Cushing's with diabetes

[Patty]

Re: Cushing's with diabetes

Just catching up on your thread. Hope the vet visit went well!

[Exist]

Re: Cushing's with diabetes

Hello everyone,

Sorry about the late update. I tried making a post late last night on my tablet but it closed out my browser while I was submitting :/

Yesterday wasn't as productive as I had hoped. Peanut's vet was not in so all my interaction was with the nurse/tech. He did teach me how to properly medicate Peanut by using the loose flesh on his neck/back. I was also told that testing the blood glucose is not necessary right now since his levels are so high. I am to bring him back regularly as they regulate him so they can do a spot test and adjust. A question I did bring up was regarding Peanut's diet. I was told to keep feeding him normally since any changes may result in throwing off Peanut's eating habits, which will lead to inconsistent or inaccurate glucose readings.

The vet did briefly call today but I couldn't really speak since I was on the road. Peanut has UTI and will need to take cefpodoxime for 3 weeks. I brought up the cataract concern and she referred my to an opthamologist, which I am seeing next week.

I don't think he has cataracts from diabetes yet, but I am not 100% certain so I'll leave the diagnosis to the doctor. I saw picturs of different cataracts and it seems like geriatric nuclear sclerosis.

For anyone with experience on cataracts, how hard is it for dogs to adjust? I have read over and over that dogs normally live "happy" lives. Will it be better, or the only choice, to limit Peanut to one area of the house away from stairs and furniture? And if anybody has opted for surgery, do you recommend I do the same?

Sorry for all the questions. So much information to absorb and searching results in more sites with ads for drops than actual information.

Thank you

[Exist]

Re: Cushing's with diabetes

From all of the information on this board, I don't see how they can diagnose your dog with Cushings already. OUt of curiosity what part of the country do you live in?

Hi Bowens,

I live in the midwest (Chicago). Why do you ask?

[bowens2]

Re: Cushing's with diabetes

Just curious. Wondered if our vets knew each other. My vet puts all of his patients on Lantus and it just doesn't make sense especially with dogs not doing so well on Lantus and the high cost.

[Patty]

Re: Cushing's with diabetes

I am originally from IL and will just say I've been particularly unhappy with the way canine diabetes is managed in general in this region. U of I is not one of my fav veterinary schools for teaching about this disease.

I would make sure your dog has a full curve done, where blood sugar is taken every 2 hours throughout the day, before changing insulin doses. A one time spot check will not tell you what the high/low points are or how the insulin is matching the food.

I've heard a handful of ophthalmologists theorize that nuclear sclerosis may actually offer some protection from diabetic cataracts because the fibers become dense/tightly compressed and don't allow for the water retention/edema that typically occurs with cataract formation. (As sorbitol accumulates with high blood sugars, the osmotic pressure changes. It draws water into the lens and changes the structures.)

I like cefpodoxime (Simplicef) for UTIs because I haven't had problems with it affecting blood sugar like other antibiotics. I also like the idea of treating for 3 weeks. Is he on 100mg once a day then?

Patty

[Exist]

Re: Cushing's with diabetes

My dog Monkey is on Lantus and has been since he was diagnosed in 2006. He did very well up until November 2011 and I'm not sure the insulin is the problem but he is having night time lows. These may have been there all a long but I did not home test so I would not have know. I may have gotten lucky or he may have just reponsed really well to it. My vet really believes in this insulin. I think it has advantages and dis-advantages. Monk always ate RD which because it was high fiber worked well with the Lantus and ate with gusto now he doesn't so I don't know if its the food or the insulin or another medical reason. My vets are pushing the Cushings diagnose also at this time.

Monk also weighed 26lbs when he started. He started at 10 units and climbed to 14.25 once a day and that didn't work so we did two shots a day at 8 units and it steadily rose to 14.5 units twice a day and he stayed there until the summer of 2011 when his eating habits changed and I changed his food and increased his insulin to 15.75. I think the food change along with the insulin increase probably caused him problems that I was not aware of because I did not home test him.

I read that you work in a pharmacy so I don't know what you pay for insulin but Lantus is expensive! And it goes up constantly! It went up $16 this last time. It started at $69 in 2006 and is now $124 plus sales tax which they just added for pet prescriptions in Ohio so the total is $135. The only reason I stayed with Lantus is because Monkey did well. But he isn't now so it may be the time to take the jump for Monkey to another insulin.

