Oreo - hypothyroid, diabetes and atypical Cushing's

[Shaggydog]

I'm new here, fresh from the Canine Cushing's forum.

Oreo is a 12 year old, black and white Tibetan Terrier. He's been hypothyroid since he was 2 years old, and was diagnosed with diabetes in April 2007. We've never managed to get his diabetes properly regulated, despite our best efforts. Just yesterday we discovered he also has atypical Cushing's Disease, which may well account for the regulation difficulties. He also has long-term digestive problems and allergies ... what a mess!

Our primary goal at the moment is to get the atypical Cushing's under control, then to see where we are with the diabetes. Oreo is under the care of an Internal Medicine specialist at a large specialist practice in San Mateo, California.

Weight: 23.5 lbs
Vetsulin 8 units 2 x daily
Soloxine .2mg once a day
Food: Royal Canin Potato and Venison, Limited Ingredient Diet. 4 cups daily, split into 4 meals. (Not a typo - 4 cups total, per vet's orders, because he's not metabolizing his food properly and losing a lot of weight.)

That's about it for now. I look forward to getting to know all of you and your dogs.

[BestBuddy]

Re: Oreo - hypothyroid, diabetes and atypical Cushing's

Hi and welcome,
I also cross over between the diabetes and cushing board. Wow 4 cups is a lot of food. I don't believe that giving more food will help the weight problem and it may even be messing up BG regulation. Until you get the right amount of food and insulin Oreo won't start using the food correctly. The cushing problem could also be a big problem with the regulation as well. How long has it been since a thyroid check to see how that is going?
Jenny & Buddy

[Denise]

Re: Oreo - hypothyroid, diabetes and atypical Cushing's

Hi there!

I also have a Cush dog and one also has diabetes and now cancer. Both are atypical. We tried the Lysodren on the diabetic and that was a disaster, he was sick and not himself so we stopped treating that as long as we could some what control his diabetes.

My second dog with atypical was prescribed Lysodren and I just couldn't go there so started the melatonin and flax essence and it's worked wonderfully! Took a couple months to see improvement though and we ll hate waiting!!

Not had a thyroid dog yet...fingers crossed!

What range is his glucose staying at? Was the insulin increased when food was increased?

There are lots of dog foods out there that have huge feeding amounts listed, RC is one of them. I once tried some of their breed specific foods and the feeding amounts were double and sometimes MORE than what I was feeding with Flint River Ranch.

Allergies are a pain but at least they have foods that might help now!

Have te digestive issues been dx'ed or would digestive enzymes help? Upset tummy? vomiting? diarrhea?

You can do this!

Hey Oreo! Bogie, Molly, Reba, Lex, Liv, Micah and Zeke say hello!!!

[k9diabetes]

Re: Oreo - hypothyroid, diabetes and atypical Cushing's

I confess I haven't read the post in detail, something that already tripped me up at the Cushings board today!...

But I too wonder whether feeding four cups of food a day can actually help much and might make the diabetes difficult to control because whatever rapidly digested carbs that convert easily to sugar would be passing into the bloodstream pretty much directly from all four cups even if the primary protein, etc. is not being digested. Depending on how the kibble is processed, seems like potatoes could convert into a lot of glucose.

Bet you spend a lot of time scooping the backyard!

Is the digestion problem seen as a lack of enzymes or IBD?

Our cat just had a series of blood tests that can differentiate various bowel and pancreatic issues - maybe this is something that couldhelp Oreo.

http://www.cvm.tamu.edu/gilab/assays/index.shtml

Serum Trypsin-Like Immunoreactivity (TLI)
For exocrine pancreatic function testing (i.e to diagnose EPI )

Serum Cobalamin (Vitamin B12) and Folate
Test of small intestinal function (not species specific)

Pancreatic Lipase Immunoreactivity (PLI)
Test for diagnosis of pancreatitis in dogs and cats (species specific)

Our cat is diagnosed with IBD and possibly emerging lymphoma. His results on the test after a couple of months of treatment showed mild IBD in one part of the small intestine.

