best test för acro?

hi. In sweden there are no reliable tests to diagnos acro. what test have your vet done to diagnos your cat?

and yes I grew up with Abba and Love the Music.. and I won't disapear as some suggested (if I'm not asked to)

 

Hi @mammamia6673 I’m glad you’re still here, learning is always good! My cat had acro and was given the IGF-1 test. I’m not sure there are any other tests out there other than maybe an MRI, but I’ll tag @Wendy&Neko who is our acro guru.(She lives on the west coast, so it may be awhile before she chimes in) Not sure if you’ve seen it, but we have a forum for acro and other high dose conditions
http://www.felinediabetes.com/FDMB/forums/acromegaly-iaa-cushings-cats.12/

 

what I've read about that test is that it's not so reliable...

 

@mammamia6673 , we have one vet here who came to help her diabetic cat since her practice didn't treat many diabetic felines, mostly dogs. As it turned out her kitty is an acro cat. Her name is Janine and cat is Floyd. We welcome all vets here!

 

You may have already seen this article. http://veterinarymedicine.dvm360.com/feline-acromegaly-keys-diagnosis

 

Glad you are here! I saw "MammaMia" 6 times......so far. Guess that means I am a fan! I refuse to see the sequel, they are never any good IMO.

 

I think you have to send the blood sample to RVC in London as they are the only ones in the UK who run it. Wendy will know for sure.

 

Welcome mamamia. This site was started by a human physician when her cat was diagnosed with diabetes and she found little information available. We definitely welcome vets here! And some vets here in the states actually recommend their clients come here for more information. A vet gathers info and maintains the food list with carb content.

I’ve had 3 diabetic cats, and even though Maggie, my avatar, has been gone for over 10 years, I still visit daily. So much to learn! My vet knew nothing about home testing, but encouraged me once I asked about it. When we needed to change insulin years and years ago, she also welcomed information I printed from this site about using Levemir and Lantus to treat diabetes in cats. She decided on Levemir for Maggie after reading the info I gave her and checking with colleagues from vet school.

People here love their cats and try to encourage and help others. You will see members staying up all night helping someone whose cat has gone dangerously low. And as you’ve seen, we jump to support members. Please don’t get put off by it. We mean well.

 

Hello and welcome @mammamia6673 I admire your interest in learning more. Vets of a certain age used to be taught "this is acromegaly, it's rare, and you won't ever see it". My vet was of that age - still love her in spite of that cause she was willing to learn with me. She told me I needed to get above 10 units to get the tests done, and that's after consulting with the local internal medicine vet. I had to practically beg to get the high dose tests done. She said she'd humour me. Highest dose we got to was 8.75 units. Shortly after both tests for "high dose" conditions came back positive, my vet diagnosed another acromegalic cat in her practise.

Grown hormone assays are no longer available for felines, and aren't that reliable because GH production is not even throughout the day. Instead, we get the IGF-1 test done. There are exactly two places in the world to get IGF-1 tests done for feline acromegaly, Michigan State University in the US, and the Royal Veterinary College in London. The RVC is your best bet, and the test form is here. It's in the difficult diabetic cat profile. Since I'm in Canada, blood went to MSU.

As far as reliability, the IGF-1 test is pretty good, as long as the kitty has been on insulin for a couple months. Otherwise there can be some false negatives. In a study by the RVC vet Virginia Woolhead testing over 200 cats, she found that 19% tested positivie for acromegaly right away. An additional 9.1% changed from negative to positive after 73 days of insulin treatment. Something about exogenous insulin impacted the IGF-1 production initially. Note that this study and others by RVC on even larger number of cats has shown one in four diabetic cats has acromegaly. The results are in this 2015 research paper. Yes, 2015 is the year - knowledge about feline acromegaly has grown a lot in the last few years. Note that paper even found acros with doses as low as 1 unit. We have seen some cats here need 100 units bid.

Our experiential knowledge here is that if a kitty is on all low carb wet food or raw food, has no secondary issues like needing a dental or other secondary conditions, and reaches six units by starting at a low dose and increasing safely, the odds are pretty good that they will test positive for what we call a "high dose" condition, though I prefer calling endocrine disorders. Other conditions in that category are Cushings and IAA or insulin auto antibodies. Again we have cats with both those conditions on less than 5 units, they aren't all high dose. But if they do get to high dose, chances are one of those tests will be positive, with acromegaly being the more common. Some like my girl, have more than one such condition.

