Any treatment w/acromegaly when you can't increase insulin?

Chester continues to be a bouncy boy. His numbers stay quite high - until he throws a low. And some of the lows he's reached in the last month have us worried.
The daily schedule has changed. My husband found a job, so now there is no-one around during the day. This means that Chester does not get lunch like he used to. There's still dry kibble out that he can munch on, but he's not often interested in that. We tried a couple of days of shutting him in the bathroom with his food for the day (including lunch) and that keeps him from dropping too low, but...I don't want him to spend half his life shut in the bathroom (our bathroom is smaller than my cubicle at work).

The vet thinks he may have acromegaly, but says it's just a point of reference. Short of brain surgery, there's nothing really to be done about it except increase his insulin. Even she admits that his swings are too unpredictable to make that a really feasible option. She says the next best thing is to shoot the Lantus on a sliding scale around his AMPS/PMPS - when he's high, shoot high and when he's low, shoot just a little. We both agree that's not how Lantus is most effective, but it may be the only way to "manage" Chester based on those unpredictable lows. She's suggested ProZinc because the U-40 syringes make it easier to see and measure dose adjustments but says that it would still have to be dosed around PS tests like the Lantus.

And the few mid-cycle readings we get suggest that (on a normal cycle) he's getting down to some good numbers. He just swings too high by the end so he ends up roller-coastering.
To top it all off, he needs dental work done, but they want to hold off until his blood sugar is more stabilized except that the dental is probably contributing to his bad sugar m=numbers, but they don't want to treat him with numbers that high...

 

Re: Any treatment w/acromegaly when you can't increase insul

No to shooting Lantus on a sliding scale.

And I would not use ProZinc by itself as it may last less than 12 hours in higher dose conditions.

You could, however, use a shorter-acting 94-5 hours) supplemental insulin (R) when you need to mitigate the highs that Lantus can't do for you because they are erratic. You might even be able to use N for a smidge longer duration (6-8 hours). This is something you could work out with your vet.

To do this, at first, you must be home to monitor until you learn how he responds. You'll want to do R curves on 0.25 unit doses and be ready to intervene with high carb to steer the numbers if needed. Take a look at the info in the Acromegaly/IAA/Cushings forum to read more.

 

Re: Any treatment w/acromegaly when you can't increase insul

Based on BGs and doses in your SS, I do not suspect acromegaly. There are tests that will better determine if he has acromegaly.
My Bailey had BG reading like yours both in dose and frequency of low BGs. I just lived with for years.

 

Re: Any treatment w/acromegaly when you can't increase insul

I don't think his dose is all that high.
And I would recommend starting any R unless you have someone experienced with it to guide you and start with only 0.10 units as some cats are very sensitive to it. It is a very powerful insulin and can be dangerous without guidance and constant monitoring. I won't give it to J.D. unless I am going to be home.

What are all the missing squares in your units columns? Are they all skipped shots?

 

Re: Any treatment w/acromegaly when you can't increase insul

I agree. Chester's dose does not suggest acromegaly to me. Cobb is a probable acrocat and he is at 23uL BID.

Did your vet say why he suspected acro? Are there physical signs of it? Has he told you about the IGF-1 test that Michigan State University runs to determine the probability of acro? The only way to definitively know is with a head CT so they can see the tumor. You treat it with radiation, not surgery.

Are you on the Lantus TR forum? There are several people who have/had acro cats and had them treated with SRT.

Definitely don't shoot Lantus on a sliding scale...it won't work.

 

Re: Any treatment w/acromegaly when you can't increase insul

Hi Mary - Is Chester eating more dry during the day than at night? That might be a very big factor with his numbers. I know it's hard to change them from free-feeding to designated meal times, but it has helped my civvies, helped them lose weight (much needed for some of them), and has allowed me to control how much they're eating. And Grayson, my FD/Acro kitty, gets fed away from the others. I also have an auto-feeder (PetSafe 5) that has a round try with 5 compartments that revolves, and you can set the timer for whatever increments you need. G gets mini-meals every 2 hours... which keeps him from having food spikes.

