NEW MEMBER: Acromegaly cat

Hello

I've just joined the forum on the advice of someone through the Guardian Newspaper.

My cat is a Maine Coon aged 11. He was diagnosed with diabetes in November 2020 with typical symptoms including weight loss at which point he was 7.4kg.

He was put on Caninsulin (4 units twice a day) increasing at 0.5 unit whenever his blood glucose increased.

By April 2021 he was lethargic and gaining weight and an IGF-1 test indicated he had acromegaly (more than 1000).

We changed to Prozinc and a year later we are at a point where he is no longer responding to an increase in dose.

He is on 9 units twice a day and his blood glucose is around 25. He weighs 9kg

My vet consulted others and no useful advice came back (pituitary gland removal which I don't want to put him through, or put him on Hills Diabetic Food; he is on Purina Diabetic Dry food for cats; won't eat wet food).

Has anyone got any practical suggestions for managing his diabetes please? I would just like to get his blood glucose down a bit

He won't live a long life but if we can reduce his blood glucose that would be great.

I don't do home testing but I measure his water intake and recently it went to more than 800mls every 24hrs. It started to come down a bit in the last week but his blood glucose was still 24.1 at our fortnightly visit to the vets.

All suggestions welcome

We are in the UK

 

Hello and welcome from another member who had an acrocat. Also with Maine Coon heritage, and started on Caninsulin. Not a very good insulin for cats at all. With the size of dose you are giving or Prozinc, I would suggest that Levemir would be a much better insulin for him. It could also just be that he needs more insulin. I've seen acros with much higher doses.

As for your vet's suggestion, the pituitary removal surgery done at the Royal Vet Clinic is top notch. They are the experts in the world at that and it is curative, meaning cats can live happy and healthy non diabetic lives after surgery. Your vet's second suggestion on the DM food is garbage, it is nothing magic. Any regular low carb food is just as good and often better ingredients. I'm including some links to diabetic appropriate foods and supplies available in the UK. UK Diabetic Cat Food Info (includes some supplies) and UK Cat Food List. Getting him onto low carb wet or raw food will immediately help his blood sugar numbers. The "diabetic" dry food is not low enough carbs for a diabetic cat. I know you said he won't eat wet food, but sometimes it takes a little extra effort. Tips for transitioning to wet food. At least in North America and some other places, you can get freeze dried or air dried food that still has the crunch, but not the carbs.

Any chance you would consider home testing? We can help you if you'd like to try. It's the best way to keep him safe. It could also be that he needs more insulin. I've seen acros with much higher doses. And then we can help you with dosing suggestions to help get him into better numbers sooner if you are home testing. Also, if you plan on changing his diet, it can have quite an impact on blood sugar needs, so it's best to be testing him at home first. A lot of cats test higher at the vets office too so it's not a valid number to base dosing decisions on. It's also cheaper for you to home test.

We've had acros live 5 years like mine did. Acromegaly can be a slow moving disease, there are other treatments that can also help slow it down. There is a medication called cabergoline, given daily, that is fairly cost effective and we've seen some success in lowering dose and reduce acro symptoms. We've even had a handful of acromegalic cats that have gone completely off of insulin.

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Thank you for this advice

I've mentioned home testing to my vet but he wasn't sure about it.

I would still need his advice of course whatever the results

My cat was a year old when I took him on and was addicted to dry food. I have tried weaning him off but to no avail. It would be hard to change this as you say without home testing and I note it isn't so good to do for sick cats

The suggestion of a different insulin was something he had considered but his colleagues didn't respond on that. I will talk to him again

The drug that you mention popped up in my Instagram feed! I'll ask him about that too.

Really grateful for your advice

Thank you

 

I don't know why some vets discourage home testing. If you were to ask them if they'd test their small child before giving insulin, the answer would be a resounding "yes!". You don't need his permission to start testing. We have videos and tips on home testing in this post: Hometesting Links and Tips

My vet encouraged home testing. Once I showed her the dosing method I was using, and copies of the spreadsheet data, she was fine with me managing my cat's diabetes. My vet only worked 4 days a week, she wasn't on call to me when I needed answers on dosing. The people here were as we have members from around the world and there was pretty much someone on all the time to help.

