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Cushing's and diabetes.

Species: Dog
Breed: corgi/dachshund
Age: 11-15 years
My dog was diagnosed last month with cushings disease and diabetes. He's up to 14 units of insulin twice a day and trilostane 30mg twice a day. His blood sugar was at 600 and yesterday it was 265. The reason I had his blood sugar checked,he was listing to one side and losing his balance. The vet took a blood sample and injected sodium under the skin, and gave him 2.5mg of prednisone. It didn't help and the blood tests came back pretty good considering everything, but no answer to his lose of balance problem. I'd like an honest prognosis for him. I'd do anything for him, but I don't want him to suffer in the process if it might not make a difference. Can you help me make sense of all this? Thank you so much!

Online vet, Dr. Marie

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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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

Thank you for responding so quick! We have done the glucose curve and he starts high(500-600+), then midday he's 260-300 and then starts coming back up again. She did check his legs and back. The unbalance just started and is getting worse. This morning now, his front legs are wobbly and there's a slight back and forth movement of his head. I know these diseases had been present for a long time with no noticable symptoms and for it to get so bad so fast is hard to watch. I rescued Chester when he was 4 (really, he rescued me!) and he is the best dog ever. He lives to please, and now it seems like he's asking me, please...

Thank you again,
Margaret and Chester

Online vet, Dr. Marie

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.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.