new to diabetes

[MisterMax]

I am so overwhelmed and scared. I don't know what to ask or where to begin! My almost 12 year-old MinPin received a diagnosis of Cushings this morning (2/4). On 1/17, I took him in because he was urinating and drinking excessively and very lethargic. The urinalysis and T4 were extremely high (I don't recall the numbers). Max was started on Vetsulin, 3 U in AM and 2 units in PM. The following day, his blood glucose was tested by the vet again. There was a significant improvement (over 200). Max returned to the vet on 1/21 for a blood glucose test and it was back up around 600. His insulin was increased to 3U in Am and 3U in PM. A return visit for a blood glucose level on 1/23 showed no improvement. A curve was scheduled for the following week and the insulin was increased to 4U BID. Max was at the vet all day on 2/1 for the curve test. I don't remember the numbers they got, but they remained high throughout the test. On this day, he was prescribed a thyroid medication (0.3MG BID) and his insulin was increased to 5U BID. Yesterday (2/3) he was back at the vet for the Cushing test. Insulin was increased to 6 U BID. Blood glucose is still in the 500 range. Today the results came back positive. The vet also mentioned pancreatitis as a complicating factor. I need to decide how to proceed and was told one option is Trilostane. I was cautioned this is a toxic medication and Max may suffer while the appropriate levels of all the issues get leveled out. It is so difficult to watch my once lively boy deteriorate in a matter of 2 weeks! I don't want him to suffer for my benefit. I am looking for some information on others' experience with this medication with pets that have a similar medical profile.

He does NOT have polyphagia, no loss of hair or change in his coat, no skin problems and no panting. He is also not presenting with being overheated.

He does have excessive drinking and urination, lethargy, a change in his body composition (i.e. pot belly and loss of fat around his back hips and has loss of strength in his hind legs).

There is so much I don't know and don't know what to even ask. So, thank you for offering any advice you believe will be helpful.

Thank you!
Dixie

[CraigM]

Re: new to diabetes

Welcome to the forum.

Tell us more about your pup.

Weght?
Type of insulin? (Just saw that you said Vetsulin)
Feeding / injecting twice a day, 12 hours apart?

Really anything you can think of to share.

Craig

[CraigM]

Re: new to diabetes

One thing. Although I don't have any experience with Cushings, I think I've read that it's next to impossible to diagnose Cushings when the blood glucose is WAY out of control. I think the "experts" suggest getting the diabetes under somewhat control before messing with Cushings.

I hope those with experience will check in later this evening. You might also like to join our sister website: k9cushings(dot)com and see what they say.

Craig

[MisterMax]

Re: new to diabetes

Craig,
Thank you for your reply. Max is newly on prescription Royal Canin Glycobalance. He is fed 1 cup twice a day, if I can get him to eat it. I haven't been really great at feeding every 12 hours, but after reading posts yesterday, I will start. It has been more like between 10-14 hours. He eats better in the evening and I have to really coax him to eat. My vet suggested serving him some white chicken breast. This has helped but he still does not eat all the dog food. I have also read posts where people are serving their pets green beans, cottage cheese and chicken. He likes vegetables. Even when they are raw. Would broccoli be a good addition to his dog food? I also found he eats it better when I soak his dog food in water. He is still very thirsty!

He is 20 pounds.

I started out at k9 cusingings.com and they suggested I start here first. I also read the article about Cushings being difficult to diagnose when blood glucose is out of control. Thank you for that information!!

I feel like my vet is too conservative with the insulin. I was reading where others are dosing Vetsulin at 7U BID. I almost feel like I want to increase the dose and see how he does. How immediate is the effect? I know so little about diabetes!

I have a glucose tester on order through my vet, so I can't check blood glucose at this time.

