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CarolW
11-16-2008, 06:13 PM
A friend of mine reported this:


And Just a side note, [my dog's...] readings have been consistently over 500, but today was 490, but the vet won't increase her insulin till we get the Cushings test results, how frustrating!


Does that make sense?

Sun, 16 Nov 2008 18:12:33 [PST]

BestBuddy
11-16-2008, 11:24 PM
When Buddy was dx with cushings it was high BG's that prompted the testing. We put his insulin up but it didn't make any difference until we started treating the cushings and then we had a sudden drop and had to decrease the insulin after a hypo. Maybe the vet wants to move quickly on the cushings treatment and that may help the BG quickly.

eyelostit
11-17-2008, 12:57 AM
I don't know too much about Cushings and Diabetes together, but Marianne, Nat and Kathy should be able to advise.

bgdavis
11-17-2008, 06:02 AM
Hi,

My Crissy was diagnosed with diabetes prior to having a confirmed Cushings' diagnosis. The vets at the University of Missouri wanted the diabetes under control prior to testing via a full adrenal panel (done only at the Univ. of Tenn.).

I would never want my dog to be running in the 400-500's for any length of time! Can't understand why the vet would wait.

Bonnie and Crissy

CarolW
11-17-2008, 06:21 AM
Hi,

My Crissy was diagnosed with diabetes prior to having a confirmed Cushings' diagnosis. The vets at the University of Missouri wanted the diabetes under control prior to testing via a full adrenal panel (done only at the Univ. of Tenn.).

I would never want my dog to be running in the 400-500's for any length of time! Can't understand why the vet would wait.

Bonnie and Crissy

This is my feeling, too. I know nothing about Cushings, apart from having read on the Cushings message board, following Marianne and Pebbles. But to let a dog run over 500 without doing something scares me. I DO notice, sorry - I forgot who posted this - that one dog had to have insulin dose dropped, after Cushings was confirmed.

So far, thanks all for your replies!

Mon, 17 Nov 2008 06:20:23 (PST)

CarolW
11-17-2008, 06:24 AM
When Buddy was dx with cushings it was high BG's that prompted the testing. We put his insulin up but it didn't make any difference until we started treating the cushings and then we had a sudden drop and had to decrease the insulin after a hypo. Maybe the vet wants to move quickly on the cushings treatment and that may help the BG quickly.

Oh - that was you, BestBuddy - the thing is, I gather my friend's dog isn't diagnosed with Cushings yet. Like Bonnie, I would be scared to be letting my dog run over 500. I wonder if my friend is using something like an AlphaTrak for testing, or some other meter that won't read numbers over 500 - only HI or something like that.

I don't know how long a diagnosis takes, either!

Mon, 17 Nov 2008 06:23:53 (PST)

k9diabetes
11-17-2008, 07:57 AM
Carol, do you have any more details?

Like is the dog already at 1 unit of insulin per pound and running that high?

Also has the dog's BG been that high all along or is it higher since the Cushings test?

The stimulation of cortisol that they do with that test can send the BG through the ceiling, especially if it's not well controlled before. Chris' BG ran high two to three days after he had an ACTH stim test.

Are they checking urine for ketones?

The results should not take long to get back unless they did the atypical panel sent to Dr. Oliver but context could make a lot of difference here.

Natalie

k9diabetes
11-17-2008, 07:59 AM
Also, confirming Cushings wouldn't drop the insulin dose but treating it would.

Cortisol drives blood sugar and Cushings is too much cortisol (usually; sometimes other hormones that generate the same effect).

So when you control Cushings with medication, you reduce cortisol and when you reduce cortisol you reduce blood sugar levels and need for insulin.

CarolW
11-17-2008, 08:15 AM
I don't know the answers to your questions, Natalie, but I just wrote to my friend and asked her to join here. I hope she will.

She could answer your questions.

