? 7/14/21 newly diagnosed Ruckus

Zorrain

Zorrain

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Well unfortunate news for my baby ruckus, he does have acromegaly. I’m happy to finally find out the issue since it’s been a hard year for him with uncontrollable numbers. So where do we go from here, I did some reading way before he took theses tests. I’m feeling extremely worried where to go now with him. Some days he’s extremely playful and others not so much. He’s always seems to be having extremely red eyes is that a big deal? Is he in extreme pain? How do I know just if he’s very sleepy?

Also wanting to start him on some b12 but what is the dose I should do? He’s about 18 pounds I think. Any other drug suggestions also? This is also my vets first cat with this disease so he said very rare and has no answers but he said he do some reading also.
 

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Zorrain said:
This is also my vets first cat with this disease so he said very rare and has no answers but he said he do some reading also.
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It's so "rare" that about 1 in 4 diabetic cats has it. Unfortunately your vet is out of touch with newer research on this condition (not unusal), but it's good that he wants to do some reading. There are lots of papers linked in this conversation, the paper in number 7 post is one you could send to him. This paper has some even newer stuff on treatment:
(2020) Updates in Feline Diabetes Mellitus and Hypersomatrotropism I seem to remember you are in Calgary? Western Veterinary Services is one of the few places in Canada that does radiation treatment on this benign pituitary tumour. Cabergoline is a drug a number of people here are giving their cats that is a more cost effective solution.

And regardless of whether you think of treatments, you need to get him to an insulin dose that will get him in better numbers, ideally under renal threshold as much as possible. Don't worry about the size of dose, a cat needs however much insulin they need. If it's at all possible for you to follow Tight Regulation, which means getting more mid cycle tests, and definitely more tests at night, you will get to a better dose faster. The problem with acromegaly is that the tumour can pulse, meaning you may be chasing a good dose. Holding onto a dose too long is not good, but you also need to be able to increase safely.

Red eyes - not a symptom I've seen before, though weepy eyes yes as the tear ducts can get blocked by soft tissue growth. Pain is hard to say, human acros says there is pain as there is growth in bony and soft tissue. Many acros also get arthritis, my girl did, and end up taking things like Cartrophen and pain meds for that. Buprenorphine or gabapentin are a common medication given. As for sleepiness, lethargy is common, better BG values will help. I've not heard of anyone giving B12 for their acrocat, unless it has GI issues. But maybe test for B12 levels first, to see if it needs supplementation.
 
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Just took a look at your labs report above, looks like he has IAA or insulin auto antibodies as well. It's not an uncommon combination, Neko had it too. The antibodies will also mean insulin resistance and not sitting on a dose too long.
 
Hey Zorrain! Glad to see you posting on the board! You couldn't get better advice than Wendy's. She's been through it all!

I'm going to suggest that you post in the Lantus, Basaglar and Levemir forum, only because it's a much more active board than this one. There's tons of information here to read though!

You might want to also add "Dx Acro/IAA" to your signature too because that's a very important part of Ruckus's health status.

Hang in there. There's several other cats here with acro and/or IAA and a lot of people with experience with Levemir and the different dosing methods.

The main point is that You are not alone! Not only do you have DCIN behind you, but hundreds of other sugarcat moms and dads here on the board! As you post more, you'll meet lots of nice people and soon you'll become part of the family!
 
Zorrain said:
View attachment 61654

Well unfortunate news for my baby ruckus, he does have acromegaly. I’m happy to finally find out the issue since it’s been a hard year for him with uncontrollable numbers. So where do we go from here, I did some reading way before he took theses tests. I’m feeling extremely worried where to go now with him. Some days he’s extremely playful and others not so much. He’s always seems to be having extremely red eyes is that a big deal? Is he in extreme pain? How do I know just if he’s very sleepy?

Also wanting to start him on some b12 but what is the dose I should do? He’s about 18 pounds I think. Any other drug suggestions also? This is also my vets first cat with this disease so he said very rare and has no answers but he said he do some reading also.
Click to expand...
Are you giving zobaline for the b 12? You could do one zobaline a day. So sorry for the diagnosi.
 
