Diabetes, Acromegaly, Anemia

My Duncan was diagnosed with diabetes on August 16, 2009. Within 2 months, he was diagnosed with acromegaly. He is on Lantus and was getting 40 units twice a day. My vet at the time was really pushing brain surgery to have the tumor removed, but I refused, not wanting to put him (at 11 years old) through brain surgery, despite purported promising results. I asked her about radiation, and she was against that, thinking it would not work for him and there wasn't anywhere close that does radiation (about 3 hours away is the closest).

Last month, Duncan had three seizures for the first time in his life, all within a 18 hours or so. The vet reduced his insulin to 35u twice a day following that, and diagnosed him with anemia.

Now I am at another vet (long story that involves the first vet telling my sister she could put Duncan down if it was too "inconvenient" while I was out of the country). The new vet is ok with the 35u of Lantus twice a day, but now he recommends radiation therapy (and is strongly against the idea of brain surgery).

At this point, it's been almost a year since diagnosis, and I just am not sure if it's too late for radiation. He is 11 years old and is already showing signs of acromegaly, particularly his tongue, which no longer fits in his mouth so its like he is sticking his tongue out all the time. I suspect he has headaches as well, and he is always jumping into the refrigerator for the coolness (though both vets believe that is unrelated with the acromegaly.)

While at first I liked the idea of radiation, I just wonder whether it is too late for something like that. He now has the physical signs of acromegaly, it's been a long time since his diagnosis, he has anemia, and I just can't imagine that his heart and kidneys aren't affected yet, making radiation difficult I would think.

I just wondered whether another had done radiation at a later stage as opposed to right away, and whether it was successful. Obviously having two vets give conflicting advice is even more confusing to me. Any advice or suggestions would be very much appreciated.

Thank you.

Stephanie

 

Colorado State University has a "Stereotactic Radiation" machine -- extremely accurate and the only one in the U.S. for veterinarian use.

They did a study for treating Acromegaly in cats -- several members here participated and some have had fantastic results.

Dr. Lunn is the contact at CSU.

Please read the sticky posts in the HIGH DOSE INSULIN SUPPORT GROUP -- viewforum.php?f=12

My Acro-cat Norton had brain tumor symptoms - walking in circles -- however, he developed an aggressive and inoperable intestinal cancer that took his life, so we could not pursue the CSU radiation treatment.

 

Hi Stephanie,

My Boo was treated at CSU last year (in fact, exactly a year ago). Dr. Lunn is our hero around here...she did the radiation trial and she's currently doing a 6-month drug trial (that might be an option for you).

From what I've read, brain surgery is not a good option. Regular radiation is very, very hard on the kitties and costs as much as the SRS. The stereotactic radiation surgery (SRS) is pretty easy on them - it takes one week. Boo went off insulin after about 14 weeks. There are a few others that had the SRS - Holly & Pablo just completed it; Wendi and Milo did it about 1.5 years ago; Joan & Madison did it close to 2 years ago (?).

I'm sorry you've been dealing with things on your own! We'll try to get some of the other acromoms to stop by. There is actually a high-dose forum here, which would be a great place to ask questions. Please do get in touch with Dr. Lunn; she's a very kind person and can help you decide what might be best for your boy.

 

Hi Stephanie,
I am glad that Heather stopped by and I hope some of the others will be by as well.

While you have provided alot of info, there's much more that could help in assisting you and giving you helpful advise and suggestions.

My first questions would be the following:
1. what were the results of the acro test and did you have the IAA test done as well. Do you have pictures of Duncan?
2. recent blood work done and what were the findings, any values out of range. Are there any other health issues past or present that may complicate issues.
3. what is diet fed.
4. what testing are you doing. hopefully home testing. please advise the testing numbers. I would be horrified to hear that no home testing was being done and shots have been 40u BID. That's one scary thought to me as my highest has been a mere 22u for Oliver.
5. what was initial dose at start of insulin when dx, what was dose when tests done for acro.
6. how was dose increased handled and at what frequency.

