed out about him and an emotional wreck... :(((

[frijole]

Hi and welcome. You are right to stop the trilostane - vomit could mean that the dose is too high. Your vet did do the right thing by starting on a low dose. We so often see cases where dogs are misdiagnosed and the combination of diabetes and cushings makes it even more complicated.

Could you please tell us what tests were done to determime cushings? Was a blood panel done? If so what enzymes were elevated? What specific cushings tests were done? What were the results on it?

Do you have access to an internal med specialist (IMS) in your area? I ask because it is tricky to work with a dog with these two concurrent illnesses and it may be necessary to go to a specialist, at least to get things under control. Kim

[charansuri]

Thanks Frijole for your reply. I had been up since 1 am, fell asleep for a bit, and woke up to poop on carpet (more liquidy). So, I guess it's safe to say he vomited and has diarrhea... sigh...

Our vet had instructed to stop Vetoryl immediately, in case these side effects happen. Our vet performed low-dose dexamethasone test. Cooper was at the vet for whole day and blood work was done on him every 4 hours. He wasn't able to confirm if it was pituitary related issue. He was planning to run ACTH test on Cooper after 2 weeks on Vetoryl. As it stands now, I don't know he will do.

Our vet admitted that he has only seen 3 cases of Cushing's in all of his career and he is an older gentleman. I think Cooper is his first Diabetic-cum-Cushing's patient. Vet also told us that he needed help reading the test results and had to discuss with some specialist friend of his to confirm his findings. we feel he really did all he could before confirming the results. That said, it's unfortunate he doesn't have much experience with this complicated situation.

Beyond this, I currently don't know details about the result itself. I can ask for a report from the vet. I don't know of any IMS in town but I can sure find out. I will also ask my vet about it. Do IMS people directly treat the pets or do they work with the vet to determine dose?

Cooper was really hungry this morning. I think his body was pretty flushed out. I fed him a cup of green beans and he hogged it and he is drinking water. I was worried he is going to be dehydrated with all the vomiting and diarrhea. I am going to feed him small amount of dog food frequently during the day. I hope his belly can handle it. I plan on giving him his insulin this morning.

Is there any advice on how to control the vomiting and diarrhea for now?

Also, what kind of questions should I ask vet about this situation? Sometimes, it's all Greek and Latin to me.

I appreciate everyone for taking time and letting me share my experiences. I am at a point where I feel I need a support group to even handle this.

[molly muffin]

Hello and welcome from me too.
We have a sister site for diabetes that you should also join.

www.k9diabetes.com they are wonderful people who can help you with the diabetes aspect while we see whats going on with the cushings.

Stopping the vetoryl any time you see vomiting, etc, is a good thing. It's a delicate balance, but you can get there. It just takes a bit of time to work it all out.

I know this is very stressful. Hang in there

Sharlene and Molly Muffin

[charansuri]

Thank you.
My husband and I are just baffled that he got sick all of a sudden. He was so fine yesterday morning and doing so well for last 4 days on Vetoryl. We thought we finally saw the light at the end of this tunnel. So, we are just little shocked and bummed to see him sick again.

We are really doing our best to be positive and make sure we try everything and that Cooper is comfortable. But some days are just emotionally draining...

[molly muffin]

If they can give you a copy of the LDDS, then we see plenty of results and can usually give you and idea of what they mean.

Also any blood work, like the CBC, and urinalysis, would be helpful. We only need to know abnormal results high/low with range.

It might be that insulin that was off high/low causing the upset or it might be the vetoryl. Which is why we always stop and re-evaluate.

Many vets aren't familiar with cushings, the medications and the testing protocols. So, getting up to speed yourself is the best course of action, always. We help with that.

IMS usually will work with the vets. It sounds like the vet might currently be consulting an IMS? As he said he needed some help on interpretation.

Sharlene and Molly Muffin

[charansuri]

Ok. I will be taking Cooper over to the vet tomorrow. I will be sure to ask for the reports.

[Tina]

Hi, and welcome from me too. I have two Miniature Schnauzers, Jasper is my cushpup. You did great to stop the Vetoryl, the rule of thumb is to never give it when your pup isn't feeling well. When you take Cooper to the vet tomorrow, ask about having his electrolytes checked. They can get out of whack very quickly with vomiting and diarrhea, and also if the Vetoryl dose is too high.