Gus' test results were good. The vet looked at the aspirates and didn't see anything he felt needed to be sent to a pathologist. Plus his Texas A&M GI Panel came out well also.

Cobolamin Test: 594 ng/L
- control range is 290-1499 = normal.

Folate Test: 9.6 microg/L
- control range is 9.7-21.6 =
consistent with proximal small intestinal disease (but not far off)

Pancreatic Lipase Immunoreactivity (PLi): 6.7 microg/L
- control range is 4.1-12.9 = normal

Trypsin-like Immunoreactivity (TLi): 53.7 microg/L
- control range is 12-82 = normal.

Natalie

[Debbie & Apollo]

Re: Oreo - hypothyroid, diabetes and atypical Cushing's

Hi and welcome --
Hi Oreo and Mom!

We too cross over from the Cushings forum

SO far Apollos test are not conclusive enough the treat for Cushings -- but with his diabetes IF we have too he will be using Trilostane.

The questions about food -- interestering --
on the bag of the food comes in -- for Oreos size - what amount to they recommend???

I also am curious about the feedings 4 times a day - digestion like Natalie said...
Natalie - Apollo gets one cup of dry- I split it into 5 meals - right now levels are looking good. we have only done one all day curve -- it was good...
I started the mini meals because he seemed to be starving

Debbie and Apollo

[ladysmom06]

Re: Oreo - hypothyroid, diabetes and atypical Cushing's

Hi and welcome,

I'm another one that crosses over between both boards. Lady has both diabetes and cushing's. We could never get her diabetes regulated until we started treating the cushing's. She has pituitary cushing's and we treat it with trilostane. Good luck with Oreo and please keep us posted.

Luv,
Lynne and Lady

[Shaggydog]

Re: Oreo - hypothyroid, diabetes and atypical Cushing's

Thank you all for your welcome. It's great to be among others who understand how difficult this can be.

4 cups IS a lot of food and I do have concerns about it, but then again I just did Oreo's weekly weigh-in and he's now up to 25 lbs! His average pre-illness weight was about 34 lbs, so he's very thin right now.

I'll explain how we came to be feeding him so much, but it's a long story. Oreo has a history of digestive problems since puppyhood (chronic diarrhea, mucus in his stool, vomiting) presumptively diagnosed as IBD, but it has never been methodically evaluated and diagnosed. I was told it would be very expensive and difficult to diagnose and that we may never get an answer. We've had a bunch of pets needing urgent and expensive vet care over the last few years and our vet (at that time) led us to believe the best thing was to try and manage Oreo's problems through diet.

We've always fed him premium foods such as Wellness, Wysong and California Natural, but it was always the same story - he'd do well on a food for a few months and then start having problems. In the meantime, he also developed skin problems, (intense itching, dryness and flaking, hot spots)and we consulted an allergist/dermatologist. She put him on a prescription diet, Hills z/d Ultra as I recall, same story - initially did well, then the problems started again. We tried various novel protein foods, same thing - OK at first, then developed problems. Finally, we tried IVD Potato and Venison Limited Ingredient, which then was acquired by Royal Canin. He's was doing well on this food for at least 3 years, pre-diabetes, with a good appetite and weight, way longer than any other food we've tried. Hence my reluctance to change.

The weight loss started gradually, after about a year of trying to treat his diabetes, and accelerated over the past 6 months. When I first consulted the IM, in April 2008, he weighed 24.4 lbs and was getting a total of 2 1/2 cups of food a day, split into 2 meals. The bag recommends 2 cups for a 20 lb dog, 2 3/4 cups for a 30 lb dog. There's about 300 calories per cup. He continued to lose weight, so the IM increased the total, first to 3 cups, then on July 11 to 4 cups. Oreo goes through phases where he vomits bile whenever his stomach is empty, therefore we split his food up into smaller meals. Each time we increased the food we also increased the Vetsulin, but since he wasn't regulated in the first place we ended up at about the same point. Nothing seems to make much difference to his BG.

