New to site, looking for treatment options for possible Cushing's diagnosis

[StarDeb55]

Welcome to you & Muffy! I'm sorry to hear that Muffy may be dealing with the "double whammy" of diabetes & Cushing's. I do want to comment on the diabetes aspect.

She is more concerned with possible diabetes at this point, to get that under control, so we will be doing a fasting blood test this week

Your vet is dead on correct. The diabetes has got to take priority as it can be life threatening, if not brought under control. As a medical lab tech with 30+ years experience, your baby's glucose would be considered a critical result in a person. Do you know if your vet checked her urine for the presence of ketones? If a urinalysis was done, then the ketones were checked. If ketones are in the urine, Muffy may be at high risk for diabetic ketoacidosis. Cushing's needs to be put on a back burner for now. Cushing's develops at a snail's pace, literally taking years to do its damage to the internal organs. Diabetes alone could easily explain the elevation in the alk phos. IMO, if Muffy were my pup I would put the emphasis on getting the diabetes diagnosed & under control. One tip-off that Cushing's might be in play is if the diabetes is difficult to get regulated on standard amounts of insulin.

Please keep us posted. We are here to help in any way we can.

Debbie

[frijole]

The elevated alk phos and the urination and diluted urine could be from diabetes and not cushings is what I was saying - happens all the time. As Deb just said, if you focus on treating the diabetes and find it hard to regulate then you could also be dealing with cushings. There isn't a rush to treat it but the diabetes needs to be addressed. (as you know) Kim

[k9diabetes]

Hi!

I am the administrator of the sister site for canine diabetes and encourage you to join there if you haven't already. www.k9diabetes.com is the main website with lots of information on diabetes and the forum is at www.k9diabetes.com/forum.

Given the normal Cushings results 8 months ago, I would not do anything with Cushing's disease at this time. It is very difficult to diagnose Cushing's accurately in a newly diagnosed diabetic.

And with blood sugar of 411, there's no question your dog has diabetes. While Cushing's can theoretically raise blood sugar, I have (1) never seen it actually occur, and (2) would expect the elevation in blood sugar to be mild in a dog with normal insulin functioning.

Also, keep in mind that the enzymes tested are "liver enzymes", not "Cushing's disease" enzymes. They tell you something is bothering the liver, but that can be many different things, many not a big deal once some other condition like diabetes is controlled.

One of the few upsides of canine diabetes is it will pretty much tell you whether your dog has Cushing's disease because if she has Cushing's, her blood sugar will not regulate well. So you can start insulin and see how she does and that will help tell you whether Cushing's should remain a concern.

So I think an ACTH at this point would not be very reliable and would be a waste of money better spent on her diabetes regulation.

Have you considered testing her blood sugar at home? We have tutorial videos on where and how to get a sample and can recommend a couple of meters that work well with dogs. That will save you a lot of money in terms of monitoring her blood sugar.

Also, I wouldn't wait to start her on insulin. And checking for ketones is wise as that is one thing that can be fatal before treatment gets underway.

Natalie

Thanks all. Just got off the phone with the vet. She is more concerned with possible diabetes at this point, to get that under control, so we will be doing a fasting blood test this week, along with the ACTH stim test for Cushing's disease. She did not see a Thyroid test in her lab work and said we could test for it, but it wasn't usually a cause for her symptoms. The Low Dose Dexamethasone Suppression (LDDS) test we did in October came back normal, which surprised us all, but now that her ALKP levels are 2,000 (norm 23-212) she wants to do the ACTH test. The treatment costs for Cushing's are kind of scary, especially since her earlier escapades with the boxer the last few months have totaled about $2500 in emergency vet bills.....but, of course, we will do what we can to keep her comfortable.

[molly muffin]

Hi and welcome from me too.
It looks like the LDDS test was negative for cushings when done. I wouldn't pursue the ACTH until you've had time to address the diabetes first, which is the most important. I would think that some aggression can come from out of control blood sugar too. The K9Diabetes group would know more about that. I would definitely encourage you to join there too.
It is possible that once the diabetes is controlled that the cushings symptoms will go away and that could be a non issue. Especially with negative LDDS testing so far.

Sharlene and Molly Muffin

[lyriclover]

Thank you all. That gives me a lot to think about. The only thing that I am unsure of is, for the past year, her blood sugar has been normal each time they tested but her liver enzymes have been elevated, and increasingly so. That makes me think it would be cushing's, and maybe even contributing to the diabetes, but of course I am no doctor, and it seems that they are two separate things. Maybe we will hold off on the ACTH test for now and concentrate on regulating her blood sugar. But, then if she has Cushing's obviously that is going to be a problem in and of itself. This is all so confusing....I'm trying to learn as much as possible. Thank you all for your input, help and support! I don't know if they did ketone testing, but the vet was emphatic about further blood tests to verify the diabetes and brought up the ketone thing. I don't know anything about it. This will definitely be an educational experience. She just doesn't feel well it's obvious. The poor thing is just not herself. Drinking constantly, peeing all over everywhere, panting, heavy breathing, lack of energy. We have to do something soon to get her feeling better. So is it possible for Muffy to have such high readings of ALKP (375, 895, 1203 and 2000 quarterly) and have normal blood glucose levels and it still be diabetes, since her blood sugar was normal just 2 months ago?

[lyriclover]

So is it possible for Muffy to have such high readings of ALKP (375, 895, 1203 and 2000 quarterly) and have normal blood glucose levels and it still be diabetes, since her blood sugar was normal just 2 months ago?

[k9diabetes]

I am not saying Muffy has cancer... But as an example of high liver enzymes not being Cushing's, I knew a dog who was already diabetic and whose insulin needs were dropping while the liver values were going up. Vet kept pushing Cushing's, which made no sense with low blood sugar. It turned out that he had a liver tumor. So remember that high liver enzymes does not mean Cushing's disease.

[goldengirl88]

Happy Birthday Muffy and welcome:
I have an 11 1/2 year old Jack Russell Tipper with Cushings. She has been on treatment since August. Since she developed this disease I have been more aware of other dogs with it. There are many Jack Russells with this disease that I have seen. It seems to really affect the terrier group. God Bless you and good luck
Patti

[lyriclover]

We held off on the ACTH Stim test. It seems obvious now that she's diabetic:
6/17/2013 Urine Appearance Normal
6/17/2013 Urine Color 0.000 Normal
6/17/2013 Urine pH 5.000 Normal 5.000 - 7.500
6/17/2013 Urine Occult Blood 0.000 Negative
6/17/2013 Urine Protein 30.000 Normal 0.000 - 30.000
6/17/2013 Urine Bilirubin 0.000 Negative
6/17/2013 Urine Ketone 0.000 Normal 0.000 - 0.001
6/17/2013 Urine Glucose 1000.000 Above Normal 0.000 - 0.001
6/17/2013 Urine Urobilinogen 0.000 Normal 0.000 - 2.000
6/17/2013 Glucose 349.000 mg/dl Above Normal 70.000 - 143.000 mg/dl

[Budsters Mom]

Yes, from her Glucose level, it certainly looks like she's diabetic. If she was my dog, I would hold off on Stim test also and get her diabetes under control first.
Hugs,
Kathy