considering switching to lev

My cat Tony has been on Caninsulin since mid-summer. We have only had one mild hypo, but that was scary enough, and I knew from the months of data that his nadir is between 7 and 8 hours, so I was pretty comfortable in the time that I had to be with him. This is one thing that worries me about Levemir - the length of thime that the insulin acts after injecting. however, I also don't like the way that he goes so high and then drops. I would like this to change, and since a few months on Glargine was not successful, I am considering trying Levemir. He is on 10 u Caninsulin right now so what does would he go to for Levemir? He has never had ketones, but has had neuropathy and I certainly don't want to go back to that problem by having his glucose go high and stay there for a couple of days until I can increase the dose. I understand the start low idea.

Another complicaating factor is that some pre-dental blood work found some problems with his heart, and so he is scheduled for an echo in a couple of weeks. Should I wait to switch until after that? Does switching cause stress - I mean in the cat - if sure does in me!

Tony's vet is a little skeptical, but is interested in trying this change to see if it will help him.

Thanks for your thoughts.

Just curious but what did you mean that Lantus did not work? Do you have the ss with the numbers of Lantus shots and dosing?

Also, was the dental done because you will have high numbers if you have dental issues.
I switched my cat from Lantus to Lev at the same time as her dental and she was fine.

I'd also be curious if Tony was an acro kitty just because his DM isn't regulating, he appears to be a big cat and has heart issues.

I was so discouraged when he was on Lantus that I didn't keep the data - I know now how stupid that was, but in mid-summer I didn't expect him to live. Each time that he went to the vet I gave her the sheets. I was testing at home - he just went in for weight checks.

He hasn't had a dental yet b/c he was judged a poor risk for anaesthetic based on the blood work. Hopefully with the echo we'll know what the story is there and if a dental can be done. He doesn't have any obvious big dental issues - no apparent infection and no problems eating - just some tartar.

I would switch over to Lev; I started Shadoe on Caninsulin and it was horrible.
Lantus and Lev are very similar, but both are much better than Caninsulin.

You have seen the warnings, yes? Vetsulin, Caninsulin, same thing.
Lawsuit against Vetsulin Manufacturer
Vetsulin FDAs Warning December 15, 2009

Not having the teeth done could very likely be contributing to the high dose. I had Shadoe's teeth done and her dose dropped from 14u down to 2.75u quickly.

At any rate, has your vet discussed testing your cat for acro and IAA? I think by now it's obvious there is a bit of insulin resistance in the picture here.

I would switch to Lev right away. You can go to London Drugs or Shoppers DrugMart out your way and just pick up a package of 5 cartridges of Lev. Being in Canada you don't need to futz around with any rx from your vet.

Just-As-Appy said:

I was so discouraged when he was on Lantus that I didn't keep the data - I know now how stupid that was, but in mid-summer I didn't expect him to live. Each time that he went to the vet I gave her the sheets. I was testing at home - he just went in for weight checks.

He hasn't had a dental yet b/c he was judged a poor risk for anaesthetic based on the blood work. Hopefully with the echo we'll know what the story is there and if a dental can be done. He doesn't have any obvious big dental issues - no apparent infection and no problems eating - just some tartar.

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Hi there, Melissa asked me to take a look and I see Gayle and Debbie have already been here with good suggestions.

Don't worry, we don't think you're stupid for not keeping the lantus numbers. We know how frustrating it can be. (((hugs)))

I'll explain why I think the Lantus didn't work. Not sure what dose you were on, but it's possible you never achieved the dose you needed to be at. Insulins are not comparable when it comes to dosing, 10u of caninsulin/vetsulin will act far differently than 10u of PZI or 10u of Lantus or 10u of Levemir. Also, you might have started to dose too high, without knowing what dose you started at, I just couldn't make that call. It's ok though, because Levemir is a stellar insulin for a high dose cat, and I believe you will really like it.

Your cat is at a high enough dose to warrant questioning the presence of a high dose condition such as acromegaly or IAA. If it is acromegaly, it would explain the heart condition, which is basically a given in acrocats. Acromegaly is a disease of gigantism which often results in oversized organs. Has your vet commented on this?

