Oscar - complex case with steroids and brain tumour

[Renee2602]

Hi everyone, I have been a member of this forum for a little while, reading posts, but have only just posted now, apologies if I don't get something right. Its a long post but I wanted all the info down.

I am Renee (24, Melbourne Australia) my dear cat is Oscar, 11, 7.39kgs, ginger and white tabby. I have had Oscar since I was 13, he is our family cat but I am doing my best to be the main manager of his care. It is very hard to know where to start as so much is going on.

Oscar's history:
-feline herpes virus as a young boy
-luxating patellas
- triaditis episode in 2018 requiring emergency surgery
-ongoing pancreatitis, EPI, and IBD since 2018 - can not tolerate any wet food, took a long time but got his diarrhoea managed for the last 6 years by feeding 1/2 cup plain cooked chicken morning and night and hills z/d dry food as in between snacks. Creon, a pancreatic enzyme, also used which was a saviour.
-2 or 3 pancreatitis flare ups requiring hospitalisation with IV fluids, ultrasound, antibiotics, appetite stimulants etc since 2018, but overall well managed
-allergic granuloma around 2020/21 - resulted in us trying prednisolone again, he was on 0.5ml (2.5mg) every second day as the lowest dose
2023 - diagnosed with hyperthyroidism from a mass on his thyroid. Using thyronorm liquid to control this.
2024 - terminal diagnosis of pituitary brain tumour

Current medications:
-Creon twice daily with each main meal, thyronorm, high dose liquid prednisolone, catlax & metamucil for constipation.

The current situation
This has all been extremely devastating and traumatic for me. Oscar had symptoms in 2023 but several vets we went to assumed he had arthritis or his thyroid issues and meds were causing the issues. In late February 2024 symptoms got worse and we saw an internal medicine specialist, where Oscar was diagnosed with a large progressive pituitary macroadenoma (or carcinoma, no biopsy taken) in the brain and we were told 3-6 months to live on palliative care by one vet and 2-3 by another. We looked into every option. Surgery not an option due to size. We met with the top (and only) expert in our country regarding radiation. It would have been $16,000, require a 2 week stay, and require us driving Oscar up (doesn't travel well) 8 hours each way. We were told it was not curative but the intention was to shrink the tumour to hopefully get it below levels where its impacting his functioning and that could give us anywhere from months to 6 years extra with him. We have no pet insurance. The procedure came with risks and possible side effects, it ultimately was not up to me but we decided we simply could not put Oscar or ourselves through it, and we don't know what would be around the corner with his other health issues. I can't live with myself but the decision has been made. So we are doing palliative care requiring high dose prednisolone, keeping up his usual medications, and basically nothing else can be done.

Symptoms
Oscar's tumour is incredibly rare as it is believed to be non-functional, meaning it did not cause diabetes, cushings, acromegaly, which is how it was able to get so big before being discovered. We have not had IGF levels tested. I understand the majority of these pituitary tumours are functional, causing acromegaly, which is why I was only able to find similar circumstances in groups like this. So all of his symptoms are neurological and caused from the size of the tumour and it being so big (1/3) brain on scan 2 months ago, that it is causing brain inflammation resulting in symptoms. We do not believe he is having seizures yet. His main symptoms are cognitive dullness, ataxia and muscle weakness, reduced perception and cognition, and loss of learned behaviours. Before we adjusted prednisolone dosage he was circling and pacing, meowing (yowling) alot. So many aspects of his personality are no longer there, he does not sleep in his favourite beanbag anymore, he does not jump on our beds, he cannot play, we have to show him where food is. It is similar to dementia. It is incredibly distressing. He still is eating and drinking very well, loves his food, always has. He grooms himself well and kneads his favourite blankie when I show him (and purrs), he hunts us down and meows for food and knows his routine. He loves being warm, and going in the sun, but has trouble finding it. It is controversial but he still goes outside, he knows to stay in one area and does not leave it. We don't leave him home alone outside and make sure we know where he is. We do this as he has LOVED going outside his entire life and we don't want to take that away from him for however long we have left. If things worsen we understand we may have to start keeping him in.

