How to test for Acromegaly in Australia

Hello Everyone,
Does anyone know if it is possible to test for Acromegaly in a diabetic cat in Australia and how much it might cost? All I seem to read online is links for testing in the USA.
Thankyou for any info.

 

Hello, and a warm welcome to FDMB,

I'm sorry to hear that you think your cat might have acromegaly. May I ask what is making you think that? (Insulin resistance? Body changes?)

There is an acromegaly forum on this site, but it doesn't get a lot of traffic. However you may like to take a look at the 'Cat Acromegaly' site (an offshoot of FDMB) here:
http://www.catacromegaly.com/501.html
There is also an Australian general cat health forum here:
http://www.cat-world.com.au/forums/index.php?/forum/94-cat-health-support-group/
But hopefully someone seeing your message here on FDMB may also be able to help.


Elizabeth

 

Are you actually in Australia (ie as opposed to posting on behalf of someone else who lives there)? If so, what has brought the condition to your attention? If it is apparent insulin resistance, don't automatically assume your cat has acromegaly. It may be but it may not be. Is your vet making you think acromegaly could be among the issues? - in which case, can you ask him/her what the cost of a test is? It is really only a medical professional in your own country who can advise of costs (it would be a more specialised one than the routine ones run in-house). My own cat Tom had acromegaly; we are in the UK and I don't remember any particular issues about a test here, so I would think that Australia would be equipped to offer the test too.

Good luck.
Diana

 

Hi Elizabeth,

I will try to give you a brief history of Tom's diabetes so far. Tom is a rescue cat who is jointly owned by my sister and I (approximately 7 years old). Please forgive me for my early ignorance on treating diabetes as we originally believed that our (former) Vet was knowledgeable on the subject and that we could trust his judgement.

He was originally diagnosed in February 2011 after gaining some weight combined with all the symptoms like extreme thirst, lethargy etc.

Our Vet prescribed 4 units of Lantus, twice a day due to his being a 'bigger framed cat'. Since then we took him to the Vet every two weeks or so to have his blood glucose tested and the Vet gradually increased his insulin levels to 8 units, twice a day where he apparently stabilised for some months. Unfortunately this changed and until early December 2012 Tom required higher and higher doses of insulin but his blood glucose remained in the low to mid 20's (mmol/L). He was eventually receiving 20 units, twice a day and had lost much of his zest for life. He also gradually went up in weight despite him receiving no extra food and sourcing none from elsewhere.

Our Vet stated that he was most likely just an insulin resistant cat and that we would just have to keep increasing the dose until he responded. At this stage I had been reading online for some time the benefits of raw/wet food diets but all suggestions such as this were met with criticism. Out of sheer frustration watching Tom suffering we opted to switch to a wet/raw food and change Vets as well.

Our new Vet convinced us to attempt home testing of Tom's blood glucose and we have been testing him ever since, once a day just before his afternoon shot of Lantus.

As soon as we switched him to the wet/raw food we saw his blood glucose drop dramatically over a few days (and alot of his old spark came back). His lowest figure ever was 3.2. Our new Vet was at a bit of a loss to explain the drop and claimed that it must be a new bottle of Lantus (despite us using countless 'new' bottles over the last two years). She also was at a loss to know how we should now dose Tom as she had never encountered a cat with such high levels of insulin use and only had guidance on hand for cats that are on a few units of insulin. She told us to drop his dose down to 15 units, twice a day over the next few days and from there we managed to steadily drop his dose down as far as 9 units, twice a day, because his blood glucose seemed to be quite low (all over the place but low). We had no guidance or direction on this matter and even the internet does not seem to offer any other cases of cats who are on such high insulin levels then drop down quite so dramatically. So, apologies if this was the wrong approach to make but this is what we had been told.

Since then (approximately three weeks ago) Tom started getting figures back in the early 20's. Despite this his neuropathy (which he developed mid 2012) in his hind legs showed some improvement. Our Vet's only advice has been to gradually increase his dose again. This seemed to result in him having a good reading one day then gradually have his blood glucose climb up until it was in the 20's again at which point our only option seemed to be to increase the dose again.

