Newest member to the acrocat gang

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Bronx's dad (GA)

Bronx's dad (GA)

Member Since 2016
Hi all,

Bronx's IGF-1 came back at 434 (normal is 12-92). Welcome him to the acrocat club! Not sure what the vet will recommend next but we did discuss switching to Lev before these results came back and he was ok with that. IAA levels were 8 which is normal (<20). I will continue the TR Protocol, but is is ok to do increases aft 4-5 cycles instead of 6 at this point since I know now Bronx will be a high dose kitty?
 
Sorry about the Acro dx but good news IAA isn't added to the mix. I would not increase sooner than the 6 cycles personally. Some Acro's really don't go as high as you would think in dose and TR is an aggressive approach as written. If other high dose beans recommend differently such as @Wendy&Neko or @julie & punkin (ga) then I'd go with what they advise. My Doodles is IAA only although I do believe it has recently broken at least some anyway. Lantus really bothered him with stinging after 5u so I would certainly pursue switching to Levemir since you are seeing that with Bronx already. Doodles overall demeanor was better after switching to Levemir even when stuck in red/black.
 
Well, we aren't members but Gussie and I want to tell you we're happy you have a starting point now with a definitive reason why it's been hard to find a dose that works for Bronx:bighug::bighug:
(And giving you a bump up for the acro club pros! There are some great ones here! You are going to love the members!:bighug:)
 
:bighug::bighug:So sorry you have officially joined the high dose club but with the look of Bronx's numbers and being over 6 units, something was happening. It's always best to know what you are dealing with and it can impact our suggestions on dosing. Just so you know who the other people are have experience in dosing for acromegaly, I am tagging @julie & punkin (ga) . We've also spent quite some time trying to learn about acromrgaly itself. The latest research from the Royal Veterinary College in England shows that one in four diabetics has acromegaly and that same team may have found the gene that causes the condition. Wes, @saltycat and his cat Jack are entering a trial with the RVC for a drug to help control acromegaly. The future for treating acromegaly is brighter than when my Neko was diagnosed four and a half years ago.

I remember it being hard to receive the acro diagnosis, but at the time Sienne stressed to me is that my kitty is still the same sweet kitty and doesn't know she/he has that diagnosis. Give him a cuddle from me.:bighug::bighug: You are not alone, keep posting and asking questions.

I like the idea of going ahead and ordering Levemir. Let us know when you get it in and we can help you with the dose switch. It may not be a 1 to 1 switch when you start the new insulin. As for now, as long as you do not see anything below 300 AND you are getting at least two tests for each cycle day and night, it is OK to increase every 4 to 5 cycles. Once you see yellow we may slow the pace. Again, post and ask for help when that happens. And it will, there is a dose that moves every acrocat. Not having IAA in the picture too will help.

Last but not least, keep trying to get ketone tests every day. How is that going? If ketones start showing up, we may have to discuss getting short acting R insulin to add into the mix.
 
Good news on the ketones!

The most current collection of information on acromegaly here is in this post. I have a couple more changes to make on treatment options, pretty much all at RVC.
 
Julie and Wendy are among the people here who have recent experience with acro kitties. You may want to look at their spreadsheets and I suspect they can recommend a few other spreadsheets for you to look at.

Depending on what you want to do, there is a stereotactic radiation therapy intervention for acro. Again, Julie and Wendy can fill you in better than I can.

 
Sorry to hear but glad you have answers and have experts here to help you and Bronx. :bighug:

Hoping the switch to Lev. goes smoothly and you get to a good dose to help Bronx soon.
 
Bronx's dad said:
Hoping he responds to that better than the Lantus
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The best part is it shouldn't sting/ bother him. Remember every cat hits that magic dose eventually. Some Acro's however we've seen hit doses in the 30/ 40 unit range. Each cat needs what they need. I'd encourage you to read up on the link that Wendy provided regarding SRT and the new trial treatment that is underway that @saltycat will be doing with his Capt. Jack soon. In the meantime hopefully Lev will agree with Bronx better.
 
