3/1 Cleo AMPS=452 We have labs & diagnosis

Cleocatra

Cleocatra

Member Since 2020
Took Cleo to VCA diagnostic hospital in north Dallas last Mon. 2/24. Did a complete blood panel. They put her under to do all tests & ultrasound. Weight= 7.53kg/16.6lbs. BG reading by lab shows 420 at mid-day so my test readings w/ Alphatrak2 are good. Do not have the IGF growth hormone test back yet that looks for acromegaly but she is not showing any physical signs in face. Also did ultrasound and image along w/ PSL level shows pancreatitis. Urine shows glucose & protein, no UTI's. Cholesterol is elevated. Ultrasound showed "thickening of small intestine wall" which indicates a bit of irritable bowel. All other blood tests were within normal range. Dr. said to raise lantus to 6u 2x day.
She's been getting 6U for 5 days now and AMPS today is still 452. It's like she's not responding to insulin at all. Her hind legs are weak, she walks a few yards then rests, still squatting in her poop, usually early in morning or evening. On Zobaline 50mg 1x evening meal. Attitude is good, bright and cheerful, wants to be around us all the time, appetite is good but she just lays around. We are keeping her on 1 3/4 can of Purina DM canned and nothing else. We found if we give her Fancy Feast tuna feast (the one w/ good carb #'s) or any other different food, we have a big mess to clean up the next day and she mopes around like she has upset system. So DM it is from here on out. Her thirst has dropped dramatically since we put her on all canned food and that's about the only good thing to report at this time.

I'm very disappointed at this point, not seeing BG#'s coming down while insulin keeps going up. Why is this cat so insulin resistant? Watching her hobble around knowing what's going on inside her is very upsetting and I feel like we are not aggressive enough w/ her treatment while she's slowly declining. Is Lantus not the right stuff? I will give latest curve to the Dr. tomorrow.
 
Good morning to Cleocatra and you!

First thing to do today is to take the "GA" out of your subject line. GA means "gone ahead", or "guardian angel" and is our way of telling others that the kitty has died.

Sounds like the lab results have given you many concerns, but I know that the members here who have experience with acro and IAA will be able to give you good advice. It can take a while to get a kitty on a track of improvement. Don't despair. At least you have the food issue in hand (is it possible that she's allergic to fish?). You might consider switching insulin from Lantus to Levemir. At high doses Lantus stings. Keep in mind that Lantus (and Levemir) dosing is based on the lowest number of the 12-hour cycle, not on the preshot number.

Sending many good thoughts for Cleocatra to feel better.

:bighug::bighug::bighug:s for you
 
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Ooops sorry about that! She does ok w/ plain canned tuna in water. It's just whatever else is in tuna cat food is not agreeing. So we'll just stay with what works. DM canned seems to be good so far.
Ok, so her lowest # in the past month or so is 305 but closer to 350ish. That was when I switched her over to all canned food. Seems she reacted to losing the carbs in the dry food for a few days, and then the #'s shot right back up. The increase in dose for the past week has done nothing to bring the #'s down. Today I'm doing a complete curve and turning it in to Dr.
Tell me more about Levemir, please.
 
Levemir is a depot insulin and while it is pharmacologically different than Lantus, in terms of how you dose, it works in a similar way. TR was developed for use with both Lantus and Lev. The biggest practical difference is that Lantus is acidic. For cats that are on larger doses of insulin, the sting associated with Lantus can become more noticeable. One other difference is that Lev has a later onset and nadir.

I'd encourage you to try to get more spot checks. What we can't tell is whether Cleo's numbers are dropping in the middle of the cycle and what you're seeing at pre-shot times are bounces. Also, PLEASE get a test every single time before you shoot. Despite thinking that Cleo is likely in high numbers, you do not want to be surprised and when you test at +3, find your kitty is in the 30s.
 
Sienne and Gabby (GA) said:
Levemir is a depot insulin and while it is pharmacologically different than Lantus, in terms of how you dose, it works in a similar way. TR was developed for use with both Lantus and Lev. The biggest practical difference is that Lantus is acidic. For cats that are on larger doses of insulin, the sting associated with Lantus can become more noticeable. One other difference is that Lev has a later onset and nadir.

