Acromegaly/IAA Newish-member

Dear All,

I joined FDMB about 1 1/2 years ago when my cat, Eddie, was diagnosed with acromegaly. I was somewhat overwhelmed because my other cat, Blue, his brother also had acromegaly.

Blue had hypophysectomy at WSU in Feb. 2018. He later that year had fractionated radiotherapy for a small regrowth and then, more recently, (Nov 2020) had SRT at VCA Calgary, Alberta for another small regrowth. He recovered really well from everything and has now been in remission for nearly 8 weeks. It is not about him that I'm writing although I mention him because caring for two acrocats with accompanying DM has been really quite challenging.

I first wrote about Eddie when we were about to go to WSU for his hypophysectomy, which he had in December of 2021. it was supposed to be relatively straightforward but there were complications. Twice he had dehiscence of the palate incision and twice had debridement. The last time they determined dehiscence was caused by him eating so they inserted an esophageal feeding tube. Eddie was in the clinic from Dec 4th - Dec. 28, when I was able to bring him home. He was a wreck. Traumatized and very weak. He pulled through. The surgery was able to remove only about 60% of the tumour (after all that!) and so we went to VCA Calgary in February 2021 for SRT and he had 3 fractions.

It's been really quite intense as he was often really reactive, so much so that one vet prescribed Trazadone, which I have weaned him from. Being IAA (75%), we are currently have insulin wars. I am attaching the link to his spreadsheet below (I just started keeping it in earnest in the last while). I am getting some great support from the FB Feline Acromegaly Group (closed) but am wanting to get involved here as the insulin wars are creating some havoc and I'm worried frequently about either DKA or a hypo incident.

We are travelling this week (Sept 29th to VCA Victoria) for a CT scan check up and I'll have a better sense of what's happening with him, at least image-wise. I'm hoping just to hear some of your thoughts about his situation as I know there are many acro/IAA/folks on here and I'd be really grateful to hear what you think.

I feed Eddie 4x daily. He is currently receiving 13iU Lantus/Glargine BiD. He also takes DDAVP, Thyroxine and Prednisolone (dosage supplied if necessary)

Thank you.
https://docs.google.com/spreadsheet...cabxLoT0BeAbzpFBIuUv4Drxs/edit#gid=2129497126
Jodey and Eddie

 

Hello and welcome. Waving at you from the Vancouver area. You have been through a lot with your kitties - two acros! My girl Neko (acro and IAA) had to have SRT twice - both times at Colorado State University. Three fractions the first time, one the second when she had a heart block during her CT scan so they decided just to do one. She had been cleared by her cardiologist less than a month before for the anaesthesia. I never got follow CT scans, I figured it was too much stress for Neko, and her numbers told me when her tumour was returning. Plus it's pricy! There is a good CT can team at Canada West in Vancouver. Are you consulting with an internal medicine vet? I didn't until Neko added heart disease and small cell lymphoma to the picture, but they are a great help with complicated kitties

Which year did you go? Not quite December of 2021 yet. Plus it's hard to go across the border these days. I can only think of one other member who went to WSU for hypophysectomy and posted here about it. It was a few years ago, and there were complications in that case that also required SRT afterwards.

Where did you get your spreadsheet? It looks a little different than ours. For one, the "handy reminders" at the top, including the "not shot below 11" is not what we believe in once you are no longer a newbie. Which I would not consider you to be. Lantus (and Levemir) are great at keeping lower numbers low and flat. Everytime you skip a shot, you disrupt the insulin depot. Have you ever considered switching to Levemir? It often produces flatter, and I found more predictable numbers with higher dose cats. And one other thing, a of the people here who help with dosing are from the US, so we have tabs on the spreadsheets that do the automatic blood sugar number conversion for them.

Do you have specific questions you'd like to talk about? When was Eddie diagnosed with both diabetes and acro/IAA? Did he ever have DKA? We have some basic questions that people will ask over and over again. It helps to put those answers in your signature. Some information about what and how to do that in this post: New? How You Can Help Us Help You!

 

Hi Wendy, thanks for responding. Let me answer your questions.
I got the spreadsheet from the FB group Feline Acromegaly. I don't really use the "handy reminders" at the top. They came with the spreadsheet which was given to me by a member of the FB FA group. If I've ever skipped a dose, it would be because the vet (internist here) would have recommended it. Eddie was on Levemir prior to Lantus and we went to Lantus on the recommendation of the vet.

