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Shaggydog
07-24-2008, 11:03 PM
I'm new here, fresh from the Canine Cushing's forum.

Oreo is a 12 year old, black and white Tibetan Terrier. He's been hypothyroid since he was 2 years old, and was diagnosed with diabetes in April 2007. We've never managed to get his diabetes properly regulated, despite our best efforts. Just yesterday we discovered he also has atypical Cushing's Disease, which may well account for the regulation difficulties. He also has long-term digestive problems and allergies ... what a mess!

Our primary goal at the moment is to get the atypical Cushing's under control, then to see where we are with the diabetes. Oreo is under the care of an Internal Medicine specialist at a large specialist practice in San Mateo, California.

Weight: 23.5 lbs
Vetsulin 8 units 2 x daily
Soloxine .2mg once a day
Food: Royal Canin Potato and Venison, Limited Ingredient Diet. 4 cups daily, split into 4 meals. (Not a typo - 4 cups total, per vet's orders, because he's not metabolizing his food properly and losing a lot of weight.)

That's about it for now. I look forward to getting to know all of you and your dogs.

BestBuddy
07-24-2008, 11:26 PM
Hi and welcome,
I also cross over between the diabetes and cushing board. Wow 4 cups is a lot of food. I don't believe that giving more food will help the weight problem and it may even be messing up BG regulation. Until you get the right amount of food and insulin Oreo won't start using the food correctly. The cushing problem could also be a big problem with the regulation as well. How long has it been since a thyroid check to see how that is going?
Jenny & Buddy

Denise
07-25-2008, 04:46 AM
Hi there!

I also have a Cush dog and one also has diabetes and now cancer. Both are atypical. We tried the Lysodren on the diabetic and that was a disaster, he was sick and not himself so we stopped treating that as long as we could some what control his diabetes.

My second dog with atypical was prescribed Lysodren and I just couldn't go there so started the melatonin and flax essence and it's worked wonderfully! Took a couple months to see improvement though and we ll hate waiting!!

Not had a thyroid dog yet...fingers crossed!

What range is his glucose staying at? Was the insulin increased when food was increased?

There are lots of dog foods out there that have huge feeding amounts listed, RC is one of them. I once tried some of their breed specific foods and the feeding amounts were double and sometimes MORE than what I was feeding with Flint River Ranch.

Allergies are a pain but at least they have foods that might help now!

Have te digestive issues been dx'ed or would digestive enzymes help? Upset tummy? vomiting? diarrhea?

You can do this!

Hey Oreo! Bogie, Molly, Reba, Lex, Liv, Micah and Zeke say hello!!!

k9diabetes
07-25-2008, 10:02 PM
I confess I haven't read the post in detail, something that already tripped me up at the Cushings board today!...

But I too wonder whether feeding four cups of food a day can actually help much and might make the diabetes difficult to control because whatever rapidly digested carbs that convert easily to sugar would be passing into the bloodstream pretty much directly from all four cups even if the primary protein, etc. is not being digested. Depending on how the kibble is processed, seems like potatoes could convert into a lot of glucose.

Bet you spend a lot of time scooping the backyard!

Is the digestion problem seen as a lack of enzymes or IBD?

Our cat just had a series of blood tests that can differentiate various bowel and pancreatic issues - maybe this is something that couldhelp Oreo.

http://www.cvm.tamu.edu/gilab/assays/index.shtml

Serum Trypsin-Like Immunoreactivity (TLI) (http://www.cvm.tamu.edu/gilab/assays/TLI.shtml)
For exocrine pancreatic function testing (i.e to diagnose EPI )

Serum Cobalamin (Vitamin B12) and Folate (http://www.cvm.tamu.edu/gilab/assays/b12folate.shtml)
Test of small intestinal function (not species specific)

Pancreatic Lipase Immunoreactivity (PLI) (http://www.cvm.tamu.edu/gilab/assays/cPLI.shtml)
Test for diagnosis of pancreatitis (http://www.cvm.tamu.edu/gilab/research/Pancreatitis.shtml) in dogs and cats (species specific)

Our cat is diagnosed with IBD and possibly emerging lymphoma. His results on the test after a couple of months of treatment showed mild IBD in one part of the small intestine.

Gus' test results were good. The vet looked at the aspirates and didn't see anything he felt needed to be sent to a pathologist. Plus his Texas A&M GI Panel came out well also.

Cobolamin Test: 594 ng/L
- control range is 290-1499 = normal.

Folate Test: 9.6 microg/L
- control range is 9.7-21.6 =
consistent with proximal small intestinal disease (but not far off)

Pancreatic Lipase Immunoreactivity (PLi): 6.7 microg/L
- control range is 4.1-12.9 = normal

Trypsin-like Immunoreactivity (TLi): 53.7 microg/L
- control range is 12-82 = normal.

Natalie

Debbie & Apollo
07-26-2008, 04:00 AM
Hi and welcome --
Hi Oreo and Mom!

We too cross over from the Cushings forum:)

SO far Apollos test are not conclusive enough the treat for Cushings -- but with his diabetes IF we have too he will be using Trilostane.

The questions about food -- interestering --
on the bag of the food comes in -- for Oreos size - what amount to they recommend???