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Not to scare you with the 30/40 range, but each acrocat really is different. When the Royal Veterinary College did their study, they were testing diabetic cats and wanting to exclude acros from their study. So they were surprised there were so many. They found the acrocats they tested were on a range of 1-35 units of insulin, with an average of 7. We have seen acros with less than 5 units and higher than 50. You won't know until you get there.

As for treatments, there are several. The "classic" treatment was radiation therapy on the pituitary, which morphed into stereostatic radiation therapy (more focused, less intense beam of radiation). That's what Neko had at Colorado State University, which was a 3 day drive for us. Since then, there has been more experience in hypophysectomy, which is surgical removal of the pituitary. It's more commonly in dogs and harder in cats because of their smaller heads. The experience of the surgeon is a direct correlation to the success of the surgery. The best expertise is in, you guessed it, Royal Veterinary College in England, which have done over 50 cats now. There have been some procedures done in Washington State University and a vet clinic in West LA. New research is focusing on medical trials. Pasireotide was proven to have some success in both the short and long term form, but is very pricy. I never found the price in Canada of the long acting version (which has better success and is a once a month shot), but the short acting one was something like $5000 for a 3 month supply. Needless to say, I abandonded that approach. :rolleyes: I've heard it's a couple thousand a month in the US. The latest trial is a much cheaper drug but the trial is just starting so no results yet. All our paws are crossed on that one. Treatment at home is best.

And finally, the majority of caregivers don't actively treat acromegaly but manage the symptoms that can happen as a byproduct of the excess growth hormone and insulin growth factor. It's not a fast acting disease and treatment requires financial resources or travel that are not available to all. Getting Bronx to a place where he spends most of his time under renal threshold should be your goal, whether or not you pursue treatment. He will be a much happier cat when he gets there. And it will be much easier on his kidneys.
 
Wendy&Neko said:
The "classic" treatment was radiation therapy on the pituitary, which morphed into stereostatic radiation therapy (more focused, less intense beam of radiation). That's what Neko had at Colorado State University, which was a 3 day drive for us.
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Did the radiation therapy work for Neko?

Wendy&Neko said:
Getting Bronx to a place where he spends most of his time under renal threshold should be your goal, whether or not you pursue treatment. He will be a much happier cat when he gets there. And it will be much easier on his kidneys.
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Under renal threshold means getting his BG levels in check?
 
Sorry for the Acro Dx, we went through the same thing earlier this year. One positive is you now know why he is not reacting the way most cats do. The insulin is getting blocked from getting into the cells by the IGF-1.

Jack is one of the Acro/IAA cats mentioned. I suspected something was wrong when like you, we just kept climbing the dosing ladder while his bg numbers stayed the same. He currently gets 30u each shot and doesn't flinch a bit. I switched from Prozinc, so cannot comment on Lantus. We have just been working on keeping his numbers in a good range and using zobaline for his weak back legs. It is a supplement that many users here have had good luck with in treating diabetic neuropathy.

The levemir tends to have a little later onset and nadir then lantus, so be prepared for a little change in those times when you do switch.

It has been an interesting journey to say the least. We are enrolled in a new trial drug that the RVC mentioned above thinks might help slow the release of the IGF-1 which would help slow the progression of the acro. I am currently waiting for a compounding pharmacy to get in touch with me, but it looks like it will be pretty cheap compared to the current amount of insulin he is getting or any of the other available treatments. The dose is in the micrograms per day.

Other then needing more insulin then most cats he is still the same cat as always. Occasionally the tumor will pulse and put out more or less hormone which keeps me on my toes. No 2 days are the same which makes monitoring interesting. Julie and Wendy both went above and beyond in helping show me some articles about acro and working on getting Jack's numbers down.
 