I've more or less given up on the internist. There is only one in Kelowna and he is semi-retired and focussed on Eddie more as if he was diabetic rather than IAA In fact, the vet said he "would have to read up" on IAA and he doesn't put much store in it as a diagnosis. I requested specifically an IAA test, which the vet authorized because I asked for it. Even though the vet has been responsive to emails it would only be to increase or decrease after 7 days and then do a BG curve, which I've been doing all along. I've only just started to do the AMPS (morning pre-shot) and PMPS (evening pre-shot).

Sorry about the date: we were at WSU in Dec 2020. The borders were open for "essential travel" only and I was able to get a letter from vet here and from the pituitary team at WSU. Eddie was diagnosed with acromegaly in spring of 2020 after a high IGF-1 result. I could find it but if memory serves me it was over 300. I had the IAA test done when we returned from the hypophysectomy. He's never had DKA, at least not yet... I will look at the link for signature (I see yours and that's so useful).

At this point, I'm not really sure of what I'd like to ask except What to do about IAA? My intuition is we will be looking at another round of SRT for Eddie but I won't know until the scan is done. I've taken Blue to Canada West (Dr. Nick Sharp) before but we're going to VCA because Dr Genevieve Hammond is the radiation oncologist who drew up the plans for both cats for SRT. VCA Victoria has just opened a new clinic (this last week in fact) and they may be offering radiation and possibly surgery at some near point. Anyway, she is really the best. She's phoned me when I needed some help and I'll be meeting her in person this coming week.

As I mentioned, there is only one internist in the Okanagan and, as I said, he's semi-retired and works only two days/week.

Again, I guess what I'm seeking are answers re: acro/IAA/SRT relationships. While Eddie may never be himself again after that month at WSU, he is still having a good life and I'm committed to doing the best for him.

Thank you so much, Wendy.
Jodey and Eddie

 

Many vets don't think IAA is important or worth testing for. Semi retired vet says it all. It is important in terms of dosing strategy, especially if the IAA starts breaking. If you look over at the forum on Lantus / Basaglar (glargine) and Levemir (detemir) you will see we have some yellow starred Sticky Notes at the top of the forum, including one on dosing methods. I strongly recommend following Tight Regulation if you can swing it and are feeding all low carb wet or raw. Antibodies seem to do best when you are getting as much safe green as possible, numbers in the 50(2.8) to 100(5.5) range. By "doing best" I mean less likely to take over and force increases. If the antibodies break, then I'd recommend being more conservative and taking reductions sooner. TR also means not holding doses as long if it's not giving you numbers you want.

One of the biggest changes I'd recommend for you is trying to get a PM test after PMPS, each and every night. Getting one just before bed is a good time if it is at least 2-3 hours after shot time. Many (probably most) cats go lower at night. Neko once went three months dropping low and earning reductions and night, then bouncing during the day. If I had dosed based on day time numbers, I would have increased, when in fact she needed a dose reduction.

Truth be told, there is very little research on IAA, and I've only seen a couple studies on very small numbers of cats, both with differing answers on how common it is. Many people don't test for it, or vets don't in spite of being asked, so it's hard to put together numbers of members here.

Neko had acro and IAA when she had SRT. And both times her dose needs started dropping quickly, within 2 weeks, of the radiation therapy, though much more dramatically the first time. Individual cats can differ and the radiation therapy neuters the tumour cells so you have to wait for the tumour cells to die off and not reproduce before you start seeing numbers drop. I've seen cats take as long as 3 months to start showing some changes, so generally not quite that long. Not so many people are getting SRT here now, since it is so expensive and you have to travel most of the time. The drug cabergoline seems to help many cats and is way cheaper. Not sure I'd get SRT redone again so soon after the previous one, for us it was 3 years, and redoing SRT is very uncommon. Plus it's yet more anaesthesia on our older kitties. Has your Eddie had an echocardiogram?

I presume it was the same vet who suggested going from Levemir to Lantus? Again, a lot of vets aren't familiar with Levemir either. I went rogue and just did it, and Neko did so much better on Levemir. I could tell Lantus was stinging her a bit too.

We've had one or two other members say their cat experienced personality changes after hypophysectomy, but it improved over time. Again, we don't see a lot of it here because of the cost and so few places offering it. There do seem to be better results out of the UK at RVC where they are so much more experienced with the surgery.

