? 2/27 Kokkinoulis Acromegaly diagnosis AMPS 111 Dose advising?

Kokkinoulis

Kokkinoulis

Member Since 2023
Dear all,
@Wendy&Neko, @Bandit's Mom , @Marje and Gracie , @tiffmaxee , @Chris & China (GA), @Ale & Bobo & Minnie (GA), @Sienne and Gabby (GA)

Yesterday, I received Kokkinoulis diagnosis for Acromegaly IGF-1 >1000 ng/ml.

ACROMEGALY >665 ng/ml according to the lab interpetation
The vet prescribed cabergolin (Galastop syr. 50μg/ml) dose 1.3ml every 24 hours with food. I saw that in most stusies it is given every 48h. I will buy and start it today or tomorrow. I saw that one of the adverse events is vomiting. Any info how to prevent it from your experience?
Do you know if this dose is ok according to his kg (6.6 to 6.7 kg)? Any tips or info about cats with Acromegaly and also cabergoline? I heave already reαd the section for Acromegaly in this forum as well as some clinical studies about it.

Moreover, I would like your opinion about insulin dose in my ss. You will see a big decrease in his insulin doses in a shorten period without to has earned them according to the TR protocol. The reason is that suddendly in the last days unpredictably and inexplicably become sensitized to the effect of the insulin, resulting to low numbers. Also, last week I was requested to work only 2 days per week remotely from home and the other days to go to office or to Hospitals. For this reason Kokkinoulis is alone at home more than 9 hours without anyone to assist me and keep an eye on him. I am very afraid of hypos during my abcense. I put a camera to watch him and a feader to have snaks especially every 2 hours between 12:00 to 18:00 o'clock when his BGs decrease.
Although most of the lately measurments in SS are with libre 2 I also have double check the low numbers. It seems that libre is not so accurate below 50 but the last 2 days I have the same results with libre and my glucometer in BGs above 80s. I would prefer to have numbers between 120 to 80 when he is alone than at greens and near to hypoglycemia as I don't know yet how he will react to very low numbers. I saw that when I feed him the BG is not increase a lot as in the previous period. When he had a low number (45 with libre and 50 with accu-check) at +5 on 24Feb2024 which was not a hypo but close to it I was afraid as it was his first so low number and gradually from +5 till +9 I fed him 3 tbs low carb can, 1 Royal Canin Vet Diet Cat Diabetic wet, 1 little can high carb , dry kiddle friskies and the BGs had not increased a lot. They increased a little and decreased and again the same. Then at night he has a bounce due to so much HC food and also low BGs.
So mainly for safety reasons I decreased the insulin dose to 6 unit as I could not help him when he will be alone. Otherwise if I was at home to closely monitor him I had stay at 7.0 iu for 1 weak as it has to be.
What do you think about his current dose of 6 iu under this circumstances?
I also dont know how he will react with cabergoline and how the BGs will drop with it. Do you have any idea?

Thank you in advance.

Previous posts:
https://felinediabetes.com/FDMB/thr...-measurements-in-your-ss.287029/#post-3155832
https://felinediabetes.com/FDMB/thr...e-advise-pm-insulin-dose.287019/#post-3155802
 
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Hi Gabriella :)
I'm sorry to hear about Kokkinoulis' diagnosis. He's so lucky to have you. You're taking such a good care of him.
I think it's great that you think about safety first. It's not easy to manage FD especially if you do it alone.
I can't advise on dosing. I'm sire someone with experience will pop in very soon to give you suggestions.

Kokkinoulis is very newly diagnosed so I think you're doing right by being careful as you don't have a lot of data yet.
What I've noticed with Fistuk is that with time, changing his diet to LC he's become very carb sensitive. If at first I had to stuff him with honey to pick him up from a low, now I only need to give him his normal LC food and he's going up. ECID but perhaps it's good to keep in mind that things could change and you'll get a better sense of how to manage lows. At first I was very afraid of them, now it's just a matter of taking care of it. Had just another incident like that this morning :p

You're an amazing mum to Kokkinoulis :bighug::bighug::bighug:
 
Out of curiousity, do you know which labs did the IGF-1 test processing? There have been some recent changes in the type of assay used for testing, so the ranges may be changing and I'm trying to get current information.

Cabergoline dose is 10 microgram per kilo dose once daily. So the dose for Kokki looks right. Some people dose that amount every other day, if they find their cat has GI issues. Not all cats respond with GI side effects. And it's impossible to say how Kokki will respond to it. He will probably see some improvement in both dose and acro symptoms. We've had a small number of cats go off of insulin on it, which is the best outcome, should it happen. Cats typically take at least 7-10 days to start responding to it. Some take months before they see any difference. Some cats see fast changes, some slow. Cats on smaller doses seem to do better, so that's a plus for you. But unfortunately there is no way to say how your cat will respond. Being cautious with the dose is a good idea.

I am about to go to sleep, so will try to respond more in my tomorrow. Remember that the larger depot can influence 4-6 cycles after a reduction. There could still be some impact from the 7.5 units dose that you are seeing. Generally when following TR, you don't take back to back reductions. With cabergoline, you can take back to back reductions. Though you likely won't see it's effect for a week, maybe longer.
 
When you start cabergoline, could you put a blank line in the spreadsheet and label it "start cabergoline" or something like that. Knowing when it is started can tell us some things.

As far as dosing goes, when people are doing some treatment for acromegaly, such as cabergoline, I suggest being more cautious. After Neko had her SRT (radiation therapy), I started taking reductions when she went below 70 on a BG meter. Cabergoline can make quick changes in dose needs. You may find you need to take larger reductions than normal. Or if Kokki goes below 70 (human meter), you might want to do a half dose the cycle following, to help drain the depot. Feel free to skip if he's low and you can't monitor that day. These are modifications to TR, but may be necessary during the time when treatment is impacting the dose. With Neko, I used the below 70 guideline when her dose needs were actively reducing, and went back to 50 for reductions when they stopped or stalled for a while.

I'd also suggest browsing the acro forum postings on cabergoline, and look at the spreadsheets of some cats who have taken it. These are the two of the most extreme reactions - see Marvin's SS starting 6/23/2017 and Mr. Kitty's SS starting 7/1/2021. Mr. Kitty went from 13 units to off of insulin in 11 days.

Good luck. :bighug:
 
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