I also wonder about changing vets to someone who seems to know more about diabetes. My vet clinic/ hospital is a father/ son business. The father recommended the Cushings test and the son wanted to work more the insulin. When the Cushings test came back "positive" the son acquiesced. Does anyone have any thoughts about whether a change in vets is a good or bad idea? I saw the link to the vet specialist link and see there are several options reasonably close to me.

This morning, at 4 AM, Max threw up kibble. Not a lot, but undigested kibble. It had been almost 12 hours since he had eaten. Should that not have been digested?

I am also wondering about when to give the injections. From what I have read, I am wondering about giving it to him 1/2 hour after he eats rather than immediately after. Any suggestions?

Should I be concerned about charcoal colored feces?

Thank you for any and all of your wisdom! It is greatly appreciated!

Dixie

[Judi]

Re: new to diabetes

Hi Dixie: My dog had both cushings and diabetes and my vet strongly encouraged me to see a specialist so I think your instinct to find a vet with more experience is a good idea. Especially with everything else going on.

There have been many false cushings diagnoses around here which is why everyone is cautious. Especially if your dog has thyroid issues because that can also lead to the insulin issues you have.

Cushings meds treat the symptoms, the only time cushings can be "cured" is if it is caused by the type of tumor that can be surgically removed. And that isn't as common.

I'm not a real technical person but I've been around here since 2011, here is what I've seen:

the dogs with thyroid issues would initially respond to insulin then their blood sugar would go back up (sounds like your dog)

some big dogs, esp. a lot of labs, get the back leg weakness and giving B12 (the methyl version) helps over time

the cushings test measures levels of cortisol. If a dog has other things going on stressing his little body out, it can be a false positive. My dog didn't respond to insulin much at all until we got to 7 units twice a day for an 8 pound dog.

Holli used to mention a test out there that could rule out cushings. I don't know anything about it but it is worth asking about.

I definitely think you should find a specialist, keep on the thyroid meds, and consider B12. (just my opinion)

Reading about cushings is scary and depressing. Dealing with it can be expensive and worrisome but it is doable. My Jenny had some good years. So, try not to be too scared or depressed.

Keep us posted. Judi

[Judi]

Re: new to diabetes

ps. I've had dogs that have thrown up like that before.

the only reason people wait half an hour is in case the dog pukes so you don't give the full dose of insulin. Maybe waiting while Max's tummy is upset is a good idea.

Is he over the pancreatitis?

[jesse girl]

Re: new to diabetes

a starting dose for your pup would be about 4 units but some dogs like my jesse ended up being on a dose lower than a starting dose . i dont have a problem with the dose your pup started on and you did see a substantial drop in sugar with that starting dose

I do have one question is your vet doing complete curves or just one single blood glucose test and basing that one test to adjust the insulin dose with that method you could easily pass the dose thats needed and that includes adjusting the dose off just symptoms as not being prudent

if you do have any curves it maybe helpful to post them . add the amount of insulin given with food and time given of each test

diabetics are prone to pancreatitis and ketoacidosis which can be life threatening so something to check for and some of the digestives symptoms you are seeing are part of those complications

I am not one to force feed a dog if they dont want to eat there is a reason . i would rather listen to the dog and adjust the dose based on how much food is given that becomes more easy with testing sugar at home . Actually my jesse only gets one meal a day so there is allot of flexibility if what your doing isnt working as long as you stay consistent

if this food is just going to be a problem for your dog for the long haul you may want to look for an alternative a prescription diet isnt mandatory as many here feed all kinds of diets with some staying on the same food they were eating before diabetes

its still very early into this the additional diagnosis of cushings can be a problem if its a miss diagnosis which as you know can be difficult to diagnose with unregulated diabetes and is put at the top of the list if diabetes is difficult to control . It took my jesse 6 months to stabilize but she had additional challenges

[MisterMax]

Re: new to diabetes

Thank you! Thank you! Thank you! I am so appreciative of the opinions, especially since they are non-medical. I think a big part of my being overwhelmed is the vet gave me too much information. In retrospect, I don't think he knows what is going on and is talking to make himself more comfortable.