I hope the vomiting and diarrhea stop as the Vetoryl gets out of his system. Yes, it is very stressful, and this type of thing always seems to happen on a holiday or weekend when the vet is not available.

Tina and Jasper

[frijole]

The test that you had done is the low dose dex suppression test and it is prone to false positives when something else is going on - that includes diabetes. I would insist on having an acth test done NOW. It could be that your dog doesn't even have cushings which would explain the vomit and diarrhea.

I appreciate the fact that your vet was honest that he isn't experienced with treating cushings. At least you know for sure that his experience is lacking. To be honest we see this alot and frankly that is why this forum was created - we help alot of people through this and in some cases they coach their vets.

If you tell us where you are located we might be able to help you find a specialist in your area. Yes they can work with your local/regular vet.

Kim

[charansuri]

Thank you, Tina and Frijole!

Since this morning, Cooper hasn't had an episode of vomiting yet. Touch wood! He ate just green beans. I might brave it and give him some dog food in half hour. He did seem like restless, but for now he is laying down.

Frijole - Thank you so much for willing to help with finding the right help. We are in Reno, Nevada. I tried to browse online but didn't find anyone specific. Maybe I am not looking the right way...

When I go in tomorrow, I will ask the vet to run ACTH test and look at those results. Once again, I appreciate all the support so much!

- Suri and Cooper

[charansuri]

Ok, now I am panicking!!!

I just walked out to the backyard with Cooper and he still has diarrhea but there is blood in his poop.

Should I take him to ER now? or it is normal for dog with Vetoryl side effect?

Please advice.

[Mel-Tia]

I really don't know I saw it only once and the vet said it was colitis as my Tia had eaten fox poop

Posting to you to also bump this back up to the top so hopefully someone else will come in and advise.

Hang in there

Hugs

Mel
Xxxxx

[Tina]

I am not an expert and have not used Vetoryl, but I just looked at the product insert on the Dechra website, and it does list hemorrhagic diarrhea as a more serious adverse reaction that can happen "occasionally". I know it can also happen with colitis.

Has Cooper ever had bloody diarrhea before? And is there a lot of blood now? Any further vomiting? Is he lethargic or weak?

Sorry for all the questions, I know this is so scary.

Hugs,
Tina and Jasper

[Squirt's Mom]

Hi,

Is Cooper still drinking and eating ok? No vomiting? How is his energy level?

Is it possible he could have eaten something he shouldn't have?

Colitis can cause bloody diarrhea - my Trink has colitis and it can get quite nasty. She typically takes a round of Baytril and I use Slippery Elm Bark with her when she has a flare. And I typically withhold food for 24 hours - but that would be difficult with a diabetic pup. ;)

As long as there is no vomiting, he is drinking and eating, and the stool isn't pure blood, he can probably wait until tomorrow. If you are concerned, by all means, take him to the ER. Sometimes our peace of mind is worth most of all. ;)

[frijole]

Found some! Tried importing into excel so it was formatted but it didn't work. Kim (frijole)

http://www.acvim.org/PetOwners/FindaSpecialist/Results.aspx?LASTNAME_field=&ORGNAME_field=&INTERESTCDLST_field=&STATECD=NV&ISMEMBERFLG=Y&CUSTOMERTYPE=Diplomate&LASTNAME=&INTERESTCDLST=&ORGNAME=&WBP=specCust_List.htm&WHP=specCust_Header.htm&RANGE=1%2F25&NOWEBFLG=N&SORT=LASTNAME


Specialist List - 13 Match(es)
Name Univ/Hospital Specialty City State
Andrew Vaughan Las Vegas Veterinary Referral Ctr.* ONCOLOGY* Las Vegas* NV

