5/30 Floyd AMPS 210, +6 110, +8 227, +8.5 353, shot 1 u R, PMPS 448

[Janine & Floyd (GA)]

Yesterday

Nice yellow number this morning, so I decided to break the TR rules. In my recent discussion with Dr. Lisa, she suggested a 25% dose reduction on mornings where he gives me a much lower number than we're used to. Hopefully, this will prevent a hypo today.

I picked up some 8% carb Friskies yesterday, so today I will start feeding that at +3 of each cycle to see if it helps with dropping so fast. I tried 4% carbs at +2 in my previous experiment, which did not seem to make a difference. We'll see if this does anything.

Feel free to ask questions or pose ideas as you investigate treatment options. Even though I had had suspicions before Neko's tests came back positive, I remember going into overdrive when I got the confirmation. There is a lot of collective experience here and maybe we can save you some time.

Thank you, @Wendy&Neko! I'm going to call about the price for me to get pasireotide, but I doubt it will be doable even getting it at cost. I priced cabergoline at $40/month through Wedgewood, so I think that's going to be the route we take.

ETA: I just diagnosed a kitty with FD yesterday, so wish me luck!

 

[Tracey&Jones (GA)]

Good luck with the new food, dose decrease and the new FD client!

 

[Olive & Paula]

Will be interesting to see how the food works. You have the tools for the new pet client. Put them to good use.

 

[Wendy&Neko]

I had been meaning to ask if you or DH had seen an acrokitty client yet. Good luck with the new FD kitty.

Nice yellow number this morning, so I decided to break the TR rules. In my recent discussion with Dr. Lisa, she suggested a 25% dose reduction on mornings where he gives me a much lower number than we're used to. Hopefully, this will prevent a hypo today.

Looks like the R really kept a lid on things last night. Even for brand newbies, we suggest shooting full dose over 200. But one option on the "shooting and handling low numbers" sticky is to shoot a reduced dose. Call it that then you aren't breaking the rules. Hopefully you (and Floyd) will eventually get used to shooting lower numbers.

Floyd has hit lime green on Lev starting with a pink preshot, so I'm not sure using the preshot is the best warning on when he might go low. I found it best to go back a cycle or two and see if I could see patterns for when Neko might go low. Taking just a quick look at Floyd's SS, it seems that the lime green happens each time he's breaking a bounce. By that I mean that the cycle before one with lime green, or perhaps the one before that, he has a cycle that is a "slide". ie. starts high and the numbers go down all the way to the next preshot. Not sure if you saw that last night becaue of the R. However, if you do see a big drop by +3, that's be a good chance to try the somewhat higher carb experiment.

 

[Kris & Teasel]

At some point I'd love to read your reflections (as a vet) on the real world experience of treating a complicated diabetic kitty, Janine. I know some cats are fairly straightforward and can do well with simple dosing and monitoring but I suspect there are many in this big category of complicated. Many owners wouldn't do what we do but for those of us that will, how best can we be supported by our vet?

 

[Janine & Floyd (GA)]

I had been meaning to ask if you or DH had seen an acrokitty client yet.

No, Floyd is the first!

Looks like the R really kept a lid on things last night.

Yes. And actually, I did consider that as "less" R because on 5/28 I tried 1 u on a black and didn't see much effect. At that point, I decided that the next time I gave it on a black, I'd give more. So only shooting the 1u again on a pink, was "less". Does that make sense?

Even for brand newbies, we suggest shooting full dose over 200. But one option on the "shooting and handling low numbers" sticky is to shoot a reduced dose. Call it that then you aren't breaking the rules. Hopefully you (and Floyd) will eventually get used to shooting lower numbers.

I'm usually fine shooting a full dose on a "low" number, especially with Floyd's history of asymptomatic hypos and voracious appetite. I just wanted to see what would happen if I tried Dr. Lisa's advice of shooting a reduced dose. It's all a data-gathering experiment, right?

