Moe: trying to decide whether to test for acro and IAA

Hey everyone. This is going to be long...sorry in advance, and thanks for reading it.

I've been reading up on Acromegaly and IAA the last few days, trying to decide whether or not to have my vet run tests for them for Moe. Moe was first diagnosed with diabetes at the end of August 2019. He was started on basaglar, 1 unit BID, increased briefly then immediately started to decrease. By the middle of October, my vet declared that he was in remission (BG in the low 100s for 14 days, no insulin). In February of this year, Moe started acting off, so I started checking his glucose again. He was in the mid to high 100s, a couple of 200s, so I took him in for bloodwork and a once over. Vet couldn't really find anything wrong on his bloodwork, but he had some diarrhea and some stress from a new kitten in the house. Within a couple of weeks, BG was in the 500s. (All these numbers are from an Alpha Trak meter.)

I started him back on basaglar, but his BGs just kept increasing. I switched to a ReliOn meter at the end of March, so now I see lower numbers, but I don't really feel like his glucose has actually changed, it's just reported differently. He had a dental with five extractions on 4/13 and I was hoping that would help turn things around, but with the exception of a few blue and yellow numbers, we continue to stay consistently in the pinks and reds.

We are now up to 5.0 units BID. Moe has a good appetite, pees a ton, has good solid poops, and sleeps all the time. No ketones. He's a big boy, currently 16 pounds. He's got a big round belly, which I've tried to capture in some photos, attached. (Sorry, they're not the best pics of his tum - he won't cooperate today.) He's also wheezy when he breathes. I always assumed it was allergies and his weight, but wonder if that could point to Acro. His snout looks larger to me as well, but since he's just had his two top canines extracted, I don't know if that's some lingering swelling or my worried-mom imagination. I just know that with every increase, his numbers don't move.

So, bottom line. Can you guys take a look at his spreadsheet and the photos I've attached and let me know if you think it's worth checking for Acro and/or IAA? Thanks so much!​

 

First off, must tell you I love the picture of him snuggling with his buddy. Second, not all cats show physical signs of acromegaly when they are diagnosed with it. I read a paper that said only something like 35% have clinical signs. Having said that, a pot belly and airy breathing are two common signs.

If you are wondering about acromegaly and/or IAA, and at the dose you are with little movement in his numbers, I think I'd get the tests done. Normally we suggest it at six units if the caregiver isn't already thinking about it. But there are acros on smaller doses too. You will wonder until you get the answers one way or the other. And if you do get a positive result for one or the other, there are things we can do with dosing to try to get him to better numbers faster. Knowledge is power.

 

That’s JuneBug; he’s absolutely in love with Moe. Normally Moe loves him back but he’s not as affectionate now that he’s feeling crappy.

I might hold off until we get to six units; not that far away anyway. I plan to do a curve tomorrow and send the results to my vet Monday. I’ve already inquired about testing for acro, just need to find out how much it’s going to cost.
One other question. I’ve seen some references to cats who are on too much insulin and when the dose was cut back, the BG numbers dropped. Do you think that’s worth exploring at all?

 

No and I wish people would stop quoting that old chestnut. There have only been a couple of times I have ever seen this happen and only when either the dose was started way too high, or the person was increasing without testing. On the other hand, I have seen people follow this myth, do what some call a reset, and then the cat gets ketones and even DKA as a result. If you follow the protocol, start at a reasonable dose, and test like you do and do safe increases, it's not an issue. What I see on the spreadsheet looks like something causing insulin resistance. If all you are seeing is reds and pinks at 5 units, he's not going to be regulated before six units. The reason we suggest testing at six units, is that there have been the odd cat get up to 5.5 units, then turn it around. But those cats were seeing much lower numbers than Moe is now.

Once Moe gets back in good numbers, I hope he'll feel like snuggling some more.

 

Okay, good to know. I’ll just keep on my current path.

 

Hi Erin, Moe is so cute!

I am only a recent member to this forum but reading your post I felt I could add my little bit of experience. My cat Flynn has recently been diagnosed with acro, he never showed any of the major visible signs of acro like enlarged jaw/paws (although his paws are slightly larger now) but he did have a pot belly that has progressively gotten worse over the last couple months, he too also had laboured breathing/wheezing. As he was showing that he was insulin resistant (5units and was always flatlining, staying between 20-25) my vet decided to do a CT scan. They included his head in the scan and found his organs were slightly enlarged and that he had a small mass on his pituitary. They did the igf blood test which has come back positive sadly. We are at 6 units currently and still haven't seen a difference, not yet anyway

I'm not sure if this has helped but I hope you and Moe get some good answers if you decide to go ahead with testing. Much love

 

Thanks for sharing your story. Flynn is gorgeous. Moe sounds similar to your boy: high flat numbers, pot belly and wheezing. I am going to ask my vet to run the tests.

 

Sounds very familiar to my Cleo. She's up to 6U of Prozinc and still hitting 500's in am. I'm getting drops of ~100-200 nadirs, but can't even get near 200 or below. Cleo has IGF-1 of 400+. MSU dx'd her w/ acro. We all think my vet is playing it too safe and won't let me ramp up the dosing so we can get some good drops, but I'm about ready to ramp up on my own after getting support from Deb and others in here and tired of watching the poor cat struggle w/ neuropathy and hi BG's.

 

The Moe and Junebug pics are great. The cuddle pic is the best. You are getting good advice from others. I would get him tested for Acro if you have thoughts of doing something with the results - like SRT or cabergoline.

 

Junebug looks like my GA Fred. He was a cuddler.

My Ollie has most of not all the physical symptoms. The very first time I saw her long before I knew about acro, her huge feet stood out and she was only 9 lbs. Vet thought she was probably a large cat before being found as a stray.

She had this grunt, raspy, sometimes gurgling breathing. Labored at times. No engery, lethargy, pot belly came on quickly. Sensitive to light, headaches. Murmur, HCM. Insulin didn't seem to touch her. She was miserable.

So got the test done. It was positive. My whole mindset changed. For me it was more about managing the symptoms and getting the glucose down to slow down any damage to other organs.

Getting the tests done will let you know what your dealing with and you can be proactive.

 

Freckles tested positive for acromegaly and IAA in February of this year. Freckles has no overt physical symptoms - just ravenous appetite and high insulin doseage. This forum and the experienced people on here have been extremely helpful not only for knowledge but also for their supporting ways. Either way, acro or not, you are at the right place.