Mon, 17 Nov 2008 08:14:59 (PST)

JeriLeighR
11-17-2008, 09:54 AM
This is Jeri Leigh, Princess's mom. She was diagnosed as diabetic just under a year ago, and was put on 3 units of Vetsulin twice a day. After a couple weeks the vet increased her dose to 5 units twice a day. She is a 16 pound toy poodle. Recently, her belly is getting very large, but she isn't gaining any pounds. She keeps falling with her back legs going out from under her. Her BGs were over 500, as the meter would just read H. He won't increase her insulin until the cushings test comes back, which will be any day, as it was done 1 week ago. I tested her bg again last night, and 490, but has been reading 515, 516, etc. So frustrating. She has been on the 5 units twice a day for 6 months, I just hope she wasn't running that high that long!

k9diabetes
11-17-2008, 10:13 AM
Jeri Leigh,

Good grief, Jeri Leigh, that's a SMALL dose of insulin for her size. Has her BG been this high for a whole year?

Are you testing for ketones? That's imperative with blood sugar this high and anything more than a trace should be treated by a vet immediately.

If you can give a fuller history, it would really help...

How has her BG been monitored for the past year?

How high has her BG been long-term? In other words, are these highs a recent development or has it always been this way?

The legs going out from under can come from Cushings and from diabetes - dogs do get neuropathy that results in weak hind legs from high blood sugar but I've seen it come from Cushings too.

Please provide the results of any tests you and the vet have done - curves at the vet, lab analyses, urine testing.

I almost have to assume that her BG levels were better previously, allowing for the low dose of insulin, and that now suddenly they have risen.

Cushings is one possibility but so is "honeymooning" in which Princess might have retained some ability to produce insulin, just not enough to manage her blood sugar on her own. If that were the case, that ability might finally have failed completely, making 5 units of insulin not nearly enough.

Best way for us to help you is to provide as full a history as you possibly can.

Don't worry about a long post - we need to know as much as you can tell us in order to offer any good advice.

And do get some ketodiastix ASAP if you're not already checking for ketones.

Natalie

k9diabetes
11-17-2008, 10:15 AM
I've got to go out now and do some errands but I will check back when I return as I'm worried about Princess and potential ketoacidosis.

Natalie

JeriLeighR
11-17-2008, 10:17 AM
I will write more later, a longer post, but her ketones have never been tested, I have no idea where to get the strips or how to do it. The only monitoring she has had was the initial test when she got sick, then 1 bg curve to find out that the 3 wasn't enough, so he increased her to 5, and the week after that she had another bg curve, and it was in high 200s, and he said it was high, but he was good with it getting that low, he didn't want her to bottom out, as one reading was in the hundreds. I only took her in this last week because she was acting very lethargic, belly getting large, falling, and her tail started to turn black. I have no idea what to do. I have an accucheck Aviva machine that I have been using, rarely, but more the past week, and she is always high 400s to low 500s.

CarolW
11-17-2008, 10:50 AM
Jeri - thanks for joining us here. You will find a goodly collection of high-powered knowledge here, always sensibly used. Looking forward to your more-detailed report. Give that Princess hugs, licks and wags from us (Kwali, Kumbi and me). And here's a hug for you.

Oops - forgot to say - you can get ketodiastix at any pharmacy; ask the pharmacist for them. They're not very expensive.

Mon, 17 Nov 2008 10:49:49 (PST)

We Hope
11-17-2008, 11:01 AM
Hi Jeri,

http://www.cat-dog-diabetes.com/dogs-urine-testing.asp

You may be asked by your veterinary surgeon to monitor your diabetic dog by regularly testing samples of its urine.

What you need

Clean containers for collecting urine.
Urine dipsticks provided by or recommended by your veterinary surgeon.
A place to record results.

Testing urine using urine dipsticks

Follow the instructions for the dipsticks you are using, particularly for the time to read the results.
Place the dipstick in the container with the urine and soak the test pads.
Remove the dipstick and tap dry.
Read the result after the time specified on the stick bottle (usually 1 minute).
Hold the stick against the chart on the dipstick container to compare colours.
Record the results including time of collection and times of insulin injections given for that day.

