My diabetic girl just started Vetoryl - please help!

[SammiGirl2004]

My girl Sammi just turned 13, on March 1st we took her to the vet due to increased drinking/peeing. Diagnosed with Cushing's and Diabetes. Vet started her on 2 units insulin 2x/day and 10 mg of Vetoryl. No change in drinking/peeing and she seemed more tired once on Vetoryl. Had "stim test"and Glucose curve last week, Vetoryl up to 20mg and insulin to 3 units 2x/day. Appetite is fine no diarrhea/vomiting, still peeing/drinking alot. She is very lethargic...pretty much just lays around all day no energy at all. Is this normal? Is it a temporary period of withdrawal of lowered Cortisol? The vet said that some dogs just don't tolerate the Vetoryl well and may need to try Lysodren. I don't know if I want to do that as I heard its just not safe. Read alot about natural supplements such as Flaxseed Ligans, Melatonin etc..anyone use these with success? I would love to give her something natural with no side effects if they are truly effective. Thank you so much

[Squirt's Mom]

Hi and welcome to you and Sammi!

I have some real concerns with the dual diagnosis being made at the same time but I will let the experts on diabetes discuss that with you. Please go to our sister site and register asap. And personally I would stop the Vetoryl for now primarily because the does is not supposed to be increased in the first 30 days. She is already showing lethargy and that would be enough for me to stop it for now. ;) Here is the link to k9diabetes - go now and register so you ca start talking to them. Diabetes is a life-threatening disease requiring immediate and appropriate attention, Cushing's is usually not. ;)

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

Hugs,
Leslie and the gang

[SammiGirl2004]

Thank you so much, I will go and register now. I am very concerned about the dual diagnoses as well and the vet did mention that the Diabetes is definitely what we should be focusing on and efforts to get that regulated. But I also know that the existence of Cushings can also make it harder for the insulin to be effective. I am just so confused right now, I have been reading about both diseases every day and just want my baby to be comfortable and happy. What do you know of the natural supplements for Cushings...do they work? Also, thats the first time I heard that the dose was NOT supposed to be increased in the first 30 days...why would my vet do that?? This is so hard...Thanks again :)

[labblab]

Hello and welcome from me, too, although I'm surely sorry your sweet Sammi is having such a tough time right now. I agree that it'll be great if you have a chance to join the k9diabetes group. Another super helpful thing will be if you can get copies of the actual test results that were used to diagnose both the diabetes and the Cushing's. It is indeed possible for dogs to suffer from both ailments. But since the disorders share many common symptoms, it can be challenging to sort things out. Diabetes is by far the easier to definitively diagnose since it is clearly reflected in elevated blood glucose levels. Cushing's is more of a challenge, especially since both of the diagnostic blood tests can register "false positives" when a dog is ill with another disorder (such as uncontrolled diabetes :o). For this reason, I believe many specialists choose to first attempt to control glucose levels. If glucose doesn't respond to increasingly higher insulin levels and a dog tests positive for Cushing's, then it becomes more likely that elevated cortisol is a genuine issue in its own right, too, and may be further fueling the glucose rise. These are all general comments, though, and we don't yet know the specifics that have led your vet to proceed in this manner. So you may indeed be on the right path, and Sammi may be feeling unwell due to several different factors.

Can you tell us more about her overall health history, and also her weight? Any other symptoms aside from excessive thirst and urination? How about her skin and coat? The results of her monitoring ACTH stim test from last week will also be very helpful. I'm assuming she'd been taking Vetoryl for about two weeks at that time? It's true that, everything being equal, the makers of Vetoryl recommend waiting for a month before increasing a starting dose. However, there can be exceptions. For instance, if a dog is started on a very low dose to begin with (less than 1 mg. per pound), and/or the ACTH results remain quite high at the two-week mark, an earlier increase might be considered. This is why learning Sammi's weight and monitoring ACTH result will be a big help to us.

Personally, I would not alter Sammi's med regimen right now without discussing things with her vet, and until we know more specifics about her situation. Your vet is trying to link the action of her insulin and her Vetoryl right now. Stopping the Vetoryl may affect her insulin needs, so I don't think it's safe to do that without your vet's knowledge. I know it will be a pain to gather all the info I'm asking about, but it will really help guide us forward.

Thanks so much in advance!
Marianne

P.S. I took the liberty of adding diabetes to your thread title -- this way our other members with diabetic dogs will be more likely to join in our discussion here. ;)

[judymaggie]

Hi and welcome to you and Sammi! She is so cute -- I am glad that you have found us and that Leslie has given you the link to the k9Diabetes group.

