Newly Diagnosed Diabetes & Probable Acromegaly

Hello. Four weeks ago my 10.5 year old male Maine Coon (Maestro) was diagnosed with diabetes, and a heart murmur. My head has been spinning and my heart breaking as I watch my once healthy boy refuse food, have difficulty walking, and lose weight. We started at 2.0 units of Lantus every 12 hours and I have been home-monitoring his BG with an AlphaTrak 2, calibrated for cats. Switched him to a prescription canned food and have also offered raw fish, which he used to gobble up. He is now on 4.0 units of Lantus every 12 hours and consistently has readings in the red and black range. The doctor suspects acromegaly, (a tumor in his pituitary gland, which produces excess amounts of growth hormone, causing insulin resistance among other health problems). He will be going in for more blood tests and a possible ultra sound on Monday to determine the underlying cause. From what I have read, blood glucose levels in cats with acromegaly are extremely hard to regulate and patients are often on very high doses of insulin. It is so hard to know what to do. The only treatment options seem to be radiation or surgery to remove the pituitary gland. Unfortunately those are both very expensive options.
If you have experience treating a cat with acromegaly I would be grateful to learn about your experience. Thank you.

 

Hello, I'm sorry to hear that Maestro may have acro. My Tom was also an acrocat and the condition is actually more common than people think. I know it's a shock but don't give up - even though bg is hard to regulate, yes, you may be able to keep Maestro in reasonable numbers by careful home monitoring and appropriate dosing. It does require a lot of commitment but that's what we do when we love our kitties!

There's a high dose / acro forum on this board that will probably be the best place for you to hang out - read some of the other threads and create your own to introduce yourself. I think you'll feel better when you know that you're not facing this alone.

Would just query though why the vet suspects insulin resistance / acro so soon after FD dx. Usually you would start with a low dose of insulin and increase with small increments over a period of a good few weeks or more until insulin resistance / acro was suspected. See what they say on the acro forum.

Wishing you the best of luck.

 

Welcome! I’m glad you’re home testing and already have a spreadsheet! We usually suggest testing for both acro and IAA when kitty gets over 5-6u, but of course you can test now and get a jump on it if it turns out positive. If Maestro is positive for acro, there is a new treatment option, cabergoline, that is being used by a few of our members. I’ll tag @Olive & Paula as she just started it and can tell you more. As Diana said, it may be good to post in the acro forum as well.

ETA here’s the link http://www.felinediabetes.com/FDMB/forums/acromegaly-iaa-cushings-cats.12/

 

There's an acro board on this Forum, I would post there.

 

Thank you kindly!

 

Thank you so much!! Good to know of new treatment option.

 

Hello and welcome.

There are a couple of questions I have.

When was Maestro diagnosed? How often was the dose raised and how much each time?

Lantus should be started at 0.5 units or 1 unit every 12 hrs and held at that dose for at least a week. Then if indicated increases are done in 0.25 units increments. So as not to bypass the optimal dose.

Since diabetes doesn't happen overnight, it will take time to see steady glucose results. Kitties have high glucose for awhile so it takes awhile to get it under control.

In regards to high dose conditions. The IGF 1(acro) test and IAA (for insulin resistance) are sent to MSU. The IAA, kitty should be on insulin for 73 or 76 days or you can get a false reading (@Wendy&Neko) can tell you, she is the guru on acro.

Olive started medical treatment for acro. We are on day 14 of cabergoline. There are very few studies on acro and a lot of vets are unaware of the treatment using cabergoline. When or if they ask a specialist they are told it doesn't work. Therefore they won't try. But then there are no guarantees any treatment for any illness will work.

It took me months and change of vets to find a Dr willing to try it. Side effects are minimal. We have everything to gain and nothing to lose. My goal is to hopefully slow down or stall the tumor activity so Olive is more comfortable.

I have say in the short time she's on it, she is more alert, not as lethargic. Her glucose is leveling out although preshot can still be high.

There are options for treating should Maestro have it.

 

Maestro was diagnosed on 9/26/18 and started on 2.0 unit Lantus every 12 hours 9/28/18. His dose was increased to 3.0 every 12 hours on 10/11 and to 4.0 units every 12 hours on 10/17/18. His bg level has only been below 300 two times and all other readings have been in the high 400's - 600's. His symptoms have been troubling; not eating much, hind leg weakness, very little physical activity other than to the water bowl and litter box. I am taking him to the vet on Monday for another set of labs and to test for acro.

