Sissy's Mom- need help!!! - possible cushing and diabetes

[Sissy's Mom]

Hi to everyone.
I am on the k9 diabetes forum, but it appears I need help.
Let me tell you about my very special little girl;)
Sissy is a 10 yr old spayed female bichon. She has had diabetes since
July 20, 2012. She now eats Wellness Core Reduced Fat, 1/2 cup morning and nite, with 1 teaspoon pumpkin, and 1 teaspoon merrick 96% chicken. She is on Novolin N, varying units, but most recently 5 units day, 4 units nite.Since her diagnosis, she has been all over the map. from 100 to 600, (and last nite 800) with small keytones. She is down now to 300 and trace keytones.
We have done bloodwork, ultrasounds, she had a thyroid panel done about 4-5 months ago, and it was negative. Her regular vet and her IMS suspect cushings. She has the pot belly, the hair loss, and her skin is thin and some of it is dark.

Tell me what you would like for info to help me with her. I am scared and confused, and do not know where to turn...:eek:

[Roxee's Dad]

Hi and welcome to you and Sissy,
Sure sounds like you and Sissy have been through the ringer. Well it certainly can be cushings and once that is under control, the diabetes management should get easier.

I would definietly test for cushings, can you tell us what her ALK was on the last blood test? Also does Sissy have a ravenous appetite?

We have a few members who are dealing with both cushings and diabetes, I am sure they will stop by to welcome you and share their experiences.

Hang in there, both are manageable.

[Sissy's Mom]

Hi John,
Yes, her ALK was as high as 435, last test 179, her ALT was 283, last test 78. I don't know a lot, so any info is helpful!!!
I contribute her better numbers to a food change, from DCO to the Wellness core reduced fat.

Thanks, Jackie

[Harley PoMMom]

Hi and welcome to you and Missy from me as well! Very happy to see that you are a member at our sister site, k9diabetes, they are wonderful people and have great knowledge of canine diabetes. Some of our members here are treating for both diabetes and Cushing's, so I am sure they, along with the "others" will be along soon to welcome you and Missy and share their advice.

If you could get copies of any tests that were done on Missy and post only the abnormal values with reference ranges and units of measurement, that would be great! As an example...ALT 150 U/L (5-50). Also, could you post the findings of the ultrasound, such as the size/shape of the adrenal glands, liver, kidneys, etc...

Is Missy drinking/urinating a lot? Does she have a ravenous appetite? If Cushing's is suspected, since she has diabetes, then I would recommend having an ACTH stimulation test done to see if her cortisol is elevated.

Here is a link to our Resource Thread where you will find lots of info regarding Cushing's: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10) Feel free to print anything out, and if you have any questions please do ask them.

Hugs, Lori

[Sissy's Mom]

Hi Lori,
On her ultrasound, she has had 2. but the latest showed liver slightly enlarged, due to diabetes. Her pancreas was ok and her adrenal glands were both within normal. One was on the high side of normal, that was done 3 days ago.

Her alk phosphous was high 179 ( normal 5-131)
Her BUN/creattinine ratio was high 33 (normal 4-27)
Cholesterol was high 524 (normal 90-324)
Trigylcerides were high 617 (normal 28-291)

thanks, Jackie

[Sissy's Mom]

LOL, how do I change my settings, so the newest post is at the top of page?????

[molly muffin]

Hello and welcome to the forum. :)

At the top left corner of the web page, you'll see a link for USER CP. Click that and here is where you can do all kinds of thing. On the left hand side you will see Edit Options. Click on that and a page with a whole slew of options for the forum will open. You'll have to scroll down for a little ways and you'll see a section entitled "Thread Display Options" In this section you can set up how you few threads. Let us know if you run into any difficulties.

So glad you found us. Interesting that the liver enzymes aren't way over like we often see and the adrenal glands are enlarged either. Some of those seem to go along with diabetes.