I'd encourage you to try to get more spot checks. What we can't tell is whether Cleo's numbers are dropping in the middle of the cycle and what you're seeing at pre-shot times are bounces. Also, PLEASE get a test every single time before you shoot. Despite thinking that Cleo is likely in high numbers, you do not want to be surprised and when you test at +3, find your kitty is in the 30s.
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I have done spot checks. I put them on the spreadsheet along w/ the previous curves. They don't curve much! She's never been below 200.
 
If the DM is the pate one it is carb appropriate. There is I think one that call savory which has shredded pieces in it, that is not carb appropriate. My 1st kitty did well on DM pate. He had a lot of the same issues.

You can give zobaline 2x a day. What isn't absorbed will pass in urine. Once glucose is better, you can go back to once a day.I

What are you doing for pancreatitis?
 
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Olive & Paula said:
If the DM is the pate one of us carb appropriate. There is I think one that call savory which has shredded pieces in it, that is not carb appropriate. My 1st kitty did well on DM pate. He had a lot of the same issues.

You can give zobaline 2x a day. What isn't absorbed will pass in urine. Once glucose is better, you can go back to once a day.I

What are you doing for pancreatitis?
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Dr. did not give any treatment for pancreatitis, said there is none. The food should not be the cause. Can't get the BG#'s down! I know that's what's causing the back legs to go out and Zobaline won't do anything if her BG is too high.
Just tested- 425!! It's like the insulin is doing nothing. I'm so pi$$ed.
 
Cleocatra said:
Dr. did not give any treatment for pancreatitis, said there is none. The food should not be the cause. Can't get the BG#'s down! I know that's what's causing the back legs to go out and Zobaline won't do anything if her BG is too high.
Just tested- 425!! It's like the insulin is doing nothing. I'm so pi$$ed.
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Zobaline will help her legs even if glucose is high. Of course getting it down is best. In the meantime. Zobaline will help with the nerve pain in the legs caused by diabetes. It can take weeks to see slightest improvement, but it will help with the legs.
 
Cleocatra said:
Dr. did not give any treatment for pancreatitis, said there is none. The food should not be the cause.
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There's no cure per se for pancreatitis, but the symptoms can be managed. In particular, pain meds can help a lot to make kitty more comfortable-- pancreatitis is a very painful condition. In some cases, subcutaneous fluids (can be given at home) also seem to help with comfort.

It's great you've gotten some spot checks between shots. Definitely make sure to get at least one of those each time. Although it seems as if she is always high, we've found that a single low BG value can provoke a cat's body to react by zooming up for up to three days of high numbers. That means that, if you're in that situation, it takes frequent testing (or a lot of luck!) to catch the low. Right now, Cleo is on a pretty high dose of insulin, so it's really important to make sure that that high dose is justified, because otherwise it could be very dangerous.
 
Olive & Paula said:
I'm confused. You said ultrasound and PSL show pancreatitis, but Dr says no. I don't understand then.
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yes Dr. said pancreatitis based on ultrasound:

"Cleo's abdominal ultrasound revealed changes to her pancreas that suggest previous or possibly chronic ongoing pancreatitis, although she is not showing any symptoms. This could be contributing to her poorly
regulated diabetes, but unfortunately, there are no specific treatments for this"
"We did not find any other causes for insulin resistance so far, but her IGF-1, evaluating for acromegaly, is still
pending. We instructed Mr. Hasek to raise her insulin dose to 6U every 12 hours and repeat a curve at home
in 5-7 days. We will update again once her results are in."
 
I don't know if you've seen this post on pancreatitis that Marje put together.. Pancreatitis is quite painful and cats are masters at disguising any discomfort. Pain can also contribute to elevated BG numbers. Perhaps your vet would consider providing your cat with buprenorphine to help manage the discomfort. FWIW, getting a Spec fPL (it's a blood test) is also an easy way to diagnose pancreatitis.

It can take weeks, if not months, for methylcobalamin to work, especially if BG numbers are high.

Did your vet also ask for labs for insulin auto-antibodies to be run? This is a test for insulin resistance.
 