 

Hello and welcome. One in four diabetic kitties has acromegaly, so there are a few of us out there. Some are actually quite well regulated. My Neko also had IAA (insulin auto antibodies) which made regulation a bit trickier. as Sharon suggests, get the test done for IAA too. The blood for that test goes to the same place as the IGF-1 test, so it's a small cost add on. Even less vet's have heard of it, but it does make a difference in dosing strategies.

There has been a study at Royal Veterinary College that showed that one in three acros test false negative if tested too early after starting insulin. The time frame is somewhere like Paula said, can't remember exactly and am out of town for a few days.

As far as dose size, it's all over the place with acrocats, just increase until you find a good dose. The paper showing acros are one in four found some acros on doses as small as one unit, we've also seen some up to 100 here. We can help you with dosing on the Lantus forum, general knowledge about acromegaly is on the high dose forum.

I am glad you are testing, as that is key. I might suggest getting a few more tests at night, maybe before bed. Many cats go lower at night and we dose Lantus based on how low that particular dose takes the cat.

 

Hello and welcome. You will get very good advice here. We went for the surgery, but you are right to say it was expensive, and it was even more so than we expected. But in New York there are hefty subsidies available, and two members here have recently benefited from that. Read their stories.
The "official" advice that Cabergoline doesn't work should be taken with a pinch of salt. The study that concluded that, was very small and short term, and for some cats it obviously can work.
Do insist on both the insulin antibody(IAA) and the acromegaly tests( IGF-1) . All knowledge is useful.
You have made a great start by finding this forum (we reckon it saved Titan's life) and by setting up your spreadsheet . Good luck!

 

Thank you for the information and encouragement. Maestro has not had a bg reading below 460 since we increased his Lantus to 4 units every 12 hours three days ago. He is also experiencing hind leg weakness. I'm so frustrated that we can seem to get his bg level out of the red or black range. His AMPS just measured 721.

 

Understand your frustration. Take a look at our spreadsheet and you can see between mid July and mid August we were suffering the same difficulty. I would think an increase is in order BUT I am very inexperienced compared to Wendy and JeffJ. So don't pay any attention to my opinions. ALSO you are using a longer-lasting insulin than we were, so increases must be more cautious because of the depot or backlog effect that can build up.
Titan also got to be weak and wobbly, which we put down partly to starvation, as he wasn't absorbing any food, and partly down to nerve damage caused by the high blood glucose levels. Both can be survived and reversed when you get it under control .

 

For hind leg weakness, start adding Zobaline to Maestros food. https://www.amazon.com/ZobalineTM-D...57&sr=8-1&keywords=zobaline for diabetic cats It can help, along with getting those bg numbers down. Also please start posting in the Lantus forum so @Wendy&Neko and the others can help you with dosing.

 

Thank you. Good to know that nerve damage can be reversed.

 

Great info; thanks! I am ordering Zobaline and will start posting in the Lantus forum. <3

 

Are you checking for ketones? Consider starting that daily with these high numbers. You can get ketone dipsticks in any pharmacy, you dip in urine or hold it under them when the go. There is also meters you can use just like glucose meter but strips are super expensive. This test will earn you about DKA super expensive to treat (hospitalization) and can turn fatal very quickly.

Let's do a basic check here

Any dry food or any kind in house?
Any rx food being used?
Does he go outside where he can food from neighbors
Any ear, eye meds given in pill, liquid, gel form that have steroids in them?
Been checked for urine infection?
Had dental to check for bad tooth?
Have you checked food your giving against food chart, make sure it's under 10% carbs. Your probably better off using food under 4% right now.I
Is insulin good? Clear no floaties or cloudy? Kept in fridge?
Are the syringes the right ones?
Can you post a picture of how much your pulling up?

Just brainstorming here. Sometimes it's something simple people didn't think about.

 

No dry food in house
Feeding Hills Glucose/Weight Management m/d prescription diet per Rx from vet
Does not go outside
No eye or ear meds
urine infection test results were negative (no infection)
Vet looked at teeth
I can't find the carb % info on the food can but I'm confident it is low in carbs
Insulin is clear, no floaties, kept in fridge
Syringes are for use with U-100 insulin for 30 units or less (as prescribed by vet)
I will post a picture showing how much I pull up.

