Introduction Roxy and Judy

[jk9cuts]

Hi all,

I am new here and just wanted to introduce myself and my furbaby Roxy.
Roxy went blind from SARDS in August.2008. In March 2009 she started drinking alot and messing in the house, also losing weight (3 lbs. from January). She was diagnosed with diabetes on March 253, started Vetsulin. In April I had her tested for Cushings. The test was positive. She was started on 30mg Trilostane once a day. On May 11, she was changed to Humilin N insulin. Her bg have been high..her lowest reading has been 362. Yesterday I took her back to the vet and requested another stim test for her. I was told she may need an increase in Triostane 21mg BID. I am not convinced!!!!
The vet increased her insulin from 5u to 7u bid.
I have tested her blood today and just did fasting level at 7:00 and it was 146 on the glocopet meter.

Numbers today:
8:30 597 (1 hour after shot)
12o 423
1:30 380
3:30 247
7:00 146 (fasting)


I don't know whether to jump for joy or be nervous.

Also, I made an appointment for Friday at a new vet for a second opinion.

Judy and Roxy (USA, PA)

Roxy, canine, Miniature Schnauzer,Birth date 11-14-99, 9 y/o, F (spayed),
weight 15.4, Sudden Acquired Retinal Degeneration Syndrome (SARDS dx 8/08),
Diabetes Mellitus dx
3/25/09, Humilin N 7 U twice a day
Cushing's syndrome (dx with ACTH stim test on 4/21/09,
Trilostane 30 mg started 4-23-09 once a day
diet/nutrition: Solid Gold Barking at the moon
The other girls that rule the house:
Misty, Beagle, 8-18-95 13 y/o F (spayed)
Jenna, Miniature Schnauzer, 10-23-02, 6 y/o F (spayed)
Baylee, Miniature Schnauzer, 5-9-05 4 y/o F (spayed)

[We Hope]

Re: Introduction Roxy and Judy

Welcome Judy!

It looks like you weren't able to get Roxy's bg's down before because of the Cushing's; now that it's been found and is being treated, you're seeing much better ones.

Without going further in depth into adrenal or pituitary based Cushing's, either one of them is basically an excess of cortisol the body puts out. Cortisol is one of the counter-regulatory hormones when it comes to diabetes, meaning it's there as a "fail-safe" to drive your bg's up when they go low. The excess of the cortisol makes for high bg's when there's Cushing's. Getting the Cushing's controlled (stopping the excess cortisol) also means that it's not there to make the bg's go up and stay up.

This is a type of insulin resistance caused by the Cushing's and so until that's taken care of, you will see bg's that are high and stay that way--until you start working with the Cushing's.

My thought would be that Roxy does need work with the Trilostane--either more of it or to take it twice a day instead of once. The high morning reading you get looks to me like it's because there's not enough Trilostane at that time to control the cortisol--and that's making for the high bg's. When we look at 12 hours later, we can see that both the Trilostane and the insulin are doing what they're meant to.

Kathy

[k9diabetes]

Re: Introduction Roxy and Judy

Hi Judy,

It's quite common for the Trilostane to need to be given twice a day in order to adequately control the cortisol. The vet is going to twice a day but decreasing the amount per dose so it's not much of a change in dose, just a change in how it's delivered with the goal, I'm sure, of giving better coverage of the cortisol production for a full 24 hours.

Why was the insulin changed? Was the Vetsulin not working or was this before the Cushings treatment?

At 15 pounds, she's been on a low-side-of-normal insulin dose so that definitely could go up more. Could be the vet has been waiting to see what the Trilostane treatment does for her blood sugar before raising the insulin.

The Trilostane should reduce how much insulin she needs. I agree with Kathy that the very high morning glucose probably reflects the Trilostane not lasting 24 hours and if it was my dog I would go to twice daily dosing of Trilostane.

You will need to very carefully monitor her blood sugar on twice-a-day Trilostane, though, as she would likely need less once the cortisol is better controlled.

Have you joined the Cushings forum? www.k9cushings.com/forum Seems like you did... they can better help you with the Trilostane issue.

