2/19 (New member) Tommy. AMPS: 387. Dx'd 01/20. Vet increased to 4u today.

[Cozy Biscuits]

Hello everyone,
It's a pleasure to meet you all, my name is Gabby. I've been lurking for a few weeks and trying to get familiar with the forum. There is a wealth of information here- this has eased my tension about our situation a bit. I've included some background info on Tommy below. I've been following the vet's instruction regarding dosing over this past month. Please let me know if I can provide any further information.

Before the diagnosis...
My sweet Tommy (12 years old) was diagnosed 01/20/23. In the weeks leading up to this diagnosis, Tommy began urinating and drinking water more frequently. A few days before I made the appointment, Tommy would not leave my lap and seemed to be snoring while breathing when sitting in certain positions. His pupils were very dilated most of the time and I could tell he just did not feel good.

Diagnosis and medical history...
The vet did a chest x-ray and lab work (01/17/23). Tommy's labwork indicated that his thyroid reading was nearly non-existent according to the vet. X-ray came back normal (I was worried about the wheezing, vet seems to think it's just fat. Tommy is a bigger guy at 15lbs.) Vet requested Tom come back to test his BG, and he was officially diagnosed with diabetes with a glucose reading in the 400's.
Tommy was dx'd in 2021 with hyperthyroidism and received radioactive iodine treatment in October '21. Vet hasn't advised me further regarding the thyroid issue after the latest labwork. I'm wondering if he was very unlucky and now has hypothyroidism as a result of the RIT.

Insulin and BG home-testing...
We're currently dosing at 4u, twice daily with Lantus. Initially, I was monitoring his AMPS BG with the Relion Premier Classic. On 02/07/2023, Tommy had a Freestyle Libre 2 monitor installed and it will expire tomorrow. Tommy's doctor has adjusted his dose a few times over the last two weeks based on the readings.
I will resume monitoring his BG AMPS as well as PMPS with the Relion after tomorrow to get more accurate data for the SS. I'm new to this and initially believed AMPS value was enough to keep an eye on his day-to-day progress.

Food and feeding schedule
I have been feeding him a 2:1 ratio of Royal Canin Glycobalance wet food and Fancy Feast Classic Chicken Feast Pate each day, which ends up being 220 calories. I am working remotely so I feed him every few hours, whenever he's hungry, starting with his shot and the final meal usually once after the PM shot. Vet insists on only Glycobalance but I haven't discussed LC Fancy Feast with her yet.

Members, I seek your wisdom.
Do you think Tommy is on the right track based on his SS? I am not expecting a miracle overnight but I have not seen a positive improvement in the past few weeks. I just don't know what to expect. I would be eternally grateful if anyone has the time to look over Tommy's SS and let me know what they think about how he is doing, especially compared to your own cat's journey during the first month of treatment.

When we first got the dx, I was more confident that we'd get a handle on this sooner than later. However, over the past month it's really tearing my heart apart seeing my playful, mischievous sweet boy feeling ill. I can tell he is not happy and this all came on so suddenly. He's always been so healthy and it's killing me seeing him like this. I know you all feel the same way about your cats... he means everything to me. I would do anything to make him feel better as soon as possible.

Thank you for this community.

 

[Bandit's Mom]

Welcome Gabby & Tommy!

It is indeed really hard to see our kitties unwell. My Bandit was miserable for the first few months after we started insulin. Once her numbers got better and the neuropathy resolved, she was back to her "old self". Hang in there.

Royal Canin Glycobalance is 14% carbs. It is less in carbs compared to dry food and some other wet foods with gravy etc, but it is too high in carbs for a diabetic cat. You want to feed less than 10% carbs - preferably less than 5%. I guess you have seen this food list by Dr. Lisa Pierson, DVM. It's a little old and doesn't have all the foods in it though.
https://catinfo.org/chart/index.php

You might want to switch completely to FF pates since they are low carb. Not sure why your vet is asking you to continue with the Glycobalance - are you buying it from him? If you decide to make the switch, you want to make it very slowly and with close monitoring of his BG. The removal of carbs can make a big difference to a cat's numbers and reduce its insulin requirements significantly.

These are the dosing methods we follow. We do not increase by whole units. Even with TR, which is an aggressive protocol, increases are by 0.5U units if nadirs are over 300. Otherwise we increase by 0.25U every 3 days till you start seeing nadirs below 200.
Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

Dosing is based on nadirs. You want to get preshot tests as well as at least 1 mid-cycle test to see how low a dose is taking Tommy. Without enough tests, too much insulin can also look like too little insulin.

I don't have any experience with thyroid issues so I will tag a few experienced members.

@Bron and Sheba (GA)
@Wendy&Neko

 

[Diane Tyler's Mom GA]

Welcome Gabby and Tommy
I would also add to your signature
Tommy was DX'd with hyperthyroidism in 2021 and he received radioactive iodine treatment, Oct '21.
Yes the Royal Canin Glycobalance is 14% too high
Like Bhooma mentioned dosing is based on how low the kitty is dropping ,not based on the Pre Shot numbers
Do you have the U -100 syringes with the half unit markings?
If it wasn't for the advice I received from the experienced members here Tyler would not be in remission since 1-24-21. Knock on wood. You are in good hands here
Tommy is a cutie pie
@Cozy Biscuits

 

[Cozy Biscuits]

It is indeed really hard to see our kitties unwell. My Bandit was miserable for the first few months after we started insulin. Once her numbers got better and the neuropathy resolved, she was back to her "old self". Hang in there.

