Yuki has crossed the bridge Dec 2020

[Judi]

I think you definitely need to see the internal medicine doctor. When Jenny was diagnosed with Cushings my vet at the time told me it was too complex for him to handle and referred me elsewhere. I was hurt but in the end, he was right.

Yukon needs a specialist. Can you check with the Cushings forum people to see how much it might hurt giving up the melatonin

Jenny had to take prednisone for awhile which can raise blood sugar, so we just increased her insulin. Your goal is to find an insulin dose for his current situation. if he needs the melatonin, you need to find an insulin dose to offset it.

Seriously, I looked at jenny's old records. We spent $1,200 on curves at the vet before her sugar moved much at all. I'd be all excited, go in and they'd tell me no movement.

you can do this. See if you can get in to the specialist earlier. Judi

[Raysaint]

Originally Posted by YukiesMom

Hi,

We were supposed to have the Glucose Curve again tomorrow, but my vet said not to do it because it is still in the 500's.

She wants me to do a blood glucose test 3 times a day for a couple days and see what the results are. Starting today I will be doing the glucose test at 6:30 a.m., 12:00 p.m. and 5:00 p.m. and tracking it.

She said to give it a few days and then she would decide whether to increase his insulin or not.

I am just concerned that it was under 500 when he was diagnosed and now all of a sudden it is sometimes almost 50 -75 points higher. But mostly I am concerned of the long term effects of high blood sugar on his organs.

According to the Emergency Vet they said not to mess with the dosage - the opposite of what my vet is saying. She told me that even if he was on a low does, it would have lowered the Sugar a little and not keep it at the same level.

I am so leary about those 24 hour Emergency Care vets. Seems like all they want to do is give you a price list of how much it is going to cost you and they don't actually care about your dog.

When a dog is first diagnosed, he can still be producing his own insulin, so BG could be a bit lower than now.

Your dog will probably increase 4-6 units before you see decent numbers. If you have a meter, do the curves at home. You're looking for the lowest number in the 12 hours, that tells you if there's room to increase insulin. Increase by one unit, then curve, increase, repeat.

Dogs do OK organ wise with high sugars for a while. It's built into them, knowing it takes a while to regulate a dog. Don't worry about that.

I'd increase his insulin now, knowing he's under-dosed. You're early in the game and anyone here will tell you this is how it goes. Believe it or not, you dog seems typical for the most part.

I'm not sure how Cushings impacts it, but dogs do manage with both.

My biggest fear for you right now is inexperienced vets, giving poor advice.

[YukiesMom]

I truly feel so much better when I write and talk to all of you . I googled all the Meds Yukon is on and tried to figure out if they interact with insulin.

When I got to the melatonin and there were many articles. One article stated that melatonin binds two receptors on pancreatic cells to suppress insulin secretion. This causes them to be more sensitive to the effects of melatonin which results in an exaggerated inhibition of insulin secretion. That makes their bodies less effective at regulating blood sugar levels.

Yukon it's on 3 mg of melatonin twice a day for his Cushing's. We give him the melatonin within an hour of his insulin injection. It picked my curiosity and I called the University of Tennessee to see if maybe they knew anything about melatonin and insulin problems.

I spoke with someone there and he said they didn't have any conclusive evidence but they had heard of many dogs that are having issues with melatonin and diabetes.

So for now I'm taking him off the melatonin. His BG reading at 5 o'clock was 386 which puzzles me but I love it.

I have also made an appointment with an internal medicine doctor on October 29 to evaluate and hopefully advise what needs to be done as well as far as the Cushing's.

[labblab]

I’m really glad you’ve made the appointment with the internist. Yukie’s situation is complicated enough that guidance from a specialist should be very helpful!

In all my years on K9C, I don’t know that we have ever discussed the impact of melatonin on diabetic management. In honesty, I can probably count on one hand the number of dogs on our forum who have presented with the dual diagnosis of “Atypical” Cushing’s as well as diabetes. As I’ve talked about before, it’s the combo of the elevated cortisol of traditional Cushing’s and elevated glucose levels that we commonly encounter. So Yukie’s situation is a bit of a new frontier for us all.

