Cushings and Diabetic Dogs
I have been trying to research Cushings in Diabetic Dogs and it’s a lot to take in. I have a friend that has two pups with Cushings, one with Diabetes and one without. She was writing a piece for a group that I belong to and happened to publish it today. SCORE!!! I promptly asked if I could steal it for the blog. To my great relief, she said, “Of course!” So without further ado, I give a heartfelt thanks to Tricia Kummer who is my “go to” gal for all things Cushings.
We have many in our group that are managing both diseases. Personally, I have 2 dogs with Cushings Disease, 1 of those, Allie, has both Diabetes and Cushings and was diagnosed in Jan. 2014. Neither disease is a death sentence if managed properly. The best thing to do if you are faced with either disease is educate yourself so you can advocate for your pup! Both of these diseases are specialties and unless a vet has treated them, they really do not get much education on either and when they are faced with a pup with both, the experience is even less. It takes patience and finding the correct balance.
In a nutshell, Cushings Disease (Hyperadrenocorticism) is when the body produces too much of the hormone, Cortisol.
You may see insulin resistance mentioned in regards to Cushings. It is rare to have true resistance, although if Cushings Disease is present and untreated, you will see the need for much more insulin than the recommended starting dose. Once you start treatment for Cushings Disease, home blood glucose testing becomes a necessity because as the cortisol comes down, the blood glucose will likely also reduce and needs watched carefully as a reduction in insulin is usually needed.
The most common form of Cushings Disease (80-85% of cases) is Pituitary (PDH); the other 15-20% is Adrenal (ADH)
When diabetes is present and you think your pup may have Cushings Disease, the test you will want to do is the ACTH Stimulation test. It is the most accurate with diabetes but you want to do it when the blood glucose is more managed, preferably 350 or less at the time of the test. The test is a 1 or 2 hour test depending on the stimulant the vet uses. For diagnostic testing, your vet will need to talk to the testing laboratory to confirm whether the test should be done fasting or not. Most do not require fasting for diagnostic anymore. For the test, your vet will take an initial blood draw, if you want a CBC check; this is a good time to do it. Then they will give an injection of a stimulant called Cortrosyn. In one hour they will take a second draw and what we call the "post" number is what your vet will use to determine if your pup has Cushings. They may also do an ultrasound to check the adrenal gland and/or sometimes the pituitary gland. If you live in a part of the World other than the USA, it’s likely that you will be using tetracosactide (Synacthen) rather than Cortrosyn as the synthetic ACTH preparation.
If Cushings is confirmed, Vetoryl (Trilostane) is the most common treatment. The biggest thing to remember is to start low and go slow. If you follow dosing and testing protocols, the disease can be managed very well. If you have heard horror stories of side effects of the drugs, they are rare and usually because the dose is started to high. Starting dose should be 1mg/lb. for dogs under 40 lbs. For dogs over 40 lbs., it has been found best to start dosing at 1/2mg/lb. With diabetes, it is recommended to take that dose and split it in 2 and dose in the am and pm, with food and insulin due to the half-life of the medication. As for the cost, it is the most expensive at the beginning, getting the proper dose and making sure the monitoring tests are done. As I said it is important to be home testing the blood glucose because lowering the cortisol will also lower the BG. If you had increased the insulin to compensate for high numbers, suddenly lowering the cortisol may bring those numbers down. It is important to monitor that and decrease insulin as necessary. Testing protocol is to do another ACTH test 14 days after starting medication. This test should be done 2-4 hours after giving food and medication and try to do the test at the same time every time you test. You do not increase but watch for any low result because the cortisol will continue to come down in the first 30 days. Then you do the second ACTH Stim test at the 30 day mark to check and see how the medication is working. This is where you increase the dose (no more than 25%) if needed. After any increase, the testing starts all over. If the test is within range, you would stay the course and do another test in 3 months. More on monitoring protocols can be found here;
https://www.dechra-us.com/therapy-areas/companion-...
I realize this can sound overwhelming and costly. Truly, the worst part of the disease is the beginning when trying to find the correct balance. Once you have achieved that, there are many cost saving tips and the cost of monitoring is less because testing drops to every 6 months to 1 year.
✔Below are some common symptoms associated with Cushing’s disease in dogs:
(Not all may be present)
For more information, we have a great group here on Facebook that we do work closely with https://www.facebook.com/groups/89435412886/
Once again, I want to thank Tricia for sharing her expertise on Cushings Disease and taking some of the mystery out of it for those of us that find it daunting.
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Until next time…