Cleo on cabergoline

Cleocatra

Cleocatra

Member
Day 3 on cabergoline. I've only given her 2 doses (75mcg capsules) the last 2 mornings. It has seemed to slow her down, make her more irritable when messing around w/ her hind legs so I think she's hurting more today. I have not given her the dose of cabergoline for today yet. I gave her a dose of gabapentin this morning because I think she's hurting, so it will be easier to give the caber later on this morning.
No apparent GI upset so far. She's still eating, pooping and peeing as usual but she's dragging her butt in the litter the last 2 days because of the neuropathy.
Any thoughts on the initial effects of caber?
--Gave her the caber 75mcg dose.
 
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Are you doing any blood sugar testing at all? I don't see anything on the spreadsheet. It can take 7-10 days for cebergoline to impact the numbers, but when it does, it can be significant.

I have no personal experience with cabergoline, but if there are impacts, it seems to be on the appetite.
 
Wendy&Neko said:
Are you doing any blood sugar testing at all? I don't see anything on the spreadsheet. It can take 7-10 days for cebergoline to impact the numbers, but when it does, it can be significant.

I have no personal experience with cabergoline, but if there are impacts, it seems to be on the appetite.
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I have to do a good curve this weekend and send to the Dr. So does the appetite reduce? I would think it would if it brings down the IGF #.
I need to do some spot checks tonight and into the weekend.
Thanks.
 
The appetite will reduce when her numbers come down. I don't know what I can do to stress the importance of testing, even more so with cabergoline in the picture. Take a look at Marvin's spreadsheet. Starting end of June 2017 is when cabergoline was started. Marvin was on 8 units, spreadsheet didn't look much different than Cleo's other than having more data. End of week 2 they were down to 6 units, down to 1.5 units the following week. If Nat hadn't been testing, Marvin would have been way overdosed and probably hypoed.

Cabergoline does not reduce the IGF-1, it impacts the growth hormone, which IMHO is the worse of the two.

How much experience does your vet have with acrocats on cabergoline?
 
Wendy&Neko said:
The appetite will reduce when her numbers come down. I don't know what I can do to stress the importance of testing, even more so with cabergoline in the picture. Take a look at Marvin's spreadsheet. Starting end of June 2017 is when cabergoline was started. Marvin was on 8 units, spreadsheet didn't look much different than Cleo's other than having more data. End of week 2 they were down to 6 units, down to 1.5 units the following week. If Nat hadn't been testing, Marvin would have been way overdosed and probably hypoed.

Cabergoline does not reduce the IGF-1, it impacts the growth hormone, which IMHO is the worse of the two.

How much experience does your vet have with acrocats on cabergoline?
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Just tested- 472 :( . they have a dr. that does the SRT,

Ok- I thought the IGF-1 was the growth hormone.

wow- 1 week and he came down, what, 50%+? That's pretty dramatic. I can only hope Cleo responds like this- she's just been so high for so long.
Do you think the Alphatrak2 is showing inflated readings?
 
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Glad you vet is easy to work with, but I wouldn't take dosing/testing advice from her.

Growth hormone is produced in the pituitary - it triggers insulin growth factor -1 to be produced. So you've got both things going on.

Yes, the Alphatrak will read higher than human meters, though they get closer to human meters as the numbers get lower. Since our dosing methods were written using human meters, and their test strips are cheaper, most people use human meters. Also easier to get the strips when you need them.

Marvin's reaction was probably the strongest of any we've seen. Some take longer. Here is Tiffany's spreadsheet. They numbers are using the AT. She started cabergoline on 9/20. Marvin and Tiffany were of the lucky 2 that went off of insulin. Most of the others did see a good drop in dose.
 
