Armani's new diagnosis of Acromegaly

[Armani’s mom]

Hello! I've been struggling to get Armani's numbers under control since he was diagnosed with diabetes last fall, and the results of the Acromegaly test came back today at 331. I'm wondering how to go forward with this, as well as if anyone has information about what kind of prognosis we are looking at? If their blood sugar is controlled, how long do cats live with this, and how is the quality of their life?

Armani is 12 and I'm not sure we are able to cover the finances of a surgery or radiation (which breaks my heart!), though I would like to learn more about what amount we might be looking at, and how much extra time for him these treatments could hope to gain.

I've read as much as I can on this forum, and it sounds like many cats take Cabergoline, is this recommended, and is there information about dosing I could pass on to Armani's vet?

The first critical thing is getting his blood sugar under control. His spread sheet is copied in my signature, but overall we gradually worked up to 6 units of Lantus, and his numbers only seemed to get worse, so the vet thought the dose was too high, so we worked back down to zero, where he has been for just a few days. I'm starting insulin tonight, and was planning on going up by .5 every 6 cycles. Does this sound ok, or are there other recommendations?

I read here people recommend Levemir over Lantus for the large doses. Is there any chance Levemir is less expensive than Lantus? I still have Lantus pens I'd like to use - at what point should Armani be switched?

He is currently on Fancy Feast classic patés. Would it be ok to give him Friskies patés? Are there any food issues specific to acromegaly cats I should know about, so his diet doesn't cause more problems?

Any other medications or supplements which could possibly help?

If anyone has other information to share, I feel like I don't even know what questions to ask. Thank you so much for your help!!

 

[Howiesmom]

Hello and welcome to the this forum. I’m tagging @Wendy&Neko so she can provide her expertise and advice. My Howie was diagnosed with acro on 1/19/21 and has been on cabergoline since 2/4/21. I’m not sure I’m seeing it’s effects yet (Howie is a high dose kittie who ranges between 30-55 units of Levemir twice/day). Some kitties see the effects in a couple weeks, others take a couple months. The dosage is based on your kittie’s weight. Howie is on .9mL that is 100mcg/kg. I’m not good at linking things in here but there are 2 main studies on cabergoline in kitties you can give to your vet. The first is from RVC in the UK and the 2nd is a study from South America. I think you can find info on the studies from the sticky notes in this forum (or Wendy can easily get them to you). Howie was on ProZinc until I switched him to Levemir last Fall. Im Very glad I did as the Levemir keeps his levels flatter than some of the other insulins. Most of us order it from Marks Marine Pharmacy from Vancouver and it’s $169 + $25 shipping for 5 pens. Levemir doesn’t sting like Lantus does once you get into higher doses. As for food, there are no issues I’ve seen. Just keep him to the low carb ones. If you look in the Think tank forum, there is an updated food chart that is helpful. Howie isn’t on any other medications as he luckily doesn’t have any other conditions.

one thing I’m not seeing is if you are following any sort of dosing strategy (TR or SLGS). With acro, I would suggest following TR. you can find more details about that in the Lantus/Lev forum. You need to do more testing with acros and TR.

As for tons of questions, I was right there with you. Spend some time going through old posts in this forum as they are really helpful. Do searches for ones I’ve posed if that is helpful as a starting place! But don’t be shy about asking! There is so much to take in and I thought I would never be able to track it all. Big hugs to you and your kittie!

 

[Suzanne & Darcy]

Hello there and welcome. My kitty Darcy has been where your cat is/was. We tried several different insulins. Every time I increased, it seemed like his numbers maybe were going to get better... then got worse. I was getting bad advice about holding doses for far too long a time. Nothing was working. Finally, I had him tested for Acromegaly and he was positive. Since, coming to this board and getting better advice, I have been able to control his blood glucose much better. Darcy started Cabergoline 7 weeks ago and we have been really seeing some changes in the last few weeks. I've had to decrease his insulin quite a bit recently. Right now, he is in a state of flux so I'm having to make a lot of adjustments all the time... but definitely he is starting to need a LOT less insulin since starting the cabergoline.

