Bichon - Diabetes and possible PDH?

[bmarra]

Nikki, thank you for your replies. Please let me clarify...Lacie's ultrasound indicated two slightly enlarged adrenals so, if Cushings, it is the pituitary type. As far as getting the diabetes symptoms (drinking/urinating excessively) under control, that happened as soon as she was given insulin. The only issue we are having now is that she gets big swings in the levels and goes very high at times.

I wrote to Dr. Peterson over the weekend and he responded almost immediately. He told me that, with the information I gave him, it was difficult to say whether or not Lacie definitely has Cushings, but, even if she does, the swings in the glucose levels would not be caused by Cushings especially since she's seen numbers in the 100's. He said Cushings would cause insulin resistance and high numbers continually.

So, currently I am at a place where I am just trying to get her numbers more in range and stable throughout most of the day.
I've decided to see another vet who hopefully is more knowledgeable with diabetes and can help me with food, dosage, etc. My current vet just kept raising the dose over the past 2 1/2 months and I'm not sure that is the answer for Lacie.

Brenda

[bmarra]

Hello Everyone -

I was hoping I wouldn't have to return to this forum but here I am again!!
My 9 yr. old Bichon had the LDDST last year which indicated Cushings then 3 weeks later she was diagnosed with diabetes. Since then I've only been treating the diabetes but her bg has not been well controlled. Her numbers are all over the place...some lows and some very highs but more highs than "normal" range numbers. Went to vet today and he wants to do the ACTH this Friday.
I have so many concerns. First of all, besides the crazy bg numbers the only other possible symptoms she has are brown/black spots on her skin which vet says are an overproduction of oil from skin glands which could be caused by Cushings (is this true?) and a thinning tail. Her fur overall is thinner than it used to be but still all in tact. No panting, pot belly, excessive urinating, hunger etc.

With the test, since she has to eat at 6:00 am then have insulin, he plans to have her fast as he's also doing full blood panel, then giving the solution for the ACTH test, then feeding her & giving insulin which will be at least 3 hrs after her usual time. I'm wondering if the feeding will affect the result of the ACTH? Can anyone tell me? He says that it won't affect it of course.

Also, she will be stressed I'm sure and that may affect the result. Do you all think since the 8 hr test she had last year was positive and this ACTH comes out positive that should definitely confirm Cushings?

Have you heard of treating for Cushings helping to get the diabetes under better control?

Thank you,
Brenda

[Harley PoMMom]

The feeding should not skew the ACTH stimulation results, and since her BG is not that well controlled the ACTH stim test is the one that should be done.

Once that elevated cortisol is under control it should make it easier to get her BG normalized.

BUT Has a thyroid problem been ruled out? I have read where people with diabetes are more prone to a thyroid issue and thyroid disease complicates blood glucose control.

Hugs, Lori

[bmarra]

Thanks Lori,

She was tested for hypothyroidism last year but they said it was negative. The blood panel she's having done this week may indicate more although not specifically testing for that.

I am frightened by all of this as my girl, besides having the crazy bg numbers, doesn't have any other symptoms that seem to be affecting her quality of life. I am more afraid of the medicine than the disease especially since I won't be able to tell if it's actually doing what's it's supposed to since those "usual" symptoms aren't there.

[Harley PoMMom]

It does make it very difficult to judge how the treatment for Cushing's is working if there are no symptoms to control.

Have other types of insulin been tried? I wonder if a change in food, feeding schedule, or amount of food would make a difference.

[labblab]

Hi again, Brenda! I'm so sorry you're having to worry about the possibility of Cushing's again. But after going back and reading through your whole thread, I'm reminded of all the reasons why Cushing's has been suspected for quite some time. And since you are still having problems with the BG regulation, I do think it makes sense to go forward with an ACTH at this point. If it comes out "positive," I do think I'd bite the bullet and give the trilostane a try. I know you're worried as to how you'll judge treatment issues, but if Lacie's BG comes under better control, I think that'll be your big and most important clue that you're seeing success. And of course the signs of overdosing are the same for every dog: vomiting, diarrhea, unusual lethargy, etc.

If you do end up proceeding with treatment, here are a couple of points to discuss with your vet. First, it is strongly recommended that diabetic dogs be dosed twice daily instead of only once in the morning. Second, the initial total daily dose should not exceed a formula of 1 mg. per pound (or 2.2 mg. per kg.). It's ideal but not necessary to split the daily total in half. But if unequal doses are given, it is best to give the larger dose in the morning. So for instance, if you're giving a daily total of 40 mg., you could either give 20 mg. twice daily, or give 30 mg. in the morning and 10 mg. in the evening.

Just bear in mind that if Lacie does not improve after taking the trilostane, you can always stop the treatment. But at this point, I do understand why Cushing's remains a possible underlying issue.

Marianne

[bmarra]

Thank you for your replies.

I emailed Dr. Peterson yesterday to find out if Cushings would, in fact, cause lows in bg. He said that it would cause insulin resistance so more & more insulin would be needed for control. Lacie does not have resistance as insulin does take her down. Also asked him if excessive oil on skin is symptom as my vet indicated and he said he's never seen it but couldn't be sure.

Anyway, the vet that I've been seeing for about 6 months (maybe 5 times total) got an attitude yesterday and actually yelled in my face. I wanted to walk away right then but didn't and went ahead and made appt for testing on Friday. Since then I could not get past what he did and how awful that was so decided I'm not going back as he hasn't been much help anyway.

Seeing a new vet next week and will proceed from there. Hoping to find a good "partner" in Lacie's care that will listen to the pet owner since we know our pups best. This vet apparently goes by the book and where he thinks her numbers should be but every dog is different.

If I end up having to have the test again for Cushings I will be back.

[labblab]

Oh Brenda, sounds like you've made the right decision without a doubt! How awful that your vet yelled at you! Good riddance to him, and let's see how the new vet wants to proceed. Please keep us in the loop -- we are always here if you need us!

Marianne

[molly muffin]

Oh my gosh! How absolutely awful and unacceptable!
I hope the vet you have the appt with is a better partner for you. That is so very important to have that partnership (exactly the right word) between you and your vet and your dog. I personally really like it if the vets bond with my dog, so I feel like they have a vested interest in doing all they can for her because they love her too.
It's just so not acceptable to yell. sheezzz