 

Hello Wendy,
There's a lot to absorb from your email. I will look closely at learning to do TR (now that I know what that means!) and doing a BG after the PM shot.

Eddie often goes high in the morning. I've learned he may be having the "dawn phenomenon", based on what you've described?

I think Eddie's personality change my be due to injury of the hypothalamus. I did a lot of research on him in the past months and found a refereed article from 1944 (!!!) based on terrible research done on a large number of cats wherein lesions were purposely put on or near the hypothalamus. All the cats became food-driven (Eddie has gained nearly 7 pounds since December), become far less friendly (even isolating) and displayed "sham rage" but when approached and touched stopped hissing, which is what Eddie was doing big-time at first. Now he hisses when he's uncertain or startled or if I come up to him too quickly. But then I hold out my hand and he's fine.

I will have to learn more about TR. I'm appearing here in anticipation of this learning curve when I've returned with him from the CT scan. The surgeon at WSU was Tina Jo Owen and she's one of the pioneers of transphenoidal hypophysectomy in the US. It was explained to me, unfortunately after the fact, that the drill that was used in the surgery was slightly bent and it overheated. I feel horrible even imagining what this means but there you have it...

As for the Lantus: yes, he changed it from Levemir. He said Lantus was longer-lasting (depot?). Eddie doesn't seem to mind the injection at all. I give it as he's nearly finished eating and being so food-driven he pays little heed. He's very easy to do home-testing.

Thank you so much for sharing this information and directing me to the relevant places. I will get to these places and be better equipped to ask questions.

Jodey and Eddie

 

You might want to read this post from others who had surgery, with differing results. Post pituitary surgery discussion of medication and other issues Amanda's Schmee really had personality changes. And he eventually had to go back on insulin too.

Wrong, it's the other way around. Levemir tends to be longer lasting in cats. As long as it's not bothering him, it's not a rush to switch. It's just that higher dose cats seem to do better on it, so something to consider at some point in the future if you can't get him more regulated on Lantus. A good goal is getting him under renal threshold as much as possible. He doesn't need to be really tightly regulated, though I have seen some acros respond that way.

When I said going high during the day, I meant it looked more like an inverted curve from a bounce. From our definitions:
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

 

Hi Wendy,
I was reading some of the other posts on change in personality and found in particular the post from Amanda and Schmee to be so very sad, yet so familiar to me. Eddie has been making slow, slow progress--sometimes he even jumps on the bed like he used to and will purr a little. It's always a wonderful surprise when he makes an appearance. I haven't lost hope but sometimes it's so hard. I will say he is 1000% better than the first 3 months of his return from WSU and even prior to his surgery he was going off the deep end around food. The only time he does now is at feeding times but even then he is systematic about it. He will race for his food and inhale it but will not try to take over Blue's bowl. In fact, they finish and then cross the room to each other's (empty) bowls. It's like clockwork. Blue did not suffer the same changes as Eddie. If anything Blue is extremely chill, zen-like. He follows me from room to room and speaks to me when we move about. He's is not shy of anyone and he even see the vacuuming as a non-event. As I said, he's been in remission (2iU BiD) for at least 6-7 weeks after he went hypo and I took him to emerg. I woke up in the night and just knew something was very wrong. I did a BG test on him and it was around 3.0. I used my hypo emergency karo syrup and some high carb food and took him in. He recovered over a period of two days and hasn't had insulin since then.

Anyway, I'll post a photo of Blue with this email and you can see him as well. Blue and Eddie may be brothers. I adopted them from the Humane Society in December of 2011. They were being neutered at the vet's and I ended up taking them home.

Anyway, we have miles to go before we sleep. Marje is setting me up (already!!!) with a SS. The only thing is that it uses a measurement that I'm not familiar with. I think it's just a matter of multiplying my AlphaTrak2 results by 18 if I'm not mistaken?

Again, Wendy, thank you so, so much for your support and guidance. Once we (Eddie, Blue and I) are back from Victoria I'll look into changing to Levemir. If I recall the previous change (Levemir-->Lantus), I had to start at a lower dose...

I'll see about doing the +2 following tonight's dose of 13iU. Goodnight!
Jodey and Eddie

 

Just tried to upload a photo of Blue but got an error message... You do not have permission to view this page or perform this action.

 

The upload action is not currently working. But you can copy and paste into the text box, or drag and drop. Look forward to more pictures.

