Cushing's, Diabetes and Hypothyroid

[momofdecker]

Re: Cushing's, Diabetes and Hypothyroid

Was Lulu fasted for her blood work (see there was a nice drop in her cholesterol value)?


For some reference:
Decker had a pot belly and elevated ALT and ALKP - we originally suspected Cushings was his reason for insulin resistance. He was 97 pounds and on 10u of levemir before we did the testing for concurrent diseases. Decker was overdosed on 40u of NPH insulin by his original vet when he was diagnosed. So when he went to 40u of NPH and we could not control his blood glucose, we knew something was wrong.

We switched him to levemir (detemir) and started at 5u and worked our way up to 10u with little movement in his blood glucose. Levemir was much more level for him - his curves were pretty flat lines. On NPH his glucose bounced around and left him feeling terrible.

In June 2012 we tested him for:
Pancreatitis (he was positive, despite eating and never vomiting)

Fasted for high lipids - cholesterol was over 1000 at fasthing. Triglycerides were high at fasting

4Dx for tick borne diseases - negative

UC:CR for cushings - negative

T4 for thyroid - low (diabetes can cause a low T4 value so we had to follow up with a full thyroid panel).

Here are some links:
Picture of the pot belly - before the thyroid diagnosis: https://inmemoryofdecker.shutterfly.com/pictures/169

Several months after starting thyroid meds:
https://inmemoryofdecker.shutterfly.com/pictures/241

His December 2011 and Feb. 2012 blood work:
https://inmemoryofdecker.shutterfly.com/26

June 2012 testing for concurrent diseases:
https://inmemoryofdecker.shutterfly.com/27

Full thyroid panel results:
https://inmemoryofdecker.shutterfly.com/28

November 2012 blood work:
https://inmemoryofdecker.shutterfly.com/32

Holli

[MikeMurphy]

Re: Cushing's, Diabetes and Hypothyroid

It looks like you are in very good hands with your Internal Medicine vet. Proceeding patiently with Detemir increases, because of its high potency, is a good thing. It may take a few more increases before you see a break in insulin resistance.

As Marianne(labblab) pointed out, low Thyroid levels, especially free T4, along with high TSH probably point to primary hypothyroidism. This would be a good thing, as the thyroid meds along with insulin increase might break the insulin resistance.

Best of luck and keep us posted.

This is a quote from an article by Dr Jean Dodds. It suggests a 60 to 80% chance that high TSH along with low free T4 point to primary hypothyroidism...

Endogenous Canine TSH (Thyroid Stimulating Hormone)
In primary hypothyroidism, as freeT4 levels fall, pituitary output of TSH rises. Since about 95 percent of thyroid hormone regulation in humans is controlled by TSH, it is a highly accurate screening for hypothyroidism. However, only about 70 percent of thyroid hormone regulation in dogs is controlled by TSH, so this test shows relatively poor predictability. The remaining 30 percent of a dog’s thyroid regulation is controlled by growth hormone, which, like TSH, is manufactured, stored, and secreted by the pituitary gland. For this reason, the TSH test provides a false negative or false positive in approximately 30 percent of canine cases. So, although elevated TSH usually indicates primary thyroid disease, there is 20 – 40 percent discordance observed between expected and actual results in normal dogs as well as in hypothyroid dogs or those with NTI.

[Lulu'sMom]

Re: Cushing's, Diabetes and Hypothyroid

Holli, yes she was fasting for all labs done. The only thing done between initial cholesterol and the second value is a diet change to a low fat, high fiber dog food with supplemental boiled chicken when needed. On her highest dose of Novolin N at 32 units twice a day and highest dose of Levemir at 12 units twice a day, I have still not seen much improvement in her glucose levels. I'm so hoping that by treating her hypothyroid that the resistance will finally break.

Mike, your information has given me great hope that this resistance will break. I had been asking my regular vet for months to check her thyroid level as I thought this could be a reason for resistance and I was put off. Now I feel terrible, of course, that I didn't push harder. How long after starting thyroid meds should I expect to see a break? She is on 0.4mg twice daily. Does this seem like an adequate dose?

[momofdecker]

Re: Cushing's, Diabetes and Hypothyroid

Decker went from 10u of levemir (detemir) to 5u of levemir in the first five days of starting thyroid meds. He had a lot of muscle mass loss in his back end and general weakness prior to the hypothyroidism being diagnosed. He walked stiffly with joint pain. He slept a lot and foamed at the mouth on a five minute walk. He had belly and eye infections. He also had a host of behavioral issues. We'd had him shaved down in May 2012 and his fur didn't grow back at all until after staring thyroid meds in June 2012. His fur didn't fully recover until October/November 2012.

His energy level took a few weeks to return and his strength took a couple of months. Unfortunately - he continued to have rear leg weakness and his front paws continued to knuckle. Oct. 2012 we ended up taking him to a neurologist who diagnosed him with cervical spinal compression. We didn't have the money to diagnose the cause but it likely was IVDD or wobblers. December 2012 we had to put him on steroids so he could walk. His blood glucose was easier to manage on steroids than it was before his hypothyroidism was diagnosed.

Since you went from 12u of levemir to 2u prior to starting the thyroid meds, it may take time to work back UP to a dose that will work. It seems many vets will start dogs on .5u of insulin per kg of weight. At 49 pounds - Lulu would be around 23 kg of weight. With levemir being four times as potent - 3u would be around the same as 12u of NPH or vetsulin insulin.

