Jack is possibly insulin resistant. :-/

Jack now has Addison’s Disease due to not having enough cortisol. He had Cushing’s due to too much cortisol, but apparently the Mitotane killed too many cells in the adrenal gland, so now it’s not producing enough cortisol. He’ll be on an injection once a month for the rest of his life. We have to give him Prednisone to help restore cortisol. My poor guy, he is acting hungry and tired all of the time. I bought all of the testing supplies but still haven’t been able to get enough blood for the test strip. We got the Freestyle Libre 2 reader and sensor last week, it seems that the readings only go up to 400, so I have no idea how high his sugars are. Every time we check them, it’s at the max level of 400 on the reader. Once it did show 378 and another time 379. But other than that, it just shows HI and when I transfer the data, it shows he was exactly at 400 for all of the other tests. So I’m pretty sure it doesn’t read over 400. The vet believes he may be insulin resistant. I was thinking of purchasing the genteel device to use for testing. But what if that doesn’t work either? Then I’ll be out $70 on that. I already have the meter, test strips, lancing device and lancets not being used. It isn’t about the money, but I’ve spent close to $4k since he was diagnosed in January. My only other option would be to bring him to the vet to get tested once a week, they charge me $40 each time. But then that’s just sporadic testing and I’ll never know how his levels are at any other time. Even if I do test him and his levels are still high after taking 18U of insulin, what would I do? I already feel like he’s on a high dose. He seems miserable, he doesn’t want to play. He only gets up to eat, drink or go outside. We switched insulins from Vetsulin to Prozinc. We’re now at 18U twice a day and his reader still just shows HI. :-/ We’re injecting into the back of his neck area because that’s the only place we can get enough skin to tent. I feel like I’m failing him.

Update on Jack 3/24/21

3/22/21 - after 7pm Jack vomited. 3/23/21 - had multiple accidents on the kitchen floor, wasn't interested in eating breakfast and he was drinking a lot of water again. Damian texted me around 1pm saying Jack threw up 5 times. I called the vet, they wanted us to drop him off so they could squeeze him in to be seen. They ran some bloodwork, he was dehydrated, his cortisol was really low and he had low sodium and high potassium. All of this was an indication that the adrenal gland is now under producing cortisol, which could be fatal. We were instructed to stop the mitotane, hold off on the pimobendan (heart meds) for the night and only give insulin if he kept his food down for 90 mins after dinner. We need to keep him out of any stressful environments, him getting stressed activates some other hormone which isn't good for him at this time. They also ran a test with his blood work, fructolose(?) or something like that, it will tell us how effective the insulin has been. Which I'm thankful for because I feel like he is on a super high dose.

Jack’s glucose this week...

Today his blood sugars were 142!! 

Week 1 -600’s (started 5units 2xs day vetsulin)

Week 2 -550 (increased to 10units 2xs day)

Week 3 -440 (increased to 15units 2xs day)

Week 4 -142 (holding at 15units for the next week to see how he does)

Thank goodness, I was getting pretty concerned with him being on such a high dose. 

He did throw up A LOT overnight last night. 

But since he devoured his dinner, we’re not going to treat it like a mitotane overdose. 

Update on Jack - Cushing's and Diabetes

Jack had his ultrasound yesterday. They did not see a tumor on the adrenal glands, there wouldn't have been concern of cancer, they're just narrowing down the reasons for high cortisol levels. After the ultrasound they completed a cortisol blood test, which did confirm the Cushing's diagnosis. His blood sugars during fasting were 565. We're going to increase his insulin from 5 units twice a day to 8 units twice a day. We are going to start on a medication called Mitotane. This is the scary part. The Mitotane will help reduce his cortisol levels by destroying parts of the adrenal glands. But it can be life threatening if it gets too low. And the symptoms of that are pretty much the same as his Pancreatitis episodes. It's all so overwhelming.

Below is some info that I found on the Mitotane research I've done so far. I don't have all of the answers yet, but I'm compiling a list of questions to discuss next week with the Dr. My comments are in italic.

Mitotane and trilostane therapy are effective and relatively safe in dogs with adrenal-dependent hyperadrenocorticism. Dogs with adrenal tumors however, tend to be more resistant to mitotane and trilostane than dogs with pituitary-dependent hyperadrenocorticism. This is why we didn't want a tumor!

Dogs with Cushing's disease have elevated levels of cortisol, which increases triglycerides and cholesterol. To help combat these increases, a food that's lower in fat (less than 12 percent on a dry matter basis, or DM) and moderate in crude fiber (8-17 percent DM) is reasonable. But as you'll see below, it's preferred that you give the Mitotane with a food that is high in fat.

The basis for increased panting in dog's with Cushing's disease is multifactorial. First, Cushing's disease results in increased fat deposits in the abdominal cavity and around the chest. This might explain the fatty deposits he began getting a few years back. I'll have to reach out to his prior vet and request his records.

Second, an increase in liver size impedes the diaphragm from being able to expand with ease. Mitotane, also known as o,p’-DDD (brand names: Lysodren®, Lisodren®) is an anticancer medication that is toxic to the adrenal gland cells and is used to treat hyperadrenocorticism (Cushing’s disease) or adrenal gland carcinoma. Its use in dogs and ferrets to treat adrenal disorders is ‘off label’ or ‘extra label’. Many drugs are commonly prescribed for off label use in veterinary medicine. In these instances, follow your veterinarian’s directions and cautions very carefully as their directions may be significantly different from those on the label.

Mitotane is given by mouth in the form of a tablet. It should be given with food, preferably one high in fat. Your veterinarian may provide you with a high fat pet food, or you can give the medication with a little corn oil, butter, or cheese. Wear gloves when administering this medication and do not allow the medication to come into contact with your skin, eyes, or mouth. Wear gloves when handling your pet’s urine, feces, or vomit, as the drug may be present.

The following medications should be used with caution when given with mitotane: central nervous system (CNS) depressant drugs, fentanyl, insulin, midazolam, phenobarbital, selegiline, spironolactone, or warfarin. Your veterinarian will monitor your pet to be sure that the medication is working by monitoring clinical effects and performing regular ACTH response tests. Your veterinarian may also monitor liver and kidney values, blood cell counts, blood sugar levels, and blood electrolytes. Regular monitoring at home for adverse/serious side effects is very important in addition to regular monitoring by your veterinarian.


Recommended Facebook Groups: Support group for owners of dogs with Cushing’s disease Dogs with Cushing’s support and information Canine diabetes support and information