I am sure the others will have many better questions, but that's my first thoughts.

As already mentioned, there is a HIGH DOSE group on this site and you would do well to post there or also in the Lantus group.

Please advise when you can and we can help in what ways possible.
You can see the info on my two acros in my signature; the spreadsheets list all of my BG hometesting, and the profiles give a bit of background on each of them.

 

Hi Stephanie. I do not have any experience with acro's so I'm just dropping in to give some support. I see that some of our acromoms have already dropped in and gave you some information. Visiting the high dose ISG is a good idea. I hope that it will help.

 

Stephanie - Lanky & I are new at this too. Please continue to ask questions as there is much that can be done. Don't loose hope, as we can help your Duncan.

Lots of hugs, Lanky & Susan

 

Hi and Welcome Stephanie and Duncan! I am so glad you found us! If you can answer the questions that Gayle listed, it would be a great help. Definitely check out the high dose forum and also see the site that a few of us acromoms created: http://catacromegaly.com/501.html You can sign up for the message board there, too. Also check out the acrotracker which lists our acrocats and their symptoms: http://catacromegaly.com/acmb/viewtopic.php?f=2&t=792 and Joan and Madison(GA)'s experience with the radiation: http://catacromegaly.com/acmb/viewtopic.php?f=2&t=780


My Fletcher is also an acrocat. He gets 10mg Prednisone daily to help combat the soft tissue growth in his throat/back of tongue. For him, the steroids do not affect his bgs... but he is the only acrocat who goes on and off insulin. This might be something to discuss with your vet. Also, add water to his food (canned/raw only) and it may be easier for Duncan to eat. BIG WARNING!!!!!: Do NOT ever pill him! You're already seeing the results of the tissue overgrowth, so pilling can be dangerous/deadly. I cut Fletcher's pills and put them in a piece of soft treat (Friskies soft hairball ones work really well). Also, if at any time Duncan needs to be intubated, they need to use the smallest tube possible (like kitten sized) for the intubation. Fletcher is placed in an oxygen tank preemptively because we've had issues with this.

And to maybe give you some hope.... Fletcher was diagnosed as an official acrocat in January of 2007....3.5 YEARS ago! He has breathing issues and an enlarged heart and CRF, but he's still pretty happy (he does get half a baby aspirin every 3 days for pain-- acrocats tend to get some pretty severe arthritis which seems to affect their spines).

Please let us know how we can help you and Duncan... and here are some ((((((hugs)))))) for you.

 

Hey Stephanie,
I am so glad you found us, ( I HOPE you find your way back and post again!) There are quite a few of us "acromoms" here and we would love to help you out, and provide moral support for what you have been through. Our diabetic "reality" is quite different from normal FD, so you will get more acro eyes if you post in our High Dose Forum ( which Phoebe posted a link to above)

Hope to see you around- WELCOME!

 

Hello everyone. THANK YOU so much for the advice and support.

Phoebe, I looked at the high dose forum, but the first thing I read was, "do we really need this?" and so I didn't really explore any further. When I have time, I will check it out in further detail.

Re: Gayle's questions:
1. What do you mean the results of the acro test? I was told the results were that he had acromegaly? I don't know what an IAA test is? Is that the heart test? He had an EKG heart test at a specialist in November, if that's it. I have TONS of photos of Duncan, but they are all at home. I'll have to post one when I am at home! Many of the photos are out of date though, because it's hard to take photos now b/c he is very light sensitive.