We have considered CBD oil and have not started this for now as things are so up and down, he is not showing obvious signs of pain, and we are careful to introduce things that may flare up his pancreas. He has had 6 weeks of b12 shots for low b12. Cabergoline has been discussed and there is essentially no data for cats with non-functional large pituitary tumours. We agreed with our specialist we could still try it though its unlikely to help. We have not been able to start this as we are concerned about side effects on the pancreas, IBD, his stomach, and things have been changing so quickly we haven't had a chance to even try to start it.

Diabetes
Oscar was put on 5mg/1ml prednisolone for palliative care. We did urine tests and a few weeks later it came back with glucose and ketones. We were shocked how quick it happened, though we admit we had been spoiling him with as much food and treats as he wanted given the diagnosis. We reduced the prednisolone to 2.5mg/0.5ml every day and I stopped the hills z/d dry food. We stopped the constant treats which has been hard not to spoil him given we have limited time. Instead of hills z/d dry I started adding zucchini as he was ravenous, and high protein low carb fancy feast pate. I think the pate really helped AT FIRST with his hunger and he was so excited to have wet food again like a kitten. We celebrated his 11th Birthday on April 15th. His next urine test was negative for glucose and ketones. But he was not coping on the 0.5ml prednisolone, we quickly raised it to .75ml, then 1ml, and he was still not okay, circling, pacing, getting stuck in corners, starting to show head pressing.

Last Tuesday 23rd April we visited the specialist again - we have tried to limit vet visits as he hyperventilates and pees himself now which he never did before. Vet specialist said unfortunately with his mentation he needs the prednisolone increased, to atleast 1ml twice daily, so 10mg a day. He said we can start there and we will likely have to keep going up. So we did that. Its been just over a week and he very likely has diabetes again. But he is overall doing cognitively and mobility wise better on the higher prednisolone, though we will have to increase. We tested urine collected at home on Monday 29th and it came back with glucose 4+.

This week has been incredibly hard. On Saturday Oscar stopped eating and had diarrhoea and vomiting. We used zofran and he seemed to recover very quickly and was back to eating. Monday morning we collected the urine sample that came back glucose 4+. By midday Monday Oscar once again was not eating, and started having diarrhoea. He vomited overnight and had diarrhoea so bad that he was using the litterbox every hour or so. We removed the fancy feast as we thought this could be the culprit, and put him on his diet of just the plain chicken. We started antibiotics Wednesday night. He seems to be okay as of now (Thursday) with no diarrhoea or vomiting that we have seen, he has not done a bowel motion. But because of the bland diet and the glucose from Monday, we are worried he is starting to struggle with the diabetes symptoms. He is peeing 4-6 times in 24hours, drinking a lot, and is so hungry, to the point I think he is struggling to sleep as he's so hungry. I have been feeding him chicken throughout the day and night to try to get him by but his hunger won't stop. Since we upped the prednisolone, Oscar seemed cognitively better and more content. But we have seem behaviour changes and we don't know why. He started to not be able to fall asleep or curl up like he had been, to get a deep sleep rest. He has been trying to get comfortable but seems like he can't - like he will have to shift positions and he is now constantly sleeping on the carpeted floor rather than on the couch. He will jump on the couch and try to sit and relax but feel like he can't, move to the ground and then fall straight asleep, and sometimes move around on the ground trying to get comfortable. a few weeks ago he was falling asleep on the couch for hours at a time. He also has had increased breathing rate which I sent videos of to the vet specialist. I am worried he may have trouble breathing that is causing some of this behaviour. He also has been sneezing so I don't know if his breathing is being impacted by that. He isnt showing obvious signs of pain. He's eating, drinking, grooming, kneading his blankie when shown, meowing at us for food, wanting to go outside to sit for a little bit. It's getting to the point where he will rest but not really sleep or settle down, until he basically exhausts himself. Surely this can't be good for his brain. At the same time he doesn't seem to have much motivation to do things. The issue is I don't know if this is because of the diabetes or the prednisolone or the brain tumour itself. We still haven't had a blood glucose reading this week yet. We couldnt start insulin or get bloods done until the diarrhoea and vomiting stopped, which we are hoping it has but it has only been a few days. I also have been using ketodiastix urine strips at home and he's been negative for ketone and ranging between 2+ and 3+.