I agree, it wouldn't be fun to be locked in the bathroom. Maybe there are other options you could try?

Lu-Ann

 

Re: Any treatment w/acromegaly when you can't increase insul

I agree with the previous comments - there's nothing at all to suggest acromegaly. More likely you just need a hand managing his dosing, mary. I looked back at his spreadsheet and what i see is that when Chester has given you a low number, you often skip the shot. The result is a high number hours later and so his zig-zagging of numbers continues.

learning to shoot low can actually help a cat's body heal and become diet-controlled. This is what Lantus is best at - when you see a low preshot, you want to be ready to shoot, but before you do that you want to become "data-ready." Here is a good post on the process: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=147. The critical thing with shooting low is that you can't shoot and leave - you have to monitor to make sure he's safe.

But when I look at Chester's spreadsheet, I see a cat that is trying to heal. I think it looks optimistic, honestly. Nothing there looks mysterious or despairing. Look over on the Lantus TR forum and you will see 3 current members whose cats are on OTJ trials - their pancreases have sputtered back to life, which cats can do - and they are seeing if they can go off insulin and become diet-controlled. The 3 cats to look for are Jersey, Boots and Davidson. Take a look at their spreadsheets and see what happened when they shot lower numbers. Those of us with experience will shoot everything over 50 - but i'm not advising you to do that at this stage, just telling you that is the path to follow if you want him to get regulated.

If i were you, i would remove all dry food and get it out of the house. go to 100% low carb canned food. Read the information about how to become data ready and shoot lower numbers. Look at the spreadsheets I mentioned above.

If you are interested in having help in getting him regulated, and possibly heal, i'd encourage you to post on the Lantus TR forum and let people teach you how to get there. Chester looks to me like he wants to go there. Every time you see a lower number at preshot - i think of that as a gift. That's the opportunity to shift his whole range of numbers down.

 

Re: Any treatment w/acromegaly when you can't increase insul

How can I shoot low numbers when I know from my data that Chester can drop as many as 300 points in a cycle?

How can I "just not leave" when both my husband and I have to work full time (10-11 hours) 5 days a week? We can't stay around to watch him. We can't stay up all night and be functional the next day (unless it's a real, unavoidable EMERGENCY). And that seems to be the whole thing to getting used to shooting low - you always have to be around to run a whole bunch of tests and to monitor the cat during the cycle. We only have that kind of time on the weekends, and even then we don't have that kind of time.
Same thing with Lantus TR. All the tests. We get maybe one day a week where we might be able to pull off a 12 hour cycle. And that will almost certainly be a day when he's high and not low (which is the one we want to track).

Short of locking him in the bathroom, we have no way to ensure that he gets a mid-day meal. I don't even think a timed feeder would work for him because of the other cats (particularly Blackie the scarf-n-barfer, Cosmo the sneak-thief and Shady the huff-n-puff-n-stuffer). We tried (briefly) to get all six onto canned food, with mildly disastrous results. There's no way to make it work without supervision, and I don't have enough rooms in the house to shut everybody up separately.

Look, I don't mean to sound all whiny and like "I can't..."
But I don't know how you guys manage all this and still have anything like a normal life.
It's not like I adopted a diabetic cat and then decided it was too much work for me. Chester is a valued member of our family and has been for years - long before the diabetes came up! But NOBODY in this family gets all the time or attention or care they deserve. Call me a bad pet owner if you want. call me a bad parent. Call me a bad human being for all I care!!
Maybe one of you guys should take Chester so he can get the care he deserves - because I'm doing the best I can with what I've got and it's obviously not good enough...

 

Re: Any treatment w/acromegaly when you can't increase insul

Try switching insulin, I would start with going to Levemir.

 

Re: Any treatment w/acromegaly when you can't increase insul

Mary, I can see how frustrated you are. I know we all sympathize with that. I can offer some reassurance that it does get better. We were completely overwhelmed when a Cobb was diagnosed. It's normal to feel like you are trapped at your house and can't do anything. When we were running BG curves for the vet on Saturdays, we had enough time between tests to go to the grocery store, come home test, run another errand, home to test, etc. It was beyond irritating.