You should have the "World" version of the spreadsheet. It'll have one tab that is mmol/L that you are used to and will enter values there. The mg/dL (multiplied by 18) will automatically be calculated and populated on the US tab for others to read. Good to note you are using the Alphatrak and worth noting in the signature. Most of us use human meters for two reasons. One, the test strips are SO much cheaper, and two, our dosing methods were written for human meters, back before Abbott started marking their meters so heavily to vets. OK, a third reason, you can pop into any pharmacy at all hours to pick up test strips should you find yourself suddenly going through a lot of them.

Good thing you were home testing and caught that low for Blue.

Safe travels. Take your umbrella this week.

 

Here's Blue, aka Mr. Blue, aka Mr. Magnificat.

Thank you so much. Goodnight.

 

Good morning, Wendy

Just getting things organized for the trip to Victoria. I'm wondering, though, if you have any thoughts, recommendations, observations about insulin dose and Eddie's BG. I took a reading last night @ a little over + 2 and just now this morning. Should I just keep on with 13u until after the CT scan, which won't make any difference other than to increase his stress and BG level?

Umbrella is packed.
Thank you.
Jodey and Eddie

 

Yikes! Quite the bounce last night. If you ever see that +2 as lower than the preshot, that's an indication of a more active cycle (dropping) that might need later testing, and/or higher carb food left out. I'd stick with this dose and get a couple more nights of +2 tests, just to make sure you aren't missing any lows. He did get below 100 on 12 units not that long ago.

I found my cat would go lower during car trips and vet visits.

 

I'll keep steady @ 13units and will check tonight and tomorrow at +2 night tests. We head out on Wednesday, so we'll see. My main concern for now is the long trip to Vic, ferry, etc. & having to encourage kitty-box activity in the car. Blue's a seasoned traveller; Eddie not so much but he may surprise me.

Those below 100s look so good.

Thank you! J&E

 

Good morning, Wendy, Eddie this morning is at 157! Still give 13u??? I did give 13u and will monitor today. He seems really with it this morning.

 

He probably spend quite a bit of time in blues last night. That +2 last night showed he was moving down. Good to hear he's feeling good.

I'd start with a +2 or +3 test if you can.

Side note, if you are ever looking for advice on dosing, it's better to post on the Lantus/Basaglar/Levemir forum. There is a lot more traffic there and even people without acros can help with dosing or handling low numbers, should that be an issue. This board tends to be more on acro specific issues. No problem posting here, just that it's a lot more quiet so slower to get answers.

 

I was able to do a +3 and he's hovering mid-yellow.
I didn't know about posting to another board as I thought these questions were acromegaly specific. Is it necessary to provide Eddie's whole acromegaly/treatment background story to the L/B/L forum?
Thank you, again, for keeping an eye out for Eddie posts.
J&E

 

Looks like his body is not used to spending time in lovely blues yet and is bouncing. A higher +2/+3 tells you it'll be a quiet Lantus cycle.

As far as dosing and acros, you do have the hypophysectomy and SRT notes in your signature, so people should be aware of it. If you do decide to post on the LBL forum, you can link back to this post for more background info. Eddie is pretty unique. We've had only a few kitties have hypophysectomy and none with SRT afterwards post here. If you do look around in LBL, you will find a few other people with acro and IAA combinations, or one or the other. I found looking at others spreadsheets informative.

 

I don't know what on earth is happening! Look at the crazy day. It started out so promising. I feel discouraged. The VCA clinic just contacted me to tell me we have to cancel the CTs in Victoria as the scanner has gone down and parts are coming from Japan. I had to cancel hotel, ferry, all after I spent two days putting things in order for my sitter for the other cats and Max, the dog. This is exhausting this week.

But what about the numbers? What is happening??

 

Read the definition of bouncing that I listed in post #5. It's his body reacting to the lower than used to numbers last night. Nothing to do but wait it out. He did the same thing after the greens on the 14th.

Bummer on the VCA visit, you think they'd give you more notice than that! Good thing it's not a rush to get the CT scan done. I honestly never had CT scans done other than the ones just before SRT. The results of the CT scan wouldn't have changed anything I did. Not sure what you expect to see out of the scans. Plus they are pricey.

 

Yes, I think I finally understand the meaning of the "bounce". It's like a fail-safe response.

Yeah, for sure, bummer on the VCA visit. The scanner broke down late this afternoon. I was on a Zoom meeting and I guess they were trying to call me. It was still a drag, especially after all the preparation for travel.

