Midas, dose has been aggressively decreased, can I go even quicker?

C

colin72

Member Since 2014
Midas: 13 1/2 yo, diagnosed diabetic December 2021. Glargine, low carb wet diet. Tested positive for Acromegaly and IAA (IGF-1: 329, IAA: 38). Taking Cabergoline since August 2022

Midas was on 11.5 U insulin in March 2023 (and had been on for 6 months at that point).

As you can see from his ss, I've been increasingly aggressive in reducing his dose over the last 8+ months. He's currently at 4 U.

When he hits low numbers, I've had to give him quite a bit of food (about 3 oz at a time). This results in him getting a lot of food per day (which is a worry due to possible weight gain). Normally, he's happy to eat all that I give him. However, the last few days his appetite isn't as endless as it's been. He's still hungry and getting a lot of food but he's leaving food behind which has never happened before.

I'm looking for feedback on his situation so far. Can I be even more aggressive in reducing his dose?

Any insight or advice would be greatly appreciated. Thanks!
 
When kitties have secondary endocrine conditions like acromegaly and IAA and have had treatment for it, it's absolutely OK to "break the rules" and reduce by either larger amounts or sooner than the TR protocol calls for. That will help keep them safe. After Neko's SRT, I started taking reductions at 70, took some back to back reductions and larger reductions. It's much easier to go back up if you reduced by too much than to fight low numbers. You could experiment by taking him to 3.5 units, and see how he does there.
 
Just to add a little more context, cats react differently to cabergoline, some respond early, some take their time. I've seen a couple cases of cats responding in 7-10 days and being off of insulin two weeks later. Some take months to respond and are more gradual in their dose reductions.
 
Wendy&Neko said:
Just to add a little more context, cats react differently to cabergoline, some respond early, some take their time. I've seen a couple cases of cats responding in 7-10 days and being off of insulin two weeks later. Some take months to respond and are more gradual in their dose reductions.
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Thank you very much for the quick reply. I will try going to 3.5 U.

I do wonder if Cabergoline is responsible for his much better numbers this year. He started Cabergoline on August 2, 2022. I don't think he saw anything that could possibly be interpreted as improvement for 5-6 months. If I remember correctly, studies showed most cats had improvements at 2 months.

Although I'm skeptical if Cabergoline is responsible for his good numbers, I'd never take him off of it.

Thanks again for your help. I really appreciate it.
 
Not an expert, but when Charlie came off pred and we changed his food, he really ran down doses from 6 u and my gut was telling me to go with bigger drops and it seems to work. I feel like I read somewhere that higher doses can get bigger increases (because proportionally it's less, I assume). Maybe it also works in reverse? No idea! Good luck!!!
 
Wendy&Neko said:
You're welcome. :) Good luck with the lower dose. Sorry Midas, less food for you.

Some people have seen decreases in acro symptoms and only slight lowering of the insulin dose with cabergoline. I'd call reduction in acro symptoms a win in quality of life.
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Could I please get your thoughts on where Midas is now? I thought maybe I was reducing too quickly this week but he's continued with low numbers.

Any advice on how to proceed would be greatly appreciated. Thanks!
 
You've been reducing so fast that he's still got the larger depot influencing the cycles. The larger depot can influence 4-6 cycles after a reduction. The 3.5 unit depot was still influencing yesterday's cycles. I see you are still having to give him high carb food. One way to reduce the depot is to skip insulin for a cycle. Or give half a dose for one cycle, then return to the regular dose. If he still gives lower numbers after that, I'd reduce again. Something, TBD, is changing in Midas.
 
Wendy&Neko said:
You've been reducing so fast that he's still got the larger depot influencing the cycles. The larger depot can influence 4-6 cycles after a reduction. The 3.5 unit depot was still influencing yesterday's cycles. I see you are still having to give him high carb food. One way to reduce the depot is to skip insulin for a cycle. Or give half a dose for one cycle, then return to the regular dose. If he still gives lower numbers after that, I'd reduce again. Something, TBD, is changing in Midas.
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Thank you!

I decided that I'd try giving Midas a half dose (1.25 U) this morning. Then I'll go back to the 2.5 U this evening.

If his low numbers continue, how long should I wait to reduce from 2.5 U?