Welcome again,
Sharlene and Molly Muffin

[Sissy's Mom]

Thanks Sharlene,
Got it ;)

[Sissy's Mom]

I have not been on for awhile. Been dealing with diabetes regulation. Just started her on Levemir yesterday, she had been on NPH. This past week I had a blood panel, urinanaylsis , and apt with IMS. Some of Sissy's #'s are better, like triglycerides, ALT, however ALK is 218, she has some protein in urine, and gall bladder numbers were elevated.
Also, the IMS said she has calcinosis cutis, however treating for cushings is questionable because of my income. I can afford to find out if she has cushings, ACHT, but the required blood tests, ACHT's, to track levels, will put it out of my reach.
Has anyone else been in this situation and is there ANYTHING I can do for the calcinosis cutis?????? I just happened to come on here from a google site, and did not realize when the vet told me about this, that it was such a huge diagnosis and problem.:eek:
Any suggestions greatly appreciated.
I am also on our k9 diabetes site.

[Harley PoMMom]

Sissy does not have a confirmed diagnosis for Cushing's, right? How is the diabetes coming along? Does the diabetes seem to be really hard to regulate?

It is true that calcinosis cutis can be attributed to elevated levels of cortisol, however; calcinosis cutis can be caused by other non-adrenal illnesses.

We do have members dealing with that dreaded CC, which I am providing links to their threads: My girl pug (confirmed Cushings & confirmed calcinosis cutis) / Introduction (http://www.k9cushings.com/forum/showthread.php?t=5908)

new to Cushing searching for advise for Buttercup (Calcinosis cutis) (http://www.k9cushings.com/forum/showthread.php?t=5850)

I have no experience with CC, but I am sure those members that do will be along soon to sshare their advice.

PS: I have included calcinosis cutis in you thread title so members dealing with this will see your thread and share their knowledge.

[molly muffin]

You could try to do a UC:CR test to check for cortisol levels. There is also a new hair tests that some labratories offer now to check cortisol levels. I know of one lab up here in Toronto that offers it and the kit is about $98. You could ask your vet about that option, cheaper than an ACTH to start out with. This could determine if cushings is the problem. Then take it from there.
Basically to get CC under control you need to lower the cortisol. To do that you need to treat if it is caused by cortisol levels. The monitoring tests can be very costly, so discuss any and all options with your vet and see if there is anything that they can do as far as the monitoring goes.
Also Care Credit if you don't already have it, can be very helpful too and many of our members use it.
There is a spray that some members use Trizchlor spray. You get this via prescription. (always check online prices as they can be better than vet pricing, you just need the prescription) Same with a medicated shampoo.

hugs,
Sharlene and molly muffin

[Sissy's Mom]

Thanks Sharlene,
I will look into all of it. Wow, also check on care credit...:confused:

[Sissy's Mom]

I have just made appt for an ACHT for Sissy. All her vets believe she probably has cushings.
Question??? How should it be done , what do I need to know, and will she have any after effects???
They said blood test & medicine at 3 pm, then another blood test at 4 pm, then we can come home. We are doing it 9 hours after her breakfast and insulin(she is diabetic):eek:

[Renee]

So glad you are getting the ACTH done. I don't know how the diabetes affects the results, or the timing of the insulin / meal in relation to the results, so hopefully someone else can chime in with some input.

[Sissy's Mom]

Sissy had her ACHT last week. her reading was 15.9 out of 17 I think.
She has had really high numbers with her diabetes, since the test. I wonder if the test could be affecting them.
Also, there is some question about typical or atypical???
I don't know if the signs and symptoms are the same or different.
She drinks a lot I guess, has a pot belly, really thin hair. Almost none on her tail.
Can anyone tell me what is the difference and if she is borderline cushings, could she be atypical?

[Harley PoMMom]

Atypical Cushing's is when one or more of the adrenal hormones namely; androstenedopne, estradol, progesterone, 17 OH Progestereone, and aldosterone, are elevated but the cortisol is not. The lab at the College of Veterinary Medicine The University of Tennessee performs the testing but your vet must draw and prepare the blood samples and then send them to the UTK lab.

Could you get copies of Sissy's last ACTH stim test and post those results here?