Charles Brockus SAIM* Reno* NV

Chrysann Collatos High Desert Veterinary Service* LAIM* Reno* NV

Dennis Macy Cancer Care Specialist* ONCOLOGY Las Vegas* NV

SAIM*

Dennis Meyer SAIM* Sparks* NV

Guy Pidgeon Western Veterinary Conference* SAIM* Las Vegas* NV

Jaime Hustace LAIM* Smith* NV

Laura Browand-Stainback NEUROLOGY* Las Vegas* NV

Linda Matros IVS/IDEXX Laboratories* SAIM* Reno* NV

Meghan DeLucia Las Vegas Veterinary Specialty Center* SAIM* Las Vegas* NV

Scott Forney CARDIOLOGY* Las Vegas* NV

Shane Lyon Las Vegas Veterinary Referral Ctr.* SAIM* Las Vegas* NV

Stacy Hosking Nevada Veterinary Cardiology* CARDIOLOGY* Reno* NV

[frijole]

Re the blood - no not a sign of cushings or trilostane to my knowledge. I would try to find a specialist to help out your vet asap. Cushing's isn't a 'rush to treat' thing but the diabetes obviously creates a sense of urgency for obvious reasons.

I would try to find a specialist asap. I googled and the list I gave is short when you remove the ones that don't practice on small animals or have a clinic.

SAIM is small animal internal med and LAIM is large animal (horses ex)

The gal that has IDEX by her name works for the lab that does testing and they can offer advice to vets (which might be what your vet was referring to)... my experience here in Nebraska was that they were not seasoned enough when my small town vet was trying to get help. The guy named Charles seems to specialize in pathology for vets.

I would absolutely PHONE one of them and explain you are looking for the best internal medicine specialist within driving distance. Make sure they know that your dog does have diabetes and was recently diagnosed with cushings but only the LDDS test was done and after a few days on a low dose you have vomit, blood in diarrhea. I did google and there are specialists in Sacramento which is certainly closer than Vegas. (Note I had to drive 5 hrs each way to the closest specialist and it saved my dogs' life and my sanity)

As someone else mentioned earlier when you go in not only should they do the acth test - they should check the electrolytes. Obviously they should also check for any issues with glucose regulation, ketones etc.

If we didn't mention it - we have a sister site www.k9diabetes.com which you might want to join for help in getting it under control. If your vet has only dealt with one other diabetic that is a bit unsettling as it can be tricky to regulate and you don't want to be practiced on.

Saying prayers for you now. Kim

Kim

[molly muffin]

Kim, do you think the vet ER she mentioned would have a specialist on staff? Mine does, so I wondered about that.

Yes it could be colitis but always better to error on the side of caution I think, until you know for sure.

Sharlene and Molly Muffin

[frijole]

I would guess not. You probably live in a major city and things are so different when dealing with smaller rural or remote areas. We had ZERO IMS in our entire state when I was dealing with Annie's issues. Now there is an office in Omaha and that's it. The one's I saw in Reno don't seem to be attached to a clinic - only the ones that work on horses.

That directory is not 100% but it's the only one we've found. Next best chance of locating is to google or call and ask for names. Most vets understand they can't be up on everything and will refer.

[charansuri]

Update -

We did take him to the Emergency Animal Care because bloody diarrhea was listed as one of the serious side effects of Vetoryl on their product description and they advised Animal Care right away.

The doctor said that he would prefer to hospitalize him and give him IV but doesn't seem to think it's too bad since his energy level is fairly decent. If we wanted to wait until tomorrow to go to vet, we have to make sure he eats, drinks water and stays hydrated. He is getting fed small amount of bland food at short intervals, in hopes that he will be able to keep it in his body. We decided to bring him home and monitor through the night. If his condition remains the same, he might need IV.

Cooper has never had diarrhea before let alone the bloody kind. And I know he hasn't eaten anything he wasn't supposed to.

He hasn't vomited yet since morning, but he still has diarrhea and still blood in it. He ate food an hour ago and drinks little bit of water... he likes ice cubes, so I am trying to give him that every now and then. He pants a lot too.

Dr suggested pedialyte for kids. We tried that but Cooper hates it. Is there any other way I can gets some electrolyte in him?

Medical Tests - Cooper was tested for Ketones just couple of weeks ago and he doesn't have that. He constantly gets glucose test and that will continue because of his diabetes. ACTH test is the only test that has not been done on him yet.

[charansuri]

Thank you, all, for showing so much care! Cooper is very thankful too!