Our regular vet tried to treat Oreo's diabetes for a year before giving up. He started out with Vetsulin, got up to 12 units twice a day without being regulated, switched to Humulin N, no improvement. So, he referred us to an IM, who started back at square one, with Vetsulin 5 units twice a day.

Most recent BG levels:

I usually do a 24 hr test once a week, on the weekend. 10am and 10pm levels are before food and insulin.

10am 332
12 417
2pm Hi (over 600)
4pm 459
6pm 526
8pm Hi (over 600)
10pm 504
12 513
2am Sorry, I missed it.
4am 596
6am 502
8am 361
10am 155

Spot checks on weekdays:
10am 351, 4pm 486
10am 246, 4pm 447
10am 356, 4pm 469
10am 273, 4pm 482
10am 326, 4pm 463


Thyroid levels - most recent evaluation was a T4 in April 2008. Value was 2.8 (ref 1.0-4.7) On July 11, the vet reduced Soloxine dosage from .2mg BID to just once a day, with the aim of slowing his metabolism. (I wasn't quite on board with that, but so much else is going on I let it go). I should ask her to evaluate thyroid level again.

[k9diabetes]

Re: Oreo - hypothyroid, diabetes and atypical Cushing's

What a relief to land on a food that has kept him going for a long time!

I think the Texas A&M GI panels may be fairly new. They are simply a blood test so might be worth trying just to see what they tell you about the location and nature of Oreo's issues. Our cost was about $200 for all four tests.

Did they ever treat the IBD/allergies with prednisone or Temaril-P? Or anti-histamines?

Not that you necessarily want to do steroids now with the diabetes but I wondered if they did in the past and whether it had any affect.

Our IBD cat is on prednisolone and I know another dog, even after diabetes, took prednisolone for years - it was the only way to keep him alive. Otherwise he started bleeding in the intestines from his allergies!

Perhaps atypical Cushings has been in the mix for years and has been exacerbating Oreo's skin and GI problems. Will be interesting to see if treatment for the Cushings helps with those things.

Bonnie's Crissy Ann (she's a member here and at the Cushings board) had atypical Cushings but you'd never know it was atypical from the strong overt symptoms of Cushings she had. Lots of skin problems and loss of hair. Once they got her atypical under control, she looked like an entirely different dog.

Natalie

[Shaggydog]

Re: Oreo - hypothyroid, diabetes and atypical Cushing's

Thanks for the info. I'll certainly consider the Texas GI panels, but I have to admit, after $350 for the UTK adrenal panel, and $91 for 10 Lysodren, it may have to wait a bit. I'm checking Lysodren prices online right now, $91 is outrageous!

Yes, Oreo was on prednisone and also took Benadryl for his allergies when he suffered extreme flare-ups. They did help, but I wonder if the prednisone contributed to his diabetes.

I truly believe he's had more endocrine problems than simply thyroid for a very long time. Now I look back, little things add up, like certain odd behaviors we thought were just part of his weird personality, constant food scavenging and stealing, extreme height for his breed, etc.

I'll look at Crissy Ann's story. I've also been reading about another atypical dog - Kiska, I think?

[We Hope]

Re: Oreo - hypothyroid, diabetes and atypical Cushing's

Re: these types of steroids and diabetes, there's evidence that it sure CAN play a part in the developent of diabetes:

http://www.vetinfo4dogs.com/dpred.html

"Prednisone and diabetes

"Q: Hello, I have two separate questions.

"1) The first question is have you seen any reports or studies that indicate an association between the use of predisone in dogs or cats and the onset of diabetes?

"A: C- It is pretty widely accepted that prednisone may predispose dogs and cats to diabetes. It is not as clear to me whether this is enhancement of an existing tendency to develop the disease or if it is an independent effect. They also can induce insulin resistance, leading to hyperglycemia. In diabetic patients, corticosteroids can make insulin regulation more difficult since they have this effect on blood sugar levels. I think this is a relatively rare side effect but it is a consideration, especially in a pet likely to already be predisposed to diabetes.

