cushing and diabetes

[tasia]

Our dog Gina a mini poodle is suffering from diabetes 3 months now.We started with diabetic food and one shot of Caninsulin a day. No results so turned to another shot a day. Nothing again so we took her to another vet.He examined her thoroughly, made blood tests and found high phosphatase ALT and cortisol levels.After a low dexamethasone test she was positive with Cushing so we started giving Vetoryl twice a day 2,5 mg each dose.Gina was 6,9 kg and now she is 5,1.We are very worried about her.Can anybody give us any advice, please?

[lulusmom]

Hi and welcome to the forum.

I have manually validated your membership so that your posts can now be seen by all members. You may disregard the email from us asking for your response to validate.

We are always concerned when dogs are diagnosed with cushing's before the diabetes is under control because chances are, the results are false positives. This is particularly true with the low dose dexamethasone suppression test (LDDS). It would be highly unlikely to get a negative LDDS result in a dog with uncontrolled diabetes. Many of the symptoms of cushing's and diabetes overlap as do many of the abnormal lab values. Does Gina have thinning or loss of coat? Any skin issues. How many units of insulin was Gina getting before your vet started testing for cushing's?

We have a sister site, www.k9diabetes.com, and I highly recommend that you join there too so that we can all work in tandem to help you help Gina. The members there are amazing but that's not to say we aren't amazing but they certainly are a lot more experienced and educated in providing you with more meaningful feedback as it relates to diabetes.

With respect to the Vetoryl, that dosing is in keeping with safe protocol for a dog who has been properly diagnosed with cushing's. Is your vet a general practitioner or an internal medicine specialist? Sorry for asking so many questions but the more information you can provide us, the more meaningful feedback we can provide you.

I'm sorry for the circumstances that brought you here but I'm glad you found us. We'll do whatever we can to help as will the folks on k9diabetes. I'll be looking forward your responses.

Glynda

[tasia]

Dear Glynda, thank you so much!Gina has thinning and loss of coat as well as a skin problem on her tail and near the tail which the vet said has to do with Cushing.Also she was getting 4iu Caninsulin twice a day. She is 5,1kg. The insulin is too much for her weight and still her glucose was ranging from 451 to166 , and she went on losing weight. Thats why we decided to go on with further blood exams. They were ALT 161,SAP 509, cortisol 12,9 at 6,5 pm. After this she had the LDDS which was 14,7 at 9,5am -5,02 after 4 hours and 4,19 after another 4 hoursAll the vets in greece dont have a speciality. So this brought us to the treatment with Vetoryl 2,5 a day- the capsules were divided by a pharmacist -till now -2 days - Gina has not a change . Thank you .

[Harley PoMMom]

Hi and welcome from me as well,

Cushing's is one the most difficult endocrine diseases to get a confirmed diagnosis for and it is often misdiagnosed. When a dog has a non-adrenal illness, such as uncontrolled diabetes, false positive results are common from the LDDS test.

Dr Peterson, a renown Cushing's expert and who also is a contributor to Dechra's continuing education site, has a blog in which diagnosing Cushing's in a diabetic dog is discussed:
The problem with diabetic dogs is that it's very difficult to make a diagnosis of Cushing's with certainty unless we see cutaneous changes. PU/PD, polyphagia, and high liver values all could be secondary to the diabetes. False-positive test results on a LDDST are very common in dogs with nonadrenal illness, such as diabetes

Full article can be found here: Q & A: Diagnosing Cushing's Disease in Dogs with Diabetes Mellitus (http://endocrinevet.blogspot.com/2012/01/q-diagnosing-cushings-disease-in-dogs.html)

I, also, highly recommend that you join our sister site that deals with canine diabetes: http://www.k9diabetes.com/forum/

Hugs, Lori

[AngelToto]

Yikes diabetes more trouble and much more expensive than cushings. So sorry :(

[Jenny & Judi in MN]

you can do this. My dog has cushings and diabetes and I'm actually calmer treating her diabetes because it is easier to check her blood sugar levels at home than to check cortisol levels at the vet.

Like Glynda and Lori mentioned, we have seen a lot of dogs get misdiagnosed for cushings because the diabetes in their system stressed them out and raised their cortisol levels.

Other things that can make them hard to regulate are thyroid problems.

It took a little over a month for my dog's cushings meds to have an effect on her insulin dose. I would definitely stick with the twice a day dosing of insulin though

I haven't used caninsulin but here in the US they say a dog isn't considered "insulin resistant" till they require more than 1 unit per pound. If 5 kg is about 11 pounds I don't think you are close to that. Come over to the diabetes forum. Natalie and our adminstrators are very knowledgable and we have some folks using caninsulin.

My dog was at 7 units twice a day at 8 pounds till we started getting her cortisol down. It didn't happen overnight. Are you testing blood sugar at home? you may want to as my dog had some scary low blood sugar readings as her insulin needs dropped.

hang in there. If I can manage these 2 diseases anyone can. And it's been almost 3 years. Judi

[tasia]

Its 10 days now since we started Vetoryl and Gina has no side effects.She is taking her insulin, then has food with a Vetoryl capsule. This is done twice a day.We check her blood for glucose and things go really fine. 100-230.Tomorrow we ll take her to the vet for testing her cortisol.Lets hope she ll do well.Thank you for standing by me!!

[molly muffin]

Oh I'm very happy to hear that things are going well. It sounds like the blood glucose has been better too?

Hoping for great numbers on the test this week

Sharlene and molly muffin

[flynnandian]

sounds as gina is doing pretty well. hope her cortisol numbers will be fine.

