Hyperthyroid Diabetic cat? UPDATE 4/12

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kse

kse

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Let me start with a little history...My cat Kitty was dx Feb. 4 with diabetes. Prior to the dx, in November she had a 2.3 T4 test. I took her in for bloodwork in November due to excessive drinking, excessive urination and poor coat. Her bg was 150 in November.

I took her back in Feb. for additional bloodwork--she was now losing weight quickly. Her bg was 425 and she was dx with DM. A T4 test was not done at this time--as the vet had her diagnosis and has to send the T4 test out.

Since then, we have been through a lot. First, my vet recommended only once a day PZI dosing (2 units) as she felt the duration was lasting longer than 12 hours and didn't want to overlap. Three weeks later she had an awful UTI--- and at the same time went into DKA. She survived the DKA and the UTI cleared up. We are now up to 3.5 units of PZI bid. Her preshot numbers have improved and are normaly ranging in the 300s. But, we are getting very little downward movement.

Kitty is HUNGRY all the time. Her drinking and unination has decreased. My vet suspects, as well as I, that something is going on with Kitty outside of the diabetes. She is going to perform a T4 test Tuesday. Can anyone tell me if, hyper t could be the culprit in the lack of downward movement?

Kitty only weighs 8.5 pounds and is not gaining any weight--even after eating between 3 and 3.5 cans of FF a day. Cushings and acro really don't come to mind when looking at Kitty. My vet says any dose greater than 1 unit per pound a day, suggests an underlying problem.

One more note- prior to the increase from 3.0 to 3.5 units her preshot numbers were in the 400to 500 range.

I am looking any suggestions!
 
Re: Hyperthyroid Diabetic cat?

I cannot advise but I do know that insulin is not dosed by weight. This will bump your thread up to get more eyes.
Sorry I'm not much help.
jeanne
 
Re: Hyperthyroid Diabetic cat?

I have a hyperT kitty, but she is diet controlled so I can't help you with your Kitty's numbers...
But, wait for the T4 test to see if it is Hyperthyroidism. The losing weight and constantly wanting food are symptoms of it. If it is HyperT, you will get meds. I don't know if HyperT causes high numbers in cats on insulin. Sweety's numbers were not high.
 
Re: Hyperthyroid Diabetic cat?

Yes if the Hyperthyriod levels are high it will eat the insulin faster is what Dr Fry told me about Suzie. Everything goes faster in a cat with hypo. It makes a differance what kind of Insulin it is on also. Humlin what was suzie was on and it ate it to fast. She was changed to prozinc.
 
Re: Hyperthyroid Diabetic cat?

Are you using ProZinc of PZI?

Hypert could be the cause but the first T4 test you got was not that bad. How old is your kitty? Unregulated hypert kitties can also be prone to urinay tract infections, but the same could probably be said for some FDs. When you have that much activity going on down there, things are bound to be off.

I'm more concerned with the BGs then the T4 test. Too much insulin or too little could cause DKA, too little numbers stay high for too long, too much and numbers could rebound high. I hate to say this, but you went from once per day dosing to twice per day dosing.

The two units you were on was making a difference, there are not a lot of tests, but we some some big movement in numbers where there are tests. By the time the insulin wore off, probably at +12 if you had given another dose then you might have been doing well.

If Hypert were causing the metabolism to rev in overdrive I'd think you'd see low numbers sooner than you did. I'd suspect that lowering the dose to to find the right dose for your kitty might be helpful.

What do you think?
 
Re: Hyperthyroid Diabetic cat?

Thanks for the response.

It has been a long hard rode to this point.

My vet suggested the once a day dosing of 2 units of prozinc. You are correct that I was getting decent numbers on that dose--but no substainablity through the night. While only getting the 2 units once a day, she went into DKA, with the assistance of a terrible UTI. The vet immediately then went to 3 units twice a day. I am scared to drop the dose at the risk of ketones. The vet has done some mini curves that I haven't posted and has never seen rebound. At the present we are just getting a high flat curve.

The vet has mentioned Insulin resistance, but I find that hard to believe due to the early movement. I had a complete panel and T4 test done yesterday--I am awaiting the results. Truly, I am grasping for straws. My Kitty is 15.5 years old and weighs 8 lbs 9 onces and is presently getting 3.5 units of PZI twice a day and very little movement.

Any thoughts?
 
Re: Hyperthyroid Diabetic cat?

I agree, we don't want ketones. The 2 units once a day was working, but only for 12 hours. ProZinc is similar to PZI


Taken from Boehringer Ingelheim website, the makers of ProZinc, they suggest twice daily dosing.
http://www.prozinc.us/faq.aspx#prozinc
_____________________________________
Is it possible to use PROZINC once a day?

Historically, protamine zinc insulins were administered once daily to diabetic cats, a protocol based more on clinical perceptions of response to treatment than on results of absorption of kinetic studies. Studies show that absorption of protamine zinc insulins in cats can be quite variable.

In the field studies, mean time of the blood glucose nadir was between 5 and 7 hours, and subsequent blood glucose concentrations were increasing in most cats by 9 hours after administration of PROZINC. These results suggest that PROZINC should be administered twice daily in most diabetic cats to maintain glycemic control.7
____________________________________

My thought is that you may be experiencing rebound, but like you said you want to avoid ketones. Do you test for ketones at home? Regarding the vet's mini curves, some cats experience stress at the vet's office and will have higher numbers because of that.

How do you feel about testing at home more often?
 