Mike Richards, DVM"

http://petdiabetes.wikia.com/wiki/Co..._they_are_used

"Long-term use can cause permanent diabetes. For pets and people who are diabetic, the use of oral or injected steroids brings with it higher blood glucose levels."

http://www.childrenwithdiabetes.com/...4/d_0d_dv6.htm

"Prednisone is a drug that is also a synthetic hormone. It has anti-inflammatory effects, but it also antagonizes blood sugars. In large doses, it will aggravate blood sugars in those already diagnosed with diabetes. In some without a previous diagnosis, but genetically susceptible, it may bring the diabetes out.

"Knowing you have to use the prednisone, you have to make sure you can treat the blood sugars."

So while it's not the drug of choice for treating those with diabetes, there are times when it becomes the drug of necessity and there's no other option but to use it and adjust the insulin to counter the hyperglycemia it can cause.

I've seen a lot of case histories on the Pet Diabetes Wiki with regard to feline diabetes and steroid use. When we categorized the cases, here are quite a few feline cases where the diabetes was steroid-induced.

http://petdiabetes.wikia.com/wiki/Ca...-induced_cases

Here also is a link saying that steroids may be responsible for some Cushing's cases too:

http://www.veterinarypartner.com/Con...=619&SourceID=

"OVERUSE OF CORTISONE-TYPE HORMONES

"Cortisone derivatives may well be the most over-used drugs in veterinary medicine. Their anti-inflammatory actions soothes such common maladies as allergic skin disease (especially flea allergic dermatitis) and degenerative arthritis. Relief is usually rapid and many owners find themselves requesting "cortisone" shots or pills over and over again. In time, Cushing's syndrome results, not from any inherent disease in the pet's system but from the effects of the hormones given."

I have a friend whose non-diabetic, non-Cushing's dog was treated with prednisone for a skin problem not long ago. She started PD (polydipsia-too much water consumption) and PU (polyuria--too much urination) almost immediately after being put on the oral meds. When I mentioned to her that these were what we see in diabetic dogs and spoke about the steroid/diabetes possibility, she worked with the vet to switch to a non-steroid treatment for the problem. I believe it's possible that her dog may have developed diabetes if the steroids hadn't been stopped quickly.

Kathy

[Shaggydog]

Re: Oreo - hypothyroid, diabetes and atypical Cushing's

Oreo was never on prednisone for extended periods, just the shortest possible course on a few occasions, when his allergies were out of control and he was in total misery. At times it was so bad he'd have to be in an E-collar 24/7 or he'd chew huge holes in his flesh. However, it's certainly possible it may have contributed. I try not to beat myself up over it, but at 2 am I sure can think of a very long list of things I would do differently, if I had the chance to do them over.

Anyway, Oreo was feeling poorly the last couple of days. His appetite is usually voracious, like a starving beast, but he's been off his food. This is so rare, the only other time I can recall him not wanting to eat is immediately prior to being diagnosed with DM. Of course, this started the day I gave him his first Melatonin and Flax Seed Lignans, Saturday, so I haven't given him any more until I figure this out. I'm not freaking out - he ate something eventually, with a lot of persuasion. I'm inclined to think it's just that 4 cups of food a day is too much and it eventually caught up with him. At least, I hope so.

Sunday and Monday he ate very reluctantly from my hand, about 2 cups total, and showed signs of nausea.

This morning he ate 1 1/2 cups kibble without me having to sit on the floor and spend an hour coaxing him to eat single pieces out of my hand. So, since 10 am yesterday, whenever I've been able to check it, his BG has consistently been in the 200's, he drank only 1 liter of water in 24 hours and got me out of bed just once to go pee. Compared to recent and Sunday BG readings in the 500s to over 600, regular water consumption of 2-2.5 liters/day, and 3 nightly trips to smell the roses, this is looking interesting.

I called my vet 24 hours ago to tell her what was going on and get her thoughts it and on continuing with the new meds (Melatonin, Lignans and possible Lysodren) as planned. Still waiting for her to get back to me .... not happy.