Yes, something is definitely changing. Midas was diagnosed as diabetic on Christmas Eve 2021. I'm very surprised (and cautiously optimistic) that 2 years later, he's at this point.

Thanks again!
 
What does your gut tell you that you should do? If you think it's 1.5U, then try it.

Note for any lurkers, Midas is a very unique case and any of my suggestions are for him only. He has acromegaly, and either cabergoline, or some other factor such as waning tumour is causing him to need a lot less insulin.
 
Wendy&Neko said:
What does your gut tell you that you should do? If you think it's 1.5U, then try it.

Note for any lurkers, Midas is a very unique case and any of my suggestions are for him only. He has acromegaly, and either cabergoline, or some other factor such as waning tumour is causing him to need a lot less insulin.
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So this is just a judgement call? There's no way to "mess up"? My fear is that there is something I don't know about this process and I make a mistake that causes problems.

For example, his numbers skyrocket uncontrollably and someone says... Yeah we've seen that before. We call that X. You reduced too fast.

Or I get down to no insulin, and because I do something wrong along the way, his numbers skyrocket and someone says... Yeah you shouldn't have done it the way you did. You should've done XYZ.

I'm also afraid that I get to no insulin and for some reason I'm still fighting low numbers and there's some other condition that I'm not aware of.
 
The safe option is to reduce and see what happens. If you have to go back up in dose, so be it. Keeping him safe is the most important thing.
colin72 said:
I'm also afraid that I get to no insulin and for some reason I'm still fighting low numbers and there's some other condition that I'm not aware of.
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Has Midas been to the vet lately for blood work? How is he acting and feeling otherwise. At this point the reason why change of numbers is just a guess. We've seen a acro cat on over 50 units of insulin go off of insulin, so that does happen, though rare. Midas is on cabergoline which has also caused a few cats to go OTJ. A cat not on insulin can test in the 40's, I had one that did.
 
Wendy&Neko said:
The safe option is to reduce and see what happens. If you have to go back up in dose, so be it. Keeping him safe is the most important thing.

Has Midas been to the vet lately for blood work? How is he acting and feeling otherwise. At this point the reason why change of numbers is just a guess. We've seen a acro cat on over 50 units of insulin go off of insulin, so that does happen, though rare. Midas is on cabergoline which has also caused a few cats to go OTJ. A cat not on insulin can test in the 40's, I had one that did.
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Midas has not been to the vet recently for blood work (or anything). He seems perfectly fine.

When I said I'm afraid there could be some other condition, that's just because I'm shocked that I've been able to reduce his dose this much. It seems too good to be true.
 
Wendy&Neko said:
The safe option is to reduce and see what happens.
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I've given him 1 U for the last 4 cycles (with high carb food).

When reducing at this point, should I go slower? Should I reduce by .25 U? Are there any guidelines for attempting to go OTJ?

I thought I read somewhere about giving a token dose for awhile before going to 0 U. But that was a long time ago and I don't recall the exact info and can't find it again.

Thanks!
 
There are guidelines for when a conventional diabetic cat is ready for OTJ, but I think Midas isn't doing things the conventional way right now. :D Reminder: *earning* reductions and starting OTJ trials

I'd be curious to see what happens if you don't give him high carb food. With acromegaly, it's not like he's healing the beta cells in his pancreas, which is the goal of our dosing methods. Many acros already have working pancreases, but they've been working extra hard to combat the action of the pituitary tumour. If the tumour fades for some reason (treatment, time, or ?) then exogenous insulin might not be needed. I'd keep going with 0.5 unit decreases and see where he takes it.

For examples of acros flying down the scale on cabergoline, take a look at Marvin SS, starting July 2017 and Mr. Kitty's SS, starting July 2021. These aren't guidelines, just what the caregivers had to do to keep them safe. In 2017, Lily was up to 55 units, then her tumour just gradually turned off. In Lily's spreadsheet, January 2020, you can see the fast path to OTJ.
 
Wendy&Neko said:
There are guidelines for when a conventional diabetic cat is ready for OTJ, but I think Midas isn't doing things the conventional way right now.
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Wondering if you could take a look at Midas's situation at this point and give some advice/feedback?

I'm not sure what numbers would be acceptable at this point given his situation or when I should give up the OTJ trial.

Thanks very much!
 
This post was started December 10th, it's time to start a new one.