Our Resource Thread has information regarding Atypical: Congenital adrenal hyperplasia-like syndrome/ Hyperestrinism/ "atypical Cushing's" (http://www.k9cushings.com/forum/showthread.php?t=198)

Does Sissy still have the calcinosis cutis? I do believe that the stimulating agent that is used in the ACTH test can have an effect on a dog and diabetes, it should be short lived.

Hugs, Lori

[Sissy's Mom]

thanks Lori,
LOL, yes I think the ACHT test caused even crazier numbers with her glucose than she has already. I don't know how to post the page, but her reading was 15.9...is that what you meant????
sample 1 1.2 (range 1.0-5.0)
sample 2 15.9 ( 8.0-17.0

[Sissy's Mom]

Hi,
I have a diabetic bichon and am on the k9 diabetes forum. It was always thought she has cushings, but could never get a definite diagnosis. It was thought best not to treat as her symptoms don't seem to bother her. She has pot belly, severe hair loss, but otherwise does ok. She has been diabetic for 3 yrs +.
However, I have a 15 year old bichon, Fritz. I adopted him when he was 13. He was an owner turn in. He is fairly low key, never a very good eater. In the past 2-3 months, he is ravenous! he eats every bite and growls if anyone gets near him. !!! He also is drinking more water and he pants a lot.
My question is: if I was to test him, besides a general blood panel, would I be better off to get a ACHT or a low dose dex suppression
I think I remember that one of the tests was better if you had a diabetic and one was better if your pup was not diabetic..
If it turns out he is positive, would you even treat a 15 yr old???
Would love thoughts,

Thanks in advance :)

Jackie

ps. he weighs 22 lbs, eats 1/2 cup wellness core reduced fat kibble
morning and night with a spoonful of hamburg or ground turkey.

[labblab]

Hello Jackie, and welcome to you and Sissy and Fritz!

Your memory indeed serves you correctly in that both the ACTH and LDDS have strengths and weaknesses in terms of diagnostic testing. Unfortunately, there is no single perfect, definitive test for Cushing's, so deciding upon which test to use does depend upon every dog's individual situation.

The ACTH is less likely than the LDDS to deliver a "false positive" in the presence of other nonadrenal illnesses. For this reason, this would be the preferred test for a dog who is known to be diabetic or suffering from another significant illness. However, the downside to the ACTH is that it is more likely to return a "false negative" and miss making the diagnosis even if a dog truly does have Cushing's (it does an especially poor job of identifying the adrenal form of the disease).

Because the LDDS is a more sensitive test, it is generally considered to be the better choice if a dog exhibits strong symptoms and does not suffer from any other known illnesses. It is less likely than the ACTH to return a "false negative" if a dog truly has Cushing's.

So in Fritz's case, it sounds as though the LDDS might be the preferred diagnostic blood test. And if he were to indeed test positive for Cushing's, what to do about treatment? For elderly dogs, I usually recommend that immediate quality of life issues be the deciding factor. Prevention of slowly developing, chronic systemic issues takes the backseat for me if a dog is already nearing the end of its natural lifespan. But if the Cushing's symptoms are making the dog uncomfortable and compromising quality of life, then I'd probably go ahead and pursue treatment. As you probably already know, Cushing's treatment does require close monitoring which involves repeated vet visits and blood draws. So that is another consideration in terms of an elderly dog's quality of life.

In the case of my own Cushpup, he was so miserable with his Cushing's symptoms that I would have considered treatment for him at any age. But other dogs are not particularly bothered by milder symptoms, and so the decision may involve more consideration. Whatever you decide, we're so glad to have you join us and we look forward to reading more about both your furkids!

Marianne

[Sissy's Mom]

Hi Marianne,
Thank you so much for your great info. I thought I was correct, but wanted to be sure. Sissy had acht and was borderline. as I remember without looking about 16 or 17??? anyway, Natalie and others suggested not treating if she wasn't uncomfortable and it wasn't pretty sure. the acht test was really hard on her. She was sick for about 9 days, her numbers skyrocketed...
With Fritz, I'm not sure I would treat at this point, as he doesn't seem to bothered. he has no pot belly, his hair is so thick it's impossible to brush,lol, but tested his blood sugar and that is fine, so thinking cushings or maybe thyroid??? I think I will get regular panel done and go from there. Will let you know ...
Thanks again for your info :)

Jackie

[molly muffin]

Hello and welcome from me too.

