New Member - possible Acromegaly - worried

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Nell

Member Since 2020
Nell had a CT scan yesterday after high blood sugars of 335 (18.6mmol/L) were found in her blood work at the vet’s (as well as a high fructosamine result of 489 umol/L). Her Spec fPL was slightly elevated, as well as her cholesterol and ALP. Diabetes was suspected but she has also had behavioural changes and clearly does not feel very well or happy (seems very uncomfortable and depressed) despite wanting to eat vast amounts - hence the CT scan which showed a “large mass arising from the pituitary“. We are currently waiting on the results to confirm acromegaly. She was started on 0.5 of a unit of Lantus last night, to be given twice a day (She weighs 5.5Kg).
This is all very scary stuff as she is a somewhat fractious cat when it comes to handling her. It took two of us to give her the insulin but how on earth can I know what her blood sugars are doing if I can’t test her blood? I have Keto-Diastix urine strips but waiting to get a sample is a nightmare... she finally had a wee 7 hours after this morning’s shot of Lantus and it has dropped to between the 259 and 500 mg/dL from around the 1000 mark - not really sure what that means and whether it equates to blood levels. Earlier on she seemed a bit more unsteady than usual but I don’t know where her glucose levels were. Has anyone had success with a Libre continuous monitor? The vet just wants me to monitor her clinical signs and report back in a week - she said she didn’t want me to try to prick test her. I’m worried sick especially if we need to increase her Lantus... any suggestions would be appreciated.
 
Hi and welcome to you and Nell.
I’m sure you are very concerned about Nell but you have come to the right place. We can help you. Yes, people have used the continuous Libre monitor. It is certainly worth using in the beginning if you think you might have trouble home testing.
But I have to tell you almost everyone can home test. We have had people arrive who say ‘I could not possibly test my cat’ But they find they can. It’s a matter of patience, getting Nell used to having her ears touched and more patience ..... bribery and corruption goes a long way:joyful:. We suggest offering a treat every time you test whether you are successful or not and cats cotton on very quickly that tests= treats.

I’m going to tag @Wendy&Neko as she is very experienced with Acro.
all the best
Bron.
 
Thank you for getting back to me so quickly Bron. To add to the ear testing problem Nell is black and has dark skin, and my eyes aren’t what they used be, so I can’t see what I’m doing! I know not many people seem to use the pads but could this be an option where I have a bigger target area?
 
The thing about cats with acromegaly, they are usually very interested in food, and very open to bribes. My girl also had dark ears. I put a very tiny bit of vaseline on the ears so the blood drop would well up and not get hidden in the black fur. I put a small flashlight under her ear, along with a gauze make up pad. That helped illuminate things. Other people have used craft head lamp/magnifiers.

There are a couple conditions that a pituitary tumour can cause. One is acromegaly, the other is Cushings. Typically people will get the blood test for acromegaly done first, as it's much cheaper than a CT scan.

This post has a discussion of using the Libre. Click the blue link.
 
Poor kitty. I have an acro cat. She was diagnosed diabetic 4 years ago in May. Fortunately she's cooperative with testing her ears so I'm thankful for that. You would just have to prick the very outside edge of the ear.
 
Wendy&Neko said:
The thing about cats with acromegaly, they are usually very interested in food, and very open to bribes. My girl also had dark ears. I put a very tiny bit of vaseline on the ears so the blood drop would well up and not get hidden in the black fur. I put a small flashlight under her ear, along with a gauze make up pad. That helped illuminate things. Other people have used craft head lamp/magnifiers.

There are a couple conditions that a pituitary tumour can cause. One is acromegaly, the other is Cushings. Typically people will get the blood test for acromegaly done first, as it's much cheaper than a CT scan.

This post has a discussion of using the Libre. Click the blue link.
Click to expand...

Thank you Wendy and Neko. That is very helpful. Do you know whether Oskar is an acromegaly cat?
 
JanetNJ said:
Poor kitty. I have an acro cat. She was diagnosed diabetic 4 years ago in May. Fortunately she's cooperative with testing her ears so I'm thankful for that. You would just have to prick the very outside edge of the ear.
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Thank you JanetNJ. I’m sorry your kitty is an acro cat but thank goodness she allows you to test. Unfortunately Nell turns into something possessed the minute you attempt to “fiddle” with her despite having cuddles and titbits - just the giving of insulin twice a day is quite traumatic for all concerned (it takes two of us). The stress is no doubt going to impact her glucose levels so maybe a try with FSL might be worthwhile - My initial consult with the internist recommended using it whereas the specialist who we saw for the CT scan (both from the same clinic) said not to use it (or test) yet until after the next fructosamine test in two weeks and then maybe if needed - presumably she means if we need to increase the insulin dose. She felt the conservative starting dose of 0.5 of a unit would not be a concern...
 