I also am curious about the feedings 4 times a day - digestion like Natalie said...
Natalie - Apollo gets one cup of dry- I split it into 5 meals - right now levels are looking good. we have only done one all day curve -- it was good...
I started the mini meals because he seemed to be starving ;)

Debbie and Apollo

ladysmom06
07-26-2008, 04:16 AM
Hi and welcome,

I'm another one that crosses over between both boards. Lady has both diabetes and cushing's. We could never get her diabetes regulated until we started treating the cushing's. She has pituitary cushing's and we treat it with trilostane. Good luck with Oreo and please keep us posted.

Luv,
Lynne and Lady

Shaggydog
07-26-2008, 02:53 PM
Thank you all for your welcome. It's great to be among others who understand how difficult this can be.

4 cups IS a lot of food and I do have concerns about it, but then again I just did Oreo's weekly weigh-in and he's now up to 25 lbs! His average pre-illness weight was about 34 lbs, so he's very thin right now.

I'll explain how we came to be feeding him so much, but it's a long story. Oreo has a history of digestive problems since puppyhood (chronic diarrhea, mucus in his stool, vomiting) presumptively diagnosed as IBD, but it has never been methodically evaluated and diagnosed. I was told it would be very expensive and difficult to diagnose and that we may never get an answer. We've had a bunch of pets needing urgent and expensive vet care over the last few years and our vet (at that time) led us to believe the best thing was to try and manage Oreo's problems through diet.

We've always fed him premium foods such as Wellness, Wysong and California Natural, but it was always the same story - he'd do well on a food for a few months and then start having problems. In the meantime, he also developed skin problems, (intense itching, dryness and flaking, hot spots)and we consulted an allergist/dermatologist. She put him on a prescription diet, Hills z/d Ultra as I recall, same story - initially did well, then the problems started again. We tried various novel protein foods, same thing - OK at first, then developed problems. Finally, we tried IVD Potato and Venison Limited Ingredient, which then was acquired by Royal Canin. He's was doing well on this food for at least 3 years, pre-diabetes, with a good appetite and weight, way longer than any other food we've tried. Hence my reluctance to change.

The weight loss started gradually, after about a year of trying to treat his diabetes, and accelerated over the past 6 months. When I first consulted the IM, in April 2008, he weighed 24.4 lbs and was getting a total of 2 1/2 cups of food a day, split into 2 meals. The bag recommends 2 cups for a 20 lb dog, 2 3/4 cups for a 30 lb dog. There's about 300 calories per cup. He continued to lose weight, so the IM increased the total, first to 3 cups, then on July 11 to 4 cups. Oreo goes through phases where he vomits bile whenever his stomach is empty, therefore we split his food up into smaller meals. Each time we increased the food we also increased the Vetsulin, but since he wasn't regulated in the first place we ended up at about the same point. Nothing seems to make much difference to his BG.

Our regular vet tried to treat Oreo's diabetes for a year before giving up. He started out with Vetsulin, got up to 12 units twice a day without being regulated, switched to Humulin N, no improvement. So, he referred us to an IM, who started back at square one, with Vetsulin 5 units twice a day.

Most recent BG levels:

I usually do a 24 hr test once a week, on the weekend. 10am and 10pm levels are before food and insulin.

10am 332
12 417
2pm Hi (over 600)
4pm 459
6pm 526
8pm Hi (over 600)
10pm 504
12 513
2am Sorry, I missed it.
4am 596
6am 502
8am 361
10am 155

Spot checks on weekdays:
10am 351, 4pm 486
10am 246, 4pm 447
10am 356, 4pm 469
10am 273, 4pm 482
10am 326, 4pm 463


Thyroid levels - most recent evaluation was a T4 in April 2008. Value was 2.8 (ref 1.0-4.7) On July 11, the vet reduced Soloxine dosage from .2mg BID to just once a day, with the aim of slowing his metabolism. (I wasn't quite on board with that, but so much else is going on I let it go). I should ask her to evaluate thyroid level again.

k9diabetes
07-26-2008, 03:05 PM
What a relief to land on a food that has kept him going for a long time! :)

I think the Texas A&M GI panels may be fairly new. They are simply a blood test so might be worth trying just to see what they tell you about the location and nature of Oreo's issues. Our cost was about $200 for all four tests.

Did they ever treat the IBD/allergies with prednisone or Temaril-P? Or anti-histamines?

Not that you necessarily want to do steroids now with the diabetes but I wondered if they did in the past and whether it had any affect.

Our IBD cat is on prednisolone and I know another dog, even after diabetes, took prednisolone for years - it was the only way to keep him alive. Otherwise he started bleeding in the intestines from his allergies!

Perhaps atypical Cushings has been in the mix for years and has been exacerbating Oreo's skin and GI problems. Will be interesting to see if treatment for the Cushings helps with those things.

Bonnie's Crissy Ann (she's a member here and at the Cushings board) had atypical Cushings but you'd never know it was atypical from the strong overt symptoms of Cushings she had. Lots of skin problems and loss of hair. Once they got her atypical under control, she looked like an entirely different dog.

