Shih tzu recently diagnosed plus Cushings

[PaddysPerson]

Hello Everyone. My sweet boy, Paddy, was diagnosed with diabetes a week ago. He's also had Cushing's for 5 years or so and takes 10mg vetoryl once day as well as 3mg melatonin 2x. He had just been to vet for his regular check-up in mid-March and his glucose was 137. He had to have an ultrasound afterward because of his high ALP (@ 3400).
The weekend after ultrasound, he began to drink alot more than normal and peeing more. Thought it could be the cushing's... He went back to vet last week because of dental/mouth problem (my fault for neglecting his teeth) and had not been wanting to eat. While there, at the last minute, they checked his glucose and it was 440 -ish. He now has to have an injection once a day - vetsulin 4 units. And he also is limited to twice a day feeding. He got an rx of Royal Canin Glycobalance food. He's supposed to eat a whole can in one day - but it looks like ALOT for him to eat at once. So he's been getting 1/2 cup.
I added a spoonful of pumpkin today (which he used to eat regularly). He's been having problems with his poop (soft and some are small and more frequent). He did get an antibiotic injection - Covenia - last week, but he had the poop issue before that and it had gone back to normal. Is it alright to give him a probiotic? The one I have on hand is Purina Fortiflora? Should that be ok with diabetes?
He's got some other health issues, which I'll mention later. I posted the results from some of his labwork on the k9cushings board. (The melatonin was discontinued because of it blocking insulin absorption..??)

[Pippi's Mama]

Re: Shih tzu recently diagnosed plus Cushings

Hello. Welcome to the group.


I wonder why the vet has Paddy on insulin just 1x daily. Most dogs need insulin after eating a meal as that is when the blood sugar is going to spike. My Pippi was given insulin 2x daily just after eating. Most diabetic dogs are put on a strict 2x a day meal regime with insulin injections just after eating a meal.



Pippi was on Novalin N from Walmart, and it works well for many dogs, but a lot of diabetic dogs use the Vetsulin, also. I would think dogs on Vetsulin would also need it 2x a day just after eating. It is important to feed around the same time in the morning & evening every day to keep the blood glucose as stable as possible. And it is also important to give the same kind of food and the same amount of food each time. I weighed Pippi's food on a scale. Some people don't go to all that trouble, but I would have stressed out if I hadn't weighed it. LOL.



Has your vet done a blood glucose curve? You didn't mention if you are using a glucometer or not. This is extremely important as it helps you keep an eye on the blood glucose levels in case it gets too high or too low. If you have a glucometer, you can learn to do your own blood glucose curves instead of the vet, which can get expensive.



I gave my little Pippi Purina Fortiflora and it didn't bother her blood glucose levels. Interestingly, I also gave her melatonin and it also didn't affect her blood glucose levels. However, every dog is different. What might affect one dog might not affect another.



Plus, Paddy has Cushings, so there might be other factors to consider with that. I don't have experience with Cushings.

[PaddysPerson]

Re: Shih tzu recently diagnosed plus Cushings

Sorry it has taken me so long to reply. I had been waiting for test results from UTK re Paddy's cushings, then to hear from the specialist about that. And Paddy had his first curve done by the vet last week.
Paddy is usually a bit overweight, most always 21 lbs. When he had his regular check-up in March, he weighed @23 lbs on vet scale. In early May, he had not eaten well for a few days due to his teeth/mouth problem & weighed 19-20. I tried to weigh him at home (before vet) & he was 17.2. At vet, he weighed 16.4. He's also been losing ALOT of fur.
He had been getting 4u of vetsulin 1x a day. I fed him at home - 1/2c of RC Glycobalance & gave injection before going to vet for curve (8am, 8:30am) & we got there a little after 9. He was there til after 5pm. The first few results were off the charts (700) & the only time it was below 600 was the last one at 5pm which was still over 500. It had been 430ish in May.
So, of course, he's going to 2x a day now & they want to increase it to 5u. Does that seem like too much for his current weight? I'm pretty sure I read that reccommended dose is 1/2u per 2.2kg & 25% less if 2x a day.
The vet had said in May that he should be fed 1/2 can of food twice a day (one can is 13.75 oz). At first I think she had said 1 cup twice, but then 1/2 can. I have been giving him @ 3/8 - 1/2c of food plus an additional 1/8c pumpkin & a spoonful of the Glycobalance right after his injection (not day of curve, though, as he wasn't interested). I used to feed him 3-4 small meals per day. So much at one time now.....it just looks like alot for him to eat. That's why I wait a few minutes & give a little more.
Also, re his cushings & the test results from UTK...they were understaffed & it took a month to get those back (e-mailed to me) but they seemed to indicate atypical cushings & that Paddy should discontinue vetoryl & change to Lysodren, which requires a month break in between. Lots of phone tag with the specialist followed. After 2 weeks of wondering, I decided maybe I should stop giving vetoryl, anticipating the Lysodren switch. So he went without vetoryl for 2 weeks, which may have been why his glucose was so high on curve day. When I finally spoke with the IMS the day after the curve, he told me to start giving him the vetoryl again as he doesn't want to start anything new until diabetes is better regulated. So, I'm a dummy & should not have assumed...probably made things worse.
Thank you for your answer about the fortiflora. I felt better about giving it to Paddy later.