He is now on 13 units of insulin, twice a day and for the last week his readings go up one day then down the next consistently, ie 12.9, 18.8, 11.9, 20.2, 6.1, 17.1. He has, however, gained no extra weight since being on wet/raw food. He is 7.4kgs but as claimed by the Vet he is a 'large framed cat' as well. We feed him the raw food diet as per the Cat Nutrition website, 100g per serve, twice a day but he is always very hungry. I have noticed recently that he is drinking a bit from his water bowl which he was not doing in the weeks previously and this is despite me mixing lots of water into his food. His dandruff has also returned after disappearing initially on the wet food diet. The Vet has tested his urine for infection and organ problems but found none.

I am just wondering if his weight increase (he does not appear fat but more in proportion with some fat all over), his high insulin use, his constant hunger and his slight wheezing at times (could not be determined by the Vets) could be a sign of Acromegaly? Our Vet has mentioned the condition but has said that there is not really a test for it here and if there was there is no treatment. Is it normal to have a cat's readings spike up and down so much? I did spend one day testing him every four hours between shots - he hates the ear prick - however his readings on that day stayed in the 20's the whole day.

Has anyone else experienced something similar? While we have (happily) spent a huge sum of money thus far we unfortunately are at a point where there is literally no extra money left to spend on tests, hence I was enquiring if anyone knows the cost of the test if it exists here.

Sorry for the long explanation.

***Hi Diana, yes I am in Australia (Brisbane) but was wondering if anyone might have had the test done here already.

 

I really sympathise, having struggled to treat my Tom's acromegaly (undiagnosed but suspected for quite a while before the test was finally suggested by my vet and confirmed). These swings in numbers are not really unusual for acromegaly, as in this instance it is not the pancreas that is at fault but a benign tumour on the pituitary gland that can behave very irregularly (for want of a better medical description) and mimic the symptoms of diabetes.

I really think that your best bet is to seek guidance on the high-dose forum here - it may not have a lot of traffic but if you are new to the board and clearly need support, people will find you and do whatever they can to help.

Diana

 

OK...

So, if I've understood correctly, apart from 'apparent' (but not proven) insulin resistance there is nothing else pointing to acromegaly?

And whilst on insulin you switched your cats diet to wet/low carb? Had s/he previously been on dry food?

Well, yes, a minority of cats presenting with diabetes certainly DO have acromegaly. And some 'ordinary' diabetic cats do need larger than average doses of insulin. However...(and this may not be the case at all with your cat, but please bear with me)... The dose that your vet started you on - 4 units of Lantus - was a huge starting dose. Do you know what your cat's blood glucose levels were at that time?

It just strikes me that there is a possibility that your cat was prescribed too much insulin initially and that s/he may be suffering from chronic rebound. 'Rebound' means that, the cat's blood glucose having dropped too low, the body then responds with putting glucose into the system as a protective measure, and also other agents such as glucagon that cause temporary insulin resistance. So, people often see high pre-shot numbers and assume the cat might need more insulin.

So, you're testing each day before insulin shots? And are you getting any mid-cycle numbers?

I really don't want to give you false hope here. But I do think we need other eyes on this so I'm going to post on the Lantus forum here about this and get some 'experienced' Lantus eyes here. Will also post a link in the Acromegaly/High dose forum.

Eliz

 

I agree with Elizabeth. That was a very high initial dose that your cat was started on. I don't have personal experience with Acromelaly, but I am going to get some Lantus eyes on this, and I would also suggest that you post in the Acromegaly/High dose forum to see what the folks most experienced with these conditions have to say.

 

Hi Diana, I am very sorry to hear about your Tom. I will have a look where you suggested, thankyou.

Hi Elizabeth,
Yes, nothing proving Tom has Acromegaly at present.

Tom was originally on a prescription dry food for a UTI that he had in 2008 and then our (previous) Vet changed that to a prescription 'Diabetic' dry food and so he has always been on dry food with the exception of a teaspoon of commercial canned food that he gets as a treat to distract him from having his shot. Now he is ONLY on homemade wet food.

Yes I can see now that 4 units was alot - we really had no idea at the time. He is only tested once a day before his afternoon shot at present. Mid cycle I have only tested once before due to the fact that often we are both working so are not always home at that time (his readings stayed high that day all day). I can test him again tomorrow all day to see if I get a different result. Do you think every four hours is an OK interval to test?

Thanks to both of you for your responses.

 

Hi, and welcome to the board!

I would test as often as you can to ensure that he/she's not dropping too quickly, and be sure to mark it in a book so that you can transfer the #s to the spread sheet. I would highly recommend getting a spread sheet set up so that you can post your kitty's #s on it. Be sure to put it in your signature so that the experts can quickly click on it and see how he/she's doing. Here's a link on how to create one for him/her:

http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207&start=0

Here's the main link where the above came from, but it also has a whole lot of information on it to look over, including how to do curves, etc.

