She was diagnosed with diabetes 8/18. She’s on 7 units of Lantus two times daily. She tested positive for acromegaly 2/15/19 With hg- 1 of 325.
Hello and welcome. Sorry about the diagnosis, but at least you now have an explanation for the higher dose. You mentioned on your post on Feline Health that the vet has mentioned some treatment options. What were they? We may have some cheaper options for you. We have had some acrocats that were not treated live longer than two years. One of the important things to do is to get to a dose where Paris spends most of her time under renal threshold. Acromegaly is hard on kidneys by itself, adding in high blood sugar makes it worse. Do you have any more recent data for the spreadsheet? We can help you get her into good blood sugar numbers. Depending on where her dose goes, at some point you may wish to consider Levemir insulin instead. Many cats on higher doses find the Lantus acid base to sting. Also, many cats numbers are flatter on Levemir, though it’s not guaranteed. Does Paris have any other acro symptoms?
Welcome to the forum. Both Wendy and I have direct experience with Acro cats. BG regulation is really the key to keeping your kitteh healthy. Note - I was a big fan of Super Dave Osborne (Bob Einstein). I was sad to see him pass from leukemia last month.
the vet specialist recommended a few options and is putting a plan together. Here is the letter that I received from the vet.
Paris has neuropathy and it's deteriorating more rapidly than I thought it would. This morning she was struggling to jump up on the bed. I feel for her. It really hurts th see this happening to my poor baby.
My MurFees IGF-1 was >571. I adopted MurrFee as a diabetic cat that was already being treated. He also could not jump well at all. I started Cosequin and controlled his diabetes a lot better. After I had difficulty with BG control and with dose about 10 units I went to a specialist. She was not really much help and I just kept increasing dose. I then had my regular vet do the IGF-1 and IA tests done and when the results were back went to the head internal medicine specialist in the same speciality practice as before. She was so much better. She agreed with using both Leemir and N insulin and pointed out to MurrFee physical features that also suggested acromegaly. Prior to this MurrFee vomited and was lethargic and I went to ER. They did ultrasound and confirmed pancreatitis. The US also noted wall thickening if the small intestines and some kidney degradation like noted in Paris' US. MurrFee had history of loose stools so I started a probiotic and weekly B12 (cyanocobalamin) injections.
Wow, what a lot of bad advice! Let's start with food. First of all, there is nothing magic about the DM food, other than helping fund the vet's childrens education plans. The ingredients aren't the best and many kitties grow tired of it. You can choose any low carb commercial wet or raw food to feed Paris. Check out this list of common commercially available foods, and look for something under 10% in carbs. And please get rid of the DM kibble - it's too high in carbs for a diabetic cat and will make regulation very difficult. It sounds like Paris is very hungry, my girl would steal food if I didn't hide it. Very common with acros. Instead of two meals a day, feel free to spread out her feedings in the first six hours or so after her insulin shot. Human diabetics spread out their food into mini meals as it's easier for the pancreas to handle. The same principle works for cats on long lasting insulin like Lantus or Levemir. I used an automatic pet feeder, the Petsafe 5 to feed the mini meals. It meant Neko's attention moved to the autofeeder from me, and also meant I could leave the house and know she would be safe because meals would be presented to her. The one meal before shot is a relic from the old fast acting insulin days. Next topic is testing. Here, testing your cat is strongly recommended. At a minimum, we test before every shot to make sure it's safe to give the shot. We also determine how to change the cat's dose based on how low the dose takes the cat. Those lows are somewhere in the middle of the cycle, so we recommend spot checks. That includes a test before bed, as many cats go lower at night. I've lost track of the number of times I've seen people start home testing blood sugars and realize their cat is way overdosed and about to hypo. Testing will keep Paris safe, and allow you to get to a good dose faster. Cats need as much insulin as they need. We have had some acros need over 50 units. I was lucky that Neko maxed out at 8.75 units per dose. Do you have any recent blood test data on Paris? I don't see anything for this year in the spreadsheet. It's very important for you to try to get to an insulin dose where Paris spends most of her time below renal threshold, ie. mostly below 200, in order to give her kidneys a break. Acromegaly is hard on kidneys by itself, you need to do what you can to ease their load. Over on the Lantus/Levemir forum, we have a couple of dosing methods that you can use if you want to be more in charge of getting Paris to a better insulin dose sooner. One of the dosing methods, Tight Regulation, requires more testing, but also allows you to make dose increases every few days, depending on what sort of numbers you are seeing. We can help you over on the L/L forum if you want to go that way. My Neko, and many other acros have been well regulated and much happier that way. It also reduces how hungry they are. OK, now to treatments. SRT and hypophysectomy (done in New York) and both rather costly. There are other places that do SRT (stereotactic radiation therapy) than what they listed. I had SRT first done for Neko back when it was around $4000 and that included the CT scan. Now it's double or more that price. I wouldn't do what they called the definitive or non stereotatic radiation therapy