Sienne and Gabby (GA) said:
I don't know if you've seen this post on pancreatitis that Marje put together.. Pancreatitis is quite painful and cats are masters at disguising any discomfort. Pain can also contribute to elevated BG numbers. Perhaps your vet would consider providing your cat with buprenorphine to help manage the discomfort. FWIW, getting a Spec fPL (it's a blood test) is also an easy way to diagnose pancreatitis.

It can take weeks, if not months, for methylcobalamin to work, especially if BG numbers are high.

Did your vet also ask for labs for insulin auto-antibodies to be run? This is a test for insulin resistance.
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We are waiting for the IGF-1 (growth hormone associated w/ acro) lab results. Should get results in a day or so.
Test for ketones was negative, so that's good. Everything's pointing to mild pancreatitis:

PrecisionPSL 46 Normal range: 8 - 26 U/L
(PrecisionPSL elevations correlate closely with abnormal PLI
concentrations. In cats with appropriate clinical signs, this
PrecisionPSL is supportive of, but not definitive, for a diagnosis of
pancreatitis. In cats without clinical signs of pancreatitis, a mild
elevation is an insignificant finding)

-Abdominal ultrasound:
The liver appears normal in size, shape, and echogenicity. No masses or nodules are noted.
The gall bladder appears normal. No bile duct dilation is noted.
The spleen appears enlarged (1.75cm thickness), but normal in shape and echogenicity. No masses or
nodules are noted.
The left kidney appears normal in size (4.7cm), with slightly irregular margins, and normal echogenicity. There
is decreased corticomedullary distinction.
The right kidney appears normal in size (4.77cm), shape, and echogenicity. There is decreased
corticomedullary distinction.
The bladder appears normal. No stones or masses are present.
The stomach appears normal.
The duodenal wall thickness is mildly increased at 0.31cm.
The jejunal wall thickness is mildly to moderately thickened at 0.23-0.33cm, with a prominent muscularis
layer.
The ileal wall thickness is mildly thickened 0.35cm.
The colon appears normal.
The right limb of the pancreas is moderately enlarged (1.19cm thickness) and mixed echogenicity with cystic
regions. The left limb is mildly enlarged at 1.14cm in thickness and has a more heterogenous appearance.
There is mild mesenteric lymphadenopathy, measuring 3-6mm in thickness.
No free abdominal fluid is present.
Summary: Age-related changes to kidneys. Splenomegaly, which may be secondary to sedation. Diffuse
thickening of small intestines with prominent muscularis layer and mild mesenteric lymphadenopathy (r/o:
IBD, food allergy, small cell lymphoma, or Histoplasmosis). Changes to the pancreas may be secondary to
nodular hyperplasia, previous or ongoing chronic pancreatitis, or less likely neoplasia.
 
I'm not familiar with the Precision PSL but my vet uses IDEXX and they were the company that developed the Spec fPLI.

If there is a suspicion of IBD, it's possible that inflammation is contributing to the higher numbers, as well. Have you given any thought to trying Cleo out on novel proteins? I tend to think it's reasonable to try to rule one underlying condition out at a time. Unless you've been seeing symptoms of IBD (typically diarrhea, vomiting, etc.), it may be a long shot.

I'd encourage you to have @Wendy&Neko have a look and tag her when your results come in. She has a wealth of experience with cats with acromegaly and @Sandy and Black Kitty is the resident guru with IAA/insulin resistance.
 
Sienne and Gabby (GA) said:
I'm not familiar with the Precision PSL but my vet uses IDEXX and they were the company that developed the Spec fPLI.

If there is a suspicion of IBD, it's possible that inflammation is contributing to the higher numbers, as well. Have you given any thought to trying Cleo out on novel proteins? I tend to think it's reasonable to try to rule one underlying condition out at a time. Unless you've been seeing symptoms of IBD (typically diarrhea, vomiting, etc.), it may be a long shot.