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=18139

Here's the Tight Regulation Protocol that is followed. This helps us to control/manage our kitty's diabetes:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Most of us increase doses by 0.25u, and in some cases by 0.50u, but that's not too often. Your old vet suggested 4 units of Lantus to begin with, and frankly I think that's a bit too high in the beginning. Most, if not all, of the people on here start dosing with 1u BID (2x a day), and then increase by 0.25u after 3-5 days (6-10 cycles... A cycle being a 12 hour period). Lantus is a 12 hour insulin, and needs to be administered every 12 hours (but then, you probably already know that).

A low carb diet is the key with helping to reduce the blood glucose #s. Some cats do well on a higher carb diet than others, but it all depends on the individual kitty. My cat, Blackie, can't have a high or medium carb diet as it'll spike her #s through the roof. Even a crumb of contraband (the kibble that the others eat) will spike her. So, she's on Evo 95% Chicken & Turkey 8x a day as mini meals. You may need to divide the 2 meals that you're feeding into several smaller ones throughout the day. This will help to stabilize the #s better, and also help to keep your kitty fuller longer. Eventually, he/she will begin to show less signs of being so hungry, but it'll take time.

Make sure that he/she has plenty of fresh water available, and you can always add a few teaspoons of water to your kitty's food. This will help to keep ketone levels in check, and possibly avoid them. If your kitty is in the high range of #s, be sure to get a ketone check by placing a ketone strip in the stream of urine as your kitty urinates (or get some fresh, cleaned aquarium gravel, place it in the bottom of the litter box, and collect the urine that way... Make sure that the regular kitty litter is out of the box before you do this).

I have no experience with acromegaly, so hopefully an expert can come by and help you with that. Good luck, and welcome!

 

Some people use a soup ladle under the tail to catch the pee. I hold a very small plastic cup under my cat's tail to catch a sample of pee for ketone testing.

 

Hi again,

Wow, well done for feeding homemade cat food! Your cat is very lucky in having you care for him. :smile:

As for how often to test, well, I don't use the same insulin as you but my understanding is that the peak of the Lantus cycle (lowest blood glucose) typically happens about 6 hours after the shot (but 'every cat is different'..) So, getting a test in at around that time would be especially useful. And any other tests you can get - especially in the first half of the cycle, would be good too...

If your cat does have acromegaly though, or indeed if he has a 'rebound' problem, then you may not see a 'typical' Lantus pattern. You may see eratic numbers or just high flat numbers...

I've posted a link to this thread on both the Lantus forum and the Acromegaly forum, and I really hope you get some experienced help soon.

Eliz

 

Some useful info here from one of the 'stickies' in the Acromegaly forum:

"How do we spot a potential acromegalic cat? Questions we ask.

*Cats are normally flagged up as potentially not being 'normal diabetics' when they are getting higher than normal doses of insulin and/or it's proven difficult to get control over their BGs.

*Just like a 'normal' diabetic cat we think/ask the same questions of a cat’s mom/dad before we think of acromegaly – basics such as appropriate diet, right insulin and doses, and hometesting need to be sorted out first. For example:

1) How long has your cat been on insulin?
2) At what insulin dose did you start?
3) How was the insulin increased and by how much, and over how long a period of time?
4) How did you determine that an increase was needed?
5) Are you home testing now, and if so, have you kept a record?
6) What food are you feeding?

*Once the more common causes of having a cat on high insulin doses have been dealt with, for example dry food, too fast dose rises, infection, etc., - then we start thinking that something else might be going on.

*Acromegalic cats typically have certain patterns or issues going on with them that act as 'red flags' to point us towards thinking 'acromegaly'. It's a collection of these issues that just aren't 'right'. We then start asking more hi-dose specific quesitons such as:

7) Have you noticed changes in the way your cat breathes? Any changes in their eye sight?
8) Have you noticed any behavioral changes in your cat? For example, appearing to be in pain, avoiding bright light.
9) Have you noticed any physical changes in your cat's appearance?
10) Has your cat had a tendency to gain weight despite no increases in amount of food you are feeding?"

 

I have a couple of thoughts...

