Mitsy's BG lowering

Discussion in 'Acromegaly / IAA / Cushings Cats' started by Rardito, Oct 23, 2018.

  1. Rardito

    Rardito Member

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    Jul 20, 2018
    Just a recap, Mitsy is my Cushing's cat who was diagnosed this summer.

    Lately her numbers have been lower. She hasn't been in the 200s since 9/26. I've reduced her dose down so much she went from 5u twice daily to .25U only if she's over 120! Tonight at PMPS she was 92, without even having insulin this morning since she was 105 AMPS!

    Her diet and insulin haven't changed... so I'm not sure why this is happening (especially since she has Cushing's). I'm not complaining of course, but I'm just confused. I need to do another curve on her the next day off that I have that she is given insulin. I just started holding off since she had .25u once when she was in the low 100s and dropped to 56 two and a half hours later (she peaks at +3 though).

    Would you all still be giving insulin at these low (for a diabetic) numbers? I don't think it's possible for me to do less than .25u with the U40/Vetsulin syringes because it's already barely anything in there at .25u! But I definitely want to hear everyone's thoughts/suggestions.

    Thanks everyone! 20181022_192143.jpg
     
  2. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    I am real happy to even hear that Mitsy is still around. She did not seem very healthy, and it is quite amazing you have done such a great job. That is great news.

    Some people use U100 syringes and do conversions for U40. Basically
    1 unit on U40 is 2.5 times on a U100 syringe
    http://www.felinediabetes.com/insulin-conversions-printer.htm

    So a simple example. If you gave 0.1 of Vetsulin, you could use the U100 syringe. It would be:
    0.1 x 2.5 = 0.25 (in the U100 syringe)
    So you would estimate that on the U100 syringe between the very first mark and the 0.5 mark.

    Or you could just avoid doing this altogether. Her numbers look pretty darned good.
     
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  3. JeffJ

    JeffJ Well-Known Member

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    And that is a great picture of Mitsy, what a cutie.
     
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  4. Rardito

    Rardito Member

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    Jul 20, 2018
    Thank you! And thank you for the advice as well! She just gave me a AMPS of 91 this morning :)
     
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  5. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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    Jan 19, 2018
    I would do an OTJ trial. It is possible that she could go in remission with good glucose control that you have been able to achieve. Cats with Acromegaly have gone into remission, so i don’t see why a cat with Cushing’s wouldn’t. The tumor itself may produce variable levels of cortisol also from time to time, so it may be possible that it’s producing less now. Frosty was on 0.25 units of Lantus at one point, and doing great - blues and greens. Then it suddenly changed. But I think remission is definitely possible.

    @Wendy&Neko @Tuxedo Mom what are your thoughts?
     
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  6. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Dec 2, 2014
    Certainly with the results you have been getting trying an OTJ trial is not unreasonable. With my limited experience...one kitty with Cushing's and did not use medication...it is very unusual that the Cushing's end of the FD would go into remission without some sort of medical intervention such as Vetoryl ( trilostane) The tumour, as far as any researching I have done will not go away on its own. However, it is possible for the tumour to wax and wane...the actual physiological process of how this happens I have no in-depth knowledge of.

    I don't see where you have tried the Vetoryl ( trilostane) but the tumour 'could be' in a dormant phase. Since the numbers are good and you are at such a low dose trying OTJ would seem reasonable, but regular monitoring is also very important.

    Good luck!!

    ETA My Tuxie never got higher than 6 units, but during his fight with Cushing's his numbers were very erratic and could range from high highs to low lows within the same cycle on a regular basis.
     
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  7. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Other than her numbers, how is Mitsy doing?

    You could certainly do a trial, which would be 14 days without insulin. If you see a blue number at preshot, try testing a few hours later to see if her pancreas is working and bringing down the numbers.

    I agree with Mary Ann. This could be temporary, so regular monitoring (maybe not every day) is still a good idea. In the mean time, looking good!
     
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  8. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Dec 2, 2014
    Just one more comment. The link below is another Cushing's kitty Zoey (GA) who was given trilostane. She was only on the meds for a short period before she passed, but you will see how erratic the numbers were, From the people I have communicated with over the years this tends to be a common factor in a Cushing's kitty who is not treated with vetoryl (trilostane). When I look at your numbers I do not see the same type of wild swings that I personally have come to recognize in a Cushing's kitty who is not being treated medically. What tests were done to determine Cushing's ?? Maybe @Ana & Frosty (GA) can add some more insight into this question.

    https://docs.google.com/spreadsheets/d/1ZSx88fvA4ku4mzZA4JZpfAtSs-lEQV9wPqKoaWVN4t0/pubhtml
     
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  9. Rardito

    Rardito Member

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    Thanks for the advice. No, Mitsy hasn't had Vetoryl - the vet didn't want her to be on it until her blood glucose numbers became erratic. I was wondering about the dormant possibility - mainly because she was peeing outside of the litterbox exactly two years to the month she started doing it this year, but then a couple months later stopped. The vet had just said she had behavioral problems at that point (her sugar wasn't elevated and she had no other symptoms of anything, and I had just gotten divorced so that's what they thought was happening). So I'm wondering if that's happening - she hasn't been nearly as bad about the peeing (is actually going on the puppy pads lately and even went in the litterbox today). Maybe both of these instances the tumor was just waxing and waning a few months later.

