It's official - Baby has Acro and IAA

Discussion in 'Acromegaly / IAA / Cushings Cats' started by Mary Ann & Baby, Oct 5, 2018.

  1. Mary Ann & Baby

    Mary Ann & Baby Member

    Joined:
    Aug 6, 2018
    I'm really sad. Not that I didn't suspect it, but Baby's results came back positive for both acromegaly and IAA. Her IGF-1 was 347 and her IAA was 83%. :(
     
  2. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Sorry for the results. :bighug::bighug::bighug: Give Baby a little kiss from me, she is still the same sweet cat she was before diagnosis. But now you have a diagnosis, we can find a path forward.

    Did your vet have any suggestions? Probably time for a cabergoline discussion and even ask if they have heard of Levemir. Sometimes the change in insulins can have an impact on the antibodies, and allow you to get ahead of them for a bit.

    For the moment, I would increase by 0.5 units every six cycles, until you see blue. You might even increase every six cycles with a high blue too. It'd help us if you do daily posts, so we can track and help where possible. At some point, 10 units total dose, we would suggest larger increases.
     
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  3. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    With those higher insulin doses, Acro is always a strong possibility. I'm sorry to hear it.

    Baby's insulin demand seems to have progressed fairly quickly from 1 unit to 8 units. Leo had a similar fast rise with insulin demand, leading to his Acro diagnosis then SRT.

    Agree with Wendy - it is important to give Baby a break from those high numbers by striving for some time in the blue region, if only for nadirs.
     
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  4. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    I should have added, even with blue nadirs you would still increase, you just might slow down the increases. With the antibodies, it's wise to stay ahead of them. Green nadirs should be your goal.
     
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  5. Mary Ann & Baby

    Mary Ann & Baby Member

    Joined:
    Aug 6, 2018
    I brought up both Levemir and Cabergoline with my vet. She had heard of the Lev, but not the Cabergoline and said she would discuss both with the IM doctor and get back to me soon. She also talked again about possibly adding R. She told me she feels more comfortable with my frequent dose increases now that Baby is diagnosed with the acro/IAA. I'm glad that my vet and I will be able to work as a team now at least. It really did bother me a lot to go against her advice. She mentioned that none of the five vets in our practice had ever had a cat with acro or IAA in all their years combined! I'm pretty sure we'll be switching to Levemir soon.

    So the Cabergoline...highly recommended here on FDMB? More so than adding R to the mix? My only concern in reading some of the Cab stories is the apparent stomach upset that occurs (vomiting and/or diarrhea). Right now Baby is still feeling well, almost hate to rock that boat.

    If we do switch to Levemir, at what dose? Did I read 30% less than her current dose of Lantus (which right now is 9U), so like 6 or 6.5U of Lev?

    Same for R - how do you know where to start the dose, and how to increase/decrease?

    Lastly, I guess I should mention that it is not my intention to do SRT or surgery, and octreotide and pasireotide are out of consideration due to their cost.

    Oh, and also, is the belly fat/pooch skin an okay spot to give shots? Trying to mix it up a little because maybe the scruff isn't working very well? She didn't like the flank shots I tried.

    Thanks!!
     
  6. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    R is another insulin. It won't fix the underlying Acro issue.

    Cabergoline is a treatment for Acro. I'm not surprised your vet was not aware of Acro, as many are not.

    For dosage sites, I work the back and sides all the way to the flank. I think the belly is a bit more tender.
     
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  7. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    One thing at a time. I would start with the Lev switch, then think about R or cabergoline next. Yes, we generally start the Lev dose at 70% of the Lantus dose. If that seems to be going backwards, we can fast track you. Or it could be she'll have a strong reaction even to the reduced dose of the new insulin and you'll see lower numbers than you are used to. It'll help to get more eyes on you if you post on the Lantus/Lev forum at the time you switch. This forum is pretty quiet for dosing/low numbers help.