yes capsules. 75 mcg compounded at Wedgewood Pharmacy in New Jersey. I think it comes in a liquid form too. $100 for 30 caps.
So she's had 13 doses. On Friday, we noticed the ravenous hunger had subsided. She wasn't eating like she was starving first thing morning. Calmer and not always begging for food, and food intake has reduced a little.
I pill her after she eats at 7am. I haven't noticed any stomach upset...until this morning- I pushed the pill toward the back of her tongue and hold her mouth shut until she swallows...only she must've bit it open, but I let her chase it w/ more food. 5 minutes later she threw it all up!!! This is the first time she's done that. So I need to get it to more to the back of her mouth otherwise if she bites it open, it will upset the the tumtum. Just a word to the wise.
We are also on 2U 2xday of Prozinc. Vet told me not to test until next weekend. She doesn't think daily testing is necessary. But on the lower dose of Pz, I think we'll be ok if all of a sudden her BG#s drop from the cabergoline taking affect.
-Freckles' #'s look pretty good. I wish Cleo would hit some yellows and blues.
 
Ok. Good to know about the cabergoline. I'm still trying to connect with an IM vet to see about giving it to Freckles. I read something on this site about dry pilling a cat could do damage to them. I'm glad to see that you are giving food/water with the pill.

I would be scared shitless shooting insulin blind even though Freckles has only had 1 low PS number.... it only takes once. There was a CG that just posted a couple of days ago that the new owner of the cat gave a dose that was higher than what the cat actually required. It's too bad the new owner didn't connect to people on this site. The kitty didn't make it. cat_wings>o

Even with Freckles having higher numbers, I always feel that I'm gathering good data to see some trends. My vet initially told me that I don't need to test regularly but only once/month. In my head I thought "Are you out of your mind? Would you give a child an insulin shot without testing first?" Looking at some other SS on this forum, I'm so glad that people test.

Cleocatra said:
Freckles' #'s look pretty good. I wish Cleo would hit some yellows and blues.
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We are using a different glucometer than you though too. When we used the Alphatrak, we had pinks and reds (See 2019 top of SS). Since the numbers on this forum are calibrated to human glucometer, plus the Alphatrak strips were way too expensive to test frequently, we switched to Freestyle Lite glucometer.
 
Because of the possible narrowing of the pharynx in an acrocat, I think liquid formulation is better that capsules, if you have that option.
Cleocatra said:
Vet told me not to test until next weekend. She doesn't think daily testing is necessary
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Your vet is just wrong. She has no experience with cabergoline and what it can do. Two weeks after starting is often when it can make a significant difference in the dose. Judy gave you one example, but we've had countless numbers of caregivers come here, we convince them to test, and they find their cat in dangerously low numbers.

Cleo could hit yellows and blues, if you tested enough to increase to a good dose.
 
Wendy&Neko said:
Because of the possible narrowing of the pharynx in an acrocat, I think liquid formulation is better that capsules, if you have that option.

Your vet is just wrong. She has no experience with cabergoline and what it can do. Two weeks after starting is often when it can make a significant difference in the dose. Judy gave you one example, but we've had countless numbers of caregivers come here, we convince them to test, and they find their cat in dangerously low numbers.

Cleo could hit yellows and blues, if you tested enough to increase to a good dose.
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No, I hear you loud and clear. I understand pretty much everything about the cause/effects here. I think I'll take a couple of tests in the next couple days since she's showing a change in appetite and behavior. I don't need to tell the vet I'm doing it, right?!! thks
 
Chris, you can get suspension cabergoline from Wedgewood. Many flavors to choose from. Ollie loves the bacon/marshmallow flavor.

I guess I missed quite a few posts. When you changed to Prozinc why such a lower dose?
 
Olive & Paula said:
Chris, you can get suspension cabergoline from Wedgewood. Many flavors to choose from. Ollie loves the bacon/marshmallow flavor.

I guess I missed quite a few posts. When you changed to Prozinc why such a lower dose?
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I might look at going w/ the liquid caber. The pill is a real challenge every morning. I don't like getting clawed, either. I talked to Dr. Stiller about maybe switching insulins and she thought PZ was worth a try. It is also a slow acting insulin. She didn't tell me why she went down to 2U, maybe to not to start too high w/ an insulin that might have a stronger effect?? IDK.... But she didn't want me to test for a week and I think that's not safe. So I will do a few random tests until I do a full day curve. Something's happening tho, cuz kitty is behaving differently. Less aggressive appetites, wants to go outside w/ me for coffee on patio in the morning, wants lap time on the couch at night, is very alert and happy (as long as I don't mess w/ her back side too much) and just not as edgy. She still has the neuropathy which I feel bad for her, especially when I have to do a butt bath.
 
