6/9 Frosty - 1st week of Vetoryl. AMPS 517, +2 344, +4 277, +6 284, +8 264, +10 288, PMPS 371

[Ana & Frosty (GA)]

Good morning, everyone.

Last week’s post.

Today marks 1 week of Frosty being on Vetoryl. I can’t say I am seeing any behavioral improvements -still begging and screaming for food all the time. Our sugars seemed to have come down a little bit, and I was thinking of maybe going up on the insulin dose, but then he gave me an 87 last night. And now he’s bouncing in the 500s, which we haven’t seen in a while. I decreased the dose to 2.75 this morning. Not sure how valuable today’s curve is going to be, but I’ve been pretty good at waking up in the middle of the night to test him lately, so I have some data.

He is going back to the vet in 2 weeks for ACTH testing, at which point they will adjust his Vetoryl dose, if needed.

@Wendy&Neko your input is always appreciated.

Thanks everyone.
Ana

 

[Sienne and Gabby (GA)]

Ana -

Is there a reason you can't follow TR? I'm wondering whether using a lower cut off for a dose reduction may not help to get Frosty's numbers lower. Cushing's is going to tend to keep numbers higher. The increased frequency of dose increases and lower cut off for a reduction may help to improve numbers along with the Vetoryl. Wendy may have a better spin on dosing strategy than I but, FWIW, I work full time and I was able to manage TR with Gabby.

 

[Ana & Frosty (GA)]

Ana -

Is there a reason you can't follow TR? I'm wondering whether using a lower cut off for a dose reduction may not help to get Frosty's numbers lower. Cushing's is going to tend to keep numbers higher. The increased frequency of dose increases and lower cut off for a reduction may help to improve numbers along with the Vetoryl. Wendy may have a better spin on dosing strategy than I but, FWIW, I work full time and I was able to manage TR with Gabby.

I can’t for 2 reasons. 1. With Vetoryl there’s risk is going hypo once it starts working with an insulin depot on board. So I wasn’t even sure I should go up to 3 units. We decided that my cut off for reduction will be 100-110 instead of 90 due to this.

Second, I’m out of the house for 12 hours 5 days a week for work. I’m a PA and work in surgery and my job is 45 mins away and given the nature of my job I can’t leave and sometimes even work late.

The reason Frosty’s numbers look so scary to everyone is because of the Cushing’s. We should be able to get it into a better range with the right Vetoryl dose. Just a lot of patience and crossed fingers.

 

[Tuxedo Mom]

Ana

I totally understand your fears of increasing insulin dosing. Because it is commonly believed that many/most Cushing's animals have diabetes SECONDARY to the Cushing's there is a real fear of hypos once the vetoryl starts adequately blocking the natural steroid production. As was shown with Zoey, the glucose numbers rapidly declined once the vetoryl dosing took effect. Unfortunately the early stages of treatment are hard to judge..how long it takes for vetoryl to produce results and what dose gives optimal results, so your concerns are very understandable.

Sending you and Frosty positive energies for good results with your treatment plan.


ETA Even though Tuxie was never treated with vetoryl he had a history of HIGH highs and LOW lows, since the pituitary tumour responsible for PDH does not affect the cortisol production in the body at a regular pace and can wax and wane.

 

[Ana & Frosty (GA)]

Ana

I totally understand your fears of increasing insulin dosing. Because it is commonly believed that many/most Cushing's animals have diabetes SECONDARY to the Cushing's there is a real fear of hypos once the vetoryl starts adequately blocking the natural steroid production. As was shown with Zoey, the glucose numbers rapidly declined once the vetoryl dosing took effect. Unfortunately the early stages of treatment are hard to judge..how long it takes for vetoryl to produce results and what dose gives optimal results, so your concerns are very understandable.

Sending you and Frosty positive energies for good results with your treatment plan.


ETA Even though Tuxie was never treated with vetoryl he had a history of HIGH highs and LOW lows, since the pituitary tumour responsible for PDH does not affect the cortisol production in the body at a regular pace and can wax and wane.