Ok just looked at the spreadsheet. Try very hard to get a mid cycle reading everyday. The tumors output can sometimes just decide to dial down or of nowhere and he'll suddenly drop. The other thing is you don't want to stay on a dose for too long that's not working. I wouldn't hold it A while week. I have never used your insulin so I'll let others guide you there.

@Bronx's dad (GA)
 
Ruckus also needs more mid cycle and before bed testing. We decide to change the dose based on how low it's taking the cat, and we have no idea what that is for Ruckus. Any chance of a curve soon? Or before bed or when you get up tests if it's a couple hours before shot time?
 
I want to welcome you to the IAA and acro family. Howie has both diagnoses and he is doing very well right now but it took quite a while to get him to this good place where he is staying in a range of 70-120. I can’t stress the importance of testing regularly and not sitting on a dose as has been mentioned here. I know it is overwhelming and you question what you thought you know. Howie is the poster child of cats needing as much insulin as they need. He was up to 55 units twice/day this winter but now is holding steady at 17 units twice/day as I’ve gotten him pretty regulated. He is also on Cabergoline. I doubt he’ll ever go into remission but I know he feels so much better. My vet also has never treated (knowingly) an acro and/or IAA kittie. Everything that I know has come from this forum and our practical experts on here. So ask tons of questions! Using the search bar at the top of your screen was also helpful so I could read older conversations.

As for the B12, is it for some neuropathy issues or GI issues? If for neuropathy, You can use the Zobaline as previously mentioned or else get methyl B12 (different than regular B12). The difference between the 2 besides price is that the Zobaline has folic acid in it and the methyl B12 doesn’t so you can give a half tablet of folic acid with the Methyl B12. I did this for Howie for a while as I thought he had what I thought were some some neuropathy issues. However, he started having constant diarrhea so we ended up doing GI track testing from Texas A&M and it came back that his folic acid levels were way too high. Once I stopped the methyl b12 and folic acid, the diarrhea stopped. The methyl b12 is excreted for what is not needed in the body, but the folic acid isn’t. I only mention all this to caution you to figure out if he really needs the B12 or not.
 
Hi Zorrain, welcome! You are in good hands here and very lucky to have found this board. I was so overwelmed when I found out Bronx had acro, but we ended up in a good place thanks to this board, especially Wendy who was so helpful. Bronx was almost off the juice & we were at 37u shots at one point! That would've never happened if I just relied on my vet to help Bronx.
 
Bronx's dad (GA) said:
Hi Zorrain, welcome! You are in good hands here and very lucky to have found this board. I was so overwelmed when I found out Bronx had acro, but we ended up in a good place thanks to this board, especially Wendy who was so helpful. Bronx was almost off the juice & we were at 37u shots at one point! That would've never happened if I just relied on my vet to help Bronx.
Click to expand...
Paul, if you don’t mind my asking… what was it that finally brought an end to Bronx’s life? Did he have kidney disease?
 
Suzanne & Darcy said:
And I am so sorry about your C.C. I bet you miss her a lot.
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I do. She was my soul kitty and had just the best personality. Up until her last day was large and in charge of the others. But my point is that it is possible to control the acro and they can still live a full life. She was a month shy of her 18th birthday. Even with the acro and ckd and hyperthyroidism.... I really thought she was going to live to 20. She had a couple off days and I thought she was just constipated. Which she was, but then they found the huge tumor and that she was severely anemic (which she wasn't a month before, but the tumor started bleeding.). I miss her every day.
 