    I am continuing to check her BG twice daily right now and will probably continue to do that for awhile just to keep monitoring her.
     
  10. Rardito

    Rardito Member

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    Jul 20, 2018
    Thanks for the advice. Mitsy is actually doing a lot better as far as moving around (she even jumped on the couch a few times this past week which she hadn't done since June!). She is on Zobaline and egg white powder, though. She seems to be more cuddly again although she still has the neurological issues from the tumor. Her peeing is way less and she usually goes on the pads now instead of the floor. She's also not drinking a ton of water (although I do water down her wet food).

    Yeah, I'm definitely going to keep monitoring her at normal shot times. She just gave me a 101 PMPS, so I'll take your advice and test a couple hours from now to see what's going on.
     
  11. Rardito

    Rardito Member

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    Jul 20, 2018
    The printout that I have says "Cortisol Serial 3 DEX/dexamethasone suppression test." They took 3 blood samples over an 8 hour period.
     
  12. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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    Jan 19, 2018
    I think we just haven't seen it, because the sample of cats with diagnosed Cushing's is so small. If you guys look back to beginning of February, Frosty was on 0.25 units of insulin and technically I should have taken him off and done an OTJ trial because his sugars were in the 70s on AlphaTrak meter. Then suddenly, without warning, he started spiking numbers in the 500s and went up to 3 units.

    Why the tumors wax and wane their hormone release I don't think is known. Tumors are generally an abnormal growth of cells, so their behavior can be unpredictable.
    I can do a quick recap of how Mitsy was diagnosed. Rosa came to the forum a few months ago after doing some research about Mitsy's symptoms. @Rardito feel free to correct me, I am going by memory here. But I believe Mitsy started first showing neurological symptoms a couple of years ago. Rosa noticed that Mitsy's head was leaning to one side, held her ears out to the sides, and had uneven pupils. Over time, Mitsy became weak and had trouble walking and using the litter box. Many accidents outside the box. After Mitsy was diagnosed with diabetes, Rosa posted some pictures of her on the Cushing's forum, and based on the neurological signs, the unkept/thinning fur appearance, and the large belly, I suggested to her to have her get tested for Cushing's. They did the ACTH stimulation test I believe, and the abdominal ultrasound. The ACTH test suggested Cushing's, and the ultrasound did not show abnormalities in adrenals, so it must be pituitary related. But even without the test, based on her appearance and the history it I was pretty convinced. Her belly hair still hasn't come in since the ultrasound either (I follow her account on instagram, haha).

    Like Rosa said, the vet did not feel that Mitsy needed the Vetoryl since it's a pretty potent medication - he considered it chemotherapy although I don't think it's quite that, but I get it, it's a chemical to bind the extra cortisol that is produced by the tumor, and I can understand his concerns especially since Cushing's is so rare in cats. Mitsy does not have any skin tears, and although she doesn't groom as much and still has some weakness, it seems she has been doing well on insulin and over-all her activity improved based on what Rosa is saying. I would guess that the tumor is not producing as much excess hormone right now, and that may be part of the improvement. Perhaps the diet change and good glucose control also helped with some of the improvement as well.

    Its so hard to know what to expect from Cushing's. Here we have 4 total different experiences. Tuxie lived 2.5 years after diagnosis on no treatment. I know Zoey went hypoglycemic, which is really sad. Frosty did great on Vetoryl but I suspect the other organs were already too damaged from the Cushing's because no one knows how long he's had it (if his skin was sloughing of just from touch in the end, imagine what kind of beating his heart and other organs had.) None of these kitties had neurological symptoms. And Mitsy actually presented with neurological symptoms first, but seems to be doing well from the diabetes perspective. (Also, note that Mitsy is not on Lantus, as I believe Tuxie and Zoey were, and Frosty of course).

    I never did email RVC like @Wendy&Neko to discuss what insulin is better for a Cushing's cat. Due to the swings in some Cushing's cats, maybe an "in-and-out" insulin like Rosa is using is better because you can adjust the dose every 12 hours as needed based on the sugar? The rest of us used Lantus which is considered "the most potent" by some vets, although the truth is it just works differently. But Lantus is a depot so maybe it wasn't the best one to be using? Who knows.

    I really wish there was a vet here somewhere who wanted to compile our data and try to draw some kind of conclusions. It's really hard to make any kind of prediction about Cushing's when there just isn't enough information.
     
    Last edited: Oct 24, 2018
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  13. Rardito

    Rardito Member

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    Jul 20, 2018
    Yep that's a pretty accurate recap! The first signs were neurological and then came the peeing on the floor 2 years ago, then she stopped and was fine until this year (besides her uneven pupils). This year she started off with the hair loss and then the peeing on the floor/no grooming and diabetes symptoms. Luckily she has no skin tearing as of yet.

