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Cushings And Diabetes

by tainab25 - November 18, 2009

Hello Steve,
my new patient is a 13 ry Lhasa apso fs, hx of Diabetes usually glc around 300,but as of yesterday high bloodglc in 500 range, pupd.
hx of cushings, potbelly and alopecia, trilostane was tried, but made the dog sick.
Hx of allergies, pruritic, erythematous lesions inside ellbow. licking paws.
hx of uti, on maintenance clavamox sid.
earlier this year she had glaucoma and both eyes were removed.
Hx of deformed frontlegs (bowlegged and patella lux bilat and has had multiple sx to correct).
She is a rather aloof little thing, barking excessively and some loss of cognition since the husband died 4 weeks ago.Does not like the needles, hates to leave home, worse w damp weather, likes to sleep on hard floor and will get exhausted with exercise. Lately has decreased appetite and occ. vomiting. also has hx of mucousy diarrhea.
Pulse is thin, slippery/wiry, fast, weaker on left.
Tongue is swollen, purplish and dry.
She is on zhi bai di huang wan, urinary support formula, tramadol, fishoil, clavamox maintenance, alprazolam as needed for nighttimerestlessness which o attributes to pain, metagenics: cortico b6b5, transfer factor,atarax for itch, amlodipine for high bp.
I think that is it.wow.
I am seeing mainly damp heat, sp/ki/jing deficiency and yin deficiency.
I am thinking about adding in si miao san and some homotoxicology by heel aimed at diabetes an cushings (blood 9/28/09: high ALKP, BUN 32, GlC 490CHOL 475, TRIGLYCERIDES 659 H, PROTEINURIA).
I am unsure about the tcvm picture.
What do you think.
I did acupunture: bl22, 21, cv 12, r gb 34, l st 36. That was all she/the owner tolerated and it made her feel good for about 1/2 a day.
Sorry for the long post
thank you very much
Tina

by naturevet

November 18, 2009

Hi Bettina,

I agree with your assessment of Damp Heat being the big problem here, and that you need something on board to deal with that. Si Miao San was the first thing I thought of, too. If the Cushing's is pituitary dependent, it's a good choice, but only if you also change the diet away from carbs and processed foods. A home-cooked or raw diet (commercial versions also fine here) would be ideal.

The only finding that gives me pause is the purplish tongue, which is more consistent with San Ren Tang, also a Damp Heat formula. If the pulse becomes deeper and more toned with time, SRT might be a better choice. For now, though, I'd use SMS, just like you were thinking. The only possible problem would be if you were dealing with a primary adrenal tumor. In that case, SMS may not help much, and may actually de-stabilize the blood sugar. If that happens, then I'll be expecting to see you back here with the latest data on the dog. But if it's PDH, then SMS is an excellent choice.

Steve

by tainab25

November 19, 2009

Hi Steve,
Why would Si miao San make it potentially worse if it was a primary adrenal tumor?
As far as the Owner knows, the adrenals have been fine on ultrasound.
thank you so much for your advice
Tina

by naturevet

November 20, 2009

Hi Tina,

It wouldn't be the Cushing's that got worse, but the diabetes, potentially. One of the ways the formula counters insulin resistance and weight gain is by promoting Kreb's cycle activity, so nutrients are metabolized as opposed to deposited as fat. Thus, in a type 1 diabetic, for example, SMS could end up aggravating glucose control, since there is no insulin resistance to counteract (the problem isn't obesity). We've seen this in one or two cases (dogs only).

In a type II or insulin resistance case, it works well, in party by promoting lipid metabolism and reducing body fat stores. Given that your case is the PDH form of Cushings, it would probably be okay. But I just wanted to let you know you should continue to monitor the blood glucose, although I guess it's very unstable already, isn't it?

Steve

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