Shih tzu diagnosed with diabetes and Cushing's... Unsure

[Cater]

Hello everyone!

I've just joined the forum after reading through a few threads, and thought I'd share my own experience thus far - though the journey has just begun. I have an 8-year-old shih tzu named Oliver who has just been diagnosed with diabetes as well as Cushing's disease. One of these would be overwhelming enough, but for him to be diagnosed with both at the same time has me feeling very scared and concerned for my boy, as I know the prognosis for Cushing's isn't good.

Everything I've read so far has told me that diabetes and Cushing's have almost identical symptoms, and that diabetes can often appear like Cushing's in blood work and urinalysis results. The vet confirmed the Cushing's today after seeing the elevated alkaline phosphotase and cortisol levels. Do these results truly confirm Cushing's? I've read that uncontrolled diabetes can lead to elevated levels in both of these.

Oliver's sugars are currently 24 mmol, which I think is about 432 mg. We started the insulin this morning, and took him to the vet about 5 hours after his dose to see where we were at. There was no change in his sugars - is this expected after only one dose? The vet has said that before we can treat the Cushing's, we need to get his sugars under control first.

Sorry if this post is all over the place, I'm a bit of an emotional wreck right now. I'm just still so confused about the diabetes/Cushing's double diagnosis, and I'm just not sure if I should be 100% convinced he has Cushing's.

Any thoughts or personal experience with this would be very much appreciated! Thank you for reading.

- Cater

[CraigM]

Re: Shih tzu diagnosed with diabetes and Cushing's... Unsure

Welcome to the forum.

I'll have to let others give you their advice concerning Cushings, but I think your thoughts are correct. Treat diabetes first and THEN see if Cushings is present. Are there any physical signs of Cushings?

How much does Oliver weigh? Which insulin is he using? What is the insulin dosage?

Most types of insulin take several hours before they hit their peak where you might see the lowest blood glucose reading. My Annie generally has her lowest numbers about 10-12 hours after the injection. Every dog / situation is different.

Craig

[Judi]

Re: Shih tzu diagnosed with diabetes and Cushing's... Unsure

Hi Cater: Sorry you are going through this. I went through it in 2011 and it is intimidating at first.

So far you are exactly right with what you have read. We've had numerous people on this forum who's dogs were incorrectly diagnosed as having cushings because their cortisol levels were up due to their uncontrolled diabetes. So, ideally you get the diabetes under control before treating the cushings.

With us, after 6 weeks and not much budging of my dog's blood sugar. And because she had all of the "textbook" cushings symptoms: crappy hair, voracious appetite, pot belly even after losing weight, and as an 8 pound dog she was up to 7 units of insulin twice a day, we started treating her cushings.

for her, as the cortisol went down her insulin needs went down. but, our original lifelong vet didn't want to deal with the complications of treating both diseases at once so we had to find another vet.

So, I think for now you are on the right path. Lets see how the insulin works.

I didn't test Jenny's blood sugar at home for a long time. 1. She was always high and I was intimidated. So, after 12 curves at the vet offices and 3 or 4 ACTH tests, and some very scary low blood sugar, I learned to test at home. I know it saved her life.

So, I recommend starting to test at home. One test 4 or 5 hours after insulin won't really tell you much. The vet is playing the odds that most dogs have a low reading at that time. but a lot of our dogs have their own unique curve. My Jenny just stayed flat (high) for the first 6 weeks.

Sorry for writing a book but you sound like you are getting informed so I think you can do this! Eventually it will be a routine, whether you are dealing with 1 disease or 2. When I googled back in 2011 everything I read said I'd be lucky to get 2 more years with my dog. We got 3 1/2 and it was just old age that did her in, not either disease. For most of those 3 1/2 years she still managed to be her feisty demanding little self.

hang in there, you can do this. Judi

[KristinMarie717]

Re: Shih tzu diagnosed with diabetes and Cushing's... Unsure

Hi Cater!

I went through your exact situation just about a month ago. My 10 year old Chocolate lab was having some weird symptoms. Drinking a lot of water, skin/fur issues, little bit of a pot belly but I think that is from him losing weight.

I took him to his normal vet and she did a urinalysis and a blood panel. His sugar was mid 500s and his ALP level was off the charts! My vet went right for Cushings. She even told us she couldn't give us anything for the high blood sugar because the insulin would not work because of the high cortisol levels. After finding the K9cushings forum I quickly learned that we needed to go for a second opinion.

We went to another Vet and walked out with a prescription for insulin and he was diagnosed with diabetes.

Our new Vet hasn't totally let go of the idea of Cushings but where his symptoms are subsiding as his glucose levels come down, we are being optimistic.

I would focus on controlling the glucose levels. Jackson was so sick I thought he was a goner and he is slowly coming back around. I believe you are on the right track. Treat the definite issue and see what happens. I bet you will be surprised!