Your feeding FF and Friskies pates should be fine. They are both low-carb foods and are recommended for diabetic cats. Since Acromegaly is hard on the kidneys (and other organs) I have been trying to feed my kitty, Darcy, lower phosphorus foods... but he hasn't had a great appetite lately so I have had to feed him whatever low carb foods he will eat.

Wendy will stop by at some point ... she's a wealth of information about Acromegaly and other topics.

 

[Armani’s mom]

Hello there and welcome. My kitty Darcy has been where your cat is/was. We tried several different insulins. Every time I increased, it seemed like his numbers maybe were going to get better... then got worse. I was getting bad advice about holding doses for far too long a time. Nothing was working. Finally, I had him tested for Acromegaly and he was positive. Since, coming to this board and getting better advice, I have been able to control his blood glucose much better. Darcy started Cabergoline 7 weeks ago and we have been really seeing some changes in the last few weeks. I've had to decrease his insulin quite a bit recently. Right now, he is in a state of flux so I'm having to make a lot of adjustments all the time... but definitely he is starting to need a LOT less insulin since starting the cabergoline.

Your feeding FF and Friskies pates should be fine. They are both low-carb foods and are recommended for diabetic cats. Since Acromegaly is hard on the kidneys (and other organs) I have been trying to feed my kitty, Darcy, lower phosphorus foods... but he hasn't had a great appetite lately so I have had to feed him whatever low carb foods he will eat.

Wendy will stop by at some point ... she's a wealth of information about Acromegaly and other topics.

Thanks so much Suzanne! I appreciate your held and comments very much. It is reassuring to know others have gone through this - it has been a very stressful and frustrating 8 months with no progress from the insulin. I'm learning a lot though, and will ask the vet right away about the Cabergoline. I'm so happy to hear Darcy is needing less insulin!

 

[Armani’s mom]

Hello and welcome to the this forum. I’m tagging @Wendy&Neko so she can provide her expertise and advice. My Howie was diagnosed with acro on 1/19/21 and has been on cabergoline since 2/4/21. I’m not sure I’m seeing it’s effects yet (Howie is a high dose kittie who ranges between 30-55 units of Levemir twice/day). Some kitties see the effects in a couple weeks, others take a couple months. The dosage is based on your kittie’s weight. Howie is on .9mL that is 100mcg/kg. I’m not good at linking things in here but there are 2 main studies on cabergoline in kitties you can give to your vet. The first is from RVC in the UK and the 2nd is a study from South America. I think you can find info on the studies from the sticky notes in this forum (or Wendy can easily get them to you). Howie was on ProZinc until I switched him to Levemir last Fall. Im Very glad I did as the Levemir keeps his levels flatter than some of the other insulins. Most of us order it from Marks Marine Pharmacy from Vancouver and it’s $169 + $25 shipping for 5 pens. Levemir doesn’t sting like Lantus does once you get into higher doses. As for food, there are no issues I’ve seen. Just keep him to the low carb ones. If you look in the Think tank forum, there is an updated food chart that is helpful. Howie isn’t on any other medications as he luckily doesn’t have any other conditions.

one thing I’m not seeing is if you are following any sort of dosing strategy (TR or SLGS). With acro, I would suggest following TR. you can find more details about that in the Lantus/Lev forum. You need to do more testing with acros and TR.

As for tons of questions, I was right there with you. Spend some time going through old posts in this forum as they are really helpful. Do searches for ones I’ve posed if that is helpful as a starting place! But don’t be shy about asking! There is so much to take in and I thought I would never be able to track it all. Big hugs to you and your kittie!

Thank you for your help!! Thank you for the reference to the studies on Cabergoline, I will look for those and forward them to the vet. I will be following the TR dosing strategy from now on, and have been reading the details in the forum. I appreciate your comments very much.

 

[Wendy&Neko]

I'm wondering how to go forward with this, as well as if anyone has information about what kind of prognosis we are looking at? If their blood sugar is controlled, how long do cats live with this, and how is the quality of their life?

