PU/PD dog

Re: PU/PD dog

Edward Jones — Sat, 05 Feb 2011 08:52:50 GMT

Interesting comments, thank you.

Re: PU/PD dog

Kate Richardson — Fri, 04 Feb 2011 22:19:34 GMT

[quote user="David Beattie"]

Agree with everythng said, but is checking the urine for glucose actually telling us anything we don't already know? If the blood glucose conc. is above the renal threshold for reabsorption (as it is) then surely glucosuria is inevitable and hardly of diagnostic significance (at least in a sample obtained around the same time as the blood sample already documenting the hyperglycaemia)?

[/quote]

Glucosuria would indicate a more persistent hyperglycaemia, whereas a one off high blood glucose could be just that- a one off, can occur in dogs due to stress as well as cats, although not as often. Also an in house urine assessment is a cheap test, and will also give you indications of any UTI as Rob suggested, plus checking for ketones.

If there are financial constraints, I wouldn't bother with a fructosamine, checking a fasting blood glucose and establishing a persistent hyperglycaemia will tell you what you want to know; fructosamine won't change what you do. Useful for monitoring (sometimes), but I am finding them less and less reliable compared to assessing clinical stability in my diabetic cases.

I have seen a case which had an acth stim result that was consistent with cushings that didn't have it, so agree caution needed when concurrent diseases going on. So would also agree, determine if the dog has diabetes first and then treat this, and re-evaluate liver enz and revisit Cushings if not stabilising.

Re: PU/PD dog

Rob Loxley — Fri, 04 Feb 2011 22:08:45 GMT

A check for secondary UTI would be worth getting a urine sample for too

Re: PU/PD dog

Anonymous — Fri, 04 Feb 2011 20:51:21 GMT

Re: PU/PD dog

nikki — Fri, 04 Feb 2011 20:24:28 GMT

yup, i would check a urine sample for glucose, run a fructosamine and if high then start tx for DM. Would only test for Cushings if not getting the DM under control.

Re: PU/PD dog

Rob Loxley — Fri, 04 Feb 2011 19:45:17 GMT

[quote user="Christopher Saul"]Just a thought of caution on this - It is possible to have significantly elevated post ACTH stimulation in non adrenal illness - because of pathological 'stress'. I have once heard (though not seen this myself, only a rumour) of a post ACTH of >1000 in a dog which did not have cushing's.[/quote]

Have had one of these recently that had high BG, fructosamine and glycosuria, but also very high ALP and positive ACTH and LDDST. After some helpful advice we treated with insulin and are well controlled so have put the possibility of Cushing's aside and the dog is doing well.

Re: PU/PD dog

Christopher Saul — Fri, 04 Feb 2011 16:06:32 GMT

[quote user="i am ed"]Initially I intend to do an ACTH stimulation - if positive will start treatment for Cushing's, if negative will start tx for DM[/quote]

Just a thought of caution on this - It is possible to have significantly elevated post ACTH stimulation in non adrenal illness - because of pathological 'stress'. I have once heard (though not seen this myself, only a rumour) of a post ACTH of >1000 in a dog which did not have cushing's.

Therefore my approach is generally to establish if DM is present ( and my criteria for this would be persistent hyperglycaemia and glucosuria). I then treat the DM and only test for cushing's if I have evidence for insulin resistance.

It is possible to get very severe elevations in ALKP in diabetes melitus alone (because of secondary hepatic lipidosis). Also, cushing's alone isn't going to kill a dog, though treating a non-cushingoid dog with trilostane would be potentially hazardous.

I would try to demonstrate if this dog has DM - a second BG and a urinalysis - and if so treat the DM first

hope this helps

Chris

Re: PU/PD dog

Edward Jones — Fri, 04 Feb 2011 15:09:22 GMT

There are some financial constraints. Initially I intend to do an ACTH stimulation - if positive will start treatment for Cushing's, if negative will start tx for DM.

I have a resource ('5 minute vet consult') suggesting that although hyperglycaemia is common in Cushing's, only 10% of cases in dogs have concurrent DM. Do you think this dog could only have Cushing's? I think the level of hyperglycaemia is too high for this in this case.

Re: PU/PD dog

Mark Holmes — Fri, 04 Feb 2011 14:59:27 GMT

Diabetes +/- cushings +/- liver disease.