    When you add R, we'll find someone who is available to help you and hang around when you try it. First thing there, what time zone are you in and what clock time is shot time? The person who "sits" with you will help you figure out the dose, when to or not to use R and how to increase. Generally you would start with a 0.25 unit dose. You'll want to use R when it's a good time to do so. Learning when not to user R is as important as when to use it. The goal of R, if you use it, is to help you keep Baby in better blood glucose numbers by lowering her numbers by no more than 100 points. Getting Baby under renal threshold as much as possible (mostly blues) should be one of your primary objectives.

    Using cabergoline is for a completely different reason. If cabergoline works for your kitty, it can help limit or even possibly stop the output of excess growth hormone from the pituitary tumour. We have had 3 cats go OTJ while using it. The excess growth hormone can produce unwanted side effects. For those whose kitties have responded well to cabergoline, there has been some fast changes in dose. I wouldn't use R and cabergoline at the same time.

    I shot primarily scruff/shoulder area for 5 years. Neko objected if I tried elsewhere. Some people shoot sides, should be OK.

    Just had to comment on this:
    I'm pretty sure they have, they just didn't know it. One in four diabetic cats has acromegaly. I suspect they've seen more than 4 diabetic cats. Not all acros have high doses. The study that found the one in four figure saw acros as low as 1 unit, as high as 35 and an average of 7 units.
     
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  8. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    So sorry for the dx. But now you know what your dealing with and your approach will now be a bit different.

    Olive isn't that we know off IAA. Vet refused to test for it. But Acro she is and again vet didn't believe it. He was going by U.K. measurements until I told him he had to convert to the U.S. measurements. He doesn't want the cabergoline because there are so few studies on it and a "specialist" claims it doesn't work. HOWEVER, mom here is all for it as we have nothing to lose. After 6 months of searching, emailing specialists, considering the opportunity in NY to remove pituitary, I have found a vet who is local and admits they never treated an acro but after reading up on it and talking with an endocrinologist, seeing that any side effects are minimal WE ARE STARTING CABERGOLINE TODAY. I will be using a flavored compounded suspension from Wedgewood that seems to be the best price around. The most common side effect is gastro upset but resolves on its own within a few days. We can work with that. Should it become more or to much then I will stop using it and we back to where we are now.

    I think obviously it's worth the try. We have everything to gain and nothing to lose. Keep us posted plz.
     
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  9. Mary Ann & Baby

    Mary Ann & Baby Member

    Joined:
    Aug 6, 2018
    Thank you, yes, that's what I was thinking.

    Should I just regularly post on the L&L forum rather than this one?

    Wow, you all are incredible beans...THANK YOU!!! I am in Chicago, Central Standard Time. I give shots at 7am (as close as possible...Tues, Thurs...it is closer to 6:30ish.) and 7pm.

    Thank you for pointing this out!

    BTW, 9U last night and this morning. AMPS (301), +4.25 (294)
     
  10. Mary Ann & Baby

    Mary Ann & Baby Member

    Joined:
    Aug 6, 2018
    I just * don't * understand! Why would he refuse you an $18 test????? If Olive has nothing to lose by taking the Cabergoline, then I'm with you 100%!

    YAY!!!! I am excited to go on this journey with you and Olive! :) We may be joining you with the Cab!

    Paula, can you please give me the specifics of your Cab? I want to make it as easy for my vet who is unfamiliar with it as possible. Ie, size of vial, what exactly is being compounded? what flavors (and are they sugar free)? And of course, price. Thank you for your help with this!

    Amen and of course!
     
  11. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    For where to post, I would post here if it's something related to acromegaly and IAA, that may be of interest to others. However, people here are on all different insulins. If you want suggestions regarding dosing or handling numbers you aren't used to, then the insulin specific forums will have more eyes that can help.

    As for R, since I am on the west coast, I wouldn't help with the AM shot. When you are getting ready to try it, post and let us know and I'll try to find someone back east from me. If it is going to take a while to get Levemir, you could try R first. You would have to start R on a cycle you can monitor closely, with tests for at least four hours.
     

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