12/15 Eddie AMPS 236 +4 346 +333 PMPS 436 +8 315

[Jodey&Eddie&Blue]

Good morning

Here's yesterday:

https://felinediabetes.com/FDMB/threads/12-14-eddie-amps-193-3-358-8-382-pmps-265-8-250.284569/

Today's a Cabergoline day (#15). Eddie is perky, has only a trace of diarrhea, enjoyed his breakfast, sauntered over to his oversized pillow and snoozed a bit by the fire, then decided to go on a walkabout around the house.

All I can say is It's Friday. What a week. I have been to so many meetings in person and on Zoom that they are all a blur. Can't wait for the island that is the weekend.

 

[Staci & Ivy]

Good morning

Here's yesterday:

https://felinediabetes.com/FDMB/threads/12-14-eddie-amps-193-3-358-8-382-pmps-265-8-250.284569/

Today's a Cabergoline day (#15). Eddie is perky, has only a trace of diarrhea, enjoyed his breakfast, sauntered over to his oversized pillow and snoozed a bit by the fire, then decided to go on a walkabout around the house.

All I can say is It's Friday. What a week. I have been to so many meetings in person and on Zoom that they are all a blur. Can't wait for the island that is the weekend.

So glad Eddie is feeling well and enjoying his cat life. I wish you a calm and relaxing weekend, Jodey

 

[carfurby (GA)]

Glad Eddie is doing good. I hope he slides back down soon.

 

[Jodey&Eddie&Blue]

Well, at AM +8 here we are again. Or is it still?

I'm thinking because of the choreography that it might be appropriate to increase to 16u tomorrow. I'm "imagining" a conflict between IGF-1 and Cabergoline, for some reason.

I am not rushing the Cabergoline thing but depending on what happens over the next two weeks, we may be going to once daily as a trial run.

@Wendy&Neko You have any thoughts?

 

[Wendy&Neko]

I'm "imagining" a conflict between IGF-1 and Cabergoline, for some reason.

Not sure what that means. In the South American Study, a decrease of IGF-1 was seen in 35% of cats. So not a conflict between IGF-1 and Cabergoline. What that study also says is that there cabergoline doesn't always work. With Eddie as a case of one, it's even harder to predict if it'll work for him.

You are still seeing imperfect poos, I'd try to be patient for now on the cabergoline dosing.

 

[Jodey&Eddie&Blue]

Not sure what that means. In the South American Study, a decrease of IGF-1 was seen in 35% of cats. So not a conflict between IGF-1 and Cabergoline. What that study also says is that there cabergoline doesn't always work. With Eddie as a case of one, it's even harder to predict if it'll work for him.

You are still seeing imperfect poos, I'd try to be patient for now on the cabergoline dosing.

I'll just "imagining" is rather like hypothesizing after speaking with them at WLU when they said if BG+IGF-1 decrease, possible Cab decrease or the other way around. They are "imagining" as well. In an email, they said "Not sure if that is the “right” answer, but it seems to make physiologic sense to get down to the lowest effective dose and then go back up if needed."
See what I mean. The other downward option (whenever to be determined) is to dose every 2nd day OR conversely to dose every day. See what I mean? I live with Mr. N=1.

 

[Wendy&Neko]

they said if BG+IGF-1 decrease, possible Cab decrease or the other way around

"Possibly" sounds like a guess. There are kitties here who have gone OTJ and then reduced the frequency of dosing. We are talking a small handful of cats in total who have gone OTJ. No one repeatedly tests their cat's IGF-1 numbers. All data is via BG. As per the study linked above, some of the kitties that went OTJ did not have their IGF-1 reduce to normal levels, but it did reduce. Whether the IGF-1 normalized or just reduced, there is no difference in how you would practically treat going forward. Meaning, not much value in collecting the IGF-1 data, other than to satisfy a researcher.

The RVC study started with some cats on a lower dose of cabergoline, but part way through the study upped every cat to the dose you are giving now because the lower dose wasn't working. The only time the daily dose has been reduced around here, is the very few cases when cabergoline had be stopped for some reason. Cabergoline needs to be tapered if reducing. The few cases I mentioned were one for a cat that was going to under SRT instead, and a couple cases where cabergoline supply was limited so the caregivers had to reduce until new supply showed up. No other caregiver has reduced the dose, but I have seen one increase when stable acro symptoms got worse.

but it seems to make physiologic sense to get down to the lowest effective dose and then go back up if needed."

I disagree with this. As mentioned above, lower doses didn't seem to work for cats in the studies. Plus, how do you measure an effective dose? First you have to get to a state where a cat's BG is going down, and acro symptoms are lessening. If you reduce the cabergoline dose and the BG goes up, is that because of other reasons causing insulin resistance (IAA, infection/inflammation, hyperthyroidism, CKD, heart disease, etc.) or the cabergoline dose being reduced? There doesn't seem to be harm in giving the drug, but there might be if you reduced the drug dose. Seems an easy decision for me.

15 days of dosing is not enough to base decisions on. There are exactly 2 cats on FDMB who have reacted quickly. The rest took much longer, and the majority were on every day dosing.

 

[Jodey&Eddie&Blue]

"Possibly" sounds like a guess. There are kitties here who have gone OTJ and then reduced the frequency of dosing. We are talking a small handful of cats in total who have gone OTJ. No one repeatedly tests their cat's IGF-1 numbers. All data is via BG. As per the study linked above, some of the kitties that went OTJ did not have their IGF-1 reduce to normal levels, but it did reduce. Whether the IGF-1 normalized or just reduced, there is no difference in how you would practically treat going forward. Meaning, not much value in collecting the IGF-1 data, other than to satisfy a researcher.

The RVC study started with some cats on a lower dose of cabergoline, but part way through the study upped every cat to the dose you are giving now because the lower dose wasn't working. The only time the daily dose has been reduced around here, is the very few cases when cabergoline had be stopped for some reason. Cabergoline needs to be tapered if reducing. The few cases I mentioned were one for a cat that was going to under SRT instead, and a couple cases where cabergoline supply was limited so the caregivers had to reduce until new supply showed up. No other caregiver has reduced the dose, but I have seen one increase when stable acro symptoms got worse.


I disagree with this. As mentioned above, lower doses didn't seem to work for cats in the studies. Plus, how do you measure an effective dose? First you have to get to a state where a cat's BG is going down, and acro symptoms are lessening. If you reduce the cabergoline dose and the BG goes up, is that because of other reasons causing insulin resistance (IAA, infection/inflammation, hyperthyroidism, CKD, heart disease, etc.) or the cabergoline dose being reduced? There doesn't seem to be harm in giving the drug, but there might be if you reduced the drug dose. Seems an easy decision for me.

15 days of dosing is not enough to base decisions on. There are exactly 2 cats on FDMB who have reacted quickly. The rest took much longer, and the majority were on every day dosing.

"possibly" is a guess and that's the best they've got. It seems the best I've got too, for the most part. I have no intention to getting IGF-1 tests to tell me what BG numbers can reveal.

And, as for reduction according to the best guess, I would counter that by saying that it is not only quite likely we'll be increasing the Cab (Eddie's N=1 tumour size) but that if we don't increase the dose, we will increase the frequency.

As I said, it's the next 15 days to reevaluate. He's already been on Cab for 15 doses=30 days of treatment. I think the point WSU was making is they don't know how to measure an effective dose and for sure the IM vet and the regular vet here are the same. I've no intention of reduction. I am thinking that if any changes are made it's to frequency. It's an easy decision for me, too.

 

[Diane Tyler's Mom GA]