Ugh, we’re back. With Insulin resistance?

Hi everyone! I was off the forum since January because king Chuck was doing great. He was down to 1 unit of tresiba (similar to lantus) from 6.5 units when he was diagnosed in May 2023. In November he had a weird skin infection that the vet couldn’t diagnose. It was mostly between his shoulder blades and his fur was peeling off in clumps. After 3 months it randomly cleared up and when it did his numbers began to rise. Since March of this year his blood glucose has been high 24/7. He usually wakes up around 350 and climbs to the 400-500 by midday. we’re up to 7.5 units of tresiba and it doesn’t seem to be affecting him at all. I took him to the vet last week and his blood work was perfect, aside from his fructosamine being high. I’m at my wits end. He’s on a very low carb food And I only give him dried fish snacks throughout the day after testing his BG.

I have no idea what could be causing these crazy high numbers. I’m hopefully getting a cgm on him later this week but I haven’t gotten any low when testing throughout the day. The lowest he’s been in weeks is 275 and that was this morning before his shot. Does anyone have any ideas on what could be causing these elevated numbers? Could he be insulin resistant?

King Chuck dx 5/2023
7.5 units tresiba
Eating tiki cat silver

 

Can you either draw a line to separate 2023 from 2024 to stop confusion or start a new 2024 SS please?
Also do you have any more data apart from the 2 days for 2024? A couple of weeks would be helpful

Have you checked his teeth?
Are you testing during the pm cycle every day to see if he’s dropping at night?

 

The skin issue makes me wonder… did the vet mention Cushings at all?

 

Like Bron, I'd like to see the last couple weeks of tests you do have. Your meter should store some recent data.

I agree with Erin, skin issues made me thing Cushings too. Does he by any chance have a pot belly? What is the quality of his fur? What's his appetite like?

The other conditions I'd test for at this point are acromegaly (IGF-1 test) and IAA (insulin auto antibodies). About one in four diabetic cats has acromegaly according to the latest research.

 

The vet didn't mention it but that did cross my mind as well...

 

Yes! I just updated it because the units were wrong. I don't have a ton of numbers from the past few weeks, but I'm back to tracking consistently throughout the days and trying to get a sensor on him tomorrow. He has tartar on his teeth but the vet said it's not the worst she's seen. He has a heart murmur which is why we've never done a cleaning under anesthesia. I tested him last night and the insulin brought him down a little and he woke up around 271 (from 370+ the night before). It seems like he's more elevated during the day than at night...

 

I'm not sure about the pot belly, he's definitely wider in the belly than the legs and shoulders. It seems like he's losing muscle in his hind legs and shoulder area, I think because of his age. His fur is less shiny and kind of sticks together (like a human part) but overall I think it's in good condition. He hasn't had any new skin issues since March. His back claws are disgusting though, they're thick and he gets black build up that I have to dig out. The vet thought it was from him digging in his ears (he's always had yeast and wax build up). He is RAVENOUS. He is always meowing for food and recently started meowing in the middle of the night. He gets a little more manageable when his BG is lower but not by much. Recently he started taking food off the kitchen counter, he ate half a baked potato a couple weeks ago.

The vet also said he had a little bit of protein in his urine and we're planning to recheck that once he gets his sensor on. I will ask about the other tests too!

yikes I looked at photos online of cushings skin issues and it’s very similar to what Chuck had a few months ago. His wasn’t nearly as severe as what I’m seeing but his skin was peeling off like paper. Do you know if cushings sores would just go away though? It was the weirdest thing

 

I don't think the sore go away, but maybe come in waves? Cushings is caused by a higher level of cortisol in the system, caused by one of a tumour on the pituitary gland or adrenals, or by being on regular steroids. The pituitary tumour is the most common one. I don't know too much about it, more about the benign pituitary tumour that causes acromegaly. That tumour can wax and wane. Maybe the Cushings one too? I believe it's in a different part of the pituitary gland, which itself is quite tiny. There are treatments for Cushings, and acromegaly too. But you have to know what you are dealing with first.

 

My cat also had a thing where his fur was falling off in clumps, but no rash or irritation or anything. Just bald spots. And now it's growing back. It's sooo weird!

 

We went to the vet yesterday and she wasn’t convinced it could be cushings. She said the sores don’t normally disappear and he doesn’t have a potbelly (my mistake lol). We did another urinalysis since he had protein in his urine at the last check up. His BG was under 300 all day today and hit 189 at +8. We got the sensor placed but of course it was faulty so I’m waiting for a replacement. Once the test strips arrive I’m going to do a curve, we’re way overdue

 

how weird! Chuck had irritation, I think from the constant licking but the initial issue was a clump of skin and fur that came off. From there it spread and then vanished after about 3 months in a t shirt and cone

 

Christina -
Did the vet test for a yeast infection? If Chuck gets yeast in his ears, he may scratch his skin with the same paw(s). Alternatively, it could be a systemic yeast infection vs a yeast infection of the skin.

 

We tested for everything when the skin infection was present. Yeast, ringworm, all kinds of fungus and it came back negative. I clean his back claws now with his ear solution (prescribed for yeast). It hasn’t returned, knock on wood!