[frijole]

Awesome job. If Dechra shows it on their website then it obviously is most likely a result of the trilostane. It is great that he is able to eat a bit and sip on water. Vomit and diarrhea are signs that the dose is too high. Did he check the electrolytes? Note Pedialyte provides nutrition needed to maintain electrolytes. I always bought the unflavored kind and mixed it 50/50 with regular water. I put it out in a small container and got her to drink it a wee bit at a time.

Did he say why didn't he do the acth test today? That is the only way you will know what the affect of this dose was. Trilostane leaves the body rather quickly and so by Monday the cortisol will rise again and you won't know how low he went (I am assuming that is what happened).

Do keep an eye on him and don't hesitate if he's acting yucky as in has no energy, looks like he's dying because he can't lift his head - that is low cortisol. Did he give you prednisone to give him? Did he give him an injection of percorten? This is what is done to give dogs relief when cortisol goes low. Thanks and keep up the good work! Kim

Note to Marianne or other seasoned trilostane user: Do you know how quickly the cortisol rises/returns to normal levels after you quit dosing? I'm asking because it would be nice to confirm the cushing's diagnosis with the acth test. Assuming he has cushings and let's say a reading of 23 and he went low - is it possible that by Monday he would only have a normal reading because his cortisol hasn't gone back yet to where it was?

The dosage was low and he was only on it a short time - I really want to confirm the dx is valid. Vet is new to cushings and diabetes in case you haven't had time to read the whole thread. Thanks!

[molly muffin]

I had to give molly pedialyte. She didn't care for it either, but I used a syringe and squirted it down her throat. It worked and she didn't fight it after the first time. Might not taste great but it was more important to get her electrolytes back into balance.

Good points Kim. I don't know. We know Trilostane leaves the body basically in 12 hours. By Monday it would probably be at a regular level, if not having vetoryl since earlier today or was it yesterday even. However, we've seen dogs that have gone low and you don't usually return to giving vetoryl until the symptoms return and that can take days or weeks, depending on the dog. Kicking it on to Marianne :)

Sharlene and Molly Muffin

[frijole]

Thank you, all, for showing so much care! Cooper is very thankful too!

:D I arrived here over 8 years ago with a dog whose vet was totally inexperienced and this site saved my dog's life. I never left. LOL We pay it forward because we remember. I used lysodren not trilostane (trilo wasn't even legal in the US back then).

Don't worry, we will help you help your vet through this. If he's open to learning more about treating cush dogs you can even send him to the resource section as it has all kinds of info on it.

Here is some info for you to read:
http://www.k9cushings.com/forum/showthread.php?t=185
http://www.k9cushings.com/forum/showthread.php?t=190
http://www.k9cushings.com/forum/showthread.php?t=180

Kim

[charansuri]

Yes, I tried mixing pedialyte with water and he doesn't go near it :) I will try to the syringe technique.

I particularly asked the doctor at the Emergency Center to hold off on any test if it can wait until tomorrow. I want to take Cooper back to his Vet and don't want to run all the test at the emergency care place because a) they don't have Cooper's history or medical records of what was done so far b) They are twice as expensive on holidays!!!!!!!

I am going to take Cooper to his regular Vet tomorrow since they are closed today. His glucose level was high while at the Emergency care... I don't have Prednisone. I will ask my vet about that too.

[frijole]

OK I didn't realize it was a different facility. It is great that your vet is open tomorrow so you don't have to wait so long.

That said - what the heck did they do at the ER clinic? Please tell me they at least gave him an injection of percorten. If you read the links on trilostane you will learn a bit about how trilo works and what happens when the cortisol goes too low. Typically they would give the injection to offer relief which is why you went in the first place. They would check electrolytes. It sounds like Cooper is fine but trust me that is because you were smart and ceased giving the trilo. When cortisol goes too low dogs can get very ill and even die so it pays to be up to speed on all of this. I know it's overwhelming but if I can get it you can too. And you can always post to us from the vet's office :)

Kim

[charansuri]

I don't really care or trust for the ER places. They seem to do the bare minimal in cases like these and just to "look" at the dog, they charged us $160. That does not even include the Glucose meter they used to test his sugar level. Since last year, we have spent $$$$ on all the various tests and medicines. We will do whatever it takes... but, it's one of the other stressing factors for us (I know, I tell myself that money is of no importance when it comes to loved ones), still... I wish there was some help for pet care. All the pet insurance does not cover pre-existing conditions.

