Suddenly erratic - Hyper T is the cause?

[dosgatos]

Hello,

Akane, 15 years old male, spayed, 3.8 kg, has been diabetic for 5 years. He was on BCP PZI for the first 2 years and now on Levemir since Nov 2010.
We received lots of help and support from members here when switching from PZI to Levemir and I want to thank you all very much!

Today I need your help again for his shocking readings I have started to see since around 13 June 2012.

First I thought the insulin went bad so I have bought 3 cartridges since but the result has been similar with any cartridge. But I somehow still feel it is the insulin. We buy insulin from our vet, not from the pharmacies and the vet seems to keep them for quite a long time in their refrigerator. They believe it is good until its shelf life is expired but often the rubber stoppers of them got hardened and I feel strong pressure when inserting the needle. I do not really like it..

I have recently read this. I wonder if that is the cause..
"In addition, insulin will bind to the rubber stopper of the dispensing bottle if it is stored upside down or on its side, thereby resulting in decreased insulin activity within the injection."
http://www.bsava.com/LinkClick.aspx?fileticket=+6hHSukREw0=&tabid=887&mid=2395
I have asked our vet to order a new cartridge for us in case it is the insulin and I am now waiting for its arrival.

Akane had blood test and x ray (which I did not ask for..) on 20 August and we found no major problems except slightly higher BUN 50mg/dl. His creatinine was 1.9mg/dl (within normal) and his USG is >1.040. The size of his kidneys are still fine, too. His liver enzymes are good. He eats all right. His heart is fine, too. He is active around certain time, for example, at dawn, at evening, sleeps well, just like a healthy old guy..I think. He had bleeding gums but now they seem to be settled down. His bones at his neck and back seem to have "aged", the vet said. That is all. So it is difficult for me to think bad regulation is due to his condition..

We see above 400 a lot recently and this did not happen before. Even if he went to low, for example, to below 50, he never rebounded this badly before. Now it seems insulin runs out very suddenly and very quickly at the later hour of the cycle. I reduced his dose from 0.5s to 0.25 around mid August as I thought he was rebounding. Also I realized (should have been careful..) I changed his diet to raw this summer so I thought he earned reduction. Now he is on 0.25f or 0.3. I tried TID or dose at every 10 hours a bit but we have not got a good result. It just seems the same but maybe I am missing something..

I would be grateful if you could take a moment to look at his ss and give me your feedback. Any comments and thoughts are appreciated!

 

[dosgatos]

Re: Suddenly erratic - need feedback

Sorry, the link did not work. I edited it and I think it's OK now.

I hope to find out the cause of his "not very good" curves soon before I let him deteriorate again..

Mami

 

[BJM]

Re: Suddenly erratic - need feedback

...He had bleeding gums but now they seem to be settled down...

When was the last time he had his teeth cleaned? Just because you don't see a dental problem doesn't mean one isn't present. Many issues can be below the gum line. If possible, a dental cleaning with x-rays to check for sub-gingival abcesses may identify and/or remediate some of the problem.

 

[dosgatos]

Re: Suddenly erratic - need feedback

Thank you, BJM. Actually, he has never had his teeth cleaned. May I ask how those condition with sub-gingival abscess affect blood glucose? I have no experience.. Will bg keep staying in higher range? or just erratic as Akane's is? Or it depends on individual cat?

Mami

 

[Vicky & Gandalf (GA) & Murrlin]

Re: Suddenly erratic - need feedback

Thank you, BJM. Actually, he has never had his teeth cleaned. May I ask how those condition with sub-gingival abscess affect blood glucose? I have no experience.. Will bg keep staying in higher range? or just erratic as Akane's is? Or it depends on individual cat?

Mami

Hi Mami,
Nice to see you, sorry it is under not great circumstances for Akane.

Poor dental hygiene is a problem for cats and especially diabetic cats. It causes a perhaps low level bacterial infection and that can cause the insulin to not work well or correctly and usually changing the dose doesn't help. BG results become unreliable - up one day, down the next, etc, seeming like it is a dose problem, but it is not. If he has had bleeding gums, more than likely he has considerable gingivitis and needs a cleaning, plus an anti-biotic. I am not a professional by any means, so that is my conjecture, but good dental hygiene is important for diabetic cats.

As to the insulin going bad - it is possible. It is also possible that where the vet stores it, it could be getting too cold. If it freezes, it will go bad quickly apparently.

I don't understand how a vet can dispense Levemir. It is an insulin for humans. Can you get it from a pharmacy in Japan? Their storage method would be more trustworthy.

 

[dosgatos]

Re: Suddenly erratic - need feedback

Hi Vicky,

Thank you very much for your response. I did not know about Gandalf.. I am sorry..

It causes a perhaps low level bacterial infection and that can cause the insulin to not work well or correctly and usually changing the dose doesn't help.

If his WBD is within normal range, does he still have possibility to have bacterial infection? And does it start affecting bg one day suddenly?

A vet who saw Akane last week has consulted with a dental specialist. The specialist did not really look at his teeth but seemed to have said that he would take off Akane's teeth when his condition gets worse to the state that he cannot eat but on condition that if his bg is well controlled at that time. But I am afraid of anesthesia.. Anyway, it seems I need to take Akane again for a thorough dental check.. Our usual vet would not "investigate" what causing bad regulation but would tell me "well, it is hormone after all...we would not be able to understand all.." or " something might be going on but if his bg goes down with insulin and if his fluctosamin is around 300, it is OK.". sigh.. Yes, pet owners only get insulin from vets in Japan. And it seems it takes a week to get a new insulin from manufacturer. I am still waiting.

Mami

 

[dosgatos]

Re: Suddenly erratic - hyperT is the cause?

Hi. Akane's T4 result came back today and it was 4.5mg.dl (<4.0 normal). He is diagnosed as hyper T..

I phoned to the vet and asked about his teeth, too. He said that the dental specialist saw his teeth and did not recognize gingivitis but just bleeding gum from "ruptura"(?).
And his dental treatment would come after the treatment for hyper T, the vet said. Akane does not show other symptoms such as fast breathing or panting or loosing weight.
The vet is a cardiovascular specialist and he said Akane's heart is very good with no high blood pressure yet. But he said he needs treatment now and the options will be a diet or medicine (mercazole).

I am reading an endocrinology specialist Dr Mark Peterson's blog occasionally to learn about hyper T as Lin has been in grey zone for hyper T (4.0mg/dl at that time but now 5.4mg/dl..) but I still know too little.. Akane's recent radical ups and down might be largely due to hyper T, I am beginning to think..

Could anyone share with me your experiences or knowledge as to how to manage diabetes and hyper T? Again any input and thoughts are appreciated.

Mami

 

[BJM]

With hyperthyroidism, the body is on running fast and hard; the methimazole (ex brand Tapazole) will slow this down. This results in fewer calories needed, which in turn should lower the food consumption and may alter the insulin requirements.
You'll want to be vigilant in testing so you can adjust as needed.

I've not had both in 1 cat. I did have a hyper-T cat who spent about 5 years on methimazole, until the dose got so high she had diarrhea from it. If your cat is somewhat young, you may want to check out radioactive iodine treatment (I-131) which knocks out some of they thyroid tissue to reduce the production of the thyroid hormones. If the dose is optimal, you may not need to medicate after treatment stabilizes.

 

[dosgatos]

Thank you, BJM. Unfortunately, we do not have a radio iodine treatment option here in Japan.
What symptoms did your cat have before methimazole, may I ask? I wish our cats will be able hang in for 5 years like your kitty..