? Frosty's got Cushing's. Cut down insulin dose due to starting Vetoryl. Dose advise?

So we started Vetoryl today, 10 mg. Due to fear of hypo that was experienced here by another member whose cat was on the medication, I cut down his dose for 3 units to 2.5 this morning. But I feel like I was FINALLY getting somewhere with the 3 units, and today our curve is upside down so far.

AMPS 307, +4 342, +5 370

Should I have kept the 3 unit dose and just watched him closely? I know the story of the other cat is different and she had many other issues. I don't want him to keep being miserable in the 300s, I would love to get him below the renal threshold, but I also don't want hypo since that's life threatening. UGH.

Oh, and as a side note, I think he has Cdiff because he was on antibiotics for 2 weeks due to a skin tear, and how is having watery diarrhea multiple times per day. I am bringing a stool sample to the vet. This guy can't catch a break.

Any advice??

Thanks.
Ana

 

I know about that feeling of not catching a break.

AB can cause diareah, are you giving any probiotics?

 

I hope you have as much success with vetoryl with Frost as I did with my drooler with Cushings. It was very life extending for her.

No suggestion on dose...but if it was me, I would of been tempted to keep the dose and let the BG's guide on what it should be if I could monitor very closely.

 

That’s good to hear, even if it’s a drooler, lol. There is LIMITED information about cats with Cushing’s. I read 5 case studies published in 2004 and some cats actually didn’t need an insulin adjustment and actually continued to be on insulin even after their Cushing’s was under control. But cats have been kind of grandfathered into the Vetoryl treatment bc there’s very few cats with it or at lest few cats diagnosed, so they don’t know how well it works or how it works. Prognosis isn’t great but because Frosty has skin tears we have to try to treat him. It’s kind of scary though.

It seems most cats I’ve read about, either here or in journals or other websites don’t live too long after starting it. Also, there was a really scary situation here a year ago? Or so where one of the cats became critically hypoglycemic on the medication. That’s why I decreased the dose. But I’m thinking of going back up to 3 units tonight. Not sure though. It’s hard bc I work during the week so I’m out of the house for 12 hours and can’t monitor him during the day. My vet said to just stay at 2.5 cause I probably won’t get him regulated anyway until his Cushing’s is under control. It’s a tough decision. His numbers started looking better just after 2 days on 3 units (still far from perfect though) so I really don’t know what to do.

 

Are you testing for ketones daily?

 

Yep. No ketones.

 

Looking at Zoe's SS, brought back memories. One main difference is she was already on a dose seeing some green when she started Vetoryl. That should give you some cushion. Another thing to think about is under what criteria you will reduce. After Neko had SRT to treat her acromegaly, reductions came fast and furious. I raised my dose reduction point. Following SLGS with a higher reduction point of 90 does give you another cushion (I raised mine to 70), but maybe you want a different reduction point. It's fine to skip or give a temporarily reduced dose if you think you need to, or take a reduction before it's earned. The number one rule when reductions are coming fast and furious is safety. It's OK to break the dosing guideline rules on the side of caution. It's much easier to go back up in dose than deal with an overfull depot.

 

Ugh, I can only imagine how sad it was watching it all unfold “live.” I’ve had to force myself to read all the case studies plus look through her SS carefully, and it’s really heartbreaking. It’s difficult for me to think about animals dying for some reason. But I also have to be realistic and prepared with Frosty. He might not do well. This is not a well known disease in cats. And with his skin issues it makes it complicated.

So we are at the vet for the diarrhea, waiting. I brought my other cat Pumpkin also, due to an itchy ear. So We are having a really fun afternoon... not. Thankfully Dan got out of work early and met me here. Frosty weighs like 15-16 lb with the crate so it’s hard for me to carry him.

So I still don’t know what dose to give Frosty tonight. 2.5 or 3 u ?? His +9 was lower than the +4 or +5 but still in the 300s. I didn’t record it yet so I can’t remember exactly. I agree that my reduction number should be higher than 90. Maybe 110 or even 150? I really don’t know. Ahh. I wish there was some data or something on this or some guidelines that could help.

 

Rose noted some tummy upset with Zoey, wonder if that is what you are seeing too. Maybe it's time to invest in a trendy stroller for Frosty. Neko maxed out just below 15 ( I told her no more ) so I can sympathize on the heavy carrier.

Since you are using the AT, I like upping the reduction point a bit to 110 like you suggested.

 

The diarrhea started on Thursday and he finished 2 weeks of clavamox on Monday. So I suspect it’s related to that. They are gonna give him flagyl and a pro biotic, so hopefully it will help. Due to his diarrhea I was hesitant about starting the Vetoryl, but then was like, it probably won’t get much worse.

He just got a ton of cat treats at the vet that I’m sure weren’t low carb so I expect his sugar to be high tonight. Oh well... he was so cute and social with them. He’s such a good boy. I hope he gets better.

 

@Wendy&Neko do we know the Vetoryl dose Zoey was on? Just curious. In the case studies I read, some cats were started on doses as high as 30 mg.

 

Here is the post from Rose the day she started Vetoryl. http://www.felinediabetes.com/FDMB/threads/5-11-15-zoey-at-vet.137677/

She was following a paper authored at Royal Veterinary Clinic. The folks at their diabetes remission clinic are really good at answering questions via email.

Follow some of the links in there for more info. Including this one: http://www.felinediabetes.com/FDMB/threads/newly-diagnosed-cushings-cat.133446/

 

Thanks. That’s a lot of posts to sort through, and I couldn’t find the dose, but based on that link she posted which is the vet textbook you previously posted for me to read as well, it’s probably also 10 mg.

What’s difficult in this situation is that normally when i post there’s like 20 people trying to give advice and share their experiences. Even when we were waiting for the IGF-1 test, people with Acro cats were still posting, and now it’s like cricket cricket. Lol. It’s lucky that you have some experience with this just by being around when other cushing’s cat owners posted. Otherwise I’d be on my own haha. I did sign up for the German message board for cushing’s Cats someone recommended, but I get so many emails from them that I just don’t have the time to translate and read them all.

Last night And this morning Frosty got 3 units. amps was high, 470, probably because of those treats at the vet - they were so amused by how social and food motivated he was that the tech just kept giving him treats. I was like, whatever ... let this cat have some fun and these people to enjoy him, we don’t know how long he has. We are very strict with his food and snacks at home, so this was one time he was allowed

No diarrhea that I am aware of as of today. He got his second dose of Vetoryl and Flagyl this morning.

 

When I started here, there was one other regular poster with an acrocat, and she left after a while. I got good at searching here. And since then, the number of treatment options has grown quite a bit. I hope the options and knowledge for Cushings kitties grows too.

 

Me too. Man, we are either bouncing hard today, or those treats at the vet’s were super high carb. 400s at +5 ahhh! Looks like someone is staying on 3 units for now. Hopefully this week there will be some improvement.

 

Hope Frosty comes back down soon for you.

 

and