acromegaly information needed

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Babygirlsmom

Member Since 2014
Hello:

My cat currently is uncontrolled with diabetes on a high dose of insulin. We have already regulated her diet and we are sure that we have not missed the optimal dose. We regular monitor her bg at home.

Her symptoms of uncontrolled diabetes are now pointing toward something else being wrong. She has been checked for Uti and that was negative. At this point we are going to have her tested for acromegaly.

Is there anyone that has a cat with this condition? Have you been able to regulate the diabetes with higher doses of insulin? Is your cat on any other medications that have helped with condition.

I know that there could be something else than this issue but I am trying to get further information for acromegaly. Unfortunately, from what I have read on the internet there is not much that has been proven to work for this condition other than trying to regulate the diabetes.

Thanks for any information.

Babygirlsmom
 
There are tests you can run for high-dose conditions. The two most common are Acro and IAA and cats who test positive for one often test positive for the other. Treatment really does depend on what's going on so it's best if you can get the testing done. There is a really good fb group for these conditions that I know a lot of people recommend but I don't know which it is so hopefully someone else will come by soon with a link to for it. ;-)
 
Hi!

I got a pm asking me to come and check in with you about your kitter. My cat, punkin, had acromegaly. Yes, there is help for it. What dose are you calling high dose? Punkin got up to 15.5u before we had him treated at Colorado State University. then his dose went down as far as 4-5ish units per shot. We used Lantus. Levemir would probably be my first suggestion for a high dose kitty, Lantus is also good.

If you are having testing done, a blood sample needs to be sent to Michigan State University. We usually suggest that people with higher dose kitties (over 6u per shot, twice a day) get tested for both acromegaly and insulin auto-antibodies. Sometimes cats have one or the other, sometimes they have both. We currently have about 7 cats on the Lantus/Levemir Tight Regulation Insulin Support group with those conditions. So you are not alone. :YMHUG:

I'm going to retrieve some info for you, but wanted to respond asap. :-D sounds like you are very on top of things and just looking for more information. I'd be glad to help you. I'm sure others will too. It's not uncommon, although often vets don't know much about it.

I'll be back in a few.

In the meantime, could you answer Larry's questions about the dose/insulin?
 
Here is my "journal" of punkin's treatment for acro. That will give you a lot of information.

These 2 posts have some overlap, but lots of info on acro, including some of the most recent research:
Acromegaly - Interesting Posts from the past.
Acromegaly, the basics

We don't have as much formally written about iaa (insulin auto-antibodies), but we have several kitties with it as well, including one that went off of insulin. Sandy's Black Kitty was extraordinary! Sandy helps out on the Lantus/Lev TR forum here. Wendy's Neko has both iaa and acro, Suzanne's Cobb has iaa and possibly acro as well - the 3 of them and I all help cats with both "regular" diabetes and high dose conditions on that insulin support group.

Sometimes we can tell which it is by looking at a spreadsheet and the dose changes. There is a characteristic "look" to a high dose cat's blood sugar patterns and how they respond to dose increases. With iaa, sometimes with the first couple of cycles after a dose increase, the blood sugar will improve, but then it will seem like that dose stops working. You increase the dose, and maybe the blood sugar comes down again for a bit, but then you have to go up in dose again.

With acro, there are some body characteristics that are common, although not all cats follow the typical look. Most cats (but not all) with acro are male (Neko is female). Probably the strongest characteristic of acro is an incredible hunger. Acromegaly is a benign tumor on the pituitary gland that puts out growth hormone. That growth hormone blocks the cells from being able to receive the insulin that the pancreas is putting out. So you have to give increasing amounts of insulin so that enough will get into the cells to do some work. The tumor can also rev up or down. The growth hormone makes the cat grow - and the incredible appetite (think teenage boy) goes with it. Sometimes acro cats will have a time where the tumor shuts down and the cat might go off of insulin. Sometimes the tumor revs up and you've gotta go up and up in dose to keep up.