After looking up pancreatitis, I don't believe Max had it. Like I said earlier, I wonder if my vet was "thinking out loud" and all I heard was pancreatitis. Based on the symptoms I read online, he did not have the symptoms on the list. He only threw up after I read about the symptoms. Go figure. I had not seen it previously. The symptoms he was exhibiting could easily be explained by the diabetes. I will be sure to keep it in mind as an issue. Thank you for the suggestion about giving the insulin after he eats to make sure he doesn't throw up. Especially since I don't know what I am dealing with.

There has been only 1 curve completed. I don't have the numbers, but will get them as I now realize it is very important information for me to have.

Can I get more information on the B12? Is it a prescription? Or over the counter? Are other supplements found to be helpful? I read about healthy fats and am interested in whether others have found this particularly beneficial.

Another symptom I forgot to mention earlier is shaky hind legs. This was actually the first symptom. He has had it for several months. I took him to the vet in August and he was given a joint supplement for arthritis. It, obviously, did not help. The shaking has gotten better and typically appears after a walk.

When he is so lethargic, is it recommended I continue to take him on walks? We just go around the block (about 20 minutes). He will start out really slow, like he just can't do it. By the end of the walk, he is more lively and engaged for a short time before he takes a nap. I don't know if it matters, but I live in MN. While I don't walk him in the bitter cold, it is still quite cold (20 degrees). Should I not be walking him when it is this cold? The temperature was never an issue pre-diabetes. How important (or detrimental) is exercise when his BG is really high?

Thank you for your lay-person knowledge! It truly helps me and I am certain Max is grateful as well!

Dixie

[Eddie]

Re: new to diabetes

Hello

We dealt with severe hind leg weakness after our dog was first diagnosed with diabetes (no Cushings involved).

We gave him lots of B12 methylcobalamine as well as the more usual variety. I have no idea if it helped but it seemed to do no harm and in the same situation I would do it again. At the same time he was working his way up to the required insulin dose and so it may just have been the process of getting him regulated that sorted his legs out.

We just got the B12 without any prescription (or input from our vet) from Amazon. We are in England but I think it is readily available in the US as well.

When his legs were weak, our dog did almost nothing except sleep for several weeks. We let him choose entirely how much exercises he wanted. in fact he wanted almost no exercise at that stage - just to go out to toilet in the garden and then wobble his way back to his bed, with us supporting him all the way.

(This was back in 2012 and he's still fine now by the way)

Antonia

[Judi]

Re: new to diabetes

Hi Dixie, I'm in Minnesota too! I'm in Detroit Lakes but we did see a specialist at Blue Pearl in Blaine and I was very impressed by them. They did do their own ultrasound even though my vet had done one so I wanted to warn you to just wait if you are going that route. Our original vet had also referred us to the U of M. I just went with Blue Pearl based on someone's opinion.

Some people have found that the temperature can affect the blood sugar. And as far as exercise goes, my personal opinion is that you are trying for regulation while letting Max be Max. They can burn through their insulin if they exercise too much, but exercise can also bring the blood sugar down.

Some people would test their dog's blood sugar pre walk and post walk. Then they learned to maybe give the dog a milk bone prior to the walk. Every dog is different though.

When my Jenny's blood sugar was in the 400+ range she slept a lot. That could be why Max is sleeping.

You can do this. Judi

[CraigM]

Re: new to diabetes

Meal time can be troublesome for some. Things are usually much easier if the pup eats 100% of two identical meals.

My Annie started about nine years ago on a discontinued Royal Canin prescription food. I switched to Blue Buffalo Healthy Weight (higher than average fiber which some think is important for diabetics) after maybe a year because the Royal Canin was just costing too much. Annie ate the BB Healthy Weight for about six years without a problem, them BAM! Refused to eat a full portion. For awhile, I used small jars of baby food (Gerber or Beacknut 1st foods) and I would coat any leftover kibble (not much, just a thin coating to get her attention).