Bronx's dad said:
Did the radiation therapy work for Neko?
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Yes, atthough not 100%. Her "high" dose was 8.75 units and she went down to about .75 units for a few years after radiation. A little over 3 years later, her dose needs started shooting up to 7 units over the period of a couple months. That was the tumour kicking in again. We had a second treatment and she was down to barely any insulin. But this last year she also got kidney disease, heart disease, GI lymphoma. Not sure what was the cause of her ultimate decline and we set her free the beginning of this month. But she lived with acromegaly for 5.5 years (I recognized some acro symptoms from before she was diabetic) and that's a pretty long time. Untreated acrocats will not live that long. Neko's kidney and heart conditions could have been caused by the acromegaly, her arthritis definitely was. Radiation slows the growth hormone, but not as much the IGF-1 output which contributes to soft tissue growth. Neko also had some mouth bumps which were making it harder to eat. I've heard that about 25% of cats treated with SRT go off the juice completely. But radiation neuters the tumor cells, it can take a while for full effect. Even living with small doses was so much better for me. And until this last 6 months, Neko wss in pretty good shape.
Bronx's dad said:
Under renal threshold means getting his BG levels in check?
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It's the point at which the kidneys don't have to work to get the extra sugar out of the blood stream. For most cats, it's in the low 200's or high 100's range. The ideal range of numbers for me was always blues with some greens in there too. Kidney and heart disease are two of the risk conditions for acros.
 
Under the renal threshold is under the point at which glucose is spilling into the urine. When this happens is different for each cat but generally higher than the normal range. For Purrdy (who had Cushings) the renal threshold was around 220. The point at which glucose is spilling into the urine is the point at which damage is being done. With a kitty with an untreated high dose condition you aren't aiming for normal numbers and possible remission you're aiming at preventing damage and keeping them safe.

Since you're testing for ketones using pee you may already have the tools if not you'll just need a different type of strip - Ketodiastix test for glucose and ketones. To find Bronx's renal threshold you'll need to experiment with lots of pee tests when he starts getting runs in lower numbers (yellow numbers are a good place to start) - which he will. I see a happy dance in your future, for the first time you get a pee test with a negative glucose result :cat:
 
Hello from another Acrocat bean. Sorry for the diagnosis, but now you know why Bronx doesn't respond to insulin like most cats do. If you're interested in SRT, @JeffJ recently had the procedure done on his kitty and chronicled the trip.
http://www.felinediabetes.com/FDMB/threads/leo-leoberry-the-high-doser.163717/
Wendy and Julie's knowledge is priceless and they have both helped me many times with dosing, feeding and any other questions I've had.
 
The advantage of Levemir for higher doses is that you don't get the sting of acid based Lantus. Neko was on Lantus when she hit her first high dose mark, and Lev the second time we went up scale. I thought she was fine with Lantus but realized after the switch that she was occasionally walking away from the Lantus shot. And purred through the Lev shot.
 
Hi. Wendy and Sharon helped me a lot when Leo was diagnosed with Acro. I also read all the articles that are linked on the forum. They are very useful. For us (Wendy, Sharon, me), we end up with more knowledge about Acro than most vets. Probably because the vets don't have time to spend on exotic diseases.

Anyhow. Leo is steadily improving. I document major steps in his thread now. He got SRT (radiation) in Sept, and is now +3 months. It makes a difference. His insulin needs have dropped to half. He is difficult to regulate. And he is more responsive to Prozinc than Levemir, but Levemir is a lot cheaper. So each cat has variations.

My one piece of advice is to mirror advice from others. Bronx's BG levels are way too high. That will take its toll. Even if you can't get him to nadir at 100-150, at least drive his BG down to the 200-300 range. I am very conservative. Leo doesn't nadir very well. And now his BG is bouncy. So his average BG is generally above renal threshold. But he also has never had a hypo, and a single hypo can be a killer.

Let me know if you have any questions. I tried to document the significant stuff in Leo's thread.
 
