? 2/15 Sebastian

Just wanted to give everyone following Sebastian an update. We saw the vet yesterday and they did a round of tests.

"Lab Results: The CBC is normal, chemistry panel has elevated glucose and very mild elevation in
amylase- but otherwise no major changes. The Urinalysis has a lower concentration than typical at 1.026
but kidneys are functioning well. Thyroid hormone is normal."

They also said the IAA test was probably unnecessary since that's something that is found for type 1 diabetes which cats don't really get. The IGF-1 they said they really don't think he has since it's pretty rare and usually has physical symptoms as well. I might still have them run it anyways.

They wanted me to go back to the Vetsulin at 2u and stick to that for 7-10 days, so I'm going to give that a fair shot. I'm not going to take any readings right away since I'm guessing his numbers will be up a bit and I don't want to freak myself. I'm going to monitor his weight for changes and start testing again closer to the 7-10 days.

I don't know what to think. My previous vet said the same thing about Olive and doing the IGF. I said run it anyways. They did not do the IAA even though I asked and actually I thought that was our issue. But since treatment is just giving more insulin Dr said it's not needed, uggggh.

So IGF comes back and Dr said she doesn't have it. I get copy of labs (I do for everything) and YES she does have it. But Dr was reading it at UK measurements not U.S. measures. So I told him to convert her results to UK. Then he agreed she had it.

Acro is more common then Doctors believe. With Sebastian numbers high and the dose you are giving, there is a reason for it.

Trying Vetsulin and at a very low dose, you are losing any progress you made so far. Should you then go back to lantus, you will have to start over again. Sebastian could become quite sick and your risking DKA again.I

Can you get a 2nd opinion before you go back to Vetsulin? What is doctors reasoning? Is it because they are more familiar with Vetsulin and not comfortable with a human insulin? Yep been there too. I had to start it against their advice. Once I showed him the data, he couldn't deny it. Now it's his preferred.

Please keep close eyes on ketones. Blood meter might be considered as it will pick it up before it starts showing in urine. Get help right away. Since he's had DKA before, he is more susceptible for it again.

I agree that going back to Vetsulin is not a good option. What might be a better option would be to use a bolus ( in/out insulin) like Novolin R along with the Lantus. There are peeps here that have experience using it and could help you with a starting dose and when in the cycle to give it. The Novolin R can be purchase at Walmart Pharmacy with no RX necessary for around 25 bucks . I think too that abandoning the Lantus would be a disservice.

If you put a ? mark on your thread perhaps some of the veterans will weigh in with their opinion.

The one nice thing about knowing if IAA is on the table would be to be prepared if the antibodies started to die and he would come racing down the dose ladder, as the IAA is self limiting to about one year.

@Wendy&Neko -- Wendy is very knowledgeable about the IGF testing and all things acro. Acromegaly was once thought to be rather rare in cats. Research has shown this is not the case. It occurs far more often than most vets realize and certainly more often than most vets learned in school!

Insulin resistance (insulin autoantibodies) are also far more common that your vet realizes. Most cats are Type 2 diabetics and we see lots of positive IAA values on this Board. @Sandy and Black Kitty is one of our most experienced members and the first caregiver here who's cat was diagnosed with IAA.

In many cases, asking your vet to "humor" you and run the tests is a reasonable request. After all, you'd be paying for the tests. As for the Vetsulin, the American Animal Hospital Assn recommends either Lantus or Prozinc for the treatment of feline diabetes. Given a cat's metabolism, Vetsulin is too short acting to be useful.

@Bobbie And Bubba - I think the cost for R has gone up to around $60/vial.

Sienne and Gabby (GA) said:

$60/vial.

Click to expand...

wow, glad I got mine before it went up!

ETA: I just called my Walmart pharmacy and the price is $24.88.

With his recent DKA, I would be worried about ketones if you switch to Vetsulin at that lower dose. Please check for ketones at least daily, especially if he acts off in any way. I also recommend getting a blood ketone meter, as they are easier when you need to know now, and you don't have to wait and hopefully catch them mid-pee in the litter box using the ketostix.

Mr Funk said:

They also said the IAA test was probably unnecessary since that's something that is found for type 1 diabetes which cats don't really get. The IGF-1 they said they really don't think he has since it's pretty rare and usually has physical symptoms as well. I might still have them run it anyways.

Click to expand...

Sorry your vet is horribly out of date, but it’s not uncommon. Mine was the same but I asked her to humour me to get the tests done. She was more surprised than me at the results. A paper published a few years ago on a study of a large population of diabetic cats found one in four has acromegaly. Less research has been done on IAA, cats can have it by itself, or with acromegaly like my girl did. Acromegaly is considered by some to be like a type 3 diabetes, or diabetes caused by other endocrine conditions. And as mentioned above, it can make a difference in dosing strategy. As for acromegaly, something around only 35% have clinical or visible symptoms on diagnosis.

Speaking of dosing strategy, going to a short acting insulin is going the wrong direction. Neko started on Caninsulin, which is what Vetsulin is but rebranded in the US. She did much better on Lantus, then even better on Levemir.

How is the switch to dry food going? That will also make a huge difference. Please continue testing daily for ketones.

Thanks for all the input everyone. On Monday I'll take him to our local vet and get the blood drawn to do the IGF and IAA. The specialist vet was going to do the IGF but they f'ed up the sample so we were just going to wait and see how the Vetsulin does but based on everyone's feedback I'm going to get it done for the sake of it.

I'm going to stick with the Vetsulin for the week and see what happens. We weren't making any progress with the Lantus anyways so I don't really feel like we're losing anything by giving it a shot. I actually think he's been doing a bit better the past couple days since he's been on it, he's a little more awake and active.

Food transition has been going well, we're currently at half DM Dry/half Dr Elsey with some Wellness Core wet mixed in. Tomorrow I'll be stepping up the dry transition to 1/4 DM/3/4 Dr E. I've been checking ketones whenever possible and he's still negative. Was going to start on the BG checks again on Monday.

So I just tested his BG and assuming the test was accurate it was a 209, which is the lowest I've seen it in years. So whatever we're doing seems to be working.

Glad you are testing. The food transition can make a significant difference to the insulin needs. Not the time to skimp on tests. Good news on s the low yellow.

So let me ask, are there treatments for the Acromegaly or IAA? When I was talking to the vet about it they didn't comment about the Acro much other than to say he probably didn't have it, but they did act like there wasn't a treatment for the IAA.

I ask because I'm debating on just burning the bridge with them. I thought Sebastian was doing okay on the Vetsulin but he's dropping weight fast now. He was down to 10lbs 15ozs yesterday and this morning he's at 10lbs 8ozs and hasn't eaten much. The specialist vet basically hasn't given me any explanations for anything, nothing about why he lost the weight in the first place and can't gain it back, why we should try the Vetsulin instead of Lantus, nothing. I also can't stand the fact that they make these changes to treatment and then take off for the weekend, leaving me to struggle with a potentially life threatening complication as a result.