However I used one bottle for two months with no problem and when he was diagnosed back in 2006 I think I used it longer.

It appears very few dogs do well on this insulin and some of the more knowledgable people on this board can explain it I didn't know enough in the beginning (or now) about different types of insulin or that there were even different insulins out there but I guess I got lucky for awhile any way.

If the cost is a factor for you I would definitely change now. They are supposed to come up with a new insulin next January to replace Lantus that has better duration and does not have the night time lows at least in humans. The FDA just released it for production this January is what I read but
who knows what it will cost.

Monkey has had a lot of variables in the last few months and we are still working it out. His numbers are still really good but awfully low at times but I too have been screwing up with his calorie intake apparently and he has gone from a dog that could scarf his food down in 5 seconds to a dog that turns his nose up at what he would have eaten my arm off for before. He has lost weight and is eating a lot less so i am trying to make adjustments. I just learned how to home test him! Something I should have done from the beginning and I would have know what was going on with him even though it drives you crazy.

Good Luck and you will gain a lot of valuable knowledge from this board.

Hi Bowen,

Don't know how, but I completely overlooked this post. Sorry to hear about Monkey. But it's wonderful that you were able to and still have Monkey's glucose levels under control for such a long time. It gives me hope!

Yeah, Lantus is ridiculously expensive. I just wish medicine would be cheaper so everyone that needs it can easily obtain it. I am really going to talk to the vet about NPH. I just wish regulating Peanut was quicker. I become paranoid at night and wake up several times to check on him. His water consumption seems to have gotten closer to normal. I know it doesn't mean he is fine, but it's the little things that gives hope.

Anyways, thank you. Everyone here is so nice and helps me alot, from providing me with information and advice to giving me words of comfort.

[Shellie]

Re: Cushing's with diabetes

Anyways, thank you. Everyone here is so nice and helps me alot, from providing me with information and advice to giving me words of comfort.

Anytime you need a shoulder to cry on...that's what we are here for! I know that I could NEVER have made it this far with Hank if I didn't have the support and knowledge this group has. I felt so lucky when I found them! Hank's been a tough case and continues to be but everyone has been so supportive and truly great friends! I'm awful glad you found us! Hugs!

[Exist]

Re: Cushing's with diabetes

Hello,

After discussing the direction we believe Peanut's treatment should be going and the progress made so far, my sister and I have decided to seek a different doctor. Taking the advice everyone at k9diabetes/k9cushings have given us and information from research, we feel the current vet is not aggressive enough in treating Peanut. An enormous red flag is the lack of communication. After diagnosing Peanut and regulating his bg for a whole day, she has not really discussed what our next step is except to give Peanut his insulin shots. She hasn't given us much information like:

-how treating diabetes is going to be affected by Cushing's and vice-versa
-more information about Cushing's since she diagnosed him with it
-diet: I have read Cushing's means less fiber while diabetes means more. I think such information is important to know.
-conflicts, prognosis, anything more than "it's hard to treat both. It takes commitment." how so? What should I expect? What are the warning signs treatment isn't working and we need to bring him in. What adjustments need to be made?
-what we should/shouldn't do ( exercise, any important physical signs, etc.)
-testing his levels at home
-what we should expect by our next visit AND when our next visit is
-any other important information
-discussion/explanation of his test results, bg curve, ketones...

Half the information is either from k9diabetes/cushings or from the nurses/techs at the hospital after learning what to ask here. We realize a lot of what happens next is also very much our responsibility. And in hindsight, we should have been more aggressive in questioning her as well. But given that this is all new and overwhelming for us, I feel she should have somewhat discussed the game plan until the next appointment, and more importantly, given us a next appointment.

Another major concern is her treatment method. I realize she is the expert and possesses a vast amount of knowledge compared to my sister and I. But it seems she is a minority of vets who believe Lantus works the best. From everything we have learned here to articles and studies by her peers, the majority prefer to use NPH. The longer Peanut's bg is high, the worse he becomes..After bringing up the issue, I hoped she would at least try to find out more about NPH.

We plan on making an appointment with the current vet one last time to address our concerns. But unless she makes us feel completely certain that she will work with us, it will probably be the last visit.

So we are seeking new doctors. We read that working with an animal internist is better than going to a regular vet. We weren't aware there were different types of vets. Is there a website, like human doctors, where vets are ranked and reviewed in each city? If not, is there at least a site or service that can direct me to an internist?