But I think you could get very good blood sugar control if you go to twice-daily Trilostane. If it better controls the excess cortisol, that high morning blood sugar should disappear and she's certainly getting plenty of action from the insulin since she went down to 146. You could theoretically get really great regulation.

That said, second opinions are good things. Will it be with an IM or another general practice vet?

This is one case where I don't question the Cushings diagnosis because of the SARDS. The two pretty much go together.

Natalie

[CarolW]

Re: Introduction Roxy and Judy

Judy - glad to see you and Roxy here! I just read your thread, and will be watching. Welcome!

Thu, 28 May 2009 21:39:03

[jk9cuts]

Re: Introduction Roxy and Judy

Hi all,

I just wanted to update everyone on Roxy. I took her to a new vet on Friday. The new vet did a ACTH test on Roxy and her levels were not near where they should have been after 37 days on Trilostane. Sorry I forgot to ask for the results.
Anyway it was either up the Trilostane from 30mg and have it compounded to theright dose ($$$) or switch Roxy to Lysodren and start loading her at 250mg twice a day and do another Acth test on Wednesday or Thursday. The new vet has NO experience with Trilostane, as did Roxy's normal vet. Didn't find this out till he admitted it to me on Tuesday. After weighing my options I decided to start loading Roxy with Lysodren. We started loading on Saturday and I am happy to report .......no ill effects so far.

During the course of Roxy's examine the new vet found bladder stones along with Roxy's bad teeth. I knew about her teeth but BLADDER STONES!!! The old vet totally missed those. Once we get Roxy healthy enough she will need surgery to get rid of the bladder stones and clean and pull her bad teeth.

The new dose of 7u Humilan N BID is doing a great job in keeping her bg in the
100 range. I am suppose to do a curve before I take Roxy for her repeat ACTH test. We may have to drop the dose once we get the cushings under control.

The new vet wants Roxy on the science diet W/D food. I just don't like this food and have decided to switch Roxy to Canidae Platinum. Lower protein for the bladder stones, but still a quaility food.

Any thoughts or advice would be appreciated.

Judy and Roxy (PA, USA)

Roxy, canine, Miniature Schnauzer,Birth date 11-14-99, 9 y/o, F (spayed),
weight 14.4, Sudden Acquired Retinal Degeneration Syndrome (SARDS dx 8/08),
Diabetes Mellitus dx
3/25/09, Humilin N 7 U twice a day
Cushing's syndrome (dx with ACTH stim test on 4/21/09,
Trilostane 30 mg started 4-23-09 once a day, Started loading Lysodren 250 mg Bid
on 5-30-09
diet/nutrition: Canidae Platnium
The other girls that rule the house:
Misty, Beagle, 8-18-95 13 y/o F (spayed)
Jenna, Miniature Schnauzer, 10-23-02, 6 y/o F (spayed)
Baylee, Miniature Schnauzer, 5-9-05 4 y/o F (spayed)

[Ricksma]

Re: Introduction Roxy and Judy

Just a quick welcome....so glad that you are here where there are so many knowledgeable people who will be happy to help you when you need it. Sounds as though you will have a full plate, but it's do-able. Welcome to the board!!

Teresa and Ricky

[janspack]

Re: Introduction Roxy and Judy

Hi Judy,

Glad the Lysodren loading is going OK. It's not as scarey as it seems is it? As long as you are very aware of Roxy and notice if she starts to slow down with her eating, I'm sure all will go well.

I've had two CUshings dogs (father and son) and both were treated with Lysodren (despite me being in the UK). Timba, the dad, was pre-Trilostane and Muddle, his son, didn't respond to the trilostane either, like Roxy.

Both did really well once stable and went on to live to 13 yrs old. Neither died from the Cushings either. Mind you I was lucky that they didn't have concurrent Diabetes though!

Hope Roxy is soon loaded and her cortisol levels are where the vet wants them.

[eyelostit]

Re: Introduction Roxy and Judy

Hi Judy and Roxy !

BG sounds a whole lot better with Roxy. I'm sorry about the stones, with the bg looking good and your change in cushing med's in time I think it'll be ok to take care of the bladder stones and the teeth.

Again Welcome
Dolly