Acro kitty Oddy

Hi Allie, is your kitty on other treatment besides cabergoline? Mine his BG are way of of control and his IG-1 are 412, High in comparison with other acto- cats, overall what is your experience with cabergoline?

 

I'm a little concerned your dose may be too high. There are quite a few gaps in testing lately and no nighttime tests, but that 77 and those blues you got make me wonder how low he's going. https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

We have a few dosing methods, not sure if you're familiar with them. Since you are not currently testing enough for Tight Regulation, I am assuming Start Low Go Slow. In which case you should have reduced the dose when you got the 77.

If you post over on the Lantus board we can help with dosing, but we will need some additional information - https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

Most cats on Cabergoline see at least some reduction in insulin needs, but it can also reduce the other acro side effects like soft tissue growth. A few cats, like mine, have gone into remission on it.

 

Hi! I test him at least 5 times a day but I haven’t updated the chart, I used a lot the memory of my alpha track. Now I I have a doubt, que you do TR, if for example you have reading in 400 and later 300 you’ll reduce the dose? Or just keep it as it is?
más per the protocol suggest to reduce the dose under 200 but my cat has never been in 200 more than 1 day. He is super acro at this point, next week will have a CT scan and an echocardiogram, plus full updated blood and urine panels, after that is cabergoline abs see if it might help. This doctor has seen good results on cats no over 250 IG-1c but mine is 412, overall prognosis is not that favorable. For me the frustrated thing that I can’t manage to reduce his blood sugar levels, he ates wellness (5-8% carbs), but his endocrinologist said I shouldn’t be afraid bcs, the acro cats he treats have reached up to 18U with a weight of 5 Kg.
Any suggestion?

 

Would you mind moving these questions to a new post in the acro forum and tagging me? I don't want to clog up the Sticky too much

 

@Rosario Espinola @FrostD I started a new post for Oddy

 

The IGF-1 number has no relation to the size of the acro tumour nor overall prognosis. My girl's IGF-1 number was 440, but she still live 5 years with acromegaly. I did get radiation therapy done, and she got down to very tiny doses.

 

With TR you reduce any time you get a number below 68 on an AlphaTrak. If you start treatment, most of us choose to raise that limit to something around 75-80. With SLGS the reduction point is usually 90 either way

When you get a preshot under 150 on TR or 200 with SLGD, the first few times we recommend you stall without feeding and ask for help. Eventually you will lower that number until you shoot anything over 68/whatever reduction threshold is with TR, or 90 with SLGS.

Like Wendy said, IGF does not correlate to tumor size. If you are planning on starting cabergoline anyway, I would not bother with the CT scan. All it will tell you is how big it is; there is limited data showing cabergoline works better on smaller tumors and can possibly shrink them a bit, but I would save your money. If you choose to do something radiation or hypophosectomy that would be another CT scan anyway I'm sure, done by the performing surgeon/hospital.

An echocardiogram is always a good idea though, since acro can cause heart issues.

My cats IGF was 323 at diagnosis. Cabergoline worked fine for him. I don't think I've noticed any relationship between IGF number and how well cabergoline does it doesn't work.

I see you added a little more data - now I think that 77 wasn't real, was a bad strip or not enough blood. It would be very unusual for him to go from 77 to 400+ in an hour or two.

Id suggest you follow TR if you can. It will allow you to raise his dose faster and hopefully get him in better numbers more quickly. We've had cats here at 60 units twice a day and more. I would consider a switch to Levemir if you can get it where you are - a lot of us with high dose cats find it works better than Lantus, and the acid base in Lantus often starts to sting around 10 units.

 

I’ve been in communication with an Argentinian vet, one of the authors of a paper you shared in March, in Argentina they tend to use cabergoline due to a lack of resources, he mention than converting his IG-1 (412) to other measurements standard is above 3000, they have good results with cats not over 1500, he would like to try that medication but his prognosis on Oddy is reserved. Right now he is on 10U today’s (4/4) AMPS was 348, as per the TR protocol, his sugar levels are always between <300 <400
I’m holding the dose a bit longer than 3 days, sometimes I’ve seen an improvement, but yet again goes up to 400, I’ve seen myself increasing the dose. His food is wellness core turkey and fish (giving half/ half) 2 times a day, no snack in between as per latest doctor’s order. Before that she uses to split breakfast/ dinner 1 1/4 and 1/2 at lunch time. His PMPS where quite high, we decide to take the lu BG away and add this to their PS meals. He is not drinking. Water like crazy and no ketones (for now). Next Saturday he will have a CT scan, Echocardiogram, full blood and urine panels. Currently living in Singapore and unfortunately they don’t have SRT for small animals or either perform surgery. I guess for the time being I’ll try with cabergoline and see how it goes.
In regards to TR if a PMPS is 490 next day AMPS is 348 should I reduce the dose? Or keep it? But if goes under 290> reduce 0.5? Right now that’s my biggest doubt.
Thanks!

 

One other reason to not get a CT scan unless you are planning on doing something with the results. Heart issues are very common with acros, and not always obvious. Anaesthesia can be hard on hearts. Definitely get the results of the echnocardiogram first. However, I had an echo done with Neko 3 weeks before an anaesthesia for a CT scan and it caused a heart block, she almost didn't make it. Plus a CT scan is very expensive. If there is no radiation therapy there, and they don't do surgery (closest place to you is Australia), I would save my money and not risk my cat.