If you have the insulin on hand, I'd start now. I see you're getting some spot checks, but would like to warn you to test a little more frequently when starting any new insulin. Understanding that we have real lives and jobs and etc, I'd say start it on a weekend if you're out of the house during the week (friday night would be excellent) so that you'll be available to watch. I'd probably not start higher than 5u. From there, if you see him go high and flat immediately, you can increase at 1/2u increments on the 7th dose for the first couple increases, and the 5th dose thereafter if he seriously falls behind. He IS a high dose cat so he won't apply 100% to Tilly, provided that he shows no response to the 5u start point. As a high dose cat, you can't let the high numbers scare you. These cats for some reason can withstand a day or two of high numbers far better than "regular" diabetics, and if acro, they can withstand FAR longer. Let go of that fear The best thing you can do aside from testing bg's, is to also test urine for ketones during any switch to any insulin at any dose. It's more important to be informed. Be watching the 5 p's.. peeing pooping playing purring and preening.. be watching the appetite. Make certain to report anything that changes during the changeover, good or bad.

One question.. I see the metronidazole (flagyl) in your ss... what was that for?

I have seen the warnings - in fact his vet discussed them with me when we switched. The hope was that the short acting component would help - and it has to a large extent. His neuropathy is resolved, his weight is back to nearly normal, water intake near normal, and he is active and bright. What I don't like is the black or red to blue swings in his numbers, and neither does his vet (who is onside with switching whenever I'm ready).

My questions would be:

How did you arrive at 10u of caninsulin? What was the starting dose?

What food does he eat?

What were the blood test indicators of heart disease? I don't know if any indicators in the standard blood panel tests done at vets. There might be cholesterol levels, higher would suggest an increased risk of heart disease, but are not an indicator of HD itself. And there might be indicators of inflammation but no blood test can tell you where the inflammation is.

Did the vet hear a heart murmur?

On what dose did Tony hypo on? How low did he go? Did he have symptoms or did you catch it in a BG test?

Are you using u40 syringes or u100 syringes to administer the caninsulin? If you are using u100, are you giving 10u as indicated on the syringe or 10 actual units of u40 insulin? That would be drawing to the 25 unit line on a u100 syringe. Conversely, drawing to the 10u line on a u100 syringe would give you 4 units of u40 insulin (caninsulin). I just want to be real sure of what actual dose you are giving.

My cat, Beau, was on vetsulin (US name for Caninsulin) and was diagnosed with hypertrophic cardiomyopathy at the age of three. His diabetes Dx was at the age of 8. I switched him to levemir after 2+ years on vetsulin. I have seen no indication that either insulin effected his heart disease or vice versa. I did see much more even and lower BG numbers on levemir right from the start even though he was rebounding pretty much from the start. When I started lowering the dose his numbers got better and better. He has been off insulin for 16 months now.

Beau was on up to 7u (true) of vetsulin before I started home testing and changed his diet to all low carb canned (he was getting a lot of dry food). His dose came down to 3u right away, then lowed to about 1u over about a month. His vetsulin dose varied from 1.2u down to .2u, but I n ever could seem to get him at a stable place with good numbers. The levemir was just so much better for him. I started him at .5u, which was half his then current vetsulin dose, and it was too much, but it took me a while to figure that out ohmygod_smile.

I am an advocate of starting low and moving up steadily so I would still suggest starting at 1u. You can move up more quickly after the first settle period if his numbers are not good.

At a Glance Tony is a neutered male. He is DSH brown tabby
Date of birth (or an estimate): 1998
Date of diabetes dx: Early Spring 2010
Status: Unsure. We are working on it and remain optimistic!
Insulin:

* Type: Started Glargine, by mid-May up to 6u, changed to IM to try for better absorption at 3 u. Still PU/PD, neuropathy. Increase slowly to 13 u. Switch to Caninsulin in early July. up to 14 u by early October, and slowly dropped back to 6, now rising again.
* Concentration: U40
* Units per shot: check spreadsheet for latest dose
* Shots per day: 2

Oral diabetes medications: None
We hometest BG: Yes
Meter: OneTouchUltra2
We regularly do BG curves: Yes - 7 to 10 days
Hx of complications: PU PD Neuropathy
Current health issues: IBD, pancreatitis
Current medications: B12, PepcidAC 2.5, metronidazole, Leukeran
Past health issues: None
Corticosteroid use: None
Food Brand Name: m/d
Formula:
Consistancy: Wet or Canned
Amount fed per meal: 1 can am and pm
Number of meals/day: 2
How is food given in relation to the insulin shots? Test, feed, shoot
We use Janet and Binky(GA)'s foodcharts: Yes

This cat is a very confirmed high dose cat on canned food. IMO, I think 1u would likely be detrimental to the health of this kitty.