Does your kitty ever show interest in your own food? Do you give him treats?

 

Hi There

Thank you

My cat hates being handled but I will ask the vet again about home testing and will email in with the ideas that you've given which are welcome

My cat has never shown interest in my food.

Unusual I know

Occasionally he will want my drink as he's thirsty and I give him tuna and water which he laps

 

The most important thing about home testing is getting them associating a treat with testing. Now to find a low carb treat he will like. Usually we suggest a pure meat freeze dried treat. The questions is whether he'll like it. Some people give bits of baked/boiled chicken, but sounds like he wouldn't be interested. Some cats like brushing and people use the loving time with a brush as their treat for testing. The task is to find something he loves. Piece of tuna? My acro was so food motivated it was very easy to convert her to a better diet.

 

If you have to feed dry food, acceptable ones are Wysong Epigen 90, Dr Elsey's Chichen Clean Protein, their other Clean Protein varieties are OK since the Chicken is hard to get, and Young Again Zero Mature.
I have had 2 and maybe my first "diabetic" cat had acromegaly too. MurrFee the second one, did OK for about two-three years and he got up to 50 units twice a day. At the high dose, it was 25 units N and 25 units Levemir twice daily.
My present one, Snuffles is on 6 ½ units Levemir and about 2 ½ units N twice daily. He is also on cabergoline one a day since Dec 2020. He is doing better than my MurrFee who was only treated w/insulin.

Home testing BG is a must. Snuffles doe not like to be held so I do few BG tests between shots. I can maintain hi BGs below 150mg/dL
There is a closed FB group for acromegaly
https://www.facebook.com/groups/acromegaly
Thee is also a forum here just for acromegaly. There is some good reading i the references given at the top of the page
https://felinediabetes.com/FDMB/forums/acromegaly-iaa-cushings-cats.12/

 

Agree with everything said so far, also have an acro cat. The acro forum has a wealth of information, including a recent study documenting the success of Cabergoline (from the sounds of it, your vet may need to be persuaded on that too).

My vet had never used Levemir before, but was willing to let me give it a try since he knew I home tested - he has a link to my spreadsheet, he can view it whenever he wants, and we are both happy with that arrangement.

Treating just with insulin only manages the diabetes part of the equation - but if he's still not regulated, over time the high BG does wear on his body as well. It does nothing to stop the progression of the other acro side effects - organ enlargement, soft tissue growth, etc.

Cabergoline is relatively new, but we decided it was at least worth a try for us. It's pretty cost effective, at least in the US, and minimal side effects. There is limited evidence that cabergoline can actually shrink the tumor if it's on the smaller side. Since it effectively helps block the IGF-1 from getting to the cells, it can help with the other acro side effects.

There's also the surgery Wendy mentioned (hypophosectomy), and SRT radiation as well. Downside to those is cost, and the possibility they can't get it all and it regrows.

For now at least, the best thing you can do is (1) change his diet, and (2) start home testing so you can make sure he's safe, but also keep increasing his dose until he does get as regulated as possible

 

I'm not sure if any of the dry foods Larry posted are available in the UK. From the UK Diabetic Cat Food info link I included above:

There are currently (May 2020) three dry kibble foods in the UK that are relatively low in carbohydrates (close to 10% cals from carbs or a bit above). These are: Porta 21 Sensible 'grain free' from Zooplus, and Thrive premium plus ('chicken' and 'chicken & turkey' flavours - NOT the fish flavour..)

There is also Ziwi Peak air-dried cat food which is less than 10% calories from carbs. This is really dried meat with nutritional additives, so the texture is not like that of regular kibble.

 

That'd be me!

Welcome, Claire, to yourself and your not-so-little fella. (What's his name?) I'm glad you've made it over here. I see that Wendy, Melissa and Larry are already on the case.

It can seem a little daunting when one first arrives here and so much emphasis is put on home testing, but I can personally vouch for how it can transform the management of one's kitty's blood glucose (BG) levels - and help them to feel much better. Down the years I've seen soooooo many kitties and their caregivers get really solid help and support here.