 

All you can do is keep increasing the dose u til you gets nadirs close to 68 per TR. Remember the growth hormone binds to the same spot insulin would on his cells - that's why it causes insulin resistance. Just have to keep adding insulin until the insulin can make it through.

If you follow TR, you only reduce when you get a number under 68. Preshots do not matter really, nadir determines if the dose is good. The only time preshot matters is if you get one lower than usual, then just ask us for advice and we can help.

Keep in mind the diabetes is not the only aspect of acro. It affects soft tissues, bones, organs, etc. So even if the cabergoline doesn't put him into remission or help drastically with insulin dose, a lot of people here find it still helps the other side effects.

 

I would also consider getting some tests in the PM cycle. Many cats go lower at night. A test before you go to bed, if it's at least a couple hours after the shot, can tell you a lot about what he's doing at night.

 

Hello both!
Wanted to seek some guidance in regards to the mini meals.
Oddy now is on 12 U still high BG, going against my vet’s orders I would like to try 4 mini meals.
Below you can see Oddy meal plan:

Wellness Core Turkey & DuckTurkey 3/4 can, 5.5 oz can: 141 cal

Wellness Core Salmon, Whitefish & Herring- for a little extra flavor, he loves salmon.
1/4 can 5.5 oz can: 38 cal
Total: 179 cal

Macros both food combine:
Protein: 37.75%
Fats: 55.25%
Carbs: 7%

Total will be 1 can and half 5.5oz split into 2 portions.

Breakfast: 7 am
Dinner: 7 pm

What has been your experience? I don’t wanna mess up even more his Bg. Ideally I should split into 2 morning/noon meals? Same as PM?
He eats ravenous bcs of his insulin, and he is on Lantus so don’t have any fear of shooting after a small meal.
My main goal is to spot the weight dropping 100/200 less here and there and be steady.
Sometimes I think, maybe I’m under feeding him, but with this high BG is difficult to determinate that’s why the vet insist only in 2 meals a day.
Thanks for your help.

 

Oh no. The vet is wrong about feeding him only twice a day. With those high BG numbers, his body cannot properly make use of the food he is eating and he needs to eat more than a cat in normal BG numbers- quite a bit more, in fact. You can feed him about until his nadir. Feeding after that can shorten the duration of insulin, but if I am being honest here, I fed my Acro boy whenever he was hungry - low carb food didn’t seem to raise his BG. Or you can choose to feed right up until two hours before your PM pre shot test. That way, if you haven’t fed for two hours before his evening test, you can be certain that the number you are getting is not artificially raised up by food…. And you will know whether it is safe to shoot the insulin.

 

Also how much does he weigh? How much weight has he lost? If you are only feeding one and one half five ounce cans per day then I would say that you are underfeeding him.

 

AS a reference point, my Snuffles eats 150 gr canned Friskies and 10 pieces Epigen 90 twice daily. He weights about 17 lbs.
Note 5.5 oz is 156g.

 

Hello! I feed Howie 3 mini meals in a feeder each cycle. So after breakfast/supper, he gets a mini meal at +3, +5, and +7. His nadir is normally +10-12. This has really helped keep his BGs stable as his body got used to it vs just 2 meals/day. As for quantity of food, I was always advised that a healthy cat needs 20 calories per pound of body weight. Howie is 13.3 pounds so gets 260 calories every 24 hours. I feed him Weruva pouches of pate food, so I split a 5.5 oz pouch for his main meals and a 3 oz pouch for his 6 mini meals. This is 8.5 oz/day. So quantity of food doesn’t matter as much as how many calories he gets. I hope this helps some!

 

But aren’t Snuffles blood glucose numbers regulated? What kind of numbers do you get on Snuffles, Larry?

Oddy is in black and red numbers right now and necessarily will be starving and want/need to eat a LOT.

 

A comment about dosing, over 10 units you can increase by 1.0 units at a time. Think of the increases as a percent of the total dose, you can go up by 10-15%. Since he's so high, you can even go up by 1.5 units right now until you start seeing some yellows (nadirs below 300). Are you testing regularly for urinary ketones? In those high numbers, I would try to get a test every day or two.

As for food and how much. Use a scale to see if he's adding weight, maintaining, or losing. Your vet should be able to give you and ideal weight for Oddy. Use the scale results to tell you if he needs more, less, or the same amount of food. And definitely feed more smaller meals. It'll be easier on both of you. Neko got about 1/3 of her cycle food at shot time, then a couple other smaller meals the next couple hours, then again around +9. In the early days on Lantus she used to dive down early in the cycle so the extra food early was to slow that dives. Her nadir on Levemir was around +9 so the meal then was to help any lows. If I was away, the meals would come from her autofeeder.

 

I agree with Suzanne, it does sound like underfeeding unless he's on the smaller side. For reference: my cat is 14 lbs ideal weight. When he was unregulated, he needed almost four 5.5 oz cans per day to maintain his weight. As he got more regulated those needs came down, and now he's maintained at almost two 5.5 oz cans a day.

Everyone else gave good advice.on meals, I'm glad you'll be splitting them up

 

The amount of food a cat needs also needs to factor in activity level of the cat, and calories in the food, which can vary by quite a bit. My Maine Coon cross girl maintained her weight (14-14.5 lbs) with about 4 oz of raw food per day, or one 5.5 oz can of Wellness, both of which were a little over 200 calories per day, depending on protein served.