My diabetic girl just started Vetoryl for Cushings - please help!

[Sammigirl2004]

My girl Sammi just turned 13, on March 1st we took her to the vet due to increased drinking/peeing. Diagnosed with Cushings and Diabetes. Vet started her on 2 units insulin 2x/day and 10 mg of Vetoryl. No change in drinking/peeing and she seemed more tired once on Vetoryl. Had "stim test"and Glucose curve last week, Vetoryl up to 20mg and insulin to 3 units 2x/day. Appetite is fine no diarrhea/vomiting, still peeing/drinking alot. She is very lethargic...pretty much just lays around all day no energy at all. Is this normal? Is it a temporary period of withdrawal of lowered Cortisol? The vet said that some dogs just don't tolerate the Vetoryl well and may need to try Lysodren. I don't know if I want to do that as I heard its just not safe. I posted this same message on the Cushings site and was told to come here as they advised the Diabetes should be more of a concern right now - any advice would be so helpful, its a scary time right now as I know how hard Diabetes can be to manage when Cushings is present as well

[MikeMurphy]

Re: My diabetic girl just started Vetoryl for Cushings - please help!

Hi and welcome to the forum!

There are several members that have dealt with Cushings and diabetes. Hopefully they will chime in soon.

What is Sammi's weight?

[labblab]

Re: My diabetic girl just started Vetoryl for Cushings - please help!

Yay! I'm so glad you and Sammi have started posting over here!

As I confessed over on K9C, I am surely not a diabetes expert . So that's why it will be great to get some guidance from the good folks here.

Just to update people re: the Cushing's side of things, we're encouraging Sammi's parent to get copies of all the diagnostic tests, and also the numerical results for the recent ACTH stimulation test. We've noted that the Cushing's blood tests are vulnerable to "false positives" in the presence of other illnesses, including uncontrolled diabetes. So we do have some concern about the dual diagnosis. Also, since Sammi seems to be doing worse instead of better since starting the Vetoryl, the vet has agreed to temporarily discontinue the Vetoryl altogether for the moment. We're thinking it might be really helpful to seek a consultation with an IMS in order to help sort through things. So I think that's where things stand right now on the Cushing's front and most importantly, we're hoping Sammi can get squared away with her diabetic treatment.

I will keep following progress over here, too, in order to keep tabs on the Cushing's side of things.

Marianne

[jesse girl]

Re: My diabetic girl just started Vetoryl for Cushings - please help!

i was also concerned about a dual diagnosis at the same time

now stopping the cushing meds and letting that run its course

may have to start at the beginning with a normal starting dose for insulin multiply .2 by the weight of your dog . give a week and do a curve and reevaluate after

if you see some improvement maybe it was the cushing meds

[Sammigirl2004]

Re: My diabetic girl just started Vetoryl for Cushings - please help!

Thank you all so much...you don't know how much it means to me to have found this community as well as the one for Cushings...I have been scouring the web on a daily basis reading as much as I can and trying to figure out the best way to help my girl deal with both of these issues. I have completely revamped her diet...high protein...low fat, low carb etc...she's been so so good with her insulin injections they don't bother her one bit. Mike - she is 19 lbs by the way. (she was 22 lbs on March 1st, the day of her diagnosis so she has lost quite a bit, which I understand is common?) She is so so hungry like ALL the time though..and I don't want to feed her too much as I know that even a small snack can raise her sugar. She eats 1/2 a cup of Nutrisca grain free chicken and chickpea kibble mixed with a little poached chicken in the morning at 6am and then for dinner. I am expecting a shipment of the Royal Canin diabetic canned food to arrive any day now as I understand that canned food is better for her then dry kibble..although the Nutrisca has a very high protein percentage - 30% I believe? Are there any snacks I can give her that will keep her more full during the day? High fiber snacks? I am sorry for all the questions...just so much to learn and I just want her to feel better and do what's best. Yes still tired today (just stopped the Vetoryl yesterday) Her values were still quite high last Thursday for her curve (600) Could that be causing her to feel crappy and be lethargic? Thank you all so much again!

