Recently diagnosed with Diabetes, worried about Cushing's.

[pvriz]

Came upon this forum from k9diabetes. My 13 yo, 15lb chihuahua Spanky was diagnosed last month with diabetes. I know the symptoms of Cushing's and diabetes can be difficult to distinguish and concurrent. He has all the physical symptoms of cushing's so I am trying to get a better idea whether he has it without another battery of expensive tests.

From the beginning I presented the idea of cushing's to my vet. He did not rule it out but (understandably) wanted to get his blood sugar under control first. A rather high insulin dose of 7.5 units twice/day is where he is at currently. The vet stated he wanted to see him in 6(!?) months and to call if I felt the need. Not very comfortable with that game plan so before I possibly consult with another vet I'm trying to get a better grasp if he may have cushing's.

Ok, I read an article regarding lab hints pointing at cushing's. First is "the Stress Leukogram." Not sure if he exhibits this as I cannot find an exact definition beyond a ratio within the white blood cells.
Spanky's WBC results were as follows:
Neutrophils 8550 75%
Lymphocytes 1710 15%
Monocytes 570 5%
Eosiniphils 570 5%
Again, not sure but I believe this would constitute a Stress Leukogram??

ALT normal but Alk Phosphatase was elevated at 303.

Cholesterol high at 421.
Triglycerides very high at 761

His urine was not diluted with a specific gravity of 1.032
Protein was found in his urine, as were red blood cells.

In hindsight after the overwhelmed feeling subsided a bit, I wish the vet had performed the Cortisol:Creatinine ratio urine test. Not sure why he didn't. Didn't check his blood pressure to see if it was elevated either. Also learned of the Cortisol induced Alkaline Phosphate blood test. He could have done that too when he pulled Spanky's blood..Ugh.

I'm not sure if Spanky's abnormal results are all due to the diabetes. Vet said that likely was the case, and it would cost much more to test for Cushing's, not to mention the cost of treatment. The blood pressure and two other tests listed above couldn't have cost much - so I'm not happy with the vet right now.

Any input would be greatly appreciated. Thanks in advance.

[frijole]

Welcome! To be honest the symptoms of the two diseases are very similar and the most important thing you can do is to get the diabetes under control. There is NO need to run to treat cushings if your dog has it. Diabetes is a different story. So I wouldn't spend a dime on cushings testing yet. Dogs with both disease struggle to get the diabetes under control and that is normally how cushings is discovered in diabetic dogs.

Looking at the blood tests what stands out to me is the alk phos is really not very high. A cush dog often has levels in FOUR DIGITS so either your dog doesn't have cushings or is in early stages.

Cushings is hard to diagnose and requires multiple tests. Some of them will come out positive at times when other diseases, like diabete are present so you'd have to do multiple tests. I don't see the value right now because what really matters is the diabetes.

I do agree you should find a vet that is more willing to work with you on the diabetes because if you just started treating I don't think waiting 6 months to check to see if it's regulated is a very wise plan.

Again, please don't lose any sleep over cushings. I had a cush dog and 3 of my relatives had diabetic dogs - trust me they have the same round tummies and symptoms.

Hopefully others will chime in with their thoughts. Best! Kim

[labblab]

Hello and welcome from me, too! We are very glad you've found your way over to us. As you already know and Kim has reinforced, it can be quite a challenge to unravel a diabetes/Cushing's diagnosis since so many symptoms are shared by the two disorders. This is further complicated by the fact that the diagnostic blood and urine tests for Cushing's can render false "positives" in the face of diabetes. So yes, you could move forward with one of those tests in the interest of seeing if it came up negative. But if not, a "positive" would not necessarily be confirmatory of Cushing's at this stage of early diabetic treatment when you are still working on control.

Does Spanky show any evidence of skin or coat changes at this point? According to nationally-known endocrinologist, Dr. Mark Peterson, those can be symptoms that may ultimately be helpful in terms of differential diagnosis. I don't know whether you've already seen this article, but I think it will be of interest:

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

So I don't necessarily disagree with your vet's advice to temporarily postpone Cushing's diagnostics while you are still at this early stage of diabetic treatment. But I do agree with you and Kim that I am astonished if he is not planning to see Spanky in any sort of follow-up for six months! :eek:

Among the abnormalities that you've listed that would be of concern to me would be learning more about the extent of the blood and protein loss in the urine. Both diabetes and Cushing's can affect kidney function. And even though effective control of the primary disease can help restabilize the kidneys, interim or continuing supportive measures may be recommended depending upon the degree of renal abnormality.