[Riliey and Mo]

Re: Shih tzu recently diagnosed plus Cushings

hi and welcome to you and your Paddy

at first theres alot to take in but in a short time getting Paddy regulated becomes easier

first off dogs do better getting injections twice a da after food every 12 hours. i.d speak to your vet and ask why hes injecing only once a day.

make a log of his daily routine, food fed, how much, exercise when how much

this all adds up to regulating Paddy

more people will be in the forum to help

[Riliey and Mo]

Re: Shih tzu recently diagnosed plus Cushings

it would be good to ask the vet why hes lost alot of weight
if its his teeth, infection, does his teeth need cleaning?

[Riliey and Mo]

Re: Shih tzu recently diagnosed plus Cushings

feed him all his food at one time without adding more after. its part of the regulation process. feeding the same amount twice a day keeping up the repition. injecting right after food. it takes 1 1/2 hours for the insulin to meet up with food

[Pippi's Mama]

Re: Shih tzu recently diagnosed plus Cushings

I would not inject him with insulin before he eats. Give the injection after he eats. The reason being if you inject him and he decides not to eat, his blood sugar could drop too low.


I'm glad that the vet changed his insulin injections to 2x a day. I feel that is the main reason why his blood glucose levels are way out of control. It doesn't make sense that she had you give an injection only 1x if she had you feed him 2x. Since he isn't making insulin himself, he needs the help of an injection every time he eats.


I can't stress enough how important it is to get a glucometer and test his blood glucose levels at home. It is daunting at first, but you will get the hang of it. His blood glucose levels are way too high. If you had a glucometer, you could check him everyday if need be to keep an eye on his insulin levels and do blood glucose curves to figure out insulin doses. You could do your own blood glucose curve once a week to see where he is so you can adjust insulin/food. Every dog food is different. The correct insulin dose for one brand of dog food might be totally different for another brand because of the different ingredients. There are so many factors that go into figuring out how to regulate blood sugar.


We can help you learn how to use a glucomter if you get one. You can post the blood glucose curve numbers on here and we can help you figure out how to adjust the insulin levels.

[PaddysPerson]

Re: Shih tzu recently diagnosed plus Cushings

Hi all.
Does anyone have experience with their diabetic dog having teeth extracted? Paddy's teeth have been bothering him for awhile now - it's why I took him to the vet in May, when he was then diagnosed with diabetes. His vet said then that he probably needed extractions but that was put off until his diabetes was better regulated. Early September was his last curve & his base was 322 (270,,207, 180, 147) and the lowest glucose level was 116. He was given the ok to see the dentist. So we had a consultation and the surgery is scheduled for next week. He goes to his regular vet this week to have another curve done as well as bloodwork to be sent to the dental clinic. At the consult, he just asked if Paddy's diabetes was regulated & I told him last glucose levels (he also had vet records).I tried to ask if he needed antibiotics but he said no...I think he may have meant antibiotics instead of surgery. I didn't know what else to mention at the time. He wanted to know if Paddy has a heart murmur. He's never been diagnosed with one.
So Paddy's surgery is scheduled for next week. What do I need to go over with the dentist before then? He's not to eat anything after 8pm the night before and no water in the morning. I've read that his glucose could get too low during or after surgery...? Should his insulin be lowered in days following surgery? And does he need to be on antibiotics before then? I'm going to ask Paddy's regular vet about it this week, also planning on going over everything with the dentist again. I'd really like to hear from someone who has experience with their own dog.

[Riliey and Mo]

Re: Shih tzu recently diagnosed plus Cushings

Yes, my Riles had teeth extracted with no problem.
I would suggest leaving some teeth in so the dog can breath letting air in.
Riles didnt eat after 12 midnight. In the morning no food and gave him 1/4 of his insulin. He was sent home with pain meds and no infection or antibiotics. He got his regular 5 1/2 units that night. No reason to lower Paddys but if there is an infection the vet might put the insulin up by .5 until the infection is gone.
I mushed up his food for a few days then he was back to woofing it down
Goodluck
P.s. great curves your getting, good regulation

[PaddysPerson]

Re: Shih tzu recently diagnosed plus Cushings

Yes, my Riles had teeth extracted with no problem.
I would suggest leaving some teeth in so the dog can breath letting air in.
Riles didnt eat after 12 midnight. In the morning no food and gave him 1/4 of his insulin. He was sent home with pain meds and no infection or antibiotics. He got his regular 5 1/2 units that night. No reason to lower Paddys but if there is an infection the vet might put the insulin up by .5 until the infection is gone.
I mushed up his food for a few days then he was back to woofing it down
Goodluck
P.s. great curves your getting, good regulation

