High bgs' in am Low bgs' in pm

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Paula

Member Since 2014
My cat Michael, has hyperthyroidism and diabetes. He is on y/d food because he is allergic to tapazole. His t-4 is 1.6 in normal range. Surgery & Iodine treatment are not an option. He is 13yrs old. It is difficult to regulate the diabetes. I have posted his bgs' on his SS and he is all over the place. I am home testing and giving shots. I think I'm doing this correctly. I myself, have health issues due to 3 brain aneurysms I had 2 yrs ago. It has left me with poor vision, poor hearing not good balance, and a left weak side. I do this alone as I have no one to help me. Any advice, suggestions and help would be greatly appreciated.
Michael is all I have and am afraid I will lose him if I can't control the diabetes. I am new to this board and don't understand all this fluctuation.
Thanks,
Paula & kitty Michael
 
Hi Paula and extra sweet Michael!

I think what you're seeing is "bouncing". Our kitties body's get used to being in those higher numbers, and when the insulin brings them back down into numbers they haven't seen in awhile, their liver thinks it's an emergency and releases lots of stored sugar and hormones to bring it back up again. It's a leftover survival system from when our kitties were wild and food was hard to come by. The liver would keep enough sugar in the bloodstream to keep them alive until they could find food.

It also looks like Michael is going lower at night. It's really important to get some tests in during that PM cycle. Most cats go lower at night, and he may even be going too low...there's no way to know without testing. But when he goes lower at night, then he "bounces" and you see those high numbers in the morning!

It can take up to 72 hours for the "bounce" to clear, so all you can do is wait it out, but you don't want to increase if they could be bouncing because they could "break the bounce" and start coming down fast...and if you add an increased dose to that fast drop, you're just going to set them up for another bounce....plus possibly going too low (below 50)

Could you try really hard to get some more testing in? Especially in the PM cycle....a "before bed" test will tell you if you need to set an alarm clock to wake you up and test again later in the cycle. Also, during the AM cycle, get more tests in if you can, and at different times. Maybe a +2, +5 and +8 some days, and +3, 6 and 9 others? We look at spreadsheets like a puzzle. If you can only see the edges, it's hard to see what the picture is!
 
Thanks Deb & China.
I will try to do more tests. These "bounces" are confusing and overwhelming.
Paula & Kitty Michael.
 
Now I'm not familiar with hyperthyroid problems, but I also think that you can try a different food for him.

What's important with diabetes is carbohydrates. You need to limit how many he's getting. The only real "benefit" I see from the Y/D food is it's low iodine. I think we might be able to find other options that are low carb (under 10%) that he'll be able to eat just fine.

I notice on their website it says "Clinically proven nutrition to restore thyroid health in 3 weeks."...Seems like if it worked as well as they say it did, you wouldn't have to keep feeding it, but again, I have no experience here.

The first ingredient is corn gluten meal, then pork fat, then whole corn...that's a lot of carbs for a diabetic cat! It says it's 28.6% carbs...again, we like them to be under 10%

Hopefully someone with hyperthyroid cat experience can chime in, but I really don't see why you couldn't feed a low carb, low phosphorus wet food. It could make a BIG difference in his numbers, and may be able to help get him into remission and off the insulin completely
 
Hi Paula!

I'm also a lantus user, but I'm going to flag someone with hyperthyroid experience to help you with that part. Hyperthyroid can make it tougher to get a cat regulated, but it's not impossible.

Kudos to you for being so dedicated to Michael! Can you tell us a little about him and about his story? How long have you had him? I'd like to hear and sometimes there are clues to things that can be helpful when people tell us about their kitty.

How long has he been diabetic?
How much does he weigh?
Has he ever had ketones?
What meter are you using?

You've found the right place now. We'll give you a hand! Sometimes it takes a while to figure out strategies and it helps to get some of that background story first.

Nice to have you here! julie
 
I would not do the Y/D diet. It basically starves the thyroid of an essential mineral, iodine.

It would be better to suppress the thyroid with methimazole/Tapazole, remove the thyroid or part of it if surgery can be done (ectopic tissue may be found sometimes in non-thyroid locations), or have I-131 treatment to ablate the thyroid (its pricey).
 