Yes the Royal Canin Glycobalance is 14% too high

Hello, pleased to meet you Bhooma and Diane! Thank you for the tip, I have updated my signature and I will pick up half-unit U-100's in the coming days. I'm relieved to hear that Bandit was feeling better (and neuropathy resolved!) after a few months of treatment. That lifts my spirits to have a general idea of a timeline when we can expect some progress. I'm also so happy for Tyler for reaching remission!!! That's wonderful. I'm grateful to have found this forum. Thank you for sharing their experiences (and for the compliment =^..^=)! I love seeing all these beautiful kitties.

As you both have mentioned, the Royal Canin Glycobalance is not a good choice. I just became familiar with Dr. Pierson's awesome food list within the past week. I'm not sure why our vet is recommending this, we're not buying it there so I'm assuming they're unaware of the high carb content I am going slowly phase the Glycobalance out in favor of the FF until we eventually find a better quality of food.

New question regarding dosing method:
I am very concerned that I have overshot Tommy's ideal dose due to the whole unit increases that have occurred the last two weeks, taking us from 1u to 4u. Due to this rapid series of dose adjustments and now switching food, would it be advised to stick with 4u or slowly reduce? I'd like to proceed forward with the SLGS method. I am concerned with glucose toxicity so I'm not sure if starting over would be advisable.

I'm sorry for the additional question outside of the original post. My partner wants me to stick with the vet's guidance but the rate/size of dosage increases and food rec's have given me pause which is unfortunate because I really do love our vet.
Thank you all for your help, I would love to know how you all would approach this going forward from your point of view.

 

[Bandit's Mom]

I'm relieved to hear that Bandit was feeling better (and neuropathy resolved!) after a few months of treatment. That lifts my spirits to have a general idea of a timeline when we can expect some progress.

For Bandit, it took a little while for her to get regulated and for the neuropathy to resolve. But ECID and some cats have gotten regulated much faster.

Regarding the dosing method, I am very concerned that I have overshot Tommy's ideal dose due to the whole unit increases that have occurred the last two weeks, taking us from 1u to 4u. Due to this rapid series of dose adjustments, would it be advised to stick with 4u or reduce in order to follow a SLGS method? I am concerned with glucose toxicity so I'm not sure if starting over would be advisable.

Thus far it doesn't look like you have overshot a good dose. You have enough data and he is seeing nothing below 250 and you are right to worry about glucose toxicity. Going forward, you might want to increase per the TR protocol and get enough tests to determine his nadir. You don't want to increase in whole units - especially if you have a food change to contend with as well! If you can get at least 4 tests per day - 2 preshots and 2 mid-cycle - you want to consider TR rather than SLGS. With TR you can get him to a good dose sooner.

 

[Wendy&Neko]

Hello and welcome to you and sweet Tommy.

If you had overshot the dose, Tommy's numbers would have dived down at some point. Since you have the Libre on him, you know he did not. Thus he's not on too high a dose. A combination of things mean he needs a higher dose, one being the higher carb food.

Getting to blood sugar regulation can take months, many in the case of my girl. She was "complicated", but did eventually get there.

It's not uncommon for cats to go hypothyroid as a result of radiation. The solution is a small pill a day, levothyroxine. Your vet needs to treat this if Tommy is hypoT. I know that hyperthyroidism can make regulation harder, I don't know about hypoT. That is less common.

 

[Dyana]

My non-diabetic kitty Ginger had the i131 treatment for her hyperthyroid and she went hypothyroid. Dr. Peterson waited a year to see if her remaining thyroid would recover and then started her on levothyroxine. She gets a half of a tiny tasteless pill that dissolves in water mixed in with her breakfast each morning. And routine bloodwork to make sure the dose of thyroid hormone is correct for her.

It would be good if you could make bold (or colored) the lab work results that are out of range in your Labs sheet.

 

[cecile & bella]

Hello Gabby and Tommy, welcome!
Oh no, you are not alone, it is so sad to see your cat become different. When Bella was diagnosed she changed completely, she is a very happy and loving cat and she was almost agressive and started stealing food, she kept missing her litter box, was limping, and just looked miserable.
Everybody here was so helpful and welcoming, and if you look at Bella's spreadsheet you will see how quickly her numbers went better after I joined here. I am so, so grateful to everybody who helped and keeps helping us. It felt to me like Bhomma and Diane and Rain and Suzanne and many other wonderful people here were behind me at all times. And they still are
It's hard at first to listen to advice that goes against what your vet says. But you will meet here people who have a great experience in cat's diabetes, which is not always the case of veterinarians.
I am glad you arrived here and feel very confident that your beautiful Tommy will get better

 

[Cozy Biscuits]

Thank you all so much for the tips and for sharing your experiences here. I appreciate the kind words here very much and the warm welcome I'm pleased to meet you all and I love seeing your beautiful fur babies in the photos! I need to start a new thread as there has been a large shift in Tommy's readings today. Thank you all again.

My non-diabetic kitty Ginger had the i131 treatment for her hyperthyroid and she went hypothyroid. Dr. Peterson waited a year to see if her remaining thyroid would recover and then started her on levothyroxine. She gets a half of a tiny tasteless pill that dissolves in water mixed in with her breakfast each morning. And routine bloodwork to make sure the dose of thyroid hormone is correct for her.

It would be good if you could make bold (or colored) the lab work results that are out of range in your Labs sheet.

Updated! Thank you for the tip and thank you so much for sharing Ginger's experience post i131. It seems like kitties going hypothyroid after this treatment is not as uncommon as I thought. I'm checking back in with the vet tomorrow regarding the hypothyroid, I'm happy to hear the medication is simple to administer.