[We Hope]

Re: Oreo - hypothyroid, diabetes and atypical Cushing's

Wow 4 cups is a lot of food. I don't believe that giving more food will help the weight problem and it may even be messing up BG regulation. Until you get the right amount of food and insulin Oreo won't start using the food correctly

It sounds like you may have part of your answer already--the amount of insulin and the amount of food are beginning to match. People with diabetes have the same type of problem in that they need to match their food/calorie intake to the amount of insulin they're using. When someone with diabetes "overdoes" it, it shows up as high/higher bg's. The person will most often take an extra corrective dose of fast or rapid-acting insulin to compensate for the extra food.

http://petdiabetes.wikia.com/wiki/Ke...How_it_happens

"Our bodies normally are "fueled" by burning glucose; they are able to do this provided they have enough insulin (normally or by injection). When there's not enough insulin to allow the body to burn glucose for energy, it begins metabolizing fat to fuel its cells."

Without a good match between the amount of insulin and the amount of food, the body doesn't get the chance to go back to doing things the "right" way--burning glucose instead of fat for energy. This is why you often see newly diagnosed or undertreated dogs with diabetes who look like they're being starved; they start regaining their lost weight when they get near or at regulation.

http://petdiabetes.wikia.com/wiki/Polyphagia

"Polyphagia can best be described as constant hunger. Meals can be perfectly adequate but the pet or person remains hungry, actively looking for (and eating if possible) just about anything and everything.

"This is another "trick" diabetes plays on all those who suffer from it. For the most part, brain cells don't need insulin to be able to use glucose. The part of the brain which controls appetite is called the hypothalamus. It is an area of the brain which is dependent on insulin to permit it to use glucose.

"Because the appetite center needs insulin to be able to use the body's glucose, it perceives the low level of insulin in the body as a lack of food or "fuel". And so it sends out signals indicating the need for more food--hunger signals causing the body to crave more food. The food eaten because of this sets up another vicious circle, as all it does is add to the excess glucose in the system."

So the appetite center that tells someone they are "full" relies on being able to use the body's glucose for that. Without enough insulin in the system, it can't send out the "full" signal and it's keeps telling the body it needs more and more food, which turns out to drive high bg's.

My little guy always had a healthy appetite--before and after diabetes. But when he was first diagnosed, he could never get enough food. He would start trying to get his meals hours before it was time for them. When we came close to and got to regulation, he was glad to have his meals, but there was no more looking for dinner almost immediately after breakfast.

Sounds like Oreo's starting to reveal some of his secrets.

Kathy

[Shaggydog]

Re: Oreo - hypothyroid, diabetes and atypical Cushing's

I'm so frustrated. Please can you guys help me work out a new starting point for the amount to feed him?

His normal pre-diabetes weight was 34 lbs and he was doing well on 3 cups of the RC Potato and Venison kibble, same weight and same amount of same food for 3 years. Then he started drinking and peeing excessively, followed by going off his food for the first time in his life. My regular vet diagnosed DM and started out at Vetsulin 5 units 2 x daily. We kept him at the same amount of food, increased the Vetsulin slowly until we were at 12 units twice a day and he still wasn't regulated. Switched to Humulin N, still no success. By this time he was losing weight, so we reduced his food to 2 1/2 cups.

Enter the IMS, who put him back on Vetsulin and increased his food to 3 cups, then 4 cups. Which brings us up to the present and I'm having a very hard time trusting my vet . It seems to me I should be feeding less than 2 1/2 cups. How much less and how much insulin is the question, and how to get there from here (4 cups and 8 units twice daily)?