Thank you, Mary Anne. Yes, the high highs and low lows are really frustrating. It definitely makes sense.

Do you agree with the dose decrease due to the 87? Or do you think I could stay at 3 units and watch what happens over the weekend? @Wendy&Neko ?

Tomorrow is my doughnut 5K so I won’t be able to do a thorough curve like today (I can probably do a +2 but then won’t be able to check before +6.) but I could try going back to 3 units tonight - depending what today’s curve shows and what you and Wendy think, and then see what he does. Of course my fear is him going low during the weekdays when I’m not home. There’s no way for me to check since I leave at 6:30 am and get home around 6-6:30 pm. OCCASIONALLY (like last thursday) I can leave a little early, but honestly I only did bc I was feeling under the weather and needed to sleep. I was able to get a +10. But that’s the first time this happened since I started this job in September. I definitely can’t count on that - some weeks we just have more patients than others.

Thanks for the support. Looking forward to your advice.

Ana

 

[Tuxedo Mom]

Do you agree with the dose decrease due to the 87? Or do you think I could stay at 3 units and watch what happens over the weekend?

That is a hard call. I always found with Tuxie that with lower numbers, especially when there was a huge drop in the cycle, that he would run much higher the next cycle or two, so I usually would hold the dose for the next cycle at least. Although I used Lantus then Levemir with Tuxie I had my own 'protocol' for him based on his numbers and knowing how the trends with him showed. I tried to get readings at the 'usual' onset time and if they were dropping too quickly I would give higher carb food to slow down the drop and try to avoid the usual high bounce that followed. At one point I even considered going to an in and out insulin type such as caninsulin (vetsulin) or prozinc in order to be able to deal with each cycle as it occurred.

Cushing's is difficult to dose because of the waxing and waning and in your case with the vetoryl on board and not knowing if it is 'kicking in' yet or whether the optimal dose is being used. My own personal approach would be dosing more cautiously in order to avoid a potential hypo. Of course regular ketone testing should be done. I was very fortunate with Tuxie, that even with all his high reds and blacks he never develop ketones over the 2 1/2 years that we battled diabetes.

 

[Ana & Frosty (GA)]

@Tuxedo Mom yes, frosty hasn’t had ketones either. I test blood ketones every couple of days, or if numbers look weird. I also kind of was thinking maybe I should have kept the 3 units because I expect a bounce today, but... who knows. If things go well maybe I can devise a protocol, but I feel like Zoey’s mom was planning on doing the same from what I’ve read, and then poor Zoey didn’t make it. So just taking it one day at a time... can’t think that far ahead right now.

I’m just worried about the kidneys, but if he’s gonna bounce from lows 2.75 vs. 3 probably doesn’t matter much. At least I have the luxury to closely monitor fri night - Sunday and can try tweaking the doses then.

I’ve thought about maybe switching to a different insulin, but I have 9 more Lantus pens. I could probably sell them, but with all the other stuff going on and all the expenses I just don’t want to go through that right now. Has there ever been any kitties with Cushing’s on another type of insulin on this forum? Do we know?

Thanks!

Ana

 

[Tracey&Jones (GA)]

No advice but cheering from the side lines.

For my drooler it took about a month from the recheck point to notice the clinical signs of the reduction in cortisol to really be noticabe. Less pacing, drinking and panting. So I hope you see the benefits soon.

 

[Ana & Frosty (GA)]

No advice but cheering from the side lines.

For my drooler it took about a month from the recheck point to notice the clinical signs of the reduction in cortisol to really be noticabe. Less pacing, drinking and panting. So I hope you see the benefits soon.

Good to know! Thank you, any experience with this med is appreciated!

Just out of curiosity - was he diabetic? Was he ravenous with food? I know you said he did really well and it prolonged his life. Feel free to share more about him.

 

[Tuxedo Mom]

I’m just worried about the kidneys, but if he’s gonna bounce from lows 2.75 vs. 3 probably doesn’t matter much. At least I have the luxury to closely monitor fri night - Sunday and can try tweaking the doses then.

