Looking for feedback on Martin's strange numbers

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jakes

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Every time I think Martin's BG is starting to stabilize and we're starting to get into a consistent routine, something changes again. Today he seemed to have a very stable AM cycle, but then shot way up at his PMPS. Looking at his spreadsheet it seems like every time he starts to stabilize for a day or two, his BG suddenly shoots way up for no apparent reason. I don't think he's getting rebound because his BG isn't really getting that low, but I also don't think he needs more insulin because when we've tried that he ends up going hypo.

Any thoughts or comments are appreciated as we try to get him regulated :smile:
 
Wow! You HAVE been all over the board. I'm with you, I think the .5u is a good dose for him. He's done the same thing Grayson did following a "re-boot"... the lower he got, the fewer red preshots we saw.

Given his range on .5u, I would definitely continue the dose and see if he settles into it a little better. He's still kinda wobbling around, but in spite of the reds you've gotten, the other numbers are looking pretty good.

Sorry I've not been around much lately... you've probably already addressed this, but is it possible to get some more mid-cycle tests?

Lu-Ann
 
Hi Jake

That SS is definitely confusing to me!
I have a question, and maybe you've answered this on another thread, but can you give us some info on what and when Martin eats? I would like to understand how much he eats, and when each day in relation to his shots. I'm a big believer in trying to find out how the food and insulin interact with each other over the 12 hours of a cycle. That might help me make more sense of the numbers.

Carl
 
Wow. I don't know. He sure throws odd numbers with very little patterns. Could anything else be influencing his levels? Wet low carb food and treats - no chance of anything else? Any infection? Any pain?

.5 looked good for a while and so did .6. Then he goes high out of the blue....
 
Yeah, I'm very confused as well. To answer the questions that were asked...

Grayson & Lu said:
you've probably already addressed this, but is it possible to get some more mid-cycle tests?
My wife and I are doing all that we can to get mid-cycle tests whenever possible. We both have really busy schedules and generally can't test very often, but we test whenever we're able to. Some days we get lucky and one of us is at home most of the day (like today), so we're able to get a lot more tests and more data on those days.

Carl & Bob in SC said:
I have a question, and maybe you've answered this on another thread, but can you give us some info on what and when Martin eats? I would like to understand how much he eats, and when each day in relation to his shots. I'm a big believer in trying to find out how the food and insulin interact with each other over the 12 hours of a cycle. That might help me make more sense of the numbers.
Martin eats Friskies Liver and Chicken Dinner canned food, which seems pretty low carb from Janet and Binky's charts. We test his BG, then feed him a half can, then give him his insulin, and we do this twice a day (once in the morning and once at night). He always eats all of his food very quickly - it's gone within 5-10 minutes of us setting it out for him.

He also has thyroid issues and is on thyroid meds to help with that. To make it easier to give him his thyroid pill we put it in a Pill Pocket, which is a small treat that the pill goes inside of. The Pill Pocket does have some carbs (chicken is the first ingredient but it also contains corn and wheat), but it's about the size of a single kibble of dried food and he only gets to eat one when he gets his medicine. He gets his medicine twice a day, right before he gets his canned food, so he gets a total of two Pill Pockets each day. We also give him a freeze-dried chicken treat with his pill.

Martin is an indoor only cat so as far as we know he's not getting into any other food.

Sue and Oliver (GA) said:
Wow. I don't know. He sure throws odd numbers with very little patterns. Could anything else be influencing his levels? Wet low carb food and treats - no chance of anything else? Any infection? Any pain?

.5 looked good for a while and so did .6. Then he goes high out of the blue....
No infection or pain as far as we know. He just seems like an ordinary, happy kitty and is acting the same as always.
 
Can you tell us the name if the thyroid med? Also, how much does Martin weigh, and did he weigh more pre-diabetes?
Carl
 
Some cats have better numbers with small frequent meals rather than two big ones. Could you freeze some food and leave it out for him to snack on? I use an automatic feeder that is such a convenience for us. Not sure, but might be worth trying?
 
