High ALP-Trying to isolate on diabetic dog

[sibhus]

Hi, im newbie and looking for some advice and help if possible. My 8 year husky whom is already diabetic and well regulated has had his ALP climb from 600(when he was diagnosed as diabetic) to 1000 in one year. He also exhibits high cholesterol at 700 which elevated from 500 and glucose was at 225(he is diabetic). Every other marker on his biochem is in the normal range relating to the kidney liver and other organs. He's also developed hip dysplasia and has some rear end weakness but does well on Carprofen and walks up to 3 miles a day. Ive read cushings dogs have insulin resistance when diabetes is at play but not sure, his insulin requirements have remained the same over the last year and he is not exhibiting insulin resistance (takes 57 units total daily).

What is tricky is that I know diabetic and Cushing dogs can have similar symptoms, in my case, he is able to control his pea for up to 8-9 hours and drinks only really after eating foods or excercise or when he is hot. He is about 15lb overweight at 85lbs and I need to get him down but it seems hard. He has a full coat of hair and likes cool areas but its confusing as he is a husky as well.

My vet has recommended going straight to a ultrasound and was curious if anyone thinks this is the best thing to do or can advise if I should think about having say a UCCR test done to see if its worth going down the path of cushings.

Thanks for any help, Kal

[labblab]

Hello and welcome! I'm so sorry we've been so slow to respond, and especially so since I'm afraid I'm unable to yet take the time to write a more thorough reply. But I will definitely return to do so. In the meantime, we're very glad you've found us, and we'll do our best to offer our thoughts and suggestions as soon as possible.

Marianne

[labblab]

OK, I finally made it back again! Upon re-reading your posting, I’m going to ask what may be a dumb question. But since it sounds as though your dog’s diabetes is currently well regulated and he is not exhibiting any uncomfortable outward symptoms of Cushing’s — what is the actual goal of pursuing Cushing’s diagnostics? If his only abnormalities are elevated ALP and cholesterol, I don’t believe it’s certain that Cushing’s treatment would ever totally normalize those particular values, and the trade off would be launching into an expensive and monitoring-intensive treatment protocol that might even temporarily destabilize your dog’s insulin regimen.

Since your dog isn’t exhibiting any observable Cushing’s symptoms, I’d personally be reluctant to launch into any involved related diagnostics at this point because I probably wouldn’t start treatment now, regardless of test results. A total lack of observable consistent symptoms always makes a confirmed Cushing’s diagnosis suspect, especially since other conditions can increase ALP, as well. Elevated ALP *is* a typical finding in Cushdogs, but when it’s caused by Cushing’s, it doesn’t usually herald actual damage to liver function. So, if your dog’s other liver and kidney values are all normal, I’m not sure how ominous that ALP elevation actually is, regardless of cause.

I’m not a vet, though, and if your vet *is* concerned, then I guess an ultrasound could be warranted for the reason that it could reveal the presence of any internal organ problems that might be responsible. But gosh, your dog sounds as though he’s generally doing quite well, overall. Congrats to you for your excellent care!

I definitely may be missing a piece of the puzzle here, though. So please do feel free to return and discuss your concerns with us further.

Marianne

[sibhus]

Marianne, thanks so much for following up I greatly appreciate the input.

What led me down the path of cushings was that although my boy bear is well regulated diabetes wise, his alp and cholesterol levels were still high 1000/700 supposed to be less than 180 and 375 respectively, and after researching, I could only deduce that cushings and possibly hypothyroidism can cause cause the two markers to be elevated. Ive read there are other markers such as urine specificity and a few other red/white blood cell markers which can be off in Cushing dogs but I don't see it and everything in his bloodwork was in range. Ive also read maybe I have an asymptomatic Cushing dog as well but again im speculating. For the time being my vet has recommended an ultrasound so im planning to get one as the other possibility is a liver tumor which causes high alp.

I guess I was just looking for some input as want to go down the best path for diagnosing whats causing his problem.

Thanks again, Kal

[labblab]

You’re very welcome, Kal. Again, it sounds as though you are doing a terrific job of educating yourself and advocating on behalf of your Bear. I really hope it turns out that there is no significant issue associated with those lab elevations. But in terms of diagnostics, I can never argue with the general value of an abdominal ultrasound since it provides a broad amount of information about the status of multiple internal organs. In Bear’s case, since Cushing’s seems unlikely to me based on his lack of other typical symptoms, the ultrasound to view multiple organs and alternative explanations doesn’t seem unreasonable.

No matter what you find out, we’ll surely remain interested in an update if you’d like to provide one to us. Good luck!

Marianne