Collecting urine

Collect urine samples from your dog a few times a week at different times of day. The best times to collect urine are in the morning and afternoon before feeding and at night just before bedtime.
Take your dog out for a walk on a lead.
Have a clean container ready to catch urine when your dog urinates.

http://www.cat-dog-diabetes.com/video/testing_dog_urine.mpg

Urine testing Video. This show you how to use the test sticks, but they are using the glucose testing ones only--you want the ones that test for ketones also:

http://groups.msn.com/ValleySugarcats/fornewbies2.msnw

Ketostix section

http://groups.msn.com/isapi/fetch.dll?action=MyPhotos_GetPubPhoto&PhotoID=nGwAAAGAHNkic8xYxPPvbHlhlbayt78zzInuQ6dXHM joCyN8!fOpNc3HNQ1O2l!Al
Ketostix color codes--this is a ketones-only test strip.



http://groups.msn.com/isapi/fetch.dll?action=MyPhotos_GetPubPhoto&PhotoID=nGwAAAFMHO0furvnXlDQXkBsROYu3nRO9VH1sdbDqg JCRuFWqFlltchywAjweX8fl
Ketodiastix color codes--these test both glucose and ketones.

Since you blood test, you can get either the Ketostix that test ketones only or the Ketodiastix that test both glucose and ketones in urine. Tell the pharmacist what you need and he/she will be able to point you in the direction of them in the store.

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

"How to catch urine. Some people place the stix under their pet's stream when s/he is urinating. Others catch urine in a dedicated spoon, ladle, or other collection device and dip the stix into the urine."

http://www.healthypet.com/faq_view.aspx?ID=148&sid=1

"If you're performing a urine test at home, such as a taking glucose level for a diabetic dog, or if you need to collect urine at home to take into the veterinary clinic, you can do it without making a mess or upsetting your dog. Attach a light, thoroughly cleaned container, like an empty margarine tub or an old Styrofoam egg container, to the end of a yardstick. Keep your dog on a leash when you take him out, so he can't get too far away from you.

"When he starts to urinate, wait a second or two for impurities to be flushed out, then slip the container into the urine stream. Pour the urine into a clean jar that seals tightly. You don't need a whole lot of volume for most tests. Five to ten cubic centimeters (less than an eighth of a cup) will usually suffice."

Then you can follow the steps above with the sticks to test the urine.

Hope this helps!

Kathy

k9diabetes
11-17-2008, 02:29 PM
From what I've been able to gather so far, it seems that the very high BG may be a somewhat recent development but that there has been virtually no monitoring of her blood sugar levels since she went to 5 units and had the curve at the vet.

I'm very happy to see that you've started home testing blood glucose! That's a good start, even if those numbers are scary to look at.

Let us know ASAP about whether she has ketones in her urine.

If she does and they are anything more than a trace amount, please notify the vet or emergency hospital and have her treated right away.

Also, can you advise what test was done to check for Cushings? ACTH? LDDS? UTenn panel, which covers atypical Cushings?

And post the results when you do get them - have the Vet give you an actual hard copy showing the test results and the reference ranges for them.

I'm wondering if it was the UTenn panel because otherwise I do not think it would take so long to get the results back. I thought they usually came back in a day or two.

I can only guess, based on an apparent lax monitoring plan for the diabetes, that the vet doesn't want to change the insulin dose now and then potentially have to change it again after Cushings treatment is begun. However, now that you are home testing and can monitor the BG, I would want to have the dose increased now to get the BG under better control. It's not like once you go up a notch you can't go back! And those high BGs are, at best, uncomfortable and at worst will lead to cataracts and/or to ketoacidosis.

So I believe it's either time to demand more from your vet or look for another who is more willing to tackle these problems assertively.

Looking forward to more information,

Natalie

Debbie & Apollo
11-17-2008, 03:39 PM
HI there Jeri

If they sent the test to UT - their panels are done on certain days of the week -- that could be the reason for what seems like a long delay in getting the response.

Have you figured out where to get some Urine Strips???

Debbie and Apollo

We Hope
11-17-2008, 04:58 PM
Sometimes the color chart links aren't showing up.

