Just diabetes.......or something else?

RE: Just diabetes.......or something else?

Kate Richardson — Wed, 07 Jun 2017 21:38:13 GMT

I think vaguely similar, prominent jaw, wide interdental spaces, generally weight gain but think this is variable if diabetic. Resistance or variable response to insulin if diabetic. Only seen one case. Can find more info on line

RE: Just diabetes.......or something else?

Busybee — Wed, 07 Jun 2017 21:27:19 GMT

Thanks Martin, I'll speak to the lab about further testing tomorrow.

Kate, what, if any, other symptoms could you expect from a dog with acromegaly? Are they like the cats?

Thanks.

RE: Just diabetes.......or something else?

Martin Atkinson — Wed, 07 Jun 2017 12:27:51 GMT

[quote user="Kate Richardson"]Its rare Martin, but it does occur.[/quote]Well given we've only recently realised how common non-phenotypical pituitary hypersomatotrophism is in cats I wonder if we will have a similar revelation in dogs?

RE: Just diabetes.......or something else?

Kate Richardson — Wed, 07 Jun 2017 12:11:23 GMT

Its rare Martin, but it does occur.

RE: Just diabetes.......or something else?

Martin Atkinson — Wed, 07 Jun 2017 10:44:32 GMT

[quote user="Kate Richardson"]Just a thought- could he have acromegaly? An acromegalic cat I am treating...... [/quote]Its a dog Kate. Interesting point though, whats the incidence of acromegaly in dogs?

RE: Just diabetes.......or something else?

Kate Richardson — Wed, 07 Jun 2017 09:59:15 GMT

Just a thought- could he have acromegaly? An acromegalic cat I am treating currently has some days where he has the most perfect glucose curve, then unexplicably he has a day with no control whatsoever- its due to varying levels of IGF I believe. Appetite variable according to level of control on that day.

RE: Just diabetes.......or something else?

Martin Atkinson — Wed, 07 Jun 2017 09:06:28 GMT

Looks ostensibly like a perfect curve but are those just highlight figures you've given us? Don't think its an issue here at all but if you only test every 2-3 hrs you could miss a lower nadir and/or Somogyi overswing.

Time for ACTH stimulated 17-hydroxyprogesterone and a liver profile? Wouldn't do any harm to give it some SAMe as well.

RE: Just diabetes.......or something else?

Busybee — Tue, 06 Jun 2017 19:11:20 GMT

Many thanks all.

I've since had the dog in for an abdo scan and LDDST. The abdominal scan was relatively unremarkable except

- v small amount of 'sludge' in gall bladder

- uniformly thickened bladder wall

The LDDST read as follows...

Base Cortisol 48 nmol/L; 3hrs 15.7nmol/L; 8hrs 33.4nmol/L. The pathologist's comment suggested it could represent PDH with the 8hr 'escape' rise in cortisol but she wasn't fully convinced.

His fructosamine was 450 on that day but his mini-curve looked great!

8.30am 15.9mmol/L

8 iu Caninsulin given

11am 5.1mmol/L

1pm 6.2mmol/L

4.30pm 11.8mmol/L

So! No obvious physical problem in the abdomen (other than slight sludge) and an unconvincing LDDST......

Stick on 8 iu Caninsulin BID for longer??

RE: Just diabetes.......or something else?

Anthony Dennison — Fri, 26 May 2017 13:05:58 GMT

[quote user="Busybee"]

Many thanks, these were both the lines I was thinking along. Though if he has Cushings, why is his appetite poor?

[/quote]

The other consideration is that if he is cushingoid, they can be more prone to biliary sludging and cholangitis - this could be contributing to the abdominal pain and the reduction in appetite. Definitely worth an abdominal ultrasound scan.

RE: Just diabetes.......or something else?

Busybee — Thu, 25 May 2017 21:11:17 GMT

Many thanks, these were both the lines I was thinking along. Though if he has Cushings, why is his appetite poor?

RE: Just diabetes.......or something else?

Martin Atkinson — Thu, 25 May 2017 14:57:38 GMT

I think you've got to eliminate Cushings so a LDDS test is essential. If that is still inconclusive go looking for atypical HAC and test for ACTH stimulated 17-hydroxyprogesterone. Never lose sight of the fact that although dogs can be non-diabetic with pancreatic disease the pancreas is the common denominator and with evidence of pancreatitis I would looking closer at that - scan/pancreatic biopsy?

RE: Just diabetes.......or something else?

Braden Collins — Thu, 25 May 2017 14:46:32 GMT

Any time I see an old dog with diabetes I test for Cushings. It saves months of unsuccessfully trying to stabilise with insulin. I think it's worth a low dose dex test to make sure.

If that's clear, look for infection as that will affect insulin sensitivity, especially checking teeth and urinary tract.