Are you giving Zobaline for neuropathy? It helps with the nerve pain. I used it in the beginning and it helped Ollie's legs. Then when she went on gabapentin I stopped it, then the bupre thinking those would help more. Couldn't brush or touch her back. Lately the legs appear shakey. I started the zobaline back up and I can brush her and legs less shakey. She doesn't seem to have as much nerve pain now.
 
Olive & Paula said:
Are you giving Zobaline for neuropathy? It helps with the nerve pain. I used it in the beginning and it helped Ollie's legs. Then when she went on gabapentin I stopped it, then the bupre thinking those would help more. Couldn't brush or touch her back. Lately the legs appear shakey. I started the zobaline back up and I can brush her and legs less shakey. She doesn't seem to have as much nerve pain now.
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Yes I'm giving her the zobaline every night. We need to get that BG# down that's causing the neurop.
 
Cleocatra said:
So I will do a few random tests until I do a full day curve.
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Good for you Chris. Testing is soooo important. It just boggles my mind why a vet would tell the client not to test... It's up to you if you tell your vet.

When I had the frank discussion with my vet I asked if I didn't test, what if Freckles went low? His reply was, "You'll notice because she'll start wobbling around and look all spaced out." I'm sure my jaw hit the floor because after my reaction, my vet said that I could test if I wanted. Why would a CG allow their cat to get to the "wobbly/spaced out" state when a simple glucose test could catch a dropping number much earlier and keep the cat out of harm's way.

I blatantly told my vet that I was testing... end of story.
 
With my first cat I was told if he has a seizure bring him in. I asked what if it's after hours or a weekend, I was told go to ER. I asked don't we want to prevent seizures? Why can't I test at home like my mother tests her own sugar? He said if you go that far, its okay. I didn't know of this place at that time.
 
Cleocatra said:
She didn't tell me why she went down to 2U, maybe to not to start too high w/ an insulin that might have a stronger effect?? IDK..
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Prozinc does not have a stronger effect. Typically when people switch from Prozinc to Lantus or Levemir (hardly anyone goes the other way), we suggest the same dose to start.

Good to hear Cleo seems to feel better. I wonder if the Lantus sting was bothering her. The acid base of Lantus can impact cats at higher doses and we often hear of cats changing behaviours with an insulin change.
 
Wendy&Neko said:
Prozinc does not have a stronger effect. Typically when people switch from Prozinc to Lantus or Levemir (hardly anyone goes the other way), we suggest the same dose to start.

Good to hear Cleo seems to feel better. I wonder if the Lantus sting was bothering her. The acid base of Lantus can impact cats at higher doses and we often hear of cats changing behaviours with an insulin change.
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yes her behavior is better, not so hungry, but she still gets pissed off when I'm trying to test and she still wants to eat. I still think she needs a higher dosage NOW. Last 2 tests were around the 500 mark. I don't like seeing the neuropathy and I think the hi BG is a direct driver to that. Why do I have to wait so long to ramp up if her BG#s are already so high?
 
Olive & Paula said:
Chris, is your ss up to date? Seems to have days missing.
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yes, vet said don't bother with testing everyday. But I did some randoms the past couple days. She's still too high. Tomorrow I am doing a full day of tests and reporting to vet on Fri. morning.
I really think her doses need to increase as fast as possible. I saw Lily's SS and can't believe she was up to 55U 2x !!! That's crazy but it worked for Lily. Then they tapered her down. But she's now in bad shape due to other stuff.
 
We have seen acro cats on more than 55 units, if that's what they needed. You could increase faster if you tested more. As I've said before, your vet is wrong about testing every day. Your vet's method is having Cleo linger in higher numbers longer and doesn't seem to be working for her. Nice to see that spot of yellow yesterday. Still too high, but better.
 