Marianne

[goldengirl88]

Welcome to the forum. Your Spanky sure is a cutey pie. I would want to get the diabetes under control first, that is the most important thing to do. I would look around at other vets as not wanting to see your dog back for that long of a period with diabetes sets of alarm bells with me. make sure if you go elsewhere you call and question to see if they have treated Cushing a lot and know what they are doing, as you can go from the frying pan into the fire. You need to educate yourself on these diseases as you are the only advocate your dog has. Do not put blind faith in anyone even a vet. Make a doggy diary of daily things going on with your dog, you will need it to refer back to. Blessings
Patti

[pvriz]

Thank you all for the replies. Yes Patti Spanky is a cutey. Gets it from his dad..lol. Marianne I read that article. Spanky definitely has been shedding excessively. His coat looks more dull and feels almost kinda greasy. I have had to bathe him much more frequently lately as well as continuously change the sheets in our bed. Very noticeable difference. Also the warts he has, which were becoming pretty abundant (and my biggest cosmetic concern prior), have mostly stopped growing, or shrunk. I don't know if that means anything. As in cushing's (and diabetes) I see the muscle wasting, weakness, shaking, shrunken skull appearance, pot belly, etc. Much like the dog referenced in the article, Spanky's insatiable thirst has decreased with insulin yet is still much greater than normal.

He seems rather unsettled at times - moving around on the bed then plopping down or really scratching at the carpet or bedding to "prepare it". This behavior became very noticeable recently. I haven't seen that anywhere as a diabetic symptom. He pants a bit more than he used to, but I would not say it's extreme or that I would have noticed it unless I knew it was a symptom of cushing's.

Not sure what to do, and I'm not made of money.. Do I make some calls and bring him to a new vet straight away? Wait a month or so for improvement? This is all new and stressful, especially when I really don't have complete faith in my vet. I had hoped he would simply need insulin and infrequent follow ups, but the 6 month follow up sure raised red flags, and now has made me question everything.

Paul

[labblab]

Paul, what feedback have you been getting from the folks at k9diabetes re: Spanky's current insulin dose and stability? I do think the diabetic management is your top priority at the moment. If it turns out that you simply cannot get him well-controlled or if additional worrisome symptoms develop, that's when I'd add the possibility of Cushing's into the mix, but not right at the get-go. (By the way, is his thyroid function within normal range? That's another disorder that can cause some similar symptoms.)

Whether or not you decide to test for Cushing's now, it sounds as though you are dissatisfied enough with your vet that you'd be well-served to look for someone who is a better fit for your needs. Since Cushing's might end up being a consideration, I'd make that question part of your "interview" process: does the prospective vet have experience treating both disorders. Do you live in an area where you'd have access to an Internal Medicine Specialist to offer a second opinion? These are vets with advanced training in more complicated disorders, and even though often more expensive than GP vets, can save you money in the long run by being more astute in terms of diagnostics.

I know you are anxious to see Spanky feeling more comfortable, and it may be the case that Cushing's turns out to be part of the equation for you guys. But in the short run, I don't think you're doing significant damage by holding off on those diagnostics and focusing isntead on the diabetes management. Either way, do keep us updated, though, OK?

Marianne

[pvriz]

Thank you for the informative replies. Spanky's thyroid is normal. Unfortunately I have not been successful with consistent at home glucose testing so I'm not sure how well the insulin has been working. The folks at k9 diabetes agree that a six month follow up is absurd especially when he had quickly escalated to a dose of insulin (7.5 units/2x) which is on the high end (but not textbook insulin rsistance) for a 15lb dog. However it does raise another red flag toward cushing's - perhaps in the early stages. He has had insomnia as well and trouble staying settled.

Regarding kidney function and blood /protein spillover here are urinalysis results from initial visit:

Blood: Trace Negative
Protein: 2+ HIGH
RBC: 11-20 0-3 HPF HIGH

I will be calling around to find a vet with experience working with concurrently cushinoid/diabetic dogs. Good advice.

