Thanks to the folks here I had an acro/IAA test done on Kea. IAA was negative, but acro was 288. My vet hasn't had a lot of experience with this, but is willing to work with me on this. We've already discussed the 3 options: surgery, SRT and meds. Advice, please.
Hello and welcome over on this forum, though I'm sorry for the diagnosis. Just remember Kea doesn't know he's any different. But now you have an explanation for his higher dose and a path forward. First and most important, will be getting him to a dose where he's seeing better numbers, mostly under renal threshold. It will be beneficial if you can follow Tight Regulation for dosing, which should be easier with a Libre on him. At some point you may want to consider a switch to Levemir. It is similar action to Lantus, but onset and nadir are a couple hours later. The big thing is that Lantus has an acid base that can sting at higher doses. If you didn't see anything below 200 today, you can increase to 7.5 units now. As for treatments, can you tell me where you live? Surgery and SRT aren't available everywhere - travel has been a deciding factor for some people. As does cost. Surgery is over $10,000, as an example. Though some people here got it done when there was a donation in place at AMC to help. In England, surgery is usually the treatment of choice.
I live about 20 miles south of San Francisco, California. The closest vet school is UC Davis, which my vet is going to call tomorrow to discuss Kea, and to find out what Davis can do. Davis is less that 2 hours away so the stress would be far less than having to travel out of state. I can try to get readings every 3 hours. I've started ketone testing already. Thus far Kea hasn't reacting when getting his shot but I will keep in mind about switching to Levemir. I just ordered 2 vials of Lantus from Marks Marine, so....we'll use those up first regardless. We'll increase to 7.5 with the first shot tomorrow. His readings are all in the 300s (yay!) so we're trending downwards but still high. I do need to mention that we have a 2 week vacation planned starting August 26. Our cat sitter can give insulin but home testing or readings for the Libre won't be possible. We may not start anything additional or different other than insulin until we return. Thank you for your help.
It's good your vet is reaching out to UC Davis, they have some people there knowledgeable in acromegaly. UC Davis was doing a surgery trial - details here. But that was fall of 2018 so don't know if they are still doing it. The good part of the trial was that the costs were considerably cheaper. The down side is that the surgeons may or may not have had much experience with the procedure. The requirement for following TR is at least two tests per cycle, the preshot and one other. The every 3 hours is for when you first start Lantus. After that the second test is ideally somewhere near nadir. You can always do more tests until you figure out his onset and nadir. Once you know that, you can be more strategic about when you test. Some people test more, just because they like data, or their cat is more unpredictable. A couple days before leaving on holiday, post and ask for a petsitter dose to use while you are gone. Not uncommon to have to temporarily lower the dose, depending on what sort of numbers he's seeing. And a FYI, if you want dose help with Lantus, best to post on the Lantus forum. It gets a lot more traffic and we have a number of people with acrocats over there. This forum is good for information about everything except timely info on dosing.
Well, the Libre sensor fell off around 3 pm yesterday; we got a new on put on him at 5:30. Now his readings are all in the upper 300's, low 400's again. IDK if it's because the sensor is back to being in the same place as the first one or not. When I'm done with work I'll use a meter. Wondering, though, if I should increase to 8m BID?
How long did this Libre last? As for dosing, let's give him tonight to see if he comes down. He might be experiencing some New Dose Wonkiness. Which is a temporary increase in BG's after a dose increase. We aren't sure what causes it, but could be the depot rebuilding. If you don't see yellow tonight, I think you'd be OK going to 8 units. By the way, you are more likely to get dose suggestions on the Lantus/Basaglar/Levemir forum. It is more active than this one and that's were the majority of the acros on Lantus or Lev post for insulin dosing help.
okay, thanks. the 2nd Libre lasted 11 days. I think the placement made it harder to stay on - there are a few days when the sensor didn't have any readings and we didn't have that problem with the 1st Libre. I'm fairly sure Kea didn't remove it. He's been such a good boy.
