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Re: Difficulties of Cushing's diagnosis in poorly controlled diabetic

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  • Re: Difficulties of Cushing's diagnosis in poorly controlled diabetic

    Hi Douglas,

    Five units of insulin doesn't sound like a very large dose so it seems to me that saying Cooper is insulin resistant and therefore possibly has Cushing's disease would be premature unless he is a very very tiny dog.

    The most commonly accepted definition of "insulin resistant" is a dog who is being given 1 unit per pound and still has poorly controlled blood sugar.

    Unfortunately, some vets impose inappropriately low limits on the insulin dose and thus jump to Cushing's.

    So that's my first thought is that Cooper might just need more insulin than he's been getting.

    How much does he weigh?

    Then add in the triglycerides likely in a mini Schnauzer and you have another reason to consider the possibility that he does not have Cushing's disease but rather high blood sugar related to high triglycerides.

    I have never quite gotten around to learning how to interpret the LDDS - are you a member of our sister forum for Cushing's dogs?

    They could tell you whether the LDDS results fit a diagnosis of Cushing's disease.

    But the blood test can't necessarily tell you whether Cushing's is present even if the results are a textbook case of positive for Cushing's.

    The problem is that a body that has other concurrent illnesses, such as poorly controlled diabetes, can have elevated cortisol production. Which can look like Cushing's disease but not be it.

    One thing that can help in a dog like Cooper is to do an ACTH Cushing's test. My understanding is that it is less likely to yield false positive results in a poorly controlled diabetic.

    The other big indicator to me is the presence or lack of visible Cushing's symptoms - bony head and hips and saggy belly associated with changes in fat distribution, hair that's very thin or not growing back after being shaved.

    If a diabetic dog's body doesn't physically scream "I have Cushing's disease" and there are other factors potentially involved, such as high triglycerides and poorly controlled blood sugar... AND the insulin dose has not been raised to 1 unit per pound to see if the dog just needs a higher than average dose... well, you can see where I'm going with this. I would not put a lot of trust in a Cushing's diagnosis and would not start treatment with the kinds of powerful medications used to treat the symptoms of Cushing's disease.

    Even elevated liver values don't mean Cushing's. They mean the liver's unhappy, and that can occur for many reasons.

    So, it has to be a big picture thing and, in my mind, unless the dog's body screams Cushing's disease, the first thing to do is up the insulin dose and find out for sure whether they are technically insulin resistant or just need more than average.

    I've seen a few terriers who weighed about 24 pounds and needed 21 units of insulin per injection (twice a day). Not Cushing's - just unusual need for insulin and probably not processing it all that well.

    The big thing I see with diabetic mini Schnauzers is erratic dosing. They go for months at one dose and then suddenly it's far too low or far too high. So they can be challenging to maintain in that regard.

    Tell us all you can - and a photo of your dog now might also be helpful. You can email it to me at if you don't want to post it here.