Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

[chasing_bella]

When Bella was diagnosed last Saturday with diabetes mellitus, it wasn't a big surprise. My 10 yr old mini schnauzer has been tested for both diabetes and cushing's about 11 months ago with negative results. Her prior history with bouts of pancreatitis (not acute), liver inflammation, and low grade heart murmur (1 on a scale from 1-5) has kept me on my toes. In August, she had her annual cardio work up & geriatric blood work done. Every thing came back normal. 8 weeks later, a rush to the emergency clinic, and it was confirmed. She had developed diabetes mellitus. The good news is that there were no ketones in her urine, the upsetting news, the emergency vet strongly recommended testing for cushing's asap. Bella spent 4 days at the regular vet clinic for the sugar curve test and was put on insulin (2x's daily). We are waiting for her to regulate/stabilize b/f testing for cushing's.

So now that our journey has begun, I'm not as prepared as I thought I would be. My hopes and prayers were for her to live out her golden years without having to go through this. Bella is hanging in there like a trooper. As for me, I'm a total mess. Between the nervous breakdowns, sleepless nights, worrying, and tears, its a wonder I can even get my thoughts together to administer the right dosage of insulin.

Here are some questions I have.

-Bella has been on Hill's RX W/D diet for the last 2 years. Her treats were apples, bananas, carrots, and milkbones. I have changed over to veggies because of the sugar content in these fruits. She now gets romaine lettuce, peeled cucumbers, celery, and raw string beans. How much can I give her for snacks during the day? She struggles during the 12 hr span between breakfast and dinner (7am-7pm).

-Will waiting a month b/f testing for cushing's going to cause more damage to her? (not that we have a choice, just trying to prepare).

-How manageable are both diseases?

I could call my vet again & ask, but I'm trying to save my phone calls for emergency situations. I believe I've talked to him about 50 times in the last week.

Thanks for the advice and support.

[peggy0]

Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

Hello and welcome. You've come to a great place for advise and support. All of us have gone through what you are feeling at the moment. I'm so sorry your Bella has to join our club. We manage though and have happy pups to prove it. My forbin is 10 and was diagnosed last Christmas. The people here helped me get through. Forin went blind from cataracts and was just operated on to remove them. He can see again.

I'm not sure why your vet wants to check for Cushings. Kathy and Natalie will give you advise on that one as I am not familiar with it. My dog shows no symptoms of cushings, just has diabetes. Once you stabilize bella on the right dosage, you can experiement with treats. There are some out there that don't seem to bother diabetic dogs. I use Neumanns Organic Chicken treats. They have no sugar and don't raise Forbins BGs. Others do feed their dogs veggies like you, but I'm not sure the quantity that they give. If you home test, you will have peace of mind. Do you have a monitor? There is a lot of advise about monitoring as well. Knowing your dogs BG patterns not only gives you some peace of mind but also helps determine how food and treats are affecting it.

You'll feel much better given a little bit of time and sticking to the board here. We are all here for each other and you can reach out day and night.

There are several schnauzer friends here to talk to. Welcome again.

[We Hope]

Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

Welcome to you and Bella!

What you've posted about the plan to test Bella for Cushing's sounds VERY right!

There are times when the initial diabetes diagnosis is made that the results of the tests indicate there's diabetes, but there also may be Cushing's too. Waiting until the diabetes is under control and then, if it's still suspected, testing for Cushing's, would be the right way to go.

The initial lab values may indicate the possibility of Cushing's, but as you get the diabetes under control and then do a Chem 21/full panel again, if there's no Cushing's, you will see that those abnormal values that made you wonder if there might be Cushing's have gone back to normal levels.

If Cushing's is present, you will notice that it's very difficult to get regulation (lower bg's). Cushing's is basically an excess of cortisol and cortisol is one of the hormones that drives bg's up.

Waiting until Bella's diabetes is better under control before doing any Cushing's testing sounds right--we've had members whose dogs were initially diagnosed as having diabetes and also possibly having Cushing's.