 

Is the Hills MD wet or dry? The wet is 13% carbs, so higher than the recommended 10 or lower. I’m not sure of the carbs in the dry, but I’m sure it’s even higher since it contains corn, rice and wheat. You may want to start there, by lowering the carbs Maestros bg may drop some. We recommend wet food only. Cheaper options are Fancy Feast Classics and Friskies Pates

 

https://drive.google.com/file/d/0B_iQdthPakUfTDBWMGp5Q3ptU1doMV9jZUxaWWRFYWxVa3Fz/view?usp=sharing
https://drive.google.com/open?id=0B_iQdthPakUfWG0xMmdBeTlrZDlEX3JjbEZpNE02WC13RXlF

 

It is wet. He does not get any dry food. I used to feed him Fancy Feast Classic Pate before the vet told me to change him to Hills rx. Interesting. How do you find carb %?

 

The easiest way is to use this chart
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
To calculate on your own you need the as fed values (not guaranteed analysis) for protein, fat, fiber, ash and moisture. Then calculate for % calories from carbs as explained in This thread
http://www.felinediabetes.com/FDMB/threads/calculating-calories-from-carbohydrates.204052/

 

Wow... just looked at the chart you provided. I'll never complain about the cost of Fancy Feast Classic canned food again, compared to Hills m/d !!!

 

There are a few food charts. Dr. Lisa updated hers last year. The newer foods aren't on it as they were not out at the time.

You can find them here. Here

 

VICTORY!!!!! Maestro's BG just tested at 160!!!
What we did since yesterday:
1) Switched from Hills rx m/d canned food (13% carbs) to Fancy Feast Classic Ocean Whitefish (0% carbs)
2) Played 50 minutes of Rife Sound Frequency on YouTube "Killing Diabetes With Rife Frequencies".
3) Prayers!!!

 

In this picture it looks like 4.5 units because plunger is not on the line. If that's where you measure, stick with it and mark ss accordingly.

The m/d food is over 10% in carbs. Maybe you can try and switch it out for a better choice. I personally use Ff chicken, FF beef (only thing one cat will eat) and ProPlan chicken with Spinach is 2%. Nulo brand is also low in carbs but my cats won't eat it. There are 2 fancy feast medleys primavera that are low even though it's in sauce. I give occasionally.

Don't forget the ketone checks. Very important until those numbers come down.

I forgot to send this, now I see your new post. That's great. Keep in mind he can bounce from this for a few cycles since he isn't use to it.

 

I switched him back to FF Classic salmon (1%) yesterday. That’s what he was on in the past along with Royal Canin Maine Coon dry. I have eliminated the dry food from his diet. Will start testing urine for ketones. Thanks!

 

Really nice. Keep monitoring closely because change in carbs can drop him fast until they are out of his system.

 

Well, we're back up to 461 at 8 hrs after injection. Is it really possible to have that large of a swing? @Wendy&Neko

 

I'm not Wendy but yes it is. That is a number that he is use too whereas the 160 is totally foreign. The liver panics and sends out stored glycogen causing the "bounce". Now being new on insulin this bounce can last 3 days (6 cycles) from the 160. So don't get upset if he's high for awhile. Over time as the body learns it's safe, they happen at lower numbers and don't last as long.

 

Sorry for the delayed reply - been out of town. And not back home where internet is out. Yes entirely possible to swing that high that fast. We've had kitties go from black (over 500) down to green mid cycle, then back to black at the next preshot. That's why we are such strong advocates of mid cycle testing.

 

Thank you for your response. This is such a roller coaster. Within 8 hours he goes from totally despondent, refusing food, wetting himself, extreme hind leg weakness, hiding under the bed to alert, hungry, using litter box, climbing and descending stairs without much trouble, jumping up on furniture.

 

I’m so grateful for this website and forums. I live in a rural area where the veterinary clinics do not have first hand experience treating a diabetic cat or Acro. Thanks to all the great advice and resources I have received here, I am better equipped to be an advocate for my fur baby and a care partner with his DVM. THANK YOU!!!!