Cushing's, Diabetes and Hypothyroid

[Lulu'sMom]

Hi all, so glad to have found this site. So helpful, informative and supportive. My Lulu is a sweet almost 8 yr old lab/beagle mix, about 49 pounds, who actually began her journey almost a year ago. I noticed increased drinking/peeing and thought diabetes. That's actually what brought me to my vet. Initial diagnosis was diabetes and UTI and treatment began with insulin and antibiotics. Long story short it has been one complication after another. Complete cataracts in both eyes, had cataract surgery which uncovered many lab abnormalities. Elevated liver enzymes, very low thyroid, very high cholesterol, of course very high glucose. We've been on 3 different insulins with very poor glucose control. She then developed neurological symptoms of weakness, falling while trying to walk, circling, lethargy. Finally decided to go to a specialist vet since she was not improving with regular vet and he seemed to be out of options other than just keep increasing her insulin until we get improvement. We were up to 12 units of Detemir twice a day! Normal dose is 2 units twice a day as this is very potent, and her glucose still 500-600. Meanwhile my girl was wasting away, coat thinning, pot belly developing and appetite decreasing. New vet was amazing. She listened to what I was observing, had already tried, and what I had not yet had done. She did labs, abdominal ultrasound, glucose curves and discovered what I had long feared. Cushing's, but with the added complication of uncontrolled diabetes, now completely insulin resistant, and very hypothyroid. It this point I'm devastated. She does not believe that Lulu can tolerate the treatment for Cushing's nor does she feel confident that it would be effective given the advanced state of her poor health. She feels we will not be able to gain good glucose control now as she is resistant to insulin. So what to do?....can't really treat either disease with any meaningful confidence of improvement. The cost will kill me if the treatment doesn't kill her. Either way her life expectancy is poor. I'm at a complete loss of what to do, but I know that I will eventually have to put her down. ANY advice is very welcome. I am financially tapped and in debt thousands at this point and am not sure I can continue. Please help...

[labblab]

Hello, and welcome to you and your sweet Lulu. Your avatar photo is so dear! I’m so sorry, though, about all the challenges you are facing. First off, I need to let you know that none of us are vets, so our suggestions come from experience as opposed to medical training. But I’m hoping that some effective treatment options may remain for Lulu. Even if not, we’ll be here to walk alongside you girls no matter where the path leads.

An additional resource that I want to give you is our sister forum devoted to diabetes:

http://www.k9diabetes.com/

You’ll find lots of informative links on their homepage, and then please proceed to register on their interactive forum which mirrors our own here. They’ll be much better prepared to offer guidance re: the diabetic side of things. As far as the treatment of Cushing’s, I’d hope to find out a bit more as to why your specialist doesn’t think Lulu could tolerate the medication. It may be due to unbalanced blood chemistries, or the possibility that Lulu’s kidney and/or liver function is compromised such that metabolism of the medication would be adversely affected. Or perhaps something else altogether. But just so you’ll know, diabetic dogs who also suffer from Cushing’s are most often given trilostane (brandname drug “Vetoryl”) on a twice daily basis. Monitoring blood testing is required in order to ensure that the dose of medication is therapeutic in terms of optimal control of cortisol levels. There can be extra challenges in terms of balancing both glucose levels as well as cortisol levels, but we have had multiple members through the years who have successfully controlled both disorders.

One concern I do have about Lulu is your description of her neurological issues. Possibly these are related to her endocrinological imbalances? However, I do want to alert you to the possibility that she may have an enlarging pituitary tumor which is responsible for both the adrenal abnormalities as well as the neurological problems. It is expensive to image a dog’s head — either a CT or MRI is required. So this may well not be a diagnosis that you’ll choose to definitively pursue. But if this is the problem, it will worsen and may render the other treatment options immaterial. Pituitary macrotumors can be reduced via radiation or radio-surgery, but it is a very expensive undertaking and not every dog would even be a candidate. In her compromised state, it easily might not be a reasonable option for Lulu from a health perspective alone. Once again, this may not be involved at all, but I just wanted to mention it in the event you want to discuss this possibility further with your new vet. I lost my own Cushpup to the effects of what we assume was an enlarging macrotumor, although we did not confirm the diagnosis with imaging ourselves.

But first things first — again, I encourage you to register and post on K9diabetes. I’ll check for any postings you make over there, and hopefully we can then combine forces to offer suggestions! We’re so glad you’ve found us, and we’ll try to help in any way we can.

Marianne

[Lulu'sMom]

Thank you so much for the advice and support. I do believe that the doctor does suspect a tumor, at least as a possibility, since her neuro symptoms have progressed rather rapidly, over last 3 months or so. We did start a thyroid med and that has improved her energy somewhat. I am not able to afford imaging and would not be able to afford treatment even with definitive imaging so that is not an option for us. As explained to me it is a vicious circle..the pituitary is causing the elevated glucose so insulin is not effective in treating the glucose and she remains at risk for repeated infections due to high glucose, such as UTI's and ear infections, of which she has had many. It is not advised to treat the cushing's until good glucose control is achieved in diabetics and since now it appear she is completely insulin resistant we can't get good control of either disease. I will search the other forum site you provided and thanks again.

[labblab]

Once again, I am not a vet, but my feeble understanding is that genuine insulin resistance is a prime reason to begin Cushing’s treatment — it is actually one of the diagnostic indicators that Cushing’s may additionally be at play for a dog who suffers from overlapping symptoms of both diseases. Once the cortisol can be lowered into therapeutic range, the insulin needs may become more manageable. I’m hoping the folks at K9D can give you more guidance in that regard.

And I totally understand about treatment costs. Unaffordable expense was one of the reasons why we didn’t pursue imaging/radiation with our boy, either. But hopefully a macro may not even be an issue for Lulu.

Marianne

[Lulu'sMom]

Thank you Marianne,
I did look at the other site and didn't find much about dogs with both diseases. They seemed to separate the questions out once this site was started so the threads left there are all strictly diabetic threads, however, I will continue to look around and see if maybe an older thread can provide some information. I think the vet is concerned that even if cortisol levels can be reduced that her body's own mechanism for utilizing insulin may not "kick in" since it has been resistant for so long. Does that make sense? I may not be explaining it right.

[labblab]

If I were you, I’d register and start a thread of your very own. That way, folks can address the specifics of Lulu’s insulin situation. They will likely defer to us about Cushing’s diagnostics/treatment, but they do have familiarity with insulin resistance, including when it’s been associated with Cushing’s.

[Lulu'sMom]

Oh that's a great idea! Thank you!

[labblab]

This is where you’ll want to start your thread. We do have folks who post on that forum who have dogs who suffer from both diabetes and Cushing’s.

http://www.k9diabetes.com/forum/forumdisplay.php?f=2

Marianne

[labblab]

I just wanted to let everyone know that Lulu’s Mom has also started a new thread over on K9Diabetes. I’ll be checking in over there myself, and we’d love to be joined by any other folks who want to monitor the diabetic side of things, as well. In the meantime, we’ll remain available to keep track of any Cushing’s developments right here.

http://www.k9diabetes.com/forum/showthread.php?t=7743

Marianne