Diabetes Talking

Question:

Yes, Dr. Martin, thank you!! – Hide quoted text — Show quoted text – Dr. Martin:  Just wanted to thank you for being here all the time!  (And up so late too!)  Your professionalism really stands out as you have always been thoughtful, considerate and generous with your time.  I appreciate your answering my *general knowledge* questions. buglady take out the dog before replying <snip good advice

Response:

Dr. Martin:  Just wanted to thank you for being here all the time!  (And up so late too!)  Your professionalism really stands out as you have always been thoughtful, considerate and generous with your time.  I appreciate your answering my *general knowledge* questions. buglady take out the dog before replying

<snip good advice

Response:

Dr. Martin:  Just wanted to thank you for being here all the time!  (And up so late too!)  Your professionalism really stands out as you have always been thoughtful, considerate and generous with your time.  I appreciate your answering my *general knowledge* questions.

Aw shucks! J.

Response:

There are certainly several approaches one could take in this case.  My preference would be to treat the Cushings soon.  Dogs with cushings require higher doses of insulin because the excess corticosteroids secreted by the adrenal gland(s) interferes with the action of insulin.  If you wait until a normal blood glucose curve is established you may find that your dog becomes dangerously hypoglycemic when treatment for cushings is started because insulin requirements could suddenly drop.  Your dog’s nose condition (which I don’t quite understand) may throw another wrench into the works.  If this condition requires immunosuppressive drug therapy (azathioprine) then it may worsen when the Cushings is treated because the high levels of corticosteroids may be aiding in the treatment of the nose condition. Given the complicated nature of this case, I would definitely consider asking for a referral to a board certified internal medicine specialist. J. – Hide quoted text — Show quoted text – Dr. Martin, Thanks for you info.  I took Fred into the vet this morning to have the ACTH stimulation test done; however, after reviewing his records the second vet realized that Fred had already had that test performed before his rhinoscopy. He then consulted the vet who performed the rhinoscopy and they both agreed to increase his insulin by 10-20% every week, have the glucose curve done after each week, and see if they can control his Diabetes before starting him on his Cushings therapy.  His glucose is still in the dangerous levels (400’s and even 490 this weekend).  I can definitely see that there are several opinions on which to treat first.  We are to increase his insulin to 13 units starting this evening (he’s been on 11 units twice a day for two days, but he’s still drinking excessively and urinating).  On Friday, he goes for another curve. I’m not trying to point fingers or assess blame, I just want Fred to get better.  Do you think I should take him to an endocrinologist vet?  Is there such a thing?   Will the insulin work better if his Cushings was treated? Thank you very much!! Wendy My 9-year-old terrier mix has just been diagnosed with Cushings and Diabetes.  Here’s the kicker, he was fine until we had a rhinoscopy procedure done on him approximately a month and a half ago.  He was diagnosed with rhinitis (nose infection) and put on prednisone.  We objected to the prednisone medication but were assured that it was a very mild dose.  After he was done his medication he continued with excessive drinking and urination.  It worsened after he finished the prednisone.  At first the vet thought it was just the side effects of the medication; however, after further examiniation and tests, he was diagnosed with Diabetes.  His Cushings was diagnosed prior to this surgery through the pre-surgery blood tests.  He was on 9 units of Humanlin N insulin twice a day.  Now he’s up to 11 units.  He weighs approx. 60 pounds.  He still has reading of 350-425 blood glucose.  We now have another vet telling us that we should treat the Cushings first and that the Diabetes may control itself.  Any advice???  Routine peoperative blood work will not diagnose Cushings Syndrome. Generally cushings is diagnosed with an ACTH stimulation test or a low dose dexamethasone suppression test,  usually followed by a high dose dexamethasone test to determine if the cushings is due to a pituitary tumour or an adrenal tumour.  All of these tests require a short stay in hospital to take repeated blood samples.  If your dog has been diagnosed with cushings with any of these tests then it needs to be controlled with medication in order to better control the diabetes.  The excess cortisol secreted in cushinoid dogs interferes with the action of insulin. Unfortunately it is highly unlikely the diabetes will go away once the cushings is controlled. J.