I'd encourage you to have @Wendy&Neko have a look and tag her when your results come in. She has a wealth of experience with cats with acromegaly and @Sandy and Black Kitty is the resident guru with IAA/insulin resistance.
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I think Cleo always has had a sensitive stomach. When we changed foods, or she ate too much too fast, or went out and ate grass- she would vomit. At times, she would just shut down and go lay down for 1/2 day or so like she just didn't feel good. Then should would be ok. No chronic diarrhea history, just runny poop if we changed foods in years past. We took her in about 3 yrs ago when she stopped eating and laid around w/ this clear liquid coming out her butt. I think they gave her a steroid and she got over it and everything was fine.
I will forward your comment about the insulin resistance to Dr. Stiller at the diagnostic clinic. thanks!
 
Mild elevation in PSL. That could be the diabetes. With p'titis you do treat symptoms, but Cleo doesn't have any. That's good. Ollie is chronic, so I treat immediately when she eats half or less than normal, and/or vomits. She is on bupre routinely, but I will up her dose if needed. She will turn around in a day or two.

Hope test comes back favorable.
 
Olive & Paula said:
Mild elevation in PSL. That could be the diabetes. With p'titis you do treat symptoms, but Cleo doesn't have any. That's good. Ollie is chronic, so I treat immediately when she eats half or less than normal, and/or vomits. She is on bupre routinely, but I will up her dose if needed. She will turn around in a day or two.

Hope test comes back favorable.
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So the buprenorphine is a pain killer/sedative, right? I do have some gabapentin they gave us to calm her down before the lab tests. It seemed like she liked it and seemed happy, not groggy!
 
Cleocatra said:
Why is this cat so insulin resistant?
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The results of the IGF-1 (acromegaly) and IAA (insulin auto antibodies) tests will go a long way towards explaining. My girl had both conditions, they both cause insulin resistance. From the sounds of it, not sure you got the IAA test done too. Blood goes to the exact same place, so it’s a cheap add on if done at the same time.

Regarding the thickening of the bowel walls, there are a couple things that can cause it. One is inflammatory bowel disease (cats don’t get irritable bowel syndrome), the other is small cell lymphoma. The latter sounds scary. It can be managed with mild chemo and with the proper protocol, a large majority go into remission. Novel proteins will not help SCL. Pancreatitis is commonly concurrent with both.

How is Cleo’s weight doing over the last few month? Often cats lose weight in high numbers.

I would strongly encourage you to get at least two tests every day, before giving insulin. In addition, getting at least one test in between the shots when you can. Preshots in the 400’s are no guarantee she is staying high the entire cycle. My Neko earned her first dose reduction (got below 50), starting the day at 430. She had bounced back up at the next shot time. Only those spot tests in the middle can detect those lows.
 
Cleo's weight has never gone down, only up--gradually over the past 5 years. We've tried to wean her food down, but she demands food although we try to count her calories. I know we're not grossly over-feeding her w/ heavy food. The past 6 months, she's been on ~200-250 calories/day on Purina DM dry, and now canned only. We saw a nice BG drop right after I got her off the dry DM food and onto the canned. But her BG#'s are back up again. I thought she'd drop more into the 250-350 range from the new food and increased Lantus dose. But she hasn't. But I'm not messing around w/ the food anymore- she's staying on the canned DM so we don't have anymore sh!t-shows in the morning!
 
Cleocatra said:
So the buprenorphine is a pain killer/sedative, right? I do have some gabapentin they gave us to calm her down before the lab tests. It seemed like she liked it and seemed happy, not groggy!
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Bupre is a pain killer. Ollie gets 0.2 ml every 8 hrs as a maintenance dose. She is 13 lbs and not groggy at all. Was also on low dose of gabapentin 25 mg twice a day, before we knew results of tests. The IM told be to double her dose and give every 8 hrs because how uncomfortable she was when they did the ultrasound. I couldn't even pat or brush Ollie because it hurt her so. It did help some and she was not groggy. A lot of vets give high doses to help sedate before visits. I do think and my opinion only that it needs to given consistently to be effective if it's for pain management. If it's seems to sedating, cut back on dose.
 
If Cleo's main problem is p'titis, would it cause pain that is raising her BG? She's just been laying around the last couple of days and doesn't want to do anything. She only walks a few steps then sits and then walks a few more. She purrs when I pet her and has good appetite. She'll nip my ankles when she wants food. Back legs are still wonky. PMPS was 411 an hour ago. Only had a curve of 100 today.
 