Keep us posted! We are thinking of you and Oliver!

[jesse girl]

Re: Shih tzu diagnosed with diabetes and Cushing's... Unsure

You can check in with our sister site k9cushings which can be helpful

[Cater]

Re: Shih tzu diagnosed with diabetes and Cushing's... Unsure

Hi everyone, sorry it's taken me so long to reply. Thank you for all the kind words and advice.

Craig - Oliver is a bit heavy for a shih tzu, he is close to 20lbs. Clearly we need to get him to lose some weight. He is on 6 units of Caninsulin a day, I think this must be a Canadian brand of insulin. As for physical symptoms of Cushing's, he does have a bit of a belly but it doesn't appear like a "pot belly" to me. His weight seems pretty evenly distributed. Also, he isn't losing his fur and it's not thinning either. He was just recently groomed and his coat seems to be in good condition.

Kristin - You've given me hope, thank you! It was the exact same results for Oliver. High sugars and his ALP levels were really high. The vet also told us it would be difficult to regulate the sugars because of the Cushing's. I'm happy to hear that your boy is responding to the insulin, I hope he continues to improve!

Judi - Thank you for suggesting testing at home, we will look into this as well. It sounds to me like Cushing's can create a resistance to insulin, so we will see how Oliver responds.

I will be checking out the k9cushings forum as well for more information. Thank you all so much again for responding. You've all made me feel a lot more at ease. I will keep you posted about Oliver as often as I can!

- Cater

[CraigM]

Re: Shih tzu diagnosed with diabetes and Cushing's... Unsure

Vetsulin in the States is named Caninsulin in the rest of the world. Seems about ½ of the members are using Caninsulin / Vetsulin.

6 units for a 20 pounder might be close. Annie was getting about 7 units of Vetsulin when she was on it. About 18-19 pounds at that time. Of course every situation is different (food, exercise and other factors).

Hope your pup doesn't have Cushings, no need to rush into that!

Craig

[CraigM]

Re: Shih tzu diagnosed with diabetes and Cushing's... Unsure

Is Oliver on 6 unit per day, or 6 units twice a day? I don't think we've seen any dog really make it with once a day injection. Most feed / inject every 12 hours.

Craig

[Cater]

Re: Shih tzu diagnosed with diabetes and Cushing's... Unsure

Is Oliver on 6 unit per day, or 6 units twice a day? I don't think we've seen any dog really make it with once a day injection. Most feed / inject every 12 hours.

Craig

He has two injections a day 12 hours apart, each 3 units for a total of 6 units a day. The vet said they would start him on this dosage because they don't want his sugars to drop too quickly, which now that I think about it kind of confuses me since she was so certain of Cushing's, and that it would be hard to bring the sugars down.

He goes back to the vet on the 10th to determine whether he needs a higher dosage.

[CraigM]

Re: Shih tzu diagnosed with diabetes and Cushing's... Unsure

He has two injections a day 12 hours apart, each 3 units for a total of 6 units a day. The vet said they would start him on this dosage because they don't want his sugars to drop too quickly, which now that I think about it kind of confuses me since she was so certain of Cushing's, and that it would be hard to bring the sugars down.

He goes back to the vet on the 10th to determine whether he needs a higher dosage.

Does Oliver control his urination? No "accidents" in the house? Sticky urine from sugar being passed is sometimes a visual indication that the insulin dosage is too low. Of course we wouldn't adjust dosage based on this, but it might be a indicator that something isn't correct.

Have you considered home blood testing? Many (most) of us blood test at home. There are videos on this website, and on YouTube. It might sound difficult, but most pups and parents learn fairly quickly.

NOT as accurate, but there are also urine dip strips that you can probably get at any pharmacy / chemist. These dip strips can give an idea if the patient is spilling excess glucose into the urine. You probably wouldn't control diabetes with urine dip strips, but they may tell you if additional testing should be done.

Craig

[Cater]

Re: Shih tzu diagnosed with diabetes and Cushing's... Unsure

Oliver had started having accidents in the house which is why we took him to the vet, and of course that was when we got the diagnosis. This was his third day on insulin, and he hasn't had any accidents in a couple of days. His need to go potty has seemed to normalize as well. Before we were having to take him out every couple of hours! He doesn't seem as lethargic either, and he even barked at a couple of crows today (he hates crows ). So he seems to be feeling more himself at least, so I'm hoping that means the insulin is working.

I've been trying to convince my mother to test at home, but she seems pretty content to let the vet do it. I might bring it up at Oliver's next visit. I've been doing a lot of reading here and also at the k9cushings forum so I think we're on the right track. I'm just really hoping we will see a decrease in his sugars on the 10th, but I'm trying to keep my expectations down as I know it can take time.

It's hard not to feel a bit guilty, even though I know we're doing this for his own good, I just wish I could explain it all to him somehow. He usually would get a dentastix chew every morning and he gets very upset with us now that he doesn't get one, haha!

