6/14 Mr Kitty AMPS 353, +2.5 233, + 3.5 163, +5.5 138

I'm not much help with Levemir or acro, unfortunately, but it looks like you're still building back up to an effective dose since the switch from Lantus, so it wouldn't surprise me if you see some weirdness. Hopefully Wendy or Suzanne will have more useful advice!
 
Well I guess we are heading for late nadir just these big drops are a little surprising. I'll chalk it up to the increase.
 
After you have been on the Levemir a while let me know what you think. I'm seriously thinking about trying a switch to that if I don't see some better numbers soon. Problem is I still have two and 1/2 pens of Lantus left. Is the Levemir more or less expensive that the Lantus?
 
FrostD said:
Any thoughts as to what I'm seeing these last two cycles? These seem like pretty big early drops vs late nadir which doesn't seem very Levemir-like?
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I've seen the odd Lev cat onset early, though not usually the IAA/acro ones. But it's still early in the game, the Levemir depot still has to build at this dose. I also found that as the dose got better, the nadir got later. I think you aren't getting great duration yet, hence the higher preshots. What are his feeding times in the last part of the cycle?
 
Wendy&Neko said:
I've seen the odd Lev cat onset early, though not usually the IAA/acro ones. But it's still early in the game, the Levemir depot still has to build at this dose. I also found that as the dose got better, the nadir got later. I think you aren't getting great duration yet, hence the higher preshots. What are his feeding times in the last part of the cycle?
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I was thinking similar about the duration, because it doesn't look like bouncing.

He's free fed, he doesn't really eat late in the cycle. He basically eats a lot as he's dropping from onset, then nibbles and stays fairly flat. Once he's on his way back up he doesn't really eat, maybe 1-2tsp in that 5-ish hr window between +7 and PS
 
Summer and Susie said:
After you have been on the Levemir a while let me know what you think. I'm seriously thinking about trying a switch to that if I don't see some better numbers soon. Problem is I still have two and 1/2 pens of Lantus left. Is the Levemir more or less expensive that the Lantus?
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I order from Marks, through them it works out about the same.

For what it's worth I'm not sure changing insulin will help. I think you just haven't hit the right dose (or perhaps held it long enough because of your reduction threshold). That said, Levemir is supposed (?) to be a flatter insulin so it may help prevent those drops that were worrying you.
 
Since he has higher preshots, but keeps on going lower afterwards, it does look more like lack of duration. Especially since he's not getting food later in the cycle.
 
Just got off the phone with the vet, as I suspected his first acromegalic cat (that he knows of). The good news is he had done a lot of research and consulted with endocrinologist. He gave me all the options - surgery (10-20k), radiation (4k-20k depending where and what kind), pasireotide ("but I don't even know where the hell to get that and its 10-20k for humans" HA), cabergoline, and doing nothing. If I wanted surgery or radiation he'd refer me to endocrinologist or IM vet.

Radiation is at the top end of what we can afford, so mulling that one over. He's still "young" and otherwise healthy as far as we know.

We decided to at least start cabergoline, they can compound it in house. Should have it next week. And I'm thinking an echo in a few months just to check on his heart.
 
Good to see your vet has been doing research! That makes him a keeper. :) We have yet to see a cat here on pasireotide. Due to the cost. Cats need less than humans, but it's still outrageous. The one study on it in England had to do it on donated insulin, it wasn't even allowed in the country at the time.

Good plan to start on cabergoline, it will give you time to think about other options. I got Neko's first echo done when the vet noticed a murmur. She was also Maine Coon heritage which has higher incidence of HCM. The murmur turned out to be benign, but gave us a baseline for later. So good idea to at least be thinking of it.
 
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