? 4/21 Eleanor Dose Increase Question AMPS 292 +3 202 +4.5 232 +6 292 PMPS 285

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Responding to Julie's PM here since the FDMB is a peer-reviewed message board:

Hi Julie. Happy to hear Eleanor is skipping around and feeling good!!!

I took a look at her spreadsheet. I think you've done a great job increasing her dose slowly and methodically. Eleanor numbers are pretty flat. In my opinion, she is not over dose. At this point, if I were in your shoes, I would continue with doses increases (as you have been) until her numbers tell you otherwise.

Not sure if the subject has been brought up, but if a kitty gets to around 6u BID, we usually suggest testing for high dose conditions, specifically Insulin Auto Antibodies (IAA) and Acromegaly. Just throwing that out there because while Eleanor isn't there yet, 6u BID is getting closer.

Just my thoughts...
have a good day!
 
@Jill & Alex (GA) we have actually had a couple kitties here test positive for acromegaly with doses of 4 units and under 3. The recent study by the Royal Veterinary College found one in four diabetic kitties has acromegaly, with an average dose of 7 units and some as low as 1 unit.

But regardless Julie, you still follow the same process for dosing. And Eleanor is seeing improvements. What was a pink and yellow SS is now yellow and blue.:) Keep marching on and we'll soon be seeing more blue.
 
@Wendy&Neko
Wendy&Neko said:
@Jill & Alex (GA) we have actually had a couple kitties here test positive for acromegaly with doses of 4 units and under 3. The recent study by the Royal Veterinary College found one in four diabetic kitties has acromegaly, with an average dose of 7 units and some as low as 1 unit.
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Yep. I'm very well aware of both stats, but I didn't think we were actively suggesting the tests be run until kitty reached 6u BID. Has that changed recently?

FWIW, I've always encouraged tests for high dose conditions long before reaching 6u BID when/if the caregiver expresses concern...
 
@Jill & Alex (GA) I have also seen kitties go over 5 units for reasons other than acromegaly or IAA, so 6 units seems a good marker if the caregiver hasn't wondered about the dose size before then. Or if they haven't mentioned clinical signs indicative of acromegaly. Many acros do not show clinical signs or at least obvious ones.
 
@Wendy&Neko
Wendy&Neko said:
@Jill & Alex (GA) I have also seen kitties go over 5 units for reasons other than acromegaly or IAA, so 6 units seems a good marker if the caregiver hasn't wondered about the dose size before then. Or if they haven't mentioned clinical signs indicative of acromegaly. Many acros do not show clinical signs.
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Yes, I've also seen kitties go over 5u doses for various reasons.
For the reasons you've mentioned, it's good to know the practice of actively suggesting testing for high dose conditions at around 6u BID hasn't changed.
 
Jill and Wendy, thank you so much for weighing in on this.
This is all so confusing and upsetting to me!

I'm trying to find a new vet, I don't think the current one will go along with testing for high dose conditions. I mentioned it to him the last time I saw him and he looked clueless and told me what's happening is Somogyi.

I was not able to get online before the PM injection so I shot 5u again. I'm going to increase next cycle.

Eleanor is having a good day, in spite of her numbers.
 
Julie and Eleanor said:
Jill and Wendy, thank you so much for weighing in on this.
This is all so confusing and upsetting to me!

I'm trying to find a new vet, I don't think the current one will go along with testing for high dose conditions. I mentioned it to him the last time I saw him and he looked clueless and told me what's happening is Somogyi.

I was not able to get online before the PM injection so I shot 5u again. I'm going to increase next cycle.

Eleanor is having a good day, in spite of her numbers.
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Hope you can find a better vet soon! Glad that Eleanor is having a good day!
 
Julie and Eleanor said:
I'm trying to find a new vet, I don't think the current one will go along with testing for high dose conditions.
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Neko's vet didn't want to test for high dose conditions until we got over 10 units - never did. I asked her to humor me, so she got the tests done. She was more surprised than me at the results and I earned a lot of respect by being right. And not long after she identified another acrocat at the clinic. Remember, the vet works for you. It shouldn't matter to them how you want to spend your money.
 