Unfortunately, this really is hard to say. A lot depends on any side effects of acromegaly, if and when they get them. I've seen a couple cats go 4-5 years on insulin alone, and some last not much more than a year. Treatments, if you can afford them, do seem to help life span, but more importantly, quality of life. Getting blood sugar controlled will be easier on the kidneys, and acromegaly by itself is harder on kidneys.

Is there any chance Levemir is less expensive than Lantus?

They are pretty close in price. Some cats (Darcy as an example), need less Levemir which can be cost savings. Some need more, so no guarantee. At some point, Armani may start to show a reaction to the acid base of Lantus. Not all cats do, but that would be the point I'd switch, or whenever you get close to the end of your Lantus if he doesn't react.

Any other medications or supplements which could possibly help?

Other than cabergoline, there is pasireotide, which is obscenely expensive. Any other supplements are what you give an aging diabetic cat. At some point he might get arthritis, common enough with acros. Some discussion about dosing and other things cabergoline here.

I'm starting insulin tonight, and was planning on going up by .5 every 6 cycles. Does this sound ok, or are there other recommendations?

Jump straight to 4.5 units, you at least saw some blues there. Call it the last "good" dose. Otherwise you are wasting time and building glucose toxicity, where he gets used to high numbers.

 

[Armani’s mom]

Unfortunately, this really is hard to say. A lot depends on any side effects of acromegaly, if and when they get them. I've seen a couple cats go 4-5 years on insulin alone, and some last not much more than a year. Treatments, if you can afford them, do seem to help life span, but more importantly, quality of life. Getting blood sugar controlled will be easier on the kidneys, and acromegaly by itself is harder on kidneys.

They are pretty close in price. Some cats (Darcy as an example), need less Levemir which can be cost savings. Some need more, so no guarantee. At some point, Armani may start to show a reaction to the acid base of Lantus. Not all cats do, but that would be the point I'd switch, or whenever you get close to the end of your Lantus if he doesn't react.

Other than cabergoline, there is pasireotide, which is obscenely expensive. Any other supplements are what you give an aging diabetic cat. At some point he might get arthritis, common enough with acros. Some discussion about dosing and other things cabergoline here.

Jump straight to 4.5 units, you at least saw some blues there. Call it the last "good" dose. Otherwise you are wasting time and building glucose toxicity, where he gets used to high numbers.

Thanks for your help!! I appreciate the information about Cabergoline, and read the posts you linked, but as I was looking up articles about Cabergoline, found this article from 2020: https://journals.sagepub.com/doi/10.1177/1098612X20933213. Am I correct that this is the same study as the one at the Royal Veterinary Clinic? It says that Cabergoline did not help cats, which seems to be in direct conflict with what others on this website have found for their own cats. I'm very confused on this count!

I will follow your suggestion for changing to Levemir when we finish with the current Lantus pens. And will jump to 4.5 units tonight as you suggest.

You comment some cats have lived quite awhile on insulin alone is very comforting, though I understand there could be a huge range in how a cat does. Thank you very much!!

 

[Wendy&Neko]

The RVC study just looked at a small number of cats. And their goal was to reduce the output of IGF-1. Cabergoline doesn't do that, so it "failed" from that point of view. The South American study has now used cabergoline in something like 50 cats and has a much better success rate, but lowering IGF-1 was not their goal. We've seen 3 cats here go completely off of insulin, and most have reduction in dose. And more important, relief of some side effects.

 

[Armani’s mom]

The RVC study just looked at a small number of cats. And their goal was to reduce the output of IGF-1. Cabergoline doesn't do that, so it "failed" from that point of view. The South American study has now used cabergoline in something like 50 cats and has a much better success rate, but lowering IGF-1 was not their goal. We've seen 3 cats here go completely off of insulin, and most have reduction in dose. And more important, relief of some side effects.

Thank you so much for the clarification. That makes sense, and I will share the information with our vet. I appreciate the help!