The CT scans are intended, they say, to track the results of the SRT and to determine visually, rather than physiologically, the status of the tumour. I get it. I did want to see what's happening with Eddie because if there's a regrowth he would still be a candidate for SRT again. The other thing, of course, is that we are seeing the BG carnival as possibly an indicator of either a) a regrowth or be) the death pulses of the tumour. I'll take Door #2.

There's are possibility I can get to CanWest and see Nick Sharp (he's done the MRIs on Blue) and, there's another possibility to get a CT here. VCA wanted it to be in-house and not here because there is no radiologist here. Jeeze, no radiologist, no internist...

Anyway, as I said, I'm glad the CT scanner didn't break down while I was en route to Victoria. I can put my umbrella away for awhile.

 

I don't get it. Anaesthesia is harder on our older pets. Acros are more likely to have heart issues, which make anaesthesia even riskier. I tried to limit the amount of anaesthesia Neko got to just required procedures. I don't think a CT scan is required now. Eddie's SRT was only 7 months ago - way too early to say that SRT has failed. It can take a couple years for full effect to be seen. You might want to read this paper on SRT. Stereotactic radiation therapy for the treatment of functional pituitary adenomas associated with feline acromegaly The authors include Neko's radiation oncologist at CSU. I had some good discussion with the IM vets and radiation oncologists there. They had a lot of experience with SRT and acros. The cat they refer to as having 2 SRT treatments was Neko.

 

Thank you so much for this paper on SRT. it really is informative. I'm assuming though that none of the cats in the study had surgery?

Also, keto-meter arrived. I'm not proficient in this testing but I tried it out on Eddie and got a reading of 0.2. I went to this page http://www.diabeticcatinternational.com/knowledge/ketones/
to learn about ketone range (both urine/blood) and it would appear that Eddie is far below the <0.6 (Normal -- No other action needed). I'll try it again in awhile but I think I'm doing the testing correctly. Do you know anything that might help clarify what I'm doing?

So, no CT scans at the moment. I'm going to get blood panels done to see where he's at in that department before doing anything else, like CT scans.

Thank you!!

 

Correct. Surgery in the US is a relatively new thing, actually most anyplace in the world it wasn't done regularly until 5-6 years ago. We had one other person here contact WSU and asked about the number of acromegalic cats they've treated with surgery, and it's still just a handful of cats. There have also been some surgeries done at AMC in New York. Royal Vet Clinic in England has the most experience of anyplace, I think it's over 50 now.

You looked at an incorrect page for ketones. They have published charts for humans, not cats. 0.2 is barely anything. Start to get concerned closer to 2.6. More info here: Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

 

I think Tina Owen & Annie Chen Allen @ WSU have treated about 50 cats since Tina Owen trained in L.A. Anyway, i think the article makes the point that SRT is really quite effective. I know that Genevieve Hammond, who developed the SRT plan for Eddie did so knowing that WSU was not able to remove all of the tumour because of proximity to the hypothalamus.

But about the ketone meter: as I said, it arrived today and (I did research on top ten meters for 2021 and the Mojo-Keto came out on top because of accuracy and the app that send the reading to yr phone). So, I got 0.2 and I guess that is good? I really don't know. I downloaded the article on ketones and meters and they seem to agree, meters are more accurate than urine strips but as to the reading I got, this is new territory for me. In any case, Eddie doesn't display any of the symptoms: not drinking too much, not lethargic, etc. Just can't regulate BG.

Like I just did +2 and it's back up to 22.4 and at +4 = 20.4

 

According to a March update from a member who asked Dr. Owen how many cats they had treated with hypersomatotropism (acromegaly), the answer was 11. I guess two of those were yours. The higher number included dogs and cats with Cushings. More details in this post: https://felinediabetes.com/FDMB/threads/unpublished-uk-paper-on-68-hypophysectomy-cases.244436/

 

September 30th: Eddie's AMPS = 26.0 I'm thinking we should increase insulin?????

 

We do dosing based on how low the dose takes the cats, not the highs. Try to ignore the preshots when you make dosing decision. On the other hand, the lowest you'd seen on this dose is 137, though he might have gone lower PM 9/27, but I still think you had room for that increase. With acros, you also don't want to hold a dose overly long if it's not giving you the nadirs you want.