Sorry for the long post...I just needed to explain (vent) my frustrations with the doctor. Maybe its not her and I'm just not giving the effort I need to, I don't know. But it is clear both sides are not on the same page. Any suggestions? Or is our course or action the right one to take?

Thank you!

[Judi]

Re: Cushing's with diabetes

sounds like you have a plan. here is a link to start:

http://www.acvim.org/websites/acvim/index.php?p=3

[spiritdog6]

Re: Cushing's with diabetes

Yes, you sound like you know you must be the advocate, big time for your dog.

I have a Cushing/diabetic dog. We see an Endocrinologist, also know as an Internal Medicine Specialist (abbr. IMS). That is what you want. But please realize that they can be wrong too, so you must try to be as informed as possible. I had to fire my first IMS because her treatment for my dogs Cushings was wrong, and I knew that because I had studied the drug (Lysodren) intensely. My dog has Adrenal Cushings, so Lysodren loading would have taken months because of tumor. As soon as we changed to Trilostane and got the correct dosage, he became "normal" again. But then the diabetes popped up.

He has been a diabetic for a year, and a Cush dog for 2. He is a happy, bouncy little guy at 12 yr. old. No one can tell how sick he is because of his happy spirit. I call my Trilostane the gift of life, as it gave me my dog back.

You sound like a great parent who is willing to learn, kudos.
PS. IMHO I wouldn't even waste the $ to see that vet just one more time, save it for an IMS, as they are not cheap either.

[MaryLea]

Re: Cushing's with diabetes

Can't say for certain, but my hunch is that you are doing the right thing--and I'd be doing it, too, if I were in your shoes. I definitely want/need a vet who works with me as a team and communication is the key. You are lacking vital information from your current vet and it's important that you get it.

Mary

[Judi]

Re: Cushing's with diabetes

My dog has Adrenal Cushings, so Lysodren loading would have taken months because of tumor. As soon as we changed to Trilostane and got the correct dosage, he became "normal" again. But then the diabetes popped up.

He has been a diabetic for a year, and a Cush dog for 2. He is a happy, bouncy little guy at 12 yr. old. No one can tell how sick he is because of his happy spirit. I call my Trilostane the gift of life, as it gave me my dog back.

.

my Jenny also has adrenal cushings. I guess it did take months for Lysodren to work for her. We started in July and felt confident she was on a good maintenance in November or so. She is doing really well now with the Lysodren.

When my vet consulted with some specialists regarding which drug to use when we were considering switching, half preferred Lysodren and half preferred Trilostane. These were IMS doctors at the University of Minnesota. So, I think each dog is different. But who knows, maybe Jenny would've regulated quicker on the Trilo. just for what it is worth. Judi

[spiritdog6]

Re: Cushing's with diabetes

my Jenny also has adrenal cushings. I guess it did take months for Lysodren to work for her. We started in July and felt confident she was on a good maintenance in November or so. She is doing really well now with the Lysodren.

When my vet consulted with some specialists regarding which drug to use when we were considering switching, half preferred Lysodren and half preferred Trilostane. These were IMS doctors at the University of Minnesota. So, I think each dog is different. But who knows, maybe Jenny would've regulated quicker on the Trilo. just for what it is worth. Judi
__________________

Judi, I agree it is split on which drug. My IMS stated when he saw my dogs Adrenal glands that Lysodren would have never worked. Later he did say it would take months and months to see if it would work. It was obvious that the dosage my old IMS wanted him on would never work. The problem with Trilostane is that it does not affect/help with the intermediate hormones (I believe Lysodren does), which is not good. But at the time there was a decision that had to be made. His Cushings was raging, and I was out of my mind for some relief for us. It took us 6 months to get GOOD help, and we suffered all that time with Cushings raging.

I think it is important that one knows which Cushings a dog has, Adrenal vs. Pituitary. And that Lyso does work on Adrenal dogs, but that the load time is significantly longer than a Pituitary dog or what you read about as far as normal loading time.

I am not against either drug, I believe they both work, but it is the vet that needs to be aware that Lyso will take a lot longer to work on an Adrenal dog, but that it can work.

My dog was very sensitive to Trilo, and because of that it took time for his body to adjust and finally get the correct dosage, so yes it did take us time as well. I didn't mean to come across as it was a quick fix over Lyso. Every dog is different, you just need a very smart vet or IMS to know what they are doing! In hindsight I wish my IMS had continued on with the Lyso because of the intermediates.
Sadly you and I are in the 15% of Adrenal dogs.