2. All his bloodwork has always been out of range, so its hard to say for sure. I have all his labwork results, but I understand from the vet that the glucose and fructosamine are the important "acro" numbers. So here are some of his numbers:

Glucose
8/22/09 - 594
9/17/09 - 512
10/8 - 580
11/30/09 - 452
2/6/10 - 564
5/27/10 - 28
Frutose
8/22/09 - 590
9/17/09 - 940
10/8/09 - 975
11/30/09 - 644
2/6/10 - 589
5/27/10 - 244​

As for other health issues other than the diabetes and acromegaly, when he had those three seizures on May 27, 2010, he was diagnosed with anemia. He also has had blockage issues of his intestines at the end of March 2009 and the end of March 2010, which required multiple enemas.He is on Lactulose for that, though the second vet recommended that instead of that perhaps we should give him canned pumpkin? Incidentally, those times when he was all blocked up, he was still eating like crazy. Despite the fact that he jumps into the fridgve EVERY time that it's opened to lay down for the coolness, his temperature has always been normal.

3. At the advice of the first vet, Duncan is fed Fancy Feast canned food (non-gravy). He got 2 cans a day, but I usually give him more just because he's hungry and the vet said it didn't really matter. The second vet recommended Evo, but I haven't found that yet (It's not at Pet Supplies Plus, which is closest to me.)

4. No, I do not do home testing. Both vets, as well as the heart specialist that he saw, are against it. They all warned that in doing that and constantly modifying his insulin, I'd actually make him worse.

5 and 6. When he was first diagnosed (8/16/09), his initial dose of insulin was 2u 2x a day. He went for a lot of blood tests the first few months while we were trying to get his (then just known) diabetes under control. The next week he was upped to 4u 2x a day. 2 weeks after that he was moved to 6 then 8 units. When the tests were done for acromegaly in October 2009, he was either at 8 or 10 units 2x a day. When he came back postive a week later (the blood had to be sent to Univ of Mich and the process took a while), she upped him to 20u 2x a day. Then she kept moving him up until she settled at 40u 2x a day. He was on that for almost 6 months before he had those three seizures while I was out of the country. She then reduced his insulin to 30 units 2x a day. After a week or two, it was uppped to 35u 2x a day. I then took him to the second vet, who was good with the 35x 2x a day with his history.

Carolyn, I've tried the join the cat acromegaly website several times (back in October when he was diagnosed, just recently when I joined this one, and once in between) but it won't let me (It won't send the code that I need.) :sad:
No one has ever recommended anything to combat soft tissue growth. He definitely doesn't have a problem eating -- anything! He even tries to eat Zoe's dry food (my husband and I have three cats). What do you mean not to pill him? The heart specialist vet prescribed a pill for him. It's some heart pill (I'm not at home now so I'm not sure) and he gets half a pill each morning. (When I get home, I can look to see what exactly it is.) He hasn't been intubated. He may have breathing problems (he sounds like he's breathing heavy sometimes, and he snores now). In November, his heart wasn't enlarged. He's still very happy, he still sleeps with me on the bed, he's still very active, he still tries to sneak outside. He doesn't get baby asperin for pain -- the vets never recommended it. How would I know if he's in pain? Light bothers his eyes, and his hind leags are weaker, but he's still pretty good.

Thank you again for all the suggestions and suppport. Duncan was my first ever cat and he's pretty much the coolest.

s-

 

All I can say is that if you are giving those doses and not testing, you are putting your cat's life in grave risk. It may well be that he needs a lot of insulin, but those dose increases are insane without proper data to back them up. I am not criticizing you in this, rather, your vet.

Please get some personalized help from Carolyn or Jojo if possible

Jen

 

Hi Stephanie,

Basically, you are playing "Russian roulette" with your baby if you are not testing on a regular basis. At minimum, you should test 4 times a day (before each shot, before bed, and one other time). Many vets are against hometesting and we really struggle to understand why...it does not hurt and it lets you know exactly how the kitty is doing. A human parent could be brought up on child abuse charges were they to shoot their children "blind". (ps....Just like Jen, I'm not criticizing you, but your vets).

Insulin needs by acro cats can change very quickly. Gayle and her two kitties are a great example. Oliver went from 20u to something like 6 in a very short time. Shadoe did very similar. Had Gayle not been testing, she could have overdosed these kitties, causing them to go into hypoglycemic shock. I honestly wonder if the seizures were not hypos?