So what do I do now? I spoke with my vet specialist who told me to come in ASAP - we have an appointment tomorrow at 4pm. We think the plan will be to take some bloods, take current blood glucose levels, fit him with a Libre, and start him on toujeo 300u/ml pen which we have been asked to pick up from the pharmacy. I have raised my concerns about starting on too high of a dose and also raised concerns about using toujeo instead of lantus. My vet specialist listened and gave his reasoning of why toujeo would be a good option and so I will go with that, but yes I am incredibly anxious going into this. I will ask about self-testing with a lancet but we are incredibly nervous about this as he wouldn't even tolerate cream on his ears, and he has begun yowling when we tablet him, likely due to the brain tumour. I'm praying that somehow he takes daily insulin injections and at home monitoring better than b12 injections and tablets. We are of course hoping to use the Libre but I am so scared it won't last long, and our vet would only recommend it on at the start to get his dosage ok. He also has a history of skin conditions so I'm worried he may react to it on the skin. It's hard enough seeing my boy shaved of his beautiful fur when we know it may not grow back before he passes away as we have just hit the 2 month mark of prognosis, even though I know its just a small amount of fur. I was so anxious going into a weekend with him feeling so hungry and restless and possibly diabetic. But now I am also anxious about starting insulin on a Friday night, going into the weekend where no support is available. If he becomes hypo, he cannot eat any carby wet food as he will likely have a reaction, causing vomiting, not eating, diarrhoea, so our only chance is using honey or maple syrup. I'm quite terrified of him going hypo. We also may do the first injection at the vet at around 5pm, but going forward that time will not work as most of us in the family aren't home from work at that time, so I'm not sure how we would shift the time to say 7am, but then I have been told cats need to be monitored closely in the first few hours after administration and we go to work during the day, we are only around about an hour in the morning. We will also get his breathing checked out, and mentation. And ask what to do about his diet now that he only has plain cooked chicken, nothing with fortified nutrients and cant tolerate the diet changes.


So, i've posted but don't even know what I'm expecting. Advice? Things I should check or ask at our appointment tomorrow? Has anyone else had a cat experience symptoms like this with the breathing and restless and not getting comfortable? Maybe just emotional support. I am incredibly overwhelmed and have never gone through something like this in my life, he is our only cat and the first I have raised since he was just a kitten, and I am not coping with the grief of his behavioural and ability changes, and the knowledge that we may have days, weeks, months left. He is honestly my best friend and emotional support, and has given me a reason to keep going.


Thank you.

 

[Renee2602]

Commenting to add:
-He is more lethargic and less hungry, less begging for food tonight, I'm not sure if that means anything. I guess I'm just worried about starting insulin tomorrow based on urine being high and then a potentially high spot blood glucose test (which can be impacted by stress can't it?), as I imagine the fructosamine blood test will take a few days to come back at the least.
- Would giving him his old dry food - the hills z/d be an option during a hypo event? I wouldn't be surprised if we have to start feeding him this dry food again anyway just to get some cat food into his diet that he tolerates, even if it is not low-carb.
-In Australia, what is the equivalent of karo syrup?

Sorry I have a million concerns, anxieties, and questions running through my mind constantly.

 

[Wendy&Neko]

Oscar was diagnosed with a large progressive pituitary macroadenoma (or carcinoma, no biopsy taken) in the brain and we were told 3-6 months to live on palliative care by one vet and 2-3 by another.

Neko lived 5 years with her pituitary adenoma. She had acromegaly, discovered because of the diabetes. But you are right that not all cats with acromegaly get diabetes, or some get it much later. And some go into diabetic remission on their own. Neko did have stereotactic radiation therapy (SRT) on her pituitary. I drove 3 days each way to the clinic that did it. Neko didn't travel well either, but after that trip did amazingly well on travel. It was 4 days, one say of CT scans, 3 days of radiation therapy. Some places do one day of radiation now.

