? 6/6 Malcolm PMPS 330-need dosing help

https://felinediabetes.com/FDMB/threads/5-21-malcolm-pmps-189.290277/?#post-3181295

Hi. Can someone please look at my spreadsheet. I upped his dose to 10. He has officially been diagnosed with acromelagy. His result was >1200. He's had some numbers in the 100s. But also 200s, 300s, 400s and 500s. I'm just confused if I'm giving him too much now and feel like I'm doing this all wrong. I wasn't able to test him today and and I don't know what his AMPS was since he was at the vet all day.
I use a pet meter, btw
 
I'd stick with 10 units for the full week as per SLGS, unless he earns a reduction. He'd earn a reduction if he went below 90, and I see no evidence of that happening yet. Malcolm is a bouncy boy and the higher dose is getting him to numbers lower than his body is used to yet. But not too low numbers.

Why was he at the vet? He OK? Did the vet give the shot? Surprised they didn't test first.
 
Isn't 90 too low though? I was told that's low for acro cats in the acro cat open FB group (I'm using a pet meter and they said that would be really low on a human meter) They also said because he's an acro cat he's not diabetic so he can fluctuate with doses but I don't really understand that...

He had an echocardiogram done since he has a heart murmur. And I had blood work done because I was concerned about his reaction to the solensia shot. I wanted to have a urinalysis done as well but they forgot and couldn't get urine from him since he had already eliminated in his cage earlier

I figured they wouldn't test before hand. My friend is the co owner and a vet there and she's also one of those vets who don't think you need to test before shots. I was telling her my frustration with another vet who told me I didn't need to test before shots and she agreed. One of the reasons I was trying to find a new vet but they are the only ones who offered to do both the IGF-1 and the IAA tests.
 
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How did the echo go? I'm glad you had it done. Neko's first echo only showed age related reasons for a murmur, so nothing bad. But it was a good baseline for later. Maybe you can get a sterile container from the vet and collect pee at home and take it in.
I was told that's low for acro cats in the acro cat open FB group
Don't listen to them. Especially not the person with the initials GC. Our experience here is that even following TR with acro cats is perfectly fine. Most of the acros here do follow TR unless they are eating dry food. Neko earned reductions when she went below 50 and was fine with it as I was monitoring closely. She was also very sensitive to carbs and I didn't need to give her much to boost her up. The only reduction exception is if a cat has been treated (cabergoline, SRT, etc.) in which case we raise the reduction point to 70. Malcolm is not in that category yet. 90 on a pet meter is perfectly safe.

Malcolm is also seeing a lot of numbers over the renal threshold, which varies by cat but is typically in the 200's (pet meter) and above. More insulin will lower those high numbers. Acromegaly is hard on the kidneys, you want to try to get him to a safe dose where he's spending time below the renal threshold, so nadirs in the 90-149 range since you are following SLGS.

Acro cats with diabetes are diabetic cats. They have diabetes type 3 - from other causes, some refer to this type as HS (hypersomatotropism) associated DM or diabetes mellitus. HS is the name of the pituitary tumour, acromegaly is more properly the symptoms associated with the tumour. To say acrocats are not diabetic is hogwash. If I had the time, I could dig and find the several articles I've seen by researchers in acromegaly who describe them as diabetic. For now, here is just one of them: see the story of Case 2: (2020) Updates in Feline Diabetes Mellitus and Hypersomatrotropism

Note, not all cats with hypersomatotropism (the pituitary tumour) have diabetes, as that is a late stage symptom. But once they need insulin, they are diabetics and have acromegaly.
 
I don't know what happened when I replied it somehow didn't post but posted all of your replies

i should find out his results in a couple of days.I will ask them if I can bring a urine sample or I may go to the other vet I've also been going to. Another reason I was trying not go to my regular vet is because they're 15 miles from me. I needed one closer for emergencies. But I took Malcolm to my friend since he was there all day and he knows her and the clinic and would feel more comfortable there. he has lost his vision either due to his acromegaly or side effects from the solensia shot.

Thank you for letting me know about the dose. I will keep him at 10 and test when I can, and do a curve after a week, and go from there. Just like I have been doing and that is also what both of the vets I've gone to advised as well.

And yes, it was that person who told me differently. They really confused me.
 
Also, I have cabergoline, but haven't started it yet since he was acting so strange which I attributed to the side effects of the solensia shot, but the vets believe it's due to his acromelagy. I just didn't want to add it too soon since he was acting so off and it scared me.
 
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