Barry needs help! I am a nervous mama :(

I am really worried about Barry. I am new to the site and not sure if I made my profile correctly. I still am trying to figure out the spreadsheet.

He is currently on 3.5u prozinc BID. Just bumped up from 2u three doses ago when we found out his BG was staying in the 500-600 range the whole time. Today, he had a very small curve where he dropped down to about 400 four hours post insulin -- only lasted a couple hours, maybe even less, then right back up in the mid to high 500's.

His diabetes has been extremely unregulated since August. Over the past week or two, he has exhibited signs of vision loss, ataxia (not just neuropathy), polyuria, polydypsia (literally drank for 14 minutes straight last night!), changes in breathing, congested now, meow-er sounds different. His right eye also appears very... off. I am not sure how to explain it. It just looks off. Almost looks darker than his other eye. Like a maroonish black haze. Not cataracts or glaucoma. Is only visable from a distance, not up close. Doc doesn't know what is wrong with it either. Ocular pressures are fine. BP is fine. It is just bizarre. I have had a weird feeling that he has a tumor somewhere in his body since the day I took him home. But, I had no reason to really think that other than some weird neuro things here and there. I briefly mentioned acro but told myself there is no way since his phenotype doesn't match.

Today, I was talking to the doc on his case about him. She all of a sudden looked at me and said, "acromegaly". She's never had a case but remembered it from vet school. I felt my heart literally drop. We are sending out an IGF-1 test next week. Should I also go ahead and send the IAA test too? What even does an IAA check for? Beneficial or no? Could one come back positive and the other negative? I read the pinned posts on here about it but would like a more direct answer.

None of the five docs in the hospital have ever actually had an acromegaly case (well, that they were aware of). Does anyone have any awesome scholarly sources that I can share with them to educate them more about it? Also -- does Barry even fit acro? He has had some other weird neurological things that are only intermittent. Was not able to get a BG during any of them before so not sure what he was at.


I do not know too much of his history since I took him in from a client at the vet clinic I work at a month ago. I am just really really worried about him. He has seriously crashed over the past two or three days. Does he even sound like a possible acro case? He has all of the docs stumped because of how he has responded to ProZinc.

 

Tagging
@Wendy&Neko
@Olive & Paula
@JeffJ
who all had high dose cats.

Did the vet test for ketones?

• Ketones/Diabetic Ketoacidosis (DKA): Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

 

Yes. I do daily. Significant amount of glucose spillage in urine though.

 

My cat is a high dose kittie. 19 units twice a day of levemir as he has IAA but no acromegaly. Howie was also on Prozinc but I switched him to Levemir in October. I won’t get the textbook definition of IAA right (Wendy and Sandy can) but kitties who have it have antibodies to the insulin so their bodies don’t actually use all of it. So yes, I would suggest testing for both just to know. The tests both go to Michigan so you might as well do both. I am sorry to hear about all the physical concerns he is having. That has to be very scary. The folks with lots more experience were tagged earlier so I hope they have ideas to help but I’m also tagging @Deb & Wink as she is great with Prozinc. Just know we’re here to offer you virtual hugs and support. I hope you get some answers soon.

 

Yes it’s worth while doing an IAA test at the same time as an IGF-I

 

https://www.felinediabetes.com/FDMB/threads/new-member-needs-help.239711/

Previous post

 

Is DKA something that can have a slow onset? I have only witnessed it in crisis situations. Is sudden neuropathy in the back a warning? I’ve read most the stuff on here, along with what I’ve learned in school and work.

 

@Bandit's Mom

Hi Bhooma would you set up a SS for Emily
Thank you

 

@Emdavv
Hi Emily I have asked Bhooma to set up your SS, I'll also post
Understanding the grid ( spreadsheet)
Does Barry have on the Libre?
If so can you add that to your signature

 

https://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

 

Cats can have one or the other or both of acromegaly or IAA (insulin auto antibodies), think like an allergy to injected insulin. Antibodies bind to the insulin, making it unusable, until they die and release it. My Neko had both.

I saw a research paper that said only around 35% of acros had clinical signs at diagnosis, the others didn't.

Highly likely they have seen acros before and not known it. One in four diabetic cats has it. Check out this post for articles and an overview. Acromegaly - the basics
A ton of articles included if the vets want to go crazy learning about it. Plus I have more. My vet thought acromegaly was unlikely cause it was so uncommon (how they used to be taught), but after Neko's diagnosis identified another of her kitty patients as one. Neko's acupuncture vet thought she hadn't seen it either, then after learning from me, figured one of her neighbourhood rescue cats likely had it.

 

Hi Emily,

Barry seems to have a lot going on, and this must be so scary for you. (I'd be scared!)

I'd just like to suggest asking your vet for a referral to a good veterinary opthalmologist. The one I consulted knew much, much more and was able to give me much better advice than our (good) general practice vet (who referred me to her).

Given that you mention the maroon cast to the eye colour, I'd wonder whether there might be blood involved (brainstorming wildly here as I've not come across the issue you describe before). I had a look online and found this article:

https://wagwalking.com/cat/condition/cloudy-eye

Is there anything there that might correspond to what you're observing in Barry?

(((Barry)))


Mogs
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My cat Zimmy's eyes were like that with one bigger than the other. They couldn't figure out why. He did layer develope kidney disease and high bp but you said they checked that.


My cat CC has Acromegaly. She was diagnosed about 19 months ago but I suspect she's had it much much longer. I don't think it's a rare as they once thought it was. Thankfully she hasn't had neurological issues (knock on wood). Her's presents as insulin resistance (which is getting better), bowed legs as her elbows have boney growth. I give adequan shots weekly to help with that. Great stuff. She has a pot belly which is common for acro cats because the organs tend to enlarge. She has a heart murmur but isn't on any medication for the heart. She has ckd as well.

Overall she is happy and doing good despite it all (and has hyperthyroidism on top of it all). She's still boss of the other cats. Lol

 

So you have a meter at home to test? I have a video in my signature showing how I test my cat CC at home.

 

Kind of repeating what others said.
Acro is a lot more common in diabetic kittehs than most vets have been taught. AND the majority of vets don't know about Acromegaly at all. My cat-only vet has over 3,000 patients. Yet my Leo was her first known Acromegaly patient. She learned a lot from him.

Neuropathy - you want to avoid it if at all possible. The key to avoiding neuropathy is to keep your kitteh's BG regulated (under 200) during nadirs at minimum. Those 500-600 range values are unhealthy. Neuropathy is a common topic here - you can search other threads.

 

When a cat starts generating ketones, it's possible for levels to build up very fast (hours). If they become moderate to high then without emergency veterinary intervention a cat may then tip over into DKA very quickly.

Some ketone-prone kitties may bump along for some time between negative and trace levels. Diligent administration of insulin (avoiding skipped shots and closely monitoring BG for dose effectiveness), ensuring adequate calorie intake, encouraging consumption of extra fluids/home admin of sub-qs, daily monitoring of ketone levels and vigilance WRT any signs of inflammation/infection/other stressor can go some way towards keeping the cat safe. The advice generally given here is that veterinary treatment should be sought immediately if a cat tests any higher than trace.


Mogs
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He definitely has some going on unfortunately. Found out his BG is staying around 500, dropping to 300 at the lowest during his curves. I have educated all five docs I work with about acro now! None of them knew it was as common as it is. They were all taught it is a very rare condition that you will be able to diagnose based upon physical presentation.