Suzanne & Darcy said:
Paul, if you don’t mind my asking… what was it that finally brought an end to Bronx’s life? Did he have kidney disease?
Click to expand...
He was having trouble walking and it got worse. Was hocking on his front legs and rear legs were in bad shape from the athritis. Could only walk a little bit before having to stop. Was so hard to watch. At the end he lost control of his bladder/colon and was going anywhere, not even close to the LB. Sad part is his kidneys were fine and blood work always came back great. Basically it was the athritis that was the main problem. He was in pain but never stopped eating or anything like that. Stopped playing though and was not a happy kitty. I decided it was time. Miss him every day :(
 
Wendy&Neko said:
Ruckus also needs more mid cycle and before bed testing. We decide to change the dose based on how low it's taking the cat, and we have no idea what that is for Ruckus. Any chance of a curve soon? Or before bed or when you get up tests if it's a couple hours before shot time?
Click to expand...

I have tired to do few more tests, ruckus is on day 4 at 9.5 units of insulin. He still seems to be very high like the insulin is not working. I’m feeling extremely overwhelmed with everything this why took me few days to process everything.

My regular vet seems not be interested in giving me cabergoline, he just said he’s never used this drug and has not treated a acromegaly cat before. I did ask for a referral to the western animal vet you mention. I wrote them a letter also about the situation with ruckus. They don’t take appointments unless referred by another vet.

My vet I go to seems to be frustrated with me or something or maybe just my anxiety. I told them about ruckus peeing on my boyfriends stuff and the front desk girl thought I was meaning he had a blockage or urinary tract infection. He always has peed since being diabetic when he’s high in numbers. If my boyfriend leaves his stuff on the floor is a huge factor. So they wanted me to bring him in on the weekend or emergency over this miscommunication. Anyways he ended up giving me Gabapentin for two weeksdue ruckus pain due to acromegaly. Hopefully Ican see the specialist soon and it’s not to expensive.
 
Howiesmom said:
I want to welcome you to the IAA and acro family. Howie has both diagnoses and he is doing very well right now but it took quite a while to get him to this good place where he is staying in a range of 70-120. I can’t stress the importance of testing regularly and not sitting on a dose as has been mentioned here. I know it is overwhelming and you question what you thought you know. Howie is the poster child of cats needing as much insulin as they need. He was up to 55 units twice/day this winter but now is holding steady at 17 units twice/day as I’ve gotten him pretty regulated. He is also on Cabergoline. I doubt he’ll ever go into remission but I know he feels so much better. My vet also has never treated (knowingly) an acro and/or IAA kittie. Everything that I know has come from this forum and our practical experts on here. So ask tons of questions! Using the search bar at the top of your screen was also helpful so I could read older conversations.

As for the B12, is it for some neuropathy issues or GI issues? If for neuropathy, You can use the Zobaline as previously mentioned or else get methyl B12 (different than regular B12). The difference between the 2 besides price is that the Zobaline has folic acid in it and the methyl B12 doesn’t so you can give a half tablet of folic acid with the Methyl B12. I did this for Howie for a while as I thought he had what I thought were some some neuropathy issues. However, he started having constant diarrhea so we ended up doing GI track testing from Texas A&M and it came back that his folic acid levels were way too high. Once I stopped the methyl b12 and folic acid, the diarrhea stopped. The methyl b12 is excreted for what is not needed in the body, but the folic acid isn’t. I only mention all this to caution you to figure out if he really needs the B12 or not.
Click to expand...
For the Cabergoline how much are the paying for it? I also hope ruckus will not need that much insulin because that be very expensive. Reading all this really scars me but thanks for telling me.
 
JanetNJ said:
Ok just looked at the spreadsheet. Try very hard to get a mid cycle reading everyday. The tumors output can sometimes just decide to dial down or of nowhere and he'll suddenly drop. The other thing is you don't want to stay on a dose for too long that's not working. I wouldn't hold it A while week. I have never used your insulin so I'll let others guide you there.

@Bronx's dad (GA)
Click to expand...
So what would be considered staying on a dose to long? After the 6 days ?
 
Chris & China (GA) said:
Hey Zorrain! Glad to see you posting on the board! You couldn't get better advice than Wendy's. She's been through it all!

I'm going to suggest that you post in the Lantus, Basaglar and Levemir forum, only because it's a much more active board than this one. There's tons of information here to read though!