How did they determine he does not have acromegaly? Only about 35% of cats diagnosed with acromegaly actually have clinical signs, other than diabetes. And some don't even have that. The percentage is unknown, because it's not something been studied or something vets even know to look for. A number of non diabetic cats were found out because of heart conditions - also common with acros. Has Oscar had his heart checked? The breathing issues are what make me ask. Oscar is diabetic, loves his food, has GI issues, all common with acro. With no IGF-1 test done, you don't know whether or not he has acromegaly.

I would strongly recommend you try the cabergoine. It's a fairly recent treatment that has helped many of the acros here. See the article attached in this post to the vets:
New paper on: Cabergoline treatment in cats with diabetes mellitus and hypersomatotropism
It's probably not curative in Oscar's case, but many people have found it reduces symptoms and gives longer lives. We have had 4-5 cats go off of insulin completely on cabergoline. With IBD you probably want to do the every other day dosing to start. Cabergoline has also been used on cats with Cushings, so a different pituitary tumour type.

The sneezing with increased pred may be a herpes flair up. Not uncommon. Have you tried l-lysine?

We have hardly any experience with Toujeo here. It's so concentrated that you can't make the fine dose changes we like to make, and it's harder to give small doses. It's a U-300 insulin, so you have to use the pen. We used syringes to make smaller dose changes.

z/d is more than high enough to be high carb food. Typically we prefer giving high carb wet, because it gets out of the system later.

We don't have karo in Canada either, it's just a brand name for corn syrup. Regular maple syrup or honey are OK too.

 

[Bron and Sheba (GA)]

Hi and welcome.
I live in Sydney.
Wendy is the expert on pituitary tumours here so I won’t add to that.
I will comment on the choice of insulin though. I would recommend you talk to the specialist about using Semglee which is similar to Toujeo but is not as concentrated and is much more suitable for cats.
I used honey for any low numbers.
Let me know if I can help you with anything Australian.
Bron

 

[Renee2602]

Hi to you both. I thought I would give an update on Oscar. Apologies for not replying fast, it has been a confronting time and a lot to adjust to.

Firstly, we started on 1 unit of toujeo daily and are now giving 2 units of toujeo daily. Toujeo was advised as Oscar's diabetes is purely steroid induced and toujeo is recommended in cases where this is the case. We were also advised that hypo episodes are very unlikely given Oscar's high dosage of steroid and as it is steroid induced, hypo's are not often seen in this situation. We tried the libre and it was excellent...for about 36 hours and then it fell off. I understand this is not recommended but given we want to reduce the stress Oscar is under and maintain his quality of life, we have not been doing daily at home glucose testing. We have been monitoring for hypo symptoms (he is only alone when all 3 of us are sleeping, he has someone home with him 98% of the time) and have been testing his urine using ketodiastix and it has still routinely been showing as negative for ketones, and 3+ to 4+ for glucose. I understand the urine gives us no way of testing if he is LOW but it does give a way to monitor the renal threshold at least. We are still discussing options for at home monitoring via another Libre or a kit, but nothing has been acted on yet. Our vet recommended the Alphatrak, we aren't sure the best place to buy this in Australia, if there are recommendations we would appreciate it. I understand majority of people use a human glucose monitor because of the cost. We would like to go with the Alphatrak as we have been told its the most accurate, and to put it bluntly, while ongoing costs are not great, with Oscar's prognosis we are unlikely to need to do years of buying testing strips.

He does seem to be doing a bit better. He is urinating less often and drinking copious amounts less often. He is more able to sleep for a few hours now and settle himself down rather than getting into a cycle of needing to eat/drink/urinate on a constant loop like before. He is less ravenous but still very hungry. He seems more comfortable but still will not sleep on the couch or his previous favourite spots. He still prefers to sleep on the ground. He has had slightly less severe, but still present, back muscle spasms and head tremors, which we are worried may be a form of seizure, but we do not know if it is related to the diabetes or the brain tumour.