[labblab]

Re: My diabetic girl just started Vetoryl for Cushings - please help!

Here's a question from me on behalf of Sammi: since the Vetoryl has been discontinued, would that typically call for an adjustment in the amount of insulin that's given?

Marianne

[MikeMurphy]

Re: My diabetic girl just started Vetoryl for Cushings - please help!

i was also concerned about a dual diagnosis at the same time

now stopping the cushing meds and letting that run its course

may have to start at the beginning with a normal starting dose for insulin multiply .2 by the weight of your dog . give a week and do a curve and reevaluate after

if you see some improvement maybe it was the cushing meds

I agree with jesse girl here. It's best to concentrate on getting the diabetes under control, now that the Cushings meds have been stopped.

Seeing that a Sammi currently weighs 19 lbs, her normal starting dose using Novolin N would be about 4 units every 12 hours (19 x .2 = 3.8 units). What type of insulin is she on?

If she really does have Cushings, there may be some insulin resistance going on, so she could wind up settling in at a quite higher dose.

Just remember that you have to take things slow with insulin increases, let her body adapt to the insulin change and evaluate the results by doing a curve after 5-7 days.

Are you home testing or having your vet do the curves?

[CraigM]

Re: My diabetic girl just started Vetoryl for Cushings - please help!

Welcome!

As Jesse Girl stated, a common starting insulin dosage is .2 units per pound. So in your case about 4 units twice a day. Of course, this is just a typical STARTING dosage and it could end up being more. Just as an example, my 18 pound Annie is getting 8.5 - 9 units of Novolin-N. Are you blood testing at home? What insulin are you using?

High blood glucose is likely to keep Sammi hungry and loosing weight. Basically, the food she eats gets converted to glucose to feed the body, but without the proper amount of insulin the glucose remains in the bloodstream and doesn't feed the body's cells. The glucose gets filtered out by the kidneys and is expelled in the urine. Feeding more would probably cause her to loose weight even faster. So, home blood testing is probably the best thing you can do for her.

Best to avoid snacks until you home blood test and can see how they affect her blood glucose readings. Some give something like frozen green beans as a treat for good behavior, like after a blood test. I use to give Annie 1-2 frozen green beans straight from the freezer, but haven't done that for several years.

Craig

[Sammigirl2004]

Re: My diabetic girl just started Vetoryl for Cushings - please help!

Sammi was started out on March 1st on 2 units of Novolin 2x/day and 10mg of Vetoryl...was increased after ACTH test/Glucose Curve on March 16th to 20mg of Vetoryl and 3 units of Novolin 2x/day. I am still waiting on the vet to send me actual numbers of her results (they are so slow to respond its very frustrating) however I was told briefly when I called a few days ago and asked in passing that her BG levels were still quite high around 600. I had no idea that the starting dose was based on weight and just assumed the vet knew what the proper dosage was. Should I call and express my concern that the 3 units is not enough? I am not home testing as of yet but I am def going to be going that route based on everyone's recommendations. That's the other issue...the vet does not have her scheduled for another curve until April 6th...thats a full 3 weeks after her last increase. I feel that's too long to wait, especially considering the Vetoryl has been stopped. I was told to see how her lethargy was after a week off the meds and then we will see how to proceed...perhaps start her off again at only 5mg per day or even switch to the Lysodren. I do not want the Cushings to go untreated as I realize that it will be harder to keep her regulated. I am learning so much from all of your replies...thank you so much!!!

[jesse girl]

Re: My diabetic girl just started Vetoryl for Cushings - please help!

Here's a question from me on behalf of Sammi: since the Vetoryl has been discontinued, would that typically call for an adjustment in the amount of insulin that's given?

Marianne

in theory with the medication you would reduce the cortisol levels which would reduce the amount of insulin that is needed so discontinuing the cushing med you would think you may need more insulin

the problem is you dont know if the dog truly has cushings so you really cant determine its a guarantee so basically your starting over with dosing

maybe after a curve with high stable sugar(no big swings ) maybe in conjunction with typical diabetic physical symptoms you may be able to possibly give a higher dose adjustment . most times 1 unit is the largest adjustment for a smaller dog to medium but maybe you could give more

home testing would be a big help

[CraigM]

Re: My diabetic girl just started Vetoryl for Cushings - please help!

