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Thread: Cushing's and Diabetes, what's been your experience?

  1. #1
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    Question Cushing's and Diabetes, what's been your experience?

    Hi all! I have just come across this website and posting for the first time. Just wanted to hear what everyone is doing for their dogs with cushing's, and if anyone else has experience with battling both Cushing's and diabetes at the same time. My maltese is 8.5 years old, fairly young to be having all of these endocrine issues. We have suspected Cushing's for a couple of years, but decided not to put her on medication and formally diagnose based on what I had read about Vetoryl being a dangerous medication. Until July of this year when Daisy started to drink excessively and urinate a lot. We figured it was the fact that her cushing's was progressing, and somehow diabetes didn't cross my mind at all! Until Daisy went into a DKA episode, she got really sick, and we had to hospitalize her. It was a very heartbreaking time as we thought we would lose her. The hospital bill for just 2 nights was outrageous of course, and caused debates in our family about whether or now we should have hospitalized her to begin with, but anyway that's another topic.

    So after we diagnosed her with Diabetes and started treating with insulin, the vet suggested that she be formally diagnosed and treated for Cushing's as well, as it's most likely that Cushing's was the underlining cause for the Diabetes. So she did test positive for Cushing's, and we have had her on 5mg of Vetoryl once a day for over 3 months now. The initial lab test was within good limits. Now we have to take her back in for a ACTH test 3 months later. Daisy's sugars have not been easy to regulate. I do glucose curves at home from time to time, and they're always different. Sometimes she's within good limits of 100's-200's, other times she's in the 300's-500's. We feed her 12 hours apart the same way, so that doesn't vary too much. Not sure what else to do for Daisy at this point, should we continue her on Vetoryl? What can we do to stabilize those sugars? All of it is adding up to so much money between the medications, and the tests, the insulin, syringes and glucose strips, and not to mention the time everyone has to put into it to be home at certain time for the shots. Of course we love our little fur baby, and are willing to go above and beyond for her. I just wish we could establish more or less a stability with her cushing's and diabetes, without always feeling like things will go downhill at any moment.

    What is your expert advice?

    Thank you!

    -Daisy's mom

  2. #2
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    Default Re: Cushing's and Diabetes, what's been your experience?

    Hello and welcome to you and Daisy! We’re so glad you’ve found us, and I’ll be back later on to talk with you in greater detail. Unfortunately, I only have a few moments free right now, but I wanted to let you know that we’re glad you’re here, and that more information will be coming ;-).

    Marianne

  3. #3
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    Default Re: Cushing's and Diabetes, what's been your experience?

    Hi and welcome to you and Daisy!

    It is extremely hard to diagnose Cushing's in a dog with unregulated diabetes. It is recommended that the diabetes be under some kind of control before performing any diagnostic testing for Cushing's. Can you post the results of all monitoring ACTH stimulation tests that were done on Daisy? Also, what test did the vet use to diagnose the Cushing's? Did the vet tell you to give her the Vetoryl with a meal so that it is properly absorbed?

    We have a sister forum that deals with canine diabetes and I do suggest that you join there also, here is their link: http://www.k9diabetes.com/forum/ In this way you'll have the best of both worlds!

    Please know we will help in any way we can and don't hesitate to ask any questions you have, again welcome to the family!!

    Lori

  4. #4
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    Default Re: Cushing's and Diabetes, what's been your experience?

    Hello again from me, too. I’m so glad that Lori’s had the chance to greet you, as well, and to give you the link to the k9diabetes group. At this point, I just have a couple thoughts to add — actually, mainly a couple more questions to ask. Can you tell us more about Daisy’s overall health history, and especially about the symptoms that originally led you to suspect Cushing’s a couple of years ago? Lori is absolutely right that it can be really hard to untangle the chicken vs. the egg when it comes to Cushing’s and high glucose levels. As she says, it’s difficult to accurately diagnose Cushing’s in a dog with uncontrolled glucose levels, because the uncontrolled diabetes can cause a “false positive” on the Cushing’s tests. However, diabetic dogs who truly suffer from uncontrolled Cushing’s may never achieve well-regulated glucose levels. In fact, that can be one reason to test for Cushing’s — if a diabetic dog with consistent symptoms cannot be controlled with even large doses of insulin.

    As far as Daisy’s specific situation, if you had reason to suspect Cushing’s long before the diabetes manifested, then it does make it seem more likely that the Cushing’s is a genuine underlying problem. And if so, it may simply be the case that she needs a higher dose of Vetoryl to bring her cortisol under effective control. In turn, that can help make her diabetes more manageable, as well. So we’ll all be really anxious to find out the results of this next monitoring ACTH test. And it’ll be great if you can get us exact numbers for the previous Cushing’s tests, as well.

    Thanks in advance for any additional information!
    Marianne

  5. #5
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    Default Re: Cushing's and Diabetes, what's been your experience?