Several months ago we made another switch that she seems to like. We are mixing Healthy Weight kibble with Beyond brand canned that has a gravy. I'm not sure the Beyond with gravy is a great choice, but at least she has been eating her entire meals (most time)

Guess the important thing for me is to get a food she will eat

Craig

[MisterMax]

Re: new to diabetes

Thank you, EVERYONE for your posts. I feel I am getting a better understanding! It is helpful to know it takes time to stabilize and that he is going to be lethargic until the BG has leveled off more. Websites don't tell you the every day challenges so I really appreciate you taking the time to post your experiences. Every post is a Godsend! I appreciate it all. Please keep them coming!

Night time seems to be the worst for drinking and urinating. He is up every hour after about 2 AM drinking and peeing. Maybe it just feels like it is the worst because I am trying to sleep.

[amydunn19]

Re: new to diabetes

I won't repeat the same things as you have received great advice so far. Another factor is that Min Pins have always been a bit difficult (kind of like schnauzers) - they don't usually love the injections and testing and they have a history of needing a larger dose than is typical for their size. I am not saying increase it without some blood testing, but don't be concerned or surprised if he ends up on a higher than normal dose. I don't know why it is that way - something in their makeup is just harder to regulate. Schnauzers typically have high triglycerides that make them a tough case, but I am not sure what the deal is with min pins.

With thyroid issues and diabetes, there is already a whole lot going on. I would let the cushings go for now. You just don't want to change so much when it comes to medications, food, and routine. My advice is get the routine down, treat the thyroid and diabetes, make sure he is willing to eat the food as is (you can add boiled chicken or a wet food or baby food to make it more appealing), before you get too much going on.

Get a journal or use an iPad/computer to keep a diary of everything he eats, times, amounts, how much insulin, when you give the dose and note any things that seem odd - the throwing up for example with times, etc.. Until I made diabetes a mission to manage, it was all very hard to see the big picture. When you keep a very detailed journal, especially when you start blood testing, you will start to see things much clearer.

By all means, get a second opinion with a specialist, if it is in the budget. I think at a minimum, you are dealing with two conditions, and maybe three. Even if you stay with your vet, the extra opinion won't hurt.

You are in a great place - there is hardly anything that someone in this group hasn't experienced. Feel free to use this resource. Having a forum was a life saver for my dog - my original vet was horribly insufficient- great person but knew nothing of diabetes. They told me Maggie wouldn't make it 6 months when she was about three months in. She almost made it 9 years with diabetes. It would have never happened without the help of some experienced members and a new vet who is an internal medicine specialist. I made every mistake a person can make and was horrible at injecting and testing but these pups are tough and I learned by living it.

[MisterMax]

Please advise!

Max didn't want to eat this morning and I didn't push it. He only ate about a 1/4 c. and he usually eats about 1 c of food. In situations like this, how much insulin do I give him? Do I give him any? 1/4 the regular dose (even though the current dose is not adequately stabilizing the BG)?

Please advise for future incidents!
Thank You,
Dixie

[CraigM]

Re: Please advise!

Max didn't want to eat this morning and I didn't push it. He only ate about a 1/4 c. and he usually eats about 1 c of food. In situations like this, how much insulin do I give him? Do I give him any? 1/4 the regular dose (even though the current dose is not adequately stabilizing the BG)?

Please advise for future incidents!
Thank You,
Dixie

Generally, we would give ½ dose if they ate ½ the meal. Would give 1/4 dose if they ate 1/4, or less, of the meal (give 1/4 dose even if they don't eat anything at all).

Of course, getting them to eat by adding something like a little baby food, grated cheese, beef/chicken broth might help. I've soaked Annie's leftover kibble in a tiny amount of broth for several minutes to get her going again.

Craig