Just-As-Appy said:

I have seen the warnings - in fact his vet discussed them with me when we switched. The hope was that the short acting component would help - and it has to a large extent. His neuropathy is resolved, his weight is back to nearly normal, water intake near normal, and he is active and bright. What I don't like is the black or red to blue swings in his numbers, and neither does his vet (who is onside with switching whenever I'm ready).

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Can you tell me if he

1. snores or breathes loudly
2. has a potbelly
3. eats you out of house and home, even inappropriate food like chocolate cake or broccoli
4. has gained a lot of weight as your dose has increased
5. appears to have headaches (hides from the sun or bright light, squints)
6. has any time of largeness in comparison to other cats, predominately feet and ears, but also allover largeness
7. has overly sensitive hind legs and/or feet
8. joint issues
9. vision issues, such as ONLY peripheral vision
10. body or facial tremors, ticks or twitches
11. excess moisture at the nose or mouth, sort of dripping or drooling
12. heat sensitivity, panting or hyperventilating
13. lower jaw changes, head shape changes, jutting chin
14. broad nose

None of these are conclusive, and 1 or 2 of them probably mean nothing, but several of them together might help you one way or the other.

Thanks for your comments - it is all so helpful. I'm digging back in my file to find as much history as I can.

The acro questions. He has none of the things that you mentioned. In addition, he has had 3 adbominal ultrasounds and no mention of large size. He does have small intestine wall thickening, evidence of chronic pancreatitis, and normal lymph nodes.

He was on a basket of antibiotics initially in the hope that he had an acute pancreatitis. Unfortunately, this wasn't the case. However, the ibd began to show and I had a bit of a time finding food that works for him. It seems that the m/d and metro has been a good combination - no vomiting and no diarrhea. His weight in the summer of 09 was 5.6 kg and in April 10 he had dropped to 4.8. He is now back up to nearly 5.6.

He recently completed 6 months on metro and so is off it now - fingers crossed that things remain fairly stable. He started on Leukeran 3 times a week and is tolerating it well. He had a little appetite drop, but fortiflora helped us through that.

He has no murmur. The heart test is called proBNP by IDEXX laboratories. I think its fairly recently introduced. The lab report says that for results greater than 270 pmol/L "clinically significant cardiomyopathy is highly likely". His result is 570.

We started Lantus at 1 u and went up to 13. Maybe we didn't go high enough. The first notes I have about Caninsulin looks like the dose was 3u.

I have the correct syringes, so the dose is 'real'.

The hypo - He was on 12 u. I noticed at noon that he wasn't outside as is his habit and found him in his bed looking dazed. I picked him up and he seemed a little stunned - and was startling at every sharp noise. He was 4.1 which isn't that low, but I guess a big shock for his body. I started back at 5 u the next day.

I hope that I've covered the questions. I'm really wondering what dose to start Levemir at - I think its a u100 so I'll have to get new syringes, right?

Thanks. Yes, I think you answered all my questions. Part of me was hoping he was only getting 4u of caninsulin :roll:

Yes you need to get u100 syringes for lev.

I know you have gotten very different suggestions on a starting dose. Where I am coming from is that starting at doses over 1u can overshoot best doses for cats at a normal dose range. I have no experience treating acro/cushing or IAA. Starting at 5u of lev scares me in a cat that does not have a diagnosis of one of those conditions. What if he drops very low? With 5u onboard that would be a real emergency. Can you get the IAA test before switching?

If you start at a higher dose I would recommend posting on the high dose ISG where people have experience with that. Ask them what to expect. Carolyn posts on the high dose ISG.

I do want to mention that I have had experience with an immediate response to lev (1st shot, no shed yet) and very low numbers on the 3rd shot - at half the dose of the previous insulin. I know of others who have also had that happen. Lev works differently. Maybe that is why I am so cautious.

I guess just plan to be there, like on the weekend, so you can monitor him and be prepared for anything.

