11/9 Gryphon AMPS 688 Strategies for BG control in Acromegaly cat?

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Cindie, Nov 9, 2018.

  1. Cindie

    Cindie Member

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    Sep 9, 2018
    Gryphon has been diagnosed with Acromegaly, (IGF 269). I have really been struggling to try to manage his seemingly unpredictable BG. Pre-shot numbers are often low at times when I'm not available to stall or continue monitoring. Following a reduced dose, the numbers will be very high for a few days. I'm wondering if there are any strategies specific to Acromegaly kitties? Our vet mentioned mixing Lantus with Toronto insulin. Is anyone familiar with this approach?
    10/23 Gryphon AMPS 265 Dose Advice Please
     
  2. Olive & Paula

    Olive & Paula Well-Known Member

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    Sep 6, 2015
    What is toronto insulin?

    With acro you will have unpredictable glucoses. Usually higher than normal insulin doses. The tumor is running the show. Was IAA was done? There could also be insulin resistance. Gryphon needs as much as he needs.

    @Wendy&Neko is the best source here for information and help in understanding it.

    Olive started cabergoline 34 days ago. She hit 8.75 units twice a day. Finally found someone to agree to the cabergoline. She probably tomorrow will be 5.5 units. Besides lowering the insulin required I was more interested in it helping the pain the acro causes. And slowing the production of the hormone the tumor releases.

    Looking at your ss and the comments, lantus is based on the lowest glucose in the 12 hr cycle. If a preshot is low, there are something's to try before lowering or skipping dose.
     
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  3. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Take a read of the Tight Regulation Protocol Sticky Note. I am a firm believer in using it as a guideline for dosing acrocats, as long as you are feeding an all low carb wet food or raw diet.

    As Paula said, it also means getting used to shooting lower. Skipping or drastically reducing isn’t doing him any favours. Some acros nadir later, which means you have to get used to shooting lower. Neko often nadired st preshot time. On this forum, we suggest it’s a good idea to not feed, post and ask for help if you see a preshot under 150. Gradually you will lower that number. Above 150, try shooting full dose. Due to the nature of the depot, the cycle may play out the same or similar even with a reduced dose.

    Shooting lower produces flatter cycles. More time in those normal numbers will reduce how much they bounce as their bodies get used to normal numbers again. That is no different for any diabetic cat, acro or not.

    Was you Vet talking about R or Regular insulin as a bolus? It’s an option some use, but should only be started with a person experienced in R helping you to start. And it’s not nlways appropriate.
     
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  4. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Looks like it’s the same as Humulin R or Novolin R that is used here.
     
  5. Cindie

    Cindie Member

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    Sep 9, 2018
    The full name for Toronto insulin is Novelin ge Toronto. I tried to do some research on it, but couldn"t find much information. My vet said it's a fast acting insulin. He has read that mixing it with Lantus will reduce the extreme high and low BG that Gryphon experiences.

    Thanks very much for the information about cabergoline. I will mention it to my vet. I hope Olive does well on it!!
     
  6. Cindie

    Cindie Member

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    Sep 9, 2018
    He just called it Toronto insulin and said it is a fast acting insulin. He said he has never tried it, but has read that mixing the two might reduce the high and low BGs. You mentioned it's not always appropriate. Can you explain?

    I know Gryphon suffers a set back when I skip or reduce the dose. I am nervous about shooting low numbers when I am not going to be around to test and monitor, and that's when it often happens. There have been times when the full dose of insulin has lowered the BG from over 500 to under 150 within 5 hours, so it seems possible that the full dose or even a partial dose given when his BG is around 150, could cause it to drop too low? Maybe I just don't understand how it works.
     
  7. Olive & Paula

    Olive & Paula Well-Known Member

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    Sep 6, 2015
    That is the Regular or Novolin or even NPH insulin here in the states. As Wendy stated it hits quick and drops fast but only for a few hours. Definitely need experienced people helping you should you choose to use it.