Response:

Here are some links so you can gather information.  Personally I think it sounds a little weird that your dog was prescribed prednisone *after* they thought he had Cushings disease.  I’d go with the second vet or even get a third opinion.  If your dog hasn’t had the suppression or stimulation tests, I would think that would be the place to start. Cushings links: http://www.cvm.uiuc.edu/ceps/PetColumns/CUSHINGS.HTM http://www.vetinfo.com./dcushing.html http://www.geocities.com/Petsburgh/Zoo/3190/ http://www.io.com/~lolawson/cushings/ Diabetes links: http://www.weir.net/~lglass/page6.htm http://www.original1.com/diabetes/ Good luck to you and your pup buglady take out the dog before replying (thanks to Dr. Martin for replying!)     Prior to his rhinoscopy, he had pre-op blood work done which showed he had Cushings disease but not Diabetes.  After his rhinoscopy he was prescribed prednisone     <snip

Response:

Dr. Martin, Thanks for you info.  I took Fred into the vet this morning to have the ACTH stimulation test done; however, after reviewing his records the second vet realized that Fred had already had that test performed before his rhinoscopy. He then consulted the vet who performed the rhinoscopy and they both agreed to increase his insulin by 10-20% every week, have the glucose curve done after each week, and see if they can control his Diabetes before starting him on his Cushings therapy.  His glucose is still in the dangerous levels (400’s and even 490 this weekend).  I can definitely see that there are several opinions on which to treat first.  We are to increase his insulin to 13 units starting this evening (he’s been on 11 units twice a day for two days, but he’s still drinking excessively and urinating).  On Friday, he goes for another curve. I’m not trying to point fingers or assess blame, I just want Fred to get better.  Do you think I should take him to an endocrinologist vet?  Is there such a thing?   Will the insulin work better if his Cushings was treated? Thank you very much!! Wendy – Hide quoted text — Show quoted text – My 9-year-old terrier mix has just been diagnosed with Cushings and Diabetes.  Here’s the kicker, he was fine until we had a rhinoscopy procedure done on him approximately a month and a half ago.  He was diagnosed with rhinitis (nose infection) and put on prednisone.  We objected to the prednisone medication but were assured that it was a very mild dose.  After he was done his medication he continued with excessive drinking and urination.  It worsened after he finished the prednisone.  At first the vet thought it was just the side effects of the medication; however, after further examiniation and tests, he was diagnosed with Diabetes.  His Cushings was diagnosed prior to this surgery through the pre-surgery blood tests.  He was on 9 units of Humanlin N insulin twice a day.  Now he’s up to 11 units.  He weighs approx. 60 pounds.  He still has reading of 350-425 blood glucose.  We now have another vet telling us that we should treat the Cushings first and that the Diabetes may control itself.  Any advice???  Routine peoperative blood work will not diagnose Cushings Syndrome. Generally cushings is diagnosed with an ACTH stimulation test or a low dose dexamethasone suppression test,  usually followed by a high dose dexamethasone test to determine if the cushings is due to a pituitary tumour or an adrenal tumour.  All of these tests require a short stay in hospital to take repeated blood samples.  If your dog has been diagnosed with cushings with any of these tests then it needs to be controlled with medication in order to better control the diabetes.  The excess cortisol secreted in cushinoid dogs interferes with the action of insulin. Unfortunately it is highly unlikely the diabetes will go away once the cushings is controlled. J.

Response:

My 9-year-old terrier mix has just been diagnosed with Cushings and Diabetes.  Here’s the kicker, he was fine until we had a rhinoscopy procedure done on him approximately a month and a half ago.  He was diagnosed with rhinitis (nose infection) and put on prednisone.  We objected to the prednisone medication but were assured that it was a very mild dose.  After he was done his medication he continued with excessive drinking and urination.  It worsened after he finished the prednisone.  At first the vet thought it was just the side effects of the medication; however, after further examiniation and tests, he was diagnosed with Diabetes.  His Cushings was diagnosed prior to this surgery through the pre-surgery blood tests.  He was on 9 units of Humanlin N insulin twice a day.  Now he’s up to 11 units.  He weighs approx. 60 pounds.  He still has reading of 350-425 blood glucose.  We now have another vet telling us that we should treat the Cushings first and that the Diabetes may control itself.  Any advice???

 Routine peoperative blood work will not diagnose Cushings Syndrome. Generally cushings is diagnosed with an ACTH stimulation test or a low dose dexamethasone suppression test,  usually followed by a high dose dexamethasone test to determine if the cushings is due to a pituitary tumour or an adrenal tumour.  All of these tests require a short stay in hospital to take repeated blood samples.  If your dog has been diagnosed with cushings with any of these tests then it needs to be controlled with medication in order to better control the diabetes.  The excess cortisol secreted in cushinoid dogs interferes with the action of insulin. Unfortunately it is highly unlikely the diabetes will go away once the cushings is controlled. J.