It's great to hear she is perking up. I do agree with Marianne that Lulu's blood work and urinalysis still have some markers that are more consistent with cushings than hypothyroidism, however, low thyroid levels can cause a lot of internal issues so giving her time to heal may help clarify things down the road.

[MikeMurphy]

Re: Cushing's, Diabetes and Hypothyroid

Lily was started out on .6mg twice daily of thyroxine when first diagnosed with hypothyroidism. She is currently on .3mg. She weighs 62lbs.

She was on 28 units of Novolin N when diagnosed with hypothyroidism and her IMS kept her on that dose for the first few days on thyroxine. After about a week her BG started to come down and she settled in at 18 units twice daily. She currrently is on 13 units Novolin N and 3 units Novolin R.

Your situations a little different in that your vet dropped Lulu down from 10 units to 2 units of Levemir after starting thyroid meds. 2 units is basically a starting dose for her weight of 49lbs. Your vet sounds like she’s very methodical, so it may take several weeks and several insulin increases before you see a break.

Hey Holli! Nice to see you helping out. Decker was always an inspiration for Lily and me

[momofdecker]

Re: Cushing's, Diabetes and Hypothyroid

Hey Holli! Nice to see you helping out. Decker was always an inspiration for Lily and me

Thanks Mike - Glad to hear Lily is doing well!

[Lulu'sMom]

Re: Cushing's, Diabetes and Hypothyroid

Ok so I did another curve over the weekend now that we have been on 3units Levemir twice a day for almost 2 weeks. I think I see a tiny curve!

7am BG 448 ate and gave 3 units
9am BG 438
11am BG 378 took an easy 20 min walk
1pm BG 430
3pm BG 386
5pm BG 393
7pm BG 341 ate and gave 3 units
9pm BG 417
11pm BG 420

Hopefully this is a good sign that I will finally see some lower numbers! Her thirst and urination have both returned to normal and her appetite is good. All positives in my book!

[MikeMurphy]

Re: Cushing's, Diabetes and Hypothyroid

Nice... With some BG numbers below 400, it looks like the insulin is starting to work!

Glad she’s feeling better and hope things continue to improve as insulin is slowly increased

Compared to your last curve on 2 units, this is real progress...

Curve from 9/2/18:
7am BG 556 fed then given 2units Detemir
9am BG 503
11am BG 506
1pm BG 494 (went for 15 minute easy walk)
3pm BG 512
5pm BG 537
7pm BG 542 fed then given 2 units
9pm BG 530
11pm BG 522

[Judi]

Re: Cushing's, Diabetes and Hypothyroid

lol, a tiny curve but a curve! I'm so glad she is feeling better, that is truly a big deal!!!

[jesse girl]

Re: Cushing's, Diabetes and Hypothyroid

I would not worry to much what the curve looks like but the overall trend is lower with raising the dose by one unit . Also physical symptoms has reduced which maybe showing you are going on the right direction

Fingers and paws crossed for continued progress

[Lulu'sMom]

Re: Cushing's, Diabetes and Hypothyroid

Thank you all! The vet said to stay at 3units twice daily and do another curve in 2 weeks, then would consider an increase if needed, but she was very pleased with the slight downward trend. I'm glad Lulu is able to tolerate a little bit of exercise now as she was not just a few weeks or a month ago. The Texas heat letting up a bit has helped too. Keeping finger and paws crossed!

[MikeMurphy]

Re: Cushing's, Diabetes and Hypothyroid

Thank you all! The vet said to stay at 3units twice daily and do another curve in 2 weeks, then would consider an increase if needed, but she was very pleased with the slight downward trend. I'm glad Lulu is able to tolerate a little bit of exercise now as she was not just a few weeks or a month ago. The Texas heat letting up a bit has helped too. Keeping finger and paws crossed!

Mike, your information has given me great hope that this resistance will break. I had been asking my regular vet for months to check her thyroid level as I thought this could be a reason for resistance and I was put off. Now I feel terrible, of course, that I didn't push harder. How long after starting thyroid meds should I expect to see a break? She is on 0.4mg twice daily. Does this seem like an adequate dose?

Sounds like a good plan. And don’t beat yourself up concerning the late hypothyroidism diagnosis. My Lily also had a lot of the classical signs of hypothyroidism, including thinning hair, rat tail, high triglycerides, high cholesterol, insulin resistance. Her original vet ran the T4 test which came back normal, so she concluded that hypothyroidism was not a factor. I couldn’t convince her to do a full thyroid panel, so I took Lily to an IMS who saved her life.

This is Lily, looking awful, before thyroid meds and with very hig BG...



And several months later on thyroid meds and BG at levels between 120 and 300...



Best of luck to you and Lulu

[Lulu'sMom]

Re: Cushing's, Diabetes and Hypothyroid

Mike, I'm so glad your Lily is doing so well. I hope my Lu continues to improve. I too can say my new vet has saved her life

[MikeMurphy]

Re: Cushing's, Diabetes and Hypothyroid

How’s Lulu doing? Will you be doing a curve this weekend?

[Lulu'sMom]

Re: Cushing's, Diabetes and Hypothyroid

Unfortunately we did not get to do a curve this weekend. Lulu developed ear infections in both ears so I had her at the vet Friday. Her numbers would likely be higher with the infections so I will delay the curve until next weekend when her ears are hopefully better! PS: She is now able to jump up on the bed again! I'll take a small victory any day!