I seriously doubt that Oscar has acromegaly. The numbers and dose don't look like it would be a match. I just used that link to show you that there were several people who have used the Libre and some discussion on how to attach it. Cats taking off the meter has been an issue for some members that have used the Libre.
 
Wendy&Neko said:
I seriously doubt that Oscar has acromegaly. The numbers and dose don't look like it would be a match. I just used that link to show you that there were several people who have used the Libre and some discussion on how to attach it. Cats taking off the meter has been an issue for some members that have used the Libre.
Click to expand...

I suppose I was being hopeful that the numbers Oscar achieved would be possible on lowered doses of Lantus... I did see the potential for problems with the removal of the device or it becoming dislodged. The idea of superglue is a bit worrisome but I just don’t know what to do if Nell has to have significant increases in Lantus and I can’t test her...
 
Cats with acromegaly don't always have high numbers. Remember, insulin can help to manage the numbers. More often, it's the dose of insulin that's increased but insulin needs change. Once you have the results from the blood work, if acromegaly is diagnosed, there are also treatment options. At this point, it's one step at a time.

Many people have cats who are not thrilled (at first) about being poked with sharp objects. Treats can help -- a lot. You can set up a system of taking your cat to your testing spot and give a treat. Any time you take the cat to the spot, there's a treat. Take the cat there and scratch his ears, give a treat. Gradually work your way up to poking his ear. Even if the test isn't successful, give a treat. This is a post on the psychology or ear testing. Whether you test ears or paw pads, the principle is the same.
 
Thank you Sienna and Gabby. The post was very helpful too. I’ve been so overwhelmed and stressed by this and worried that I’ll let Nell down and I’m sure she senses the tension which doesn’t help. Last night’s Lantus shot was a debacle and I’ve bruised her which has upset me no-end but this morning’s shot was uneventful thank goodness and I did it on my own so I feel a touch more confident. While we are still on a low dose I shall attempt some testing... thanks again.
 
We have a spreadsheet template you can copy, to keep track of the BG (blood glucose) tests and the units of insulin you are giving your cat as well as lab results and lots of other useful information. You can even share the spreadsheet (SS) with your vet.

Directions for setting up the SS and linking it to your User Id "Signature" has detailed instructions with pictures for setup on a pc, tablet or smartphone. FDMB Spreadsheet Instructions

What it means is here. It's just a simple grid, where you enter the numbers, but oh so handy.
Understanding the Spreadsheet/Grid
 
I am unsure whether or not to give Nell her next insulin shot. Please can someone explain the numbers on the urine Keto-Diastix. I have not been able to get a blood glucose test done (almost a few times but not enough blood to do the test before she got fed-up). However I got a urine sample not long ago - two hours before her next insulin shot is due and it came back in the green zone (100 mg/dL or 5.5 mmol/L). This is the lowest I have ever seen it - it is usually in the brown zone (around the 1000 mg/L or 56 mmol/L). She has been fairly quiet today and hasn’t wanted to eat as much as usual. Any suggestions would be much appreciated.
 
Did you shoot, or get another test? For blood testing, make sure you have a lower gauge lancet, 26-28, also be sure her ear is warm before you prick. It will help the blood to flow
 
I frankly don't know of anyone here who uses urine glucose tests. There are inherent issues with testing urine glucose -- it's not a test of where. your cat's numbers are at the moment is one of the issues. (In other words, you cat has to wait until there is sufficient urine collected in the bladder to have the urge to pee in order for your to test. It generally takes hours for that to happen.) In addition, the urine test strips do not give you information about very low or very high numbers. It's truly a problem on the low end of the range.

As you noted, you tested 2 hrs before Neil's shot is due. You have no idea what his numbers will be at shot time and it's unlikely he's going to decide he has to use the litter box (and you'll catch him while he's there) prior to a shot.

I'm inclined to suggest skipping the shot if you can't get a blood test. As I said, a reading in the range you noted could be a 100 or it could be 30. The urine test strips don't give you an exact reading.

One option, until you get acclimated to home testing, is to ask your vet about a Freestyle Libre. This is a temporary disk (it lasts for 2 weeks) that is attached to your cat's skin and you can get blood readings any time you want. It uses a cell phone app for the readings.
 
Sharon14 said:
Did you shoot, or get another test? For blood testing, make sure you have a lower gauge lancet, 26-28, also be sure her ear is warm before you prick. It will help the blood to flow
Click to expand...

I couldn’t get another test - she won’t let me near her ears so the attempts were on her paws. I got hold of the vet and asked their opinion - I was told that if ate her normal meal to go ahead with the shot (given it’s a relatively low dose). I held off for about 40 minutes and gave her the dose. She was fine and this morning her urine sample was showing high glucose again before this morning’s shot and still high 4 hours after...
 