You hit exactly the point that I'm most worried about - the longer acting component and hypo combination. Sometimes the 'devil you know looks better than the devil you don't know'. I really hope that it will be better for my cat.

It will be better on Lev.

Hi, I'm Melissa- I'm the one that asked the Acro beans to look in on you since you had sucha a high dose and also concerns about starting Lev.

You've answered No to all of Carolyns questions on classic Acro kitty signs, right? And you have concerns about doseing Tony with long duration insulin and having a long duration hypo, right? ( who wouldn't! ;-) ) And you have been the spectrum with other insulins and would prefer to get Tony out of the high numbers, right? (again, who wouldn't?)

With all of those factors and the heart issue, too, I woulod just sincerely suggest a starting dose of 1u. As per Tilly Protocol, you'll hold that dose for a minumum of 6 cycles ( 3 days) and then can change the dose accordingly...Some go with .5u at a time, several here that microdose prefer to change by .25u or less.

You'll be testing for ketones the whole time, right?

I just hate to see you miss a great dose by skipping the starting point all together...lev is a great insulin, but one of the caveats is that sometimes the higher the numbers are, the less insulin actually works...we have seen that over and over and over here...

What we have also seen is people start too high, change doses, meds, food- everything but start over...and when they finally do start over, they have to go through all the dose changes again...why not just start at the start and take the easier method?

Ultimately it is your choice and we will support what you choose ( unless it is outright dangerous, which I doubt you would do).

(((hugs))) Hang in there- we know you are concerned, we are, too...

Answering No to my questions does not rule out ANY high dose conditions. I highly disagree with this 1u advice.

Edited: less rude?

Carolyn,

yes, less rude,thank you for the edit.

Hellooo
I'm just one more hi dose mom peaking in. My name is Patti - I've been around here for a number of years now. I have to admit starting back at 1 unit is quite frightening considering your history. Sounds like you done the whole start lo go slow on both insulins you've tried and both insulins you have wound up on fairly significant dosages.

What i will address here too is the BNP - I'm also a pediatric ICU nurse - work with a lot of open heart cardiac kids. BNP stands for beta natriuretic factor - measures the degree of congestive heart failure. J(CHF) It's nice to see them starting to use it in cats. 570 is significantly elevated. Are they starting any heart meds on your kitty. CHF can be due to a number of things. BUT it is extremely common in cats that have acromegaly. In fact literature shows that they are suspecting that there is even a particular form of heart failure/disease in human/cat acromegalics.

What is worrying us here is:
you have a 12 year old male cat - TYPical age and gender of acro
fairly hi doses of insulin on 2 different types of insulin and you increased slowly
and your cat has CHF

We are not the end all be all here. But acromegaly is being diagnosed more often. Some reports have shown that 30% of all diabetic cats have acro. Unfortunately it is something that is still argued against a lot! If this were me - I would seriously look into having your cat be tested for acro/IAA. Here is a link to why we are talking more about this:
viewtopic.php?f=12&t=375
and if you would like more help please please come visit us in the hi dose section:
viewforum.php?f=12
We don't deal with just one insulin in this group but basically all the insulins as we try to find the one that works best for each acro cat.
Wishing you the very best always

Patti, that was a much kinder and more informational way of posting that this cat could still be Acro, regardless of the answers to the questions.

I appreciate the additional information and concern and the time you took to post here.

Since I have called out Carolyn for being rude in her repsonse, it occurs to me that I, myself, could have worded my own prior post differently, so to further ensure the safety of this cat and further a learning experience here.

My post could have read, "I wonder if answering no to all of these questions and your Vet not thinking of Acro could mean that your cat is not Acro? I wonder if you should reconsider and go for the lower starting dose instead of the higher one you've chosen...maybe you should ask the Acro mom's to look here again"...or something like that.

In any case, I'll not further hijack this thread with my own self-serving banter and whatever path this cat and bean take, I hope it does include Acro testing and I hope things work out well for all.

Tony's vet did say that acro was a good possibility when he first didn't respond to the Glargine, but after the u/s when his pancreas showed up in poor condition, we agreed that the $300 for the test could probably be better used. On the first u/s his liver was slightly enlarged and he started on ursodiol. From the last one there was no mention of enlargement.