Natalie

Shaggydog
07-26-2008, 03:24 PM
Thanks for the info. I'll certainly consider the Texas GI panels, but I have to admit, after $350 for the UTK adrenal panel, and $91 for 10 Lysodren, it may have to wait a bit. I'm checking Lysodren prices online right now, $91 is outrageous!

Yes, Oreo was on prednisone and also took Benadryl for his allergies when he suffered extreme flare-ups. They did help, but I wonder if the prednisone contributed to his diabetes.

I truly believe he's had more endocrine problems than simply thyroid for a very long time. Now I look back, little things add up, like certain odd behaviors we thought were just part of his weird personality, constant food scavenging and stealing, extreme height for his breed, etc.

I'll look at Crissy Ann's story. I've also been reading about another atypical dog - Kiska, I think?

We Hope
07-26-2008, 08:08 PM
Re: these types of steroids and diabetes, there's evidence that it sure CAN play a part in the developent of diabetes:

http://www.vetinfo4dogs.com/dpred.html

"Prednisone and diabetes

"Q: Hello, I have two separate questions.

"1) The first question is have you seen any reports or studies that indicate an association between the use of predisone in dogs or cats and the onset of diabetes?

"A: C- It is pretty widely accepted that prednisone may predispose dogs and cats to diabetes. It is not as clear to me whether this is enhancement of an existing tendency to develop the disease or if it is an independent effect. They also can induce insulin resistance, leading to hyperglycemia. In diabetic patients, corticosteroids can make insulin regulation more difficult since they have this effect on blood sugar levels. I think this is a relatively rare side effect but it is a consideration, especially in a pet likely to already be predisposed to diabetes.

Mike Richards, DVM"

http://petdiabetes.wikia.com/wiki/Cortisone#Why_they_are_used

"Long-term use can cause permanent diabetes. For pets and people who are diabetic, the use of oral or injected steroids brings with it higher blood glucose levels."

http://www.childrenwithdiabetes.com/dteam/2006-04/d_0d_dv6.htm

"Prednisone is a drug that is also a synthetic hormone. It has anti-inflammatory effects, but it also antagonizes blood sugars. In large doses, it will aggravate blood sugars in those already diagnosed with diabetes. In some without a previous diagnosis, but genetically susceptible, it may bring the diabetes out.

"Knowing you have to use the prednisone, you have to make sure you can treat the blood sugars."

So while it's not the drug of choice for treating those with diabetes, there are times when it becomes the drug of necessity and there's no other option but to use it and adjust the insulin to counter the hyperglycemia it can cause.

I've seen a lot of case histories on the Pet Diabetes Wiki with regard to feline diabetes and steroid use. When we categorized the cases, here are quite a few feline cases where the diabetes was steroid-induced.

http://petdiabetes.wikia.com/wiki/Category:Steroid-induced_cases

Here also is a link saying that steroids may be responsible for some Cushing's cases too:

http://www.veterinarypartner.com/Content.plx?P=A&C=&A=619&SourceID=

"OVERUSE OF CORTISONE-TYPE HORMONES

"Cortisone derivatives may well be the most over-used drugs in veterinary medicine. Their anti-inflammatory actions soothes such common maladies as allergic skin disease (especially flea allergic dermatitis) and degenerative arthritis. Relief is usually rapid and many owners find themselves requesting "cortisone" shots or pills over and over again. In time, Cushing's syndrome results, not from any inherent disease in the pet's system but from the effects of the hormones given."

I have a friend whose non-diabetic, non-Cushing's dog was treated with prednisone for a skin problem not long ago. She started PD (polydipsia-too much water consumption) and PU (polyuria--too much urination) almost immediately after being put on the oral meds. When I mentioned to her that these were what we see in diabetic dogs and spoke about the steroid/diabetes possibility, she worked with the vet to switch to a non-steroid treatment for the problem. I believe it's possible that her dog may have developed diabetes if the steroids hadn't been stopped quickly.

Kathy

Shaggydog
07-29-2008, 01:53 PM
Oreo was never on prednisone for extended periods, just the shortest possible course on a few occasions, when his allergies were out of control and he was in total misery. At times it was so bad he'd have to be in an E-collar 24/7 or he'd chew huge holes in his flesh. However, it's certainly possible it may have contributed. I try not to beat myself up over it, but at 2 am I sure can think of a very long list of things I would do differently, if I had the chance to do them over.

Anyway, Oreo was feeling poorly the last couple of days. His appetite is usually voracious, like a starving beast, but he's been off his food. This is so rare, the only other time I can recall him not wanting to eat is immediately prior to being diagnosed with DM. Of course, this started the day I gave him his first Melatonin and Flax Seed Lignans, Saturday, so I haven't given him any more until I figure this out. I'm not freaking out - he ate something eventually, with a lot of persuasion. I'm inclined to think it's just that 4 cups of food a day is too much and it eventually caught up with him. At least, I hope so.

Sunday and Monday he ate very reluctantly from my hand, about 2 cups total, and showed signs of nausea.

