Tyler's Story

I firmly believe there are angels walking among us on earth. My angel came to me as a black Miniature Schnauzer named Tyler. When I went to the breeder to look at another younger puppy, Tyler was sitting in a cage all by himself. His eyes followed me wherever I went. When I stuck my fingers in his cage-he licked them and wagged his tail so happily. My heart was his forever! However, at 12 weeks old I wondered why was he still there? I now know God had meant us to be together. Tyler came to me at a time when I needed a buddy. Now he's the one that needs me.

Tyler was born Jan 21, 1991. For 6 years he had no major health problems. In April 97, we noticed he was drinking and urinating excessively. Within two weeks we had him at the vets, who diagnosed him as diabetic. His life from that point on gets complicated.

We had trusted Tyler's vet for many years. Tyler's blood glucose on the initial visit was already in the upper 300 range. However, the vet didn't start him on insulin right away. Instead, he told us sometimes with weight loss and diet his diabetes would correct itself. We were also told regardless of what we did-Tyler would only live 6 months. We were devastated!

A month later we took Tyler back for a complete Blood Chemistry and fasting CBC. The vet said he was going to keep him over the weekend to get him stabilized. The next morning, his office called and said he had got Tyler BG down to 200-Come and pick him up. After learning more about diabetes, we realized the reason his BG was "lower" was because Tyler doesn't eat away from home.

Tyler was started on 4 units of NPH Iletin I once a day. We increased the insulin 1-2 units every 2-3 days until we reached a maximum of 22 units. Throughout, we realized the insulin was only lasting a max of 11-12 hours. We kept asking his vet to put him on 2 shots a day. He would always say no-it was too hard on a dog. However, on every visit Tyler's BG was in the 300+ range-within a few hours of his injection. The vets opinion-Tyler was doing wonderful! Our opinion-we could see him getting worse. In July we sought a new vet.

On the first appointment Tyler's BG was 400. The new vet believed Tyler was resisting his insulin and wanted to rule out any medical reasons. At the time I believe he also thought Tyler's first vet had done everything possible to stabilize him. It also didn't help matters that the first vet told him WE were the ones who couldn't get him under control.

He did a blood profile which showed most of Tyler's levels were elevated. The most concerning-his liver enzymes, alkaline phosphate, cholesterol and steroid levels. The levels were some of the highest Tyler's new vet had ever seen. He suspected Cushings. Both an ACTH and low dexamethasone were done-both came back with positive readings. His vet also believed Tyler had only Cushings and once that was controlled he wouldn't need insulin.

Tyler was started on rapidly increased insulin shots given twice a day. At one point going as high as 36 units total for the day. We also started the loading procedure of Lysodren. He was also started on prednisone to counteract steroid withdrawal.

Our vet decided the loading should be done at home. The main indicator when the loading is complete-is they go off their food. Since Tyler wouldn't eat away from home-that would cause a major problem.

Tyler never reacted normally to the Lysodren. We gave him 1/2 of a 500mg pill of Lysodren once a day. Our vet told us he thought we wouldn't see a reaction for at least 10 days. After almost 2 weeks he still hadn't responded. An ACTH test was than done, which showed Tyler's cortisol level was below normal. We stopped the loading and gradually decreased the prednisone. The maintenance dose of Lysodren was begun the next week.

From that point on it was a BATTLE! We'd increase the Lysodren. We were able to decrease the insulin. A few days later we'd have to increase the insulin again. ACTH rechecks were done-which showed he needed more Lysodren. It was a constant cycle!

Finally, we were at the maximum safe dose of Lysodren at 2 pills of 500mg each per week. His vet wasn't comfortable with how Tyler was reacting and not reacting to the Lysodren. He referred us to an internist and also an ophthalmologist in Nov 97.

In Sept, Tyler also lost his eyesight overnight. He had been to the vets the day before. At that time he felt Tyler's cataracts weren't going to be a problem. In fact when his eyesight went so suddenly, he was convinced it was SARD (which is believed to be connected to Cushings) Tyler's eyes had watered since his diabetic diagnosis. Both vets advised us diabetics get watery eyes-nothing to worry about.

We saw the internist in Nov. He reviewed Tyler's previous tests and history. It was his opinion, Tyler never had Cushings. They kept him 24 hours to run tests. Tyler's adrenal glands were sonogrammed twice. The first time-he couldn't find them, they were abnormally small. He confirmed that Tyler never had Cushings and if we continued with the Lysodren-we would kill him.

The internist said Cushings is very hard to diagnose-in fact it's "overly" diagnosed too often. However he understood why Tyler's vet thought the way he did based on Tyler's elevated levels. Tyler's uncontrolled diabetes had put a lot of stress on his system. This resulted in the high levels and false positive readings. Also when a normal dog (one without Cushings) is given Lysodren-their body fights it, making it seem at times as if the Lysodren is working to some extent. In turn Tyler's body was also fighting the insulin. Everything he said made complete and perfect sense. A month later, Tyler had a ACTH done which came back normal-No Cushings.

THE BOTTOM LINE:

When diagnosing Cushings a vet shouldn't rely only on tests or lab results. There should be some physical symptoms present. Also when dealing with a possible diabetic-all efforts should be made to stabilize them first on insulin.

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The following page has moved to the Pet-Diabetes site:

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Date Last Modified: 5/30/99