Lingering can cause glucose toxicity which will take even higher doses and longer to break through it. Been there, done that.

If your on caber now you need to start testing more so you know what is going on. Don't be surprised if out of the blue, you are going down 2 units in 5 or was it 6 days time. It was crazy fast. Half doses, bcs, missed doses, late shots and still dove needing honey and syrup.

With all due respect, your vet and you are unfamiliar with cabergoline. Do not underestimate what it can or can not do.
 
I'm still not happy w/ this slow progression on ProZinc. Her #'s are mid 400's to mid 500's. Now shooting 3U 2x. Why can't we ramp her back up? The SS looks awful. Too many blacks. The only evidence that cabergoline is doing anything is she's not attacking the food bowl in the morning. The aggressive hunger is not as aggressive, but the BG#'s seem to be creeping higher now.

Paula, if you say you have to shoot higher doses to "break through", how fast should we ramp up the increase? This vet will only increase 1U every 7 days. I think that's way too slow. At this rate, the cat will be dead by the time we hit the right dose.
Wendy- I think the vet just doesn't think it's necessary because the trend will be too slow. But I, like you, disagree. Why can't I increase the dose every day or so, while testing everyday, until we start seeing some reductions??? I'm getting impatient, can't ya tell? What am I missing here??
 
Olive & Paula said:
Chris, is your ss up to date? Seems to have days missing.
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Sorry- yes it's up to date. I've just been spot-testing- last Friday I tried to get some good tests for an 18hr period. Miss Cleo only lets me test when she's not hungry or in a bad mood. She is only docile when she wants to be. She's a little stinker and a tough, stubborn little b!tch. I think the neuropathy makes her cranky. I could give her a gabapentin pill, but I don't want to keep doing that because I don't want her GI tract to slow down. Then we have a big mess.
 
With our dosing methods, you can increase as fast as every three days. That would mean you stop getting dosing advice from your vet, and test more, so we know the increases are safe. Take a read of the dosing methods sticky notes in the Prozinc forum. The dosing methods have been written in such a way that you can take the dosing into your own hands, with help from others here in the beginning. I stopped asking my vet for dosing advice because the turnaround in answers was too slow and Neko was in high numbers. Like you, I wanted to increase faster, but safely. Fortunately a locum vet had suggested FDMB could help me and they did. In fact, probably saved Neko because they were the ones who helped me understand she had acromegaly and IAA and told me how to treat her and get her regulated.
 
As Wendy stated you can increase every 3 days, but you need to test.

Get a routine going, one spot for testing (mine is a throw rug on kitchen table). Ear rubs first, sometimes she licks my hand. Test, treat. At times Ollie even jumps up waiting. Then there are times I can test her when sleeping in her chair. They do get use to it.
 
and Freckles gets a treat while I prick her ear. She doesn't even notice because she's so focused on the food. One benefit of having a ravenous appetite!
 
Judy and Freckles said:
and Freckles gets a treat while I prick her ear. She doesn't even notice because she's so focused on the food. One benefit of having a ravenous appetite!
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Cleo's appetite has been waning. This am she didn't want the DM, only drained tuna. Was calm during feeding time. I was able to test after she ate the tuna. She's still a crank and now gets really pissed off if I touch her back feet. She's not walking but 3 feet and sits for a rest and then another 3 ft.... I'm thinking about giving her a gabapentin today, but I don't want to slow down her poop schedule and then wake up to a sh!t show. I'll have to decide if she needs some pain therapy based on behavior.
 
Ollie does the walk then rest think. When she jumps off her chair she has to rest 10 minutes before walking. She has very little stamina. I don't know if feet hurt (looks like they got bigger all of a sudden) although she is on gabapentin and bupre, heart or what. But I have to remember she is also 13+ yrs and she has never been active. But then I remember my 18 yr old diabetic and how he ran up and down the hall playing with Tux and he had heart disease and had a heart attack we didn't know happened.
 
