Insulin change for suspected Acro cats

I have been thinking that the standard advice given to suspected acro cats might be modified.
Obviously, at a certain dose, we should encourage the IA/IAA test and the IGF-1 test.
Next step, if any kind of treatment is contemplated, should IMHO be a switch away from super long acting insulin that builds up a depot, onto an in-and-out inulin like PZI.
This would enable more confident rapid dose increases to mitigate damage before treatment without fear of overdose caused by depot.
It would enable more effective dose reduction without depot interference when for e.g. cabergoline treatment was started.
Same thing for after surgery.
If it is eventually decided that insulin will be the only medication then switch back to a long acting insulin, and the well established protocols that have been developed.

 

Interesting thoughts. Our experience here has shown that people get better blood sugar results when they switch from Prozinc/PZI to Lantus, or more likely Levemir when acromegaly is involved. The longer lasting insulins are just that, better duration and overall lower numbers for longer. More time under renal threshold. The beauty of the L insulins is having a Protocol to follow. The depot does not cause overdose, but incorrecting dosing or lack of testing can. And we have a fast track mechanism to get cats to better doses faster. There is also considerable experience using R insulin as a bolus with Lantus and Levemir. Using R can help by again bringing down the higher numbers, and also gives a bit of cushion against the depot if dose needs drop rapidly.

As one whose cat was first on Lantus, then on Levemir following SRT and rapid dose reductions caused by it and IAA breaking, I used just a couple modifications to protocol guidelines and that worked for me. I raised the reduction point, which gave me some safety margin. I also used one time dose reductions to drain the depot after some reductions. I also took back to back reductions at times and sometimes larger reductions than normal. The beauty of the depot is that it smooths out the numbers if you have to skip, reduce, or delay a dose.

But treatments like SRT and cabergoline do not have the scale and speed of dose changes you see with hypophysectomy. On FDMB we only have seen a few kitties with hypophysectomy surgery. It will be interesting to compare the results post surgery of cats on different insulins, once we have more examples.

 

I’ve debated this for a while too (in case of kitty with Cushing’s). I didn’t contact RVC to ask what they recommend because I had 10 new Lantus pens for Frosty. However, if I didn’t have them I would be very curious to see what type of insulin they recommend for Cushing’s or Acro cats. The biggest challenge is obviously due to tumors giving off inconsistent amount of hormones. My thoughts are also that an in and out insulin may be better for a Cushing’s kitty. I know @Rardito used a fast acting insulin on her Cushing’s cat and Mitsy is now OTJ.

 

RVC would likely suggest PZI, as that along with Caninsulin are the insulin’s they can prescribe first in the UK.

 

They can’t prescribe Lantus there? Interesting.

 

Yes they can prescribe Lantus, but only after the others have proven not to work. It used to be Caninsulin only first, so now they have a better insulin for cats as a first choice.

 

My Mitsy (Cushing's) was on Vetsulin. However, she went into remission after only a couple of months. She's an odd one... she seems back to her normal self but this also happened two years ago so I'm guessing the tumor is "waxing and waning" so to speak. She never went on Vetoryl because she went into diabetes remission.

 

I wish I had tested Yum earlier for acromegaly, when she was stuck for so long at 2.75 unit shots.