Well . . . that's a lot. I think i'll stop with that, let you read and process what i've put out.

I'll be glad to answer whatever questions you have.

ah, i just saw Kay's post that says 10u. That's not too huge of a dose - some cats get up to 100u per shot. But yes, that's above normal and i'd get her tested for both acro and iaa. The incremental cost of doing both isn't much more than doing one. Acro is more common, but we see lots of iaa too. The dosing strategies are different, depending on whether she has one or both of the conditions, so it's good to test for both.

A third high dose condition is far less common - Cushing's disease. I've seen it 3 or 4 times. That's also caused by a benign tumor, but usually it's pretty readily identifiable. Cushing's causes the cat's skin to tear easily. Do you see skin issues like that?
 
Hi there :cool:

My Black Kitty was high dose, due to extreme insulin resistance for the condition call IAA (insulin auto antibodies).
When his Acro and Cushings tests came back negative,it was a last ditch effort to figure out why in spite of some 45u per day, his BGs barely budged,
He was the first kitty here at the FDMB to test for IAA (October 2008). We were in uncharted territory.
However, after 21 months on insulin he went into remission and is now closing in on 5 years 'Off the Juice".

Like others have suggested, have your vet send blood samples to MSU to test for both Acro and IAA.
Once you get the results, we can help you with strategies.

I read in your previous post that your vet is feeling like this is beyond her area of expertise - I had the same experience.

No worries - You came to the right place - a whole lot of experienced folks to help guide you along the way. :cool:
 
Hello from another mom of a high dose baby girl. Neko has both IAA and acromegaly. We got up to 8.75 units of Lantus. I've since switched her to Levemir and we seem to have flatter curves now. Neko had SRT (stereostatic radiation therapy) a little over two years ago, just like punkin. She is now down to around 1-1.5 units. Another of our members (Marilyn) had Polly treated just last week. Both Neko and Polly are long haired girl cats. Studies show it's mostly commonly short haired boy cats that have acromegaly. Ours just like to be different. :roll:

As for regulation, you just have to keep increasing in a safe way until you get to a dose that will get you into good numbers. You may have to keep tweaking the dose to match tumor output (if your kitty has acromegaly) but it's doable. As Julie mentioned, most of the active FDMB members of high dose kitties hang out on the Lantus - Tight Regulation Forum here. It's a protocol that works for high dose kitties too, on either Lantus or Levemir.

I presume your kitty has also been checked to see if she needs a dental?
 
Hello:

Wow what a response.....thanks everyone. I have checked the post that larry and kitties referenced.

Baby takes lantus 10 units bid. she eats 2 5.5 oz of wet cat food a day. her bg is about 400-500 when we check. right now because it stays high and because of her aversion to being tested we only test every couple days.

i have already contacted Michigan state and they told me the prices of the needed test and for the reading.

i am going to see if the current vet is willing to open an account with them and have the test run with them.

i will be getting her lantus from canada next time around.

she does have a ravenous appetite that has been present since diagnosed. she has even resorted to eating vegetables when they land on the floor.

i am waiting for a call from the current vet, but she wants to refer us out to a specialist. i have called the specialist and they want 700 for a consult and ultrasound and that does not included the blood work. i simply don't have the money for that. should i try to establish with another local vet that might be willing to work with us?

also if it is acromegaly, is the only known treatment the increased dose of insulin and try for regulation? Maybe hopefully remission?

Again thanks

Babygirlsmom
 
Maybe tell your regular vet you cannot afford a specialist.

If you work with the folks here who have acromegaly cats, they've been through it, so they can tell you things to guide your decisions and to educate your vet, and provide scientific reference citations if necessary.

Stereotactic radiation therapy has been successful in reducing or eliminating the tumor in acromegaly.