WRT the heart test, he will have an echo (better use for the $300?) and then decide about meds. He has no clinical symptoms. B4 I brought him to my own barn, he was at a commercial barn and had at least 3 really bad abcesses. I treated them when I found him, but he didn't always come around when I was at the barn. I don't know if these sorts of untreated infections might also cause myopathies.

I didn't think the acro test was that expensive. Maybe others can speak to that. Might be the shipping from the West Coast of Canada. I think there is only one place in the US that does the test (not positive on that).

As for infections causing cardiomyopathy - yes, it can happen. That is probably what happened with Beau. He suddenly stopped eating, wouldn't jump up on things, tried to get on the bed and fell... my regular vet thought heart disease from that description and could hear a murmur so she did an xray where his heart looked enlarged. I took him to a specialist for an U/S of his abdomen and chest. Both areas were full of fluid indicating inflammation (or wet FIP, which, thankfully, it wasn't). That vet aspirated nearly 600 cc's of fluid from his chest and abdomen (almost 2.5 cups!). It turned out he had an acute pancreatitis flareup going (which at the moment was more life threatening than the heart issues). She said that had probably been "simmering" for a while and caused the fluid build-up and put stress on his heart. But inflammation itself causes heart disease:

Inflammation also plays a role in heart disease because the immune system attacks LDL "bad" cholesterol that has been embedded in arterial walls. Ongoing inflammation eventually damages the arteries, which can cause them to burst. In fact, inflammation is so closely associated with heart disease that many doctors now use use a test for inflammation called CRP (C-reactive protein) to assess a person's risk of heart attack. Research shows that CRP can predict the risk of heart attack and stroke as well or better than cholesterol levels.

(from: http://www.achooallergy.com/chronic-inflammation-disease.asp

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He was a feral I caught so was never cuddly or even really touchable, so I hadn't noticed him acting like he was in pain. I had tried to pick him up about 6 weeks before all this happened and he freaked and ripped my hand/palm with his back paws. Looking back, I bet he was in pain and when I picked him up by the belly it hurt like h*ll!

As for the pancreatitis, the vet thought that might have been caused by bacteria from things he was eating in the wild (the woods where I got him) or parasites. He has at leat two kinds of worms when I caught him.

He has been on diltiazem since he was 3 and was given a 2-5 year life expectancy. He is 12-1/2 now, so you just never know. In the first few years he would pant if he played hard (from the heart issues), but he hasn't done that in years.

.

Girlcat, as you know, I don't think starting at one unit is "extremely dangerous and unwise" - not when there is not a diagnosis of acro and no characteristics of it. From my experience I have great reservation about starting at 5u, but I would not use the words you did because they are judgmental and imply that the posters that have suggested it are stupid. And it doesn't help the OP, it only makes then anxious in an already stressful situation.

I respect the experience of those who have acro/cushings/IAA kitties, which is why I have either referred folks to the high dose ISG or PM'd people from there to check in on someone's post (both of which I have done in the past week). I understand that starting at 1u is not the optimum dose for an acro, et al, but there is a lot that is unknown about this particular cat because it has not been tested yet.

It would be better if you could speak from your experience and explain why starting at 1u won't work and why it would be "dangerous". Why is it more dangerous than starting a new insulin his body has never encountered at 5u when a hypo from that dose would be devastating? I actually want to know the specifics so I can learn something. From what I understand, if he is acro, it would not be enough and his BG would go high, so why isn't testing for ketones and planning to raise the dose after 6 cycles, then every 3 days enough? Isn't that how the high doses were arrived at for most cats on the HD ISG?

.

Question...I think echoing Sheila's...

I've watched this discussion and others, mostly from afar and hardly ever commenting because I've ZERO hands on experience with such issues. But since the question is out there and since I'd like to understand in case I do give advice...

I'd like to know more about the recommendations here...5 units vs 1 unit. When the OP first started posting about the high caninsulin dose and how lantus didn't work, 'we' on health were concerned that the optimal dose had been missed due to starting too high.

Then by the information in this current thread, it would appear that the cat in question doesn't exhibit obvious signs of being an acro cat.