This morning he ate 1 1/2 cups kibble without me having to sit on the floor and spend an hour coaxing him to eat single pieces out of my hand. So, since 10 am yesterday, whenever I've been able to check it, his BG has consistently been in the 200's, he drank only 1 liter of water in 24 hours and got me out of bed just once to go pee. Compared to recent and Sunday BG readings in the 500s to over 600, regular water consumption of 2-2.5 liters/day, and 3 nightly trips to smell the roses, this is looking interesting.

I called my vet 24 hours ago to tell her what was going on and get her thoughts it and on continuing with the new meds (Melatonin, Lignans and possible Lysodren) as planned. Still waiting for her to get back to me .... not happy.

We Hope
07-29-2008, 03:19 PM
Wow 4 cups is a lot of food. I don't believe that giving more food will help the weight problem and it may even be messing up BG regulation. Until you get the right amount of food and insulin Oreo won't start using the food correctly

It sounds like you may have part of your answer already--the amount of insulin and the amount of food are beginning to match. People with diabetes have the same type of problem in that they need to match their food/calorie intake to the amount of insulin they're using. When someone with diabetes "overdoes" it, it shows up as high/higher bg's. The person will most often take an extra corrective dose of fast or rapid-acting insulin to compensate for the extra food.

http://petdiabetes.wikia.com/wiki/Ketoacidosis#How_it_happens

"Our bodies normally are "fueled" by burning glucose; they are able to do this provided they have enough insulin (normally or by injection). When there's not enough insulin to allow the body to burn glucose for energy, it begins metabolizing fat to fuel its cells."

Without a good match between the amount of insulin and the amount of food, the body doesn't get the chance to go back to doing things the "right" way--burning glucose instead of fat for energy. This is why you often see newly diagnosed or undertreated dogs with diabetes who look like they're being starved; they start regaining their lost weight when they get near or at regulation.

http://petdiabetes.wikia.com/wiki/Polyphagia

"Polyphagia can best be described as constant hunger. Meals can be perfectly adequate but the pet or person remains hungry, actively looking for (and eating if possible) just about anything and everything.

"This is another "trick" diabetes plays on all those who suffer from it. For the most part, brain cells don't need insulin to be able to use glucose. The part of the brain which controls appetite is called the hypothalamus. It is an area of the brain which is dependent on insulin to permit it to use glucose.

"Because the appetite center needs insulin to be able to use the body's glucose, it perceives the low level of insulin in the body as a lack of food or "fuel". And so it sends out signals indicating the need for more food--hunger signals causing the body to crave more food. The food eaten because of this sets up another vicious circle, as all it does is add to the excess glucose in the system."

So the appetite center that tells someone they are "full" relies on being able to use the body's glucose for that. Without enough insulin in the system, it can't send out the "full" signal and it's keeps telling the body it needs more and more food, which turns out to drive high bg's.

My little guy always had a healthy appetite--before and after diabetes. But when he was first diagnosed, he could never get enough food. He would start trying to get his meals hours before it was time for them. When we came close to and got to regulation, he was glad to have his meals, but there was no more looking for dinner almost immediately after breakfast.

Sounds like Oreo's starting to reveal some of his secrets. :)

Kathy

Shaggydog
07-29-2008, 04:52 PM
I'm so frustrated. Please can you guys help me work out a new starting point for the amount to feed him?

His normal pre-diabetes weight was 34 lbs and he was doing well on 3 cups of the RC Potato and Venison kibble, same weight and same amount of same food for 3 years. Then he started drinking and peeing excessively, followed by going off his food for the first time in his life. My regular vet diagnosed DM and started out at Vetsulin 5 units 2 x daily. We kept him at the same amount of food, increased the Vetsulin slowly until we were at 12 units twice a day and he still wasn't regulated. Switched to Humulin N, still no success. By this time he was losing weight, so we reduced his food to 2 1/2 cups.

Enter the IMS, who put him back on Vetsulin and increased his food to 3 cups, then 4 cups. Which brings us up to the present and I'm having a very hard time trusting my vet . It seems to me I should be feeding less than 2 1/2 cups. How much less and how much insulin is the question, and how to get there from here (4 cups and 8 units twice daily)?

BestBuddy
07-29-2008, 05:14 PM
Hi,
What does the feeding guide on the food say. Buddy does well on the recommended on his food label. I tried to find info on your food for amount but didn't have any luck, so have a look at the bag and see what it recommends. I have a dietitian friend (for humans) who says that they need to get a good diet and the right amounts and then you match the insulin to the food, may not be the same for dogs but it is a good start.
Jenny & Buddy

We Hope
07-29-2008, 06:49 PM
I was all over the Royal Canin site but nowhere do I see any feeding guidelines information. So I wound up at Hill's Prescription Diets, who does provide that for their products.

I had to go with the best match for the type of product and why it's being used and that would be Hill's Z/D Canine Ultra Dry.

http://www.hillspet.com/hillspet/products/productDetails.hjsp?PRODUCT<>prd_id=845524441760430

They suggest the total daily amount of food for a dog who is 20 lb./9 kg would be between 2 and 2 3/4 cups of food and that's for maintaining weight; we have a fella here who needs to gain some.

What we do know here is that for the 8 units of insulin, the 1 1/2 cups of IVD that Oreo ate willingly seems to be very close to a good food/insulin match, otherwise he wouldn't be in the 200 range--the PU (urinating too frequently) and PD (drinking too much water) would not have subsided to this point either. If we take everything else except Oreo's diabetes off the table for a moment just for the sake of an example, with a little adjusting of his insulin--Oreo would appear to be on the road to regulation.