It is true that the smaller increases and decreases may not be as worrisome with a Cushing's kitty. It is the unpredictability of the amount of natural cortisol production that makes it difficult. Tuxie could go from a higher black to a low lime green in one cycle and then stay high for a week with the same dose. I basically tested him about 8-10 times a day to try to get some pre-warning on when he was going to throw out whacky numbers. Outside activities were always planned as close to home as possible so I could stop in and get a glucose check. Hopefully once the vetoryl starts taking effect and the correct dose is determined, the insulin needs will drop to very small amounts or maybe none. There was a Cushing's dog my vet was treating with vetoryl and he had gotten down to 0.25 units within a few months of starting treatment...he was a large dog. I don't know what happened down the line since I really couldn't ask my vet for updates on another patient. I was only aware of this case because I was in the treatment room and my vet commented about how difficult it would be to measure 0.25 units. At that time she was not aware that there were syringes with 1/2 unit markings, so I showed her the cut out front from my syringe box that I keep in my purse for reference and she was very happy to know that information.

I don't recall any other members that used different insulins for their Cushing's kitties, but as you know there is so little information. I chose to stay with the Levemir after I switched from Lantus because at least I understood the pharmacolgy with it and even though Tuxie's numbers were erratic I was familiar with Levemir and scared to have to relearn a new type of insulin.

 

[Tracey&Jones (GA)]

She was not diabetic but she did have liver issues. She was diagnosed at the same time as she was diagnosed with mammary cancer. She was a rescue from a puppy mill so was was not taken care of very well. They thought she was around 3 but probably closer to 5. We were trying to get the surgery done for the cancer but her liver values were a huge concern.

We ended up doing the surgery once she was diagnosed with Cushings. When she was recovering from the mammary surgery (4 weeks later) we started the vetoryl along with SAMe. Did the recheck b/w and it was determined she was on a good dose. About 4 weeks later, like I mentioned she stopped pacing and panting. Her water consumption and urination decreased. About 6 months later her "pot belly" started to disappear.

She was on vetoryl for the rest of her life. In fact at 2 year mark she went off the SAMe and her liver values were normal and it was no longer enlarged. She was 10 when we had to say good bye as she developed dementia. Vet said it wasn't related to the Cushings.

I believe not only did the vetoryl let her liver heal, I believe it helped reduce the stress to her system overall. We only went up in dose once when I noticed her drinking and pacing more.

She was a real sweetheart and all she wanted was loves. I miss her to this day.

 

[JeffJ]

I'm hoping you will be able to find a good dosage regime soon. Frosty's high BG numbers will take their toll on his organs and nerve sheaths (neuropathy). At least on the weekends you are able to do nadir testing.

 

[Ana & Frosty (GA)]

It is true that the smaller increases and decreases may not be as worrisome with a Cushing's kitty. It is the unpredictability of the natural cortisol production that makes it difficult. Tuxie could go from a higher black to a low lime green in one cycle and then stay high for a week with the same dose. I basically tested him about 8-10 times a day to try to get some pre-warning on when he was going to throw out whacky numbers. Outside activities were always planned as close to home as possible so I could stop in and get a glucose check. Hopefully once the vetoryl starts taking effect and the correct dose is determined, the insulin needs will drop to very small amounts or maybe none. There was a Cushing's dog my vet was treating with vetoryl and he had gotten down to 0.25 units within a few months of starting treatment...he was a large dog. I don't know what happened down the line since I really couldn't ask my vet for updates on another patient. I was only aware of this case because I was in the treatment room and my vet commented about how difficult it would be to measure 0.25 units. At that time she was not aware that there were syringes with 1/2 unit markings, so I showed her the cut out front from my syringe box that I keep in my purse for reference and she was very happy to know that information.

I don't recall any other members that used different insulins for their Cushing's kitties, but as you know there is so little information. I chose to stay with the Levemir after I switched from Lantus because at least I understood the pharmacolgy with it and even though Tuxie's numbers were erratic I was familiar with Levemir and scared to have to relearn a new type of insulin.

