A few interesting insights from the Chapter on Acromegaly (HST) written by Drs Niessen and Scudder out of UK:
New Insight- not always associated with external features, or with difficult to control DM or DM at all.
However, due to the research the “overall message” coming from studies over the past decade, they now propose that
feline HST should be ruled out “in any cat as a possible cause of its diabetes mellitus.” : estimates are 1 in 3 to 1 in 5 have underlying HST
They have actually now discovered that in non DM cats, cats with HCM-like disease with thickening, later life-onset snoring, CNS issues—that the disease states are actually triggered by underlying HST.
Now, what I found interesting within the section pertaining to “Diagnosis”.
The plasma IGF-1 is the primary test but it looks like the factor range they use is different than what your was:
>1000 ng/ml in diabetic cats (they note that this arbitrary cut off is likely high, increasing specificity while decreasing sensitivity of IGF-1 assessments.
The recommendation is lower values (600-1000 ng/ml) are “also, in principal, abnormal & should at the very least be followed up up if encountered.”
“At the start of developing HST and especially since these cats are not intrinsically prone to become diabetic (unlike a cat with primary DM) the excess GH will be countered by the pancreas simply synthesizing and secreting more endogenous insulin. This is initially possible, given the fact that there is no B cell dysfunction in most cats with acromegaly. Furthermore, at the start of exogenous in insulin therapy after diabetes mellitus has occurred, the combination of exogenous insulin, subsequent lowering of blood glucose and reduction of glucose toxicity effects on B cells can improve endogenous insulin synthesis and even enable temporary remission.”
I have not had a chance to look to see if a PIIP assay is actually available, but they have found that “medium serum PIIP concentrations were five times higher in HST cats with secondary diabetes compared to cats with uncomplicated diabetes mellitis.” “There was also a significant correlation between serum IGF-1 and PIIP”. They are thinking it can be a useful part of the screening panel to reliably diagnose HST without imaging (they say imaging most likely won’t be used in the future and should not rule out HST currently if it’s done and nothing is seen).
The chapter does go on to describe some interesting treatment options in depth.
I wanted to share this initial info before I move onto the “Unstable Diabetic” written by Drs Rand and Gottlieb. The chapter includes underlying diseases like HST, pancreatitis, as well as info on rebound hypoglycemia, lack of duration with an insulin & the key to figuring out what is going on by using a CGM. That dang CGM recommendation keeps showing up
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and hope the R brings him back down. I was keeping the faith....
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