Most of us didn't adopt a diabetic cat and even when we got the diagnosis of FD, I don't think any of us thought there was anything else wrong like acro, which is a heartbreaking diagnosis for everyone.

The good thing about learning to shoot low is as the pancreas heals, it will lead to smoother curves and you won't see the 300 point drops.

I'm curious. Yesterday you shot 1.5 units in the morning. I don't see anything for last night. But then you shot 3 units this morning when he was in the upper 400s. You're seeing those high numbers because you've skipped the second shot because the number was too low for you to comfortably shoot.

Lantus is a long acting insulin, but it looks to me like you're raising the dose to get that number down immediately. That's not quite how it works.

If Chester were my cat, I might be inclined to cut that dose in half and hold it for a good number of cycles so you can really see how it is working. That way you aren't shooting 3 units at a 96. 3 units is probably way too much for Chester.

Hang in there. This is a frustrating dance that we've all had to tango with. You'll get some great advice here. Yes, the advisers will want to see a few more tests - when you are able to get them. Many of the people here work full time and can't run home at lunch to test their cats. They'll give you advice on what worked for them. It is possible to have a diabetic cat and live a normal life. Your definition of normal will just be a little different. :smile:

 

Re: Any treatment w/acromegaly when you can't increase insul

Eventually you'll get into a routine that works for you. And its OK to enlist help wherever you can find it - a student interested in veterinary sciences or in a vet tech or pre-vet program, or a tech interested in a bit of part-time work.

It helps to test around the nadir period (+5 to +7 hours after the shot) to see how low the glucose is going. It does not have to be daily, in fact, the protocol suggests holding the same dose for 3 full days before checking around nadir to see if an increase is needed.

 

Re: Any treatment w/acromegaly when you can't increase insul

I always test pre-shot. I do not always remember to record the number. I also do not get around to updating the spreadsheet twice a day, or even once a day. That doesn't mean that I'm skipping shots or tests - just that I forget to record everything every single time.
There is no help here. There are no vet schools that I know about, and I'm not sure I'm comfortable giving my housekey to some stranger I don't even know. The people that I do know and might trust to look out for Chester are just about as busy as we are. I sure don't trust the kids to help out - they still forget their own lunches some days.
I KNOW Lantus is a long-term, "shed"-type insulin and that it's not intended to chase BG Numbers. I agree that 3units is probably too high for him, but his numbers don't get any better at any lower dose. That's how we ended up at 2.75-3 in the first place. Chester has never given me any kind of smooth curve. He bounces and roller-coasters, and until he STOPS bouncing, I can't trust to give him low shots. If he would quit swinging 300 points in a cycle, I'd love to shoot him at lower numbers, but it's not safe. Not for him. I'm not sure how you think it could be.

I'm sorry - I AM frustrated.
Everyone here is doing great, and their cat is well controlled or going into remission. Wonderful for you! That's great!
Must be nice.

I'll try to get a curve this weekend somehow.

 

Re: Any treatment w/acromegaly when you can't increase insul

You can instruct all you want, get references too, but actually 'testing them' with a supervised visit let's you get a better idea of whether you want to hire the person. It can be like hiring a baby sitter. Trust, but verify.

Since you're not near colleges, I'd check with the guidance counselor at the high school to recruit someone, especially a senior with a good GPA, taking advanced Biology,who loves cats, and is planning to go into veterinary sciences.

Of, if there are other things some home help could do to relieve the stress on you, that might be another way to help with being so busy.

Ps Spitzer was never regulated. He had other things wrong with him, then threw an excfrutiating saddle thrombus/blood clot to his hind legs and was euthanised. I turned myself inside out trying to control his glucose including layering ProZinc on top of Lantus, since I couldn't keep the Lantus at a higher level with erratic glucose levels. You would not believe the uproar I created doing that!