BJM, Paula said Michael was allergic to Tapazole and surgery wasn't an option.

Paula, i did want to mention that numbers all over the place are typical of a cat that is newly diagnosed and not regulated yet. What your seeing is pretty normal, so try not to worry too much about it.
 
Hi there & Welcome! :cool:

My kitty, Black Kitty (BK) was diagnosed with hyperT a couple of years ago, well after his diabetes went into remission.
He is on methimizole and so far so good.

julie & punkin (ga) said:
How long has he been diabetic?
How much does he weigh?
Has he ever had ketones?
What meter are you using?
I have one more question to add to the ones Julie asked and that is when was Michael diagnosed with HyperT

You picked up the basics of testing pretty quick, well done!
I too believe the best first step is to switch Michael to low carb wet food , exclusively. This alone can sometimes have a profound effect on BG.

Regarding testing, for safety sake the 'minimum BG testing required is right before you shoot and at least once during the cycle, both AM & PM.

The between shot tests don't all have to all be at +6; as a matter of fact it's more revealing if you stagger the times you do those tests.
To determine when in the cycle you should test, take a step back from the ss and look for the 'wide open spaces' that do not contain data.
Then try and place your next test in a +hour that has not seen a test in a while. In this way you are sprinkling tests throughout.

If you can manage to do this consistently a clearer picture of what is going on with his BG will emerge.
 
Hi Paula :YMHUG:
I'm so happy to see you posting, and it looks like you're doing a lot better at testing and you have your spreadsheet up. Good job :thumbup

Just be aware, that if you switch from 28% food to 10% or under food, that Michael's BGs may come down a lot, so when you do make the switch, you will need to test extra that day or maybe for a couple days, just in case he needs a reduction in his dose with the lower carbs.
 
Hi Paula I posted yesterday but guess it got wiped out. Just wanted to say welcome and what a wonderful job you are doing. Wow with all you health problems too. You have found the best site to help your ((Michael)) sending you both tons of healing green light and prayers on the way. cat(2)_steam ~O) deep breaths ;-) cat(2)_steam and your on your way Hugs Kath
 
Thanks to everyone for all the suggestions.
This is Michael's story.
I have had Michael for 13yrs. He is 13 yrs old. He had a brother, Martin. There were brothers, litter mates and inseparable.
Unfortunately, I lost Martin to cancer 2yrs. ago in 2012. Michael has never got past losing his brother. He is still very lonely. I can't have another cat right now due his health conditions and mine. (I too miss Martin very much.)
Michael was diagnosed with Hyperthyroidism in 2012. The Y/d food has kept the Hyperthyroidism under control. If I change his food then the hyperthyroidism goes out of control. He has to be on the Y/D for the rest of his life. He is allergic to tapazole) If I don't put him on a low-carb diet the Diabetes is hard to regulate and he starves. There has to be a solution. As I said before Surgery & Iodine treatment are not options.
Michael weighs 15.5 lbs. (he was 18 lbs.) Since March he has lost almost 3 1bs. (that's scary) There are no ketones as far as I know
(that is what the vet told me.) I am using the Relion Prime meter. (wondering if it is working right.) I tested this morning and it read HI (never happened before.) I tested a few minutes later and it read 371
If I can ever figure out how to put his picture in my signature, you can see how handsome he is. He is a tuxedo cat.
Back to testing: Lately I have been having a hard time getting blood. ( I make sure his ears are warm) I usually have to try about 4 times. This is beginning to stress Michael and his poor little ears are being poked more than I would like.
 
I have a tuxedo boy too - his name is McGee, although he's just a little over a year old. I'm sorry for your loss of Martin - our kitties are family and it's so hard to lose one.

Has anyone suggested using Neosporin with pain relief, or generic equivalent? The pain relief part is what's important. It takes the owie out of the ears and really helps with healing quickly. I've used it on myself and the stuff is amazing. You can either rub it in about 20 minutes before you're going to test, or what i always did was just to put a generous amount on every evening. Punkin's ears would heal overnight.

What dose of Tapazole was Michael started on? Do you recall or could you find out?
 