Response:

Sorry for the confusion.  He was having chronic nose discharge.  Prior to his rhinoscopy, he had pre-op blood work done which showed he had Cushings disease but not Diabetes.  After his rhinoscopy he was prescribed prednisone (twice a day for five days, once a day for five days, and then half a pill every other day until the end of the pills).  I think it was a 5 mg. pill.  A few days after the last prednisone pill, we noticed he was drinking and urinating excessively. After urinalysis it was determined he in that ketone situation and diabetic. After two days at the emergency center, they concluded he needed 9 units of insulin.  He still has glucose levels of 350 to 425, but no ketones.  His insulin was then adjusted to 11 units.  However, today he’s still drinking excessively.  He’s also currently on Azothiprine (sp?) every third day for his nose condition.  His nose is cleared up but now we have a dog with both Cushings and Diabetes.  Any help and advice would be greatly appreciated.  We feel so guilty that we’ve done this to him.  I’d take that runny nose anyday over this!! – Hide quoted text — Show quoted text – I’m a little confused about the order of things!  Are you saying he was: 1.. diagnosed with rhinitis and then put on prednisone? 2.  You decided to do surgery, then the pre-op blood tests showed Cushings and diabetes? How long after the end of the course of prednisone were the blood tests run? Was he weaned off the pred slowly?   Was the Cushings diagnosis from the cortisol levels in the blood or did they do the dexamethasone suppression test in combination with ACTH stimulation test? Maybe if you can answer these questions Dr. Martin can chime in here! Vet Merck manual says that dogs with Cushings show moderately elevated blood glucose.  The endocrine system is complicated with direct and indirect feedback loops.  Hard to adjust just one thing, without something else getting affected.  I’d at least talk to the second vet about his treatment plan. buglady take out the dog before replying My 9-year-old terrier mix has just been diagnosed with Cushings and Diabetes.  Here’s the kicker, he was fine until we had a rhinoscopy procedure done on him approximately a month and a half ago.  He was diagnosed with rhinitis (nose infection) and put on prednisone.  We objected to the prednisone medication but were assured that it was a very mild dose.  After he was done his medication he continued with excessive drinking and urination.  It worsened after he finished the prednisone.  At first the vet thought it was just the side effects of the medication; however, after further examiniation and tests, he was diagnosed with Diabetes.  His Cushings was diagnosed prior to this surgery through the pre-surgery blood tests.  He was on 9 units of Humanlin N insulin twice a day.  Now he’s up to 11 units.  He weighs approx. 60 pounds.  He still has reading of 350-425 blood glucose.  We now have another vet telling us that we should treat the Cushings first and that the Diabetes may control itself.  Any advice???

Response:

I’m a little confused about the order of things!  Are you saying he was: 1.. diagnosed with rhinitis and then put on prednisone? 2.  You decided to do surgery, then the pre-op blood tests showed Cushings and diabetes? How long after the end of the course of prednisone were the blood tests run? Was he weaned off the pred slowly?   Was the Cushings diagnosis from the cortisol levels in the blood or did they do the dexamethasone suppression test in combination with ACTH stimulation test? Maybe if you can answer these questions Dr. Martin can chime in here! Vet Merck manual says that dogs with Cushings show moderately elevated blood glucose.  The endocrine system is complicated with direct and indirect feedback loops.  Hard to adjust just one thing, without something else getting affected.  I’d at least talk to the second vet about his treatment plan. buglady take out the dog before replying – Hide quoted text — Show quoted text -My 9-year-old terrier mix has just been diagnosed with Cushings and Diabetes.  Here’s the kicker, he was fine until we had a rhinoscopy procedure done on him approximately a month and a half ago.  He was diagnosed with rhinitis (nose infection) and put on prednisone.  We objected to the prednisone medication but were assured that it was a very mild dose.  After he was done his medication he continued with excessive drinking and urination.  It worsened after he finished the prednisone.  At first the vet thought it was just the side effects of the medication; however, after further examiniation and tests, he was diagnosed with Diabetes.  His Cushings was diagnosed prior to this surgery through the pre-surgery blood tests.  He was on 9 units of Humanlin N insulin twice a day.  Now he’s up to 11 units.  He weighs approx. 60 pounds.  He still has reading of 350-425 blood glucose.  We now have another vet telling us that we should treat the Cushings first and that the Diabetes may control itself.  Any advice???