This was breakfast and insulin, so it would sort of make sense that dinner of 1 1/2 cups of IVD followed by the 8 units of insulin would be the same.

Now we come to him still getting his 8 IU of Vetsulin twice daily and a total of 3 cups of IVD-- 1 1/2 cups morning and evening.

When the bg's are running high as Oreo's have been, they often don't care to eat because the high bg's make them feel lousy.

When you started cutting back the amount of IVD on Sunday and Monday, making it about 2 cups total that he ate, but stayed on with the insulin dose of 8 units of Vetsulin twice daily, this is what happened:

You didn't raise or lower Oreo's insulin at all--but you DID change the amount of food he was eating--to one which is a better match to those 8 units of insulin twice a day. So there was more insulin able to cover less food, and the bg's started dropping.

Please understand that it does take 2-3 days for them to come down from being so high--being consistent as you were with the insulin is what "won this race."

At one time, we had weak pork Lente insulin from Lilly which was roughly only half potent. My Lucky's bg's went up quite high from it. When you had to have pork insulin before Vetsulin, you had to have the pharmacy order it for you, so there was no way to just go out and replace the vial. This happened on a weekend on top of that, so you couldn't get an order placed until Monday.

We turned to the old vial that the weak one was meant to replace. We knew it was less than 100% potent--it turned out to be more potent than the brand new one. Since we had no way to know exactly how much potency was left in the old vial, we couldn't raise Lucky's insulin dose for fear that we might send him hypo, so we had to stick with his normal number of units.

It took 3 days of being consistent with that less than perfect vial, but we did manage to get his bg's down once again. This is much like what happened with Oreo--consistency paid off for us both.

So what we do know is that the current insulin dose comes pretty close to being able to handle the daily total of 3 cups of IVD. If the insulin was adjusted a bit, I believe Oreo would be in the ball park for beginning to regulate.

What I don't know is if this is enough food for Oreo or not. If not, this also tells us that he will need to have his insulin dose raised to handle more food.

Seeing this also says that the insulin is effective for Oreo because if it wasn't, he never would have come down from those burning hot bg's as far as he has. When the insulin is not effective, what you see is either only a slight drop in the bg's before they climb again or that they don't drop at all.

My Lucky had immune-mediated insulin resistance to both human and beef insulin. His body viewed those insulins as "invaders" just as if they were viruses or bacteria. His system would destroy those insulins before they ever got a chance to do anything about lowering his bg's. He was only able to use pork insulin, which is a perfect match to a dog's own insulin. His bg's were in the 500-600 and up range until we tried pork insulin; within a week of starting that, he was in the mid 200's, dropping about 400 points.

It sure looks like Oreo's in a good range to begin to regulate now, but not being a vet, I can't say if he's getting enough food for his medical problems other than diabetes with the 3 cups of the IVD daily.

Kathy

Shaggydog
07-29-2008, 08:57 PM
Thank you both for your help.

The bag recommends 2 cups for a 20 lb dog, 2 3/4 cups for a 30 lb dog. There's about 300 calories per cup. Oreo now weighs 25 lbs.

We spent some 8 months very methodically and carefully going from 5 units of Vetsulin twice a day, to 12 units twice a day, all the while feeding nothing but 3 cups of kibble a day. 1 1/2 in the morning and 1 1/2 in the evening.

Seems to me somewhere in there we should have found the right food/insulin ratio, but it never happened.

My vet finally called me back this evening. We agreed to try 3 cups total/day and 8 units twice a day.

Shaggydog
07-29-2008, 09:09 PM
The nutritional info on Royal Canin products is kind of hard to find. It's available in pdf form on this page:
http://www.royalcanin.us/library/veterinary.aspx

We Hope
07-29-2008, 09:57 PM
Food: Royal Canin Potato and Venison, Limited Ingredient Diet. 4 cups daily, split into 4 meals. (Not a typo - 4 cups total, per vet's orders, because he's not metabolizing his food properly and losing a lot of weight.)

Going back to your original post, I see that you were feeding Oreo 4 times a day. Don't know whether you were giving more than two meals per day--one before each insulin injection--previously or not.

Most dogs are on a twice daily schedule for feeding and for insulin, and it sounds like you stepped down from feeding 4 times a day to twice a day when you made your discovery.

http://www.k9diabetes.com/insulinfood.html

"So insulin and food are an issue of balance. Kind of like a race... a relay race really, because there is constant processing of the food and the insulin throughout the period of time between meals and injections. The finish line is the bloodstream. Sometimes the food team is ahead, sometimes the insulin.

"If the insulin gets ahead of the food being digested and turned into glucose, your dog’s blood sugar can drop too far too fast. If the food gets ahead of the insulin, your dog’s blood sugar can rise too far too fast. A dead heat is what you want - food and insulin being delivered in balance, giving your dog a steady supply of glucose in a good range throughout the day."