 

If I'm understanding correctly, the peak of the insulin is the same (time?) as the nadir? If this is correct and looking at Eddie's SS, how may I best determine or decide on an actual dosage? If the nadir shows a really good number then what? And vice versa? I think I've not truly understood about dosing decisions or, rather, I have been reacting to the preshots. I see now it was no longer appropriate to be holding the dose @ 13iU...

 

I'll be interested and grateful to hear thoughts on the relationship between BG/insulin and Prednisolone specifically with acrocats. Eddie just had his prescription for Prednisolone renewed and the medication is in capsules of 2.5 mg. Eddie's original prescription for Pred was based on his surgery and his SRT: 2.5 mg/BiD.

It struck me today that just maybe 5.0mg a day is far too much and making him insulin resistant. I learned that Prednisolone is a commonly used drug in cats and potential adverse effects include hyperglycaemia and diabetes mellitus. I thought that coupled with IAA (or related to it?) the Prednisolone was related the high BG levels as he's been on it for months. He's also been on the new "batch" compounded in the pharmacy here for about 4 days...

I contacted the vet and he answered! Perhaps he missed me. But anyway, he said to decrease the Pred dosage to q.d. and so we'll see what happens over the next few days. I'm bringing Eddie into clinic here next week for CBC, Biochemical profile, urinalysis, T4, urine culture (cystocentesis) all to reference lab. The vet wants to do a Urine culture because "we are looking to rule out subclinical urinary tract infection."

I wonder if anyone else with an acrokitty had a similar issue with Prednisolone?

 

The nadir is the lowest point of the cycle. It may, or may not be the same time each cycle.

Why is Eddie being treated with pred? We do have a few cats here it, and it typically requires an increase in dose, though not a huge change. If a kitty gets prednisolone after SRT, it's typically for a week or two at most to combat any inflammation from the radiation itself. Most SRT cats don't go on pred. Is there another reason for the pred? Common reasons kitties here are on pred are for GI issues or asthma or other allergies.

 

According to the discharge instructions from the internist at Washington State University following hypophysectomy, "Eddie will need long- term (life-long) supplementation of thyroid hormone and physiologic doses of steroids to replace hormones affected by the removal of his normal pituitary gland."

Eddie had SRT following the hypophysectomy because the tumour could not be entirely removed because of its proximity to the hypothalamus, although the pituitary was removed.

In any case, the vet has agreed to decrease to a lower dose of Prednisolone. I have a feeling this might help somewhat.

 

Of course, after the hypophysectomy. Reading up on the other kitties here that had hypophysectomy, they were on quite a bit smaller doses of pred. Discussions in this post.

 

@Wendy&Neko
Just tested this morning 8.8/158
Should I stay steady? He's on 14u and we've finally decreased the Prednisolone to physiologic (1.25mg/q.d.)

Ok, that was this morning. I held steady with 14u.

It's now +5 and his BG is 6.1/110

What do you think is happening??????

 

Sorry, today was visit day with parents who live on an island. If you ever have dosing questions that need quick answers, start a new post on the Lantus/Basalgar/Levemir forum.

Sounds like he's starting to get nicer numbers (except PMPS tonight). Might be the reduced dose of prednisolone, or the depot of the insulin dose is built and you are seeing what this dose can do. Would have been nice to get a later test last night to see where he went to before showing that 158 in the AM. Anyway, I don't see a reason to reduce the dose yet.

 

Ok, I didn't realize that I could post there if the issue of acromegaly was involved. Thank you.

Also, the numbers went swinging in the other direction tonight @ PMPS and +2. I was so excited this morning that we were in the blue...

Earlier I had tried getting some support from the vet (you know, the nearly-retired) and sent him the SS asking for his opinion on the numbers. Without commenting on the numbers, this is what he wrote back:

"Jodey
1)Please provide explanation in your spreadsheet on ALL abbreviations you use. They are not standard abbreviations and I want to know what you mean. [I think he mean AMPS and PMPS but I'd already told him what that meant].

2) Your spreadsheet glucose is in mg/ml and we work in mmol/l. Please convert into units that we use.

3) Your color codes ranges are they arbitrarily chosen? I like the idea of colors to quickly see what is going on but I find there ate too many. I would do ‘too low’(red as this is dangerous < 4mmol/L), ‘normal’ ( green as this is ok 4-10mmol/L), too high ( yellow as this not ok but not immediately dangerous ( >10 mmol/L). If you want you can add a category if BG >20 (orange?). "

Nothing on the numbers. Anyway, Eddie went the opposite of blue.

Thank you.