Well Guys Here Goes:
The adrenal function panel is back and shows mild elevation in cortisol, progesterone, and more significant increase in estradiol (estrogen). This can be associated with insulin resistance. Therefore treatment is definitely recommended. A combination of products are recommended which help to inhibit the production of some of these hormones:
1 Flaxseed HULLS:
WWW.FLAXSEEDHULLS.COM recommended give 3/4 teaspoon (which is equivalent to 1/2 of a "red scoop' provided) once daily.
2 Melatonin (can be purchased over the counter at a health food store) recommended give 6 mg twice daily use regular melatonin
NOT rapid or extended release product.
3 Ketoconazole 200 mg twice daily (prescription required) I will call her and she will call the prescription in for us. This is an antifungal drug but is also used in adrenal hormone excess because it inhibits an enzyme in the pathway where adrenal hormones are made.
We should otherwise continue as we have been (monitor glucose curves and insulin dose adjusted as needed) toward the goal of improved diabetes control. Our hope is with control of some of these hormone elevations, the insulin resistance will imiprove and less insulin would be needed than otherwise.
While on Ketoconazole, ideally liver values should be periodically assessed (q1-2 months) as it has rarely been associated with liver toxicity. As both diabetes AND Atypical Cushing's can contribute to elevations in liver values (ALP and also ALT to a lesser extent) this may be a subjective determination. I usually watch for elevations in ALT or AST that are incongruous to the elevatsions seen with ALP (which with diabetes or Cushing's is usually the main liver value elevated). Clinical signs are typically also present (vomiting, diarrhea, lethargy, inappetance) in the face of a ketoconazole "toxicity" so if this is ever observed you should notify us.
Depending on response, Lysodren is another drug that can also be considered. However, I have opted to start with Ketoconazole as its monitoring would be less intensive and less expensive.
Follow up: Once we start the drugs above, recheck liver values (blood test) in 3 - 4 weeks. Do glucose curve at home q1-2 weeks and continue to say in touch with me about results and dosage adjustments we may need to make.
Well that's the e-mail she sent to me. We will try to purchase the first two items on the list and I will call today and see if I can get one of the hospital doctors to call the other prescription in. I would like to start all three on Wednesday of this week if possible. Dr. Kimmel will only be there Wed, Thursday, Fri and Sat. Then I understand she's off for a week's vacation. So I also need to discuss with her who do I call in case of an emergency. Although in all honesty I did e-mail these results to Dr. Melhrose. Although he's not active in Bruno's diabetes care I still use him as a vet for Miss Starr, and my son uses him for his cat, Lana so he's still involved with our family of animals.
Anyone have any suggestions or idea's????
Marie and Bruno