Cushings, allergies, and newly diagnosed diabetes

[Raysaint]

Re: Cushings, allergies, and newly diagnosed diabetes

Being that the doses and increases got a bit inconsistent after the initial 6, the numbers probably weren't reflective of what a regimened dose increase might provide. Then false conclusions happen. Ultrasound suggestion might be based on improper dose increases and resulting numbers.

I'd give the dose and any increases a bit of time. It's amazing how messed up things can get very easily when changing anything from the current routine. I experienced it a lot, got all kinds of knee-jerk ideas, thought of all kinds of reasons why it may be, and then finally got into a methodical consistent routine, and things slowly improved. I'm sure my vet wanted to slap me.

[rocksmom]

Re: Cushings, allergies, and newly diagnosed diabetes

We’ve done a few curves in the time since I last posted but I’m on my iPad right now so I’ll post those probably tomorrow when I’m on my computer, just wanted to pose a question that’s really bugging me.

What’s it mean when they are displaying both low (ataxia, lethargy) and high (increased drinking) symptoms?

According to his curves, his bg is still very high with large swings, ranging from 300s to upwards of 600. We had dropped back to 6 then 7 and now just started 8 again tonight after his curve today. He’s still losing weight and as of this morning was at 16 even. He acts his best before meal/injection time. About an hour later he becomes lethargic and walks very unsteadily yet drinks a lot. We have never caught a low number at any point during a curve. Despite that could he still be experiencing the symogi effect? Could the drop back to 6 still have not been low enough? His numbers seem to be going down ever so slightly with higher doses but the symptoms make me worry we are going in the wrong direction.

[jesse girl]

Re: Cushings, allergies, and newly diagnosed diabetes

Its hard to say but for my jesse spiking and dropping blood sugar will make her lethargic . Its possible there could be a reaction to the insulin but that seems to be rare and only one member had a problem with a specific insulin

Having another disease like crushing is going to make regulation challenging and symptoms could be related to that .

Big drops could create rebound but its hard to know if this is what your are seeing in your dog . Most of the problems maybe cortisol related

When my jesse was struggling and still to this day if she is high i add a fast acting insulin now i guess that could muddy the waters but jesse can have periods of higher sugar but in the beginning it was a roller coaster ride

look forward to seeing the curve

[Raysaint]

Re: Cushings, allergies, and newly diagnosed diabetes

I wouldn't expect numbers to drop that low an hour after eating/injection, and then rebound. Lethargy and drinking are both signs of high sugar.
My dog drinks a fair bit after meals, for the first hour or so, then he drinks very little, until an hour before his supper, and then an hour after supper. It's not high sugars making him drink.
Your dog might have a quick spike after eating which makes him drink but it's not necessarily the cause.
If his curve and numbers still consistently show high sugar, you have no choice but to increase the dose and see what happens for the following week.

[rocksmom]

Re: Cushings, allergies, and newly diagnosed diabetes

Sorry for the delay in posting the curves.

12/18 - 8 units (This was after the jump from 6 to 8)
Fasted- 424
5:30- Breakfast and 8u
6:30- 474
8:30- 431
10:30- 412
12:30- 442
2:30- 559
4:30- 561

12/26 - 6 units (The drop back down recommended by the vet)
Fasted- 510
5:30- Breakfast and 6u
6:30- 591
8:30- 634
10:30- 384
12:30- 407
2:30- 384

1/6 - 7 units
Fasted- 459
5:30- Breakfast and 7u
6:30- 618
8:30- 604
10:30- 457
12:30- 348
2:30- 372

He's been on 8 units again now since dinner on the day of the last curve. Since the night of the second day (the day after I posted last) he seems to be doing better on the 8. Definitely less drinking, especially in that post-meal window. He doesn't seem ataxic anymore either. I wish we wouldn't have lost time dropping back to 6 like that. He also lost so much more weight in that period. Down to 15.8 today from a starting weight of around 20.5.

He's currently at the veterinary hospital with my husband. Our vet wanted us to take him to do an ultrasound but apparently there was a loss of communication somewhere and they only had him scheduled for a consult. They are "squeezing him in" so my husband is waiting there with him, but it sounds like the internist doesn't think it is necessary and his symptoms are all just from the uncontrolled diabetes and we should just be increasing his dose. Our vet seems to think his dose is already getting too high even though I know I've read on here that resistance is defined as greater than 1u per pound. Plus his cushing's… I hate it because our vet really seems to care about him and was even giving us free visits and care, only charging for labs and medications. Like you can tell she's involved, I just feel like she's not super informed on his conditions. The vet that we had when he was diagnosed with cushing's quit practicing to stay home with her kids and our current vet kind of "inherited" us. When I mentioned his allergies had gotten worse after he started cushing's treatment she was just like "if it's not one thing it's another" even though I was alluding to the fact the cortisol helps with allergy symptoms and it's well known that lower cortisol can increase symptoms.

Raysaint and jesse girl: Oh, I know the drinking and lethargy are definitely symptoms of high bg. It was basically like when he was diagnosed with dka. Sleeping near his bowl, waking up just to drink. The part that had me concerned was the unsteadiness. He was stumbling and tripping. That part had me worried that it was a reaction to the insulin or something.