We got bloods and a full check up done almost 2 weeks ago. He had to have an enema for constipation. He was on antibiotics for a recent gastro/pancreatitis flare up where he had bad diarrhoea. He is now off the antibiotics which helped a bit. The bloods came back and showed evidence of diabetes. He had also lost 300 grams of weight in 10 days, now 7kg down from 7.3. He had never lost weight like this and we had been feeding him more. He also has noticeable muscle loss in his hind legs.

The bloods showed abnormal results:
RCC: 7 (ref interval 7.26 - 11.51)
MCV fl: 52 (ref interval 37 - 49)
lymph: 0.6 (ref interval 1 - 6.9)
monocyte: 0.8 (ref interval 0.1 - 0.46)
creat: 63 (Ref interval 69 - 160)
Glucose: 14.2 (ref interval 3.8 - 7.4)
Na sodium: 145 (Ref interval 148 - 157)
Cl: 103 (Ref interval 112 - 122)
ALT: 228 (interval 19 - 97)
AST: 84 (ref interval 19 - 57)
ALP: 89 (11 - 46 interval)
Trig: 19.54 (interval: 0.1 - 1.4)

Obviously we are very concerned with the blood results, especially the liver results. It seems to confirm muscle mass loss as well. The thyroid was within range but could be better considering he is on thyroid medication. Our specialist seems to think that the liver and other results are mostly reflective of the diabetes, so we started insulin therapy.

Our main aim right now is just to make him comfortable. I'm not sure how large Neko's adenoma was, but as Oscar likely has a non-functional brain tumour - meaning it grew from pituitary tissue that does not produce hormones - the type that cause acromegaly, diabetes, and cushings - his tumour was able to grow very large already without being detected, possibly for years already. It was taking up 1/3 of his brain 2+ months ago, and we were told by the expert in Australia he may have 2-3 months, while our local specialist said we usually see 3-6 months on palliative care alone, though in some cases they can live for years. It was the size of the tumour itself causing symptoms as the brain inflammation against the skull trying to make room for the tumour is now impacting his frontal lobe, which is why we are seeing symptoms. It is incredibly hard to acknowledge but he has shown neurological and behavioural symptoms of his tumour for probably at least 8 months, but he could have had it over a year or two already, because it didn't cause any hormonal signs and so went undetected on blood test. Looking back at the last 6 months, we can clearly see he has slowly declined in his mentation and learned behaviours, looking at October 2023 he was able to jump on my bed, jump on our higher couch, see better, respond to us normally, and so we really can now see how much he has changed, even with the increased prednisolone dosage helping some of the inflammation. It is really hard to admit and talk about as I want to focus on the things he still can do, and I don't want to seem ungrateful for the time I still have with him. It is so hard as I know he wants to do things but his brain won't let him, but atleast I can tell him I love him and give him pats.

As a family (I live with my parents) we made the painful decision not to try SRT. Oscar had his first surgery at 6 years old for triaditis and has been on constant medication since then. He made a tremendous recovery and we managed his medication and condition extremely well, but I will admit that the condition and event did take away a tiny bit of quality of life for him. We still met with the only vet in the entire southern hemisphere who perform SRT, we got the quotes, got the outline of travel and stay involved, risks and aftercare. We really evaluated all options. They would have been able to do SRT 3 times across 1 week, he would have had to stay for 2 weeks in another state for scans beforehand. We would have driven 8 hours each way. Trust me I was searching up pet travel options, using gabapentin, pet-friendly hotels, everything. But we decided we couldnt put him our ourselves through it, and we were told it is not curative and could give us a few months to 6 years, it could get us the 'old Oscar' back, but it could also come with risks and brain further brain damage. I could not make the decision as I could not live with myself so my parents had to make it. I am in so much pain right now and I hate seeing him deteriorate, but looking at it now I think it was still the right decision not to go ahead with it - just the car rides to the vet 5 mins away have resulted in hyperventilating and weeing himself every time, he just has had enough. Financially, $15,000+ along with the ongoing medications and care, and constant anxiety of the tumour coming back would have been very hard for us, we don't have pet insurance. But I would honestly like to hope that we would have done it if the radiation was available in my state, local. I still can't live with the decision but have accepted this is what it is.