I am reading about Prednisone as I type. I will try to get myself more educated on this :( I really wish that I had quit giving him trilo last evening instead of this morning. He had one loose stool and we didn't think much of it until things got worse over night. I am kicking myself over it :(

On a good note - I was able to use syringe and give cooper some pedialyte. I will continue with that on hourly basis.

[Tina]

It doesn't sound like the electrolytes were checked at the ER, is that correct? And also no IV fluids were given? I am just a bit worried about that because with the diarrhea, and vomiting earlier, dehydration can happen very easily which can cause abnormalities in the electrolytes. This can be very serious in combination with low cortisol (if it has gone low). IV fluids and Percorten are the treatment for that. And emergency prednisone should be on hand in case of low cortisol.

How is he doing now? Have you been able to get any pedialyte down him? Like Kim said, keep a close eye on him, and watch for decreased energy and weakness. Great job getting him to the ER. I know, they are outrageously expensive. I hope he stays stable tonight, and then you can get him in to your vet tomorrow.

Hugs,
Tina and Jasper

[frijole]

Since you are going to your regular vet tomorrow and you said he admitted to not knowing a bunch about cushings I would suggest he do the acth test FIRST. After that he can check electrolytes and if he feels still necessary give a percorten shot. (since it'll be 24 hrs he might be much better) The reason why I'm suggesting acth first is so you can get a read on his current cortisol levels. Once you give that percorten shot it acts like cortisol and it will alter the test results. Just making sure in case he/she doesn't know that.

That said if he gets real sick the shot and IVs come first and you can do the test later. Clear as mud? :) KIM

[labblab]

Hello and greetings from me, although I am sorry that you guys are having such a rough holiday. It surely is a puzzle as to exactly what is going on with Cooper, although I must admit that trilostane must be suspected as the culprit since he has never had any similar episodes of GI distress in the past.

I do agree that it is good that you have discontinued the trilostane for the time being, and I am surely hoping that things start to quiet down for him. I do have a question about the recommendation to continue to feed him ongoing meals, because I've often been told to withhold food for several hours in the face of GI disturbance so as to allow the stomach/intestines to rest and recover. But I am guessing that perhaps it is because Cooper is diabetic that he needs to keep eating -- so as to continue to balance his insulin properly?

As for Kim's question regarding the ACTH testing, I'm afraid that you can't count on an ACTH test in the near term to have great validity in terms of diagnosing Cushing's. Theoretically, for most dogs the effects of the drug leave the body within 12-18 hours of dosing. But having said that, by mechanisms that are not yet well understood, there can be persistent effects on adrenal function for some dogs long after the drug has been discontinued. So I would think that the current value of an ACTH test right now would be largely just to determine whether or not Cooper's cortisol level has been oversuppressed by the drug.

As has already been hinted at, though, trilostane can oversuppress adrenal function in two different ways: by lowering cortisol and by lowering aldosterone. Aldosterone is the adrenal hormone that regulates the proper balance of potassium and sodium (two of the "electrolytes" that we keep talking about). Problems can be created if either of these two adrenal hormones drop too low. And the remedy will depend on whether only one or both of the hormones are involved.

Tina is really the expert on this part of things, but I believe that percoten is a "mineralcorticoid" replacement and is only given to supplement aldosterone in the event that the potassium/sodium balance is off. If the cortisol has dropped too low, the dog instead needs a "glucocorticoid" replacement such as prednisone in supplementation. And I believe it is only the glucocorticoid agent that will skew the cortisol readings, and not the percoten.

