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Annie: Diabetic with new Cushings diagnosis

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  • #46
    Re: Annie: Diabetic with new Cushings diagnosis

    Hi Karen
    Its been around 7 days since you upped Annies insulin and food
    It would be informative for you to check her blood sugar especially at fasting before food
    And spot check threafter to see how the increase in food is meeting up with the 8 units of insulin
    Most importantly to check for any low blood sugar
    Riliey . aka Ralphy, Alice, Big Boy
    20 lb male. 5 1/2 nph insulin. 1/2 cup fromms. black cockapoo, dx Apr 2012 . 5 1\2 yrs diabetic. 2000 to 2017

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    • #47
      Re: Annie: Diabetic with new Cushings diagnosis

      Oh wow—Now i’m being tracked, or rather Annie is and I want to thank you for your interest and concern. Annie had a curve done last Thursday, but I did not post the results because my sister-in-law had a kidney transplant so my focus was elsewhere. Anyway, doc raised her insulin from 8 to 9 units 2x a day after meals and no change in food amount. I even asked him if we needed to start reducing her amount and he said no. Remember that she also has cushings. She is scheduled to have another curve done this Thursday. Doc is more concerned with stabilizing her diabetes since her gallbladder surgery than the cushings—and I have to agree. Blessings, Karen

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      • #48
        Re: Annie: Diabetic with new Cushings diagnosis

        Originally posted by katy1 View Post
        Doc is more concerned with stabilizing her diabetes since her gallbladder surgery than the cushings—and I have to agree.
        Hi Karen,

        I’m not exactly sure what you are meaning to say in regards to Annie’s Cushing’s treatment. Does your vet not intend to continue to monitor her cortisol level for the time being? If so, I want to make sure you understand the possible result.

        If her current maintenance dose of Lysodren is insufficiently suppressing her adrenal function, her cortisol level will continue to rise (as it has already done). If the cortisol elevation is caught early enough via ACTH testing, often the situation can be remedied simply by increasing the maintenance dose a bit. However, if the elevation is allowed to progress uncontrolled, you reach the point where you are forced to go back to Square One and initiate the entire loading process all over again. Inconsistent cortisol levels can also make glucose levels and insulin needs constantly moving targets that are more difficult to stabilize.

        Unless an Addisonian condition is suspected, it’s absolutely true that diabetes carries the potential for more urgent crisis than does Cushing’s. But in terms of ongoing treatment success, I don’t think it’s wise to downplay the importance of keeping close tabs on Annie’s cortisol levels.

        I know you’ve remained really nervous about the Lysodren. But monitoring her cortisol will reassure you that her level is not dropping too low. And if it’s increasing, it’ll be far easier on you both to just incrementally increase her maintenance dose, if necessary, than to go through another full loading period. So I’d encourage both you and your vet to be proactive about monitoring her cortisol level now, while the opportunity to make minor dosing changes remains an option.

        Marianne
        Last edited by labblab; 05-21-2019, 05:11 AM.

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        • #49
          Re: Annie: Diabetic with new Cushings diagnosis

          Hi Marianne,
          Annie is at the vet today for another bg curve. If doc wants to increase her insulin again, I’m going to insist we do another stim test even though she had one done a couple of weeks ago. I do know that if her cortisol is going up that will effect her insulin.

          I’m juggling about 5 balls in the air right now and only have two hands. So, I just rotate between her diabetes, her cushings and keeping her eyes ready for possible cataract surgery whenever we can get her stable enough. Ugh! Blessings, Karen

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          • #50
            Re: Annie: Diabetic with new Cushings diagnosis

            I don't remember the details but I know for smaller dogs they are sometimes able to just do the first part of the ACTH test vs. the whole thing to possibly get an idea and save some money

            With my dog we were more worried about lows than highs so this may not be an option for your girl but it's worth asking about if you are going to be checking more often since it isn't cheap.

            hang in there! Judi
            Jenny: 6/6/2000 - 11/10/2014 She lived with diabetes and cushings for 3 1/2 years. She was one of a kind and we miss her.

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            • #51
              Re: Annie: Diabetic with new Cushings diagnosis

              Judi, thanks for jogging my memory to mention a cost-saving tip! In terms of the ACTH, both parts of the test are given regardless of a dog’s weight. But for smaller dogs, the vials of the expensive stimulating agent can be divided so that the cost of each individual test is lessened. Here’s a link to an article by Dr. Mark Peterson that describes the protocol:

              https://endocrinevet.blogspot.com/20...cortrosyn.html

              Within the last couple of years, some clinicians have been experimenting with using baseline cortisol levels alone for monitoring dogs taking trilostane. But not everybody is “on board” with that approach due to the surfacing of some problems/questions. I’m not aware of that approach being used to monitor Lysodren treatment, however.

              Judi is right, though, Karen. Hang in there! I think you’re doing a great job of juggling those balls for Annie. She’s so very lucky that you’re her mom ! I’m not meaning that you have to rush out tomorrow to have another ACTH done. But I was just worrying if you were planning on holding off indefinitely on additional monitoring.

              Marianne

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              • #52
                Re: Annie: Diabetic with new Cushings diagnosis

                Annie’s curve was basically the same as it was a week ago, however, she has gained almost a pound during this past week. This tells me that maybe it’s time to back down on her food and keep the insulin the same. She has been on 1 can of Glycobalance 2x per day. I was thinking about cutting her back to 1.5 cans per day divided into her two feedings

                I was not able to talk to doc when we picked her up today as he had an emergency he was tending to.

                Any suggestions from anyone?

                Blessings, Karen

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                • #53
                  Re: Annie: Diabetic with new Cushings diagnosis

                  I agree. Cut back on the food. Cushing makes them hungry. It’s hard
                  Jenny: 6/6/2000 - 11/10/2014 She lived with diabetes and cushings for 3 1/2 years. She was one of a kind and we miss her.

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                  • #54
                    Re: Annie: Diabetic with new Cushings diagnosis

                    My dog is 25 lbs. and he eats 1.5 cans divided into 2 meals, and it maintains his weight perfectly.
                    Riley, 8 yr. old maltipoo, 25 lbs., diagnosed Feb 2017, taking thyroid meds, had pancreatitis and DKA mid March, eating Wellness Senior formula can food. NPH dosage now at 9.0 units Humulin N. Adding either pumpkin, spinach, blueberries, yams, or green beans to his food. Also omega-3 oil.

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