Maybe read some of the posts in the high dose forum here to get some sense of what is normal in treating this. And maybe point your vet to us, too.l
 
Most vets think acromegaly is very rare - that used to be the thinking until recent studies. My vet was skeptical about getting the tests done but humored me by doing them. She was more surprised than I was at the results. She has since identified another acrocat in her practice. Your vet works for you. Getting the tests done is a good first step and considerable cheaper going to a specialist. A CT scan is needed to confirm the diagnosis, but that is mega $$$. High uncontrolled doses and positive IAA and/or acromegaly (IGF-1) test results are sufficient. Most people do not get scans done. The ultrasound could tell you if any of the organs are enlarged, a by product of the excess growth hormone. Saving money for an echocardiogram to check the heart would be the best way to spend money.

Where do you live? Maybe we know a FD friendly vet in your area.
 
Hello:

I live in Virginia. I live close to West Virginia, Pennsylvania, and Maryland also.

is there medications that help treat acromegaly or the other conditions? SRT I dont think will be a good option for my cat or more important my budget.

thanks
 
not sure if you had a chance yet to read my post above about punkin's SRT. That goes through all the costs that we experienced or anticipated. It also goes through all the details of the SRT, and my thought process in deciding to have it for punkin.

It is a reasonable treatment approach to just give increasing amounts of insulin. That's the option many people choose. You can't achieve remission with acro in the same way a "regular" diabetic cat can heal and become diet-controlled. The tumor can shut down, but it can also turn back on. Even having the SRT isn't a guarantee of remission - some do, some don't. Even if they don't, though, SRT does stop the damage done by excessive growth hormone.

there are no meds successful at treating acro. the only treatment is to deal with the tumor on the pituitary gland - SRT is radiation. There is also a freezing/surgery called Cryohypophysectomy discussed here in this article: "Cryohypophysectomy used in the treatment of a case of feline acromegaly" http://onlinelibrary.wiley.com/doi/10.1111/j.1748-5827.2008.00590.x/abstract

I'd encourage you to get a diagnosis first before you go too far down this road. She may or may not have acro. You don't need a specialist unless there is something more going on than "just" acro. A regular vet can prescribe the insulin, as you already are. We can help you with 90% of the rest of it, and you can get specialist help for specific things when you need them. For the overall treatment, though, a regular vet is fine.

Do you have fructosamine tests that confirm that her blood sugar has been really high? I ask that because we do occasionally see someone come in here that is on a high dose, and the blood sugar is high, but the cat is high because the doses were increased too quickly and/or by too big of increments.

I looked back through your previous post that Kay linked (thanks Kay!) When a cat's blood sugar is high, that alone can cause them to be starving, literally. The way we are nourished is that our food is converted to glucose, which then goes into our cells and "feeds" us. That's probably a lousy explanation, but you get the idea. When you measure high glucose in the blood, that means that the energy from the food Baby ate is floating about in her bloodstream and not getting into her cells. Any cat in high numbers will be starving, because they literally are. As the blood sugar comes down, that means the glucose is getting into the cells and feeding her. Her appetite should reduce some as well.

If it doesn't reduce when her blood sugar is in lower numbers, like less than 200, then it becomes more significant than when she's ravenous while in high numbers. Any diabetic cat is ravenous when their blood sugar is high.

When you say that the dose was increased in 1-2 units over a couple of weeks, can you give us the exact info? It makes a difference. Even for a high dose cat with a known acro/iaa condition, on a dose of less than 10u we wouldn't increase by more than 0.5u at a time. The reason this is significant is that if a cat is overdosed, and in danger of hypoglycemia, the cat's liver will put out counter-regulatory hormones & stored sugars to counteract the insulin overdose. Larry's comment about her curve showing a movement, and therefore it might not be from an overdose is probably right. Usually if they are overdosed it will usually be a constant high. But it would be helpful to see more data.