So when you take Cooper in for testing, I would think you'd like to have enough blood drawn at one time to perform both the ACTH and also the test of blood chemistries ("electrolytes") in order to determine whether either or both of those areas are an issue. One drawback to performing the ACTH after having gone without trilostane for over 24hours, though, is the fact that you won't have a true idea as to the effect of that particular trilostane dose on Cooper's system. So you lose the value of using that particular ACTH as a monitoring tool for that 10 mg. BID dose. But right now, your greater concern is Cooper's safety and making sure that Cooper's cortisol level is not remaining too low. One possible compromise might be to perform a baseline cortisol test instead of a full ACTH. I'm afraid I don't have a link to give you, but I have recently read that it is very unlikely that a dog with a baseline cortisol level higher than 2.0 ug/dl is suffering from an Addisonian state associated with low cortisol alone. So a compromise might be to perform a baseline cortisol and also an electrolyte test. And from those results, you can better judge whether Cooper's adrenal function is causing his GI issues or whether it is something entirely different.

I am really hoping that things will quiet down overnight, though. I can only imagine how scary and exhausting this journey has been for you all, and I truly hope that Cooper stabilizes again quickly.

Marianne

[charansuri]

Thank you all!!
Thank you, labblab. It has been a rough holiday for us, rather its been a rough year all together since Cooper got sick.

Anyhow... I have been giving Cooper pedialyte every couple of hours. I might have given him 3 quarters of a cup and I think that is helping him a lot!! I am ever so grateful for the syringe idea!!!! I have also been feeding him brown rice with some cottage cheese or yogurt and he ate that. He ate some dog food and green beans this morning. The last 3 times he was out, I tried to watch him and I didn't catch him poop. I think that is a good thing.

Cooper is fast asleep now. I am sure the poor thing is exhausted with all he went through since yesterday. His 2 buddies (Sierra and Max) are sleeping and so is my husband. It's been a long day for us...

I am going to call it a night and think about the rest tomorrow when I have had some sleep myself. Hopefully, it will be a quite night and we can all get some much needed rest.

I appreciate each and every comment and supportive words. I will keep you all updated on how things go tomorrow. Good night... **Crashes on the bed**

[Tina]

I am so happy to read that Cooper is holding his own! I am very relieved to see there has been no more diarrhea, hopefully that means things are turning around.

Marianne, you are exactly right about the Percorten. It is a mineralocorticoid replacement only and would not affect the cortisol readings. It does not have glucocorticoid properties, which is why prednisone (or another glucocorticoid) is given for cortisol replacement if necessary. Percorten is given to regulate sodium absorption and potassium excretion when aldosterone is over suppressed. If both cortisol and aldosterone are over suppressed, then both replacement hormones are needed.

I have to work in the morning, but will be checking in for an update on Cooper tomorrow. I hope you all have a quiet night and are able to get some sleep.

Tina and Jasper

[k9diabetes]

Hi,

I am the admin from the k9diabetes forum (www.k9diabetes.com/forum).

I'm glad the Vetoryl has been stopped. Unfortunately it is quite common for diabetic dogs to be misdiagnosed with Cushing's disease and I'm especially concerned if a single LDDS test led to the diagnosis.

Mini Schnauzers have a reputation for high triglycerides and lipids, and that can make them both insulin resistant and to have erratic blood sugar.

Even at 19 pounds, 10 units is a quite normal insulin dose and he may be one of those dogs who needs more than average. I have known a couple of terriers who each weighed about 24 pounds and needed 21 units of insulin per injection for good regulation! Way outside normal, but they were well regulated.

A dog isn't considered insulin resistant until he is on 1 unit per pound and still has high blood sugar - all 350 and higher.

http://endocrinevet.blogspot.com/2012/01/q-diagnosing-cushings-disease-in-dogs.html


We define insulin resistance as doses greater than 2.2 U/kg/injection to control hyperglycemia (4), so we aren't even close to the doses required to diagnose resistance.

And yes, diabetic dogs can get marked hepatomegaly secondary to fat accumulation in the liver. That can lead to a mild-moderate "pot bellied" appearance.

Because it can be very difficult to make a diagnosis of Cushing's syndrome in dogs with diabetes, observation and monitoring is the best course in many of these patients. If Cushing's disease is present, it will be progressive and other signs will develop to make the diagnosis easier to confirm.

This is where I think you need a more experienced veterinarian to step in to this case once Cooper gets stabilized.

Will check in tomorrow to see how things went at the vet appointment.