Admittedly we did not do the acromegaly test, it was not even an option. He has no clinical signs and especially for the size of his tumour. He had no diabetes, cushings, etc anything before his tumour. He has hyperthyroidism but they also found a mass on his thyroid so that is not caused by the tumour. Oscar has had his heart rate checked but no scans on his heart, though we did a full body CT scan in February where we found out about the tumour. His breathing does concern me, it has reduced a bit since starting insulin but still is there. You are absolutely right that without the IGF-1 test done, we don't know if he has acromegaly. Its so hard as loving food, GI issues, diabetes were all caused by other disorders (EPI, pancreatitis, steroid use) we think but it is possible. I think I will definitely raise trying the cabergoline, again. We had discussed it previously with the specialist who said we acknowledge it is unlikely to help but could, so we could try it. We just never got there as the diabetes popped up and his gastro flare up, so had to treat them first. It is very hard to introduce new meds due to fear of him declining or suffering a gastro flare up. Even the antibiotics made his mentation worse. I have read cabergoline is really only beneficial in cats on it for 6 months+ and with relatively small pituitary tumours, but I am willing to try. I am unsure where to get it in Australia - my vet said it is a tablet form but I know we can get it compounded into flavour, I just don't know where or how or the cost. He really has to take things in food or it won't work as tableting causes alot of stress, and we want him to be as happy as possible for however long we have. However, we are also looking at needing to treat his other symptoms that have increased like muscle spasms - which we don't know if this is seizures or diabetes, and if it is painful or not - so trying CBD oil - so with a list of potential medications to try and needing weeks to months to see how he tolerates them, its so hard to do as we may not have that time. But I can try.

We believe the sneezing is from herpes flare up as he has had this often when coming home from a vet stay due to pancreatitis, so when he is run down. Our vet wanted to try antibiotics first to see if theres a secondary infection that has popped up but we have not started antibiotics yet. I will ask about l-lysine, thank you.

We are continuing to give b12 shots monthly but I have asked our specialist about potentially also using the oral supplement - I'm not sure if he will like the flavour though?


I know Oscar is unique as his diabetes is purely steroid induced, but when do you think we might see changes from the insulin? We have seen him urinating less and less starving but does it help them feel better? Weight? Diabetic neuropathy?

Thank you for your help or just listening as I navigate this impossibly hard situation.

 

[Wendy&Neko]

Oscar is hardly unique having diabetes induced by steroids. That is quite common here. Especially kitties getting steroid shots, but even those on oral medication. Most of those cats get better on insulin and in cases where the steroids can be reduced or replaced, a good number of cats go off of insulin. By replacing steroid, a common example is a kitty on prednisolone for GI issues (IBD or small cell lymphoma) replaced the pred with budesonide which is a steroid more locally acting. Neko had to have a steroid for her GI issues, but could not have prednisolone due to her heart, and budesonide did not impact her blood sugars.

We have seen cats on steroids go into low numbers. Nothing special about the steroids prevents hypos. Typically the blood sugar bump from steroids doesn't last the full 24 hours.

We aren't against the Libre here - it serves a purpose. Just know that it can read low in lower numbers and having a back up blood glucose meter to test those lows is a good idea. By the way, everyone here used human meters quite successfully before the makers of the AT started very heavily marketing it to vets. When I started, no one used a pet meter. Our dosing methods were developed before the AT came out and work quite well with human meters. Plus, we'd rather see people use a human meter than be afraid to test because the cost of pet test strips is so high. Human meter test strips are readily available so you don't have to worry about running out. Pet meters strips, not as easy to come by - usually it's from the vet or on line.

Loving food, GI issues, and diabetes are also hallmarks of acromegaly. Has he been checked for arthritis (also common in acros and older cats in general). It could explain him slowing down too.

When we did SRT, it was a LOT cheaper than what you have been quoted. Scans were done the day before at the same clinic. It was a total of 4 days in a row, and Neko came home to our hotel after the days in the clinic. Her tumour was described as "tiny".