I wanted to give you a couple of links to resources that may answer some of your questions about dosing increases. Here is the link to one of Dechra's (Dechra is the manufacturer/distributer of Vetory) brochures -- page 2 has an excellent flow chart:

http://www.dechra.us/Admin/Public/Download.aspx?file=Files%2FFiles%2FSupportMaterial Downloads%2Fus%2FUS-046-TEC.pdf

Here is a link to our Resources forum where you can find many more useful articles:

http://www.k9cushings.com/forum/showthread.php?t=185

Lignans and melatonin are often recommended as treatment for dogs that have high levels of hormones other than cortisol. If Sammi's cortisol is high, the only medications that have been proven, through reliable research, are Vetoryl and Lysodren.

As Leslie has advised, please focus on getting the diabetes under control first!

[labblab]

I'm so glad Judy has also joined the conversation here alongside Leslie, as well. They are both making great suggestions. However, personally, I again strongly caution you against stopping Sammi's Vetoryl without discussing the situation with your vet. Stopping the Vetoryl may alter the insulin dosing, as well, and that really needs to be done with a vet's oversight. So please don't make any medication adjustment all on your own.

Marianne

[SammiGirl2004]

Thank you all for responding and giving me such helpful advice. This had been very hard...Sammi has been such a healthy energetic girl her whole life and now all of a sudden at 13 she is stricken with two serious illnesses. I just am trying to gather as much information as possible to help keep her as healthy as possible while she is still with us. I will contact my vet today and get her test results and get back to you as soon as I have them. My vet did advise yesterday to stop the Vetoryl for a week and see if that helps with her lethargy. We may perhaps start her on the Lysodren after that to see if she fares better. What are your thoughts on that treatment as compared to the Vetoryl? I do know that getting her sugar regulated is paramount right now but I also know that the presence of the excess cortisol can exacerbate those levels as well. I am hoping to hear from anyone else on here that has some good experiences to share and advice who have had dogs with both illnesses. This helps very much as alot of the time my vet is so busy and cant always respond to me right away.

[labblab]

I am very glad you checked with your vet about stopping the Vetoryl, and I hope that you'll see some improvement as a result. However, I am worried about your vet's thoughts about possibly switching to Lysodren after having been on Vetoryl for only two weeks. There really is no way at all in which you can make a valid judgement as to the suitability of Vetoryl as a treatment choice after only a two-week trial. And that's assuming Sammi actually has Cushing's, which may still be questionable.

Given the complexity of Sammi's situation, I am hoping you may be able to arrange a consultation with a vet who has more specialized knowledge and training in relation to these types of diseases. An "internal medicine specialist" (IMS) would be this type of vet, and if you wish we can try to help you locate a specialist in your area. However, your own vet may already know of a specialist with whom you can consult.

Please take a look at this article that talks about the special difficulties about jointly diagnosing diabetes and Cushing's in dogs. We know that Sammi is diabetic, so it really seems as though the important focus right now is on insulin management. It will be very helpful to see how she does in that regard this week, now that she's off the Vetoryl.

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

Have you been able to start posting yet over on the k9diabetes forum? I know they'll be a big help to you.

Marianne

[SammiGirl2004]

Thank you again so very much for replying so quickly. I was actually just speaking with my son this morning about taking Sammi to see a specialist just as you had mentioned. I can't really give specifics, but in my conversations so far with her vet I just get the distinct impression that he just doesn't have that much experience with Cushings. Do you think its possible she was misdiagnosed? I'd like to add that about a year ago she had surgery to have a growth on her tail removed and her pre-op bloodwork at that time revealed elevated liver enzymes and the vet "suspected" Cushings. (this was a different vet) No one ever advised the need for her to be tested for the disease or the serious potential it had for it to develop into Diabetes or I most certainly would have had her tested sooner. Dealing with alot of guilt over that in thinking I should have researched it more at the time. Also, after speaking with my vet about taking her off the Vetoryl for a week he scheduled another Glucose curve for three weeks from now. I would think that he would have wanted to do it sooner because she will be off the Vetoryl? Thank you again so much for your advice.

[labblab]

Yes, I do think it's possible that Sammi's diagnostic testing for Cushing's may have resulted in "false positives" as a result of uncontrolled diabetes at the time. However, given this additional info that her liver markers were previously elevated, it's also quite possible that the Cushing's diagnosis is accurate and the elevated cortisol preceded the diabetes. I really think it would be great to consult with a specialist who can help sort all this out.

Please try very hard to be kind to yourself, though. I understand guilty feelings all too well :o, but you were relying on the guidance of your vet, which is the natural thing to do. But that is all water under the bridge, and now we will move forward together!

Marianne

[SammiGirl2004]

Again I can't tell you how happy I am I found this wonderful site...I am feeling a bit more at ease now with everything and I am so grateful for any advice at all as this is all so so new to me still :) I did post at the Diabetes site this morning but no responses as of yet...not sure if they just get really busy...? This is Sammi's first full day off the Vetoryl and she still seems very tired and just not herself at all...wondering how long it takes to fully leave her system?