There is an expert in using Lantus and Levemir for the treatment of diabetic cats in your part of the world. If anyone would know where testing is available, Jacqui Rand, DVM at University of Queeensland would know where those resources are. She directs the Centre for Companion Animal Health. Dr. Rhett Marshall, who has published with Dr. Rand and who is also an expert on Lantus and feline diabetes, is affiliated with The Cat Clinic with locations in Mt. Gravatt, Paddington, and Clayfield.

With Lantus, the starting dose is generally based on a weight-related formula. (Initial dose = 0.25 x ideal weight in kilograms). This would take your cat's "large frame" into account. As others said, it's possible that the initial dose was too high and this has put a cyclic pattern of high and low numbers in place. I think the only way you are going to know if is you test more. Most of us test at each shot time and at least once during the times between each shot. What has complicated your dose picture is that your vet(s) have been advising you to adjust your dose based on the pre-shot numbers. Lantus dosing is based on the lowest value in the cycle (the "nadir"). As a result, if the dose was too high at the outset, the problem is being compounded and your kitty is over what would be a "good" dose.

That said, it is possible the your cat has a high dose condition. The test for acromegaly is a test for IGF-1 (Insulin-like Growth Factor-1) and for the other high dose condition, IAA (insulin auto-antibodies). Cushings Disease is another high dose condition but I suspect you would be seeing other symptoms than just a high dose by now.

 

Hi there and welcome

I'm afraid I don't know if there is a lab in Australia that can test your kitty for Acromegaly or IAA (another high dose condition). Perhaps one of the universities; my Black Kitty's blood sample went to the University of Michigan for testing.

I'm glad you learned how to test your kitty's blood glucose levels - home testing is key to making dosing decisions that keep your kitty safe, particularly if your cat has a condition that causes fluctuations in blood glucose levels. Also as you discovered, getting rid of the dry and switching to wet low carb makes a huge difference.

Please check out the links Angela provided. Getting a spreadsheet set up is essential and will help us help you.

We all have links to our kitty's spreadsheet - have a look at some of them. My Black Kitty is a former high dose kitty. You can see we arrived at his highest doses gradually and carefully - all based on the numbers. High dose or not, careful monitoring is essential.

I'm sure others will chime in. There is a wealth of information here

You have come to the right place for learning to treat feline diabetes, regardless of the underlying cause.

 

Hello,
If you are feeding a raw diet and giving a dose of 11u-13u twice a day and your cat has not ended up in the ER, I have a feeling you have some insulin resistance existing.

The tests that are done for acromegaly and IAA are as follows..... you may want to print the links and take the sheets to your vet to enquire where such test can be done for you.
IAA Test
IGF-1 (Acro) Test

I would guess that starting with U of Queensland because of Dr. Rand would be a good point to ask about local tests.
There are some acro owners in UK and Turkey, and I believe there was one in Australia a very long time ago. I'll ask around the acro group's owners to see if they have some suggestions for you.

The hunger..... let the cat eat because acros have quite the appetite. As you approach regulation, whatever dose that may be, you will see the hunger subside.
Both of my acros ate like crazy at the start.... Shadoe got up to 24oz/day and Ollie was around 30oz/day...around 680gr and 850gr. Once they settled in dose, the dropped to more like 6oz/10oz or 170gr/285gr.

Home testing will safe you a bundle of cash and will keep your cat safe because cats with acromegaly are not diabetic, but rather have diabetes because they are diabetic.... there is nothing wrong with your cat's pancreas.

Cats with acromegaly CAN go off insulin and it can happen very quickly, so it's important to be testing before each shot as well as at other times. My Oliver's highest dose was 37units Levemir twice a day, then he dropped down to around 21units twice a day for awhile. He had his vaccines Dec21/11, got very sick and he went off insulin within 10days, his recovery took a couple months. Home testing let me know when he did not need insulin.

 

Hi Lenke -

My Grayson is an Acro-cat. We were initially on ProZinc insulin, but changed to Levemir as it's a longer-lasting insulin, as is Lantus. Kudos to you for changing the food up already and for doing the raw diet.

Grayson is better controlled now, but initially he was eating as many as 10-12 3 oz cans of Fancy Feast at his most ravenous. He's large - always was a LONG cat, but eventually got rounder. Then shrunk from 22 to 18# at dx of diabetes. We struggled for several months without getting him out of the 300s much. We switched to the Levemir and climbed up the dosing ladder fairly quickly. On lower doses, teh .25 or .5u increase is pretty standard. As we climbed into the higher doses, I usually increased by 10-20%. At REALLY HIGH doses, that's a heck of an increase.