Thank you...I've been so worried about this. It helps to hear from someone else and that it went well. I won't know until the day of surgery how many teeth need to be removed, after they do x-rays. Paddy's back teeth are really bad and have made his inner cheeks raw and created sores. Sometimes he won't each much because of it . The dentist said that if it's alot that he would remove them in 2 separate surgeries a month or so apart.
He won't be able to have his curve done this week because the vet's glucometer is broken so just a cbc and stim test for his Cushing's. His regular vet is also going to give him an antibiotic to start several days before surgery.
Paddy's 13 now and we've been through so much together, things I never would've imagined. He's the main reason I get up most days. I just want him to feel better. He's such a good sweet boy.
I'm going to contact the vets (not sure which one - IMS or regular?) regarding his insulin for that morning. I didn't even think he'd be able to have it since no food. They said he can have water during night but not in the morning.

[Pippi's Mama]

Re: Shih tzu recently diagnosed plus Cushings

My Pippi had some of her teeth pulled and did fine. Like Riley & Mo said, you want to give him a small amount of insulin in the morning before surgery. I don't know why, but blood glucose increases when a dog doesn't eat. Maybe someone else on this forum can explain why this happens. Pippi passed away a year ago and the surgery was about 1 1/2 yeas before that, so I don't remember exactly. I'd have to go back and check, but I think I was normally giving her 4 1/2 units of NPH insulin from Walmart when she ate. The day of her surgery, I believe I might have given her around 1 unit to keep her blood glucose down. Your vet will be able to tell you how much to give him.



The vet did take blood glucose levels before and after surgery. I don't remember if he put her on antibiotics.


Do you know if they are going to put your doggie on fluids during the surgery?

[PaddysPerson]

Re: Shih tzu recently diagnosed plus Cushings

I emailed the dental office yesterday with some questions. The doctor's answers are underlined.

"I'll give him his regular dose of insulin after he eats the night before surgery (so insulin 30 minutes later). Should Paddy get any insulin in the morning, even though he won't be able to eat? Do not give insulin since he will not eat.
-What is monitored during surgery? Is his glucose level checked (how often?)? We will monitor heart rate and rhythm, resp rate, blood pressure, oxygen in blood and CO2 that is exhaled.
We do not routinely monitor glucose

-Paddy can have water during the night but not in the morning. At what time should I remove his water? Remove water 1st thing the morning of surgery
- Our vet prescribed Clindamycin for him to take for five days (He saw her yesterday & I think it's to clear up infection in his mouth..his inner cheeks.) Her office should have faxed this info along with bloodwork. Is there any issue with him taking that before anesthesia? If you can give the clindamycin without food/treat it is fine to do so,

He wasn't able to have his curve done yesterday as the glucometer at the vet's office is broken. He had a stim test done instead. Last curve was on September 7th.
I guess I'm also wondering what, if anything, is done differently during surgery for a diabetic dog. Mostly, anesthesia is the same as non-diabetic."

I'll call them today to find out about fluids.
Pippi's Mom and Riley & Mo, did your vet tell you to give a small amount of insulin that morning or is that something you thought to do on your own? I had tried to ask the vet tech (at reg. vet) about Paddy's insulin & surgery but she told me I should speak to the dentist/surgeon. She didn't want to give me the wrong info because of doctors doing things differently. Paddy's regular vet won't be at her office til after his surgery. I could call the IMS that we've seen before...? How concerned should I be that the surgeon doesn't check glucose? He's a diplomat with the AVDC.

[PaddysPerson]

Re: Shih tzu recently diagnosed plus Cushings

I spoke with the dental vet tech yesterday. She said that Paddy will be given fluids and she can check his glucose before surgery with a glucometer.

[jesse girl]

Re: Shih tzu recently diagnosed plus Cushings

Well that is a good plan . Now you need to have a plan after . Your dog may not want to eat so you might be 2 doses down . Normally you can give a quarter of the normal dose without food . My Jesse's routine was set up for only one meal a day and a biscuit snack and basically had one of her doses without a meal . It may have worked out to be 1/3 of her normal dose but she did get a small milk bone with that dose .

If not testing at home it makes it a bit more difficult in the decision giving insulin without food. Now you can ask for a glucose test before you leave the clinic and if higher a reduced dose should be ok .

[Pippi's Mama]

Re: Shih tzu recently diagnosed plus Cushings

My vet told me to give Pippi around 1 unit of insulin the morning of the surgery. (She normally got 4 1/2 units after eating). If you don't give a little, the blood glucose will rise if your dog has been fasting all night.


I'm glad they will be giving fluids during surgery and checking blood glucose before surgery. I'd ask if they can check blood glucose before you take him home as Jesse Girl suggested. If it is high, the vet can advise you if you need to give a small amount of insulin depending on what the reading is.