7/8 Xena **INCREASED to 6.0 U** AMPS 304, +3 278/ PMPS 310, +5 291

Good luck with this dose. I hope it gets her back on the downward numbers trend again.

The 6 unit dose is sort of a milestone here. When a cat reaches this dose, we suggest that people get there cat tested for acromegaly (IGF-1 test) and insulin auto antibodies (IAA). My Neko had both conditions, some have one or the other. At this size of dose, the odds are a cat has one or the other. There are cats with these conditions on smaller doses, but over 6 units it's more likely. Acromegaly is caused by a benign tumour on the pituitary that causes excess growth hormone to be output, which in turn causes the diabetes. Recent studies have shown about 25% of diabetic cats have this condition. There are treatments for it. IAA is sort of like the cat's body reaction to injected insulin. It is a condition that can go away over time. Both cause insulin resistance. The signs of which can be a dose looking good for a while, then not. You just have to keep increasing until you get a dose with good numbers. And things can still change after that. All cats, no matter the size of dose, will find a dose that moves them into good numbers.

Both tests are done at Michigan State University. Your vet can draw the blood and sent it there for testing. If you have questions, which I suspect you will, please let me know. :bighug:
 
Good luck with the new dose! I know exactly how you are feeling. Wendy's suggestion of an IGF-1 test for acromegaly is good advice. I live with with acro-kitties, Eddie and Blue, who are brothers and we've been on a long journey. Hope all goes well with you and Xena...:bighug::bighug::cat:
 
Wendy&Neko said:
Good luck with this dose. I hope it gets her back on the downward numbers trend again.

The 6 unit dose is sort of a milestone here. When a cat reaches this dose, we suggest that people get there cat tested for acromegaly (IGF-1 test) and insulin auto antibodies (IAA). My Neko had both conditions, some have one or the other. At this size of dose, the odds are a cat has one or the other. There are cats with these conditions on smaller doses, but over 6 units it's more likely. Acromegaly is caused by a benign tumour on the pituitary that causes excess growth hormone to be output, which in turn causes the diabetes. Recent studies have shown about 25% of diabetic cats have this condition. There are treatments for it. IAA is sort of like the cat's body reaction to injected insulin. It is a condition that can go away over time. Both cause insulin resistance. The signs of which can be a dose looking good for a while, then not. You just have to keep increasing until you get a dose with good numbers. And things can still change after that. All cats, no matter the size of dose, will find a dose that moves them into good numbers.

Both tests are done at Michigan State University. Your vet can draw the blood and sent it there for testing. If you have questions, which I suspect you will, please let me know. :bighug:
Click to expand...

Thanks is for letting me know. It is unfortunate news though.
These tests are probably expensive right? … and the treatment for acromegaly… what do they do for it? Unfortunately with what we’ve already spent it’s been a strain.
 
The tests require the cost of a blood draw, shipping the Michigan State University, and the test cost from MSU, which is $91 for both tests. You mileage may vary on the total cost based on what vets charge for blood draw, processing, markup etc. We've had one person recently do the shipping etc himself. The details are here:
MSU VDL testing instructions for IGF-1 and IAA Some vets are much more reasonably priced than what his vet was. Ask first. Going through Idexx costs even more (middle man markup).

Treatment for IAA is mostly time, they can be self limiting, after about a year. Again ECID on timing and in the meantime you just give what insulin they need. Neko was about 9 months, and I've seen some longer than a year. We do have some minor mods to the protocol to handle IAA kitties.

Acromegaly treatment options are now a choice. Back in my day, it was treat with insulin and manage side effects, or radiation therapy. I chose SRT (stereotactic radiation therapy). Now there is a surgery option to remove the pituitary ($$$) and very few vets experienced in doing this, just a couple in the US. London UK is the gold standard place for surgery. The last few years a medical drug called cabergoline has been show to help. Minimally it reduces doses needed and helps with side effect. At the other end, we've seen 5 cats go OTJ - two rather quickly. Some recent discussion on options here. Check out the acro forum for posts on cabergoline. I never got to use it, so don't really know what the costs are. Dose is based on weight of cat, so there is some variability but a lot cheaper than other options and you and the cat don't have to leave home. It's a drug given typically daily. We can give you links to papers if the vet doesn't know about it's use.
 
I was just looking at the treatments for Acro, and as far as surgery or radiation... unfortunately that's far out of my range of possibilities if that were the case. ( I know there are people that just would not spend the money. That is not the case. I just do not have it.) I will look at some more of this info.
Are both tests only done at MSU? or just IGF-1?
As far as IAA, I was looking at old posts and you said that Neko's broke at 9 months after diagnosis at 8.75 Units. I was just thinking, at the rate I am increasing Xena, by the time I am at 9 months the dose would be way higher, so that had me wondering.... So, does the increasing slow down or...? ( I know you said minor mods to the protocol)
 
MSU for both tests, which is why the IAA is a pretty cheap add on. Same blood draw, blood prep and shipping.

Neko was unfortunately on Caninsulin for the first couple months, and her vet restarted her back at 1 unit when we switched to Lantus - both of which delayed things. Plus she kept on showing a green (around 3.5 ish units), then it kept vanishing, so doses were held longer. We have found that unless you are aggressive enough about dosing (aiming for nadirs under 100), the antibodies really take hold, and force you to even higher doses. I have seen antibodies break at both much higher, and much lower doses. ECID. We had one IAA kitty here who never got above 3.5 units.

Radiation therapy was MUCH cheaper when we went that route. Back in the day, the majority of people here treated with just insulin. Now there are quite a few choosing cabergoline.
 
With IAA, When you say aggressive enough about dosing, I mean is there a point where increases are done faster than with TR?
and as far as ACRO I did see that there is apparently a Generic for Cabergoline, so that's good at least.
Thanks Again.
 
Don & Xena said:
I mean is there a point where increases are done faster than with TR?
Click to expand...
No, but with TR where is some variability, ie. hold a dose with nadirs under 200 for 6-10 cycles. On the flip side, if we know a cat has IAA and it's breaking, we break a few of the rules on reduction. Doses can come down quickly when that happens. Safety first, especially with larger doses/larger depots.
 
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