JeffJ said:
Bronx's BG levels are way too high. That will take its toll. Even if you can't get him to nadir at 100-150, at least drive his BG down to the 200-300 range.
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We are trying! Vet actually suggested jumping from 4u-6u 2 weeks ago, maybe I should have followed his recommendation. I know the longer he is in the blacks & reds, the worse it is for him. I have been following the TR Protocol, but now will be more aggressive & up 0.5u every 4 cycles because of the acro dx. Bronx did have a pink AMPS today which I haven't seen in a long time. Hopefully this means I am getting closer to regulation. Will be switching to Lev in a week or so when it arrives.
 
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I don't see a more recent thread for you so will go ahead and reply on this one. I'm glad you've decided to increase by 0.5u every 4 cycles. In my opinion that's the way to go at this phase. We've fast-tracked other kitties before and as long as you continue testing at the rate you are doing, it's safe. You'll be able to get him into better numbers as quickly as is safe to do so. When you start seeing blues, then you slow down the dose increases.

As far as maximum dose size, in my experience it really helps to keep the dose down by being somewhat aggressive with keeping your kitty in normal numbers. When I started there was one person who was afraid to have her cat get into green, even at the lowest doses, and she basically spread the word to let acro cats stay above 100. It just seems that when people do that (which I did) the dose continues to climb. Higher numbers cause Glucose Toxicity, which requires increasing the dose even more to get the cat's body back into normal numbers.

On the flip side, those who keep their cat in normal numbers seem to be able to keep the dose down. The risk of doing that is that if the tumor suddenly stops putting out growth hormones, you could end up with the kitty being overdosed and have a long time dealing with it. You should always have 8-10 cans of high carb gravy food on hand, just in case you need it. Choose higher high carb foods, like over 25% if possible, and know that you can increase the carbs in gravy by adding a sugar syrup like corn, maple or honey to it. I have HEARD people say that acro cats could need more carbs to be brought up, but I didn't personally EXPERIENCE that with punkin, nor have I seen it happen with the high dose cats here. This is a case where "know thy cat" is essential.

When we started there was another cat, Tommy, who was diagnosed with acro at the same time as Punkin. Tommy's IGF was 313, Punkin's was 281. After diagnosis, I let Punkin's nadirs drift up over 100. I didn't increase his dose by large enough increments, staying with 0.25u increments even when we were close to 10u. Lauren kept Tommy tightly regulated even after his diagnosis. I had Punkin treated with SRT (which I think was a good move), but I also did dose reductions in advance, anticipating he might go into low numbers and fearing (from people's stories) that I might not be able to bring his blood sugar back up. In my experience, I could bring up his blood sugar just like everyone else did, with a teaspoon or so of gravy. But there was all this drama on the high dose group around the time we were diagnosed and I was a bit adrift in what strategy to follow and was getting competing advice.

Lauren continued to follow the Tight Reg Protocol and she didn't do any other acro treatment - Tommy lived 4 years after his diabetes diagnosis, to the ripe old age of 20. Punkin died 2.5 years after his diagnosis, about 18 months after the SRT. He had a lot of things wrong with him, so I don't think what I did harmed him. His thyroid was killed by the SRT, and while I knew that was a possibility, I was getting it checked regularly. What I didn't know was while the general tests for thyroid (T-4) were showing his thyroid was fine, he wasn't. When we did more extensive tests (free T-4 and cTSH) we discovered his thyroid was extremely low. Thyroid is critical for controlling pretty much all body systems. He also became anemic.

Anyway, that's all to say that if you can't afford extensive treatments, don't despair. Carry on and treat with insulin.

The most important thing you can do is to learn how Bronx works and responds to high carbs when you do get to the point of dealing with low numbers. At some point you will.