    Levemir insulin might be and option. It's acts like lantus but could have a later nadir (Olive still has mid day nadirs though). Very possible to have lower preshots but you get use to shooting them. Might help level the glucose out too. Lantus tends to sting or burn when over 6 units. Levemir doesn't for most cats.

    Preferred treatment for acro is SRT (not affordable for me), removal of pituitary gland (to drastic for me, long recovery with whole other set of issues). Cabergoline is the medical treatment that's affordable for me. Most vets say it doesn't work don't bother. Very few studies on it. Some kitties have done well, at least one that was here went off insulin. Not sure if another did. I think how or what you expect of it is most important.

    I'm hoping to relieve the pain it causes, slow down its activity. Maybe lower insulin dosage. I don't expect Olive to go off insulin. It will not reverse the HCM she has.

    I'm new to the acro dx to. I've read what is available, Wendy also explains it well. I still don't understand all of it. But I think I'm being realistic in my goals in using it. The "specialists" or vets who say it doesn't work, we don't know if they were expecting remission or tumor to disappear completely.
     
    Last edited: Nov 9, 2018
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  8. Olive & Paula

    Olive & Paula Well-Known Member

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    Sep 6, 2015
    I can't answer about the Toronto insulin.

    I can offer insight to your concern of the dropping. 1st Olive is my second diabetic but totally different than my first. So I'm use to big drops, shooting lower than protocols suggest.

    In your example the 150 is about 5 hrs after shot. Most cats in lantus will have their nadir between 5-7 hrs after shot then start rising before next shot. That is normal. That is what you want to happen. In time you want that 150 to get lower and last more hours so the preshot numbers start getting lower. However, in your example that is still a big drop even though very safe. Kitty isn't use to normal numbers, the liver panics and released glycogen and then kitty has another high number. It's called a bounce. Again most kitties have them. Over time, the bounces get lower and clear faster.

    Olive can go from high 300's to the 50's in 3-4 hrs after shot. So I make sure I'm home the first 3 hrs. There are things to try. Many people here can help you figure it out.
     
  9. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Correct, it does not work that way. Lantus (and Levemir) don't yank numbers down, they are good at keep numbers relatively flat. Take a look at other people's spreadsheets here or their posts. See what happens when they shoot lower numbers. I really liked giving Neko her shot in the 80's, cause chances were she wouldn't move any more than 10 points all cycle. Of course, I had to work up to that with experience to build confidence. The first few were nail biters.
    I sure hope Toronto is the same thing as Humulin R, it is according to Dr. Google. Otherwise I sure wouldn't want to use an insulin that neither my vet nor anyone here has tried. And you do NOT mix the two. You give two shots, one of the basal insulin, Lantus in your case, and a second shot of R. Using R depends on the caregivers ability to monitor, his or her knowledge of the basal insulins onset, nadir and duration, whether giving R would do more harm than good. As Paula said, R can drop kitties hard and fast. Hard and fast drops cause bounces which cause high numbers. More R, more drops, more high numbers. It can be a viscious cycle. You have to start a low dose and controlled set of experiments with frequent testing. Most important is learning when not to give R.

    Further comments on what Paula said, you might want to consider Levemir, especially if you think he's reacting to the Lantus dose. I didn't think Neko was, but she occasionally pulled away from the Lantus shot. She purred through the Lev shots. Lantus has an acid base that can sting kitties, more so at higher doses. Many, but not all, cats go flatter on Levemir.

    We have had three cats go off of insulin using cabergoline and most at least a lower dose. We don't know a lot about the long term effects, cause it's so new as a treatment. But one of those cats off of insulin has been for over a year.
     
  10. Cindie

    Cindie Member

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    Sep 9, 2018
    Good luck! I hope Olive does well!!!
     
  11. Olive & Paula

    Olive & Paula Well-Known Member

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    Sep 6, 2015
    Thank you. I hope she does too.

    Have you come up with a plan for Gryphon?
     
  12. Cindie

    Cindie Member

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    Sep 9, 2018
    I haven't had a chance to discuss it with my vet yet. I will ask him about Cabergoline.
     

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