? BG numbers worse after I 131 and Food Change

[Nancy S]

I posted over a month ago about KittyLou, my diabetic, Hyperthyroid cat who was diagnosed with both conditions on June 1, 2021. On 8/31/21 she had Radioactive Iodine 131 therapy to correct the thyroid (which was at 8.8 before treatment). Since then, her blood glucose numbers have been rising. I increased the insulin (Basaglar) .5 am and pm, 10 days ago. I also changed her food after i-131 (she was their second worse patient in 17 years, they said, and she did not eat for 3 days at the facility) to RC Glycobalance because she refused everything else when she got home. Numbers still very bad.
Questions: why is she so hard to regulate? anyone have bad numbers with RC glycobalance? are the high BG numbers because the thyroid hormone is normalizing? Is it too much insulin? too little insulin? is there some other condition going on?
She has a vet appointment on Monday. What should I suggest she be tested for?
She eats well but is sluggish, pupils often dilated more than normal, seems a little unsteady. She appears to be going in the wrong direction.

 

[Red & Rover (GA)]

A rough calculation brings RC Glycobalance Dry in at 29% carbs. That could well be the culprit.

I'll leave it to others to look at your dosing and spreadsheet.

 

[Sienne and Gabby (GA)]

My first thought was the same as Kel's (Red & Rover) -- all of the RC foods are very high in carbohydrates which is not helping to get numbers at a more reasonable level. You want to be feeding your cat a low carb, preferably canned food diet. Low carb is under 10% although most of the members feed their cat in the neighborhood of 5% carb. This is a list of most of the canned foods and their nutritional data that are available in the US.

A couple of other thoughts. Please take a look at the dosing methods sticky for glargine. Given that you're feeding your cat a dry food diet, you would have to use the Start Low Go Slow (SLGS) method. Even with SLGS, you're holding your doses for too long. This can result in glucose toxicity -- your cat's body is treating the higher ranges of blood glucose as the new "normal" and it's harder to get the numbers to come down. Also, it would be helpful to get at least a before bed test every night. You have no way of knowing if numbers are dropping lower at night and bouncing back up by pre-shot. Without the PM cycle tests, you're missing half of your data. In addition, Lantus dosing is based on the lowest number in the cycle and not on the pre-shot numbers.

Just as a precaution, I'd also test for ketones. You can do a urine test with Ketostix. They are available at most pharmacies.

 

[Johann_marcel]

Hi Nancy S., I wanted to chime in about my recent experience with I131 and my sugar boy, Chuck (his spreadsheet linked to this site currently is his old one so please disregard it, I have a different file now for his utd numbers). Chuckie was in remission for almost two years. He had I131 in April 2021, July 4th weekend he office came out of remission. His diet was not changed and had perfect bloodwork both a few weeks prior, no symptoms of diabetes coming back and his bloodwork (aside for elevated bg) was perfect at the er. Physical was non-remarkable, so there was no real culprit found for him coming out. He went back on Lantus and we've been able to regulate him quickly. The change in your kitty's diet may be a big contributor to her elevated bgs, the effects on the endocrine system from the I131 treatment shouldn't be discounted (at least in my experience, and I, in no way, regret choosing the I131 for Chuckie. It was the best decision for him).

I hope your kitty's bgs stabilize soon, as things settle.

 

[Katherine&Ruby]

Agreed with @Sienne and Gabby (GA) that the RC food is not helping. You want to get down to a baseline of feeding a low carb diet to truly understand what is going on. That being said, some cats go down in insulin requirements very quickly after a switch to low carb food. That means testing a bit more often than you are, and getting in at least one test at night, because right now you are only getting half the picture of what is going on with KittyLou's glucose levels by only testing during the day.

If you cat refuses any and all wet food, the only options for low carb dry are Dr. Elsey's, Young Again, and Wysong. These companies will send you samples so you can see if your cat likes them before you invest in a bag. The best option, though, is trying any of the wet foods on the list Sienne gave you.