02/27 Kabosu AMPS 358; 6.5U no nadirs; time to check for acro?

[Dasha and Kabosu]

Hi all,

Kabosu is at 6.5 units, but his BG is just high and flat.

He is EXTREMELY hungry, I am worried he is not sleeping enough, because he is begging for food almost non-stop, day and night. This is really not like him. Sometimes he'll nap for 15 minutes, and then resumes begging. He is very active, and jumps on the kitchen counter a lot to check whether there is anything he can eat there.
The vet suggested we give him no more than 400kcal per day, which is very difficult. Right now he eats ~200 grams of chicken breast, plus 3-6 pouches of wet food (Lilly's Kitchen Catch of the Day - 0 carbs, and Whiskas Fish Selection in Jelly ~5.6% carbs). When his belly is extremely bloated and can't fit any more food he stops begging for 30-60 minutes or so... Today he was locked inside alone with no one to beg for food for 4.5 hours, and his BG did not decrease at all.

His urine culture came back clean, so the high and flat BG should not be due to an UTI.

I'm wondering whether we should check him for acromegaly, Cushing etc.? I am not seeing his BG go any lower with higher insulin doses. I started suspecting acro, because despite having very high BG, he gained weight.
I will keep increasing the dose, but at which point does it become clear no increase will help?
I'm also worried because I do not know whether we can afford the treatment for acro. My understanding is that it will be in 5 digit numbers.

Other strange things about him (probably most of those aren't related but still):
- sometimes he makes noise when breathing, but this comes and goes.
- one of his eyes is sometimes a bit more closed than the other, like if he was winking at me. Today it looked OK though.
- he has lots of hair mats on his hips (since more than a year ago)
- he often does silent meows: opening his mouth but the sound comes out only towards the end of the meow, it sounds a bit like a coughing (sorry, not sure how to explain! may try to film it). He's been doing it since years ago actually, so don't think it is related. He can meow with sound as well.
- his stool is usually soft and pale, although on some days it is normal/close to normal
- he stopped sleeping on the couch/sofa and only sleeps on the floor (although he can jump on the kitchen counter perfectly). He used to love sleeping on our bed
- he prefers being in the bathroom because it is dark there (he won't enter if the light is on)
- he lost quite a few whiskers recently: we found three last week

He is a big cat, he used to be 6.5kg when healthy, was 5.2kg when was diagnosed, and now he gained some weight and is at 5.6kg.



Previous post: https://www.felinediabetes.com/FDMB...getting-higher-every-day.243210/#post-2742260

 

[Dasha and Kabosu]

This is his meow:

 

[Wendy&Neko]

We suggest that when cats get to 6 units, are on an all low carb diet, that they get tested for some of those secondary conditions that may mean they need higher doses. Acromegaly would be my first suggestion, based on his constant hunger and weight gain in spite of his numbers, and that about 1 in 4 diabetic cats has it. I can so relate to having the kitchen in lockdown.

I will keep increasing the dose, but at which point does it become clear no increase will help?

There will be a dose out there that moves him. I have seen that happen with every cat that needs higher doses. The question at this point is how high that dose will be. I can show you a spreadsheet of a perfectly regulated cat on 60 units. One other thing for you to consider, many cats find the higher doses of Lantus sting due to it's acid base. Often people will switch to Levemir. Similar action, except the onset and nadir tend to be a couple hours later. For some cats they get better duration too.

Not everyone can afford treatments. In North America there is only one place that does the surgery and it's also pretty spendy here. When Neko was diagnosed acro, it wasn't even an option anywhere. She had stereotactic radiation therapy, which did help somewhat. Some people here just treat with the amount of insulin needed, and manage the resulting symptoms. We have a number of people trying cabergoline (medication), which can help many cats and usually at least lowers the dose.

Take a look at this paper (2020) Updates in Feline Diabetes Mellitus and Hypersomatrotropism, section 2, starting page 1092. It is current and lists what treatments there are. Just in case your vet isn't up on the latest. One of the authors is at the Royal Veterinary Clinic.

 

[Dasha and Kabosu]

I can so relate to having the kitchen in lockdown.

Thank you! Sometimes I think switching him to wet food may have contributed to this. Dry food was not very tasty, but wet food is!

There will be a dose out there that moves him. I have seen that happen with every cat that needs higher doses. The question at this point is how high that dose will be. I can show you a spreadsheet of a perfectly regulated cat on 60 units.

60 units sounds crazy and crazy expensive too...
Given that I have not seen him going below 300 much, do you think I should still wait 3-6 cycles and increase 0.5 units each time? Or should I increase faster?

Take a look at this paper (2020) Updates in Feline Diabetes Mellitus and Hypersomatrotropism, section 2, starting pate 1092. It is current and lists what treatments there are. Just in case your vet isn't up on the latest. One of the authors is at the Royal Veterinary Clinic.

Thank you! Will read it before contacting our vet again.

 

[Wendy&Neko]

Increasing any faster than every six cycles can only be done if you can get a second test in each and every cycle, including the night time ones. I see that night time hasn't had nearly as many tests as the day and some have no tests past PMPS. If you can do more frequent night testing, they increasing as soon as every 4 cycles is possible, as long as you are only seeing 300's and above.

A tip to help you save some costs on test strips. With Lantus, the +2 or +3 is a good indicator of how the cycle will go. If it's about the same as the preshot, it'll be a typical Lantus cycle. If you get that +2 or +3 that's lower than the preshot, that cycle will be very active, and at night time may mean setting an alarm for a later test. If the +2 or +3 is higher than preshot, put away your test kit and save strips until the next preshot. See the AM cycles of 2/22/ and 2/19. These patterns will become more evident as you get closer to a dose that shows more curve. Now he's pretty much high and flat.

 

[Dasha and Kabosu]

A tip to help you save some costs on test strips. With Lantus, the +2 or +3 is a good indicator of how the cycle will go. If it's about the same as the preshot, it'll be a typical Lantus cycle. If you get that +2 or +3 that's lower than the preshot, that cycle will be very active, and at night time may mean setting an alarm for a later test. If the +2 or +3 is higher than preshot, put away your test kit and save strips until the next preshot. See the AM cycles of 2/22/ and 2/19. These patterns will become more evident as you get closer to a dose that shows more curve. Now he's pretty much high and flat.

Thank you so much! This is extremely helpful!