It could also be thyroid as that tends to have some of the same symptoms as cushings.

I agree with Marianne, it comes down to quality of life with an elder pup.

Welcome to the forum.

[Squirt's Mom]

Just FYI - here is Sissy's thread - http://www.k9cushings.com/forum/showthread.php?t=5911

[Sissy's Mom]

Hello All,
Sissy has been doing pretty well, with her blood glucose staying fairly good for her!!!100-350s...all of a sudden, it seemed, about 2 months ago she started to get irratic glucose numbers. I took her in for a blood panel, which found quite low thyroid levels. I started her on thyroid pills,(.1mg morning and night). She had a recheck bloodtest today,will have results Monday.
All her vets have akways thought she had cushings. 2 yrs ago she had an ACHT and it was not definitive. I had let it go as she did have pot belly, almost no hair, but no panting, excessive drinking or hunger...
However, the time has come that both her regular vet and her IMS feel a low dose dex suppression test is a good idea. Sissy has had a very bad 2 weeks.crazy numbers and visibly not feeling well. She is more hungry,buit I attribute that to the thyroid pills.
My question... what side effects should I look for from the low dose test, what range would indicate most likely cushings????
and is there another test I should also do??? Her IMS wants an adrenal ultrasound which I would do if low dose pointed to cushings..She wants to make sure there are no tumors etc.
What else should I know or be aware of at this point??? Thank you in advance for your thoughts :confused:

[labblab]

Sorry I have only a moment to post, but I would ask your vet about performing a diagnostic ACTH stimulation test either in place of, or in addition to, the LDDS. The LDDS is generally the preferred diagnostic test for dogs without other known illnesses. However, the LDDS is more vulnerable to returning "false positives" for Cushing's when dogs are suffering from other, nonadrenal illnesses. If Sissy is not feeling well right now and exhibits erratic glucose readings, I would worry that the uncontrolled diabetes may falsely skew the LDDS results.

Marianne

[Sissy's Mom]

Thank you marianne,
I will definitely ask about that. Maybe i would be better to do the ACHT ???
Finally,with starting a new pen,raising insulin and adjusting food a little,her numbers started at 331 and are ending (at supper) around 200...hope i am getting her back in line.although,lol,she is known for doing good for a few days and then being crazy!!!! Fingers crossed

[Sissy's Mom]

[B]HAPPY 13TH BIRTHDAY TO MY SPECIAL GIRL SISSY...:D:D

Woohoo, green beans and chicken treats today...Seem to have gotten her numbers back down...waiting a couple of weeks to pursue Ldds test??? or ACHT??:confused:

[molly muffin]

Happy 13th Birthday Sissy

yummy, Green beans and chicken. :)

ACTH I think when diabetes is involved.

[molly muffin]

Hi, I changed the title of your thread as requested to reflect possible cushings and diabetes for others who might also be dealing with both. :)

[Sissy's Mom]

Thanks Sharlene,
Thats perfect...waiting for thyroid bloodtest results today.
The more i read,the more confused i get. It seems thyroid and cushings are confusing!!!!!!:eek:

[Sissy's Mom]

Hi all,
Got thyroid retest back. Originally she was .5, now up to 2.1 with range 2.6 to 6.0...
Am going to stay with current dose for a bit to see if Sissy is going to stay stable on her increased insulin dose.
Would love some thoughts on whether pursueing cushings has more benefits or negatives...anyone have ideas on pluses and minuses. ..what do i need to take into account to help with this decision.I've read so much I'm confused.

[molly muffin]

Well I think that if her thyroid is coming back to where it should be then that is good.
Thyroid and cushings Can be quite tricky, as many cushings dogs have low thyroid, which can normalize with cushings treatment.
I guess I'd see what her glucose levels do and then take it from there. Sometimes dogs are resistant and normalizing the cortisol can help with glucose control.

