Update on Robbie and questions

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RobbiesMom

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HI all - seems I'm the every 3 month poster here - although I did post a long and detailed message about Robbie's vet visit in April and somehow it didn't post and I was too frustrated to try again - which is fine cause now things are somewhat different.
I'm hoping even though I am a lousy member of this forum and have not done "my part" in any way that I'll still get some input, insights and maybe support. Robbies bg numbers hAVE continued to improve to some extent but mostly what has happened in the past 3 months is his numbers have stayed the same on less and less insulin. We are now at .5 to maybe 1 and sometimes not twice a day since if he's on the low side I haven't given him his morning or night shot depending. I suppose I could risk it and shot .5 on a 234 but I'm not home much at all these days and neither is my husband and I just hate to risk it. His amps and pmps are almost never higher than 260. His mid cycle numbers are not that low - maybe 113 120ish - but this is on .5 most days and sometimes no shot the cycle before.
So while all this is happening something else is going on as well - he's eating a TREMENDOUS amount more food - like 6-7 cans (and more sometimes) in 18 hours up from 4-5 and he SCREAMS constantly when he's hungry. Loud HORRIBLE screams. So by the end of May this is pretty bad - and he's not looking right - I'd noticed he looked like he'd lost some weight - at the Vet visit in April we'd discussed some muscle mass loss - nothing too bad but Vet said to watch it. We also had him tested for Hyper Active Thyroid - numbers came back normal a tad high normal - both tests 2.6 for one and 29 for the other if that means anything to anyone. While our Vet still suspected he's "headed" towards hyper active Thyroid the blood tests did not show it was there yet. So after Memorial Day weekend our home visit vet who is now a good friend offered to come over and check him out as a favor - we've spent quite a bit on his vet care and meds as you can all imagine and finances are tight. I always swore I'd never put my pets care second to finances but if you just don't have the $$... our vet is good about letting us pay off but by May I was still paying off March bill - so I took her up on the free home check. It didn't end up happening for various schedule conflicts till the first week in June - she heard a galloping heart beat, was pretty sure she could feel his thyroid and asked me if his nails were thicker (I had just noticed that clipping them in anticipation of her visit). So she offered to do the blood tests - not charge us anything but the lab fees and we arranged for her to come back in a couple of days with her assistant. That ended up nothing happening again due to schedule issues - so this past Saturday I bit the bullet and took him into our regular vet (still haven't paid off March but oh, well) He's lost one pound since January which includes .5 since March, this on eating an insane amount of food (this weekend from Friday to Monday he went thru almost a FULL case of Fancy Feast- I know Roxie ate some of it cause he doesn't always clean the plate but still). He was so stressed out and panting during this visit that it was hard for our vet to tell what the heart beat was actually caused by but it did sound to him like it could be a galloping beat. They took the blood. Today we got the results - STILL NO CLEAR CASE OF HYPER ACTIVE THYROID the numbers are now 2.7 and 45 (up from the 2.6 and 29) the good news is his glucose was 271 and his fructosimine 470. This after a week where he probably got an average of one shot per day based on getting none on some days.
Tonight an hour after dinner he was 310 - 2 hours later he was 240. He was eating again so we shot .5 and I'll test him before we go to bed at +4 and see where we are. Of course it's hard to really figure it all out cause there is never a time when he's more than a couple of hours from having eaten - and I mean around the clock (not getting much uninterrupted sleep around here). Our vet would like to rule out anything else and suggests we bring in a stool sample to check for possible parasites (he licks the dog all over so who knows what he could have pickedup) and did comment that if he knew money wasn't an option would suggest an ultra sound of his abdomen - but instead thinks we should wait 3 weeks, monitor him and test again. He is however going to speak to the expert at the lab and get his opinion (endrocronologist?). spoke to our vet friend and she is convinced it's hyper thyroidism and is going to speak to an expert she is friends with in Manhattan and get his advice. I did ask our vet if there is any chance this could be ARCO and that brought him up short. He thought for a while and than said he's had 2 ACRO cats in his entire career - he doesn't see that with Robbie but he is going to give it some consideration, go over his notes and do some reading up as it's been YEARS since he has encountered a cat with this.
I guess that is more than enough - for any of you who have made it this far I'd love your thoughts. Thank you - for the record Robbie remains in pretty good spirits - he plays with the dog a lot, loves for me to hold him and walk around the house with him, plays with his cat nip toys and begs for bacon whenever it's cooked. Of course he also sleeps a lot. Thanks all.
 
Hi Ellen, good to see you again. No matter how long it's been we are always glad to hear from you.

That's quite a journey you've been on and wow on the dose decrease. Have they run a free T4 Thyroid test, I'm not positive but I think that is the test that they run for a definate yes/no answer on the Thyroid and it isn't in the usual tests that are run.