It'd be worth giving the freeze-dried protein treats a go to see if your boy will like them. They'd be a bit similar in texture to kibble. There are a number of brands listed in the UK supplies link Wendy posted above. Tip: The Hi-life treats are slightly greasy compared to others (I use Thrive or Cosma Snackies).

Many, many new members think that their kitties will never accept home testing, but they can really surprise you. When I was a forum newling, I remember reading about other cats who sat at their designated stations waiting for their tests, convinced that my girl would never become one of them. However, not long after her BG levels started to improve she would sit patiently at her test spot waiting for me to do the necessary. Here's a pic of her, waiting for her sugar check:



Here's a helpful video with some tips on behavioural training (for acceptance of injections, but techniques can also be applied for home testing):

Desensitisation and Counter-conditioning Techniques

Veterinary support for home testing can vary widely. The staff at the practice where my Saoirse was registered at time of diagnosis were positively hostile to it. Like you, I was advised to monitor water intake and nothing else. I moved her to a different practice a few weeks after Dx (still there!) and the experience was completely different. There was active support for home testing and feeding a low carb diet (helped that our main vet at the practice had a diabetic cat himself).

Our vet at the new practice asked an external FD specialist to review Saoirse's BG curves just after we joined. At the time, per the original vet's treatment plan, she was on Caninsulin and Hill's w/d dry food (higher carb than the food she had been eating prior to diagnosis, essentially kitty cornflakes). The opinion of the external specialist was that Saoirse was "a true diabetic" with "no hope of achieving remission."

I was able to migrate Saoirse to a low carb, wet food diet (just - she had comorbid chronic pancreatitis so that made dietary choices very tricky). Thanks to the data gathered through her home BG monitoring, our vet was able to prescribe an insulin that suited her better (and one I would never have known existed were it not for what I learned here). Less than 3 months after starting the new insulin, Saoirse went into remission. (She obviously didn't get the memo. )

If your vet is a little hesitant at the prospect of your monitoring BG at home, you might consider starting with a reliable pet meter like the Alphatrak. It returns readings very close to those given by lab analysers, but the test strips are pricey compared to the GlucoNavii or SD Codefree (human) meters. Part of that cost could be offset against the fees for running curves at the vets (not required when monitoring BG at home - and the home data is more reliable because readings are not affected by vet/travel stress).

As others have mentioned above, we have spreadsheet templates that you can use to record your little fella's BG readings, and you can share the read-access link with your vets so that they can monitor his progress. All going well, with a little time and data gathering, you and your vets would feel more comfortable with the process and you could then consider using a more economical human meter thereafter. (NB: A different BG reference range is used with human meters.)

I sincerely hope you will find the knowledge and support you need here to help your boy.


Mogs
.

 

PS:

I see you've had a couple of recommendations for Levemir (insulin detemir), one of the depot insulins (where the body builds up a little 'tank' of insulin in the tissues which releases over time). It is typically longer-acting than Prozinc in cats.

Your vet may be a little more familiar with another depot insulin called Lantus (aka insulin glargine) or its biosimilars (Basaglar/Semgee) and they might first suggest that as another insulin to try. However, the reason why Levemir is recommended instead of Lantus for higher-dose kitties is that larger Lantus doses can sting, something that isn't an issue with Lev.

PPS:

Another practical suggestion. If you haven't already discovered it, Cat's Best Original cat litter (granules, not pellets) is an absolute godsend for diabetic cats. It's a plant-based clumping litter. Clumps are easy to remove (doesn't turn to concrete) so the litter stays fresher longer, and you can top it up a few times before needing to refresh the tray completely. Odour control's excellent, and it's easier to dispose of the soiled litter.


Mogs
.

 

Another former acro cat caretaker here. I just wanted to welcome you to the forum and say that, although it might feel like you’re being hit with a tsunami of information right now, you really are are in good hands here and are being given stellar advice.

It is a lot to absorb, so please take your time and ask questions. I remember well those early days and how confusing this whole feline diabetes thing was. But just like a Polaroid photo (if you’re old enough to remember them!?), the darkness gradually turns to fuzzy images, and slowly but surely the picture becomes clear. So stick around if you can … we’ll be happy to help you.