This last cycle is even more strange than the others have been - he was 414 at +6 but then 281 at this morning's pre-shot. So between nadir and the next pre-shot, his BG dropped by 133, which doesn't make any sense to me.

Carl & Bob in SC said:
Can you tell us the name if the thyroid med? Also, how much does Martin weigh, and did he weigh more pre-diabetes?
Carl
His thyroid med is methimazole, and he takes 2mg twice a day.

He weighs about 9 pounds now - when he was diagnosed he was fat and weighed around 12 or 13 pounds. He was free-feeding dry food at the time, so he lost a bunch of weight when we switched him over to canned food on a schedule.

Sue and Oliver (GA) said:
Some cats have better numbers with small frequent meals rather than two big ones. Could you freeze some food and leave it out for him to snack on? I use an automatic feeder that is such a convenience for us. Not sure, but might be worth trying?
We could give that a try - since we're not home during the day we would have to look into freezing the food or using an automatic feeder. Are there automatic feeders that can work with canned food? Everything I've ever seen is specifically for dry food.

Thanks!
 
Hi and Welcome,

The only 2 cents I have to offer right now is that the Pill Pockets are not diabetic friendly, the only low carb Pill Pocket is the Duck flavor. Can you try that one?

The higher carb med treats could be playing havoc with his bg's.
 
Looks like a bounce cleared out sometime late last night/early this morning and his BG returned to normal. Looks like you get a good cycle and then he goes flat or high from rebound. If there are more greens hiding in his cycles that you're not seeing that would explain why he's still moving around so much, you've been doing great at testing as often as possible so keep it up! Hope the pmps will be nicer today.
 
Robin, I saw a post when I searched for pill pockets that said they were discontinuing the duck(low carb) flavor. Of course, the only one they have.

We use the PetSafe5 and love it. It is easy to program(by the clock, not how long between feeding) and my cats haven't been able to crack it. They made short work of the ones that flip up. There is a space for an ice pack, but I put frozen food in and it thaws by the time it opens. Freezing is a breeze with a silicone cupcake pan.

I would definitely try small frequent meals to see if they make a difference. Carl is our food expert(figuring out calories needed per body weight) so he can help with food amounts.
 
Yes, can we hear about the whole Hyper-T diagnosis, when it was, etc? I've been doing some reading on Hyper-T with diabetes and maybe we can figure out what is going on...
Carl
 
He was diagnosed with hyperthyroidism before he was diagnosed with diabetes. The diabetes diagnosis was in mid-2011 and the hyperthyroidism was diagnosed around 2009. He's 12 years old now.
 
OK that's good to know. When Martin was diagnosed HyperT, was he put on a prescription food to help treat it?

Regarding his current diet, you said he gets half a can AM and PM with his shots, right? And he weighs in at 9 pounds.
I think part of the problem may be that he might need a little more food per day. There are various formulas I have seen on the board and off the board that calculate how much to feed, but the one I like is very simple:
20-30 calories per pound of ideal body weight, per day. That will keep a healthy cat at it's ideal weight. The range of calories is dependent upon a few factors, one of which would be level of activity. Anyway, by this formula, if there were nothing wrong with Martin, he'd need at least 180 calories per day to stay at 9 pounds.

From what I read about HyperT, the major issue is that cats with that have a drastically increase metabolism rate, which would translate to a big increase in caloric needs. The medicine is probably doing something to handle that aspect of the condition I would think. Also, as we all know, a diabetic cat needs more food than "normal" because their body can't get a normal amount of energy out of a normal amount of food. Their cells can't absorb glucose like they are supposed to, so in effect, we have to add glucose by feeding more (and then use insulin to help the cells absorb it), and all the glucose that can't be used ends up staying in the bloodstream or spilling over into the urine and then showing up on our meters.
So, in Martin's case, he's got two "reasons" for needing more food. One, the diabetes because he can't metabolize the food effectively, and two, the HyperT which makes him have an increased rate of metabolism.

