Diabetes or Cushings

RE: Diabetes or Cushings

Robin Grimmer — Fri, 19 Oct 2018 18:18:22 GMT

No point doing anything until you've stabilised the diabetes. The diabetes will cause raised alp. If it won't stabilise then you go looking for underlying concurrent disease.

RE: Diabetes or Cushings

Cool — Fri, 19 Oct 2018 16:31:12 GMT

I have had similar cases in the past. had a dog with overt diabetes mellitus and raised liver enzymes. liver scan revealed liver disease (liver cirrhosis). I was not sure which one came up first, whether the liver disease or the diabetes. A significant number of human patients with liver cirrhosis tend to end up diabetic. many of them show evidence of insulin resistance without initially showing clinical signs of diabetes mellitus. So i will advise further evaluation of the patient for liver disease via a liver scan, definitely do your ACTH stimulation test and consider starting the dog on low dose insulin to regulate the serum sugar level. remember fructosamine tells you what has been happening with glucose over a few weeks. it is possible fructosamine has not had much time to rise yet.

I will definitely assess the patient for liver disease, do urinalysis and ACTH stim test (what is the urine SG) and consider starting low dose insulin and go from there. I think this is one of those cases that will slowly unravel and you will have to change your plan or approach as you know more.

RE: Diabetes or Cushings

Sarah Keir — Thu, 18 Oct 2018 22:36:13 GMT

But if you do an ACTH stimulation test in an uncontrolled diabetic, you are going to get an abnormal result but not know how to interpret it as ACTH stims are very prone to effects of stress, in this case a disease stressful on the metabolism.

RE: Diabetes or Cushings

Noweia — Thu, 18 Oct 2018 17:48:41 GMT

Bit of a zebra here, but we had a similar cluster of signs in a dalmatian that was eventually diagnosed with SARDS.

If cost is not an issue an ACTH stim would help?

RE: Diabetes or Cushings

Rob Loxley — Thu, 18 Oct 2018 15:38:27 GMT

[quote user="Anthony Dennison"]Diabetes Mellitus or just insulin resistance from Cushings?[/quote]

How often does Cushing's cause enough insulin resistance to 'create' diabetes, my experience of the 2 together is that it just complicates managing an already diabetic dog?

[quote user="Anthony Dennison"]plan was to start the dog on insulin and if she didn't stabilise well then do an ACTH stimulation test[/quote]

I'd go with that. Best avoid it entering DKA...!