 

Phew! Sorry I've not been online for a while and thanks to everyone for all the suggestions

My cat is called Baxter

I intend to email my vet with the salient points

I wonder if someone could just summarise why Levemir is a better insulin than Prozinc

And also the drug that was mentioned is of interest to me if there is a link to the study that would be really helpful

My cat is eating Purina Proplan Diabetes Management dry food which I get through Pet Drugs Online

I live alone so handling Baxter can be a struggle which is an issue for home testing

He is used to being injected now but that was awful to start with and took me 6 weeks and a lot of tears to resolve

So home testing may be an issue. I have mentioned this to our vet in the past but didn't really get a handle on how he feels about this but I will ask again.

I'm grateful for everyone's support!

Thank you

 

New paper on: Cabergoline treatment in cats with diabetes mellitus and hypersomatotropism
Cabergoline as a possible treatment for acrocats: discussion

At the high doses aero cats use Lantus/glargine tends to sting but that is not the case for Levemir. As compared to ProZinc, I say Levemir gives flatter curve but do not know about stinging w/ProZinc.

 

Hello to super sweet Baxter as well.

Larry posted the latest study on cabergoline. The South American group who wrote the paper have had dozens of cats on cabergoline with good results. The Royal Vet Clinic did a much smaller study (5 cats) and for a shorter period of time with not as clear results. Our experiences here tend to mirror what the South American study has shown.

Our experiences with cats that have switched from Prozinc to Levemir is that it does seem to produce flatter curves, showing that it likely has greater duration in larger dose cats. More telling, of the many that have switched from Prozinc to Levemir, none have switched back.

There are many members here who have been the single caregivers for their cats. It takes time, but they have learned to test their cats on their own. It took many months before my husband would help with testing, so I was doing it on my own when I started. Start slowly. I had Neko in my lap and cuddled her, fondling her ears and giving her a treat so she associated good things with the session. Gradually I worked towards testing. I wasn't very good at it at first, I have a bad reaction to blood and not fond of needles. I also shed lots of tears. But I knew it was the best thing I could do to keep her safe so I persevered. Some people sing to their cats, it relaxes both them and the cats for testing. Cats can sense apprehension. And as I said before, who cares what the vet thinks. This is your cat, not his/hers. You don't need their permission to keep your cat safe.

 

You can either paste an image into the text box, or drag and drop an image if you are on a computer.

 

No image appears just an icon with "" appears.
What is format/extension of the file? JPG?

 

What is format and file size? I copied and pasted my DeeDee's it is a .jpeg with file size of 79 kb
I am using macOS and got same result with Chrome and Safari browsers.

 

This is what your image post shows for me:

 

Try dragging the image into the reply box vice copy and paste.

 

What browser and operating system on your computer?
Posting images with phones usually does not work

 

Test from my Win 10 computer w/photo downloaded from Google photos


Did you first download the file from Google photos and then copy/paste or drag the downloads to the reply box?

I think you just copied the photo from Google Photos w/o downloading and got this URL. If I try to pen the URL I get prohibited sign since I am not authorized for your Google photos
https://lh3.googleusercontent.com/r...l9JYy4tQSTKRglELKa7yu=w343-h608-no?authuser=0

 

Hello Larry

I'm not a tech person but it really doesn't matter if the image isn't viewable.

I was just sharing an image of Baxter as I know people like to see the cat.

If it was possible to just upload a file I would. There is a tab for that on this site but the action is prohibited according to the msg I get when I try.

I have found the advice really helpful but I'm not worrying about the image.

I've deleted the post with the Google photos image it.

Thanks for the comments. : )

 

Hi Mogs

I have spoken to my vet. We have agreed to trial the Cabergoline after Easter.

Levemir is only available as a pen (for humans) and the pen only has 1 unit intervals. We go up by half a unit a week.

If anyone knows what the side effects have been for cats on Cabergoline that would be helpful.

Thanks to everyone who has given advice.

Claire and Baxter

 

You can use regular U100 syringes to withdraw the insulin, that's what we all do. With the pen needles you have to prime the pen before each shot which wastes insulin.