[BestBuddy]

Re: Oreo - hypothyroid, diabetes and atypical Cushing's

Hi,
What does the feeding guide on the food say. Buddy does well on the recommended on his food label. I tried to find info on your food for amount but didn't have any luck, so have a look at the bag and see what it recommends. I have a dietitian friend (for humans) who says that they need to get a good diet and the right amounts and then you match the insulin to the food, may not be the same for dogs but it is a good start.
Jenny & Buddy

[We Hope]

Re: Oreo - hypothyroid, diabetes and atypical Cushing's

I was all over the Royal Canin site but nowhere do I see any feeding guidelines information. So I wound up at Hill's Prescription Diets, who does provide that for their products.

I had to go with the best match for the type of product and why it's being used and that would be Hill's Z/D Canine Ultra Dry.

http://www.hillspet.com/hillspet/pro...45524441760430

They suggest the total daily amount of food for a dog who is 20 lb./9 kg would be between 2 and 2 3/4 cups of food and that's for maintaining weight; we have a fella here who needs to gain some.

What we do know here is that for the 8 units of insulin, the 1 1/2 cups of IVD that Oreo ate willingly seems to be very close to a good food/insulin match, otherwise he wouldn't be in the 200 range--the PU (urinating too frequently) and PD (drinking too much water) would not have subsided to this point either. If we take everything else except Oreo's diabetes off the table for a moment just for the sake of an example, with a little adjusting of his insulin--Oreo would appear to be on the road to regulation.

This was breakfast and insulin, so it would sort of make sense that dinner of 1 1/2 cups of IVD followed by the 8 units of insulin would be the same.

Now we come to him still getting his 8 IU of Vetsulin twice daily and a total of 3 cups of IVD-- 1 1/2 cups morning and evening.

When the bg's are running high as Oreo's have been, they often don't care to eat because the high bg's make them feel lousy.

When you started cutting back the amount of IVD on Sunday and Monday, making it about 2 cups total that he ate, but stayed on with the insulin dose of 8 units of Vetsulin twice daily, this is what happened:

You didn't raise or lower Oreo's insulin at all--but you DID change the amount of food he was eating--to one which is a better match to those 8 units of insulin twice a day. So there was more insulin able to cover less food, and the bg's started dropping.

Please understand that it does take 2-3 days for them to come down from being so high--being consistent as you were with the insulin is what "won this race."

At one time, we had weak pork Lente insulin from Lilly which was roughly only half potent. My Lucky's bg's went up quite high from it. When you had to have pork insulin before Vetsulin, you had to have the pharmacy order it for you, so there was no way to just go out and replace the vial. This happened on a weekend on top of that, so you couldn't get an order placed until Monday.

We turned to the old vial that the weak one was meant to replace. We knew it was less than 100% potent--it turned out to be more potent than the brand new one. Since we had no way to know exactly how much potency was left in the old vial, we couldn't raise Lucky's insulin dose for fear that we might send him hypo, so we had to stick with his normal number of units.

It took 3 days of being consistent with that less than perfect vial, but we did manage to get his bg's down once again. This is much like what happened with Oreo--consistency paid off for us both.

So what we do know is that the current insulin dose comes pretty close to being able to handle the daily total of 3 cups of IVD. If the insulin was adjusted a bit, I believe Oreo would be in the ball park for beginning to regulate.

What I don't know is if this is enough food for Oreo or not. If not, this also tells us that he will need to have his insulin dose raised to handle more food.

Seeing this also says that the insulin is effective for Oreo because if it wasn't, he never would have come down from those burning hot bg's as far as he has. When the insulin is not effective, what you see is either only a slight drop in the bg's before they climb again or that they don't drop at all.

My Lucky had immune-mediated insulin resistance to both human and beef insulin. His body viewed those insulins as "invaders" just as if they were viruses or bacteria. His system would destroy those insulins before they ever got a chance to do anything about lowering his bg's. He was only able to use pork insulin, which is a perfect match to a dog's own insulin. His bg's were in the 500-600 and up range until we tried pork insulin; within a week of starting that, he was in the mid 200's, dropping about 400 points.

It sure looks like Oreo's in a good range to begin to regulate now, but not being a vet, I can't say if he's getting enough food for his medical problems other than diabetes with the 3 cups of the IVD daily.

Kathy