[jesse girl]

Re: Cushings, allergies, and newly diagnosed diabetes

That is why correlating symptoms with dosing and how they feel can be helpful

It maybe a struggle to regulate with cushings and you cant fault anyone for how things are going . Its very difficult to know what the correct direction is to go . All we have is clues and usually not definitive answer's

I have changed direction many times in jesses diabetic life . You have to try something to eliminate from the equation and even with that being done doesnt completely take it off the table

I had to get quite creative with jesses routine to have adequate regulation that i thought she could have a good life with

[rocksmom]

Re: Cushings, allergies, and newly diagnosed diabetes

The husband just reported in. Nothing on the ultrasound! Yay!

The internist said we did the right thing with cutting back on his food and increasing his insulin and to continue with what we've been doing.

He was on lean ground meats and pumpkin for awhile after the colitis episode but was still having intermittent diarrhea. Vet recommended adding probiotics before going to antibiotics. We added them as well slippery elm as a prebiotic and things have definitely improved. His belly is less noisy and much less gas. His poop consistency has gone from watery to starting out normal with a little bit of softer stuff at the end. Sounds gross, but we're all dog people here

His diet now which he just started with the 8u dose is called My Perfect Pet Low Glycemic Beef. It's basically like a little frozen, cooked meatloaf with mostly greens mixed in. We add a little extra pumpkin and baby food green beans for some more fiber and to mix his enzymes into. He's getting one 8 oz bar per day divided between his two meals.

[rocksmom]

Re: Cushings, allergies, and newly diagnosed diabetes

We did his curve today for the 8 units. Great results!

Fasted- 267
5:30- Breakfast and 8u
6:30- 290
8:30- 96
10:30- 101
12:30- 111
2:30- 197

So I know I'm new to this, but I've been reading the board a lot. To me this looks like he's on the right amount of insulin, but we just need to figure out how to flatten it out a bit with his food to bring down that 290 a bit and keep him from dipping below 100. Correct? I won't hear from our vet until Wednesday. I was thinking a small snack around 7:30, maybe even reserve a couple bites from his meal and give it to him in his kong at that time instead of adding additional food.

I knew he was feeling a lot better, but I really did not expect those numbers. Honestly, I thought the first one was an error and he'd be back up to the 400s and 500s after he ate. I won't lie though, those lows make me nervous. I thought we'd have awhile before I went from worrying about highs to worrying about lows!

Any thoughts or suggestions would be much appreciated!

[jesse girl]

Re: Cushings, allergies, and newly diagnosed diabetes

Very good i might give the dose more time to settle before making a change

[Raysaint]

Re: Cushings, allergies, and newly diagnosed diabetes

The 290 is a small portion of the 12 hour period, if it was me I wouldn't worry about it, the remaining hours are all good. Having the majority of the 12 hour period in a good range is success in my mind.

If you start trying to manage that one little bit of time, it will affect somewhere else in the curve, maybe make nadir too low. Then it's a constant battle to correct the affect.

Having a bit of a spike after eating is normal. It comes down fairly quick after that, I would love that.

[rocksmom]

Re: Cushings, allergies, and newly diagnosed diabetes

Today we are doing another curve and at his 8:30 check just now we got a reading of 58. I'd definitely been suspecting low numbers, but not this low. I gave him some corn syrup and food, about half his normal meal size. We will continue to monitor today, but any advice? This is obviously a first for us since last week was his first time having fairly normal numbers. Should I increase his food at dinner or drop his dosage? Both? How much?

Our vet is in the office tomorrow so we are on our own for dinner and breakfast unless we go to the hospital as an emergency case but he isn't exhibiting any symptoms other than sleeping.

[jesse girl]

Re: Cushings, allergies, and newly diagnosed diabetes

Well the curve will not give you any ideas on regulation with the intervention with sugar and food but you do want to continue testing to make sure you can get blood sugar above a 100

At 58 you may need to reduce the dose . you cant depend on food amounts to do the job

the amount of a reduction is the difficult part

[rocksmom]

Re: Cushings, allergies, and newly diagnosed diabetes

Just did another check, it's been an hour. It read 61 this time. Gave him some more karo and a little more food. Will check again in another hour.

jesse girl, that's definitely the hard part. I'm wondering 1/2 unit? 2 units? Like I really have no idea how much and I don't want a huge swing, but I also don't want to be worrying about him overnight either.

[jesse girl]

Re: Cushings, allergies, and newly diagnosed diabetes

Just did another check, it's been an hour. It read 61 this time. Gave him some more karo and a little more food. Will check again in another hour.

jesse girl, that's definitely the hard part. I'm wondering 1/2 unit? 2 units? Like I really have no idea how much and I don't want a huge swing, but I also don't want to be worrying about him overnight either.

thats the difficult part is how much . Early in jesses diagnosis i gave her spoonfuls of Karo . I would give he a spoonful and sugar would stabilize and test a half hour later and would be dropping again . Then i would give her another spoonful . As you can tell she was receiving to much insulin . Amazing all the karo did not make her sick

I think a minimum of one unit and 2 units maybe have a better chance at getting out of these lower levels but it still may not be enough

[rocksmom]

Re: Cushings, allergies, and newly diagnosed diabetes

Another check at 10:30. 98 this time. Much better, but we will still keep checking every hour. Hopefully it doesn't go down again before dinner.