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]

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]

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]

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]

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]

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]

Originally Posted by jesse girl

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]

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]

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]

Originally Posted by labblab

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