Yes, pain can raise blood sugar values. But you also have to wait six cycles for the depot to build and see what the dose can do. I'm guessing this is just her second day on 6 units? Can't tell because there is spreadsheet data missing between Feb 25th and 28th.
 
Wendy&Neko said:
Yes, pain can raise blood sugar values. But you also have to wait six cycles for the depot to build and see what the dose can do. I'm guessing this is just her second day on 6 units? Can't tell because there is spreadsheet data missing between Feb 25th and 28th.
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This is her 7th day on 6u 2x. She went to the vet last Mon. Dr told me to run the curve after waiting at least 5 days.
 
Cleocatra said:
If Cleo's main problem is p'titis, would it cause pain that is raising her BG? She's just been laying around the last couple of days and doesn't want to do anything. She only walks a few steps then sits and then walks a few more. She purrs when I pet her and has good appetite. She'll nip my ankles when she wants food. Back legs are still wonky. PMPS was 411 an hour ago. Only had a curve of 100 today.
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Is it her main problem? Pain can raise glucose. I can only say based on how Ollie is with it. When I first got Ollie she was so so uncomfortable, abdomen rock hard. Just laid like a big blob. Couldn't touch her at all. Vet said let her settle in, get insulin going (only had her 6 days). Labs came back with PSL of 97. Vet wasn't worried because insulin just started, new food, 10 hr car ride that week, New fur siblings, had no history on her.

She was eating, pooping. No vomiting. No symptoms other than bloated, hard abdomen and reacting when touching her. She was so bloated she couldn't reach back to bite you. She would flop side to side trying to get comfortable. That's when I took her to IM for ultrasound. She was miserable, I wanted to make sure she wasn't blocked or ingested something. IM confirmed p'titis and abdominal mass. Ollie had no stamina and although it's improved she doesn't walk far before needing to rest. She always ate, purred, never vomited, no diarrhea. That was Feb 2018.
In May her PSL went down but was still elevated. But she was not bloated, now months into the insulin. Zobaline for neuropathy. Stamina still poor. Still couldn't touch her below shoulders. Then in Nov 2018 her labs came back with PSL up again. No stamina, appt only slightly off. Just after Xmas her PSL is at its highest. She was vomiting, appy way off but eating some. Pain was worse. This is when the bupre, fluids, meds started. The flare up that wasn't addressed in February and May just got to far and the last episode lasted over 6 weeks. If course I don't want that to happen again. So the first sign of appy is off (usually the first sign with her), I start the meds.
 
I will be spot checking this coming week. I will be contacting Dr. this week also about IGF / acro results, discuss pain meds for p'titis
 
Definitely test before giving insulin. Just on Jan 6 Ollie's AM was 83. Can you imagine giving her the 4.75 u she was on? On 12/26 her PM preshot was 52. You have to know if it's safe to give insulin. DO NOT ASSUME it's okay. Insulin can kill.

My previous kitty was diabetic. I did not test per Dr. I didn't know better. He was on 5 units of vetsulin. On labor day weekend I knew something was off. That's when I found this site. People here told me what to do. I tested and he was around 30. He might not have survived the night.
 
Olive & Paula said:
My previous kitty was diabetic. I did not test per Dr. I didn't know better. He was on 5 units of vetsulin. On labor day weekend I knew something was off. That's when I found this site. People here told me what to do. I tested and he was around 30. He might not have survived the night.
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I had a similar experience with "Stu". I almost lost him because his vet at the time raised his dose every couple of days by a full unit. I found this group and learned how and when to test, how to find suitable foods, etc.
 
Olive & Paula said:
Is it her main problem? Pain can raise glucose. I can only say based on how Ollie is with it. When I first got Ollie she was so so uncomfortable, abdomen rock hard. Just laid like a big blob. Couldn't touch her at all. Vet said let her settle in, get insulin going (only had her 6 days). Labs came back with PSL of 97. Vet wasn't worried because insulin just started, new food, 10 hr car ride that week, New fur siblings, had no history on her.