So what is the correct path? Cutting the dose in half like the 'standard' rebound test? Or starting over at 1? Is the assumption that by starting at 5 you reduce the risks of developing ketones, and that the OP and all others reviewing test data will be able to determine if the cat is being overdosed or not? Is starting over at 1 unit in general no longer considered acceptable or safe?

Honestly, considering I have zero invested in this discussion except my own knowledge and ability to give sound advice, I'd like to know (BIG apologies to the OP for this, but...)

I'm perfectly ok with this discussion. These are all questions that I have struggled with myself, and I'm learning from every post. Thank you all for your help. I'm going to start a new post with Tony's Levemir experience.

Girlcat said:

Sheila & Beau & Jeddie said:

Girlcat, as you know, I don't think starting at one unit is "extremely dangerous and unwise" - not when there is not a diagnosis of acro and no characteristics of it. From my experience I have great reservation about starting at 5u, but I would not use the words you did because they are judgmental and imply that the posters that have suggested it are stupid. And it doesn't help the OP, it only makes them anxious in an already stressful situation.

I respect the experience of those who have acro/cushings/IAA kitties, which is why I have either referred folks to the high dose ISG or PM'd people from there to check in on someone's post (both of which I have done in the past week). I understand that starting at 1u is not the optimum dose for an acro, et al, but there is a lot that is unknown about this particular cat because it has not been tested yet.

It would be better if you could speak from your experience and explain why starting at 1u won't work and why it would be "dangerous". Why is it more dangerous than starting a new insulin his body has never encountered at 5u when a hypo from that dose would be devastating? I actually want to know the specifics so I can learn something. From what I understand, if he is acro, it would not be enough and his BG would go high, so why isn't testing for ketones and planning to raise the dose after 6 cycles, then every 3 days enough? Isn't that how the high doses were arrived at for most cats on the HD ISG?

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sheila you are absolutely correct. as the mom of an Acro as a well as a insulin resistant cat who i kept in perfect health for 2 and 1/2 years you are absolutely spot on. i have no experience with high dose.even though im my experience with both DKA and the above mentioned acro/resistance problems? and having had to shoot up to 50+ units levemir BID as well as R i conclude my posting here was a mistake.

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You have completely misunderstood my post, apparently. I did not at all question your experience. In fact I said that I respected the experience of those treating acro/cushing/ IAA cats. Really. It's right there in paragraph two. I asked you to speak from your experience and give a teaching explanation so those of us that don't have that experience can learn from it rather than just say what we suggested in "dangerous and unwise".....

I'm sorry it's taken me so long to get back here. I work long hours and the days I work I can't get here.

YOu mentioned that an ultrasound showed an enlarged liver and your kitty is on ursodial. Was your cats liver function tests elevated? Or was your cat started on this med just because of what showed on an ultrasound? I'm just asking because again an enlarged organ refers to acro. Please I am not pushing this disease. I am trying to sort thru everything here. AND having 2 cats right now with liver disease and being on this med - I just wonder if your cat had lab values to show some sort of liver disease going on. And if you are on this - are you by chance giving any denosyl to further support your kitty's liver? Was your cat ever started on any antibiotics for liver failure (amoxicillin, metronidazole) - I also belong to the liver failure feline board.

As far as your kitty's heart goes - an echo would certainly be worthwhile - but most cats with cardiomyopathy often wind up on similar meds - (lasix, benazepril, and aspirin or plavix). I don't know that you will find out if an infection truly caused his heart failure. Coxsackie B virus is the most common cause of myocarditis in humans - nothing is really quoted in cats except viruses/infections - but alot of cardiomyopathy in cats is due to hypertension/hyperthyroidism and interestingly enough - as I mentioned they are finding that acro's have a particular form of cardiomyopathy.

Sadly, the IGF-1 in Canada costs much more - and this definitely has to be considered. But as always in cases like yours where answers aren't quite clear - I find it interesting that so many other tests/lab work will be paid for and or done - switching of insulins will be again taken place - and yes even heavy discussions of where to start on what dose of what insulin is debated. If this were me - I would stay on the insulin you are on - you know your cat has cardiomyopathy - start on some basic meds, and spend your money on the igf-1. I know my reasons that i listed were quite basic but what haunts me is what I listed above:

you have a 12 year old male cat - TYPical age and gender of acro
fairly hi doses of insulin on 2 different types of insulin and you increased slowly
and your cat has CHF and what I now know - and enlarged liver

As always I hope I am wrong - this is never my agenda to be right. Nor do I ever want seeing someone else get this diagnosis.

