Cushing's diagnosis

[Janie Janich]

Hi, I was advised to post here my situation with our hairless sphynx, Bazzy.

Some background on Bazzy, she is about 11 years old. She has always had diabetic issues in the past. My family was able to get her into "remission" and off of insulin through diet. But I am led to believe she either relapsed, or her having cushing's disease caused her to go backwards in progress. She was recently diagnosed with Cushing's disease a few weeks ago. This is making it incredibly difficult to get her blood sugar(often between 400-500) under control and she has lost a lot of weight, probably at least 4 pounds. She's basically skin and bones, and her skin is is very fragile, thin and bruises easily. Before we knew what was going on, she would pretty much be curled up in a ball 24/7 sleeping and feeling too sick to do anything.

We have since gotten her back on insulin, and the medication vetoryl for her cushing's disease. Here are some of the basics that are pretty important in our situation.

• The vet told us to give her 1 unit of Vetsulin if she is above 275. If she is below 275, she gets no insulin. If she is in the higher ranges like 350ish or 500, she gets 2. The vet also said only twice a day and nothing more.
• The vet wanted her to be on a 2x a day feeding. One in the morning, one at night. And they want her to "eat until she walks away."
• She is on the DM Purina Pro Vet Died(minced wet food) currently. She eats a whole can twice a day.
• I do test her before insulin injections and also in between.
• She gets her vetoryl medication for cushing's disease after her night time feeding. So we have her on a 9 am to 9 pm schedule for insulin.

I now have since been recommended to switch her insulin over to Levemir or Lantus insulin. So my questions are basically...

1. Which of the two should I give her? Levemir was recommended at higher doses.
2. How many units do I give based off of her blood sugar levels? Is it the same as above and that's a good guideline to follow?
3. Should we no longer have her on a 2x a day feeding schedule per the vet's instructions? I'm all so very confused.
4. Which food would be best based off her having both Diabetes AND Cushing's disease for lowering her blood sugar down?

If anyone has any questions, I can answer the best I can. She has only been on Vetoryl for 10 days now and it needs more time to work if it even will work. I've been trying to research as much as I possibly can. I just want the best for my Bazzy, but I have never personally dealt with Diabetes let alone Cushing's disease in a cat. If anyone can offer advice and can answer my questions, I would be so grateful.

I will also add, the last 10 days I have noticed a slight change in her demeanor, despite her blood sugar being on the higher end. She has more energy, she's staying awake a lot longer, not constantly in a ball.

 

[Wendy&Neko]

Hello and welcome to this forum. Sorry you are dealing with Cushings but it's good you've got a diagnosis and have her on Vetoryl. Now onto the other questions.

Yes, Vetsulin is not even a recommended insulin for any cats. Lantus, Prozinc are, and Levemir is very similar action to Lantus. Personally, I liked Levemir best (flatter numbers) and is a good choice if Bazzy should ever need higher doses as Lantus acid base can sting. Some cats on lower doses also notice the sting. Levemir does have a later onset and nadir than Lantus, which can mean a change to when you are testing blood sugars. Personally the Levemir schedule worked better for me.

We can't really help with dosing and units unless we see the blood sugar data you've collected so far. We are very numbers based in our suggestions.

You don't need to have her on a 2 a day feeding schedule, and it's probably better to spread the food out a bit in the first half of the cycle. With Vetsulin, which hits hard and fast, you do want her to have eaten at least have her AM or PM food early on. But it's good to have food available for later when the insulin is still strong. Eating is how Bazzy can keep herself in safe blood sugar numbers.

As for food, any low carb diet is fine for both Cushings and diabetes. There are lots of low carb options, the "vet prescription" food is not the best choice in quality, price or carbs. Note that DM stands for dietetic management, not diabetic management. We suggest feeding food under 10% carbs. This food list, though a bit out of date, lists the nutritional breakdown of a lot of foods in the US. Food chart link. If you do switch her food, do it gradually to prevent any GI issues and if you go to a lower carb food it may change what insulin dose she needs, so you will need to make sure you are monitoring her closely.

If you'd like more help regarding dosing, it'd be great if you can put the blood sugar test values in a spreadsheet. Details on how to get started here, including information for the signature and setting up the spreadsheet, are in this post:
New? How You Can Help Us Help You!

Cushings specific info: Have you seen this article on treatment with trilostane (Vetoryl is brand name)? Link to article describing case of trilostane treatment

Second article on treatment of HAD, including trilostane, for those thinking of trilostane (Vetoryl), a good read and be prepared for sudden drops in insulins needs.

And I'm attaching a third article on Cushings that talks about Vetoryl, though briefly. Sorry for the fuzziness.