Sometimes giving more than two meals a day can interfere with the action of the insulin causing higher than normal blood glucose. It would be similar to someone with diabetes having a meal and neglecting to use either fast or rapid-acting insulin to cover it. The person with diabetes would have high blood glucose because he/she had used no short-duration insulin to handle the food.

We do see some dogs who tend to go low around the time the insulin is "peaking" or working hardest and they are given either a small meal or a snack around that time to keep them from having a low at that time.

Hope Oreo will continue to do well with what his vet suggested! :)

k9diabetes
07-29-2008, 10:01 PM
It would be almost impossible to tease out whether it's IBD or the uncontrolled diabetes that caused him to lose so much weight.

It could be purely the diabetes and feeding him a lot of food just ensured that every drop of insulin you gave was used to transport glucose. Not necessarily a bad thing but there was also likely a lot of excess glucose generated.

And if you're feeding 1.5 times as much food as normal, it would make sense that you would have to adjust your expectations for how much insulin would be considered normal. 12 units of Vetsulin isn't all that much for a 25-30 pound dog and it's even less when you consider how much food was going into the bloodstream. That would require even more insulin.

I think you came to a good decision to feed him what worked before and go from there. You know that calorie-wise that was a good spot for him. And if you can get better control of the insulin/glucose balance, he will be able to make as much use of those calories as possible.

If you can regulate the diabetes, then you can find out whether there really is an absorption problem.

It's hard to rely heavily on the feeding guidelines. They are always too high for Chris, even when he was energetic and exercised.

But once you figure out how many calories are needed, you can bounce around to different foods if need be and come pretty close with the insulin as long as the protein/carb ratio is about the same. Chris has been eating all kinds of things the past couple of months and mostly has stayed with a steady amount of insulin.

Have you asked the Cush folks about appetite problems with the lignans and melatonin? It wouldn't be surprising if there was some stomach upset, at least at first.

I know Denise has been thrilled with Reba's progress on them.

Natalie

Shaggydog
08-13-2008, 08:29 PM
I'm sorry to say things aren't going too well. After the first two doses of Lysodren to treat Oreo's Atypical Cushings, today Oreo's blood glucose levels were the worst they've ever been since he was first diagnosed:
10am 321 (before food and insulin)
12 Hi (over 600)
2 Hi
4 Hi
6 Hi

I'm going to increase his insulin tonight (the vet recommends a 25% increase just for tonight) Does that seem OK???

The IMS is also recommending increasing the Lysodren to a loading dose, which seems all wrong to me. I know the Cushing board folks will advise against it. I hate this.

We Hope
08-13-2008, 09:21 PM
With regard to the insulin, some type of increase is needed; Oreo can't continue at those levels without the possibility of some serious diabetes problems.

If you don't have some on hand now, I'd suggest your getting some urine sticks to test for ketones. You need to keep an eye on that with those awfully high readings.

http://petdiabetes.wikia.com/wiki/Urine_testing_stix

What you're trying to avoid is the possibility of ketoacidosis, which can be a very dangerous problem:

http://petdiabetes.wikia.com/wiki/Ketoacidosis

http://petdiabetes.wikia.com/wiki/Ketoacidosis#Emergency_Info

"Ketone Monitoring Needed:

"High blood sugar--over 16 mmol/L or 300 mg/dL"

The tables at the link have more symptoms listed.

"In a diabetic, any urinary ketones above trace, or any increase in urinary ketone level, or trace urinary ketones plus some of the symptoms shown in the tables, are cause to call an emergency vet immediately, at any hour of the day."

You were planning to try the lignans and melatonin for Oreo when you posted last--what I don't understand and what I hope the IMS has been able to explain to you is why Oreo's blood glucose has become so high since the beginning of the Lysodren--could he be intolerant of the Lysodren?

Have to say, there's no way I could feel comfortable about forging ahead with the Lysodren at this point, seeing the effect it seems to have on Oreo's bg's.

I wish I knew what the answer was here with regard to trying to take care of the atypical Cushing's--it doesn't sound to me like the answer is to send his bg's as high as they've been since starting the Lysodren.

Kathy

k9diabetes
08-13-2008, 09:22 PM
I am not sure an increase in insulin is the right plan... my concern is that lysodren could have cut the cortisol produced drastically and what you're seeing is actually rebound from low blood sugar.

So no, I don't think I would make such a large increase.

Lysodren, unless Oreo is having some kind of reaction to the drug itself, will reduce the hormones that drive blood sugar up.

It doesn't make sense for the blood sugar to be higher so I think rebound has to be considered as a possibility.

I'll go check your thread at the Cushings board as I just can't recall the details on what you're doing with the lysodren.

Are you checking for ketones?

Can you have an ACTH done to measure the amount of cortisol production?

Natalie

k9diabetes
08-13-2008, 09:32 PM
With such high blood sugar, an increase in insulin just for tonight likely won't hurt anything.

I think I'd stop the lysodren immediately and then have an ACTH done as soon as possible to see where the adrenal gland function is.

Could be there's a reaction, allergic type, to the Lysodren itself, in which case things should clear up when it's discontinued. Or it could be that Oreo was very sensitive to the effect of the lysodren and went hypo.

Seems to me that with Oreo's history you have to consider that this could be a reaction to the drug and so not advisable to give any more until things get sorted out.