I posted the following on the Acromegaly Facebook site - don't know if you're over there yet, but I would encourage you to do so. That's where most of the Acros & High Dose kitties are located.

I remember reading that one of the major FD studies was done in Australia, if I remember correctly (see reference above - Univ of Queensland)... perhaps that institution can do the IGF-1 or can identify a MEDICAL (non-veterinary) facility that can do it for them. CSU folks said pretty much all vets send endocrinology tests to MSU - as that's their expertise. Would like to think there's a place there as well. If not, I certainly would have them get in touch with MSU and see if they can recommend somewhere that would be in a reasonable distance to do the testing. I'd hate to think what overnight shipping would be from across the pond.

No one here has suggested you start back at the beginning - at a normal starter dose like 1u, and gradually increase. After all this time, however, I'm not sure that would be very effective - perhaps someone would like to chime in on the value of doing so.

The highs and lows you're seeing could be a lot of the bouncing as the body is reacting to such a high dose. That being said, it may be that you need even more insulin if he's Acro or just a high dose kitty - but it's essential that you have a good record of his numbers and where he's going throughout the cycle before either should be considered.

Please let me know if I can answer any specific questions.

Lu-Ann

 

Hi Lenke,
I was just googling feline acromegaly articles and Insulin-like Growth Factor (the name of the test used for acromegaly) and found this source in Australia:

Rodney Shearman Endocrinology Laboratory, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia

My cat Norton was an acrocat - he passed away due to cancer unrelated to the acromegaly in 2008.

A few acrocats have needed more than 100U BID -- so if your kitty clearly needs more insulin, don't stop at some artificial limit.

Just keep in mind -- that cats with acromegaly probably have a healthy pancreas that is producing insulin, so we don't aim as low because food can cause blood sugar to go DOWN FURTHER! as it stimulates the pancreas to kick out insulin.

It is safer to keep an acrocat between 100 and 200 blood sugar (5 to 11) instead of aiming for 54to 100 (3 to 5)

Good luck!
phoebe

 

It just dawned on me that you are in Brisbane.... same as Dr. Rand.... U of Queensland.
I bet starting local would let you know if you can test locally or have to get the blood draw shipped out to Camperdown.

 

Thankyou to everyone for your replies and suggestions.

I will pursue the availability of the test here with the information provided.

 

Please stay in touch and let us know how things go.

Good luck!

Eliz

 

Hi Lenke,
I'm from Brisbane and my kitty is suspected of having Cushing's syndrome, though with his other health issues and the huge cost of diagnoses and treatment of Cushing's, we decided to not follow through with his testing. The vet I have just started going to (today in fact), is fantastic, and suggested referring me to the The Cat Clinic in Mount Gravatt, she told me they are absolute experts in all feline health issues. Here is a link to their site they even have some price lists which may possibly help: http://www.thecatclinic.com.au/how-to-contact-us/ Maybe you can give them a call and ask if they can help?

I'm so sorry I can't help you with any other information, I'm new to FDMB, and even though my kitty has had diabetes for nearly a year now, I'm just learning all the bits and pieces as my vet knew absolutely nothing (I feel so bad that I stayed with my vet as long as I did)! I feel for you with the expenses of vet care here in Australia, since my boy's diagnoses we've shelled out over $6000 in the last 11ish months. I too am at the point where I really can't afford anything much, he's eaten through all my savings lol; my beloved kitty has diabetes, stage 4 chronic kidney disease and I just found out today that he also has possible Cushing's Syndrome, a heart murmur and has hypertension...my kitty certainly likes to be special!

I wish you the very very best in finding out everything you need to with your furry baby and hope he stays happy and strong!

Bebe and Milo

 

If it turns out you can get the test for acro, that'd be optimal.

A possible way to check the dose would be to hospitalize your cat, have a catheter inserted and serial monitoring of glucose levels with insulin dose monitoring. Ie in a controlled environment, they could see what happened with no insulin, then test various insulin doses.

Here's another thought - there might be a research or human lab that can differentiate between types of insulin and identify if it was feline insuline, or the injected insuliin.

 

I have a friend in Melbourne who had an FD cat who had IBS, allergies and feline eosinophilic granuloma complex. I emailed her to see if she knows anything about testing for acro in Oz. Will get back to you ASAP as soon as I hear back from her!