She was eating, pooping. No vomiting. No symptoms other than bloated, hard abdomen and reacting when touching her. She was so bloated she couldn't reach back to bite you. She would flop side to side trying to get comfortable. That's when I took her to IM for ultrasound. She was miserable, I wanted to make sure she wasn't blocked or ingested something. IM confirmed p'titis and abdominal mass. Ollie had no stamina and although it's improved she doesn't walk far before needing to rest. She always ate, purred, never vomited, no diarrhea. That was Feb 2018.
In May her PSL went down but was still elevated. But she was not bloated, now months into the insulin. Zobaline for neuropathy. Stamina still poor. Still couldn't touch her below shoulders. Then in Nov 2018 her labs came back with PSL up again. No stamina, appt only slightly off. Just after Xmas her PSL is at its highest. She was vomiting, appy way off but eating some. Pain was worse. This is when the bupre, fluids, meds started. The flare up that wasn't addressed in February and May just got to far and the last episode lasted over 6 weeks. If course I don't want that to happen again. So the first sign of appy is off (usually the first sign with her), I start the meds.
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Wow- Olive's PSL was 97??!! Cleo is only at 46 (upper limit is 26). I'll ask the vet if pain meds for a couple weeks might bring down her BG.
 
I'll have to test at AMPS more often. But this cat has never gone low and never exhibited any hypo signs like coming off a night-time fast and then shooting 2.5U in A.M. before a vet appt. We've been doing this since August and we've never got her to show signs of regulation (thirst, activity level, now hind legs neuropathic).
 
Cleocatra said:
I'll have to test at AMPS more often. But this cat has never gone low and never exhibited any hypo signs like coming off a night-time fast and then shooting 2.5U in A.M. before a vet appt. We've been doing this since August and we've never got her to show signs of regulation (thirst, activity level, now hind legs neuropathic).
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Ollie nor Smokey ever had signs of hypo either. Smokey that night just didn't come out when I popped the can to feed him.

Just on Feb 12th Ollie gave me a 29 when I did my bed time test. I always do a bed test. I learned my lesson long ago. Also learned to test any time before I walk out the door. Both my cats can drop big time 2 hrs after shot (not usual for Ollie) but Smokey always did. I test minimum 4x day.
 
Got the IGF results today-- not good-- she is diagnosed w/ acromegaly. IGF is 461. Range should be 12-92.
 
Cleocatra said:
BTW, my name's Chris. I should've put that in the profile when I signed up. Too late now!
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you can always add it in the signature ...
Sorry about the diagnosis, but at least you have answers now and can adjust the way you manage the diabetes with that information
:bighug:

Cleocatra said:
I'll have to test at AMPS more often. But this cat has never gone low and never exhibited any hypo signs like coming off a night-time fast and then shooting 2.5U in A.M. before a vet appt. We've been doing this since August and we've never got her to show signs of regulation (thirst, activity level, now hind legs neuropathic).
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my cat was in the 40s last night and we were playing with a catnip toy in the kitchen- cat's don't always exhibit dramatic hypo symptoms.
 
Cleocatra said:
Got the IGF results today-- not good-- she is diagnosed w/ acromegaly. IGF is 461. Range should be 12-92.
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So sorry on dx. Now you know why glucoses are not going down easily. Did you get an IAA?

I'm sure Wendy will pop in to answer any questions. What else did the Dr say?
 
Olive & Paula said:
So sorry on dx. Now you know why glucoses are not going down easily. Did you get an IAA?

I'm sure Wendy will pop in to answer any questions. What else did the Dr say?
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The IGF fights against insulin production and usage. They have focused radiation treatment that's fairly successful but 'spensive. (~$8000+-) I've read that the most common thing is just shoot huge doses of insulin to counteract the growth hormone. That's about as much as I know.
 
Sorry about the diagnosis, Chris. Let's get our resident experts to get Cleo on their radar. You're not in this alone. You now know why numbers are hard to budge.

@Wendy&Neko has helped tons of people here who have acro kitties.

@Sandy and Black Kitty has likewise worked with many people who's cat's have insulin resistance. (I thought you said that test was also run.)
 
Cleocatra said:
The IGF fights against insulin production and usage. They have focused radiation treatment that's fairly successful but 'spensive. (~$8000+-) I've read that the most common thing is just shoot huge doses of insulin to counteract the growth hormone. That's about as much as I know.
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Wendy can explain it all so much better than I.