    Sure thing! I'm glad to answer any additional questions, and really grateful to you guys for being willing to dive deeper into each pets case. That's true love for animals right there!
    As far as the symptoms of why we suspected cushings for a while, is because daisy has been struggling with constant skin infections that would reoccur every 3-4 mo no matter what we tried. This has been going on for years. At first we thought it was just allergies, but then the vet started suspecting that it's probably the high cortisol creating these skin infections. She also started getting thinner hair on her back, and instead of it being that silky hair that maltese have, it started to resemble the texture of fur more. Her back skin also got some white bumps on it, forget what the vet called them, but he said those deposits are also common with cushings, kind of like white heads. Another symptoms is that she stopped jumping up on any furniture completely. Probably since she was about 4-5 yo she stopped jumping up on the couch or even lower surfaces. But she can jump down off of them. Her belly is also more potted than concave as it should be, even though we don't overfeed her. These are the major symptoms. Polyuria and polydipsia we only noticed when she developed the diabetes, which seems to have developed rather fast. The last labs prior to hospitalization we did on her were in Jan of 2019, which didn't show any signs of diabetes. Until her DKA crisis in July.

    That is the main reason why we ended up putting her on Vetoryl, because the vet is also saying that diabetes will be hard to control if the cushing's isn't managed. According to him the glucose wasn't interfering with the cushing's test here, he said the low dex test tends to be pretty sensitive. We did test her a couple weeks after we started her on insulin, not right away. Not sure if that's enough.

    Here's the first test result of ACTH after we put her on 5mg Vetoryl once a day, this was taken about 2 weeks after she started on it.

    Cortisol pre-ACTH test= 3.6
    Cortisol post-ACTH test= 4.3


    As far as her initial diagnosis low dex stim test, these were her results:

    Cortisol pre- dex shot= 8.9 (ref range 1-6)
    Cortisol 4 hr post dex= 4.9
    Cortisol 8 hr post dex= 4.7

    So according to this, my vet said she does show indication for cushings, the fact that it did get suppressed after 4 hours though I read indicates that it's pituitary in origin, right?

    Also important to mention, that when she was hospitalized, they did do an abdominal u/s to look at her pancreas etc. And coincidentally looked at the adrenal glands and said that they did not stand out as being enlarged. She did have a weirdly shaped liver though, no tumors, but looked like it was a fatty liver. When she was hospitalized her liver enzymes were through the roof! like 5k I want to say, something really crazy, but have since come down back to normal the last time we checked in Sept.

    That's pretty much all I got now, is there anything else I can add? Thank you so much ladies! We will be taking her to the vet this week to see where her cortisol is at and will report the results.
    Last edited by anotherk9lover; 12-04-2019 at 03:59 AM.

  6. #6
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    Default Re: Cushing's and Diabetes, what's been your experience?

    Hi Lori, yes we are giving the Vetoryl with food every morning. I have visited the diabetes forum as well, is it active would you say? I noticed that a lot of the posts are from years ago and not very current.

  7. #7
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    Default Re: Cushing's and Diabetes, what's been your experience?

    Hi Daisy's mom,

    Let me add my welcome to you and Daisy!

    The problem with the LDDS is that it IS so sensitive. Cortisol will rise naturally in response to any streesor...even just visiting the vet's office. That is cortisol's job; it is one of the fight or flight hormones. So the LDDS, and ACTH, will pick up that elevated cortisol BUT neither test can tell us why that cortisol is elevated - only that it is elevated. The LDDS has a quirk in that while it is the gold standard for diagnosing Cushing's in otherwise healthy dogs it is more likely to return a false positive in a dog who has any other illness present - like diabetes. In dogs with diabetes the ACTH is the preferred diagnostic test for this reason - you can't get an accurate result with the LDDS in a diabetic dog. So this is one red flag on the Cushing's diagnosis for me.

    You said the ultrasound showed normal adrenal glands...second red flag. In a dog with Cushing's the adrenals are almost always enlarged because those glands are working very very hard to produce and release all that excess cortisol. They are either both enlarged or one enlarged with the other very small or even atrophied. So normal appearing adrenal glands red flag #2.

    While Daisy was hospitalized her liver enzymes were very high but then returned to normal on the next test in Sept...3rd red flag. The ALP in particular is almost always extremely elevated in a cush pup and it does not return to normal without treatment and sometimes not even then. It would be much more likely that 5000 or so level seen in the hospital would have remained or increased by Sept., not returned to normal. So red flag #3 on the Cushing's diagnosis.

    If you could get copies of the lab work from Jan of this year and post the abnormal results here that would be huge help. We look for specific values on the super chem, or wellness check as my vet calls them (this test shows things like the liver values, BUN, CHOL, CREAT, etc) and the CBC which shows things like leucocytes, monocytes, eosinophils, etc.

    Now, all these red flags that I have may well by my over-active mind because I have had 2 dogs misdiagnosed with Cushing's. One tested positive on all the tests but all were false positive because of a tumor on her spleen that was removed, returning her cortisol level to normal. She did eventually develop conventional Cushing's with elevated cortisol but the second baby never had Cushing's as proven via a necropsy (autopsy for animals). So I am always overly cautious when it comes to diagnosing Cushing's, especially based on one test and doubly when the pup has anything else going on, like diabetes.

    I'm glad you found us and look forward to seeing those other test results so my mind might find some peace.