Thank you Craig (and everyone!) for all of your help, it's such a relief to have someone to talk to about all this. I'm so glad I found these forums!

- Cater

[CraigM]

Re: Shih tzu diagnosed with diabetes and Cushing's... Unsure

Oliver had started having accidents in the house which is why we took him to the vet, and of course that was when we got the diagnosis. This was his third day on insulin, and he hasn't had any accidents in a couple of days. His need to go potty has seemed to normalize as well. Before we were having to take him out every couple of hours! He doesn't seem as lethargic either, and he even barked at a couple of crows today (he hates crows ). So he seems to be feeling more himself at least, so I'm hoping that means the insulin is working.

I've been trying to convince my mother to test at home, but she seems pretty content to let the vet do it. I might bring it up at Oliver's next visit. I've been doing a lot of reading here and also at the k9cushings forum so I think we're on the right track. I'm just really hoping we will see a decrease in his sugars on the 10th, but I'm trying to keep my expectations down as I know it can take time.

It's hard not to feel a bit guilty, even though I know we're doing this for his own good, I just wish I could explain it all to him somehow. He usually would get a dentastix chew every morning and he gets very upset with us now that he doesn't get one, haha!

Thank you Craig (and everyone!) for all of your help, it's such a relief to have someone to talk to about all this. I'm so glad I found these forums!

- Cater

Don't expect the vet to encourage home testing, very few encourage. Cuts into their profits?

I give Annie a Greenie brand dental treat at each meal, sort of like dessert. I treat them as a part of the meal.

Craig

[Cater]

Re: Shih tzu diagnosed with diabetes and Cushing's... Unsure

I realize I made this thread a year ago, but just wanted to give an update on Oliver.

Basically, he's still not regulated. After a year! He's at 9 units, up from the original 6. Still around 18-20lbs. He's had a few good readings where his sugars were 145 - 165. But then he still shoots up to over 300 and starts having accidents in the floor again. I still have not convinced my mother to start testing at home, she thinks the vet is the one who should do all of that. We argue about it a lot.

Also, our vet still hasn't started treating the Cushing's. Seeing as Oliver is taking so long to regulate, wouldn't it be a good idea to start treating his Cushing's as well? It just doesn't seem right for it to be taking this long to get his diabetes under control. He's still on Caninsulin, maybe he needs to switch to a different insulin?

[CraigM]

Re: Shih tzu diagnosed with diabetes and Cushing's... Unsure

I realize I made this thread a year ago, but just wanted to give an update on Oliver.

Basically, he's still not regulated. After a year! He's at 9 units, up from the original 6. Still around 18-20lbs. He's had a few good readings where his sugars were 145 - 165. But then he still shoots up to over 300 and starts having accidents in the floor again. I still have not convinced my mother to start testing at home, she thinks the vet is the one who should do all of that. We argue about it a lot.

Also, our vet still hasn't started treating the Cushing's. Seeing as Oliver is taking so long to regulate, wouldn't it be a good idea to start treating his Cushing's as well? It just doesn't seem right for it to be taking this long to get his diabetes under control. He's still on Caninsulin, maybe he needs to switch to a different insulin?

I see he was on 6 units a day, two injections of 3 units, last year. So is he on 4.5 units twice a day now? You might just need more insulin, but wouldn't want to increase on my own without blood testing.

Caninsulin is fine (same as Vetsulin in the U.S.). I think the main reason many here in the U.S. use another insulin is due to cost. If Caninsulin is affordable, I'd probably stay with it. Please confirm what syringe you are using: are the marked U-40, or U-100?

Does your pup show physical symptoms of Cushings? There are soooo many false diagnosis of Cushings.

Craig

[jesse girl]

Re: Shih tzu diagnosed with diabetes and Cushing's... Unsure

regulation can be quite different from one dog to another . i have seen some dogs on the forum that did just fine with the regulation you described and usually you dont see the urination accidents at those levels but without home testing you cant be sure what blood sugar is most of the time and its possible the accidents could be another medical condition

vets are limited in what they can do because they cant put the time in that maybe needed especially for more difficult cases . my jesse actually needed less insulin than a starting dose . we would have probably never figured that out if not for me home testing and developed a unique routine for her that would have not been figured on a medical professional level strange to say that but its about the time needed to be invested .

it sounds like there isnt allot you can do which is probably frustrating for you maybe your mom would be willing to read some threads on the forum and find out that the opportunity for better results starts with you and home management of the disease as with a human diabetic .

usually with a cushings diagnosis for a diabetic you would see insulin resistance which is just high sugar with no movement on a high dose of injected insulin .it sounds like you are not seeing that at this time

i would keep trying to convince your mom that we maybe able to do better maybe say ok lets give it another month if we dont see any progress lets try it my way