They concentrated on getting the diabetes under control and in doing that, later blood tests showed that the only problem was the diabetes. Why not wait to worry about Cushing's until after you've been working with Bella and her diabetes a little longer?

Kathy

[k9diabetes]

Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

Both diseases are entirely manageable. Diabetes is probably the less expensive one. Cushings can be difficult to properly diagnose and really requires a skilled veterinarian just to make the diagnosis while diabetes is pretty easy to identify.

Damage from Cushings disease occurs only very slowly over the long term so whenever diabetes and Cushings come up together as potential problems, I always like to see the diabetes addressed first. Unresolved diabetes leads to considerable damage from very high blood sugar, including ketoacidosis, which is fatal if not treated quickly.

Cushings will make the diabetes difficult to control so in some ways starting to treat the diabetes helps to sort out whether Cushings is present also! If you get good regulation, you can forget about Cushings.

Lots of Schnauzer folks here alright! I am starting to think that if you bring home a mini Schnauzer, you might just as well plan on diabetes!

Those snacks are virtually calorie-less so I think you can be pretty liberal with them.

Welcom to you and Bella... love your user name!

Natalie

[chasing_bella]

Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

Natalie can you please explain the difference between glucose in the urine vs. ketones in the urine?

Bella (my little chunky monkey) will be happy to know I can be a little more generous with her veggie treats.

Thanks again!

[BestBuddy]

Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

Hi and welcome to you and Bella.
My Buddy was diabetic and also had cushings. He had already had diabetes for 4 years before we got the cushings dx and one of the reasons for testing for it was that his normally regulated BG was all over the place.
Diabetes and cushings have a lot of similar symptoms so you need to start one first and diabetes is the right choice. Uncontrolled diabetes can skew the results on cushings tests and if you can get the diabetes side under control you may find that the cushings isn't an issue because regulated diabetes is usually not possible with cushings.
Good luck.
Jenny

[Margaret Boyle]

Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

Hi and welcome to you and Bella.
My Buddy was diabetic and also had cushings. He had already had diabetes for 4 years before we got the cushings dx and one of the reasons for testing for it was that his normally regulated BG was all over the place.
Diabetes and cushings have a lot of similar symptoms so you need to start one first and diabetes is the right choice. Uncontrolled diabetes can skew the results on cushings tests and if you can get the diabetes side under control you may find that the cushings isn't an issue because regulated diabetes is usually not possible with cushings.
Good luck.
Jenny

Hi Welcome to You and Bella,

I have an 8yr old mini Schnauzer called Lucy. She was dx in Dec 2007.
She was tested for cushings but came back neg.

She has just recently had cataract surgery and has her sight back.

The well known fact about Schnauzers are they are difficult to regulate, but you do get there it has taken us 1/1/2 years to get Lucy's numbers down and we still have problems. She is still with us and this is the main thing.

You will get plenty of support here, just take it step by step.

Lucy is a happy wee dog and enjoys life, this is what the ultimate aim is and you will be the same.

I will follow your thread you and Bella will be fine.

[k9diabetes]

Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

Glucose or sugar is always present in the blood - we need it to survive. And when insulin is handy, it gets moved into the cells and used for fuel.

When there isn't any insulin or not enough insulin, glucose piles up in the blood and at about 180 mg/dl, it starts getting flushed out into the urine. So with a diabetic dog you will see glucose/sugar in the urine any time the amount in the blood exceeds that 180 threshold. Normal blood sugar for dogs and people is about 80-130.

This is why diabetic dogs are very thirsty - the body is trying to get rid of that excess sugar.

When there hasn't been any insulin for a long time, the body is starving and it is forced to turn on itself to produce fuel to stay alive. That process of breaking down the body's stores produces ketones.

Ketones are dangerous because they are very acidic and as they pile up, they turn the blood acidic. It's a toxic reaction that can be fatal.

And the way to get rid of ketones is to give the body insulin so all that sugar floating around goes into the cells instead of flushing out through the urine and the body doesn't have to turn on itself.

