Xuxu 1/19/13 750.

Xuxu doesn't seem to be feeling well since I've started him on Levemir. He just lays straight out on the floor, hasn't eaten much when the mirtazapine wears off. He seems very lethargic, not even purring when being petted. I looked up side effects and it does appear that in people there can be some disorientation, dizziness, nausea. Has anyone reported anything like this on Levemir?

 

No, no one has reported those symptoms - and I wonder if those are symptoms reported by humans in response to high, low, or greatly fluctuating numbers.

My gut says he needs another dose reduction. I say this because he consistently swings from 750 to 35 and back rapidly on all doses. To me, the only explanation for that is that he needs little or no insulin. If he were my cat I would want him out of the 700s enough to risk a dose like .25u to see if his numbers improve, but I would be watching him like a hawk, testing for ketones every time he peed - using any method I could to catch a urine sample. And continuing fluids.

How is his appetite? If he isn't eating, he needs to be syringe fed at least half of his daily calorie needs.

BTW, those BG swings are probably making him feel terrible. Many have reported their cats acting as if they feel like crap when they are either in high BGS or have BG swings - that could be those smptoms you found reported.

 

He crashed yesterday again, I got his BG up and had to leave for 90 minutes. When I got back he was down again, really the worse I've seen him without the rapid breathing. He had diarrhea and was drooling a lot, and really not aware. He's never had diarrhea before. I gave karo again and when he roused, I syringe fed him AD. He finally came out of it. I was testing him every 15 or 30 minutes, which I put in a 2nd 1/20/13 line. Each cell all the way across is 15 min, except where I marked 2 hrs.

I dropped his dose to .5 at 3am when he finally seemed to be normal. That made his 6 hr test when I had him at the vet the next morning. but again, it looked like the Levemir wasn't working, but then look at the 2nd 12 hr, where it's down to 296. What does this mean?

His bloodwork this morning showed his WBC down to normal, so either the zithromax or the methronidazole cleared it up. I think it's the zithro clearing up a slight respiratory infection. He's been sneezing a bit. But that didn't stop the up and down BG.

We also took blood and urine this morning to send off for a SuperChem, cBC and Thyroid. There is a uncommon form of hyperthyroidism which is called "apathetic hyperthyroidism". It has the opposite symptoms, not hyper but depressive, not eating all the time, but anorexic. Xuxu will only really eat when on the mirtazapine and he really just lays around all day. If I keep him away from the other cats, he really acts depressed. I believe I've mentioned that before. So the blood test include T4, Free T4 and T3. It sounds like T3 won't really tell anything, but it was included. The free T4 is what can show if this odd form of hyperthyroidism is present. Anyway, if it's not that, or the panels don't show up anything else, we are back to his jut being a strange case of diabetes. It will take 3-4 days to get all the tests back. I really hope it's not the hyperth, the drug treatment has some severe side effects.

 

There are some cats that do well on methimazole/Tapazole for hyperthyroidism.
My Emmy did great on it for several years, but finally needed a dose increase that caused diarrhea. Then she had I-131 treatment. That unmasked renal disease which was the eventual reason for her euthanasia.

 

Deb, for some reason the numbers for today are not showing up. However, I believe that his "crash" proves he needs little or no insulin.

I think you said that your stopped insulin for a few days once before and he stayed high?

If he is fighting for his life against the exogenous insulin, then he is pumping out cortisol and epinephrine as well as glucagon to prevent hypo. those hormones take a while to clear the body and create insulin resistance while they re circulating. The result is a pendulum swing back to high BGs. Remove the insulin and that pendulum travels even farther before starting to reverse course.

I have seen in my own cats where a large dose causes swings from high to low, and lowering it a little just causes high numbers - I think this is because the rebound "push-back" suddenly doesn't have anything to push against and just pushes too far in the wrong direction before realizing "hey. there isn't so much of that insulin around, we can relax". So, lower the dose even more that the relaxation continues and the BG starts to drop.

To me, there is NO way that Xuxu can swing from 750+ to 20s and back without a) a significant response to insulin and b) a huge rebound reaction to that huge drop.

I am not sure when the 269 happened (can't see today's or yesterday's numbers), but that could be because you reduced the dose. Reducing the dose should take the energy out of the swings IF, and only if, it is low enough to begin easing the rebound response.

I am so sorry that he isn't feeling well. And I pray that reducing the dose will stop such extreme BG swings. I really think he may need no more insulin. You should drop his dose to .25u after the next low and then you might be able to skip insulin if he drops low again after that - and see what happens. Please test him for ketones while you are doing this.

Beau's hyperthyroid was diagnosed with the free T4 by ED test. I think it is a more common test these days as vets learn that the regular T4 test doesn't always catch it. I have nor heard of apathetic hyperT, but that is not what Beau has. He has been on methimazole for three years now. He does very well on it, but I wish I could have afforded the I131 treatment when he was diagnosed because the meds can be harsh on them. I had another cat with hyperT that could not tolerate the meds in pill or transdermal gel, she just never did well on it, but she lived to be 18-1/2 on intermittent, very low doses of it. In fact, Beau was diagnosed with hyperT about 9 months before he went off insulin and going off insulin seemed to reduce his methimazole dose too. I'm not sure what the connection, if any, is there, but they both involve the endocrine system.

 

OK - I can see the numbers now. That was really pretty scary. So thankful you caught it and could intervene.

The 296 probably doesn't mean a whole lot. He is recovering (or trying to) from that serious hypo on the 20th. So you have to factor in the rebound stuff, delaying a shot (for perfect reasons), plus a reduced dose that is adding to the mix somehow. Give it a few days to settle - and watch for more lows that may signal he needs another decrease.

What was his number this morning?