The yowling, hunger and racing heart sure sounds like the Thyroid. Is he drinking alot of water again too?
 
Hi! Yes, they ran both tests - not sure which is which but they ran all the tests there are for Thyroid. He is drinking a lot but he always does- although he's not peeing as much as he used to when the diabetes was worse.
 
Quick check - what meter are you using? Those glucose levels are still somewhat elevated. It is safe to go as low as 50 mg/dl at nadir. Are you using U-40 syringes or U-100 syringes. The later, using a conversion chart, allow you to do smaller doses. It may be that ye needs just a touch more insulin and that is partly why he is hungry.

Also, ask the vet about treating "as if" he were hyperthyroid, as the syptoms certainly seem pointed that way. Methimazole (Tapazole) is pretty cheap, may be mixed with a bit of tasty food or compounded into a gel to rub in the ear. Treating will reduce stress on the heart.

Actually, I'm an epidemiologist - we study disease in populations.
 
Quick check - what meter are you using? Those glucose levels are still somewhat elevated. It is safe to go as low as 50 mg/dl at nadir. Are you using U-40 syringes or U-100 syringes. The later, using a conversion chart, allow you to do smaller doses. It may be that he needs just a touch more insulin and that is partly why he is hungry.

Also, ask the vet about treating "as if" he were hyperthyroid, as the symptoms certainly seem pointed that way. Methimazole (Tapazole) is pretty cheap, may be mixed with a bit of tasty food or compounded into a gel to rub in the ear. Treating will reduce stress on the heart.

Actually, I'm an epidemiologist - we study disease in populations.
 
Thanks BJM I'm using an accu one I think it's called. It was my meter (still is) but has been his thru both bouts of Diabetes (he went into remission for 2 years) I'm ok with going as low as 50 but since I have not been home long enough to do a curve and he's had a few episodes in the past of dropping very fast I've been scared to risk it. For instance - last night we ended up giving him .5 when he was @ 240 at pmps - he ate HIGH cal fancy feast in the middle of the night (I was half asleep at 3am and mistakenly grabbed his sisters food which NEVER is in that drawer but...) along with 2 other cans of his normal chopped grill by the time his amps came around and this morning at amps (AFTER all that food) he was 118 so I didn't shoot at all - I won't be home till midnight and my husband won't be home till 6pm. We worked down from 4 to 3,2,1 and now either do 1 or .50 I am using U-40 so the .50 is totally by eye but we err on the side of less. During all of that he was still as hungry all the time.
Thanks for any input.
 
Good to hear from you and Robbie, Ellen. And the numbers look good! You might try a post on Health re the appetite and your test results. Maybe someone else has had a similar experience?
 
Hi Ellen :-D

You mentioned he's lost some weight. How much?
 
My cat Libby was borderline hyperthyroid and could not eat enough to maintain her weight. She was also drinking a lot of water, 1.5 to 2 cups a day, until we put her on the methimazole. She was not diabetic.

Labs have different ranges, but my Idexx lab results showed
Free T4 (ng/dL) reference range as 0.7 - 2.6 ng/dL
Free T4 (pmol/L) reference range as 9.0 - 33.5 pmol/L

If those 2.7 and 45 numbers you have are for the two ranges above, I would recommend starting methimazole based on my experience with Libby.

Other risk factors are middle-aged to older cats. If she is showing clinical signs of hyperT and a total T4 in the "grey zone", an increased free T4 supports the diagnosis of hyperT. Grey zone for T4 is defined as 2.3 - 4.7 ug/dL.

If you knew which number belonged to which test, what I have told you should help.
 
HI Carl - he's lost .5 lbs since March and a full pound since last November (or close to than) and considering how much food he's eating the fact that he's lost anything is amazing.
Deb - thanks that does make sense - I'''m going to hear from one of our vets tomorrow and I'll see what else I can find out
 
Hi Ellen - good to see you here again!

Grayson had IBD on top of his FD, and continued to lose weight after his initial dx in January of last year. He had been 22 the previous June, 18 in January, 12 in July. He's just now gotten back to his stealthy 24# :lol: Okay, maybe not so stealthy!

Grayson's appetite was ravenous. I'm sure you remember me saying he was opening Tupperware cannisters to get dry kibble, dog food, or the (my favorite) ride on the base lazy Susan (pantry) cabinet where I found him with his face in a bag of egg noodles!

Thyroid definitely could be the issue... another thing I'm thinking is Maldigestion/malabsorption. My dog Murphy used to have it. An enzyme deficiency. Fixed by mixing an enzyme with food/water for 15 min before mealtime. IBD could also be an issue. Grayson stayed low-weight until he got past the IBD issues.