Fortunately even with blood sugar at 300 to 400 ketones are a rare occurrence. Usually they show up after sustained very high blood sugar.

Every once in a while I see a dog who throws ketones at lower levels but not too often.

It is very important to get veterinary treatment for anything more than trace amounts of ketones on a urine test - the vet will give fluids and IV insulin to get the blood sugar down right away.

Hope that makes some sense.

Natalie

[bgdavis]

Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

Welcome to you and Bella,

My girl, Crissy Ann, had both diabetes and Cushings', as well as discoid lupus and hypothyroidism! She did pretty well over the years and managed to live her normal life span. She passed away in March.

You can read about her experiences here: http://www.k9diabetes.com/forum/showthread.php?t=83

Bonnie and Angel Criss

[chasing_bella]

Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

Thanks Natalie for the explanation.

What do you guys think:

When Bella’s urine was tested at the emergency vet clinic it had high amounts of glucose 2000 ++++ so they ran the blood test which confirmed her diabetes (results 596 mg/dl, reference range 70-143). She was negative on the ketones (but has an UTI).

Bella isn’t being tightly regulated. My vet wants to rule out Cushing’s before I purchase a glucometer and urine test strips. He did ask me to get in the habit of keeping a recorded journal just in case.

The reason Bella isn’t being tightly regulated right now is because we caught her diabetes within 8 weeks (early onset, which according to him is pretty amazing). It just happen that she had geriatric blood work done in August & everything came back normal.

So I’m kinda flying blind here as far as her sugar levels during the day. Should I at least go buy the urine strips? Or am I over reacting? We’ve been with this vet for almost 6 years & he’s been there for us through ever crisis. We do work closely together in managing Bella’s health especially in the last two years. I just don’t want to find her hypoglycemic. The vet said she might continue to drink water often b/c of possible Cushing’s, but it shouldn’t be anything like it was last Saturday (which is true, she drinks often but not every minute). I do watch her closely around 12-3 PM when the insulin is at its peak & check on her thru the night (she sleeps right next to me).

Bella’s RX & Feed Schedule

17 units NPH @ 7AM/PM
Ursodiol @ 9PM (liver disease)
Baytril @ 7:30 AM/PM (UTI)
Metacam (as needed for arthritis, usually given in winter months)
Heartguard Plus (once a month)
Frontline Plus (once a month)

Hill’s RX diet- dry W/D 1 ½ cups, wet W/D ¼ can 7AM/PM
Insulin injection immediately after eating.

Veggies through out the day for snacks.

Bella’s 23 lbs, 10 yrs old

We made it through our first week without incident.

Thanks again guys!
- Isabella & Samantha

[k9diabetes]

Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

I am not sure I understand your vet's reasoning, other than possibly to save the expense...

Having caught Bella's diabetes early there is definitely the potential for her to "honeymoon" - by injecting insulin, you decrease the workload on the pancreas, which can, for a while, recover somewhat and once again start producing insulin.

That sounds good but it is virtually always temporary. Diabetes in dogs is an auto-immune disorder that destroys the cells that produce insulin so something like 99% of the time the pancreas eventually loses all ability to produce insulin.

There is some risk for low blood sugar is you are injecting insulin and the pancreas starts producing its own. But, having been through an extended honeymoon with our dog, it seems like the pancreas only produces insulin to get the blood sugar to more or less normal levels. If the injected insulin is enough, the pancreas doesn't bother to produce any more.

I can't point you to a study to back that up. But our dog honeymooned for a full six months and he never had seriously low blood sugar. Every curve we did showed his blood sugar in the 70s to 90s. Each time we found this, we cut the insulin dose. We went from 14 units twice a day down to 1 unit twice a day in a 60-pound dog!!

Then, just about a month later, his insulin producing ability started to fail permanently and his blood sugar started going back up.

So... what I started to tell you... LOL

Was that I would indeed want to be testing Bella's urine and/or blood sugar at this point to see if the insulin dose actually needs to be reduced thanks to honeymooning. And to make sure her blood sugar isn't going too low.