You want B12 shots (cyanocobalamin) for GI issues. The oral B12 is typically methyl B12 - which can help neuropathy.

 

[Renee2602]

Thank you. The cost of strips and testing is not as much a concern but the availability of the alphatrak and strips is, as I said I'm not sure where to get these in Australia.

We tapered down the prednisolone and his diabetes basically disappeared, but he was really struggling. Unfortunately other steroids don't cross the blood brain barrier to help the tumour inflammation. With the SRT, that is quoted in Australian dollars, not sure if that is the difference. But it also I think is due to the availability as there is I think two machines in the entire southern hemisphere.

His tumour was first described to me as 'quite large' and seeing it for myself on the scan was heartbreaking. We could also see his brain itself bigger than usual due to inflammation.

We actually thought for a while that it was arthritis causing his mobility issues and vocalisation. And that maybe pain was the reason his mentation was a bit reduced. He got diagnosed with hyperthyroidism at this time as well so we thought he was super sensitive to low T4 from the thyroid medication and was experiencing hypothyroidism from the meds, as he was becoming slow, very tired, and spending many days in winter on top of our ducted heating, usually he slows during winter but this was next level. No vets picked up the brain tumour, we kept going in for blood test after blood test and ultrasounds etc to be told everything was fine. They said he did appear a bit sore in one area in his back leg but it didn't seem to the point of being arthritis. When we kept saying our concerns about mobility they said to increase the prednisolone he was already on and see if that helps, if it does it is probably arthritis. We were at the point of being ready to start solensia. Before we did, they said maybe go to a specialist just to run over things. We went in to the specialist wanting xrays, scans etc and believing we would be told it is arthritis, as he has had luxating patellas in his life. The specialist said we needed CT and listed off 6 possible causes of Oscar's symptoms. Arthritis was not even in the top 6, even when I asked he said there was really no evidence of arthritis. Anyway, then we got the devastating diagnosis of brain tumour after the scan. The trouble is he is experiencing muscle tone loss as well. He has the ability to walk, jump, run, but his brain tells him he doesn't, he has poor coordination and balance. It is worse for him coming down/stepping down from places. We were told the tumour is impacting the cerebellum (because it is so big now) and that will be why, so he has ataxia and gait problems. It sounds awful but one silver lining to him becoming diabetic was that he was so hungry that his hunger sort of over-rode the part of his brain telling him he couldn't do something, his reflexes kicked in and he would jump up on the couch or on the high stool in the kitchen that he hadn't been able to do in months, his hunger made him more alert as well. But I knew it wasn't right.

Thank you for advice on the b12. Do you know if cats are ok eating it on food? are there flavoured varieties?

 

[Wendy&Neko]

Not sure what B12 is available in Australia. Here you can get plain capsules you can just empty and mix with food. It's a common thing taken by people. Here there are also flavoured ones that dissolve in your mouth. Check the local vitamin store.

I am from Canada, but paid US $ for SRT cause that's where the 1 of 4 machines was in North America at the time. There was one also in Canada, and a closer drive, but they charged way more and had way less experience with acrocats. Your quoted cost is more than double what I paid, but I know the price here has also gone up. That was all in with CT scans too.

As for steroids, we've also seen kitties who have to take prednisolone for other conditions, including cancer, and become regulated. I think right now the goal is to get Oscar in decent numbers so diabetes doesn't impact his QOL.

 

[Renee2602]

Not sure what B12 is available in Australia. Here you can get plain capsules you can just empty and mix with food. It's a common thing taken by people. Here there are also flavoured ones that dissolve in your mouth. Check the local vitamin store.

I am from Canada, but paid US $ for SRT cause that's where the 1 of 4 machines was in North America at the time. There was one also in Canada, and a closer drive, but they charged way more and had way less experience with acrocats. Your quoted cost is more than double what I paid, but I know the price here has also gone up. That was all in with CT scans too.

As for steroids, we've also seen kitties who have to take prednisolone for other conditions, including cancer, and become regulated. I think right now the goal is to get Oscar in decent numbers so diabetes doesn't impact his QOL.