I agree. I don’t think I just have the energy or time to devote to trying another insulin (or the money!) and then most likely not see results because the right way to manage his diabetes is treating the underlying cause.

Thanks so much for sharing your experience. I’ll just try not to have a mini heart attack when i see a black or red in my cycle, since it’s probably inevitable right now.

@Tracey&Jones , thank you so much for sharing this experience! And I am sorry that you lost her, that must have been tough. It’s also definitely encouraging to hear that even when levels normalize, it may still take a few weeks for symptoms to start going away. Vet said the wound healing will be the last one to go back to normal, and he may not hear until 6-12 months after stating Vetoryl (assuming he survives).

@JeffJ - not sure why you think I don’t know that, but as you may have read in Tuxedo mom’s post, the disease makes it impossible to get the kind of control you guys are able to get with your cats, this is very different than Acro or a normal diabetic cat. Even if I quit my job and Frosty and I move to Central Park in a box I still won’t be able to get him to stop going from 400-500s to greens and blue. I also hope someone will drop off insulin for us, since I will no longer be able to afford it.

 

[Ana & Frosty (GA)]

I'm hoping you will be able to find a good dosage regime soon. Frosty's high BG numbers will take their toll on his organs and nerve sheaths (neuropathy). At least on the weekends you are able to do nadir testing.

Also, the SLGS regimen calls for a curve to be done once a week, not every day. So I’m following the protocol exactly.

 

[Tracey&Jones (GA)]

Sending healing vines to Frosty. All we can do is our best and hope.

 

[JeffJ]

Keep up the faith and the healing insulin treatments. Frosty has a good home with you.

I hope you don't move to Central Park in a box! Probably nice in the summer, but too cold for you and Frosty in the winter.

 

[Wendy&Neko]

he had a history of HIGH highs and LOW lows, since the pituitary tumour responsible for PDH does not affect the cortisol production in the body at a regular pace and can wax and wane.

the disease makes it impossible to get the kind of control you guys are able to get with your cats, this is very different than Acro or a normal diabetic cat

Not necessarily, a similar thing can be said about acros and their pituitary tumour that waxes and wanes. The growth hormone output is also notoriously unpredictable. It's one of the reasons they don't use a growth hormone assay to determine if cats have acromegaly. Instead, IGF-1 is more predictable. Also, some acrocats loved the rainbow, such as my girl who I nicknamed the Rainbow Queen. Take a look at acro Floyd's SS - he follows that fine tradition of green to black. I could name many others. Then there are some acros that are much more even (Pig, Phoebe, Crystal (GA)), to name a few. I think the same may be said for Cushings kitty's. Purrdy was one incredibly flat cat. Once Summer got to a good dose, she was fairly flat. As is many things, I think it's ECID. Regulation is possible over time with Cushing's kitties. Note the "over time". I wore a tight pair of patience pants for a long time.

Frosty's reaction to that 87 , tells us he's not familiar with greens, so it looks like Ana hasn't been missing anything too low due to her work schedule. As a reminder to readers, Ana uses the AT, so that 87 could be a little lower if she was using a human meter. We don't know for sure of course.

Experience with Vetoryl here is limited, just the one member was a regular here with Zoey, her Cushings/Vetoryl kitty in my time here.. We have more experience when an acrokitty has SRT, cabergoline works, or IAA breaks - in all cases, caution is key. In most of those cases, extra caution is needed because of the high dose, which is not such a player here. The other consideration is that high numbers are hard on the kidneys, so it is a fine balance between safety in the short term and long term damage.

Do you agree with the dose decrease due to the 87? Or do you think I could stay at 3 units and watch what happens over the weekend? @Wendy&Neko ?

You've done the decreaase. Any increase for just a couple cycles would just mess with the depot. In hindsight (always 20/20), I would have shot 3.0 units this morning, to help him get over the bounce. Given your inability to monitor as close as you'd like during the workday, the fact that Frosty is seeing green on 3.0 units and the Vetoryl in the mix, I would stick with your 2.75 units and still monitor this weekend as you can. Enjoy the donut run. Today's 12K row was followed by a visit to our favourite breakfast/donut cafe. It's a fine tradition.