He's also Acro, which often tends to parallel with huge appetite and large size (saddlebags). Do a couple of quick checks to see if there are some of the things I didn't know to look for. First, Mega-colon shows up as GIANT poops. Almost the same size as mine. Second, look at his teeth (assuming he still has them). Grayson has a gap between his canines, that happens with the bone growth common with Acro kitties. If either of these is obvious, you may want your vet to have the IGF-1 and IAA tests run. Your vet would get the mailers from MSU (Michigan State U) where they do endocrine testing for these. Actually, with your dose, the IAA is not needed (insulin resistance), as you're not at a high dose. Your vet draws the blood, spins, freezes, then ships overnight to MSU (the mailers they send are pre-paid). Info on the tests are at the Acro/IAA/Cushings forum here.

The other thing you may want to do is get an auto-feeder. If you can keep him eating at regular times, he won't be so ravenous when you get home. I got the PetSafe 5 at Petsmart. Online coupon on Petco.com for $49 w/ free shipping... price-matched at our local petsmart - saved $15! You can set 9 times for the round feeder to turn, exposing one of the 5 trays. I feed at 1, 2.5 and 4 hours after shot time, then reload at the next shot time. I only wished I had bought it sooner!

Lots to think about, and lots to ask your vet. Here's the picture of Grayson's tooth gap:
 

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thanks
first Robbie does have Mega Colon - that was diagnosed years ago. We have and use an auto feeder but - it's complicated with the 2 cats and the dog at home sometimes. Plus he seems to really WANT or NEED one of us to show him the food - it's odd - there is sometimes STILL food in his bowl and he's wondering around howling.
Our vet checked that tooth jaw bone growth thing- robbie had 3 teeth removed from the back left of his mouth but has all the others. Talked to our home visit vet again today and she is going to do a second test for us and not charge us at all - gonna do it after July 4th weekend since she's insane busy and us too.

Thanks again!
 
Hello, Ellen & Robbie!
What a difficult DM + journey! I could never remember verbally given lab numbers, I found it most effective to ask the vet's office for paper copies of all lab results. Keeping you & Robbie n my thoughts. Best wishes, Sophie
 
You may want to feed him a higher fat low carb food. Fat has 8.5 calories per gram vs the 3.5 for protein and carbs (numbers for animals differ from those for humans). That may help take the edge off.
 
thanks BJM I have done that a bit - mixed some in with his regular food - it does take the edge off. Our vet friend has offered to do the blood test again right after July 4th weekend for free - she'll cover the lab fee - she's that positive the numbers are gonna have changed yet again. Gonna take her up on it.
 
'Nother note: lab tests are compared to reference numbers derived from testing animals with and without symptoms. BUT... you aren't treating the lab! The numbers may be 'normal' compared to the ranges, yet be abnormal for the specific cat. Discuss with your vet.

(By the way human docs forget this, too! Its how I spent 20 years with an undiagnosed thyroid condition!)
 
And NOW Robbie is on high blood pressure meds. On July 12th as I was leaving for the biggest work event of my year after a night in the ER with a 103 temperature I went to pick Robbie up and give him a snuggle before I left as I typically do - I looked at his face and his left pupil was HUGE and his right one was normal. I freaked out - called our friend the house call Vet and she said "high blood pressure" ironically she was going as a ticketed guest to the big event I was helping run so we agreed to leave at the end of the night together and she'd come home to check out Robbie. So at midnight that Friday night Robbie got his blood pressure taken while he was fairly calm lying on our dining table and it was 220. Normal I believe is about 160 or high normal is? Anyway, he went on blood pressure pills that night - she also took his blood to RE-test for the hyper thyroid (which came out exactly the same as before - high normal). It's taken me till today to talk to our regular vet (work insanity, health issues etc) he was very kind and told me he'd met with the house call vet and they'd discussed Robbie for a while. They both feel a ultra sound and an xray would be helpful in seeing what else could be up but that there is not enough indication for them to put me thru the $700 approx cost... and we should just "sit on this" for a while. His fructosimine test was "almost normal" his amps and pmps are about 200/220 and this is for a cat who is eating about every 2 hours or LESS so he's never really without some sort of food level in his system. I'd do a curve if I could catch him when he wasn't eating LOL I do not thing he's lost more weight - he'd only lost about 1/2 lb. Seems to have stabilized at that weight now. My regular Vet is researching the whole ACRO item more carefully but I'm less inclined to think thats what's going on. Unless anyone has input on why I should seriously consider that.
Thanks for your thoughts on this.
 
Given the 'high normal' thyroid AND the high blood pressure AND high appetite, ask about an empirical trial of anti-thyroid med to see if it helps lower the blood presure and appetite.

An empirical trial is one where you treat the symptoms as if the thyroid is too high for the cat, even if the numbers don't clearly identify hyperthyroidism. And remind the doc that reference values are population averages which may not be correct for a specific cat.
 
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