option the vet mentions, too mady side effects from numerous radiation sessions. SRT is 1-3 radiation sessions. Hypophysectomy costs more, though AMC in New York did have a large donation and were doing some for minimal cost last fall. Not sure if they still have some of that donor money available. There are some posts in this forum describing people's experiences with the surgery. Pasireotide, the medical solution, is out of this world expensive, even the long lasting one which has been available for a few years in the USA. To date, I know of no one who has tried it. I talked to the folks at the Royal Veterinary College (RVC) in London, where the original research was done on pasireotide, and they too had no one try it due to cost and availability. I did explore that option (I am in Canada) and it would be several thousand per month. There is one possible treatment the IM vet did not talk about, and that is a medication called cabergoline. Discussion post here. Results are mixed, but we have had three cats go off of insulin while taking cabergoline. Most of the acrocats on it see clinical improvement and lowering of doses. If your vet gives pushback on trying this drug, I can try contacting one of our other members who is a vet in Michigan, has an acrocat herself, and using cabergoline. Might be someone your vet can talk to. RVC has researched this drug and published a paper saying results were mixed. Which they are, but the costs are something people can actually afford. If money is not an issue, then SRT or hypophectomy could be an option. We have had more cats on FDMB try cabergoline than were in the RVC trial. As for neuropathy, the thing that will help best is getting Paris into better blood sugar numbers. In addition, get some Zobaline, a pill that can be crushed and put on her food. It can take several weeks to see improvements but has helped many kitties. Sorry for the novel, that letter had me shaking my head.
Larry brings up another good point. Many, though not all, kitties find the acid base of Lantus stings when it gets to higher doses. If you find Paris flinching or seeming to react to the Lantus shots, you might want to consider Levemir instead. Many high dose kitties seem to do better on Levemir. And that brings up another couple of items from the letter. Please do NOT shake or roll the Lantus vial. Again, that is something you do with the older insulins, but not Lantus or Levemir. That may shorten it's life. We've had many people here use Lantus vials up to six months with proper care. The Lantus/Levemir forum has a yellow starred Sticky Note on care of your insulin.
thanks for the advice. I don't use kibble but I do use the wet purina pro plan DM. I will change foods> My regular vet told me not to shake or roll the Lantus. I don't. Paris blood sugar never g has gotten below 300 on a most days. Thats a lot of info.
Sorry if I overwhelmed you. The acro diagnosis means a lot to take in. Keep asking questions. Good to know you are doing the right things with the vial and kibble. Sounds like your vet knows more than the IM vet.
It is worth re-reading Wendy's long post. We have both been through it. All that information she provided is important. Maybe the most important now, is to get your kitteh's BG (blood glucose) regulated, with nadirs under 200. Until you do that, neuropathy will be with Paris. Leo had HORRIBLE neuropathy. Then I regulated him, and gave him Zobaline (B12). Within a few months, most of his neuropathy went away. There is no 5 minute fix. You have to regulate the BG, and provide B12. The B12 helps build back up the ruined neural sheaths in the damaged nerves. I now feed all our kittehs Fancy Feast classic. It is on the list. Carbs are low. There are ~10 varieties and the kittehs really like them.
With the BGs you are seeing and the acromegaly I would and did increase dose a lot faster and in larger increments than 1/4 unit.
Thanks! You all are amazing! I’m so lost and my stomach is rolling and my eyes never seem to be dry. I just jumped her insulin up to 7.5 units!
We can really help you a lot more if you test on the pre-shots and get some nadir tests too. The spreadsheet is an invaluable tool. And we know...it can be painful to keep it updated. But you will see that I keep Leo's updated as well.
There is no quick fix to acro, no magic wand. My Sophie had pituitary surgery at AMC back in September, and we are still working on straightening her out in certain areas. It has been a slow, gradual process. Yes, she is off of insulin, but she is on some other medications for life, and she is still on Desmopressin, a hormone that is used to regulate her kidneys. It has not been a linear, fast process in her recovery. Amanda and Shmee, along with Jeff and Titan (from the UK), I am sure will agree as their felines also had this surgery. The other options - SRT, medications, and just treating with insulin and what might be needed in the process, all have their drawbacks, between cost and overall result. I know you are in the learning state of this, Superdave, and I know exactly how much your head is spinning. I adopted my Sophie, thinking she was just a regular diabetic. HAHA, life gave me a quick kick and I found out she was acro 18 months after that point. Don't question yourself. Read and read and follow the excellent advice that you will find on this message board in in the Acro Forum. We all know how overwhelming this is.
The hardest thing I had to deal with regarding Sophie's acro is having to give her so stinkin' much insulin. I was convinced for MONTHS that I was just giving her too much, so that she was bouncing. Well, Duh, at the levels I was shooting, there was no way she would bounce. I was up to 20 units twice a day, and still not even close to regulated by the time she had her surgery. Glad you took the big step and realized that you need insane amounts for your furry family member, SUHPERDAVE!!!