Please, please try testing. You don't need permission and the information is invaluable and life-saving. It's only by testing can you really handle acro doses and get your baby feeling better.

 

Ack...I tried to post some more stuff and lost the post (my fault!).

Fancy Feast is fine. Wellness and Evo are good as well. Basically, any wet food is better than any dry food. Have you seen the Janet & Binky charts? They list fat, carbs, protein, so that you can pick appropriate low carb food for daily use and high carb food to bring up the numbers.

The results of the Michigan State University IGF-1 test should include a number. For example, Boo was 308 (or 408?). A normal cat is less than 100. In the High-Dose forum, people have listed the test results.

For whatever reason, acrocats are VERY cool cats.

 

When I mean don't pill him, I mean don't shove the pill in his mouth/throat like most do to administer it. Besides stressing the cat out, there's no guarantee they won't swallow "wrong" which in a cat with a compromised airway can be very dangerous. If they swallow on their own terms it's much safer.

I know Fletcher is in pain by the way he acts... he'll be much slower laying down, his eyes won't be as bright, or he holds his ears sideways when his head hurts. There are other pain meds, but Fletch reacts badly to most so aspirin works well for him. Another way to determine if there's pain is to start a pain med. If there's improvement in how Duncan seems, it's safe to say he was in pain and that the meds help.

Was his bg really 28 at the vet's on 5/27? I'm hoping there is a number missing because that is a hypoglycemic number and his insulin should've been REDUCED because of it. With an acrocat, you aren't working against a pancreas that doesn't work... their pancreases DO work. We battle the IGF-1/GH levels. Acrocats can and do hypo... and it can be deadly. So I, too, wonder if those seizures were from his bgs going way too low. As the others have said, hometesting is vital as an acrocats insulin needs can change. If I wasn't hometesting Fletcher, I wouldn't know that he didn't need insulin at times and that could be grave.

If you wouldn't mind listing your general location (nearest city & state) there may be someone who can help you with the testing. Believe us... it is SO important for Duncan't safety to do this.

Also, try registering again. I'm a moderator at the catacro site so I can activate your account. What user name did you try (I'll see if it shows up on the member list for some reason)? Also, check your spam email folder just in case!

Hope we aren't overwhelming you with all this info. Glad you came back!

 

Hi again,

The post in HIGH DOSE about "Do we really need this or not" was about having a separate Forum, and we all decided YES, WE DO

The Name is going to Change from "HIGH DOSE" to "ACROMEGALY, IAA, CUSHINGS"

The sticky posts at the top have great info about these conditions, including links to articles and the test info.

If your kitty is "light sensitive", he could very well be having "acro" headaches which would be helped by baby aspirin or prednosolone.

Norton walked in circles (a sign of brain tumor) and a daily dose of prednosolone reduced the inflammation in his brain and reduced the circling behavior.

 

WHAT?? No testing?

I am speechless! You MUST test!

 

Hi Stephanie,

Boy I sure hope you keep posting and visit the high dose forum. I have been active since January and these folks have helped us SO MUCH.

First, I wanted to address the constipation issue.

My cat, Cody after being a poorly controlled diabetic for years, developed megacolon, (the poorly controlled sugar dehydrates kitties which can make them severely constipated and their insides feel like they have bananas inside). This became a worse problem than the diabetes. Over a year I tried :
lactulose
pumpkin
cisapride from a compounding pharmacy
metaclopramide
vaseline orally
mineral oil orally
extra fluids in food-
subcutaneous fluids
hairball treats (vaseline)
vet enemas
manual extraction under sedation

When I came here folks suggested MIRALAX. I asked my vet, she approved, and now that is pretty much a problem of the past.
My point is there is more experience here than you can believe... and these folks care about your acrocat.... By the way, if you are interested in the Miralax, it is available at the grocery store, is tasteless, and is sprinkled on the food in measured quantity. It draws water into the colon, so the poop stays soft. It requires extra water in the diet and or via sub Q fluids. Every cat is different but, Cody uses 1/4 teaspoon to every 5.5oz can of food. It takes several days to work its way through the intestines, and may causes liqipoo until you figure out the right dose for Duncan.