Blood sugar tests are so important. As we get data on a cat, it's just like putting in the pieces on a jigsaw puzzle. Data doesn't lie - and experienced people can tell a lot from looking at blood sugar tests. If you can look here the second link down will help you create a spreadsheet. It's not as daunting as that might sound. There are great directions there. Any previous data you have, or can get from the vet on her blood sugar at diagnosis, dose she started at and any tests, the dose changes, etc., just as best as you can recreate it would be hugely helpful to us in figuring out what she might have going on.

To help her ears, get some Neosporin ointment with pain relief. The stuff is amazing. I slathered it on punkin's ears every night and they would look like new in the morning. If i had to poke him a lot during one day, i'd put more on. You have to wipe off the excess before you test, though, or it will goo up your strip.

You're in the right spot now :YMHUG: We are all volunteers, but live/breathe feline diabetes 24/7. we'll give you a hand - and we're free. :-D We all volunteer because others taught us and we know there isn't much help out there for diabetic cats.

julie

ps - what can we call you?
 
Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
Hi!

I'm the mom of another high dose cat!! Cobb got up to 31 units of Lantus. We switched to Levemir a little over a month ago and now are hanging on as he rides the dosing ladder down.

I'm the one who opted to not have Cobb tested for across. A lot of thought went into that decision, so I don't regret it, but sometimes I think it would help knowing because we might know more about what is happening right now.

I've received a lot of help from the people here, so you are absolutely in the right place!

~Suzanne
 
Hello Everyone:

Julie thanks for all the information. I took a look at the information on having the acro srt surgery for pumpkin. It is for food for thought right now.

My name is Annie and my kitty's name is baby. She is 11 years (not 13......she weighs 13 pounds....lol). She was diagnosed last year about this time. She had dropped a lot of weight, drinking and urinating a lot, and her coat was dull. So we kinda knew that it was most likely diabetes. I will need to get the exact testing information from the vet. She has had two curves since then at the vet and I will also get that information.

When she started she was on 2 units. We did two units for several months and then she went back to the vet and had a curve done. Then the vet had her go to 4 units. At that time we decided to get a glucometer and test ourselves. With testing ourselves we saw that the numbers were still very high and would increase by a whole unit ourselves every two weeks. We then needed to go back to the vet for another curve by that time for another script around (summer this year). Baby looked better. Her coat was better, she had gained her weight back. They were not ecstatic with her numbers, but they said that she needed more insulin because she was still not regulated. At that time she was at 6 units.

We have since then increased a unit every week to two weeks. We are now holding at 10 units. Unfortunately I will say that we went up this quickly because of another issue, being that she was urinating everywhere, but the box.

I will go ahead and administer a true curve this weekend and post the numbers for you. We have not had a fructosamine tests done but I will see if my vet will add with the other tests.

At this point I am wondering if Levimeir would be better for her? Also if we have gone up to high to fast on her dose, will that show in the curve and how many times will that have to be taken to know?

Thanks

Annie
 
we usually encourage people to just get spot checks here and there instead of doing a curve all on one day. I suspect you're not that far off on dose because of the fact that you've seen her symptoms improve, but data will tell us for sure. Yes, we can tell a lot of a spreadsheet.

One thing that can happen when people try to get all their data at once is that if you hit on a day where she's bouncing, you might measure all high numbers, when in fact, bounces clear up and the blood sugar comes down. Here is a post that explains what bouncing is all about. Look for the second post in that thread.

The first post is about New Dose Wonkiness - worth reading, but i suspect if you had held a dose for a while before you increased, you weren't measuring right after dose increases, so that might not explain high numbers that you've gotten in the past. I'd read it anyway, though, just fyi.

Why don't you get some testing info and then we can talk about your insulin and where to go next. One step at a time. :-D

and nice to meet you, annie!
 
Hello:

Ok now I am really confused. I should not do a curve but test consistently daily I think is what is being said? Should I test in the morning and in the evening preshot?

I will still get the vet information, but how much bg sticks should I have before I put up the information?

Annie
 
Sorry for confusing you! i would go ahead and start the spreadsheet now and put in any past data as best as you can recreate it, then add new test data to it. Start with the oldest data at the top of the spreadsheet and add newer tests at the bottom. It's easier to "read" that way.