[Sissy's Mom]

Sharlene,
Her glucose right now is 100 to 300s since i raised her insulin. She has good times,and not so good times with numbers.
Would you do the ldds and see what it shows???? And then make the next decision????

[molly muffin]

With diabetes in the picture I would do the ACTH, as the LDDS 'could' return a false positive.

[Sissy's Mom]

Is the acth fairly reliable, with diabetes

[Sissy's Mom]

Changed avitar...you can see sissys pot belly and hair loss:(

[Sissy's Mom]

If i can keep Sissy's blood sugar levels in decent range,and she has no bothersome symptoms ( ie- panting,excessive hunger and thirst)
What is the benefit of treating cushings????????

[Joan2517]

If I had it to do over, I don't think I would put Lena on the Vetoryl at her age. She was 15 and we were dealing with the drinking and the peeing. She was on medication for high blood pressure and I think she would have lasted longer if I had not treated the Cushing's....I could be wrong, but that's how I feel.

I wish I had known I had time to research more. My vet said we'll put her on a pill and she'll be fine. If I had found this forum sooner, I would have waited until I knew more. I certainly would not have put her on 30mgs.

The key here is knowledge...do your research and then make an informed decision...the one that's right for you.

[lulusmom]

Hi all,
Got thyroid retest back. Originally she was .5, now up to 2.1 with range 2.6 to 6.0...
Am going to stay with current dose for a bit to see if Sissy is going to stay stable on her increased insulin dose.
Would love some thoughts on whether pursueing cushings has more benefits or negatives...anyone have ideas on pluses and minuses. ..what do i need to take into account to help with this decision.I've read so much I'm confused.

Aside from the fact that Sissy’s bg recently spiked, what else was going on at that time that made both your vet and the IMS think that cushing’s is still a possibility. It was just recently that your vet put Sissy on thyroid supplementation so I am wondering why he doesn’t want to give that some time to see if you gain better control of the bg? The initial result of the thyroid test was .5 and I suspect that your vet did a snap test in which case, this result would be for the T4 hormone only. Can you confirm that please? Given that cushing’s was suspected before this testing was done, I would think a full thyroid panel would have been done to differentiate between primary hypothyroidism which will require lifelong thyroid supplementation, and euthyroid sick syndrome,which is not a thyroid problem but rather a non thyroid illness that is causing low serum levels of thyroid hormones. We see euthyroid sick syndrome a lot in dogs with uncontrolled cushing’s. Once treatment of cushing’s has effectly lowered cortisol, thyroid hormones normalize. When was Sissy put on the .1 mg levothyroxin? Was that after you increased to insulin to 2.5 units or before? I see that the recheck of thyroid was just done and results are up at 2.1 with the normal range being 2.5 to 6.0. As I mentioned previously, I suspect the vet is doing a snap test and the actual normal reference range, which is what we are used to seeing on blood chemistry is 1.0 – 4.0 ug/dl. The goal or therapeutic range is most likely the 2.5 to 6.0 ug dl you mentioned. 2.1 ug/dl is not yet within the optimum therapeutic range but it most definitely should be high enough for you to start seeing improvements in any symptoms, if they were in fact being caused by low thyroid. Those symptoms could be increased appetite, listlessness, improved control of bg, improved skin and coat issues; however the latter two would take longer to see marked improvements. Can you tell us if you are seeing any improvements?

I agree that thyroid and cushing’s can be confounding as they share overlapping symptoms. When you throw diabetes in the mix, a recent hypothyroidism diagnosis and missing information, it becomes beyond confusing. Until further clarification from you is received, I believe pursuing a cushing’s diagnosis at this point seems premature. I see that your vet diagnosed Calcinosis Cutis (CC) two years ago yet subsequent acth stimulation test was normal. CC is a rare and very difficult symptom of cushing's to resolve without treatment and even then, it can get a lot worse before it gets better. I would think that if Sissy had CC, it would be pretty horrible by now if cushing's was the cause. Did your vet confirm a formal diagnosis of CC appropriate biopsy? If not, and the problem resolved in the last two years, it's more than likely it was never CC. Perhaps you can update us on that issue.