Treatments are
1. Nothing but just give insulin as blood glucose demands to keep it down. Doses can get very very high.
2. Radiation-which will shrink tumor, possibly putting them into remission (also might need another round in a few years), or lower the dose you give significantly.I
3. Removal of pituitary gland
4. Medication-can put some cats into remission, lower dose you give, and or limit the symptoms of acro.

I do #4 because its affordable for me. Ollie's dose is lower but her symptoms have abated. She was miserable and in pain. Irregular breathing or distressed breathing. Funny walking (not neuropathy), headaches, bloating, light sensitivity all gone.
 
Cleocatra said:
The IGF fights against insulin production and usage. They have focused radiation treatment that's fairly successful but 'spensive. (~$8000+-) I've read that the most common thing is just shoot huge doses of insulin to counteract the growth hormone. That's about as much as I know.
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:bighug::bighug::bighug: So sorry about the diagnosis Chris. Neko's IGF-1 was 440, not far off. She also had IAA. The IGF-1 number does not mean anything about the size of the tumour, just that she has acromegaly. Neko had what was described as a tiny tumour on her CT scan. One in four diabetic cats has it, so you are not alone. We can help you.
Olive & Paula said:
Treatments are
1. Nothing but just give insulin as blood glucose demands to keep it down. Doses can get very very high.
2. Radiation-which will shrink tumor, possibly putting them into remission (also might need another round in a few years), or lower the dose you give significantly.I
3. Removal of pituitary gland
4. Medication-can put some cats into remission, lower dose you give, and or limit the symptoms of acro.
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Paula did an excellent summary of the options. I'll just add some more detail.

Option 1 - give insulin and manage side effects as they occur. This is something you may have to do regardless of choosing any of the other options in addition. Ideally you want to get Cleo to a dose where you see the majority of numbers under renal threshold, which means somewhere low 200's down to 100's. Acromegaly by itself is hard o kidneys, you don't want to make it any harder by having numbers above renal threshold all the time. Note that acromegalic cats can also have small doses, it's just the ones on larger doses that tend to get detected more easily. Many people choose this option due to limitations on travel or costs.

Option 2 - radiation has gotten a lot more expensive in the last several year. I originally paid around $4000. As you can see it is now double that. Neko got down to small doses after radiation, but three years later her tumour came back. Radiation helps reduce the growth hormone, but not as great an impact on the IGF-1, which can still cause some side effects by itself. Neko was the first cat in North America to have radiation twice, but not the last. At the time of Neko's diagnosis, the options for treatment consisted of just option 1 and 2. Things have thankfully progressed somewhat, though still not where they need to be. There are several types of radiation, Cyberknife being the best (and most expensive and limited locations offering it), SRT (stereotatic radiotherapy) to linear radiation. Differences are how many treatments are required, intensity of the radiation beams and whether they come from several angles or not, reducing the side effects of radiation itself.

Option 3 - hypophysectomy or surgical removal of the pituitary. The cat is left on daily meds, but the surgery is almost always a cure. In North America, there are two places doing this surgery. One in New York and one in LA. The one in New York has more recent experience and we had a couple cats here treated by that doctor. The cost is a somewhat more than radiation. At one point the surgeon had a donation to operate on cats for minimal cost - which is when the members here had the surgery done. You do want an experienced surgeon doing this. It is brain surgery on small cat brains. This is the gold standard treatment if done in the right place. Royal Veterinary Clinic in London England has the most surgeries under their belt.

Option 3 - medication. Paula's Olive is on cabergoline. There have been conflicting studies on the effectiveness of this drug. Both studies were small numbers and we have more data on FDMB that both those studies combined. We have had three cats go into remission. Most cats see some impact on the growth hormone which means lower dose and less side effects. It is also the only cost effective solution. There is another drug called pasireotide (Signafor and Signafor LAR by Novartis) that has had some good study results, including some remissions, but over a couple years would be even high priced than the surgery. It also has a very small sample size of cat that have taken it due to the cost. RVC in England did a trial on it, but they had to have the drug donated by the manufacturer. It is a new drug, I asked my vet to see if she could even source it, and she only found the price, not where to get it. That was admittedly a few years ago.