A curve is great, but personally, i think one or two tests per cycle over 3 days tells a lot more than a curve on one day. That way if there is any bouncing going on, it will show up in the 3 day time period. There are also cats that seem to save all of their low numbers for the night cycle, so getting tests in both the am and pm cycles is really valuable.

I have no idea what your schedule is like, but if i were choosing an ideal schedule, I'd suggest you get a preshot test, +2 or +3, and +5/6 and +9ish in the day cycle, then in the evening, you can get the preshot test and a before bed test. I guess that is a curve. If it's possible to do that 3 days in a row, we'd be able to tell a lot about what Baby's doing with the insulin. If work/life interfers, just get what you can.

Does that make sense?
 
Hello:

Yes this makes sense now. I will call for the information from the vet and then will post what I have.

I work full time so the testing that you speak of I can only do on the weekend. I can however check her numbers at least pre shot during the week and post that information also.

I was able to create my sheet and save it to google drive and you should be able to pull it after this post......I think (we will see)....lol

Annie
 
I can see it - great job. The link isn't "hot", so i copied and pasted it. I can't tell why it's not hot because it looks like you've got it in right. Is there possibly a return at the end of the line in the signature line?

Are you able to get a test as you walk in or out the door from work? if not, lots of people get a before bed test in the evening - that can reveal a lot.
 
There may be an "Enter" or extra spaces in the link, like the following

[URL = link ]text[
/URL]
 
Annie,
Tell your vet that you want TWO tests done, and you can printout the 2 test sheets to give to your vet.
It requires a single blood draw and just shipped to MSU. The cost to you will be the vet visit, the draw and packing for shipment, the FEDEX cost, and the cost of the 2 tests around $55 and $20.
There is ZERO need for a specialist to have tests done. If your vet will not have the tests done, go to another vet.

As for SRT, it's important to know that it does not stop the advancement of acro effects on the body, but it may stop the need for insulin, and only surgery may halt progressions completely.

When it comes to home testing, don't worry about crazy curves all the time; many people have jobs and activities that keep them away from home during the days, so you can do just like them…

When you get up to prepare for the day, test.
Get ready as usual and at shot time, test.
When you come home, get an in the door test.
At the pm shot time, test.
Just before you go to bed, test.

Then, when you have a day off or some days when you will be around to do a curve, test at shot time, and then every 2 hours until the next shot and then maybe a couple more tests after the 2nd shot.

There are other issues with acros, but for now, getting the tests done, and getting used to testing are enough.
You don't do much that diff for an acro other than give more insulin, watch for acro related health issues, and test more, but it is important for you to know what's going on with your cat, so those 2 tests are a great start.
 
As for SRT, it's important to know that it does not stop the advancement of acro effects on the body, but it may stop the need for insulin, and only surgery may halt progressions completely.
Click to expand...

That wasn't our experience post-SRT, Gayle. Punkin's acro growth ceased and many of the symptoms reversed and disappeared entirely. The stridor, large paws, large stools, all completely resolved. His insulin dose needs decreased dramatically. Nothing progressed at all and most symptoms disappeared.

What is your basis for that comment?
 
julie & punkin (ga) said:
As for SRT, it's important to know that it does not stop the advancement of acro effects on the body, but it may stop the need for insulin, and only surgery may halt progressions completely.
Click to expand...

That wasn't our experience post-SRT, Gayle. Punkin's acro growth ceased and many of the symptoms reversed and disappeared entirely. The stridor, large paws, large stools, all completely resolved. His insulin dose needs decreased dramatically. Nothing progressed at all and most symptoms disappeared.

What is your basis for that comment?
Click to expand...

I don't think you are aware of the progresses of late in the areas of feline acromegaly. Advancements and more discoveries have been made including surgery for the condition.