Hi Julie,
Thanks for the reply.
2 yrs ago, Michael was put on 5mg 2xday of Tapazole. He was on it for about a week when the vet called. Said to discontinue Tapazole immediately. His liver enzymes were way too high. When I took him off, his liver enzymes went back to normal.
The vet wouldn't lower the dose or try the gel,(I can't do the gel anyway because of home testing) for fear the liver would go out of control again and he would be in danger. So now he is on y/d for the rest of his life and that has kept his thyroid in normal range.
As for the diabetes, Michael is now hungry all the time and eats a good amount of food. He is losing weight. It breaks my heart to see this. I pray that someway somehow I can get the "D" under control.
 
Hi Paula

I'm another that Julie asked about hyperT experience. I've had two cats with hyperT.

A very common thing to occur with tapazole (aka methimazole)(MMI) is for the cat to have a reaction to it. That's because vets almost always start the dose way too high. And your vet did as well. 5 mg twice a day is high.

I can't imagine working with a vet that refuses to lower the dose. One of my kitties had the same response as Michael....plus she was scratching a lot and lost her hair above her eyes. We took her off the MMI for a couple weeks and then restarted at a very, very low dose. She did fine. I've also used the transdermal gel and it goes on the inside of the ear and if you poke on the outside edge of the ear, it shouldn't affect his hometesting. In fact, even if you poke on the inside edge, it shouldn't affect it because you want to put the gel down a little further than the edge. I don't like the gel because I think it's too difficult to ensure that the dose is consistent based on whether you get it all in there and how he absorbs it.

I agree with BJ that I would not be feeding my cat y/d. I'd try having the MMI compounded into a flavored liquid with no sweeteners, including artificial ones like maltodextrin, and start at a super low dose. Having it compounded allows you to vary the dose. Or, if you are really worried about a rxn, I would insist my vet prescribe the transdermal gel or find a new vet. Start really low on the dose, give it a month, recheck. Adjusting the thyroid takes time.

You say he can't have the I131 treatment. I don't mean to be nosy but can you be more specific? Is it for medical reasons and if so, what would those be? I've had this treatment done on my cats and it is by far the best option for a hyperT cat provided their kidney levels are normal when they are in the euthyroid state (normal thyroid numbers) and there are no other medical conditions that would preclude it.

My last recommendation is that you join the hyperthyroid yahoo group. The administrator of that group, Alice, knows more about hyperT than any vet I've met. She's amazing. I do believe there are some other medicine options ( e.g. Carbimazole) to MMI if he's truly allergic. The goal would be that meds would be a short term soln if there is any way possible to have the I131. That's why I'm asking if there is a medical condition that precludes it. I understand the other precluding factor is financial. And now they he's diabetic, that throws another monkey wrench in the works for him being in the clinic a week.
 
Marge,
Thanks for responding.
1-131 treatment is not an option. I have already looked into it. He would have to go to tustin and I don't drive. When it would be time to bring him home I could only be on contact with him for one hour per day for about 10days. He can't sleep in the bed with me. Due to my physical limitations I couldn't retrain him. I would have to leave him in Tustin, Ca. for 2 weeks. The hospital doesn't have a 24hr staff and even though they would give him his insulin, without him being monitored, I would be afraid he could go hypo. Then there is the problem of food. He has to be off the y/d 2wks prior to the treatment. He would have to be on a diabetic diet and the conversion could make his bgs' go low. The downside to the i-131 is the possibility of him ending up with Hypothyroidism. Michael is 13yrs old. and this would too stressful. If he was younger, did not have diabetes, and I didn't have the health issues I have,(due to 3 brain aneurysms) I would say yes to i-131. I wish things could be different. My hear breaks when I see Michael going through all this. He is such a good cat. I just want to keep him as comfortable as possible.
 
If you alternated ears for testing and the methimazole gel (in a reduced dose), that might work. For the liver, milk thistle (ex. Marin, Denmarin) has been helpful to support stressed livers.

Perhaps a consult with another vet for a 2nd opinion might be useful, maybe one who specializes in endocrine disorders, if you're near a big enough city.

He could have fluctuating pancreas functioning - we call it a 'sputtering' pancreas. It can play havoc with glucose control.

