Management of Cushing’s Syndrome in Diabetic Cats and Dogs

Presentation Description / Summary: Cushing’s syndrome is the most common cause of insulin resistance in diabetic dogs in populations where early neutering is routine. Spontaneous Cushing’s is less common in cats, but iatrogenic Cushing’s will impact feline diabetic management. Affected dogs and cats might present with high insulin requirement and/or excessive glycemic variability. Confirmation of the diagnosis of Cushing’s syndrome is often challenging. The sensitivity, specificity, negative predictive value, and positive predictive value of available tests when used in diabetic animals will be discussed. Practical guidelines on appropriate interpretation of test results will be provided, along with discussion of the available options when test results do not match the clinical picture. Management requires strategies to achieve and stabilize glycemic control in addition to treatment of the underlying Cushing’s. New approaches using basal insulin therapy with glargine U300, or basal-bolus insulin protocols, have improved glycemic outcomes. Practical guidelines to recognize and manage corticosteroid-associated insulin resistance will be provided. There is not consensus on the best treatment and monitoring protocol for the most common cause of Cushing’s syndrome in diabetic dogs – pituitary-dependent hyperadrenocorticism. The main challenge in these patients to balance the benefits versus the risks of medical control of hypercortisolism. Treatment guidelines to reverse insulin resistance while minimizing the risk for hypoglycemia and/or hypocortisolism will be discussed.

Learner Outcomes: 1. Interpret the results of tests for hyperadrenocorticism in diabetic animals 2. Recognize corticosteroid-associated insulin resistance and treat using either basal or basal-bolus insulin therapy 3. Manage the benefits versus the risks of treatment of hyperadrenocorticism in diabetic animals.