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Old 03-04-2013, 06:44 PM
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juliwilliams juliwilliams is offline
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Default Cooper - diabetes and cushings - sweet Cooper has passed

I'm a new member as we just got the confirmed cushings diagnosis today. My poor Cooper has been through a lot the last 3 months. Cooper is a (approximately) 10 year old, previously 73 pound, now 58 pound German shorthaired pointer. He's been drinking excessively for 2 years or so. He was tested multiple times for diabetes. Every time it can back normal but his liver enzymes were elevated, but not enough to be concerned about.

3 months ago he started peeing in the house and very quickly lost weight. That time his blood glucose level was over 500. We were told he also showed signs of cushings but the vet wanted to control the diabetes first. We did a steady increase in insulin (humulin n) until we reached 28 units. For the first time his blood glucose level was 230. He also had a bladder infection that required tougher and tougher antibiotics. Throughout the 3 months of insulin increases, there were so many factors that had to be considered, was the bladder infection causing insulin resistance? Was the possible cushings causing insulin resistance?

Once his bg level was somewhat acceptable, we waited 2 weeks then did a urinalysis to make sure the bladder infection was gone. Of course it wasn't and a urine culture was ordered. And the tested his bg again since the sugar was high in his urine. His level was up in the upper 300s. The vet said it's probably time to switch insulin. And he also thought it was time to test for cushings.

Cushings test was positive (I don't know the levels but it was an acth test). The vet has decided to keep him on humulin with the hope that his dose will decrease as his cushings is controlled. We'll be starting vetoryl tomorrow, along with a 6 week course of antibiotics since his bladder infection is still present.

At this point I don't have many questions since I've been doing an insane amount of research. I guess I'm just hoping for some stories of other dogs with diabetes and cushings. Specifically dogs being regulated for both at the same time. I haven't had much luck finding happy endings, which is something we're prepared for, we just want an honest idea of what to expect.
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Old 03-04-2013, 08:23 PM
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Default Re: Cooper - diabetes and cushings

Hello and welcome to you and Cooper.
First thing, I'd like to suggest that you also join out sister site, http://www.k9diabetes.com/forum/
We do have members on both sites that are dealing with cushings and diabetes.
I'll let those who are familiar with both comment, but we have had members who have successfully controlled both. So it is doable, but it's hard and we understand that. The bladder infections just make a difficult situation that much harder of course. Definitely join the diabetes site.

Sharlene and Molly Muffin
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Molly 11 yr old shih tzu mix, LDDS test (3 last year) continuously negative, glucose negative, thyroid panel negative, ACTH positive, ultrasound could go either way
Not currently being treated for cushings,.
Protein losing kidney disease has been diagnosed now.
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Old 03-05-2013, 07:07 AM
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Default Re: Cooper - diabetes and cushings

Hi and a big welcome to you and Cooper from me as well!

I can be of absolutely no use to you in anything regarding the diabetes, but I can tell you this place and the k9diabetes site is full of wonderful, caring and helpful people. It would be my guess that if anyone can guide you through the road ahead, they will be here and at k9diabetes.

Hang in there and don't assume the worst just yet.
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Naomi, Oscar and Marcie.
RIP my beautiful Fraser - passed October 1 2013. Original diagnosis Cushing's, but taken from us with rapidly aggressive liver cancer.
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Old 03-05-2013, 07:29 AM
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Default Re: Cooper - diabetes and cushings

Hello and welcome from me, too! Coincidentally enough, we have another new member with a little girl Cooper who is also challenged by both diabetes and Cushing's -- if you both end up posting at the same time, perhaps we'll need to shift to "Mr. Cooper" and "Ms. Cooper!"

On a serious note, though, I can imagine how worried you are feeling and I "second" the recommendation that you join k9diabetes.com, too. We have several dual members of both sites, and I know you'll receive extra support. We have a long history of dogs who are very successfully managed with both diseases. So even though there may be bumps along the way, please do not give up hope.