I've just ordered some methyl b12 online that others recommended. It will take a while to get here but hopefully won't be too late. I'm really hoping we are able to get him regulated, or atleast manageable numbers, for his QOL. At the moment, since we increased the prednisolone again last week, he is less comfortable and sometimes falling asleep next to his drinking fountain. Urinating alot again, and large amounts. So I think it is likely we will increase dosage again. He has always shown 3+ and 4+ on ketodiastix, never under. And as you can see his bloods reflected the diabetes taking a toll. We are having him fit with another Libre sensor tomorrow which I am hoping and pleading will stay on longer than the other one, so we can get a better look at his levels and then if we increase it to 3 units, see how he goes on that.

Do you have any links to people or posts who had steroid-induced diabetes? It would be interesting to know what dosage of units they had to go onto to get it managed. It seems like in Oscar's case he may require quite a large dose upfront due to the steroid use but then we are hoping to stay at a certain amount rather than having to keep increasing. I know if acromegaly is involved (which we won't know) that the units needed could get very very high. Since we saw some improvement on 2 units (less weeing, more settled, less thirst) before upping the pred again, I am hopeful.

 

[Bron and Sheba (GA)]

Is there a reason the vet is not testing for acromegaly? I think it would be better to know one way or the other. There is a place in Melbourne that tests for it.

 

[Renee2602]

Is there really? From what I heard from others the test took 4 weeks to come back. I’m not sure why we didn’t get it tested after diagnosis, I was the first one to bring it up. I think perhaps because it probably won’t change the outcome and we want to try cabergoline anyway, and it was mainly beneficial in small pituitary tumours. I think also because from his presentation he does not have obvious signs of acromegaly. No diabetes or cushings from the tumour itself either. I think it is something I may mention but I think they may just say it’s an added cost and won’t change the outcome? We were given 2-3 months by one vet and 3-6 months by another based on his tumour size, and we are at almost 3 months now. I wonder if it will help or not? I believe the assumption that our specialist and the vet at SASH said was it seemed it was likely non-functional tumour- growing from non hormone producing pituitary tissue which is why it got so big and only caused obvious symptoms when so big that it was impacting other brain regions. But they also said they can’t rule out acromegaly or if it is cancerous. We did CT not MRI and no biopsy either.

 

[Wendy&Neko]

he does not have obvious signs of acromegaly

Such signs of acromegaly include diabetes, circling, large sized cat, GI issues (such as IBD), lethargy, very hungry, constipation- all listed above. It doesn't really matter now if your vet is going to think about trying cabergoline.

I know if acromegaly is involved (which we won't know) that the units needed could get very very high

The Royal Vet Clinic study that found 1 in 4 diabetic cats has acromegaly found kitties on as low as 1 unit of insulin, average of 7 units. We've seen a wide range too, some a lot higher.

I have read cabergoline is really only beneficial in cats on it for 6 months+ and with relatively small pituitary tumours,

We've had a couple cats go into remission in 10 days or less on cabergoline. Plus several more that also went into diabetic remission, but over a longer period of time. Quite a few cats that started to see benefits within a couple months. Almost none of them have had CT scans, so we don't know if the tumour had been big. Most cats have seen some benefits in symptoms, a few have taken longer to see results.

Do you have any links to people or posts who had steroid-induced diabetes? It would be interesting to know what dosage of units they had to go onto to get it managed.

I wouldn't know where to start, other than a search of this forum. I don't keep track of them and there have been lots. We also have a saying here, ECID, or every cat is different. I don't think you'll see a common answer as to size of dose needed. None of them have been on toujeo either. Cats get steroid shots or oral meds, different types of steroids, some for allergies, asthma, cancer, GI issues. Some have other conditions that can also impact dose needed - such as pancreatitis, hyperthyroidism, kidney disease, heart disease, acromegaly, other infection/inflammation. The one thing about steroid induced diabetes is that remission is more likely in these kitties, once the steroid is stopped. Neko was on steroids, but it was budesonide for her GI issues, and it did not impact her blood sugar values.