Has there ever been any kitties with Cushing’s on another type of insulin on this forum?

I have seen several switch from Lantus to Levemir. Cushings kitties in the UK are likely on other insulins such as Prozinc. Again, I'd encourage you to contact the RVC diabetes remission clinic and ask questions. They've been great so far answering questions about our other high dose kitties, and they have dealt with some Cushings cats. Though not likely to have spreadsheets like we have.

 

[Ana & Frosty (GA)]

Thanks for your input, @Wendy&Neko .

When Frosty hit his first green (93) on 5/9 after 3 months of crazy highs, I was running low on AT strips, so I tested the same drop of blood with my ReliOn Confirm, and got 57. I know there is no known equation, but this at least gives us some idea of what this could be on a human meter. An 80 could be somewhere in the 50s as well.

 

[Wendy&Neko]

An 80 could be somewhere in the 50s as well.

Or not. I've seen people have a lot more comparison data and still not able to figure out how an AT compared to their human meter. However, it's still not below 68 AT which is the take action number.

 

[Ana & Frosty (GA)]

@Wendy&Neko Where can I contact the RVC diabetes clinic? I’ve gotten so many links over the last 2 weeks I don’t think I saw that one.

I DID join the German cushing’s Cat forum someone suggested,and the admin was nice enough to email me privately to try to help, but she wanted me to send her over labs, etc for her to analyze and I didn’t really need that. I get so many emails from them daily (all the posts and conversations get emailed), but I don’t have time to translate from Getman to English, so it all just sits unread in my Inbox. The ones I translated last week talked about how to split Vetoryl capsules... not very useful in my case either. So I kind of gave up on that idea, unless I have specific questions for her. The only thing she has said about the diabetes is that it will get better once the cushing’s is under control. Which we already knew as well.

 

[Ana & Frosty (GA)]

The reason I stopped using ReliOn is because within the same 2 minutes i would get 300, 400, and 500. If i ever doubted the accuracy of something and rechecked. i would get a TOTALLY different number, and if i tested again, it would be completely different again. I even called the company and they went over how to test with me, but of course i couldn’t tell them i was testing a cat. AT always gives me precise results, NEVER 100 points off. I didn’t feel safe with it, even though I know it works for others.

 

[Sean & Rufus]

Hoping and praying for the best for Frosty!!

 

[JeffJ]

AlphaTrak2 has also been an excellent meter for Leo as well. And the FreeStyle Lite strips work well. I think it was Sean who pointed out a cheaper variant of FreeStyle - which I will obtain in the next ebay buy.

We are using the same AT2 meter for 3 years now. For some reason the original battery lasted 1.5-1.8 years. Since then I replaced the battery every 4-6 months.

 

[Sean & Rufus]

I'm still using the regular Freestyle Lite strips for now. Trying to sell them though, because I'll never use all of the ones I have before they'd expire. I think somebody else was using Freestyle Neo with good results.

 

[Ana & Frosty (GA)]

AlphaTrak2 has also been an excellent meter for Leo as well. And the FreeStyle Lite strips work well. I think it was Sean who pointed out a cheaper variant of FreeStyle - which I will obtain in the next ebay buy.

We are using the same AT2 meter for 3 years now. For some reason the original battery lasted 1.5-1.8 years. Since then I replaced the battery every 4-6 months.

I haven't made the jump to the FreeStyle strips, as I am afraid they won't be as accurate as the AT strips. I didn't think the difference in price was that significant, although of course with pets with these many issues every dollar counts.
There's a cheaper variant? Do tell.
I've been using AT for about 6 months, and just the other day the battery icon started blinking. I ordered 2 batteries on Amazon, and since they arrived the battery icon disappeared. So I'm gonna wait to change it out for now.