The Cushings doesn't really have to be resolved right this second anyway... unless there's something I'm missing, the last thing I'd worry about right now is Cushings.

Because it also concerns me that he hasn't been hungry and seems off in recent weeks.

Chris was a dog who was sensitive to three-quarters of the medications he was given. He'd overdose on a cat-size dose of some meds even though he weighed 60 pounds. Some docs would not accept that - thought it was all in my head. But the cardiologist had a chance to see it in action with digoxin, lasix, theophylline. We always had to start with very very small doses and some drugs Chris just couldn't tolerate.

Pardon my rambling as I'm really thinking and typing... thinking out keys so to speak.

I personally think it's time to back off the Cushings and focus on the critical stuff first. I can't see any reason to rush to load Oreo, but I will catch up at the Cushings board.

Let me know if I'm totally off base.

Natalie

k9diabetes
08-13-2008, 09:39 PM
I see you're giving lysodren twice a week...

for those who want to read the Cushings side, Oreo's thread is at http://www.caninecushings.net/forums/showthread.php?t=7354.

When did he last have one?

Natalie

k9diabetes
08-13-2008, 09:41 PM
Also, could you spell out his regimen in a quick-glance list?

Current weight
Current insulin dose
Current food, how much, how often

We Hope
08-13-2008, 10:00 PM
With such high blood sugar, an increase in insulin just for tonight likely won't hurt anything.

I think I'd stop the lysodren immediately and then have an ACTH done as soon as possible to see where the adrenal gland function is.

Could be there's a reaction, allergic type, to the Lysodren itself, in which case things should clear up when it's discontinued. Or it could be that Oreo was very sensitive to the effect of the lysodren and went hypo.

Seems to me that with Oreo's history you have to consider that this could be a reaction to the drug and so not advisable to give any more until things get sorted out.

The Cushings doesn't really have to be resolved right this second anyway... unless there's something I'm missing, the last thing I'd worry about right now is Cushings.

Because it also concerns me that he hasn't been hungry and seems off in recent weeks.

Chris was a dog who was sensitive to three-quarters of the medications he was given. He'd overdose on a cat-size dose of some meds even though he weighed 60 pounds. Some docs would not accept that - thought it was all in my head. But the cardiologist had a chance to see it in action with digoxin, lasix, theophylline. We always had to start with very very small doses and some drugs Chris just couldn't tolerate.

Pardon my rambling as I'm really thinking and typing... thinking out keys so to speak.

I personally think it's time to back off the Cushings and focus on the critical stuff first. I can't see any reason to rush to load Oreo, but I will catch up at the Cushings board.

Let me know if I'm totally off base.

Natalie

Natalie,

I agree with you. My concern for right now would be to get Oreo's bg's back under some type of control and to me that would mean to stop the Lysodren to determine whether or not he's reacting to that or not. Doing the ACTH would also tell us what has gone on with the adrenal gland since the loading began, if anything.

Chris shared with Lucky an intolerance to both the protamine suspension of NPH insulin and phenol, one of the preservatives in it. Most dogs and people are able to use NPH without having issues with it, but not our two. Lucky's bg's were controlled by virtue of the insulin itself being pork, but the suspension and preservatives of the NPH were really causing him more problems than his uncontrolled bg's were, when we first started trying to get control of them. Within 2 weeks of being able to stop the pork NPH and get back to pork Lente insulin, he was back to normal 100% once again.

It looks like whatever happened with Oreo and the Lysodren has made getting his diabetes under better control the most important step here.

Kathy

k9diabetes
08-13-2008, 10:04 PM
I'm also concerned because I don't think insulin has been given a fair shake at controlling the diabetes.

Judy's Bud is a terrier who only weighs 20 or 30 pounds but he needs 20-some units of insulin. And with that much insulin, his blood sugar is beautifully controlled.

Plus Oreo sounds like a sensitive dog and I could easily see the lysodren being too much, not too little.

Shaggydog
08-13-2008, 10:18 PM
Thank you both for your replies.

I have been checking for ketones, using Keto-diastix - always negative, so far.

Current weight: 25 lbs
Vetsulin 8 units, twice a day
Food: Royal Canin Potato and Venison Limited Ingredient Dry - 1 1/2 cups at 10am, 1/4 cup at about 5pm and 1 1/2 cups at 10pm.

The most recent dose of Lysodren was last Monday evening and before that, last Thursday evening. He was fine after the first dose. I checked bg every other day, fasting at 10am stayed in the 200s and at 4pm consistently in the 400s. I'm also giving him Melatonin and Flax Seed Oil Lignans.

As I understand it, the IMS' theory behind the variation in bg levels is that these atypical Cushings dogs crank out hormones (including cortisol) randomly and that we're never going to control the bg until the hormone issues are resolved.

I just fed Oreo and gave him 10 units of Vetsulin. His appetite seems OK. He's gone to bed now, he must feel rotten.

k9diabetes
08-13-2008, 10:22 PM
What's the most units Oreo has ever had of insulin... I'm thinking it's 12 units?

