Cushing's and diabetes.

Dr. Marie replied:

Hi and thanks for your question. I have to tell you that this was a very strange coincidence. I received your email while I was in an appointment (my blackberry went off). The appointment that I was in was for a dog with cushing's and diabetes who is now having a balance issue. How strange!

This is a tough question to answer as dogs with diabetes and cushings are complicated and difficult to treat.

Often dogs with Cushing's will be very hard to regulate on insulin. It is not uncommon to see either fluctuations in glucose level or extremely high levels of glucose even though we are on a high level of insulin.

Have you done a glucose curve on Chester, or are you just having occasional blood glucose tests done? You may want to ask your vet about doing a curve as this can tell us a lot about what his glucose levels are doing throughout the day. Sometimes what we will see is that a pet's levels are super high and then they suddenly drop to dangerously low and then the body spikes the levels up high again. If this happened, then during the super low time he could definitely be wobbly.

Were either of these glucose tests done while he was wobbly? If so, then the wobbliness was not due to low blood sugar because both of these numbers are higher than normal.

Did your vet do any neurological tests? One such test would be to try to knuckle his hind feet over so that he is standing on the tops of his toes. A normal dog will instantly place his foot back in the normal position. But, if he doesn't this can mean that there is a problem with the spinal cord. This could be something totally unrelated to the cushing's and diabetes. Both corgis and daschunds are susceptible to back problems so this could be what is causing him to be unsteady.

Another possibility which will be hard to test for is a brain tumor. When a dog has cushing's it is due to a tumor either in the brain or in the adrenal gland. The most common of these two is brain. While it is rare, some dogs with a tumor in the pituitary gland in the brain can have neurological signs such as seizures or wobbliness.

Here is another thought...some dogs will have weakness because of having glucose levels that are too high for too long. You may want to ask your vet about seeing if it is worthwhile to try a different type of insulin to see if he would respond better to it.

It's hard to answer your question about his prognosis. I think this depends on how the next few days go. It is really hard to treat both cushing's and diabetes. As you know, it is quite expensive and a lot of tests need to be done. While I have seen some dogs do well with treatment, some just do not.

Let me know if you have more questions as this is a complicated issue! I will be offline now (bedtime for me!) but will be back online tomorrow.

I hope things are ok!

Dr. Marie.


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Dr. Marie replied:

Oh, these are always tough situations. It sounds like both you and your vet are doing the right things.

I'm wondering if Chester's symptoms could be related to a tumor in his brain. Dogs with cushing's will usually have cushing's because of a tumor in the pituitary gland of the brain. It's not common but sometimes the tumor can grow to the size where it causes neurological symptoms like you are seeing.

I do find that most of my clients just seem to "know" when it is time for euthanasia. This page has some information that might help you to know when it is time for euthanasia.

From what you have described, I am concerned that time may be coming soon.

I'm so sorry.

Dr. Marie.