[tasia]

After 11 days of Gina having Vetoryl we took her to the vet. These are the results of the bloodwork:glucose 302(65-118), sgtp-alt 477(10-94), sgot-ast 71(23-66),alkaline fosfatase 531(0-90),cholesterol 980(135-270) cortisol 7,51.Everything else normal.The other day she had aN ldds test 14,7 cortisol, then 5,02 4 hours later and 4,19 another 4 hours later. The vet says Gina is getting better but I cant see this except for the cortisol.What do you think? We tested her for her diabetes yesterday at home:160 at 8 in the morning before giving her insulin, 149 at 2 in the afternoon and then 180 at 8 in the evening before her second insulin shot. I need to say that we feed her after her insulin and with her food she has her vetoryl 2,5 mg.I asked the vet about the acth test he answered that they dont do it here.He said we will take her in a months time for having bloodwork again.Can I have any advice?THANK YOU!!

[Iraklis]

Hi Tasia ,

I am from Athens ,Greece ,too!
My name is Iraklis!
Welcome and sorry this happened to your baby!
***

Who is your vet?

Have you performed an ultrasound or an MRI?

What is her food?

The ACTH IS done but ,imo, an ultrasound and an MRI (even though expensive) will save you tons of money in the long run...

[goldengirl88]

Welcome to you and your baby. Sorry your baby is having troubles, but it sounds like you are doing am good job keeping things in line. I see both you and Iraklis are from the same place! Small world! Blessings
Patti

[molly muffin]

An LDDS test is a suppression test, can they suppress at 4 hour, can they suppress at 8 hour for the baseline. This is a diagnostic test ONLY. Once you start treatment, vetroyl, then the follow up is Always an ACTH or at the very least a baseline cortisol with electrolytes. I don't know what on earth that vet is thinking and it doesn't follow any protocol as set by the manfacturer or the leading professionals in the field.

So, once you are on treatment do not bother with an LDDS. DEMAND at the very least a baseline cortisol, even better, find a vet who knows what they are doing. Lordy, this one is going to give us all a heart attack with answers like that.

What you want to know is if the cortisol starts to go too low (life threatening) or if it is too high (won't help to control the diabetes) only an ACTH or at the very least a baseline can do this.

I hope that helps you out a bit.

Sharlene and molly muffin

[tasia]

Hi, Iraklis! My vet is in Helliniko,Athens. This is my second one. I think he is ok but not experienced enough with cushing. Can anybody explain what baseline cortisol is so as to talk with him about it?THANKS!!

[Iraklis]

His name?

Baseline cortisol is the reading obtained prior to being ACTH stimulated.

Try to get an ultrasound and if possible an MRI.

[labblab]

Hello from me, too. Here's a direct link to the diabetes forum. I hope you will join them, too, so that they can help you with your insulin questions.

http://www.k9diabetes.com/forum/

Also, here's a quote from one of our other staffers, Lori, that may help give you a better understanding of the use of baseline cortisol readings to monitor treatment:


Regarding the cortisol testing, Dr. Audrey K. Cook and another colleague performed a study to see whether a baseline test could be used to monitor dogs being treated with Trilostane. Here are a few excerpts from her article:
During trilostane treatment, baseline cortisol concentrations between 1.3 and either 2.9 μg/dL or ≤ 50% of the pretreatment baseline cortisol concentration correctly predicted acceptable control of adrenal gland function in 147 of 168 (88%) dogs...

...In addition, a baseline cortisol concentration ≥ 1.3 μg/dL could reliably exclude the possibility of an overdose of trilostane in an ill patient or when a patient is reevaluated following a reduction in the dose of trilostane...

...Therefore, measurement of a timed baseline cortisol concentration may be regarded as a screening test for acceptable control of adrenal gland function; a result within the target range would preclude the need for an ACTH stimulation test in a substantial proportion of patients. For those dogs with baseline cortisol concentrations outside the defined target range, an ACTH stimulation test may still be necessary before appropriate adjustments in the dose of trilostane are made...

...However, it is important to regard measurement of baseline cortisol concentrations as a screening test for adequate control of adrenal gland function in clinically stable patients; this technique is not designed to replace the criterion-referenced standard of an ACTH stimulation test when a more detailed evaluation of adrenal gland function is needed. Limitations of the use of baseline cortisol concentrations to monitor treatment should be carefully weighed by both pet owners and clinicians, and this option should possibly be reserved for patients in which the cost of an ACTH stimulation test is an issue for the owners.

Full article can be found here: Evaluation of the use of baseline cortisol concentrationas a monitoring tool for dogs receiving trilostane as a treatment for hyperadrenocorticism ( http://www.2ndchance.info/cushings-monitorcortisollevel.pdf)

Hugs, Lori

Marianne

[lulusmom]

This was a question you posted on another thread which I've provided feedback below:


Ι am sorry to thread-jack a bit but Husko never got tested for diabetes and was constantly losing weight since summer.
(anyone/everyone is welcome to answer this in my thread...is there anything pointing to diabetes in his health-tests I should look for?)

A good number of symptoms associated with diabetes overlap with those associated with cushing's; however, weight loss is rarely associated with cushing's so diabetes would be the first suspect. Your vet should have tested the blood glucose. You should also note that many of the blood chemistry abnormalities are also common with both diseases. Diabetic dogs can have elevated ALKP, cholesterol, triglycerides as well as low T-4 (thyroid hormone).

[Iraklis]

Would it also mess up LDDS and ACTH results? :confused:

[Squirt's Mom]

Yes, Iraklis, diabetes can skew the Cushing's test and result in false-positives just as can hypothyroidism, kidney or liver disease, and other conditions.