Olive & Paula said:
Ollie does the walk then rest think. When she jumps off her chair she has to rest 10 minutes before walking. She has very little stamina. I don't know if feet hurt (looks like they got bigger all of a sudden) although she is on gabapentin and bupre, heart or what. But I have to remember she is also 13+ yrs and she has never been active. But then I remember my 18 yr old diabetic and how he ran up and down the hall playing with Tux and he had heart disease and had a heart attack we didn't know happened.
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It upsets me to watch her wobble around, squatting in poop & pee, tracking it around the house....and I'm pretty sure it's caused by these high BG#'s. That's why I keep wanting to ramp up the dose. Eventually, when she can't walk and becomes a big hairy ball of poop & pee and I can't manage her, what then, have her euthanized??? Probably won't have much of a choice. Can't have a cat living that kind of life.
 
The option is to take control of dosing yourself, and safely get her into good blood sugar numbers. We have lots of examples of people with fairly well regulated acromegalic cats here. Following your vets dosing advice isn’t helped poor Cleo.
 
Wendy&Neko said:
The option is to take control of dosing yourself, and safely get her into good blood sugar numbers. We have lots of examples of people with fairly well regulated acromegalic cats here. Following your vets dosing advice isn’t helped poor Cleo.
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Then I will have to diplomatically ask/tell this vet what I want to do and see if she'll still support us. I don't think she will especially if I challenge her by asking just how much experience she's had w/ acro cats etc.
 
Vets are just like the rest of us... they don't know what they don't know - but being a professional is all about continuing education.
 
Judy and Freckles said:
Vets are just like the rest of us... they don't know what they don't know - but being a professional is all about continuing education.
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Just talked to the vets assistant and echoed everything you all have been telling me here. She wants to see the cats SS that was up to 55U day and how it curved down to be OTJ.
I expressed my frustration and that at this point, I don't think there's much of a risk to ramp it up faster now that she's back in the 500's.
 
Judy and Freckles said:
You don't need your vet's permission to test more than what she would do.

So, have you decided what you are going to do?
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Her asst will relay that I want to ramp up faster. Testing is not the issue- it's increasing dosage faster than 1U per week. I've read here that Prozinc is no more effective than Lantus, so why not get her back to 9U like where we were and keep going from there? I will ask that when we talk next.

Who had the cat that was us to 55U 2x and then tapered down to OTJ?? I think Wendy told me about it.
 
Just talked to my vet today and she said obviously the cabergoline is not working because her BG#'s continue to be so high. I told her if it's doing anything it's calming down the ravenous appetite.
 
It's not just about the glucose numbers. Insulin brings the numbers down. Besides appetite are there any other as symptoms and how are they?

After one year on cabergoline, I had repeat IGF done just to see if anything changed. Ollie's 1st IGF (382), the repeat was 432. Vet said let's wean off the caber since it wasn't working. I said no way. Her symptoms are less and some gone. Insulin dose is less. She is much better on it.
 
Yet another example your vet doesn't know much about acromegaly, or even that much about diabetes. :rolleyes: The reason her numbers are so high are because her dose is too low.
 
@Cleocatra

Something is nagging at me, but can't figure it out.

Your vet said the caber isn't working because glucoses are still high.

Cabergoline job if it's going to work, is not to lower glucoses. It can't take the place of insulin. Caber job is to inhibit or interfere with the secretions of the tumor that causes the need for insulin. The tumor can be active at any time. Or as Wendy says it pulses. You don't know ahead of time when that happens. But you might be able to tell based on symptoms. I knew when Ollie spurted activity. Now I can't tell.

Your vet lowered the dose (big mistake I think), so you have started from scratch. You lost progress and now have to make up for it. You will probably go over the 9 units you were at. You have quite a ways to go.

@Wendy&Neko Chris be raising every 3 days correct, I don't know if it should be whole unit though. Maybe 0.5 units and that's more than either method states, but I think your safe with 0.5 increases.
 
Olive & Paula said:
@Cleocatra

Something is nagging at me, but can't figure it out.

Your vet said the caber isn't working because glucoses are still high.

