4/20 Leko AMPS/389 +4/122...+11/425

[heatherh]

Hey guys! So we recently managed to (finally...grr) get Leko's hyperthyroid into range with meds. We had to switch to a liquid methimazole that appears to affect his BG. I'm not sure he was ever really regulated before that, but now it's worse.

With vet's approval, we upped his lantus dose a bit (from .5u to something like .65 - the plunger on the fat side of the .5 line). He's been on that dose for about a week now. Did a curve today.

The dose increase doesn't appear to have made much of a difference to me. Curious what you guys think. Technically, the +4 105 on 4/11 would have indicated we shouldn't increase his dose. Today's nadir was +4 122.

The thing is, he's still having symptoms. Lots of drinking and peeing.

The methimazole is mixed into a liquid suspension. Ingredients are aspartame (5mg per dose), silica gel, and tuna-infused canola oil. The pharmacist says the amount of aspartame is small and "shouldn't" be a problem, but could be and he can mix without the aspartame.

 

[heatherh]

Anyone? I'm only seeing guidelines that say don't increase the dose for nadir <150 and good clinical signs. What if we have bad clinical signs?

 

[carolynandlatte]

When do you give the medication?

It looks like prior to the medication you were possibly giving too much insulin. Even with few spot checks you caught some pretty low numbers...one worthy of a decrease!

I can see how the preshots increased quite a bit after starting the new form of medication. BUT, it also looks as if a good portion of the time you are not getting tests before shooting in the evening. Some cats are known to go lower at night. WIthout knowing where Leko is starting, its hard to say if he is going to low, or staying high and flat. Another key that he could be going low at night is that your a.m. preshots are the one's which are often the highest.

I'm not sure I would increase anymore until you could get preshot tests in the evening and possibly a test before going to bed at night (at least a few times each week). You can follow up with spot checks where ever else you can, and do a curve in another week or so. Lantus dose is based off of nadir (low point in cycle). That is what should guide you when deciding on your dose.

In case you are interested, there is a pharmacy that can compound the methimazole into a transdermal gel. They have many other options that may be 'sugar free'. I have used the gourmed treats before and *think* there was some sugar in it, but hard to say since it was a steroid. Anyway, you can look at their site and see if it is worth trying:
http://www.wedgewoodpetrx.com/symptoms/hyperthyroidism.html

Since you have the hyper t under control, it is possible the diabetes is causing symptoms. It does get tricky with concurring disease which have similar symptoms.

 

[heatherh]

I always test before his PM shot. I put it in the +11 column if I my spacing is closer to 11 than 12 hours - trying to keep an eye on how long the insulin seems to be lasting. Does that make sense?

I get his BG, give the methimazole, feed, and shoot while he eats.

I looked back over the low numbers before the liquid med, and I kind of see your point. I expected with BG reasonably regulated, we'd see an improvement in symptoms. That has not been the case.

Our pharmacist can mix without the aspartame or a transdermal gel. I'm hesitant to try the gel because 1) I have a toddler and would worry she could pick it up and 2) we had so many problems with getting an effective form - we'd likely have to do blood test follow ups if we switched forms. I *am* OK with switching to an aspartame-free suspension.

It seems unlikely (but anything is possible...) that the thyroid was causing symptoms and now it's the diabetes.