Is Sammi showing physical signs of Cushings? I think the common physical signs, that differ from diabetes, is flaky skin, hair loss, potbelly. Thirst and big appetite can be seen in both Cushings and diabetes, so we can't use these to definitely diagnose Cushings - could be just diabetes. There have been many pups thought to have Cushings, but turned out to only be diabetic. I think most would recommend treat diabetes first, then worry about Cushings?

Craig

[MomofGus]

Re: My diabetic girl just started Vetoryl for Cushings - please help!

All the questions asked are the same I was thinking. I think many vets immediately conclude to Cushings when it may not be, especially when diabetes is involved. I've read of too many false positives. I believe as well, that treating diabetes should come first. Home testing will greatly help you and your dog in keeping on top of the sugar levels and knowing how her body is responding to the insulin.

Frozen green beans work well as a snack,as well as frozen dollops of pure canned pumpkin. They add fiber to the diet and will not raise sugar levels.

[CraigM]

Re: My diabetic girl just started Vetoryl for Cushings - please help!

Is Sammi showing physical signs of Cushings? I think the common physical signs, that differ from diabetes, is flaky skin, hair loss, potbelly. Thirst and big appetite can be seen in both Cushings and diabetes, so we can't use these to definitely diagnose Cushings - could be just diabetes. There have been many pups thought to have Cushings, but turned out to only be diabetic. I think most would recommend treat diabetes first, then worry about Cushings?

Craig

Here is a YouTube video showing, I think, a severe case of Cushings:
https://youtu.be/Iq5_5zdw9S8

Potbelly, crummy skin is very noticeable in the video. I'm not sure what a newly diagnosed pup would look like.

Craig

[Sammigirl2004]

Re: My diabetic girl just started Vetoryl for Cushings - please help!

I have seen what a typical Cushings dog looks like and now that several of you have mentioned it's common to be misdiagnosed and for a test to possibly register "false positives" in light of the untreated Diabetes, I am wondering myself if she truly has the disease as well. I do need to mention that last April she had surgery to remove a growth on her tail and the pre-op bloodwork showed elevated liver enzymes and the vet "suspected" Cushings (this was a different vet) but he never once mentioned any need for concern or further testing. He never once mentioned the possibility of Diabetes either. Are elevated liver enzymes something seen in Diabetes as well? I feel like I should have researched it more at the time and feel terribly guilty about that She wasn't peeing or drinking excessively at that time it only started around the middle of February. And she had a few accidents around the house as well, which hasn't happened since she was a puppy. As far as the other signs of Cushings...NO hair loss or skin problems at all. In fact I noticed when I bathed her yesterday that she usually has some fur left in the drain but there was absolutely NONE yesterday which I thought odd since I know that hair loss is a big symptom of Cushings. She does have a small belly but I dont know as I would call it a "pot belly"...my son seems to think she looks very thin in her face and is getting more "bony" but that just may be from the weight loss? She just woke up and I am hoping every morning she will have a little more energy but she doesn't...walks very slowly to go outside to pee and I usually have to carry her up the 4 back steps. She just wasn't like this before being diagnosed...I have a video of her from Feb 24 running around the house, playing with her toys , being her usual self. Can the disease progress this fast? I did call an internal medicine specialist an hour away yesterday (hes the closest) and I think we may have him examine her and give his opinion on her test results and overall condition. Very worried about my girl

[Judi]

Re: My diabetic girl just started Vetoryl for Cushings - please help!

Hi: I think seeing a specialist is an excellent idea. We waited too long to see one and I regretted it. While her blood sugar is high, she will be lethargic.

My Jenny's pot belly was very obvious, she lost weight everywhere and still had the bully. One other sign of Cushings is muscle deterioration. So if your son thinks Sammie is getting skinnier, it could be that.

let us know what the specialist says Judi