To answer your question, we'd expect a cat not getting insulin to spend most of the time under 100. Reminder: *earning* reductions and starting OTJ trials

He was looking pretty good at 0.5 units. A week with all green like he showed for several days would have earned him a reduction to 0.25 units. After that, the next dose is 0.1 units. Those blues on no insulin, and climbing numbers, mean his pancreas is not quite ready to go solo yet. I don't know how much high carb food you were giving him at 0.5 units. If none, then go back to 0.5 units. You shouldn't have to feed high carb food to keep him at a dose.
 
Wendy&Neko said:
This post was started December 10th, it's time to start a new one.

To answer your question, we'd expect a cat not getting insulin to spend most of the time under 100. Reminder: *earning* reductions and starting OTJ trials

He was looking pretty good at 0.5 units. A week with all green like he showed for several days would have earned him a reduction to 0.25 units. After that, the next dose is 0.1 units. Those blues on no insulin, and climbing numbers, mean his pancreas is not quite ready to go solo yet. I don't know how much high carb food you were giving him at 0.5 units. If none, then go back to 0.5 units. You shouldn't have to feed high carb food to keep him at a dose.
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I'm a bit confused.

You say he should have gone from .5 to .25 and then .1 units. But I previously asked...

"When reducing at this point, should I go slower? Should I reduce by .25 U? Are there any guidelines for attempting to go OTJ? I thought I read somewhere about giving a token dose for awhile before going to 0 U. But that was a long time ago and I don't recall the exact info and can't find it again."

And you replied...

"There are guidelines for when a conventional diabetic cat is ready for OTJ, but I think Midas isn't doing things the conventional way right now."

And you also mentioned his pancreas not being ready to go solo yet but previously you said, "With acromegaly, it's not like he's healing the beta cells in his pancreas, which is the goal of our dosing methods"
 
What has changed is the attempt to go off of insulin. That's not working. You could try 0.25 units, but he needs some insulin at this point. If he had seen solid green numbers when you removed insulin, that would show he's ready to go without.
 
Wendy&Neko said:
What has changed is the attempt to go off of insulin. That's not working. You could try 0.25 units, but he needs some insulin at this point. If he had seen solid green numbers when you removed insulin, that would show he's ready to go without.
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Sorry but I'm still confused about what advice I should have followed. Maybe I'm missing something.

You're saying a week at .5 U would have earned a reduction to .25 and then the next dose would have been .1.

But previously when he was at 1 U and I asked about guidelines for going OTJ, slowing my .5 reductions, and a token dose before attempting OTJ you said, "There are guidelines for when a conventional diabetic cat is ready for OTJ, but I think Midas isn't doing things the conventional way right now" and "I'd keep going with 0.5 unit decreases and see where he takes it."

You also mentioned his pancreas not being ready to go solo yet but previously said, "With acromegaly, it's not like he's healing the beta cells in his pancreas, which is the goal of our dosing methods". So, I'm confused if the pancreas "healing" is playing a role or not. Your previous comments seemed to indicate it wasn't but now it seems like it does?

Thanks
 
When I say to try 0.5 reductions, I meant try 0.5 unit reductions unless they don't work. They stopped working went you went to no insulin. His numbers were over 100 and increasing. That's a sign he needed a little bit more insulin.

There is no protocol for acros dropping down dose quickly. Each cat is a special case, you have to know your cat. You have to go by what works and what doesn't, but err on the side of caution. The larger reductions help keep him safe, but you only go until the cat shows that is too large a reduction. Way back, over a month ago when you started this thread, you were asking if you could reduce faster. The answer was yes at the time.

As for his pancreas, some acro cats have working pancreases, but it's also possible that time in higher numbers has damaged them. Which would mean that the pancreas is only partially working. The TR methods were designed and tested for the purpose of treating cats with what is regular type 2 diabetes for them. We have found that the dosing method can work well for cats with acromegaly, especially when increasing the dose and trying to get ahead of the insulin resistance. However, when reducing, and depending why the cats insulin needs are reducing, a person with an acro may have to be more cautious or aggressive about the reductions, for two reasons. One is the size of dose (and depot) tends to be larger, and two is the underlying reasons causing the need for less insulin can be a much faster process than beta cell healing. For example, I've seen a couple acros start cabergoline and be completely off of insulin in 10 days or less.
 
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