Ask as many questions as you have. Feel free to tag people with high dose kitties if you need their help.
 
julie & punkin (ga) said:
I have HEARD people say that acro cats could need more carbs to be brought up, but I didn't personally EXPERIENCE that with punkin, nor have I seen it happen with the high dose cats here.
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Neko usually did fine with a high carb of 16-18 % and I'd save the karo/syrup for when she went below 40. ECID is a saying you will hear here and it's so true. Each cat (acro or not) responds differently to carbs. Like everyone else here, you have to learn your cat. And I always started conseratively (higher carbs) and worked my way down until I learned what was needed.
 
I had someone tell me that it took multiple cans of high carb gravy cat food to bring up their acro cat's blood sugar, but it wasn't when I was on the board and I confess I am skeptical. Still, to be on the safe side, it's good to have the ammo even if you never need it!!
 
julie & punkin (ga) said:
The risk of doing that is that if the tumor suddenly stops putting out growth hormones, you could end up with the kitty being overdosed and have a long time dealing with it.
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I had no idea that there is a chance of the tumor stop putting out growth hormones. How quick does this come on? Are there signs of this? I hope it isn't a sudden thing and it happens on a day I am away at work after shooting him? I am finally seeing some pinks which makes me happy, hopefully yellow coming soon. But, in about a week or two the Lantus pen will be done and I have Lev. on the way. Not sure how that will change things and what dose Lev. I should start with.
 
The change in tumour output does not happen in a day, you should be OK. Post a day or two before you are going to start Lev and we will suggest a dose change strategy. Many things can change in two weeks.
 
Wendy&Neko said:
The change in tumour output does not happen in a day, you should be OK. Post a day or two before you are going to start Lev and we will suggest a dose change strategy. Many things can change in two weeks.
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I hope it comes soon, he is really starting to flinch at 7u. Is there a better spot to shoot him instead of the scruff area to lessen the pain?
 
Bronx's dad said:
Is there a better spot to shoot him instead of the scruff area to lessen the pain
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Unfortunately I don't think so. One thought is to split the dose into 2 syringes and then shoot as a temporary solution. It's not something we'd normally suggest but it might help with his discomfort until the Levemir arrives.

Here is a picture of alternative shooting spots. Moving the shot placement around is encouraged so they don't develop scar tissue.
Shot Placement.jpg
 
LizzieInTexas said:
:(

Have you received a tracking number yet? My order from Mark's arrived in exactly 1 week. Ordered it on Monday and received it the next Monday.
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Yep, but the holiday may delay it a day or two. Lantus Pen is getting a little low too, it will be a close call since I will be up to 8u by next week. I do have an older Lantus pen with some left for emergency purposes but I noticed that may be ineffective since the black plunger in it never moved down. Half of site glass is filled with air, not sure if that has affected the potency?
 
In regards to the stinging of the shot. If lantus sting with a cat is similar to dilaudid sting with a human. You might try rubbing the injection site as its being injected and for a bit after. I guess this might need another person for doing so as actually injected. A nurse mentioned this method to my wife to reduce the sting of dilaudid injections and she found that it helped. She also had me inject very slowly, almost to the point that the plunger was never moving but actually was.

So inject as slow as possible and rub the injection site was her recipe for reducing dilaudid injection sting.
 
babyBoo said:
You might try rubbing the injection site as its being injected and for a bit after
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I've read somewhere, I can't remember where, that injection site shouldn't be rubbed with Lantus.
When Lantus goes under the skin, it precipitates, and if you rub the injection site, you break the precipitate, and that completely changes the kinetics of the reaction.
 
julie & punkin (ga) said:
I had someone tell me that it took multiple cans of high carb gravy cat food to bring up their acro cat's blood sugar
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As another case study, I think Jack's BG would jump just from sniffing HC food. A tbsp or 2 usually gets his numbers up and he is Acro/IAA. As has been said many times... ECID. I know others have a hard time getting low numbers to come up, thankfully with Jack it has never been an issue. Agree with Julie, even knowing he comes up easy, I still have a variety of foods to bring him up. He occasionally has some pancreatitis and if he went low then, I want a few options since his appetite gets iffy during those flare-ups.
 