 

Re: Any treatment w/acromegaly when you can't increase insul

Mary, I didn't mean to insinuate that you skipped last nights shot or didn't test. I just didn't see anything in the spreadsheet that could give a clue as to why yesterday's shot was 1.5u and this morning's was 3. I was in a hurry and didn't explain myself well enough. That's why I asked if you were trying to pull down the 400+ number with more Lantus versus yesterday where it was a lower pre-shot and a lower dose. I was just making sure you knew that by changing his dose like that the she'd is filling and draining and not having any time to steady out.

Of course you should not shoot the low numbers if you are uncomfortable and/or not around to monitor Chester.

I wish this were true! Cobb is nowhere near well-controlled and will never be in remission. I know we have 3 OTJ trials going on right now, but that is the most I've seen at one time since I joined back in November.

I'm sorry you're so frustrated and feel like this is all on your shoulders. We are here for more than just dosing and strategy advice! We are here for moral support. Even those who have lost their sugar kitties are still here, trying to pay it forward.

Get a curve when you can. If you can't on Saturday, don't stress too much about it. I, personally, would still cut the insulin dose from 3units. You want to find a dose that is safe to give twice a day. If you give a smaller dose time to settle, you might stop seeing those wild 300 point swings. No guarantees of course, but it's possible!

Ask questions! Vent away! Goodness knows sure most of us have at least one vent post on here, if not more!!

~Suzanne

 

Re: Any treatment w/acromegaly when you can't increase insul

gosh, i'm really sorry to have aggravated you so much. i was trying to give you some encouragement. And no, everyone's cat is not doing well - mine had acromegaly, never did get regulated and then died. That's about as bad as it can get. So . . . i was just trying to say that i think Chester's blood sugar wouldn't be so aggravating to you if we could give you a little help. I think his spreadsheet looks like he could possibly be one of those to go off of insulin. Not every spreadsheet looks like his - i'm not being pie-in-the-sky falsely encouraging. that is what i see. Of course, there are no guarantees, but that's what i saw when i looked at it.

The significance of the spreadsheets i was linking for you is that a cat can drop from 300 to 100 with a shot - so a 200 point drop. But the same dose shot at 100 might only drop the cat to 80. and the same dose shot at 80, the cat might only go to 75 and stay there all day. It defies logic, but that is how it works. I actually find it more nerve-wracking to shoot a 300 knowing that the cat can/will drop 200 points than to shoot a 100.

If you want help, we're happy to help you, but i don't want to make you mad, so i will step out of the conversation unless you specifically want something from me.

 

Re: Any treatment w/acromegaly when you can't increase insul

I'm sorry. You guys are fine.
I'm just frustrated. Frustrated with the vet, frustrated with Chester, frustrated with my husband...frustrated with myself.
The hardest part is knowing that I could do better my Chester, if only I could be around more often to test and monitor him. My husband wasn't much help with that even when he was home all day (He cares, but he's...not as interested as I am) and now that we're both working, even that assistance is gone. And Chester is just too damn bouncy for me to be comfortable with much of anything unless I can repeat it several times.

We did go along with my vet to try the ProZinc. I know it's not as "optimal" as Lantus, but it's worth one vial to try it out. I take Advil and my husband swears by Tylenol. everyone is different, all that happy jazz...

Hell. I ran a beautiful (for him) curve on Sunday that looked like 2u (like the vet suggested) was going to be OK and Monday we came home to a 44. Same dose, same food and my cat bottoms out. Down to 1.5u yesterday and all seems well. in the 300s but well. I do think I may be more comfortable with that conversion chart and the U-100 syringes. I'd like to be able to finer tune his dose than by 0.5u steps. I wonder if my vet would be OK with that (I think I need a prescription to buy syringes).

I know the best thing to help Chester would be more data, but I have no idea how to get it. One day of testing just doesn't tell me enough about what's going on with him because the next day will be completely different.

 

Re: Any treatment w/acromegaly when you can't increase insul

Some cats are just that way. It is the "cat", not you. This month my patches gave me a PS or 63, 80 and 76. She is on about 1.8 units Lantus. I tend to keep her PS high to avoid going to low. The 63 was based on a previous PS of 379.