    Hugs,
    Leslie
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  8. #8
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    Default Re: Cushing's and Diabetes, what's been your experience?

    OH! and on the diabetes site check out the board titled "Diabetes Discussion: Your Dog". There are current posts on that board.
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  9. #9
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    Default Re: Cushing's and Diabetes, what's been your experience?

    Thanks so much for supplying all this additional information! As Leslie has said, however, some of it raises additional questions. I agree with all three of her “red flags” in terms of diagnostic concerns. However, on the flip side, Daisy’s observable symptoms — especially the white bumps — are indeed consistent with Cushing’s. If the white bumps were accurately diagnosed as being “Calcinosis Cutis,” that is pretty much a guarantee that Cushing’s is present. That skin condition can only be definitively diagnosed through a skin biopsy, however, and generally would not clear up in the absence of treatment to lower cortisol. In fact, it typically spreads and worsens without treatment. Does Daisy still have any of those bumps? If not, did they clear up before or after she started the Vetoryl?

    Turning to the LDDS and assuming for the sake of argument that Daisy does have Cushing’s, her pattern of results actually do not distinguish between the pituitary or adrenal form.

    As far as her initial diagnosis low dex stim test, these were her results:

    Cortisol pre- dex shot= 8.9 (ref range 1-6)
    Cortisol 4 hr post dex= 4.9
    Cortisol 8 hr post dex= 4.7
    The 8-hour result is definitely elevated and therefore consistent with Cushing’s. But neither the 4-hour nor 8-hour result shows enough suppression to point towards pituitary disease. For that to be the case, either one of them would need to be less than 50% of the baseline reading (or the 4-hour would need to be less than the overall diagnostic cut-off number, which is typically 1.4 or 1.5). However, you did end up having the abdominal ultrasound which didn’t show any adrenal masses or growths. That leads us to conclude that a pituitary tumor must be the culprit. As Leslie has noted, though, typically both adrenal glands are enlarged in the presence of pituitary Cushing’s. It is not always the case, but Daisy’s lack of adrenal enlargement is one of those oddities that makes us scratch our heads a bit.

    Cortisol pre-ACTH test= 3.6
    Cortisol post-ACTH test= 4.3
    As far as this first monitoring ACTH, that is a great result — right within the desired therapeutic range. However, to be honest with you, it would have been better had at least one additional reading been taken between the two-week mark of Vetoryl treatment and now. Cortisol levels can continue to drift downward during the first month of treatment, even when the dose remains unchanged. Therefore, for safety’s sake, most clinicians retest again at the 30-day mark. If cortisol is dropping too low, the dose can be remedied. Conversely, if the cortisol is edging up again at that point, the dose can be increased. So waiting for 90 days before retesting is really a longer gap than most clinicians would recommend. That’ll make us doubly anxious to see how the ACTH results turn out now.

    Please bear in mind that we are not vets, but we do feel obligated to identify questions that you might want to pursue further with your own vet, especially if Daisy’s treatment course remains rocky. Given her symptoms, I don’t necessarily doubt that she truly has Cushing’s. But as we’ve noted, there are features of her testing profile that are not necessarily consistent. I’m especially interested in learning more about those white bumps.

    And as far as the activity level over on k9diabetes, I’m afraid that neither of our sites garner as many replies as they did in the past. Unfortunately for us, it seems that other social platforms such as Facebook may now seem more attractive to some folks than do message boards such as this. But those of us who continue to post here surely hope that we’re able to provide both continuity and depth to our replies. So if you stick with us, we’ll continue to do our very best to be of help!

    Marianne

  10. #10
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    Default Re: Cushing's and Diabetes, what's been your experience?

    Thank you all for responding. We took her in for another ACTH test today, so will have to wait until Monday to know the results.

    I spoke to my vet again, and he doesn't seem to have any doubt that she has cushings, just from all the symptoms throughout the years, he's taken care of her since she was a pup. Also, it's been almost a year since her last major skin breakout, her skin seems to have cleared up since we put her on the medications, which tells me that it's doing something. Before we would always have at least some form of a skin infection every 3-4 mo. She seems to have also perked up a bit on her energy level. She's always been a mellow dog, but the last year or so she's just been sleeping mostly, didn't seem like she was enjoying much of anything. Now she's more lively than she's been in a while.

    Also when the vet diagnosed her, he used the urine creatine ratio test as well which showed up positive. And he says that if she wasn't with Cushing's, then the Vetoryl would have suppressed her too much on the recheck lab, which it didn't. So I don't know of course, maybe something else is going on here, but everything seems to be pointing to it being Cushings. Also it doesn't seem to be a rare condition at all, especially in spayed dogs apparently.
    Have you guys come across any correlation between spaying dogs before their first heat and Cushing's disease? I was watching Dr. Becker's video on that, and she seems to be convinced that the dogs she insisted on spaying before their first heat, all started coming back to her older in life with Cushing's disease, so she is convinced that there is a link, and no longer recommends spaying until a dog is grown up.
    That makes me feel terrible, as I did spay Daisy before 6 mo because that's what seemed to be recommended by everyone at the time.

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