? Insulin resistant or result of thyroid issue?

My baby Cooper is 15 years old, and he was diagnosed with diabetes at the end of June of this year, just over 2 months ago. He was treated for hyperthyroidism in September of 2020 with the radiation iodine injection treatment. His thyroid has been completely normal and numbers are where they should be since then, but we were told his diabetes is likely due to having gone through that, as well as his age.
It has been a very short amount of time since having been diagnosed with diabetes, but we are struggling to get his blood glucose to come down. He is on Lantus insulin, and has a Freestyle Libre CGM patch on him so we can scan his numbers all day and send them to the vet as well. We've been increasing his insulin by .5 units as directed by the vet, but it has not touched his levels at all, he is consistently above the 400-500s. His neuropathy in his hind legs is also very bad, and it's difficult for him to get around. We're discussing getting him B12 with the vet for that, but of course it can only do so much if we can't get his BG down as well...
After a random drop over the weekend that had him below 50 and staying overnight with an emergency vet, we've discovered he has a UTI, a high heart rate, and slightly anemic. He was up to 5.5 units of Lantus until this drop, so we are back down to 2 units until we speak with the vet. We can't get him in for an appointment for another 2 weeks to do internal testing to see if they find an issue there.
I'm still overwhelmed with how much I'm trying to learn about regular feline diabetes, but now I'm finding out that his previous issue with hyperthyroidism could be why he's not reacting to the insulin the way he should be. Does anyone have experience with both of these and how to go from here? I know a lot of people don't get the iodine injection for their cats thyroid so I don't know how common it will be to find someone that knows both? I just feel like my head is going to explode.

Also- being told by my vet that his Hill's prescription dry gluco support food is fine, but I KNOW it is much higher in carbohydrates than it should be. Cooper refuses to eat any wet food besides Royal Canin Recovery food, and that can't be eaten long term due to sugar content. We have tried every wet food, he won't do it, so that leaves us with limited options for dry. I think I'm wanting to get Dr. Elsey's CleanProtein chicken, as it's one of the few dry foods I've seen that is safe for diabetic cats. Do I need to slowly change his food, or can I just put out the new one and see if he takes to it?

 

I am sorry that Cooper and you are going through so much all at once. It sounds really overwhelming and hard. This board can help you get through it and it is filled with very supportive people who are extremely generous with their time and all of the knowledge they bring to the table.

I can only chime in on a couple of things because I don't have the experience and understanding that many of the people on here do. Have you read this post? It gives you a starting point for things you can do so people here can help you (which is why it's called how you can help us help you): https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

A lot of the guidance here relies on the information you can supply. When you can it helps a lot to fill out both your signature and your spreadsheet. I know it's overwhelming to read everything, but if you let us know what parts you need help with and there will be someone that can walk you through it a little. I will give answering your questions my best shot, but we will also need to call in the experts.

If you can't feed can't feed him wet food right now you should definitely make the switch to the Dr. Elsey's. You don't need to change it slowly. I do know that other people who have dealt with neuropathy give their cats regular supplements. I can try and find a post that mentions it.

5.5 units of Lantus is a lot and people here start at a much lower dose and change the doses in small increments. Do you use a needle with half markings to inject? I don't want to bombard you with everything all at once so let me know and I can post information about shooting and monitoring when you are ready. Just take a moment and breathe because you can absolutely do this and you have found the right place.

I am going to take @Bandit's Mom (I hope that's okay) in case you need help setting up your spreadsheet I know she is a woman of many talents.

Also, please remove the GA tag in your title. It is reserved for kitties who have passed and crossed the rainbow bridge. It stands for Gone Away or Guardian Angel. The question mark option flags that you're looking for help and the 911 option is only for emergencies that require immediate attention.

You've got this.

 

Yes, we have the needles with half markings. He has started at 1.5 units and gradually went up by .5 increments over weeks until we made it up to 5.5. That's the highest it was until he just went into the emergency vet, and now he has back down to 2 units. They had told us it was high and they were hoping it would make some improvement on his BG, but nothing has yet, which is why we're back down.

Someone else did help me make a spreadsheet just last night so I have started that.

 

I'm glad you've got a spreadsheet and are comfortable shooting in increments. Whenever you get a chance, if you attach your spreadsheet link in your signature it would be super helpful so that everyone can see Cooper's numbers. Have you read about the two methods that are used on here? The one that would apply to you is the Start Low Go Slow method since you're unable to feed wet food. I do see that you have TR listed in your signature, but one of the requirements of following that protocol is LC wet food only. There's some information about that here: https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

In regards to the neuropathy, I know that @Bron and Sheba (GA) told another new member that she used Zobaline which are Methyl B12 tablets that she did not get from the vet, but ordered from Lifelink. She also noted that once Cooper's numbers improve it should help him recover, but that it can still take time. That's a paraphrased copy and paste answer. I would imagine if you had more questions about it she can offer more advice.

I don't know anything about concurrent conditions or insulin resistance. I do know it can take some cats a very long time to become regulated. I don't think anyone can supply answers about dosing or even possible resistance unless they have access to your spreadsheet. Everything is based on the numbers. I have read that UTIs can heavily influence a cat's BG numbers. Once your spreadsheet is visible I can tag someone to take a look at it for you.

There is so much information on here and I know it's easy to feel completely lost. There were so many things I had to read many times over for any of the information to sink in at all. I was a total mess, but spending time on here really helped me out.