I would think they would want to at least check a baseline cortisol level to make sure he's not low on cortisol.

Natalie

[k9diabetes]

Oh, almost forgot, here's the article by Dr. Peterson on insulin resistance in Mini Schnauzers.

Article concerning diabetes in Miniature Schnauzers:

http://endocrinevet.blogspot.com/2012/11/association-of-hypertriglyceridemia.html?utm_source=dlvr.it&utm_medium=facebook (http://endocrinevet.blogspot.com/2012/11/association-of-hypertriglyceridemia.html?utm_source=dlvr.it&utm_medium=facebook)

[charansuri]

Update -

Cooper slept all night without diarrhea or vomiting. yayy! He ate well this morning and has been drinking water. I gave him insulin and pedialyte. In all, he looks like a different dog today compared to yesterday... I am sort of relieved for now. phew!!

I called my vet and spoke to him this morning. I talked to him about how its a possibility that Cooper doesn't have Cushing's and maybe we just need to continue to treat his diabetes. I thought it was necessary to throw the thought out there for him to contemplate. Vet is going to talk to specialists again today and discuss with IMS again (I am glad he is already on it!!) and call me by end of today with a plan for Cooper. He is going to see Cooper tomorrow because his sugar was high yesterday (437, 4 hours after 8 units of insulin). At this point, I don't want to put cooper through more tests with out thinking this through. I am glad my vet is not very aggressive in terms of Cooper's treatment and is willing to get help. But this is going to be one of those trail and error kind of a case... unfortunately.

I am at work today... I will keep everyone updated. Hopefully it will be a quite day.

[Budsters Mom]

It is always great when our sweet babies sleep through the night!:) He ate well with no further nausea or diarrhea. That is the best news yet! I am thrilled for you!:D You are doing an awesome job!:)Xxxxxx

[frijole]

Please read Natalie's posts re controlling of diabetes and the link re schnauzers. I have 3 family members with schnauzers with diabetes - mine got cushings instead ;) Anyway I recall it took them a while to get under control and that increasing in small amounts was critical. It may be that your vet will need to consult with an IMS or you have to find one to work with. If your vet still thinks cushings is involved then you should do the acth test and not the one that was done. Keep us posted - so glad you had a good night. Kim

[charansuri]

So...

The vet just called me. He said he discussed with specialists and advised that we should stop Cooper's cushing's treatment for now. He is going to go back and try to regulate his sugar level with insulin... in short, go back to treating diabetes. If this proves to be frustrating (as it has been with Cooper), then he will do an ACTH test before thinking about putting him back on any sort of medication for Cushing's. That is the plan for now. Going to the vet tomorrow...

It's funny how my vet said pretty much the same thing you guys were suggesting. Thank you, Natalie!! Frijole, I read Natalie's post and have printed information about Schnauzer and insulin resistence. Her information was one of the reasons why I asked my vet if we should even continue to go down this part. This forum is full of amazing information for clueless pet owners. I am going to go over to k9diabetes forum.

My thanks to this supportive forum. You guys really helped me with my sanity!!!!

[frijole]

Good call by the vet. We aren't vets however we have been around a long time and we only see the cases where people are having problems. We see some things repeatedly (such as dogs with diabetes that don't have cushings) That is how we are able to provide help. No doubt we have saved $ and lives over the years. In your case you stopped the trilo and saved Cooper from being in greater distress than what he was in. Good job on that.

I have no doubt that Nat's group will help you figure out the diabetes regulation so you can guide the vet along. Keep us posted on how you are doing. Kim

[labblab]

Boy, I am really relieved to hear this gameplan, too. It seems to be the safest and most reasonable under the circumstances. Even if it turns out that Cooper does not have Cushing's, though, we hope you will still come back and update us, OK? We don't want to lose track of you guys!

Marianne

[charansuri]

Absolutely, Marianne and Kim! I hope I don't have to come here complaining about Cushing's and instead bombard the thread with pictures of my happy fur babies :)

Wishful thinking...

- Charan

[molly muffin]

We would be quite happy to be bombarded with pictures of your furbabies and never have to worry about cushings with Cooper again. :) We do luv the pictures part. LOL

Sharlene and Molly Muffin