Any acro folks around?

Hi all -- it's been awhile!

I just took in an acro cat and am trying to get up to speed on the current knowledge and treatment options.

Is the catacromegaly.com website still online? I get an error when I try to access it.

"Tubby" belonged to an elderly woman who has mobility issues; despite her best efforts, she just wasn't capable of testing, shooting, or even picking up a 26 lb cat. As a result, he's been boarded at a vet clinic for the last 9 months --basically since he started on insulin.

He's an estimated 8-9 years old, 26 lbs, with an aggressive appetite and large features. I suspected acro pretty early on when I first met him a year ago, although he was diet controlled at the time. His IGF-1 back then was around 218. Recent abdominal ultrasound confirmed that his organs are all notably enlarged.

He currently on 8U Prozinc BID. That was apparently his starting dose, which I believe was based on weight (I know, I know). It hasn't been tweaked.

To the best of my knowledge, the clinic where he boarded didn't exert much effort to regulate him--they did occasional spot checks and maybe one or two curves, but never changed the dose. They reported he was doing well until recently, when he began having PU/PD.

He's also prone to constipation--significant enough that he's had at least one, if not two, abdominal surgeries to remove blockages. One fecal mass was nearly 1/2 pound, per the vet record.

When I took him in a week ago, he had skin issues and ear infection. He's on antibiotics and an ear treatment (which has a steroid component).

He was on a high-carb diet (Royal Canin selected protein canned and dry) due to his constipation issues, per the vet where he was boarded.

Since taking him in, his BG has been running steadily on the 350-450 range. I've seen an occasional number in the high 200's, but rarely. I'm switching over to a lower carb food and waiting to see whether clearing up the infections helps his BG readings. I'm working with the university vet school now to assess his medical issues and presumed acro, and to take the necessary steps toward doing SRT in the future.

I realize 8u BID isn't crazy for an acro cat, but I'm uneasy that it wasn't reached via methodically working up the dosage scale. It looks like an increase is on order, but is it possible (or likely?) that the optimum dose was missed? Should I experiment with a lower dose before going higher? I'm good with regular diabetes, having navigated that path several times before, but this acro thing is new territory for me!

Also, have any of you had good success with Prozinc in acro cats? I've been mulling over switching to Lev but don't want to change too many things too quickly.

I've been reading the acro files, but am also curious if there are any recent updates to that info.

Also, it's been far too long -- can anyone point me to the instructions for setting up a spreadsheet? Thanks!

 

Here's the instructions on Creating the spreadsheet....if you have any problems, let us know!

Since I've never used ProZinc, and the agro component is something else I have no experience with, I can't help much there. I know @julie & punkin (ga) dealt with agro as well as @Wendy&Neko so hopefully they'll see the tags and come by to offer you some ideas.

 

Hi and welcome - where are you located? My answers may vary based on where you are located. Hypophysectomy is an newer option than SRT in a couple of places in the US, but also more expensive.

Catacromegaly seems to be no longer around. Most of us with acrocats hang around the Lantus and Levemir forum. In fact most, but not all, are on Levemir. Neko got up to 8.75U of Lantus before her SRT, but she also got a reduction then and was regularly seeing nadirs below 100 at that dose. I later switched to Levemir, it gives her flatter cycles.

Getting kitty onto all wet food or raw is best. Some acrocats get megacolon, that may or may not be one of his issues. Several peeps find Miralax helps - all things to be discussed with the vet.

I'm about to toddle off to bed. I'll get back with more answers tomorrow. In the mean time - this post has a lot of good reading in it. More to be added soon - I was in the midst of reading some new acro articles when Chris tagged me.

 

Check out Feline Constipation for tons of good info on the feline GI tract.

See my signature links Glucometer Notes and Secondary Monitoring Tools for some refresher info on glucose testing and other assessments you can make to evaluate his health.

Most of the folks with acrocats are using Levemir as it has the potential to last the longest and have the most overlap. Prozinc may last as little as 8-10 hours in some cats, so if the doses were ever adjusted based on the pre-shots, he may have been raised inappropriately. A curve will show you when it wears off in him. TID dosing may get better control until you can get a depot insulin.

You may want to check for IAA (insulin auto-antibodies) as it is possible to have both and that may slightly alter how you manage him, as once the dose gets pushed enough, the IAA breaks, at least for a while.

A booster, short-acting insulin may be needed to get him down from his pre-shot glucose level so the long-acting insulin can work its best. Regular (R) insulin is typically used.

To test if his current dose is too high, you need to be prepared with ketone testing options - urine (KetoDiaStix or generic get both ketones and glucose) or blood (Precision XTra or NovaMax Plus) - plus a short-enough acting insulin that you can bring him down quickly the minute you see any ketones. After you've done the diet switch and are stable, you might do a very time-limited decrease to half of what he is getting and monitor intensively for ketones, plus the glucose levels for 12 hours to make a decision. Based on your descriptions, though, it really sounds like he could be an acrocat.

 

No advice here. Glad you took him in! But I must say that I appalled at the fact that he was boarded at a VET and still had an ear infection when you took him in.

 

The steroid ear meds have very likely skyrocketed Tubby's BG so BG/dose is not representative.

 

Nice to see you here!

I would make the switch to Lev when you've finished your current ProZinc bottle. It seems to provide the longest control in high dose cats and some cats also show an improvement, possibly because it's a different insulin. What do you think about switching to Lev? There are a lot of high dose kitties in the Lantus/Lev isg. People start there because they are using those insulins & just stay now, regardless of their dose. Some of the people have had their kitties diagnosed with acro or iaa, or both, some have chosen not to test. The bottom line is to give the cat the amount of insulin they need to keep their blood sugar under control.

I think the best thing you can do is start to adjust his dose based upon the tests you get. It's not particularly different from what you did with Chip, but we do suggest using larger incremental dose changes once the dose has passed 5u. So at 8u, instead of adjusting by 0.25u, adjust by 0.5u instead. If a high dose cat is showing constant high numbers, sometimes it's appropriate to "fast-track" the kitty - meaning to increase the dose fairly quickly until you start seeing the range of blood sugar come down. That depends on the situation and I'd only do it if you've got some experienced eyes helping you as you do it.

In addition to the link that Wendy gave you, there are some additional bits here on the New to the Group? sticky. There's some recent info from the 39th World Congress . . . .blah blah, that's good. You'll see several links that relate to high dose kitties in that section of the sticky.

Both Wendy & I have been following the most recent info from the Feline Diabetic Remission Clinic page on Facebook - they've done some work with acro cats and are worth watching.

Let us know how we can help you!