    And yes, she still has "bare udders" as we like to call them from when she was shaved for the ultrasound in August. :)

    I really have Ana and the other FDMB members to thank for encouraging me to get a Cushing's test and not going with the vet's thoughts of "behavioral issues." I feel bad, they had put her on amitriptyline when they thought it was behavior related (fun fact, I am also on that medication but definitely not for behavior issues, haha). I know what that medication is like, so I feel bad that I was medicating her incorrectly at first. But luckily we figured out the real issue!

    IMG_20181024_074353_086.jpg
     
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  14. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    @Ana & Frosty (GA) Thank you for the recap on Mitsy. With the obvious symptoms and the additional testing it does all lead to a Cushing's diagnosis. As you said with the literature being so sparse with Cushing's kitties...IMO due to unrecognized warning signs and under-diagnosing... it is hard to say what a 'typical' Cushing's kitty is like. Tuxie never had the tearing skin, but he had very thin skin. And like Mitsy he had the bare enlarged belly over 2 years after the shaving for his first U/S.

    I used Levemir with Tuxie. I had started with Lantus but once he got to 3 units it appeared to give him discomfort on injection. I had considered trying an in and out insulin like Prozinc, but by then his sister Maxie ended up being FD as well and she was doing well on the Levemir. My thought was that it would be easier to do irrregular shooting times and have a better sense of when the insulin had cleared the system. I opted to stay with the Levemir simply because Maxie was also on it and I was familiar with Tuxie's responses to it ( as erratic as his numbers could be).

    I totally agree that more research and compiling needs to be done with Cushing's kitties. When I started my FD journey 4 years ago I was only able to find a couple of people from every source I could find that had Cushing's kitties....since then the numbers have escalated which shows that feline Cushing's is NOT the rare disease it has been presented as.

    @Rardito Mitsy is looking very good at this point and the OTJ trial may prove successful, but as I said earlier with the unknown of the actions of pituitary tumours, regular monitoring is essential...more so than with a 'normal' FD kitty in remission. I will keep my fingers crossed that Mitsy continues on with these great numbers.

    :bighug: :bighug:
     
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  15. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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    Mitsy is so cute, I just wanna bite her. :D And hug her :kiss: she reminds me of Frosty ❤️

    I didn’t know they were treating her for behavioral problems, poor baby! That’s like the #1 rule in human medicine... always rule out organic causes for any psychiatric problem. :eek: Ugh! Talk about missing the ball.

    I guess it’s easy to say though having seen a Cushing’s cat before. Some vets probably go their whole life not ever seeing one. I feel like we all had better chances of winning the mega million... :facepalm:

    I’m rooting for Mitsy, I think all 4 of the cats in here had very different experiences and it would be great if she could go OTJ. I don’t think anything is impossible, but I think you’re doing everything right, Rosa. You’re such a good kitty mom to Mitsy. And your instagram page is awesome - I suggest everyone goes to check it out!
     
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  16. Rardito

    Rardito Member

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    Yeah, they even thought her hair loss was over grooming at first. She actually saw 3 different vets before I told them to do the Cushing's test, but there had never been a Cushing's kitty at that office. Luckily we figured it out the second time around!

    Thank you everyone for your advice!!
     
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  17. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    My vet thought I was being foolish testing for Cushing's. She has been a vet..who keeps up to date...for 30 years and she had never come across a Cushing's kitty, although she has seen many Cushing's dogs. With discussions that we had over the years and the tests with Tuxie, she now looks for signs that may indicate Cushing's with her feline patients. She was especially amazed at how thin the skin was, but she wouldn't have seen it if Tuxie hadn't been shaved for the U/S. A simple, non-invasive and affordable UCCR test is all it takes to get the ball rolling with diagnosing feline Cushing's.

    We are all rooting for Mitsy!! It would be wonderful to see a Cushing's kitty go into remission without using vetoryl (trilostane) :cat: :cat:
     
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  18. Rardito

    Rardito Member

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    Jul 20, 2018
    I will keep you all updated :)
     
  19. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    It's just too bad that Mitsy does not have enough toys - like two baskets full instead of just one basket :D What a great second pic!

    Our kittehs love those catnip bananas too. The bananas are just the perfect size to bat around and chomp on.
     
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  20. Rardito

    Rardito Member

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    Haha I know! They are great.
     
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  21. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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    Hmm! I may need to get these for my civvies... Frosty wasn’t interested in catnip AT ALL. My girls love it though
     
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  22. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    We call those catnip bananas (and their relatives) "nanners" over on the L/L forum. The cat with the most nanners wins. :smuggrin::cat:
     
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  23. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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    Jan 19, 2018
    Wow! I call regular bananas naners... I thought I was so original :eek:

    Ok, you guys convinced me. I’m ordering one for them. The only issue about catnip toys is my dog always thinks they are his chew toys and steals them. (He loves stuffed toys or anything that looks like one). He gets them all slobbery and gross. That’s why I’m only gonna order one for now.. I’m worried he will get hold of them. :facepalm: But it’s annoying bc my girls can’t have nice things!!:arghh:
     
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