Floyd has hit lime green on Lev starting with a pink preshot, so I'm not sure using the preshot is the best warning on when he might go low. I found it best to go back a cycle or two and see if I could see patterns for when Neko might go low. Taking just a quick look at Floyd's SS, it seems that the lime green happens each time he's breaking a bounce. By that I mean that the cycle before one with lime green, or perhaps the one before that, he has a cycle that is a "slide". ie. starts high and the numbers go down all the way to the next preshot. Not sure if you saw that last night becaue of the R. However, if you do see a big drop by +3, that's be a good chance to try the somewhat higher carb experiment.

I see what you mean about the slide and I will keep an eye on that.

 

[Janine & Floyd (GA)]

However, if you do see a big drop by +3, that's be a good chance to try the somewhat higher carb experiment.

Only a slight change at +3, so I'll hold off on the 8% for now. Maybe at +6 if he's dropping.

 

[Janine & Floyd (GA)]

Starting to come up now. I'm going to test again at +8.5 and give R is he's shooting up.

 

[Wendy&Neko]

Are you planning on going back to 5.25 units tonight? What you are seeing today is also the lower AM dose. Good timing on the R.

No, Floyd is the first!

Neko was her vet's first, until she knew what to look for. Saw another one within a few months.

 

[Janine & Floyd (GA)]

Are you planning on going back to 5.25 units tonight? What you are seeing today is also the lower AM dose. Good timing on the R.


Neko was her vet's first, until she knew what to look for. Saw another one within a few months.

Assuming he's pink or higher, yes, I'll be shooting the full 5.25.

Did Neko have any of the physical changes in her head or feet?

 

[Wendy&Neko]

Neko's only initial signs were rather suble. Well, other than the serious polyphagia. She had some eye tearing in one eye (due to soft tissue growth in the tear duct I later found out), and blinked in bright light. Her feet never changed. She had some changes in her mouth in the later years. And the arthritis was bad after a couple years. Her heart condition came later and she had a slight increase in liver size towards the end plus the acromegaly probably impacted her kidneys. Maybe even her GI system as that seems to be a common acro issue. Her eye tearing started about 6 months before her diabetes dx, so she had acromegaly before diabetes, in hindsight. Diabetes is a later stage symptom for some acros, and there have been a few cases of diagnosed acros that did not become diabetic. I have heard of a couple of people with acros getting their cat's siblings IGF-1 tested. It was positive, but BG was not. Plus there are some papers on HCM kitties with pituitary masses.

 

[Janine & Floyd (GA)]

Interesting. The only things I could possibly pinpoint with Floyd are vision changes and abdominal distention. The vision I just attributed to age, but it certainly could be the acro, or a combo. Fortunately, no cataracts, but definite lens changes. He can't see unless there is good contrast - can't find the FD treats on a light surface as fast. The abdomen is more obvious after he eats, then goes down between meals.

I'm ordering cabergoline today. The next step will be to have DH do an amateur echo. We have an ultrasound and he can do at least a screening. We might be able to take a video and have the cardiologist take a look. I'll take him in for a consult if he feels it's necessary. He doesn't have a murmur or arrhythmia, but occult disease is always possible.

 

[Wendy&Neko]

The pot belly is common, but Neko didn't have it. Or at least not obviously through all her fur! I saw a paper that said only 35% of acros had clinical signs at diagnosis. The pituitary tumour is near the optic chiasm, hence possible vision issues.

Good luck with the cabergoline. Are you buying it from a compounding pharmacy?

Neko just had a mild murmur when she had her first echo. Of course, she also had Maine Coon heritage and I had not long before lost a civvie to thromboembolism so was paranoid. Her first echo showed left ventricle barely out of spec and just age related causes for the murmur. I was glad I had the baseline. We've had a few acrokitties here with heart surprises.

 

[Olive & Paula]

Interesting comparison of Floyd and Neko. I have to input my 2. Smokey had a lot of acro characteristics but his score was 96. Olive has same characteristics plus some and her score is 382 yet her Dr says she's not because her head and jaw are normal. IMO head is not normal but jaw seems to be. I wish my vet would "see" the whole picture.