Sienne and Gabby (GA) said:
I frankly don't know of anyone here who uses urine glucose tests. There are inherent issues with testing urine glucose -- it's not a test of where. your cat's numbers are at the moment is one of the issues. (In other words, you cat has to wait until there is sufficient urine collected in the bladder to have the urge to pee in order for your to test. It generally takes hours for that to happen.) In addition, the urine test strips do not give you information about very low or very high numbers. It's truly a problem on the low end of the range.

As you noted, you tested 2 hrs before Neil's shot is due. You have no idea what his numbers will be at shot time and it's unlikely he's going to decide he has to use the litter box (and you'll catch him while he's there) prior to a shot.

I'm inclined to suggest skipping the shot if you can't get a blood test. As I said, a reading in the range you noted could be a 100 or it could be 30. The urine test strips don't give you an exact reading.

One option, until you get acclimated to home testing, is to ask your vet about a Freestyle Libre. This is a temporary disk (it lasts for 2 weeks) that is attached to your cat's skin and you can get blood readings any time you want. It uses a cell phone app for the readings.
Click to expand...

This is my concern, whilst apparently providing helpful information re dosing, testing urine clearly cannot give the timely info needed for on-the-spot “shall I shoot” decisions. Unfortunately it was the only tool I had. As I mentioned above, after talking to the vet and Nell eating very well just prior I went ahead with the 0.5 Unit of Lantis . I was worried sick but it all turned out OK and her urine numbers are now back to the worryingly high numbers again.

I did ask about the Freestyle Libre at the time she had her CT scan but the vet was reluctant at the time and wanted to keep it in “our arsenal” for further down the track. She didn’t see the need for me to home test at this stage (which I find odd), she wants to wait for the fructosamine test (which will be 2 weeks out from starting insulin). The fructosamine test of course won’t show highs and lows, which although not timely, I think is showing up, albeit crudely, in the urine tests. Yesterday she was quiet and lethargic and didn’t want to eat much and later showed a much reduced glucose result. Today she’s wide awake and wants food constantly and has had 2 high glucose results. I think I will have to push for the Libre ...
 
I think Sienne’s idea of using a Freestyle Libre while you get used to home testing is is very good idea.
I can’t see the point of keeping it in “our arsenal for further down the track” when it’s needed now.
It will take away a lot of the stress and indecision you are feeling at the moment because you don’t know what is happening with the BG levels.
The fructosamine test will not tell you if the numbers have been high or low....but an average, which was fine when there was no other options.......but you do have options now....
Nell is your cat and you are paying the bills....I would push for the Freestyle Libre too.
 
Bron and Sheba (GA) said:
I think Sienne’s idea of using a Freestyle Libre while you get used to home testing is is very good idea.
I can’t see the point of keeping it in “our arsenal for further down the track” when it’s needed now.
It will take away a lot of the stress and indecision you are feeling at the moment because you don’t know what is happening with the BG levels.
The fructosamine test will not tell you if the numbers have been high or low....but an average, which was fine when there was no other options.......but you do have options now....
Nell is your cat and you are paying the bills....I would push for the Freestyle Libre too.
Click to expand...

I think you are both right. I’m not really sure why she pushed back on this when the original internist suggested we use it and I agreed with him. Perhaps she is not confident inserting it... One thing I do know after yesterday is that I can’t just fly blind and while Nell is so uncooperative with the testing I’ve got to do something - for both our sakes.
 
Nell said:
I think you are both right. I’m not really sure why she pushed back on this when the original internist suggested we use it and I agreed with him. Perhaps she is not confident inserting it... One thing I do know after yesterday is that I can’t just fly blind and while Nell is so uncooperative with the testing I’ve got to do something - for both our sakes.
Click to expand...
I agree. Maybe your vet doesn’t know a lot about feline diabetes...they don’t get much instruction on it at uni.
Flying blind when you are aware of the consequences is very stressful. Go for it!

Is Nell food motivated? That helps with testing. Or does she love being brushed? That could be a reward.
 
Bron and Sheba (GA) said:
I agree. Maybe your vet doesn’t know a lot about feline diabetes...they don’t get much instruction on it at uni.
Flying blind when you are aware of the consequences is very stressful. Go for it!

Is Nell food motivated? That helps with testing. Or does she love being brushed? That could be a reward.
Click to expand...

Nell hates being brushed. She is food motivated until she gets wind of something going on and then she would rather starve than oblige. It’s very frustrating. If insulin could be put in a gel cap and smothered in freeze dried crumbs we’d be laughing!
 
Nell said:
Nell hates being brushed. She is food motivated until she gets wind of something going on and then she would rather starve than oblige. It’s very frustrating. If insulin could be put in a gel cap and smothered in freeze dried crumbs we’d be laughing!
Click to expand...
Oh dear! Keep trying! You will get there in the end.
 
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