Shaggydog
08-13-2008, 10:24 PM
Correct. 12 units Vetsulin twice a day.

k9diabetes
08-13-2008, 10:30 PM
I can't say the IMS is wrong, but that hasn't been what I've seen in any of the Cushings/Diabetic dogs in the past four years.

The Cushings/Diabetes dogs I've seen have constantly high blood sugar. And it tends to come down with a dose increase but then start creeping back up. Marianne's Pebbles, for example was up to 50 units of insulin and still the BG kept climbing back into the 300s and 400s.

I haven't seen dogs who sometimes have high blood sugar and sometimes don't.

With Oreo and allergies and all, I could see the blood sugar being unpredictable for a lot of reasons. Allergies definitely contribute to higher BGs, as does inflammation.

I'm not trying to be pushy even though I'm pretty sure it sounds like I am... I'm just worried. I don't think it's a slam dunk that the problems are tied solely to Cushings and I don't think a loading or even any more lysodren is advisable until some things get better sorted out.

Some of this, like the lack of appetite, sure isn't a Cushings thing.

Oreo's very complex... reminds me of Patti's Max. I think this is going to be a very difficult road but I also think caution is warranted with any treatment. And that whoever the doc is, they will have to understand that Oreo doesn't care what the book says about what he's supposed to do.

If you can get that high blood sugar down into a more comfortable range, you'll have some breathing room to think things through.

Natalie

k9diabetes
08-13-2008, 10:31 PM
That's what worries me... 12 units is a moderate dose for a dog Oreo's size. If he was given 20 units and still had blood sugar in the 400s, then I'd say Cushings was driving it.

We Hope
08-13-2008, 10:40 PM
We have melatonin in this mix and there is a caution about it possibly resulting in hyperglycemia in those with diabetes:

http://www.mayoclinic.com/health/melatonin/NS_patient-melatonin#9FAD2677-E7FF-0DBD-13D1BC960ECC96C4

"Elevated blood sugar levels (hyperglycemia) have been reported in patients with type 1 diabetes (insulin-dependent diabetes), and low doses of melatonin have reduced glucose tolerance and insulin sensitivity. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare provider, and medication adjustments may be necessary."

There are some who theorize that dogs in general--with or without diabetes and/or Cushing's have a random cortisol release pattern. There are also studies which indicate that dogs do have a cortisol release pattern similar to humans, but the phenomenon is not as pronounced with them as with us.

http://petdiabetes.wikia.com/wiki/Dawn_phenomenon

"This is basically a process which happens to every person every day: the body prepares itself to go into "wake mode" and releases cortisol to ready itself for wake up.

"In non-diabetics, it happens virtually unnoticed, as the properly working pancreas produces more insulin to handle the cortisol release. Persons without diabetes are unlikely to be checking their blood glucose values on a regular basis, so any temporary increases would not be measured.

"We have 3 studies confirming a cortisol pattern similar to humans, 3 which found no evidence of similarity and one which confirmed it in adult non-senior dogs only."

http://web.archive.org/web/20060901064414/http://www.vfu.cz/acta-vet/vol72/pdf/72_599.pdf

Circadian Rhythm of Cortisol Secretion in Dogs of Different Daily Activities

Acta Vet Brno 2003

I'm thinking about Mickey who appeared at first to also have Cushing's:

http://k9diabetes.com/forum/showthread.php?t=197

And also about Tyler:

http://www.weir.net/~lglass/tylers_story1.htm

Kathy

k9diabetes
08-13-2008, 10:42 PM
Hi Jackie,

Sent you an email with my phone number. Feel free to use it if you want to talk things out. I promise not to force my opinion on you! :)

Natalie

Shaggydog
08-13-2008, 10:45 PM
Many thanks for your thoughts, they're much appreciated. It's certainly far from straightforward.

I'll do some thinking and check back in the morning to see if anyone here or at the Cushing's board has anything to add before making any decisions. Good night.

k9diabetes
08-13-2008, 10:48 PM
Wishing you a good night's sleep. Remember that one night of high blood sugar isn't the end of the world. This too shall pass.

Sweet dreams,

Natalie

k9diabetes
08-13-2008, 10:51 PM
By the way, we talked once about more frequent injections...

if it could be arranged to try it just for a few days, it might tell you whether duration is actually the problem. Even if you can't keep it up, it would give you an answer and then you do what you can do and go from there.

Just a thought as I was signing out.

AlisonandMia
08-15-2008, 11:34 PM
I wonder with Oreo being out of sorts lately and his BG's rising for no apparent reason if he couldn't have some sort of infection somewhere in his body wreaking havoc? The most likely suspect would have to be a UTI although very dilute urine could make this hard to diagnose.

Alison

eyelostit
08-16-2008, 12:03 AM
I can't add, but I wanted to say welcome to the board.:)

k9diabetes
08-24-2008, 06:39 PM
Hi Jackie,

We've been in touch by email but I wanted to post a note here just to say hello and check on Oreo. I know he has an IMS consult coming up and will be anxious to hear how that goes.

Natalie

Shaggydog
08-27-2008, 08:32 PM
Guess what, Natalie? Next up - Texas A & M GI panel.

Here's the scoop on yesterday's 2nd opinion:http://www.caninecushings.net/forums/showpost.php?p=76975&postcount=48