Mandi is throwing up and trembling

[mandi]

My 8 yrs old Yorkie was diagnosed with cushings last year. She recently was diagnosed with diabetes. They couldn't get her glucose numbers under the 600's, so she was sent to a specialist this week. Her glucose was now in the 400's, so he had me increase her Trilostane to 14 ml's a day. She now is throwing up, and shaking. Does anyone have this same issue? She has only been on insulin for 6 weeks, so they are just adjusting her meds. She takes 18 units of insulin daily. Is that to much?

[mandi]

What makes my Mandi tremble? Is it to much Trilostane? They increased it by 2mls's yesterday, so now she is on a dose of 9ml's a day. She weighs 16 pounds, and also was recently diagnosed with diabetes. She has not had these trembles and shaking before. Does this require an ER visit. I just had her at abspecialist 2 days ago. They did an ultrasound and all labs.

[labblab]

Hello and welcome, but I'm sorry for your baby's problems right now. We will have more time to talk later, but from what you're describing, I think it would be safest for you to take her in to be seen by a vet, even if it means the ER. The trilostane increase may have altered her glucose level or other blood chemistries in an adverse way, or her cortisol may be droppng too low. If her trilostane dose was increased solely on the basis of the glucose level and not without also checking the cortisol level, she may be overdosing. Does the IMS have an emergency service you can call directly? I do think Mandy needs to be re-evaluated ASAP.

Marianne

[mandi]

Thank you for responding. I take her to the vet weekly. 2 weeks ago her glucose levels were in the 500's throughout the day. Then last Friday they tested them and they weye around 700 all day. So my vet sent me to a specialist due to being on Trilostane at 7 a day. She spends the day at a specialist on Tuesday, and they told me yesterday that her glucose levels were in the 400's, and her ACTH stim test showed 5.3. Her ultrasound looked good. He asked me to increase her Trilostan by 2mls's. Now she started trembling, drinking alot of water, and threw up. Is that a sign of to muchTrilostane?

[labblab]

It could be. But something else may just be "off" with her glucose level or blood chemistries. It's really hard to know.

I'm glad the vet did an ACTH test. Everything else being equal, I don't know that the trilostane dose would have been increased since a result of 5.3 is within the therapeutic range. But obviously, the specialist must be hoping that if the cortisol is lowered a bit more, that will help with the glucose.

It sounds as though you are giving the trilostane in a liquid form. When you say you have increased the dose by 2 ml, that tells us the quantity of liquid, but it doesn't tell us what the actual dose of medication is. The dose should be listed in units of mg. instead of ml. The bottle should have some sort of notation as far as how many mg. of trilostane are contained within the ml. Can you double-check the bottle and tell us exactly what it says?

Regardless of cause, though, if Mandi continues to throw up or act abnormally, I think you need to consult directly with a vet.

Marianne

[mandi]

It is equal to 50mg every 12 hours. And I only increased it on her nightly dose last night. You are correct. The vet is trying to get her cortisone levels down some, without increasing her glucose levels. She finally emptied her stomach out, quit trembling and is asleep. I guess I will call her specialist this morning. UGH. This cushings is exhausting

[mandi]

It is equal to 50mg every 12 hours. And I only increased it on her nightly dose last night. You are correct. The vet is trying to get her cortisone levels down some, without increasing her glucose levels. She finally emptied her stomach out, quit trembling and is asleep. I guess I will call her specialist this morning. UGH. This cushings is exhausting

[DoxieMama]

Hello and welcome to you and Mandi. I'm sorry I don't have any suggestions to offer right now. Wow, 50mg twice a day for a 16 pound dog sounds like an awful lot of Trilostane!

I am glad you will be contacting the specialist this morning. Please let us know what you find out.

Hugs!
Shana

[mandi]

So 50mg is alot? Her levels are at 5.3. I will definitely ask her vet today about that. She was at 40mg twice a day. She has been on that for about 8 months. My biggest question is how much longer do I have with her. Is her dosage so high because she is at end stage cushings? I know it is hard to answer, but an estimate,would be helpful. My vet says less than a year with her since she now has diabetes.

[Joan2517]

There is no timetable for how long...every dog is different. Try to focus on and enjoy the time you have left with her. This is a nerve-wracking disease and it's hard to stay calm, especially when we don't know what to do for them. It sounds like you are doing everything possible and that she is very much loved...and she knows it.

[mandi]

Thank you. I cherish every second I have with her. I don't want her to suffer. I want to be selfish and keep her here for many years, but I have to be realistic also. Her in pain kills me. I appreciate your kind response

[DoxieMama]

:o Oh, I'm so sorry! I didn't mean to alarm you with my statement. I am still relatively new to all this and that just sounds like a lot to me. But like Joan said, every dog is different. Some need more meds, others need less. You've got the ACTH test result that shows it isn't too much for Mandi. You are doing a wonderful job taking care of her!

[mandi]

Thank you so much. You didn't set off alarms, you actually did comfort me. I will keep you updated. Thanks again. I would like
to add I found out this morning that my grandson fed Mandi some of his pizza last night. Hopefully this is what set her off with throwing up.

[Joan2517]

LOL! All my guys love, love, love pizza!

[Renee]

Trembling and throwing up, combined with having eaten something she should not have eaten could mean she is having an attack of pancreatitsis, which can be very painful. I've been through this more than once with my own cushings dog. I would suggest not waiting much longer before getting her in to see the vet. Better safe than sorry.

[mandi]

Thank you. I do have a call into her specialist. He will be surprised since she spent the day with him Tuesday and she was doing great

[DoxieMama]

I second Renee's comments. Pancreatitis is definitely not something to mess around with... and high fat food (like pizza) certainly can set that off. Be sure to mention it.

How is she doing now?

[mandi]

She is back to normal. And like you say, the pizza might have set her off. The vet said return to normal doses of meds today and watch her. But she appears to be better. Time to call a family meeting and discuss her health. The kids will forget but no excuse for the adults to watch the children feed her people food. I might have to monitor the adults now. Thank you all for your advice. I am sure as this cushings journey goes on you will hear more from me. This is better than going to the emergency vet in the middle of the night.:)

[Renee]

Yes, it's important to have that family meeting. It took a very dangerous bout of pancreatitis to educate my family about feeding my pug the right things. Her diet is quite controlled now.

I am so glad your girl is feeling better and it never got any worse. Good girl!

[molly muffin]

Welcome to the forum.

I also want to direct you to our sister site for diabetes,

www.k9diabetes.com/forum

They have a lot of experience with diabetes and some with cushings too. We've had dogs with both and once both are under control, they can do just fine and last a long time. There is no Set time for how long.
The key is having them both stablized.

A diet is important with the diabetes especially, we usually say it is best to have a good protein and lower fat, as it lessens the possibility of pancreatis.