Response:

My 9-year-old terrier mix has just been diagnosed with Cushings and Diabetes.  Here’s the kicker, he was fine until we had a rhinoscopy procedure done on him approximately a month and a half ago.  He was diagnosed with rhinitis (nose infection) and put on prednisone.  We objected to the prednisone medication but were assured that it was a very mild dose.  After he was done his medication he continued with excessive drinking and urination.  It worsened after he finished the prednisone.  At first the vet thought it was just the side effects of the medication; however, after further examiniation and tests, he was diagnosed with Diabetes.  His Cushings was diagnosed prior to this surgery through the pre-surgery blood tests.  He was on 9 units of Humanlin N insulin twice a day.  Now he’s up to 11 units.  He weighs approx. 60 pounds.  He still has reading of 350-425 blood glucose.  We now have another vet telling us that we should treat the Cushings first and that the Diabetes may control itself.  Any advice???

Response:

Just an update on how Fred is doing.  We went back to the internal medicine vet.  We came very prepared (thanks to all of you on this board).  We let her know that our confidence level was at an all time low and she even offered a second opinion. Her thoughts are this about Fred’s treatment.  His Cushings disease is caused by tumor on his pituitary gland.  This is treated with Lysindrin (sp?) which is a toxin.  She wants to stabilize his Diabetes and then start him on this drug.  So far he’s up to 15 units of insulin twice a day and he’ll probably end up with about 20 by the time it’s all over.  She wants his Diabetes symptoms to subside so that we can be better prepared to see the symptoms that he’s receiving too much Lysindrin. Fred is doing much better.  He goes in for another glucose curve this week. He hasn’t been drinking or urinating nearly as much and his spirits are much better.  I think it helps that our spirits are much better too.  I’ll keep you posted on how he does on his Cushings treatment. Thanks again for all those concerned.  Thanks to the vets for your expertise and concern. Wendy (Fred and Wilma, too)

Response:

– Hide quoted text — Show quoted text – Just an update on how Fred is doing.  We went back to the internal medicine vet.  We came very prepared (thanks to all of you on this board).  We let her know that our confidence level was at an all time low and she even offered a second opinion. Her thoughts are this about Fred’s treatment.  His Cushings disease is caused by tumor on his pituitary gland.  This is treated with Lysindrin (sp?) which is a toxin.  She wants to stabilize his Diabetes and then start him on this drug.  So far he’s up to 15 units of insulin twice a day and he’ll probably end up with about 20 by the time it’s all over.  She wants his Diabetes symptoms to subside so that we can be better prepared to see the symptoms that he’s receiving too much Lysindrin. Fred is doing much better.  He goes in for another glucose curve this week. He hasn’t been drinking or urinating nearly as much and his spirits are much better.  I think it helps that our spirits are much better too.  I’ll keep you posted on how he does on his Cushings treatment. Thanks again for all those concerned.  Thanks to the vets for your expertise and concern. Wendy (Fred and Wilma, too)

  Concurrent cushings and diabetes is a difficult problem to treat and can be done a number of ways.  The approach your vet is taking is a perfectly legitimate way to proceed.   The most important thing is for your vet to treat the problems in a manner she is experienced in.  As long as the blood glucose is monitored daily during the lysodren induction stage things should go smoothly. Good luck, J.

Response:

Our 7 year old Carin Terrier developed diabetes about 4 months ago, and has not responded well to insulin.  The vet has upped the dose several times, but our dog has losts much of his former energy.  We were giving him a shot every morning with 14 units of insulin.  He is also on a special high fiber diet. Two weeks ago, he stop eating and was vomiting.  He has been at the vets every since.  They say he has cushings disease and have him on Lysodren.  His blood sugar is up and down and they cannot control it very well.  They are now giving him two shots each day, morning and night.  I’m not sure we were controlling it well during the last 4 months at home either.  We visited him today and he now seems almost nomal.  We can probably take him home in two days if they can reduce the Lysodren, but I’m not optimistic about his future.  Giving him two insulin shots a day ( a two person task even for the vet)is also a major problem with our busy lifestyles.  Working and going on business trips, this will be difficult or impossible at times, and even at the animal hospital they see his blood sugar going from one extreme to another. From what I read about cushings, the outlook is not good.  I’m wondering are we prolonging life or prolonging death?    Any experiences or advise someone might have would be appreciated. Ron

Response:

(snipped) From what I read about cushings, the outlook is not good.  I’m wondering are we prolonging life or prolonging death?    Any experiences or advise someone might have would be appreciated.

The successful treatment of Cushings seems to vary widely. I have one of the success stories (so far). Flyssa has been under treatment for 2.5 years now, and has far more energy and life than she did before the treatment started. I know that others have had different results, but the Cushings alone can often betreated. Don’t give up yet. Wendy Kyzyl Kum Salukis – Smooth & Feathered

Response: