Sweet Kona has passed... August 2015

[3bostons]

Hello all, Ive been a member on the K9Cushings board since 2012 when my now 12 y/o boston terrier, Kona, was diagnosed with Cushings. Now I find myself looking for more help and advice since Kona was just recently diagnosed to have Diabetes as well.

Very similar symptoms and my vet has warned me now that there could be future frustrations trying to find out whats amiss when she has issues, does not sound like it will be fun or easy. She also mentioned that usually it is the Diabetes that comes first, but not this time.

I will say that her cushings has been under control and in the vets office last week they did a cortisol test which came back at 4.7. Her BG was 511 and urinalysis glu was at 1000, ketones negative. ( I think Glenda is attaching a link to my other posts so I dont want to duplicate info if not needed)

So, we started her on 3units of humulin-n 2 x day and also one week of clavamox due to minor UTI detected as well. She also takes 20 mg vetoryl 2x day along with milk thistle.

My concerns were how all the meds would react together and I didnt want to disrupt her cushings since she has been so stable.

She is not ravenous like expected, but she is drinking and peeing alot and her skin is flaky. I havent noticed much change in the habits yet but we did start at a low dose of insulin so I suspect it will be raised on next check which is monday 9/22.

They said at this time to not change her diet, she currently eats 1/2 wellness simple mixed with 1/2 homemade. I have already been pretty consistent with meal times due to the cushings med has to go in meals so, no change needed there. I usually rotate the dry food between a couple brands but was told that may not be good now? I need to keep her on the same foods all the time? One reason she said not to change the diet is because it took us some time to get this one to work with her cushings meds. (first complication I guess)

I do live quite a ways from the vet so shes already said I will be doing testing at home and can email her results on the curve testings and she can advise if I need to come in or make any changes. Ive been trying to read up on that, sounds like i will be making her into a pin cushion

Im curious as to the walmart brand I keep reading about for insulin, is it the same? The brand I got cost me 120.00 and was told not to use it past 30 days, at her current dose the vial should last 90 so that means I will wasting alot of insulin and money, at 120.00 every month.

So, lots of questions sorry, hope you guys can help. I look forward to meeting all of you and hearing your thoughts.
thanks !

Kona and Deb

[k9diabetes]

Re: Diabetes and Cushings

Just have a moment for answers to a couple of questions.

Walmart insulin

Regarding Walmart's Relion insulin, it is Novolin N - equivalent to Humulin N and a name brand product, not generic.

It generally is interchangeable with Humulin N, though some dogs respond somewhat differently to the two. And that's not always a bad thing... if Humulin N isn't working all that well, Novolin N may present a better choice.

Upfront in the beginning, where expense is a concern (and when isn't it!), I would go to the Relion N right away and regulated with that and then you could try Humulin N later if you find that Relion/Novolin N isn't working well enough. No guarantee the switch would solve the problem, but why start with the expensive stuff?

Diet consistency

Because food and insulin interact directly, the ideal is to feed exactly the same content of food and the same amount of food every day.

Although we did not need to, many here weigh their dogs' meals so they are even more consistent than dishing up a cupful of something.

It just eliminates variables in the content of the food, giving the most predictable conversion to sugar for the insulin to work on.

If you have a real need to vary what's in the meal, you would want to try to keep the content similar in terms of protein, fat, fiber, and carbs and the same number of calories.

Glad the vet didn't push you to change diets - there's really no need to go to the prescription diet, especially when you have worked out one that works well for your dog.

If you find that the current diet and insulin aren't well matched - as in you get a lot of insulin but not much sugar or a lot of sugar when there's not much insulin working - you might have to tweak the diet to get better diabetes regulation.

All of which is doable. For now, start with what you have and see how it goes.

Natalie

[Charlie's mom]

Re: Diabetes and Cushings

Welcome to you and Kona Deb! I think all of us bought that one expensive bottle of humulin and then switched to Novolin after we read about it hear on the forum.

We actually took our dog off the prescription food as we couldn't keep him regulated on it after after the first few months. As Natalie mentioned, consistency will be your friend

Laura

[Judi]

Re: Diabetes and Cushings

Hi Deb: my Jenny has cushings and diabetes too. I haven't been very active on the cushings board cause we pretty much killed off Jenny's cortisol production and she hasn't been on cushings meds for some time.

For me, the diabetes has been easier to manage because you can test at home.

When Jenny's insulin needs went really really really low, that should have been my wake up call that she needed an ACTH as her cortisol levels were dropping. It happened quickly so just keep it in mind as something to look out for.

We've switched from the Humulin to Novolin and after an intial blip, there was virtually no difference for my Jenny.

I'm sorry Kona has diabetes too but it is definitely manageable. Judi

[3bostons]

Re: Diabetes and Cushings

Thanks for the input Judi, so what happened when the cortisol levels were dropping? Is it something you notice right away, like lethargy, not eating or something ? How did you know it wasnt from the diabetes? These are the kinds of things i worry about. My vet said the first thing I would do is check her blood and if its low give the sugar, if they are fine then I would address cushings with the prednisone. Does this sound like something you ran into? I just dont want to miss the signs, I was just getting used to what to look for in a cushings crash and now I have to be able to determine which illness could be causing her issues.

Thanks Laura, I will definately ask the vet next week about the other insulin, so is it accurate to not use it after 30 days no matter how much we have left? I may feel safer doing it that way I guess unless I find others like yourselves know better from experience.

Thanks Natalie, Im glad too that she didnt want me to change the diet yet either. I think I will be more disciplined about my measures though like you said, just to be accurate. I do measure the dry food but I always eyeball my homemade, I will measure it too. I would prefer to keep her on what shes eating, we picked it out for her liver support too with the cushings. What about treats? I have 3 bostons and they all typically get a snack about lunch time, they are all natural crunchy treats, still ok? Also, is it odd that she wasnt losing weight before this? I thought it caused weight loss, or maybe we caught it before?

I read that most diabetic dogs will get cataracts resulting in blindness, is this pretty accurate? One of my other bostons is blind, hes been blind for 4 years now, so I can handle it, I just hope it doesnt happen

Thanks everyone, as always my little ones keep me learning

[amydunn19]

Re: Diabetes and Cushings

Hi and welcome! My Maggie was on humulin back when it was the cheap one at Wal Mart. I didn't change to Novolin right away when Wal Mart changed but eventually did. Maggie changed just a small amount and I believe it was for the best. The duration seems to be better and we dropped a half unit but since your dog is new to insulin, you may be able to switch without any issues.

Regulation takes time and patience but I am sure you get that with your cushings experience. Nothing comes fast or easy, it seems.

Some dogs never lose sight. Mine did overnight but I waited for a very long time before testing and being proactive. I thought my vet had a handle on it and she was over her head. We had cataract surgery several years ago so her sight is restored.

I always toss my insulin after a month. Her numbers start drifting up if I go much longer.

You will be a pro in no time!

[Lulusmom]

Re: Diabetes and Cushings

Here is a link to Deb and Kona's thread on K9cushing's.

http://www.k9cushings.com/forum/showthread.php?t=4464

Kona's case is a bit different from the dogs we usually see with cushing's and diabetes. Kona's cortisol is and has been well controlled for quite some time so when she became overtly symptomatic again, Deb logically thought that her cortisol was rising. However, a blood chemistry with resultant high blood glucose and a stim test with pre and post levels well within the therapeutic range ruled out high cortisol as the causative factor. I am hoping you folks will take Deb under your wings and teach her how to home test. I would think home testing is even more important when you are dealing with both diseases.

Glynda

[Judi]

Re: Diabetes and Cushings

Hi Deb. It can be worrisome wondering which disease is causing symptoms. But it sounds like your vet is on top of it cause she is right. Being able to test blood sugar is huge and way easier than testing cortisol. With Jenny she had had a good ACTH in December. Then in January and February we had some scary low blood sugar incidents. I had to drop her insulin from 3.5 units to 1.

3 months later her ACTH showed.2. So the reduced need for insulin was the clue. We did prednisone for about 6 months. We did liquid pred so I could do it twice a day with the insulin.

These dogs are tough. And when everything was settled she was herself again. Hang in there and try not to worry

[Riliey and Mo]

Re: Diabetes and Cushings

Welcome to the forum

like Glynda suggest to us is to start hometesting asap. Take control o f his diabetes

all you need is a glucose meter, strips and lancets.

i use the alphatrack 2 and the one touch ultra.

lots of deals buy a meter, this is the best advice from us. It saved my dogs life

[3bostons]

Re: Diabetes and Cushings

Thank you everyone for all the input. I think I will toss the insulin too after the 30 days, especially if it starts to lose its effectiveness, its worth it to me. I was hoping the same thing, being so early that I could switch to the other one with less complications, definately going to ask the vet.

Im already finding a problem with the insulin injections because Konas coat has gotten unusually thick for a boston, due to the cushings meds. I mean it is thick, they have a hard time doing a blood draw at the vet even cause they like to do the neck. And shes not fat so theres not alot of extra skin to draw up on the neck plus I dont want to poke her in the same place all the time.

So what about the blood checks I will do, I dont think she would like the lip, I read someplace to try the pads on the foot? Does it make their foot sore? Isnt that thick skin to poke? I suppose you want to move those around too, not in the same place all the time?

I look forward to getting her some what more regulated so the constant drinking and peeing stops again. I never knew such a little body could pee so long at times

Thanks ! Kona and Deb

[JoJo's mom]

Re: Diabetes and Cushings

Hi and Welcome
I thought the same thing about testing on the lip But because he has so much hair on his ears and feet, I thought I would try. He doesn't feel a thing, never even flinches and I get plenty of blood.
Good Luck
Mary

[Judi]

Re: Diabetes and Cushings

does he have any elbow calluses? a lot of people have luck there.

the lip is the only place I can get blood from Jenny. Dogs don't have as many nerve endings there. You have to poke close to the canine tooth or no blood.

Since vet offices don't usually use meters, I found a vet tech who had worked at an ER office and had experience. She & I tried Jenny's ear, by Jenny's tail, and her foot pads and my very good actress of a dog acted like we were killing her. (she is usually very good at the vet). so, the lip it was.

A lot of people shave a little spot where the end of the back and the tail meet, heat that spot up, and get blood there. Also, the lancets that are sold for humans usually aren't thick enough. look for different sizes. We wound up using the Accuchek softclick lancets. we get blood

As far as the shots, there is a chart on the main page that shows different areas to try. Jenny seems to feel it more when I give her shot on her right side but we do try to mix it up. At this point, if I can pinch some skin anywhere along her back, she gets her shot.

here is the link with the picture of injection sites: http://k9diabetes.com/forum/showthread.php?t=2290

Judi

[Cara Sandler]

Re: Diabetes and Cushings

I used to test Sparky at the base of his tail. He didn't seem to really care too much about it and let me poke away until I got a sample. Sometimes he even fell asleep while I was trying :-)

[3bostons]

Re: Diabetes and Cushings

She does have an elbow callous, its small but maybe I can try that. As a boston she doesnt have much of tail just a nub but there is a bald spot there, wonder if I could try that.

Cara I seen on your post you lost your little one just recently, so sorry for your loss, my heart goes to you.
I also did see you were in involved in a cataract prevention plan. I wondered about that because one of my other little ones is blind from cataracts and glaucoma and he is still on preventative meds in one eye for the glaucoma, do they have such a drop or med for the cataracts?

[Cara Sandler]

Re: Diabetes and Cushings

Thank you, 3bostons. Sparky was an amazing little guy (aren't they all?) and I know he is waiting for me at the Bridge.

As far as the eye drops to prevent cataracts, it was a clinical trial, so the eye drops are not on the market yet. The only way to get them is to be enrolled in the clinical trial, and dogs are only eligible to be in the trial if they have no sign of cataracts at enrollment. Here's the link for the website - on the page there is a link to contact them. http://therapeuticvision.com/kinosta...or-pet-owners/

They do list some of the research sites on this page but I know they've added more sites recently that aren't listed, so if you decide you're interested in the study go ahead and contact them and see whether there is a site near you. Sparky was only on the study for 3 months before he passed away, but in those 3 months he had absolutely no signs of cataract formation even when his eyes were dilated. The ophthalmologist said that almost all diabetic dogs will have some early signs of cataracts after being diabetic for 3 months, so the drops seem to have been working.