Non Urgent Questions

https://www.felinediabetes.com/FDMB/threads/10-29-bg-testing.254811/

i have not posted in about a month. We are chugging along but I do have a few questions.
1. She seems to want to eat non stop in the morning - she can easily go through a can a Friskies Pate. Should I be feeding her what she wants or limiting her intake? I know if she eats shortly before I test her the test will of course be higher (not that she is ever low anyway).
2. I have slowed down the insulin increases a bit because her sugars have come down a bit but are sill high - when you all are giving high doses of insulin to you break it down into 2 injections or just one?
3. Her head seems to be broader across the back - I assume this is due to the tumor on her pituitary.

I keep hoping everyday the Cabergoline will do its magic but so far I think we are about the same. She seems happy although I have noticed she is not as steady on her feet and she no longer sits to eat but lays on the counter and eats. Not sure I am going to win this battle for my girl but we keep trying.

Thanks for any opinions or advice

 

1. does she scarf and barf? are you feeding in between meals? I might do half a can in the morning and half in the afternoon if you are home. is she getting another full can in the evening?

2. 2 injections, one in the am one in the pm. Don't slow down the increases... it will just stall any progress and her numbers will stay high. She's due for another increase. They need what they need, esp with Acro.
3. most likely, yes. bone growth is common. My cat got a huge pot belly, and terrible arthritis. If you notice your cat is getting stiff look into adequan injections. They greatly improved my cat's quality of life for several years.

 

She does not throw up - for that I am thankful - so while she eats fast I do only give her about 1/4 can at a time but that being said she eats small amounts from about 0630 to 0830. Then sort of settles down.
And by 2 injections I meant the am and pm doses are given in 2 shots so it is not just a big shot, ie. the cat is on 40U twice a day so 2 shots of 20 units each in both the morning and evening. And to be honest regarding the dose - I don’t really see much change between 10U and 16U in her BG’s.
It could be arthritis but I feel like it could just be diabetic neuropathy also. But I will go back to increases I guess. Just so expensive even with the insulin from Canada.

 

Oh gosh! I wish you could know how much I feel for you and Bootsie and how much I can relate to what you are experiencing. Hugs! First, I see that it was only November 2 that you started giving the Cabergoline daily, so I am hoping that she will show a response from that within the next few weeks.

Next, with regard to increases, I would continue to follow TR. You won’t probably see incremental decreases in her BG with each increase. With my boy, I saw little change at all as I kept increasing. I was more than discouraging. I felt hopeless. I felt like it made no difference whether I gave insulin or not. It’s not a linear function where you give a little more insulin and the BG goes down a little- at least not for my kitty for a long time. What happened is that things started to change when I approached his “good dose.” Then the Cabergoline started to help. But I would encourage you to keep trudging along with the increases because it is very hard on her kidneys to be over the kidney threshold. Acromegaly itself is hard enough on the kidneys. I will send this long message now and then add more in a separate message. Hang in there. Keep fighting!

 

As for injections. If I could fit it into one syringe, I just used one. I reached the point where I was using two syringes. I opted for less pokes if possible. Of course, if I was giving R insulin as a supplement to the Levemir, there was an additional poke.

 

As far as feeding. My boy had a huge appetite. I fed him as much as he wanted of low carb pate food. I was happy for him to eat. Later on his appetite was not so great and I wished for the days of big appetite again. I wanted him to be happy and not to feel hungry all the time. He usually ate a lot in the morning and at his evening meal. I know people will say to not fill them up too much in case their BG drops too low so you can get them to eat to bring their numbers up — but that is a total NON issue for you right now. Also, even when my boy dropped, He either ate or I could always give him Karo. His appetite was not as voracious when he got into better numbers. Low carb food didn’t bump my Darcy up much or for very long, so I was able to let him eat what he wanted. How do Bootsie’s BGs respond to her regular food?

 

This concerns me a little bit. Have you started her on Zobaline for diabetic neuropathy? And have you had any bloodwork done on her recently? When Darcy started getting weak in his back legs it wasn’t neuropathy but high phosphorus due to kidney disease. Once I got it under control, his nerves were able to receive signals again and he could walk and jump well again.

 

Thank you - I cry frequently because I can not fix her and feel so hopeless.

 

Ok I will continue with the TR and hope the Cabergoline will kick in soon. I can fit more insulin into her syringes but it is just such a big shot. Her appetite is good, not voracious but good. I do have the Zobaline for her but I have not given it for about 2 weeks because then she won’t eat the food if I sprinkle it on. I opted for the Cabergoline as the more important med to get her to take. I can ask my vet to do labs to evaluate her kidney function. Last night someone pee’d outside the box so I will watch to be sure she does not have a UTI. My vet is super helpful and as concerned for Bootsie as I.
Thanks for your support Suzanne.