saltycat said:
As another case study, I think Jack's BG would jump just from sniffing HC food. A tbsp or 2 usually gets his numbers up and he is Acro/IAA. As has been said many times... ECID. I know others have a hard time getting low numbers to come up, thankfully with Jack it has never been an issue. Agree with Julie, even knowing he comes up easy, I still have a variety of foods to bring him up. He occasionally has some pancreatitis and if he went low then, I want a few options since his appetite gets iffy during those flare-ups.
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I see you feed Dave's cat food, never heard of it prob because it's not on the chart. Are all Dave's flavors low carb? I have been using Ziwipeak, Tiki & Instinct. The chart says they are all low carb but there are peas in the Instinct which is not a low carb veggie so am thinking of switching some food.
Here is that chart: http://catinfo.org/docs/SortableCatFoodChartCatinfo.org2-22-13.htm
 
I need to update that. I am still feeding him some daves but using it for smaller mid meal snacks. It made his tummy rumble some, I think it might have been the guar gum in it.

Not all varieties are low carb, turkey and giblets and chicken and whitefish were low carb. They list carbs on their site.

I've been feeding natures logic lately. I could not find ziwipeak locally, it is a very good food but is more expensive then some of the others. I think Ziwipeak had the best ingredient list.
 
Good luck with the changeover to Levemir. Bronx needs the change because of his very high numbers. You're getting good dosing advice.

I am ultra conservative, so a hypo with Leo is very low probability.
 
JeffJ said:
Good luck with the changeover to Levemir. Bronx needs the change because of his very high numbers. You're getting good dosing advice.

I am ultra conservative, so a hypo with Leo is very low probability.
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I see Leo is quite bouncy and you adjust accordingly at each cycle. Some big swings in dosage amounts before the SRT! Has anybody on this board brought their kitty to England for the surgery?
 
Yes, big swings indeed. And he was hard to regulate pre-SRT, and kinda hard to regulate post-SRT. Just in case you don't know, SRT = Stereotactic Radiation Therapy = radiation. Anyhow, he sure does go through some swings. Overall, he is now about 1/2 the insulin of his pre-SRT days. And his tumor was driving ever higher insulin doses pre-SRT.
 
JeffJ said:
Yes, big swings indeed. And he was hard to regulate pre-SRT, and kinda hard to regulate post-SRT. Just in case you don't know, SRT = Stereotactic Radiation Therapy = radiation. Anyhow, he sure does go through some swings. Overall, he is now about 1/2 the insulin of his pre-SRT days. And his tumor was driving ever higher insulin doses pre-SRT.
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Yes, Wendy enlightened me of SRT and saw your thread on your journey and the 5 days of treatment. I thought I also read that some place in England is the only place that does surgery to remove the gland, performed on 50 cats. Was wondering if anybody on here did that?
 
Bronx's dad said:
some place in England is the only place that does surgery to remove the gland, performed on 50 cats. Was wondering if anybody on here did that?
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It's likely Royal Veterinary College and not sure if anyone on the board has been there.

JeffJ said:
Yes, big swings indeed
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Not to be nosey but adjusting the dose at preshot is likely the reason he's all over the place. Levemir is a depot insulin and needs consistency to produce nice flat cycles.
 
I don't want to hijack the thread. Yes, I've read about the depot qualities of levemir. At low BG, we don't dose. Just above that threshold we reduce dose. And since he is recently SRT treated, we know his BG is falling, and bouncy. Plus we're trying to avoid hypos...like the very tragic one that just occurred on "Feline Health" subforum this week.
 
I don't know of anyone from here who has gone to The Royal Veterinary College for the surgery. They have had someone from Germany fly in, but I think most people have been from the UK because kitty takes a while to recover from surgery. We had one member here go to Washington State University, which has done a couple such surgeries. The cat from here had some complications from the surgery, not sure the details, she didn't post an update. I heard of one other who went to WsU, they didn't get all the tumour so she had to get SRT on top. ouch on the pocketbook!
 
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