Plus you can monitor at home generally whether she is regulating, which would tell you whether she likely actually has Cushings disease.

With such high blood sugar in the beginning, I also would want to check for ketones.

Natalie

[k9diabetes]

Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

One other thing I wanted to add...

I do not want you to tick off a vet you have a good relationship with.

At the same time, I am of the view that whether I test my diabetic dog's blood sugar or urine glucose is up to me to decide. And that there aren't many downsides to home testing blood sugar.

There are some folks who just obsess over the numbers and fiddle with things constantly as a result. But they are rare.

Diabetes, like most things, is better managed with more information and without any kind of home monitoring, you don't have any information.

For example, some dogs get really huge swings in blood sugar from the insulin. They can start out at a meal at 450 and drop down to 100! (My dog, for example: www.k9diabetes.com/k9diabetes.pdf). With only spot checks at the vet or no monitoring at all, you will see signs of high blood sugar from the 450 and possibly give more insulin, not realizing that the blood sugar is also dropping very steeply and that the additional insulin will send the dog into hypoglycemia.

So I would, at least, talk to the vet about the testing issue and try to sort out what his/her concerns are.

Personally, I'd just go ahead and learn to test. I can guarantee you that once you test blood sugar at home, you will wonder why you waited so long and how you would have coped without it.

There came a point for me when Chris' diabetes was being poorly managed, even by some supposedly world class endocrinologists... that I had to decide that I had to do what was right for Chris and for me even if the vets did not approve because one thing I knew is they were not helping him.

So my philosophy has become basically My Dog, My Decision.

It doesn't have to be in the vet's face or confrontational. But the vet does need to know that it's my expectations we have to meet.

Okay... off soapbox.

In the end, I think you will LOVE home testing blood sugar. It's the best way to know what's happening with your dog.

Natalie

[chasing_bella]

Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

Just talked with the vet. Ok, I got a little mixed up.

The reason she's not tightly regulated right now is because it takes the dog's body several weeks to respond consistently to externally derived insulin. If overaggressive therapy is instituted right out of the gate, you can kill the dog in a few weeks by over insulinating.

He wants Bella to get use to the insulin, do another curve test, then possibly test for Cushing's if need be.

He wants me to bring Bella in if she shows any symptoms or just not acting like herself. He doesn't want me to start adjusting or deviating from her insulin schedule esp. with Cushing's being a possibilty & regulating problems associated with the disease (so no home testing at this time). Any problems bring her in and he'll make the adjustments (not me). After hours, call his cell phone.

We were lucky to catch her diabetes in 8 wks..... most pets are not diagnosed until several months into the disease w/ ketones present in the urine, making it a little more serious. Bella had none.

Good grief, I vaguely remember having this conversation with him along with several others during the past week. He either thinks I don't trust him or I'm a complete idiot. It's soooooooooooooooooooooo much info to take in. You want to get it right so you don't harm your dog (almost to the point of paranoia ).

Sam

[We Hope]

Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

Sam,

It sounds like you have a good, supportive vet and that's a treasure in itself!

When I spotted Lucky drinking too much water and having an accident in the house, we went in that afternoon.

He did nicely on human insulin for the first week after being diagnosed, but by week #2, did not respond to it at all.

We initally thought he used the insulin too quickly so we tried something with a longer profile--beef insulin. That was just as ineffective as the human insulin was.

During the time from his diagnosis until he got on pork Lente, which he responded well to, I think all I thought about was insulin.

We had a joke going--wondering what type of mental problem I'd be diagnosed with if I needed to see a psychologist or psychiatrist and was asked to say the first word on my mind (it would have been insulin).

So you're not alone--I'd say that everybody here has had a major shock when they were told it was diabetes.

Kathy

[k9diabetes]

Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

Does Bella have overt symptoms of Cushings that are not also related to diabetes - thinning hair, saggy belly and bony hips, panting, starving, skin problems?

Natalie