I'm still using the regular Freestyle Lite strips for now. Trying to sell them though, because I'll never use all of the ones I have before they'd expire. I think somebody else was using Freestyle Neo with good results.

When do they expire? I've never tried them - are they accurate? I have 3 full boxes of AT strips right now, but will probably be running out soon since I am testing so much.
I really like Abbott products from working in medicine, and I trust them.

 

[Wendy&Neko]

Where can I contact the RVC diabetes clinic?

fdrc@rvc.ac.uk

As for meters, choose what you feel comfortable with. The only reason I mentioned the AT is that people reading need to keep the fact that you are using it mind when it comes to dosing. Our dosing methods were created with the human meter in mind, so that's what people here are used to the most. Note that the Freestyle strips are not made by the same company that makes the AT meter. They used to be, but no longer. Personally, that's not a risk I'd take.

 

[Ana & Frosty (GA)]

Personally, that's not a risk I'd take.

Me neither.
As for the RVC, I am not really sure what I am supposed to be asking them... how do I know that they definitely have had experience with Cushing's cats? It looks like their research is focusing on medication to aid pancreatic beta cells in producing enough insulin after a cat went into remission from DM. Would they really have information about what insulin a Cushing's cat is supposed to be on?
Has anyone contacted them in the past?

 

[Sean & Rufus]

When do they expire? I've never tried them - are they accurate? I have 3 full boxes of AT strips right now, but will probably be running out soon since I am testing so much.
I really like Abbott products from working in medicine, and I trust them.

I bought a lot of 400 on ebay for like $175. They came in 8 boxes of 50. The boxes are a little scuffed so the seller gets them and sells them at a discount. I was leery at first, too. I have gotten few tests that came back way off, but also have had that happen from AT2 strips. I did do side by side tests and they all for the mpst part were within 10 or 20 points, but that is starndard variance. And I'm only testing like every 4 or 5 days since he's in remission. The boxes I have left expire 9/30, 9/30, and 10/31.

 

[Sean & Rufus]

Note that the Freestyle strips are not made by the same company that makes the AT meter

Yes, Freestyle is made by / manufactured for Abbott and AT2 is Zoetis. The strips are the exact same.

 

[Ana & Frosty (GA)]

Yes, Freestyle is made by Abbott and AT2 by Zoetis.

Ohh, interesting. Hmm. It's tough because Frosty's numbers are so all over the place, I want to be as accurate as possible.
We talked about maybe switching back to ReliOn when he's better controlled, but now with the Cushing's dx I am not sure if we ever will be. I guess we will see.
Thanks for the info, @Sean & Rufus

 

[Wendy&Neko]

RVC has treated cats with Cushings. Not sure how many. You could just contact them and introduce yourself as a caregiver of a newly diagnosed Cushings kitty in the US. And mention you have started Vetoryl. You can ask them what they think is a good insulin choice and why. And maybe for any links to paper of information that might help you manage Frosty's condition better. Probably worth mentioning he is having skin tears. We have had several people (including me) contact them for issues relating to acromegaly and IAA.

The strips are the exact same.

For now. New (been over a year) owners can decide they want to change manufacturing processes. Been there, worked for a company that did the same for a company plant they bought. Still marketed as the same product.

 

[Sean & Rufus]

RVC has treated cats with Cushings. Not sure how many. You could just contact them and introduce yourself as a caregiver of a newly diagnosed Cushings kitty in the US. And mention you have started Vetoryl. You can ask them what they think is a good insulin choice and why. And maybe for any links to paper of information that might help you manage Frosty's condition better. Probably worth mentioning he is having skin tears. We have had several people (including me) contact them for issues relating to acromegaly and IAA.


For now. New (been over a year) owners can decide they want to change manufacturing processes. Been there, worked for a company that did the same for a company plant they bought. Still marketed as the same product.

Oh I get that. I'm just saying the one that I have are exactly the same, if she was interested in purchasing them. Either way, no big deal. Actually, I can throw in a Freestyle meter for free that I bought @Ana and Frosty . I bought it to use/test the strips to see if same numbers.