And again I always wish you and your cat well - I will check back again later as I'm off the next few days. Please if I can help you sooner - please pm me!

Ok - let's just say that he is acro. Now please explain to me exactly how I manage him differently. This is my primary criterion for any test and especially an expensive one - what information will it give me that will change how I manage him.

Until an actual acro mom comes back, here's what I've learned to date...

1. if he's acro then the doses might be really high and reducing to 1 unit would be dangerous
2. if he's acro then you can't count on him being at a consistent dose...the dose requirements might really fluctuate through time

But I'm pretty certain there is more to it than that, so I'd head over to the high dose ISG and do a little reading to help you with your decision as to whether to do the tests or not

Jen

Just-As-Appy said:

Ok - let's just say that he is acro. Now please explain to me exactly how I manage him differently. This is my primary criterion for any test and especially an expensive one - what information will it give me that will change how I manage him.

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Acromegaly is a condition typically caused by a tumor on the pituitary gland. This tumor causes an excess of Insulin Like Growth Hormone. This hormone latches on to the receptors that are normally taken up by insulin. Cats with acromegaly are not actually diabetic in the classic sense Their pancreas may be working just fine. It is just that their system is being flooded by the hormone, overwhelming the insulin. Depending on how much of this hormone is being put into the kitty's body, how much insulin you give will vary.

One of the biggest differences in treatment is to realize that if the amount of the insulin-like growth hormone goes down, the cat can go into a hypoglycemic incident that can last a long time. If you use a long-lasting insulin like Levemir, the cat can literally hypo for hours and hours. You never want to let the cat go into low numbers....and what is low is different. For a regular diabetic, the "no shoot" number might be 60 or 70. For me, my "no shoot" number is 150 and at 180, I might cut the dose.

The flip side is that the cat's BG levels can be high and stay high if they don't get enough insulin. This can result in DKA so you want to check for ketones regularly.

Besides the Diabetes caused by this tumor, the pituitary puts out the growth hormone which causes the cat to grow. This can result in longer limbs, bigger skulls and jaws and more critically, thicker lining on the various internal organs. The heart walls can become thicker or larger, reducing its ability to work correctly. The trachea gets thicker resulting in the cat snoring and makes anesthesia tricker. Since the body parts typically don't grow all at the same rate, you may see a situation where there isn't enough room inside the body cavity for all the organs. In my cat, right now her hind end is taller than her front by probably an inch and a half. Her skull grew causing entropian eyes which she had to have surgery to correct. She has a pot-belly because her organs are growing. Her coordination isn't as good as it was so I need to watch to ensure she isn't trying something outside her ability to actually do (say jump down from the counters).

This isn't all of it but I'm sure someone else will chime in with whatever I've missed. Hope it helps!

Debbie, thanks for this!

Thank you for the very thorough answer, Debbie!

Just-As-Appy...How is Tony doing today?

I guess my first answer to you about the test results would be:

there would be a "peace of mind" - you truly know what is wrong with your cat and there would be no second guessing what to do with your insulin dosing so to speak - whether to check for rebound or start over at 1 unit or whether there is an infection or all the other questions when there is an unknown reason for hi doses.

From there tho - you do have to work carefully with a group of people who understand how to work with hi doses as like Debbie said - the igf1 can fluctuate day to day sometimes - and with the longer acting insulins - you do need to really learn your cat and how these insulins work in your cat. With acro - you have a functioning pancreas - not like regular diabetics.

Also long term wise there are other health issues your cat will face due to the acro - again - heart issue and pain control of arthritic spine problems are 2 that often need addressing.

There are also some treatments available now for acrocats - SRT - Octreotide - offered thru Colorado state university.

After some offline discussions about overdosing and rebound and high dose cats, I really do realize that I don't understand the mechanics of being able to tell whether a cat is overdosed vs a highdoser so I'm going to stand back and watch the discussions and try to learn more

I know Patti and others have been trying to educate the general population of the FDMB about high dose cats, with some success but lots of frustration. Not sure how to improve the situation but I hope that we all try to keep an open mind about things we don't necessarily understand, and really try to watch what advice we give in such situations....