Cooper - diabetic and cushings

[Tina]

I am so happy to read that Cooper is holding his own! I am very relieved to see there has been no more diarrhea, hopefully that means things are turning around.

Marianne, you are exactly right about the Percorten. It is a mineralocorticoid replacement only and would not affect the cortisol readings. It does not have glucocorticoid properties, which is why prednisone (or another glucocorticoid) is given for cortisol replacement if necessary. Percorten is given to regulate sodium absorption and potassium excretion when aldosterone is over suppressed. If both cortisol and aldosterone are over suppressed, then both replacement hormones are needed.

I have to work in the morning, but will be checking in for an update on Cooper tomorrow. I hope you all have a quiet night and are able to get some sleep.

Tina and Jasper

[k9diabetes]

Hi,

I am the admin from the k9diabetes forum (www.k9diabetes.com/forum).

I'm glad the Vetoryl has been stopped. Unfortunately it is quite common for diabetic dogs to be misdiagnosed with Cushing's disease and I'm especially concerned if a single LDDS test led to the diagnosis.

Mini Schnauzers have a reputation for high triglycerides and lipids, and that can make them both insulin resistant and to have erratic blood sugar.

Even at 19 pounds, 10 units is a quite normal insulin dose and he may be one of those dogs who needs more than average. I have known a couple of terriers who each weighed about 24 pounds and needed 21 units of insulin per injection for good regulation! Way outside normal, but they were well regulated.

A dog isn't considered insulin resistant until he is on 1 unit per pound and still has high blood sugar - all 350 and higher.

http://endocrinevet.blogspot.com/201...e-in-dogs.html

We define insulin resistance as doses greater than 2.2 U/kg/injection to control hyperglycemia (4), so we aren't even close to the doses required to diagnose resistance.

And yes, diabetic dogs can get marked hepatomegaly secondary to fat accumulation in the liver. That can lead to a mild-moderate "pot bellied" appearance.

Because it can be very difficult to make a diagnosis of Cushing's syndrome in dogs with diabetes, observation and monitoring is the best course in many of these patients. If Cushing's disease is present, it will be progressive and other signs will develop to make the diagnosis easier to confirm.

This is where I think you need a more experienced veterinarian to step in to this case once Cooper gets stabilized.

Will check in tomorrow to see how things went at the vet appointment.

I would think they would want to at least check a baseline cortisol level to make sure he's not low on cortisol.

Natalie

[k9diabetes]

Oh, almost forgot, here's the article by Dr. Peterson on insulin resistance in Mini Schnauzers.

Article concerning diabetes in Miniature Schnauzers:

http://endocrinevet.blogspot.com/2012/11/association-of-hypertriglyceridemia.html?utm_source=dlvr.it&utm_m edium=facebook

[charansuri]

Update -

Cooper slept all night without diarrhea or vomiting. yayy! He ate well this morning and has been drinking water. I gave him insulin and pedialyte. In all, he looks like a different dog today compared to yesterday... I am sort of relieved for now. phew!!

I called my vet and spoke to him this morning. I talked to him about how its a possibility that Cooper doesn't have Cushing's and maybe we just need to continue to treat his diabetes. I thought it was necessary to throw the thought out there for him to contemplate. Vet is going to talk to specialists again today and discuss with IMS again (I am glad he is already on it!!) and call me by end of today with a plan for Cooper. He is going to see Cooper tomorrow because his sugar was high yesterday (437, 4 hours after 8 units of insulin). At this point, I don't want to put cooper through more tests with out thinking this through. I am glad my vet is not very aggressive in terms of Cooper's treatment and is willing to get help. But this is going to be one of those trail and error kind of a case... unfortunately.

I am at work today... I will keep everyone updated. Hopefully it will be a quite day.

[Budsters Mom]

It is always great when our sweet babies sleep through the night! He ate well with no further nausea or diarrhea. That is the best news yet! I am thrilled for you! You are doing an awesome job!Xxxxxx

[frijole]

Please read Natalie's posts re controlling of diabetes and the link re schnauzers. I have 3 family members with schnauzers with diabetes - mine got cushings instead Anyway I recall it took them a while to get under control and that increasing in small amounts was critical. It may be that your vet will need to consult with an IMS or you have to find one to work with. If your vet still thinks cushings is involved then you should do the acth test and not the one that was done. Keep us posted - so glad you had a good night. Kim

[charansuri]

So...

The vet just called me. He said he discussed with specialists and advised that we should stop Cooper's cushing's treatment for now. He is going to go back and try to regulate his sugar level with insulin... in short, go back to treating diabetes. If this proves to be frustrating (as it has been with Cooper), then he will do an ACTH test before thinking about putting him back on any sort of medication for Cushing's. That is the plan for now. Going to the vet tomorrow...

It's funny how my vet said pretty much the same thing you guys were suggesting. Thank you, Natalie!! Frijole, I read Natalie's post and have printed information about Schnauzer and insulin resistence. Her information was one of the reasons why I asked my vet if we should even continue to go down this part. This forum is full of amazing information for clueless pet owners. I am going to go over to k9diabetes forum.

My thanks to this supportive forum. You guys really helped me with my sanity!!!!

[frijole]

Good call by the vet. We aren't vets however we have been around a long time and we only see the cases where people are having problems. We see some things repeatedly (such as dogs with diabetes that don't have cushings) That is how we are able to provide help. No doubt we have saved $ and lives over the years. In your case you stopped the trilo and saved Cooper from being in greater distress than what he was in. Good job on that.

I have no doubt that Nat's group will help you figure out the diabetes regulation so you can guide the vet along. Keep us posted on how you are doing. Kim

[labblab]

Boy, I am really relieved to hear this gameplan, too. It seems to be the safest and most reasonable under the circumstances. Even if it turns out that Cooper does not have Cushing's, though, we hope you will still come back and update us, OK? We don't want to lose track of you guys!

Marianne

[charansuri]

Absolutely, Marianne and Kim! I hope I don't have to come here complaining about Cushing's and instead bombard the thread with pictures of my happy fur babies

Wishful thinking...

- Charan