 

Hi Maddy,
My Tina had the iodine injection, and also became diabetic just about 3 months later. However she went several months before she got insulin. Vet was checking thyroid, and ignored a BG of close to 600, later calling it vet stress. My fault for not always asking to see the blood work.
She developed bad neuropathy (vet thought arthritis and gave prednisone). Finally another round of blood work, and diabetes confirmed. Off the prednisone.
Lantus started July 2019, and she was back off insulin the end of November that year, and still good today. Tina started on Zobaline right away, we got her in good BG numbers, and she no longer has any visible neuropathy!
My husband always thought the I-131 treatment caused diabetes, and I thought it was the prednisone. Also, she was almost 2 lbs overweight.
You have come to the right place for your baby Cooper!!

 

Its interesting for me to hear about other's experiences with the I-131 injection and diabetes. My diabetic, Chuckie, was in remission for nearly two years when he was diagnosed as hyperthyroid. He received I-131 earlier this year and we were initially told that getting his thyroid balanced would make his bgs even better (they were already fine). About 3 months after radioiodine treatment, he came out of remission. His bgs were slowly creeping up and bloodwork/xrays were all unremarkable. He's back on Lantus and regulated, but it took awhile and he stopped jumping on things (despite receiving zobaline and acupuncture treatments). Hes jumping on things and whatever neuropathy he may have been experiencing has now subsided.. So, yeah,we went through a similar experience with I-131. I tried to look up info above the correlate the treatment and getting knocked out of remission, but I could not find anything useful.

I hope your guy balances out soon, maddyjoann (my name is Joann and spelled the same way hehe)

 

For the neuropathy it's a lot more affordable than Zobaline
Zobaline is 34.00 for 60 tablets. A lot of members use the vitacost brand, it's a capsule , you sprinkle it on wet food ,but I see Cooper won't eat wet. Even with the Zobaline you would have to crush it and put it in wet food. Maybe you can just get a little wet food add some water and the Methyl B-12 to it and syringe feed him


https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6

 

Yes please, slowly change his food. Going from a high carb food to a lower carb food can greatly change his insulin requirements. You want to do this slowly, while watching what happens to his blood sugars. I've seen a cat on 5.5 units of Levemir, where the owner thought he wasn't getting any dry food, drop to zero, or off insulin, in 2 very scary days when she removed all dry food from the house. The caregiver basically got no sleep for those two days, as she had to keep feeding high carb food and karo/syrup to keep the cat safe.

Issues with the thyroid can cause of type of insulin resistance. I've seen cats go off insulin, only to need insulin again when the thyroid medication dose needed tweaking. And one of those cats went back off insulin once the thyroid meds were right. Did this twice actually.

 

Hi Maddy,
I hope Cooper starts feeling better soon!!
I agree, if you can try to transition to wet food, it would be better. I actually enticed my guys (I have 3 cats, so they all got transitioned with one another! Lol) with Stella & Chewy's freeze dried raw food. I got a bag of their digestive formula since it was smaller and less expensive to try, took some out and crumbled it up all over their wet food. They love it. I hope this helps, good luck Cooper!!

 

Do you have any recommendations on how to slowly change his food? It's just one dry from another but I don't know how to make that transition slowly. Should I try mixing the two at first? Or just putting out half and half? I don't know if there's a right or wrong way to do this.

 

Start with 3/4 of his old food and 1/4 of his new food. Try that for a few days, then switch to half and half, then 1/4 old and 3/4 new. You may have to change that based on what his blood sugar numbers do. See if he'll do the two mixed together so he gets the appropriate amounts of each at once.

 

How is Cooper doing these days? My KittyLou was diagnosed with both diabetes and hyperthyroid in June 2021. The diabetes was not controlled but we didn’t expect it to be. She had I-131 therapy on 8/31 and was OK for 3 weeks after. Her thyroid is good now. The level dropped from 8.8 to 2.1. The diabetes numbers, after the I-131 rose to a sustained 400 to 500 range, and alarming she started showing significant neuropathy. She is not herself at all. She was at 4.5 units of Lantus twice a day but she was having huge swings in blood sugar. She REFUSES wet food. Her labs are good, she is eating OK, but she just lays around, eats, and uses litter box. I am very sad for her and looking for answers. I’m going to follow you to monitor Cooper’s progress too.

 

My diabetic cat had hyperthyroidism. The two conditions weren't related. She was on methamazol. I have another hyperthyroidism cat now. She's scheduled for the i131 injection in November.

If your cat had a sensitive system make the change slowly. My cats didnt like dr elseys. Fussy things. They do like epigen 90 which is also lower carb.

 

I hope both Kittylou and maddyjoann's Cooper are doing ok. Nancy, is acupuncture for Kittylou and option? It has improved our Chuckie's quality of life (along with adequan). We also do zobaline, of course,, but the acupuncture really helps him. Also, it really took probably 2 (long) months for Chuckie to come down from the 400's to now 150-200. He had an episode of idiopathic cystitis one week ago (not fun) , but has since been better.

I am interested in following everyone's progress here, as this I131 treatment effect on our sugar kids seems a little unique, at least in my eyes.

 

Thank you for responding. My biggest roadblock right now is the food. I just did some calculations myself because I have bags of Purina DM, Royal Canin Glycobalance, and Hills m/d.
The first vet recommended DM, the second recommended Glycobalance. It turns out Glycobalance is the WORST!
It’s such a roller coaster, and lately, since the I 131 she has lost ground. Somethings I get obsessed and then my own health suffers! Ugh.
And tips you can give me are welcomed. I live in PA also (Erie). We definitely don’t don’t have the resources you do. I know of an acupuncturist but not sure if she does cats. Is that a cat specialist?