The path forward is for you to do some reading and thinking about what would work for you and Cleo. And to try to find the dose that moves Cleo as quickly as possible. However, this is only possible if you do some additional testing. I don't know what your availability is, but you need to test before every shot, and ideally at least one more each cycle at another time. Just before bed is a good night time test to get. If cost of the AT strips is limiting you, get a human meter.

Feel free to keep asking questions. I know I had a lot at this point. I would request that tomorrow you start another new post. This one is getting rather long. Due to the number of kitties here it is easier to do one post a day, with a link to the previous one so people can go back and see the history.
 
Wendy, thank you so much for taking time for Cleo and me and Susan. We're ok with buying strips and insulin etc. Not strapped for cash. We want what's best for the little varmint and want her to have a good life quality. She's like a kid. Rt now, she's pretty happy and easy to deal with as long as her system isn't in upset. But I don't like seeing the neuropathy etc and the poopie mess it causes because of the hi BG. The 2 days where she was down near 300 she was fairly peppy. But that was fleeting. Looks like it's Option 1 going forward with consideration of anything else as we advance. I'll need to discuss this w/ the vets as well, as I don't want to play doctor on the internet! My wife accuses me of that all the time! If you have shoulder or back problems, I'm your internet doc!!
Let me read all this stuff tonight and I'll get back in here after I go for a bike ride to clear my head. This is like drinking from a fire hose.
 
Cleocatra said:
I go for a bike ride to clear my head. This is like drinking from a fire hose.
Click to expand...
Yup, know that feeling! I did and do a lot of rowing - exercise is a great way to clear the mind. Though I do have a tricky shoulder...;)

Option 1 goes for everyone, whether or not you do anything else. Well, the surgery can do away with insulin fairly quickly. Getting her numbers down will definitely help the neuropathy.

Don't forget to ask your vets how many acromegalic cats they have dealt with before. Until us, my vet thought it was rare. And that was considered true until a major study was published in 2015. My vet found a second case in her clients within months of our diagnosis.

If you like to read more, let me know, I can open up the valve on the fire hose. Lots of papers around.
 
It looks like you ran a lot of procedures on Neko. Wasn't that really hard on him? Me & wife don't want to put her through all that surgery trauma etc. We've heard so many stories of people doing all this expensive stuff to their dogs and then still have to be put down shortly thereafter. Cleo's not old but she's not young either. We don't want to put her body through radiation and all that anesthesia etc. Just sayin'...
 
I "only" had 4+ additional years with Neko after SRT, and she had much better quality of life as a result of the radiation therapy. If it had been around at the time, I might have tried cabergoline. Her last six months were more intensive when her heart started having issues - a common enough acro symptom. Would I have changed what I did in hindsight and given what was available at the time - not one thing. And she was only 11 when it started. And a great kitty I still miss a lot.

How old is Cleo?
 
The Dx of acromegaly is a hard one to swallow, that's for sure. Freckles was Dx a few weeks ago along with IAA. She doesn't have any outward symptoms either except the BG numbers and voracious appetite. We have switched to Levemir from Lantus since Freckles was starting to get irritated by the injection. We won't be doing the radiation or surgery. I'm trying to find a vet who will prescribe cabergoline so at least I can get an idea of price and see if that is an option. My vet thought I needed to get an MRI before he would prescribe cabergoline - he's misinformed. Although Freckles' numbers are crazy high, we continue to increase her insulin as glucose is still showing up in her urine. We changed the food to a lower phosphorus and had a dental done (3 extractions).

I started with Alphatrak but switched to a human meter since most of the information on this site is based on using a human meter. Alphatrak strips were super expensive and not readily accessible. I didn't see any benefit in using the Alphatrak strips.
 
Cleo is 10 y.o. She's got a big belly and a big appetite too. She's slowly gained about a lb./yr since we got her from a friend in Lubbock in Sept. '14. I thought she was just free feeding the typical dry food by prev owner, but we never could get her back to slim n trim shape. She was always hungry, but active. Our regular vet said she'd like to see her BG# at least @ 250 when we started treatment in Aug. We could never come close.
 
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