Please look up Dr. Bruyette. A great deal of info is available in the acro group for those who want to know.
If you stop and think about the IGF-1 value….. does it drop below positive post-SRT? No, it usually does not, and there are reasons.

So yes, SRT is wonderful for halting and reducing some issues but not all. Many is not all. You very likely see the acro puff disappear and that's something which comes often with the stop of the insulin needs. Oliver lost all of his acro puff and 1/3 of his body weight when he went completely off insulin Jan/2012. Stridor was also gone with him, but that did not mean progressions stopped.
 
For those looking for more information on acromegaly, Dr. Bruyette's articles can be found on the Tight Regulation Protocol insulin support group along with some other recent research on the topic that Wendy added last spring (thanks Wendy!)

Wendy&Neko said:
Bumping and adding links to some recent articles I've found.

"Feline Acromegaly" by Chelsea Sonius (Colorado State University) Spring 2011
http://zimmer-foundation.org/sch/csf.html

"Feline acromegaly: The keys to diagnosis" by Justin Wakayama DVM and David S. Bruyette DVM, DACVIM, October 1, 2013
http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=824935&pageID=1&sk=&date=

"Feline acromegaly: Treatment options" by Justin Wakayama DVM and David S. Bruyette DVM, DACVIM. October 1, 2013
http://veterinarymedicine.dvm360.co...options/ArticleStandard/Article/detail/824938

"Insulin Resistance in Cats" by J. Catharine Scott-Moncrieff, MS, MA, Vet MB, Veterinary Clinics of North America Small Animal Practice Vol 40, Issue 2 (2010)
http://www.2ndchance.info/diabetescat-insulinresistance.pdf
Click to expand...

and here.

Wendy's Neko, my Punkin & Marilyn's Polly (all on the Lantus/Lev TR insulin support group) have undergone SRT if anyone wants personal experience with that procedure.
 
Hi Annie!

Welcome to you and Baby. I don't have an acro cat but I've been in FDMB quite a while and worked with Julie, Wendy, and Sandy and they have an amazing wealth of info and experience with IAA/acro and I would trust them with my sweet Gracie. Suzanne learned very quickly how to manage Cobb and she has done an outstanding job. She is also a very smart lady and very helpful as well.

There are two spreadsheets I'd like you to see. One is Teronto's SS. The vet started him at 10u bid! What this shows is what a cat that has been overdosed can look like....high and flat as Julie was mentioning. Once Pauline, the caregiver, came to FDMB, we knew that was an insane starting dose and had her back it down and test. Look what happened.

What I'm trying to illustrate here is what too much insulin can look like. I am not suggesting you back the dose down because that would not be wise if Baby is acro or IAA but we do wonder when a cat's dose has been raised aggressively. Hopefully some spot checks will help us see if Baby is coming down and bouncing back up. And having the acro/IAA tests done will further help.

The other thing I'd like to add is that raising the dose by 1u or more in a cat that is not a high dose cat is very aggressive; but our members with acro/IAA cats at high doses can raise the dose that much or more if need be because the amount of the increase is relative to the size of the dose. If you look at Cobbs SS (be sure you look at both tabs for the full story), you will see Suzanne has had to raise his dose in large increments. However, she followed the protocol on the way up until he got to a certain dose and then increased by more based on Wendy and Julies astute advice. I'd also like to mention that Cobb has not had any treatment but Suzanne switched him to levemir and he's been doing great. We know Cobb is IAA and that is possibly the resistance breaking; we suspect he might be acro but he hasn't had the tests.

The other SS that I think can give you some hope if Baby is acro/IAA is Tommy's SS. Again, you will need to go through the tabs to see how he progressed. Tommy was acro and Lauren did not do SRT. But she managed him so beautifully that he was in normal numbers at a fairly low dose until he got sick at almost 20 years old. While SRT is great if you can do it, there is hope if Baby is acro and/or IAA and you can't do SRT.

Please ask questions....this forum is very caring and people want to help.
 
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