You might want to also add "Dx Acro/IAA" to your signature too because that's a very important part of Ruckus's health status.

Hang in there. There's several other cats here with acro and/or IAA and a lot of people with experience with Levemir and the different dosing methods.

The main point is that You are not alone! Not only do you have DCIN behind you, but hundreds of other sugarcat moms and dads here on the board! As you post more, you'll meet lots of nice people and soon you'll become part of the family!
Click to expand...
Thanks for your kind words, sorry did the late reply I felt extremely overwhelmed. I will post on the other forum, thanks for telling me. I am very lucky to have dcin, if I didn’t have there help I think I would of lost ruckus a long time ago, I’m very grateful.
 
Zorrain said:
So what would be considered staying on a dose to long? After the 6 days ?
Click to expand...
I used to raise after 2-3 days u til I'd see some blues.


Time to go to 10. Just remember he needs what he needs. I got up to 12.5-13 before fi ally hitting her breakthrough dose. Then it came back down a bit.
 
JanetNJ said:
I used to raise after 2-3 days u til I'd see some blues.


Time to go to 10. Just remember he needs what he needs. I got up to 12.5-13 before fi ally hitting her breakthrough dose. Then it came back down a bit.
Click to expand...
Okay I’ll bring him to 10 tonight thanks
 
Zorrain said:
For the Cabergoline how much are the paying for it? I also hope ruckus will not need that much insulin because that be very expensive. Reading all this really scars me but thanks for telling me.
Click to expand...
I pay $232 for the Cabergoline. I go through my vet for it as opposed to going straight through the compounding pharmacy that makes it (Wedgewood). It is better for me to maintain the relationship with my vet and go through him rather than ask for the prescription and go around him (which is what I do for insulin). I know it is so overwhelming. I urge you to consider reading up about following TR (tight regulation) in terms of when to adjust doses. There are sticky notes about it in the Lantus/Levemir forum. Basically, you stay at a dose for 6 cycles (3 days) and make adjustments until you find the breakthrough dose. But there is a lot more info about it posted over there. That is what we all mean about not sitting on a dose too long. Just keep asking questions and keep asking for referrals to vets until you find one who is willing to work with you on the treatment plan YOU want to follow. Again, everything I’ve learned about FD and acro/IAA has all come from these great folks in this forum who you’re already hearing from! Big hugs!
 
Mr Kitty gets 0.25mL of 250mcg/mL every other day (so same as Larry, 10ug/kg). My vet charges
me $25 for the pills, and $10 to compound it, it's 16mL total. So it works out to be $35 for 4 months with every other day dosing.
 
FrostD said:
Mr Kitty gets 0.25mL of 250mcg/mL every other day (so same as Larry, 10ug/kg). My vet charges
me $25 for the pills, and $10 to compound it, it's 16mL total. So it works out to be $35 for 4 months with every other day dosing.
Click to expand...
Where do you live why seem so much cheaper than others !?
 
Zorrain said:
Where do you live why seem so much cheaper than others !?
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Ohio! I think local vet is cheaper for a few reasons - I don't have to pay for the cold shipping, and he pretty much charges just cost for meds. So he gets a deal through his distributor, and just charges me what it costs him. I spend so much at the vet he's not missing out lol

I also go to an independent practice not one of the giant animal hospitals. Costs always seem to be better at the smaller places.
 
FrostD said:
I don't have to pay for the cold shipping,
Click to expand...
Cold shipping for what? Wedgewood just ships the cabergoline suspension is a plastic bag mailer. The bottle is just wrapped in a little bubble wrap.

I am tempted to try to compound my own. I can get 500ml of almond oil made for compounding meds for $25
https://specializedrx.com/products/fos-a-fixed-oil-suspension-vehicle-500ml-almond-oil-nf-sweet
I can get 8, 0.5mg tablets of cabergoline for about $20
https://www.goodrx.com/cabergoline
 
Larry and Kitties said:
Cold shipping for what? Wedgewood just ships the cabergoline suspension is a plastic bag mailer. The bottle is just wrapped in a little bubble wrap.