And when other conditions affect metabolism, appetite, vomiting, or diarrhea, those too may make stabilizing glucose more difficult.
 
i like marje's suggestion of the yahoo group to get some more ideas on the hyperT. If you opted for the gel, you can also just test on one ear. I learned on punkin's left ear but i suspect we scarred it in the process and we switched to his right ear only for testing for more than 2 more years.

Thyroid is so important in the body - it plays a role in pretty much all of our systems, and it's going to be a player in getting his diabetes regulated.

It's hard to know exactly what's going on in Michael's body. His blood sugar is all over the place, which as i said isn't uncommon with a newly diagnosed cat. It's possible he's bouncing, as Chris was speculating. Here is a post (look at the second one) that describes what's going on in the body when a cat bounces: New Dose Wonkiness, Bouncing.

Another possibility is just that he's not at the right dose yet. He's eating a fairly high carb food, which means that it takes insulin to overcome the carbs. Most of us feed in the 4-7%ish range, so 25% is pretty high. Getting him under control with that high carb of a diet is much like a human diabetic continuing to eat cake and donuts (nom nom nom!) at every meal and trying to increase the insulin dose to compensate. It's not impossible, but it's a much more complicated task. That's why everyone is focused on figuring out if we can help you find an alternative to that particular food, while still addressing his thyroid issue.

Chris mentioned my typical metaphor of the spreadsheet being equated to a jigsaw puzzle. If you have only the corners and edge pieces, it's pretty hard to see what the picture is. But if you have pieces spread here and there all over the puzzle, it becomes easier to decipher the picture. You don't have to have every piece, but the more you have, the clearer the image becomes. That's exactly what the spreadsheet is for us. It helps us to see what the Lantus is doing when we can see the past 3 or more days with a sprinkling of tests here and there.

Right now you've done a super job of getting preshot tests in. That tells you if it's safe to shoot the insulin. And you're doing a good job of getting a daytime mid-cycle test in. Can I suggest that you get some earlier, say some that are between 2-4 hrs after his shots. i'm not saying to necessarily get more tests in during the day, just to vary the times.

What would now be helpful is for us to know a little more about what's going on in his body at night. The night-time tests are so helpful because many (most?) cats have their lowest numbers at night. Could I ask if you could start getting a test in right before you go to bed? You'd be surprised how much we'll be able to learn from even adding that one test in.

The way Lantus works, it typically has a low somewhere between 3-8 hours after the shot. It varies from cat to cat, and even in one cat it can change from day to day. Lantus dosing is based upon how low a dose is taking a cat, so we really look for that low point in each cycle. If we could get a couple of days of an evening test in, we'll have a much better idea of what this dose is doing.

Be encouraged, Paula, he's eating a moderately high carb diet, and even with that, 2.0units is getting him at least into the 100's. That's not bad at all! Diabetes takes a while to figure out in every cat, but he'll make improvement! He didn't get diabetic overnight and he won't get regulated instantly either, but it's likely we can help him get better. Hang in there and keep working with us!

I like to give the reasoning on everything, so lest the suggestions get lost in the text, i'll summarize:
- are you open to figuring out an alternative to the y/d so he could get on lower carb food? (ear gel, compounded, yahoo group?)
- can you vary the daytime cycle tests?
- can you get a before-bed test every evening?

and pat yourself on the back! you're balancing a lot and you're already doing a good job of helping Michael.
 
Julie, thanks for all these suggestions. I will try to do a before bed test. I tried to get into the Yahoo website for hyperT but it wouldn't let me in.
The gel, my vet says no. I'm going to try to see if she will give a low dose of tapazole since Michael needs to be on a low carb diet. (He may have to stay on the y/d food.) How long before he quits bouncing all over the place? He was diagnosed in March 2014.
Paula & kitty Michael
 
honestly, some cats don't stop bouncing. i suspect some of it depends on how long they have been in high numbers. The bouncing is caused by the body not being familiar anymore with normal numbers, 50-120. Some cats stop bouncing quickly, some never stop. you have to work methodically and safely to get to the "right" dose. that's a lot of what we work on.
 
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