A can of Friskees Liver and Chicken is listed on Binky's charts as having 172 calories, which is a little less than the 180 that formula says he'd need. No big deal. But throw in the diabetes and the HyperT, and I'm betting that he needs more food per day.

One of the things that sticks out on his SS is that he gets huge swings in BG from such a mall dose of insulin. I am thinking that if you could feed him that same half can at AMPS and PMPS, but then more food mid-cycle, his curves would improve. If you fed him a snack at +3 or +4, you might be able to stop him from going so low in the middle, and that might help him not bounce back up so high at the end of the cycle. There is a possibility that this would increase his insulin needs, but that is no big deal as long as you can make his curves not so extreme. It might stop or slow down the roller coaster he's riding.

One thing I know nothing about is "what is the appropriate dose of methimazole"? I have no clue if it is determined by weight, or by some follow up tests that get run after diagnosis? And I also don't know exactly how it works once you give it to him, or if the timing of the pills matter in relation the to meals and the insulin injections. Do you know, or did the vet explain what it does? Has the dose always been 2mg?

The other thing I am really not sure about is what the HyperT condition (increased metabolism) does to how he would metabolize the insulin....if it would mean that he absorbs it faster than "normal", or if the methimazole would slow the metabolism rate down so that there would be no effect on the functionality of the insulin?

Don't know if any of that helps or just makes things more confusing...
Carl
 
Have you ever looked into the I131 Iodine treatment for the HyperT? When it works it is a cure.

My civie Chase was dx HyperT in 2009 shortly after Harley was dx diabetic, they both had the same symptoms and I kept testing Chase's bg's but they were always normal. We started off on the pills and quickly realized that one of us was not going to survive the daily pillings, :lol: so we tried the gel but with multiple cats grooming each other that wasn't good either. So he got the I131 treatment on Dec. 23, 2009 and has been perfect since then, he was 13 years old at that time. It was the best thing I ever did.
 
From what I read, the meth. should normalize thyroid levels if the dose is correct...has he had a thyroid level check recently? If levels are normal then metabolism should be about normal, the pills correct it. But...if the dose of thyroid meds is too little then everything gets metabolized faster; food, insulin, and even the thyroid pills! Kind of a vicious cycle, but maybe that explains the unpredictability of his BG....if one day thyroid levels are a bit higher, then the pills get through quicker and the insulin and the food.....

I agree with Carl on the feeding, maybe it will help things a bit.
 
Alright, lots of stuff to respond to :smile:

When Martin was diagnosed hyper-t he was not placed on any special food - we just started giving him the thyroid meds. His dose has changed a couple of times as we figured out what worked best for him, but he's been on his current dose for about a year and a half. The way we've tried to figure out the proper dose is to try a dose for several weeks, then take him in to have his thyroid levels tested again. With this dose his levels are within the normal range, which tells us that it's working well. His last thyroid test was about 2 months ago, and he was in the normal range then.

Feeding him a snack in the middle of the day and possibly giving more insulin to make up for it is definitely something we're willing to try, and it makes sense that it could help. Our only concerns are that we're not home during the day, making it harder to do this (we'd need an automated feeder that works well), and that we have a second cat who might get to the food before Martin does. Martin gets pretty feisty with food though so I think if it was there, he'd get at least some of it :smile:

I hadn't heard about the I131 treatment, but reading about it I'm definitely interested. We'll bring it up with our vet the next time we talk to him and see what he has to say. It sounds like they just shoot a bunch of radiation into the thyroid and somehow that makes things better permanently - is that right? Sounds a little bit crazy but if it helps, I'm willing to try it.

Tonight's pre-shot was especially bad - it was our first BG over 500 in a couple of weeks. Things seem to be getting more out of control, so we're ready to do what we need to do to stabilize his numbers and get him healthy.
 
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