I am tempted to try to compound my own. I can get 500ml of almond oil made for compounding meds for $25
https://specializedrx.com/products/fos-a-fixed-oil-suspension-vehicle-500ml-almond-oil-nf-sweet
I can get 8, 0.5mg tablets of cabergoline for about $20
https://www.goodrx.com/cabergoline
Click to expand...
Mine has to be refrigerated per the vet, so I just assumed all cab was. Maybe that's just to extend shelf life?

If it doesn't have to be that would be much easier, it's a pain to keep it in suspension long enough to draw up
 
FrostD said:
Mine has to be refrigerated per the vet, so I just assumed all cab was. Maybe that's just to extend shelf life?
Click to expand...
The instructions for my Wedgewood specifically says store at room temperature. I read somewhere if it was refrigerated it would be a lot harder to mix via shaking.

I your in an oil suspension? Mine is in almond oil
 
Larry and Kitties said:
The instructions for my Wedgewood specifically says store at room temperature. I read somewhere if it was refrigerated it would be a lot harder to mix via shaking.

I your in an oil suspension? Mine is in almond oil
Click to expand...
No it's not, but maybe next round I can ask for something that doesn't need to be refrigerated. It seems like chicken flavored water if I had to guess.
 
Okay @Wendy&Neko, don't you think Zorrain can now take Ruckus up to 11 units. He's been on 10 units for more than 6 cycles. She's been doing a good job of getting more mid-cycle tests in on Ruckus. I was telling her that once they hit ten units, the increases can be made in full units.

I found that I would keep increasing and feeling like "nothing was happening" until I started getting close to an effective dose for Darcy. It's not like it will necessarily be that you increase a little and the BG's go down a little.... it just doesn't work like that very often with Acro cats (and you have the IAA to deal with as well.)
 
Suzanne & Darcy said:
do we have Canadians using Cab right now?
Click to expand...
Not that I know of. Marvin from Montreal was he first, I think Nat just got it compounded locally.
Suzanne & Darcy said:
It's not like it will necessarily be that you increase a little and the BG's go down a little.... it just doesn't work like that very often with Acro cats
Click to expand...
Or any cats for that matter. Insulin is a hormone, not a drug. You just have to keep increasing until you get to that fitting dose. Speaking of which, I would go to 11 units.
 
Hi @Zorrain

Ruckus is looking much more comfortable now that he's on gabbapentin.

I suggested the B12 to Zorrain to help prevent any neuropathy in Ruckus since he's so unregulated.

There's allot of really good advice here from some folks that have first hand experience with Acro/IAA

Good job getting more mid cycle tests in.

I know it's overwhelming but your doing a great job!
 
Vegetable (GA) said:
Hi @Zorrain

Ruckus is looking much more comfortable now that he's on gabbapentin.

I suggested the B12 to Zorrain to help prevent any neuropathy in Ruckus since he's so unregulated.

There's allot of really good advice here from some folks that have first hand experience with Acro/IAA

Good job getting more mid cycle tests in.

I know it's overwhelming but your doing a great job!
Click to expand...

He’s in such a cute mood today and has been so cuddly.
 
Suzanne & Darcy said:
Okay @Wendy&Neko, don't you think Zorrain can now take Ruckus up to 11 units. He's been on 10 units for more than 6 cycles. She's been doing a good job of getting more mid-cycle tests in on Ruckus. I was telling her that once they hit ten units, the increases can be made in full units.

I found that I would keep increasing and feeling like "nothing was happening" until I started getting close to an effective dose for Darcy. It's not like it will necessarily be that you increase a little and the BG's go down a little.... it just doesn't work like that very often with Acro cats (and you have the IAA to deal with as well.)
Click to expand...

It does seem like that, we keep bringing the dose up but still pink numbers. I hate doing the night, it is always pink. It freaks me out
 
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