I become very concerned when a vet or even a specialist wants to pursue a cushing’s diagnosis in a dog whose insulin requirements is nowhere near that which most experts consider to be the max amount before deeming a dog insulin resistant. Dr. Mark Peterson, a renown and very well published internal medicine specialist, sets that maximum at 2.2 units per kg per injection. At Sissy’s weight, that equates to 14 units. Her current 2.5 units per injection is .39 units so she’s got a long way to go before Dr. Peterson would be suspecting cushing’s. I have provided a link to one of Dr. Peterson’s pages from his Q & A for veterinarians and pet owners. This particular page addresses a question from a vet who has a diabetic patient who seemed to initially respond okay to insulin but subsequent testing showed persistent hyperglycemia. A LDDS test was done which Dr. Peterson indicated could likely be a false positive. You will note that the only comment at on the bottom of page is from the owner of our sister site, k9diabetes. She was happy to have Dr. Peterson’s validation as to what defines insulin resistance. You will also notice that she says her group often sees dogs who are immediately tagged as being insulin resistant at only .5 unit per kilogram. Sissy is on even less than that. :confused: I did not scan your thread on k9diabetes but I am providing a link to that thread below:

http://www.k9diabetes.com/forum/showthread.php?t=5557

Lastly, I see that Sissy is getting tramadol for leg pain. Dogs with uncontrolled cushing's have an over abundance of circulating cortisol in their blood. Since cortisol is the body's natural and most excellent anti-inflammatory, these cushingoid dogs don't really feel the aches and pains joint and disk disease. Once treatment for cushing's reduces the cortisol, those aches and pains are unmasked and the dog can be very uncomfortable. I would think that if Sissy had uncontrolled cushing's, she would not be requiring Tramadol for pain.

I apologize for writing a novel here with more information from you, we will understand Sissy's complete history a lot better which will allow us to provide more meaningful feedback and ask appropriate questions that may not have been answered.

http://www.endocrinevet.info/2012/01/q-diagnosing-cushings-disease-in-dogs.html

Glynda

[Sissy's Mom]

Wow Glynda,
I relly appreciate your time and information. I will try to answer your questions, so I can figure out where I am with Sissy.
Sissy's regular vet and IMS think cushings because of Sissys hair loss, pot belly, and rat tail...They say she is the poster child for cushings.
Sissy was started on thyroid about 6 weeks ago now. She had a full thyroid panel with Dr. Dodd, Hemopet in May of 14 when her t4 was low, but not as low as it is now. then it was t4 .75 range 1.2-3.00, free t4 was .81 range .70-1.75, t4/ft4 ratio .92,27.0 range 25-60. At that time, Dr. Dodd felt it was non thyroidal issue...
No, my vet did T4,free T4 ?? with complete blood panel.
Sissy was put on the .1 thyroid before I increased insulin. It was my impression that with diabetes, the blood glucose levels would go down with thyroid meds??? Sissy has always been a rebeller,lol, but she hasn't gone down. However, with the increase in insulin( levemir insulin, not nph) I am getting great lower numbers...she is going into the low 100's with a high of 300, which is wonderful for her. Perhaps the increase in insulin and the thyroid are working together to help bg's.
The Calcinousis cutis diagnosis is from IMS. She has thought that for probably 2 yrs, however, it hasn't gotten worse, and no, has not been a confirmed diagnosis.
Sissy has had pain and problems with basically her left front leg, for some time. maybe 3-4 years. She was diagnoised with diabtese in July 2012...She limps and if she moves wrong she will say ouch!!!!
The 1/4 of a 50mg tramadol seems to help a little, but she still limps some...
I really appreciate the info. It is what I need. It is hard to know what questions to ask, when you don't know the question!!!thank you so much for your time. Please let me know if anything else sticks out to you...
At this point, if the increase in insulin and thyroid help her numbers, and she does seem to feel a little more interested in things, I am really wondering what the point would be to pursue anything else.The exception would be if internally, she would work better and feel better????:confused:

Jackie