Here's ketodiastix--tests for glucose and ketones:

http://i37.tinypic.com/34hdmqr.jpg


This is ketostix--tests for ketones only:

http://i34.tinypic.com/33cbuoy.jpg

Kathy

JeriLeighR
11-17-2008, 06:25 PM
I have not gotten the ketone test strips, embarassingly enough, I don't have the $$ until Friday. I know it's very important, but already overdrawn. I have no idea which test they did for the Cushings, but I will find out. I called today and he said I could increase it to 6 or 7 if I want (her units), but he might change it again. I took her blood sugar tonight and it was 290, lowest in a long time. Such a range. I will keep you updated. Thanks so much for your help all.

Debbie & Apollo
11-18-2008, 09:05 AM
I'd call the different stores on the strips --

what they will test for and how much -- I was surprised how much they varied the $$

also the ones that test for more than one or two things were not able to be purchased at any of our local drug stores -- I get mine at the Vet office -
BUT they price match what I have found on the internet ;) I guess they want the business bad enough!

Debbie and Apollo

k9diabetes
11-18-2008, 02:21 PM
The strips that test for lots of different things are quite a bit pricier than plain old ketostix, which is what you mainly need since you're testing blood glucose at home. Ketostix are really inexpensive... Hocks sells a box of 50 for $10 and a box of 100 for $18.

www.hocks.com (http://www.hocks.com)

k9diabetes
11-18-2008, 02:23 PM
Since ketoacidosis is potentially deadly, take her to the vet immediately if she stops eating, throws up, seems lethargic. The increase in insulin should really help prevent things from heading that direction.

JeriLeighR
11-19-2008, 05:29 PM
Well the vet called and left me a message today that Princess DOES have Cushings. He didn' say what kind, but said he wants to go over options with me in person. They are closed, so I will call tomorrow, but I am kinda upset, not knowing what the treatment options are. I know we will make it through though.

eyelostit
11-19-2008, 05:55 PM
I just saw on ebay the diastix and keto diastix at a good price and free shipping I think, i think i may order one. I was looking online and comparing the prices and shipping, then i remembered ebay. Walmart usually has them also

JeriLeighR
11-19-2008, 06:12 PM
Thanks, I will def. get some. I have no idea what to expect now with her new dx, but we will see. Thanks so much.

k9diabetes
11-19-2008, 06:16 PM
Have you already been to the Cushings board?

www.caninecushings.net (http://www.caninecushings.net)

JeriLeighR
11-19-2008, 06:21 PM
I have not, but I will be on there tonight learning all I can. Thanks

rhodesian46
11-20-2008, 05:26 PM
HI,
As you probably already I had a dog ( she passed almost a month ago:() with diabetes ,cushings and was hypothyroid Do check the cushings site out I posted there since for over a year. Pebbles was dx with hypothyriodism 6/07 ,diabetes 8/07 the Cushings 12/07. Pebbles probably had cushings around 2 1/2 years prior My butt face vet at the time told me she had diabetes insipitus. All along she had had the beginnings of Cushings. With a diabetic and cushings dog I would high,y recommend an Internal Med Specialist as these 2 endocrine disorders are very complicated to treat . I took Pebbles to Texas A & M They are one of the best in the country, Since she had diabetes as well the IMS said that Trilostane would be better for her than Lysodren. She had had an ACTH stim and ultrasound for the dx A dosage was started then the ACTH stim was done 10 days later. then I think 30 days later. It is expensive to treat at first. You can get the trilostane from a compounding pharmacy. I used Diamondback Drugs in AZ They were the most reasonable. Your vet can call the script in.Another thing that I need to mention Some untreated cush pup tend to have high blood pressure. This usually resolves after Cushings is controlled. SO please make sure that the blood pressure is taken ( Doppler) It is taken 3 x for the reading. Pebbles was put on Norvasc for around 2 months( you can get this drug from Costco dirt cheap Never knew that dogs blood pressure should be taken till A & M took it. The the diabetes will be under control after the cushings is and the insulin hopefully will be reduced. Don't want to put too much on your plate Will watch the post and reply as needed A BTW Welcome!!!

k9diabetes
11-24-2008, 08:24 AM
Diagnosing Cushings can be tricky in a diabetic... will have to go see if you've checked in with the Cushings board and described for them how the Cushings diagnosis was made as they have seen many instances where the Cushings diagnosis was in error.