 

keep an eye out in our supply closet forum for people giving away insulin. I got several bottles for free which was really helpful when i went through a bottle every three weeks

 

I had not considered that. Thanks

 

I understand that hopeless feeling. PM me any time you want to vent or cry. Sometimes it feels like nothing you do is making any difference! I am pulling for Bootsie so hard!

 

Thanks

 

So you can’t pill her with a piller? The pills also break up very easily and can fit into a gelcap if you can pill her but are worried about the taste. Or can you mask it in some cream cheese, velveeta type cheese (do they have that junk in Canada?) or make a ball of Liverwurst with the pill in it?

 

I use SureComfort syringes that come in 1/2 mL so you can do up to 50 units. Howie was up to 57 units twice/day so it was easier to just do the one shot instead of 2 as he sometimes wiggles when I give him his insulin. Since you’re increasing in whole units anyway, you don’t need the half unit markings. Big hugs…Howie has been on Cabergoline since Feb 2021. I’ve never seen the drastic drops that others have (he’s currently 36 units BID), but I hate to think how much he would be on if he didn’t have cabergoline. He also has both IAA and acro (532 IGF-1 result).

 

Eating - I would use your scale once a week to monitor her weight. Your vet can probably tell you a good range for Bootsie to be in. I used an autofeeder, even times I was around, cause then Neko would stare at it instead of bug me for more food. She and her friend "Otto" were best buddies. I also fed raw food - it seemed to be more filling. Or at least needed smaller amounts to satisfy her. At this point in her numbers, she will probably need more food than she will when you get closer to a better dose with some normal numbers.

Insulin - back to max six cycles on a dose if you aren't seeing blues. When you get to 20 units, size of increases goes to 2 units. One of the early members here, a vet tech, coined the phrase "be the tank, a tank always gets where it's going". So keep on those increases. You WILL get there. We just don't know what number will move her yet. With acro, you do have to be persistent with those increases as you are fighting the insulin resistance caused by the tumour. Also, insulin is a hormone, not a drug, meaning you just have to keep increasing and not expecting incremental improvements in numbers with dose increases. You will start to see better numbers as you home in a better insulin dose.

Yes I have seen people use multiple syringes for larger doses. I think I'd hold off until you need to.

One other random thought on insulin, have you ever considered a switch to Levemir? Many higher dose kitties seem to get better duration from Lev. And a large number feel the Lantus sting at higher doses.

Mobility issues - get the vet to check her out for arthritis. Neko's was bad enough the vet could feel it by hand, eventually so could I. I tried a ton of things for Neko. Cartrophen (Canadian similar to Adequan) and hyaluronic acid/Hyaflex both which help joints, Duralactin and fish oil (anti inflammatories), and pain relief. For Neko, the addition of buprenorphine was a game changer. Made her much happier and mobile, and she became much more interactive with us and played more. I also supplemented later on with acupuncture, which she grew to like.

It's still early days for cabergoline, I've got my fingers crossed she'll start responding soon.

 

I was going to mention that I also recommend Levemir. It really made a difference for us. But I didn’t know if it was more expensive so I hesitated to go there - figuring that you had looked into it. Does it cost a lot more for you?

I also assumed that Bootsie is not overweight. That’s why I said just let her eat what she wants. I assume you won’t let her get to an unhealthy weight!

 

Levemir can be purchased from Marks Marine, if that's where you are getting Basaglar now.

I think I've seen it in the stores but don't buy it. Jackie is in the US anyway.

 

Velveeta is pretty nasty stuff, I think - from a human standpoint. I eat only real cheese. But it’s soft so I think some people use it for hiding pills. I have used pill pockets, but they’re not low carb. But I thought you were in Canada, @Jackie55 & Bootsie Sorry. I see you are in Wisconsin.

 

So, since you are in Wisconsin… I don’t think there’s very much difference in price between Lantus (Basaglar) and Levemir, is there?

 

I am not sure about the price difference between Lantau and Levemir. I will look into it and if I can get it from Marks Marine that is even better. As i have said my vet is super great about listening to what I am learning from this site and willing to do whatever I need. Thanks

 

I’m in MN and get my Levemir from Marks Marine Pharmacy as mentioned earlier. Howie was on ProZinc before but responded nicely to the Levemir switch. I get 15 pens at a time which is the max they will ship. Their customer service is superb and reorders are very simple. I highly recommend. The nice part with Levemir is that he doesn’t have drastic peaks and valleys with his BGs. He stays relatively stable. With TR, I’ve been able to keep him in greens and low to mid blues, supplementing with Novolin R when I need to so the Levemir has something to work with when he’s higher than I’d like.

 

I'm in Ohio, and have not had an issue with Marks Marine. I just get the extra cold packs/insulation in warmer weather.

Echoing the others, I really liked Levemir