BTW< I always wondered if the lactulose affected our numbers- it is a synthetic sugar, and there are label warnings for human diabetics using it.

Second,
Acro is way under recognized. It is pretty rare to have someone show up here with a diagnosis. Typically, an insulin resistant FD mom starts wondering why Cuddles needs 6+ units , when most kitties here need 1-2 units. I'm pretty sure this forum has been instrumental in getting the conditions recognized to the extent that they are. The post you came across was a discussion about how this particular forum fits into the message board. The other insulin support groups are insulin type specific. We are unique in that it is not specific. Because there are fewer of us, the traffic flow can be less, but the forum serves a very real need- dosing a resistant cat is totally different. I'm sure many normal FD folks stopped breathing when they read 40u BID .

Third,
Please look into home testing. You do not need permission, he belongs to YOU. The tumor fluctuates unexpectedly, and you almost lost him in May probably due to a hypo, which you may have seen coming if you tested. There is a large learning curve but you love your cool guy, so he's worth the effort. Most of us use human glucose meters available at Walmart or online because the strips are cheaper and it gets pricey. Check out the green box above, Hocks.com for some good meter deals.

Anyway, welcome and come see us in High Dose

 

OK sorry about that, but I FREAKED when I saw that you were not home testing. Seriously. You have had some serious good luck that you have not ended up with a HYPO. Maybe you have but just did not recognize it.

Please put together a HYPO kit to save your cat, and please read the info in the other link.
How to treat HYPOS – They can kill! Print this out!
Jojo’s HYPO TOOLKIT
List of Hypo symptoms

Next, you can save yourself a gazillion dollars by home testing and forget about the fructosamine tests. You know what they are? They are just an average of what your cat's BG has been over the last few months and what does that tell you? It tells you that your cat's not regulated!
Compare it to taking a child's temperature every morning. No big deal; stick the thermometer under the tongue get a number and record it. One morning, you see a number that like 104! OMG! High fever! Do something NOW.
OK now let's compare it to your vet's method. Naw, you don't need to take the kid's temp every day, waste of time. We will just do a test every few months to get the kid's average temp.

Which scenario sounds better to you ??

There are TWO tests that you MUST be taking each day. They are the test just before you shoot the cat full of insulin. Seriously, if the cat's BG is low, you may not even give any insulin. Why? Because it is too dangerous and harmful to the cat. See the HYPO info above.

Please look at my spreadsheets for Shadoe and Oliver. Look at how much Oliver's numbers have changed recently. With an acro, there will always be a fluctuation; the doses are not going to be steady and smooth. Look at Shadoe's numbers a few months ago. She had dental work done and she went from 14u BID down to 2.5u BID. She has been slowly needing more and today we are at 9u.

So you may ask "What good is the fructosamine test?"
I would say that it is good to do that test when your cat is first dx and you want to know how that cat's BG has been over the past few months. If it's high then you have a cat that's not near regulated, but if it's lower, then not too badly unregulated.
The vet's robbing you blind my dear.
Go with home testing. Seriously. Humans do it all the time don't they? If you know any human diabetic, you can ask them if they shoot themselves with insulin WITHOUT TESTING FIRST. Just watch their eyes bug out at the thought of such a crazy risk.
HYPO really can kill.

OK all the info you have given is an awesome background for others to know what's happened so far and now you can fill out a profile and then you won't have to keep repeating the same things over and over. You can look at the profile I have for both of my acros from the links in my signature.
Profile Creation

Do ask your vets for copies of all blood work done so that you can review the numbers. Also, ask for copies of your results from testing done on Duncan for acro. Shadoe's number was 120 and Oliver's was 325. Any over 92 is positive.