[labblab]

I'm so glad you've posted on the diabetes site! I'm a member over there, too, even though I don't know much about diabetes :o, so I'm gonna head right over and add a reply to start off the welcome wagon. :)

At this point, I don't think we know whether it's actually the Vetoryl that has been adding to Sammi's lethargy, or instead something else. Are her glucose levels still hanging pretty high?

Marianne

[SammiGirl2004]

Thanks so much! She had her Glucose curve last week and it was still pretty high around 600...vet increased her insulin from 2 units 2x a day to 3 and its been almost a week since she's been at that amount. I dont have a home meter so I have no idea where she is right now as far as as levels...def going to invest in one although I'm a bit nervous about pricking her myself, but I know it's something I need to get used to doing if I want to help her get regulated. Could high sugar levels be making her tired as well? Sorry I know you said you don't know too much about the subject just thought I would ask anyway! :)

[labblab]

Yes, I think lethargy can be a symptom of high glucose levels. So it may be the case that the Vetoryl isn't related to this issue at all. We just don't know.

[molly muffin]

Hello and welcome from me too. I just did a quick skim and it does turn out that you need to be on vetroyl for cushings, one of the leading vet specialist in cushings and endocrine diseases in small animals has stated that for a dog with diabetes and cushings, rather than give one dose daily, which I think you said you were doing at 10mg and then it was raised to 20mg, is that the dose should be split, so 5mg am and 5mg pm or 10mg am and 10mg pm, but I'd start at the 1mg/1lb daily ratio as recommended by the manufacture and I'd try this before considering moving to lysodren with the diabetes involved.

I just wanted to be sure you and your vet had that info.

[AvileeG]

Hello,

I'm sorry I'm so late to chime in here, I'm a relatively infrequent visitor to the forum(s)... I'm posting this to both the diabetes and Cushing's forums, since I'm not sure which one you might see first, so if you see it in the other one, don't bother to read it all again!

I'm not an expert by any stretch of the imagination, but I do have experience with a diabetic Cushing's dog. In Daphne's case, we initially started testing for Cushing's but the tests came back borderline/ inconclusive; it wasn't until a few months after all the Cushing's tests that she spiked a BG of 500 on her regular bloodwork and was finally diagnosed with diabetes — always assumed by our vet to be a result of "incipient" Cushing's (i.e., starting toward Cushing's but with Cortisol levels not high enough to think about treating).

It took us about a half-year to work up from ½ unit of Humulin (2x/day) to 7-½ units (a pretty darn big dose for an 11-pound dog, probably due to high cortisol), but once we got there she was quite stable for another two years. We did see her weight to start to come back up almost as soon as we got her started on insulin (she had dropped a pound off her 11-½ pounds before the diabetes diagnosis), and by the time we got her dosage stabilized she was mostly back to her old self — although she did still have some of those incipient Cushing's symptoms (thinning hair and pot belly), her drinking and peeing came down quite a bit and her muscle tone even came back very well (she had mostly lost a lot due to the starvation of diabetes).

So I would say... hang in there, things will improve once her blood sugar gets stabilized. 600 is still very high — I don't think Daphne ever got much over 500 until the very end of her life, when she was essentially in end-stage Cushing's, and even then it was only an occasional spike — so I don't know what symptoms (like lethargy) you might see with a dog who is at that level for a long time (or even up to 800 - wow!). Of course you have to work up to the right insulin dose slowly, since too much insulin is so dangerous, and that process can be frustrating... but you will get there.

The other thing is, don't be afraid of home testing! We would never have been able to keep Daphne stable without it. During her years of stability, we were testing her once every couple of days, at her consistent nadir (right after her afternoon walk), with a full curve every few weeks; by the end of her life, when her BG levels were going crazy, we were testing her 4 times a day and adjusting her insulin accordingly (I know all the vets say never to change the insulin dose yourself, but we had a very precise calibration to 1/8 of a unit, and by then it was the only way we could keep her within range). She was an incredibly good patient, so I know it might be harder with other dogs, but it got so that she didn't much mind being "poked" (especially if it came along with a little treat afterward — we used slices of baby carrot). With a small dog like her, our test site of choice was her dewclaw pads.

One other thing — since her initial diagnosis was diabetes, with associated (but incipient and low-grade) Cushing's, Daphne went for 2-½ years on insulin (with very stable BG readings) before her Cushing's got far enough to be definitive and treated. Ironically, it was only after we briefly tried trilostane (Vetoryl), which she could not tolerate, that her BG levels started to go off the rails. It's possible that the Cushing's would have pushed her blood sugar to go crazy eventually, but the effect was so immediate (when she had been so stable right up until the final Cushing's test and diagnosis) that we always thought there must have been a connection. So I would be really leery of treating the Cushing's if there is any question of her diagnosis (how high was she on that ACTH-stim test?).

I hope some of this helps!
Avilee