Given Tennessee’s anecdotal report of melatonin complicating diabetic management, I believe I’d stop it, too. Partly because its efficacy in resolving Cushing’s-like symptoms is hit-and-miss even when diabetes is not involved, and partly because I don’t think it helps with lowering progesterone/17-hydroxyprogesterone levels (which sound to me to be the most worrisome elevations in Yukie’s profile in terms of insulin resistance).

Please bear in mind that all of this is largely supposition on my part. I’ll feel a whole lot more comfortable when you can get some professional feedback from a specialist. In general, there remains a lot of controversy about the significance/impact of elevated adrenal hormones other than cortisol, and the “Atypical” diagnosis is not one that is even universally recognized among endocrinologists. So this is a long-winded way of saying that I’d probably ditch the melatonin right now, too, if there’s any chance that it’s interfering with the insulin.

Looking ahead, if elevated adrenal hormones — including cortisol — do seem to be complicating things for Yukie, there is a medication alternative to Vetoryl named Lysodren. It’s an older medication and is no longer used as frequently as Vetoryl to treat traditional Cushing’s. But unlike Vetoryl, it has the ability to lower several of the other adrenal hormones, including progesterone, as well as cortisol. So it is much more powerful than melatonin, and might be considered down the road.

By the way, good job for researching the possible link between melatonin and insulin resistance! This may be very helpful information for all of us on K9C.

Marianne

[Raysaint]

"When I got to the melatonin and there were many articles. One article stated that melatonin binds two receptors on pancreatic cells to suppress insulin secretion. This causes them to be more sensitive to the effects of melatonin which results in an exaggerated inhibition of insulin secretion. That makes their bodies less effective at regulating blood sugar levels."

This info probably applies to a non diabetic, with the pancreas still producing insulin and regulating sugar. Once the pancreas stops working to produce insulin {diabetes), I don't see how anything can affect pancreas insulin secretion.

[YukiesMom]

Hi everyone,

So I was getting really excited yesterday because at 5 PM his blood sugar was 385 and then at 6:30 this morning it was 474.. so. I took it at lunch

I took it at lunch and it jumped up to 568. I just took it now and the first reading on the Alpha track just said high so I did it again and it registered 608.

Why would his blood sugar just keep going up after the insulin shot?

[MikeMurphy]

I wouldn’t be to concerned right now about the higher mid day reading. He is still on a low dose of insulin. Once his dose is increased, hopefully, you’ll start to see some downward movement in all his BG readings.

It will probably take several 1 unit increases until you see some progress.

[Raysaint]

We've all said his insulin is low. Increase it one unit now. Give it a week and do a curve.

[Riliey and Mo]

two reasons i found with my dog for bg rising is i fed too much food resulting in a mountain curve. i.d would read the manufactures feed guide for 29 lbs .
1 7/8 cup a day divide this in half 2 times a day.

also not enough insulin bg will rise. from what i read your injecting a lower does resulting in higher numbers.... going up one unit should help.

try not to follow one number wait 7 days do a curve see the big picture.

mo

[YukiesMom]

I raised his insulin yesterday morning to six units and finally got my brand new Alpha track machine in the mail and had the vet calibrate it for me.

Chewy.com dropped off the new Alpha track machine, and apparently when my husband turned his back the delivery person gave Yukon a treat.

My husband tried to grab the treat out of his mouth but Yukon already had half of it eaten. Last night his level was 564, but today it's been crazy 631 at 6:30 AM and at 5:40 PM 697.

I don't know if this is because of the new machine, the increase in insulin, the treat, or me taking him off the melatonin.

The doctor wants me to do a blood test tomorrow every two hours after I give him his morning insulin and she said keep doing the blood test until his blood goes the lowest and then starts to increase, once it starts to increase I can stop the blood tests.

She mentioned something about the somogyi effect?