Being in Canada, there is no miralax here but the equivalent here is Lax a Day or even Reversa Flex. Both are the same ingrediants as miralax. It does work and my Oliver seems to feel better for it.
Once you are home testing, It's just a little poke on the tip of the ear, then sip up the blood drop with a human BG meter from the drugstore, you can track your numbers on a spreadsheet.
Spreadsheet Template and Instructions
Help with signatures/links/images/avatars
Creating spreadsheets & attaching them to your signature


And here is another link to a ton of info that would help you
New to the Group

Testing matters. When you are testing, you are ensuring that Duncan's BG stay as stable as possible, and if you see his numbers dropping, then you could very well give him less insulin.
There is a protocol that is followed on this site, but acros are a bit more aggressive. Still, it is a working protocol.
Tight Regulation Protocol

Finally, know and respect the shed.
LANTUS & LEVEMIR – INSULIN DEPOT –AKA- STORAGE SHED

You are in the right place now. There are so very many people here who know FIRST HAND how to take care of their cats and keep them safe.
Please do ask every question you have and we will help to answer them

 

I just put his pills in his food, and he eats it (without even noticing). Honestly, he inhales food. He doesn't chew at all, and his can is done within 10 seconds. He's always been like that though. So he definitely doesn't notice pills in his food.

The 28 is not a typo. She did decrease his insulin from 40 to 30 (and skipped the one morning). She thought that the seizures could have been from his low number. It was definitely a seizure though. My sister (who was staying with him while I was out of town) is familiar with seizures because our family dog use to have them all the time. She said his first was really bad, his second not bad, and if she hadn't witnessed them, she wouldn't have even known because within 30 minutes he was acting normal.

I am in Cleveland, Ohio.

With his blockage issues, the Lactulose seems to work, but the second vet recommended pumpkin. I'll check out Miralax too though.

I already have all Duncan's medical records.







ETA - I tried to upload photos as don't think I did it right/

 

Cody hated the pumpkin after a short while, (and he, like Duncan inhales almost anything). I would expect it to increase his blood sugar somewhat , as well.

very cute pictures- you can really see the acro in his face.

Cody became less desperate for food when I started feeding him more.

I was raised in Shaker Heights, (east side of Cleveland) Haven't been there in years.

 

Welcome Stephanie! You have been given a ton of great comments and advice so I will just add my welcome.

FDMB and home testing have saved my Chika's life, I can't say enough good things about this site.

I sincerely hope you consider home testing, as not being "true" diabetics, acro cats insulin needs can turn on a dime.

 

Home testing will REALLY help -- once you get practiced at it, it only takes about a minute to test.

Hypoglycemia can cause seizures, coma and death.

Please read up on Hypoglycemia, and also please test more often. I test my two diabetics (adopted through this board after Norton passed away) at least twice per day - before every injection, to make sure it is safe to shoot.

Also -- more food will help. Norton ate 4 to 6 cans of Fancy Feast per day, and would still happily accept treats and snacks. Norton was not a big cat -- he weighed about 14 lbs.

 

Please come back

Please come back and post! We would really like to help you guys!

 

My acro/IAA diabetic cat Cole went from 9u BID to 1.25u in short order. You've got to be open minded with these cats. Testing is really, really essential.
I keep telling myself to get rid of preconceptions of what I think Cole's dose should be -- after all, it's not a judgement on how much I love her or how hard I'm trying to help her. Instead just watch the BG results closely. With acros, we need to give them all the insulin they need, but we've got to stay alert for those times when their needs drop. By this I don't mean fiddling with their dose constantly and I certainly don't mean fiddling blindly, but when something is not working well, you've got to try to figure out why. For me, more wasn't helping so I tried less. The BGs weren't any worse, but they weren't much better so I tried less. And again. Voila! Better BG's.

laur

 

Hey Stephanie,

What are you and your vet doing about the anemia? Boo is getting more and more anemic and my vet is getting worried.

 

Stephanie, as I asked in my PM to you earlier today, please let us know if you are hometesting yet, as 30-35 units a shot is ....well...terrifying.

We'd also like to help with the anemia if we can

Jen