What is his current dose? Dose changes are roughly 10-15% of the total dose, so above 5U we do half units, above 10U it's 1U, etc. The exception being if you're close to a good dose, smaller adjustments to fine tune

The most common cabergoline side effect seems to be diarrhea for the first week or two, but not all cats get it.

 

Hello

Baxter is on 9.5 units of Prozinc twice a day. We only went up to that 6 days ago though.

We've only ever gone up by 0.5 unit doses to date so that sounds right

 

Ok. If you have a spreadsheet we'd be more than happy to look at it.

What is your reduction point? Meaning, at what BG would you reduce the dose? ProZinc has two dosing methods here - one you'd reduce at 90, the other you'd reduce at 50 on a human meter or 68 on a pet meter. I'm not sure if you're following either of those, but if you're working with a low reduction point like 50 or 68, we do recommend raising that to leave a little extra room for safety when you start cabergoline.

 

Hello.

Baxter has very high blood glucose. We are in the UK so the units are different.

His last blood glucose was 24.7. (At the vets. I know this is higher than it would be at home but it is still much higher than when be was first diagnosed with diabetes 18 months ago and acromegaly a year ago). So we don't reduce doses.

We don't do home testing. No spreadsheet other than water intake, weight and vets blood glucose measurements).

He drinks around 1l every 24hrs so I feel confident that his blood glucose is way up there.

 

The World spreadsheet template that we use will have one tab where you enter your data and a second tab that will automatically convert your UK/world format to the format we use in the US. I'm tagging one of our members, @Bandit's Mom, who can help you with getting Baxter's spreadsheet set up.

 

Hi there. I have a spreadsheet. It has his units of insulin, water intake and vet's blood glucose test results in mmol/l. There are websites that convert to mg/dl. So Baxter's last reading 9 days ago was 24.7 mmol/l = 444.6 mg/dl (on 9.5 units twice a day). He has been over 20 mmol/l (360 mg/dl) since July 2021 when he was on 7.5 units of Prozinc twice a day. So we are way over the 'reduction point' of 68 (3.8 mmol/l). He has never had a value as low as that since he was first tested in November 2020 (18 mmol/l = 324 mg/dl). So I'm assume we are OK to go ahead with Cabergoline. My vet will see him weekly and will always see us if needs be. I was just wondering what the side effects of Cabergoline would be in cats with acromegaly? I don't know about the two schedules for Prozinc. We just follow the leaflet.

 

He really needs more frequent increases, but that is only safe to do if you are home testing. One test at the vet does not tell you what he is doing all the other days and nights in between. Many cats go low during one cycles then bounce high for the next few, come down low, repeat.

Please take a look at my spreadsheet for a drastic example of a cat that started cabergoline, but it does happen. Start on July 1, 2021. You can see how very fast his BG and dose came down; if I were not home testing and adjusting that dose every day he would be dead from a hypo.

There is no knowing how a cat will react to cabergoline, but the only way to keep them safe is home testing. It is not that difficult to do once you get up and running.

I will also add - excess thirst and urination are not only symptoms of diabetes, so I would not rely on those to infer BG. ProZinc can drop some cats pretty far on any given cycle, then on that same cycle way back up above renal threshold. So he could still be drinking a lot but seeing low numbers

 

Good afternoon.

Thanks very much for sharing your spreadsheet. Is 'AMPS' your blood glucose measurement please?

I can see that you sometimes test every hour after dosing.

We always get Baxter's blood glucose tested at 6hrs after his morning dose. I know the variability involved but it has been a good indication of his condition to date. I am at home with Baxter most of the time so if anything untoward happens I would know about it and to date he has had no hypoglycaemia.

I know that excess thirst and urination are not only symptoms of diabetes but there is no indication of kidney disease. Baxter has continued to gain weight and rarely vomits. And he has had blood tests for the full plethora of conditions that would affect an 11yr-old cat.

However, his water intake is no longer a good measure of his blood glucose and I will talk to my vet about that when I see him on Wednesday. I will also mention your cat's rapid response to Cabergoline.

He won't want to put Baxter at risk.

Thanks again, Claire and Baxter