Can you tell us what dose of trilostane Cooper will be starting with today? Also, I'm rather hoping you'll tell us he will be dosed twice daily rather than only once, because many endocrinology specialists believe that dogs being treated with insulin benefit from better management with twice daily trilostane dosing so as to keep their cortisol levels as consistent as possible at all times (rather than peaking and troughing at more inconsistent levels within every 24-hour time period).

We'll be very anxious to hear how things are going for you, so please give us an update when you are able.

Marianne
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Old 03-05-2013, 07:51 AM
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juliwilliams juliwilliams is offline
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Default Re: Cooper - diabetes and cushings

I will definitely go join the k9diabetes website.

I can't remember what the vet said his dose would be, it was either 60 or 80 mg. The vet did not mention anything about giving it twice a day. He did say that while he's treated lots of dogs with diabetes and lots with cushings, he's never treated one with both. Which seems a bit odd since they appear to go hand in hand. The vet has been fantastic and seems to be doing everything that should be done (according to what I've been reading), but I'm going to check around for a vet that has treated both at the same time. I'd hate to do it since this vet is so attentive and Cooper is finally comfortable going to his office, but I also want to give Cooper his best chance.
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Old 03-05-2013, 08:14 AM
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Default Re: Cooper - diabetes and cushings

Here's a quick link to an article that addresses twice daily dosing for diabetic dogs. Since you haven't actually started yet, I'd strongly encourage you to discuss this with your vet before purchasing the drug, if possible. Dr. Peterson is a noted authority on the treatment of endocrinological issues, and here's a quote:
Quote:
In diabetic dogs with concurrent Cushing’s disease, twice-daily administration is essential in avoiding large fluctuations in serum cortisol concentrations during the day (1,2). With once-daily*trilostane*administration,*adequate*diabetic control will be next to impossible in many dogs with concurrent Cushing's syndrome.
Here's the article: http://endocrinevet.blogspot.com/201...rilostane.html

Here's another similar quote from Dr. Ellen Behrend:
Quote:
In diabetic patients with hyperadrenocorti- cism, twice-daily dosing is absolutely recommended to avoid large fluctuations in serum cortisol con- centrations.
http://www.dechra-us.com/Files/dechr...trilostane.pdf

If your vet has questions about this, he can also contact Dechra directly (manufacturer of brandname Vetoryl). They have vets on staff who are happy to consult about issues such as this, and I feel confident that they will back up the recommendation for twice daily dosing in diabetic dogs, since both Dr. Peterson and Dr. Behrend provide continuing education on their behalf.

http://www.dechra-us.com/Default.aspx?ID=365

I totally understand your hope to remain with your current vet, and as long as he open to consultation with other folks, I would hope that he will be able to successfully continue to manage Cooper's care. I think that consultation is the key -- as long as your vet is open to talking with other more experienced specialists, there is no reason why he can't remain on top of things.

Marianne
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Old 03-05-2013, 09:47 AM
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juliwilliams juliwilliams is offline
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Default Re: Cooper - diabetes and cushings

Thanks so much for that article! I just printed it out and I will bring it with me to the vet today.
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Old 03-05-2013, 09:48 AM
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Default Re: Cooper - diabetes and cushings

And yes my vet is very open to consultation. He has already been consulting with internists when it was just the diabetes we were trying to control so now that it's both issues I'm sure he'll be consulting like crazy!!
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Old 03-05-2013, 10:49 AM
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Default Re: Cooper - diabetes and cushings

That sounds great! Also wanted to add that with twice daily dosing, you are splitting the recommended daily total into two half doses -- you are not doubling the recommended once daily total.

Marianne
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Old 03-05-2013, 01:37 PM
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juliwilliams juliwilliams is offline
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Default Re: Cooper - diabetes and cushings

We went to the vet today. The vet said he had not read about giving it twice a day for diabetic dogs. But he said it makes sense to him and to go ahead and do it. He was going to start us at a very conservative dose of 60mg. He said to go ahead and give him one 60mg pill twice a day.

Now I have another question for anyone out there: what is loading? I keep reading about giving them a loading dose then testing. Should that be a high dose or a low dose? Right now our plan is to just test is blood glucose in a week.
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