Most vets will look at a caregiver cross-eyed when they bring up testing for high dose conditions. They believe high dose conditions are extremely rare and don't think about testing until kitty is receiving a very high dose of insulin and/or exhibiting physical signs of acromegaly. Wendy's right. If you like your vet and want to work with him... ask him to humor you. If not, maybe it's time to find a new vet.

I was looking for my bookmarks from the June 2011 ACVIM Forum Proceedings, but I think they disappeared when my last laptop died. Maybe Wendy or someone else has copies? All I could find was a couple blurbs Carolynn/Fletcher wrote in the sticky, Acromegaly and Other High Dose Conditions: What We Know.

How Common is Acromegaly in Cats?

In a lecture by Dr. Lunn from Colorado State University at the 2011 ACVIM Forum Proceeding, she stated:

"Feline acromegaly has historically been regarded as a rare condition, however recent findings suggest that it may be significantly under diagnosed. In a study of 184 diabetic cats, 59 had markedly increased IGF-1 concentrations, and acromegaly was confirmed in 17 of 18 cats that were examined by computerized tomography (CT), magnetic resonance imaging (MRI), or necropsy. These findings have suggested that any cat with clinical features of acromegaly including insulin resistance, should be screened for this disorder."

At the same forum, Dr. Niessen from London, UK stated:

“Feline acromegaly is now being recognized as an important cause of feline DM, largely as a result of two remarkable prevalance studies. Both these studies suggested that feline acromegaly occurs in a significant proportion of diabetic cats with estimates ranging from 1 in 3 to 1 in 4. Even when adhering to the more conservative estimate, this has justified the initiation of several studies on various aspects of this endocrinopathy, including more careful evaluation of etiology, clinical presentation, and management aspects.”


You might also be interested in taking a look at recent info:

Research shows why vets are often missing the cause of feline diabetes - (researchers collected data between 2003 and 2011 on cats treated at vet practices across the UK) and Studying Cat (felis catus) Diabetes: Beware of the Acromegalic Imposter (link to the study talked about in the first link - published in 2015).

Perhaps they'd be something worth sharing with your vet...
 
The post Acromegaly - the basics, has an overwhelming amount of information and the more recent research we know about is listed there. The last link that Jill included is the best one - Dr. Niessen at RVC was testing all cats entering their Diabetes Remission Clinic, with a view to excluding cats with acromegaly from the study. At one point they were joking that it was hard to find not acrocats for their study. As hard as it is to find a vet who knows a lot about FD, it's even harder to find one that knows about acromegaly. IAA is even harder still.
 
If you are still doing SLGS, you would wait a week, run a curve, and then determine the dose based on the nadir.

If you are doing TR, it's time for a dose increase. Once we get to five units, we increase more so her new dose would be 5.5u.
 
Marje and Gracie said:
If you are still doing SLGS, you would wait a week, run a curve, and then determine the dose based on the nadir.

If you are doing TR, it's time for a dose increase. Once we get to five units, we increase more so her new dose would be 5.5u.
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I'm feeling so poorly, I'm not sure what I'm doing.
The plan was to increase more rapidly because her BG was so high, since I am able to monitor, then when her BG comes down, go back to SLGS.
I guess her BG is still high so I'm sticking with the faster increases. Today has been a lousy day for her.
Thank you Marje.
 
((((Julie)))

When you feel up to it, I'd increase her dose. I would also move to 0.5u increases - that's just 10% of her 5u dose and once kitties get in higher doses, we start thinking in terms of percentages.

For the cat getting 1.0u per shot, a 0.25u increase is a 25% increase. That helps provide a guideline for a safe amount to increase once the doses get a little bigger. It's reasonable to think of a 10-25% increase, depending on what the numbers are.

I sure hope you feel better. Sending healing vines your way.
 
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