[pvriz]

Went to see a new vet; very experienced (older lady), kind, animal lover with an Ivy league vet degree. Feel much more comfortable, especially because she respected my own, admittedly limited, knowledge, and took more time to have a conversation/answer questions.

She was rather confident in her belief that without addressing cushing's (if he does have it, which is her delicately expressed suspicion upon examining all of Spanky's medical records and a physical exam), one cannot adequately regulate blood glucose (at least in Spanky's case) - so they should be dealt with concurrently. I am awaiting his urinalysis cortisol:creatinine result, then likely more tests, acth and the rest. She did prescribe antibiotics for a uti, which the previous vet overlooked. Hopefully that will help Spanky feel a bit better in the meantime. I will post this in the k9 diabetes forum as it might be helpful to those who are struggling with cases similar to my own.

[grapey]

I'm sorry you're going through this. I hope you get some answers soon.

edit: I'm dumb--looks like you're already well aware of home testing. If only I could do home testing for both my cushing's dog and my diabetic cat! I've saved tons of money by testing my cat's BG at home. Guess it's all going to the dog ;)

[Jenny & Judi in MN]

hi: I don't know if I ever replied to you at the diabetes forum but we wound up starting Jenny's cushings treatment before her diabetes was regulated also. I struggled to test her blood sugar at home and didn't really sweat it when she was consistently in the 500's and 600's. But, once the cushings meds kicked in, her insulin needs went from 7 units twice a day to 3.5 units twice a day.

We had some scary lows. And we learned how to test blood sugar at home.

I'm glad you found a vet who wants to work with you and clearing up the UTI should lower the blood sugar also!

Judi

[molly muffin]

So glad to hear that you have finally found a vet who will work with you.
Getting the infection cleared up will help a great deal too.

hugs,
Sharlene and Molly Muffin

[pvriz]

Default Spanky Novolin N Question - cushing's and diabetic
My beloved chihuahua Spanky and I have been on a horrific odyssey dealing with diabetes and cushing's since October. To be brief, after getting cushing's under control in March using lysodren, as often happens, his insulin requirement changed rapidly. He went from 8 units of Novolin N to 4. I had to figure this out myself as this vet (third) didn't grasp the insulin change. One thing I have learned is that only you can be the best advocate for your dog. It's a very heavy load and you have to educate yourself quickly in a stressful environment.

My specific issue is this: 4 units of N is lasting about 8 hours then he skyrockets from 160 range to 600-700. Vet says to wait the extra 4 hours until next shot. That doesn't sit right with me. My thought is to possibly give 3 shots spaced 8 hours apart - 4 units each at 8 am, 4 pm, and 2 units at 12 am.

My vet and I fear Spanky is toward the end of his journey. He can't spend so much time hyper, not to mention the damage done by the cushing's. I almost lost Spanky a few weeks ago because he was not eating (always a big eater) and became extremely lethargic. This vet (#4) rightfully suggested giving a half dose of insulin even without food, and he made another comeback. I will run my idea regarding his insulin timing at his appointment tomorrow. Any feedback would be appreciated. Sorry for the lack of detail but time precludes right now.

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about insulin needs into Spanky’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[Harley PoMMom]

I apologize as I know almost nothing about treating diabetes, have you posted your concerns over at the k9diabetes forum? I am sure you will get some good feedback from them and hopefuly our members that are knowledgeable about canine diabetes will be along soon.

Hugs, Lori

[Wally P's Mom]

Hello:

My 15yr doxie has diabetes, treated for Cushings and is now Addison's.

I don't have experience using the brand of insulin you use. However, it is really important to feed at the same time each day and watch you snacks. A small snack could really cause havoc with a BG reading. You really need to track everything. Get a scale and measure his food and water. Please read labels. You would be surprised to see how many treats have sugar in them.

One sign that I knew my dog was going Addison's was his water consumption. This was before a crisis occurred.

I track his BG, units of insulin given, food, water in a book each day. When I see the vet, his book comes too. I also track his BG on an App on my phone. From this I can see where his life changes occurred.

This is not easy. You can do this, but it takes dedication on your end and your vets end.

Normal is not normal anymore. Don't look for it. You and your dog have a new normal.

I may sound a little crazy, but we have done this for the last 17months.

Marge