Re: Hyperthyroid Diabetic cat?

I do test for Ketones at home. I am happy to say that I just tested last night and they were negative.

Truly, I would like to test at home more, but I work a lot of hours-- so I am not around a lot. Secondly--normally the testing just depresses me. I know I need more numbers, but I feel like I am beating my head against a wall when I continue to get high flat numbers.

One night I did a complete curve on a 493 preshot and I thought I saw good movement--and truly that combined with the early success and vet curves, made me think I was getting some decent movement. It wasn't until this weekend, when I checked some mid cycle numbers that I realized how little movement we were actually getting.

I never was comfortable with the once a day dosing--I even questioned my vet, but was assured it was okay. The group on the PZI forum continually told me to split the dose and give it twice a day.

I have seen 5 different vets in my small southern town and am yet to find one that has a lot of expertise with diabetes. I am getting really frustrated.
 
Re: Hyperthyroid Diabetic cat?

Don't get depressed, if you do so will I :)

I've been doing this for years, several diabetic cats, but the one I have now I can't get her numbers looking great, but I've been trying. I think for my cat Kiki the problem is stress, she's never lived with other cats before and she doesn't care to. She's not fighting anyone, but she's not happy unless it's just her and me cuddling and the other cats aren't around.

There sometimes isn't a quick easy fix and it can be frustrating.

I think the folks on the PZI forum were right about splitting the dose, but I understand wanting a vet's advice too. Going forward, testing more often will help you because you'll be able to see if this is rebound because you might catch a low number here or there, or if this is resistance or even if it's just a case of your insulin having gone bad and no longer being effective.

Are you also keeping the carbs down? Feeding canned only or is there any dry or gravy foods? With my Kiki, even a few Temptation treats at test time will keep her numbers high for at least 24 hours. She has to be strictly low carb, the lower the better.
 
Re: Hyperthyroid Diabetic cat?

I feed Fancy Feast Low Carb. we. She has always eaten FF pate--so I didn't get a lot of help from a diet change.

I have tried everything I know to get her numbers down. I have fed large meals, small meals--different times. I feed the other cats seperatly and take their food up when they are finished.

Maybe the blood work will reveal something--I am on pins and needles waiting on the call.

Thanks for sharing your thoughts.
 
Re: Hyperthyroid Diabetic cat?

I'm not a huge fan of ProZinc. I haven't seen too many folks do that well on it. I haven't used it, I've used Humulin N and R, PZI Idexx, PZI BCP, Lantus and Levemir, just to give you an idea of my background. I'm no expert in any of them, but from what I've seen, and only my friend Peggy comes to mind right now, I don't care much for the ProZinc.

Maybe you could ask the folks on the PZI forum what they think of the insulin itself.
 
Re: Hyperthyroid Diabetic cat?

Adding to Jen's thoughts...

I'm not an expert in the various insulins and the one I did use has been discontinued. But if I were to have to use insulin again, I'd go with levemir 1st, lantus 2nd. I'd not use Prozinc, only because I've observed much less success (and more hard work) with it than the others.

Jen
 
Okay--I got the vet report and bloodwork back. The T4 test came back at 1.1. They have not done the other panel of hyper t test and are waiting on me to request/or not.

I had two vets review the results--one is most concerned with the kidneys. Her creatine was 2.2 (.6 to 2.4 range) and her BUN was 72 (range 14-36). I know the BUN can come from dehydration....the BUN/Creatine Ratio was 33 (range 4-33).These were tested a month ago at a different lab and were 1.9 and 50.

The second vet was concerned with the pancrase. Her Amylase was 1296 (range 100-1200) and her Lipase was 268 (range 0-205). These were tested in November 2010 at a different lab and were in the mid normal range. In the same November test her bg was 150. I know these can be effected by kidneys--though the vet didn't mention that.

Her bg yesterday on the lab test was 408.

Both vets suggested starting fluids to help support the kidneys, increasing the PZI to 4 units and starting a new vial. So tomorrow, Kitty will go to the vet to start the process and let them monitor her since I have to work. Both vets think the hydration might help her absorb the insulin. Heaven forbid if everything worked and I wasn't home to test her. So, I will take her in .

He unine had a specific gravity of 1.026, protein was 100 and ketones were negative.

I have to admit, I am not sure I am liking the Prozinc--but, I hate to be critical, because maybe it is Kitty not responding. But, I look at the PZI spreadsheets daily and it appears there are a lot of high flat curves.

Both vets said we might should go to Lantus. Neither have used Levemir before--isn't it great to live in a small southern town?!

I might take her to "the City" if this doesn't get better soon!

Anyone reading this that can make anything of these numbers please give me your thoughts.

Thanks for your help,
Kim
 
To me the T4 is not at all an indicator of hyperthyroidism.
The Amylase and her Lipase values do not excite me.
The urine specific gravity of 1.026 indicates some kidney insufficiency. The relatively high creatinine (not creatine) supports that.
 
Larry---would this kidney insufficiency support any type of insulin resistance?

I have all of the bloodwork and urinalysis results, are there any additional values that could shed any light on the situation?

Thanks for your help.
 
Larry - there have been a hand full of cases on here where the initial T4 values came back normal, or even low end of normal, and the free T4 test came back showing hyperthyroidism. I really wouldn't rule it out just yet until the confirming tests can be done.

I posted a thread a few weeks ago about hyperT and had a few of those beans respond. I'll be back with a link.

viewtopic.php?f=28&t=37959&p=402256
 
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