Some vets suggest CT or MRI scans to get an absolute positive test, but I have also heard from internal medicine researchers specializing in feline acromegaly at Colorado State University, that sometimes the CT or MRI scan will not show enough of a tumour for a positive confirmation. And they are way more expensive tests and require anesthesia. It's a question I personally had to ask, whether I would put my cat through those tests. I planned and did take my girl Neko to radiation therapy in Colorado and didn't want to do extra tests before I left. And I wanted to make sure the three day drive each way would be worth it. I asked if I should get her scanned, and they said based on the IGF-1 results and her spreadsheet/dose, they would see a tumour on the CT scans theyneeded to do before treatment. Which they did.

Speaking of getting tests, a number of people with suspected acromegalic kitties here do not even get the IGF-1 test. Some can not affort it, as their insulin bill is pretty high already. Sometimes there are other physical signs, but sometimes not. Another one of those papers from RVC quoted something like only 35% of acromegalic cats had clinical signs before diagnosis. My girl's only sign, besides crazy polyphagia, was tearing of one eye - which I later found was from soft tissue growth in the tear duct. Signs for each acromegaly cat can be different.

So for people who cannot afford IGF-1 tests, we focus on using as much insulin as needed, increasing in safe amounts. No matter whether people get the tumour treated, getting them below renal threshold as much as possible is the best thing people can do. A good long lasting insulin like Levemir is the best. The depot insulins seem to have work better with acros, and Lantus can sting at high doses.

One caveat to not testing, if someone is planning on treating the tumour, they should confirm the diagnosis first, using the IGF-1 test.

Sorry, I've almost written a book. I was going to start on our experience with treatments, but decided I'd stop here. Please, continue to ask questions.

 

Hi,
You might also get some helpful info from the Royal Veterinary College in London. Their research work on feline diabetes included work on Acromegaly. They may have some research results that you could read...?
https://www.rvc.ac.uk/research/rese...ion-centre/projects/diabetic-remission-clinic

Eliz

 

been doing some reading...IGF-1 test in sweden are done but considered to bee hard to be that reliable because of many false posistive..but doable...
the cost is 650 Sek (75 dollars) , not that much...
I´ll suggest that to one of my clients.
Another question- how high a dose are your cats recieving? max and min? and for how long time?

thank you!

 

I'll just briefly chime in here because I am probably out of date with thinking on the treatment of acro. My Tom was dx in 2007. I was a member of the previous version of FDMB when there weren't as many kitties dx with acro as there are now, so we were a smallish group. Vets were largely learning along with us and we didn't work to any real guidelines, we just dosed according to need. With acro, bg can vary considerably so frequent testing is important and we just dosed on an individual sliding scale, increasing as necessary. To be perfectly honest, some of us were and possibly still are hesitant to say on the forum what the maximum doses we gave were, as we realised that it could sound seriously scary - I do mean seriously scary - to people not au fait with the disease and how it was (at the time) being treated. We would not have wanted non-acrocat owners, maybe newbies to the board, to think it was ok to give extremely high doses when bg remained stubbornly high - treating acro is a completely different ballgame to treating "ordinary" diabetes.

So this isn't very helpful, sorry, but that was my personal experience. Hopefully, in the interests of helping you and others, some of our other members will give you some solid info. I do hope you make some headway - our kitties really do need all the help they can get so thank you for what you're doing.

Diana (UK, near London)

 

My cat got up to 18u BID, but came back down to 9u where he stayed for the most part. We went up in Dosage slowly, .25-.5u at a time. We had been on Prozinc, but switched to Levemir when we got to 5u BID without any progress.

 

My cat gets 18 units of Levemir and 6 units of Regular insulin twice per day.

 

My girl only got to 8.75 units bid, but if you are interested, I can show you links to spreadsheets of cats that needed much more, over 80 units per shot. Regular insulin is often in the mix. Note for any lurkers, these amounts of insulin are unsafe for most cats. Larger doses of insulin may be needed by some cats with acromegaly, and only by increasing in safe amounts at a time, with appropriate home blood sugar testing. For @mammamia6673 typical increases are around 10% of the total dose, if using one of the long lasting depot insulins, such as Levemir. Doses are held long enough to build the depot and see what a dose can do.

ETA: sorry forgot to answer all your question on dose. My girl was treated with radiation therapy, so her dose got down to around 0.25 units. The range of dose for each acro ranges quite a hit over time, even those only treated with insulin. The tumour can wax and wane. We have even seen acros go off insulin, then come back on it. There are even recorded instances of acros who were not diabetic.

Second comment, in my almost seven years here, I have yet to see a false positive IGF-1. That's a lot of acros.