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  #11  
Old 10-06-2009, 09:31 AM
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Default 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
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  #12  
Old 10-06-2009, 09:40 AM
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Default 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
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  #13  
Old 10-06-2009, 01:36 PM
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Post 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
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  #14  
Old 10-06-2009, 01:48 PM
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Default 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
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  #15  
Old 10-06-2009, 02:41 PM
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Default 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
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  #16  
Old 10-06-2009, 05:20 PM
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Default Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

Yes. The hair on her back & on the sides are really thin. Her skin pigmentation has gotten a lot darker, and she has some whitish color moles on her back & sides. She has always been a really itchy dog. We ruled out food allergies & pretty much determined it was environmental (4 yrs ago).

I started noticing her hair thinning last year and with her prior health history requested diabetes & cushing's testing. The tests came back negative. She has always been a polite lady when taking treats from my hand, now you have to drop it on the floor or she'll take your hand off. I just bought a "Break-fast" bowl to slow her down when eating. I posted pictures (album section) if you want to get a better look at her. As far as appetite.... Bella loves to eat, but she's been that way since she was young.

I just shaved her back down so it would be easier for me to see what I'm doing when giving her the injections. You can see the discoloration on her paws from chewing.

I had my husband stop and buy the Bayer Ketostix today. I'm going to monitor her urine at least.

BTW, I just watched the video of you home testing Chris. He was such a handsome fella (sorry for your lost). If or when it comes to that, it's going to be a wrestling match from hell.

Sam
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  #17  
Old 10-06-2009, 09:07 PM
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Default Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

Bella's not likely to cooperate, huh?

Chris didn't fight me but he didn't cooperate at first either. He would fidget and lick his lips... we were quite the sight!

Cushings usually will cause the insulin dose to rise, rise, rise and the blood sugar to never get much below 300. Some dogs stay at high BG levels with uncontrolled Cushings. Others will respond for a week or two to a higher dose of insulin and then, like clockwork, bounce back up into high blood sugar again.

Once a dog gets to about 1 unit per pound and still is nowhere near good blood sugar levels, they are technically labeled as resistant to the effects of the insulin and this is typically a give away that Cushings may be involved.

When you test for Cushings, I suggest, if you can afford it, that you do a full blood panel sent to the University of Tennessee Knoxville to check all of the various hormones that can cause Cushings. Cortisol is what they usually test for but atypical Cushings looks just the same on the dog but is caused by elevated sex hormones. The UT panel checks it all. It is conducted just like the ACTH but then sent to them to process. So same number of tests for Bella but covers more potential causes of Cushings. You could have had the Cush test before but have atypical Cushings causing her symptoms and the regular ACTH wouldn't catch that.

Natalie
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  #18  
Old 10-07-2009, 12:37 AM
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Default Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

Hi Sam & Bella Welcome

I'm glad you are going to start urine testing.

My first vet just did one reading per week and based the insulin dosages on that one reading, it was really the wrong thing for the vet to do.

You'll get the hang of this and be home testing in no time.

Dolly
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  #19  
Old 10-07-2009, 08:24 AM
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Post Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

Quote:
When you test for Cushings, I suggest, if you can afford it, that you do a full blood panel sent to the University of Tennessee Knoxville to check all of the various hormones that can cause Cushings. Cortisol is what they usually test for but atypical Cushings looks just the same on the dog but is caused by elevated sex hormones. The UT panel checks it all. It is conducted just like the ACTH but then sent to them to process. So same number of tests for Bella but covers more potential causes of Cushings. You could have had the Cush test before but have atypical Cushings causing her symptoms and the regular ACTH wouldn't catch that.

Natalie
Does the University of GA do full panel blood work for Cushing's or just University of TN @ Knoxville? Just wondering since I live in GA and UGA is about 1 1/2 hrs away. If not, when it's time for testing, I'll request it be sent to TN. How long does it take for the results to come back? As far as cost.... let's see, in last 2 years, I believe we've spent close to $4000.00 bucks on Bella (not to count the other 5 we have). The things we do for our fur babies. Worse case, I could start pawning family heirlooms

Sam
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  #20  
Old 10-07-2009, 09:34 AM
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Default Re: Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

I LOVE UGA!!! Truly, I have seen them do exceptional work with a diabetic dog and they are at the top of my list of vets schools. So I think you are really lucky to be so close to them.

I believe UT is the only place currently doing this test. The guy who is responsible for it is Dr. Jack Oliver, who is a saint in the view of all of the folks I know dealing with Cushings. He takes time to answer individual owners' emails.

So your local vet can get the instructions from UT and take the pre and post ACTH blood samples and then ship them off to UT. I think it takes a few weeks to get the results back.

It's actually not that much more expensive than a standard ACTH and you get a lot more information. I thought of it with Bella because the vet feels Cushings is a possibility given some clinical signs but the cortisol test came back negative. So atypical Cushings is a possiblity.

Bonnie, user bgdavis, is a poster child for atypical Cushings. Her dog Crissy Ann, who passed away this year, was a screaming case of Cushings to look at her but kept coming back negative on the standard tests. They finally discovered she was atypical and once they started treating her, she got all her hair back... got her life back! I'm actually going to post some pictures of her later today so will give you a link to them.

We have a "sister" forum for Cushings in dogs that you might find interesting. They have a large reference section. www.k9cushings.com.

Natalie
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