Cabergoline job if it's going to work, is not to lower glucoses. It can't take the place of insulin. Caber job is to inhibit or interfere with the secretions of the tumor that causes the need for insulin. The tumor can be active at any time. Or as Wendy says it pulses. You don't know ahead of time when that happens. But you might be able to tell based on symptoms. I knew when Ollie spurted activity. Now I can't tell.

Your vet lowered the dose (big mistake I think), so you have started from scratch. You lost progress and now have to make up for it. You will probably go over the 9 units you were at. You have quite a ways to go.

@Wendy&Neko Chris be raising every 3 days correct, I don't know if it should be whole unit though. Maybe 0.5 units and that's more than either method states, but I think your safe with 0.5 increases.
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Sorry, here's the note:
Mr. Hasek,
In response to your questions yesterday. Dr. Stiller said the following: no to Gabapentin for Cleo. It will just cause her to be more sedate and unsteady on her feet. It does not seem like the Cabergoline is taking effect. It is not recommended to increase insulin every 3 days. We need to give the body more time to adjust. There is high risk to making quick changes to insulin these could cause death.
Thank you,
(dr. Stillers assistant)
 
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Note that the studies on cabergoline went at least three months before making any conclusions. Today is day 15 by my count.
Olive & Paula said:
Chris be raising every 3 days correct, I don't know if it should be whole unit though. Maybe 0.5 units and that's more than either method states, but I think your safe with 0.5 increases.
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With a low yellow spotted on 2 units, I'm worried about the 1 unit increase done so far. And low yellow nadir would mean a 0.25 unit increase. With the data I see, the dose is either too high, or too low. I suspect too low because the numbers are so much worse than on a higher dose of Lantus.
 
Here is Lily's spreadsheet.
Unfortunately the parts of the spreadsheet that show earlier than 2017 are missing. That's the part that shows you how she got to 55 units. You can see how her dose came down. But I can show you lots of spreadsheets of cats on even higher doses and how they got to that dose. We typically don't increase by 1.0 unit at a time until the total dose is over 10 units.
 
Something happened because the appetite is lower and she's not aggressively begging for food. Isn't appetite driven by the high IGF as well as lack of insulin converting energy?
Wendy&Neko said:
Note that the studies on cabergoline went at least three months before making any conclusions. Today is day 15 by my count.

With a low yellow spotted on 2 units, I'm worried about the 1 unit increase done so far. And low yellow nadir would mean a 0.25 unit increase. With the data I see, the dose is either too high, or too low. I suspect too low because the numbers are so much worse than on a higher dose of Lantus.
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yes, that's what I'm thinking. I will keep testing and if we keep getting 500's, I will ask to increase before the 7 day-wait she's got me on. I was reading today about most acros go on Levemir, not Prozinc.
What is the reasoning?

P.S. I think we've dosed cabergoline 25x. I have 5 pills left.
 
Appetite is driven by the increased growth hormone (think teenage boy appetite when they are growing) and the high blood sugar numbers. Cabergoline impacts the growth hormone, not the IGF-1 according to the studies. But that's good, excess growth hormone does do damage to the body, including causing the diabetes. Limiting growth hormone means dose should eventually go down.

Sorry, I was trying to see on the spreadsheet when you started cabergoline, but it's in your signature. :banghead: I do think you want to continue the cabergoline.

Cleocatra said:
I was reading today about most acros go on Levemir, not Prozinc.
What is the reasoning?
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Levermir seems to have better duration. Depot insulins generally give better, more even numbers than in and out insulins, especially for cats needing really high doses. Lantus has an acid base, so can sting at higher doses, so most acrocats go on Levemir. My Neko was definitely feeling the Lantus, even though she only got up to 8.75 units. And her numbers were a lot flatter on Levemir. And the injections didn't bother her.
 
I've been reading Lily's SS and see 2018 is missing. How did she get up to 55U?? I only see 1 >300. Some days she was jumping 20U+ up or down. My vet couldn't believe anyone would give 55U to a cat! I don't know if Cleo would tolerate that much testing, and I'm not sure I could be that consistent.

I WILL continue the caber!
 
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