Buster - Recent Dx_Acro & IAA

[Madm4444]

Hello all. I have been posting on the Health forum for a couple of weeks about our kitty, Buster, because he's been so hard to regulate. His bg has remained high even as we have increased his doses.

Now, we know why. He's tested positive for acromegaly & IAA. We received the diagnosis on 1/23/25.

First, let me thank all on FDMB who have posted their experiences. If not for this community, we would not have known to get him tested & we would still be wondering what was wrong. We're not sure if the IM vet that has been overseeing his case would have suggested the testing but we weren't waiting to find out.

Second, I have been reading posts in this forum but more for general knowledge. Now, it's time to dig deeper.

Some questions as I get started:
1 - I believe the treatment options are SRT, CyberKnife and Cabergoline. Is this correct?
2 - I am in Columbus, Ohio. Does anyone have experience with acro treatment in this area?
3 - Is it possible that his insulin dose has been overshot & now overloading his system? Or does the diagnosis & current lack of response mean that he's still not there & may never get there?
4 - Could his slightly enlarged heart & heart murmur negate him as a candidate for these treatments? Or could they possibly be a result of the condition & be positively impacted by treatment?
5 - I understand that Lantus can sting at higher doses & Levemir has been discontinued. Were these the only insulin alternatives for ProZinc that were best for acro cats needing higher dosing?

Yikes. That's prbly enough for the moment.

Buster is taking Ondansetron & Maropitant for nausea/vomiting, Miralax, and Mirtazapine.

Thank you for any insight.

 

[Jodey&Eddie&Blue]

Hello all. I have been posting on the Health forum for a couple of weeks about our kitty, Buster, because he's been so hard to regulate. His bg has remained high even as we have increased his doses.

Now, we know why. He's tested positive for acromegaly & IAA. We received the diagnosis on 1/23/25.

First, let me thank all on FDMB who have posted their experiences. If not for this community, we would not have known to get him tested & we would still be wondering what was wrong. We're not sure if the IM vet that has been overseeing his case would have suggested the testing but we weren't waiting to find out.

Second, I have been reading posts in this forum but more for general knowledge. Now, it's time to dig deeper.

Some questions as I get started:
1 - I believe the treatment options are SRT, CyberKnife and Cabergoline. Is this correct? Yes, that's the route I've gone with Eddie and Blue but they also had transphenoidal hypophysectomy to remove tumour and pituitary.
2 - I am in Columbus, Ohio. Does anyone have experience with acro treatment in this area? I'm Canadian but we went to Washington State University Vet Teaching Hospital in Pullman, WA
3 - Is it possible that his insulin dose has been overshot & now overloading his system? Or does the diagnosis & current lack of response mean that he's still not there & may never get there? I'll set @Wendy&Neko speak to that.
4 - Could his slightly enlarged heart & heart murmur negate him as a candidate for these treatments? Or could they possibly be a result of the condition & be positively impacted by treatment? Acrokitties are notorious for heart issue. They are of concern but fitness for treatment will be determined.
5 - I understand that Lantus can sting at higher doses & Levemir has been discontinued. Were these the only insulin alternatives for ProZinc that were best for acro cats needing higher dosing? We used Lantus at first and changed to Levemir. Much easier in high dose.
Yikes. That's prbly enough for the moment.
Yikes, is right. It's a lot to take in but now you know and can move forward and make informed decisions.
Good luck to you and Buster.

Buster is taking Ondansetron & Maropitant for nausea/vomiting, Miralax, and Mirtazapine.

Thank you for any insight.

 

[Wendy&Neko]

I believe the treatment options are SRT, CyberKnife and Cabergoline. Is this correct?

Cyberknife is a variation of SRT, more focussed. Another option is hypophysectomy, or surgery. There is another medical option pasireotide that has been researched, but it not worth looking at because the drug costs are too high. If you expand Jodey's post above, you'll see her answer to the questions. She is one of the small number of people here who have had the surgery done. It's only done in a couple places in North America and costly. The best place for that surgery is the Royal Vet Clinic in London who have the best success rate.

ETA: Most people here now try cabergoline. It is cheaper and doesn't require travel but still has some good results.

2 - I am in Columbus, Ohio. Does anyone have experience with acro treatment in this area?

I drove from the Vancouver BC area down to Fort Collins Colorado to the Colorado State University. SRT has since been made available in more places. It was a small handful then. Might want to inquire at https://vmc.vet.osu.edu/services/radiation-oncology. Your vet may know someone who has been there. After Neko's SRT (first for my primary vet), I discovered that her acupuncture vet had send other clients for SRT some at CSU some elsewhere, though not for acro.

Is it possible that his insulin dose has been overshot & now overloading his system? Or does the diagnosis & current lack of response mean that he's still not there & may never get there?

Nope, you'd been seeing him dive down to really low numbers at some point if his he was overdosed. You have the Libre, so you aren't missing anything. The nature of insulin resistance (and you are dealing with two of them) is that sometimes you are constantly chasing after a good dose. The good news is that for every acrocat that has been here that I've seen in my time here, there is a dose that moves them. But there is a huge variation in what that number is. He will get there.

Could his slightly enlarged heart & heart murmur negate him as a candidate for these treatments? Or could they possibly be a result of the condition & be positively impacted by treatment?

It depends. There are cats that have heart issues go to SRT before. Neko's second SRT she had a slightly enlarged heart. If you haven't already had an echocardiogram done you should. It'll tell you if he can have anaesthesia. Most places offering SRT will ask that one be done before hand. It's quite common for acros to have enlarged hearts. Lots of older cats get benign murmurs, not just acros.

I understand that Lantus can sting at higher doses & Levemir has been discontinued. Were these the only insulin alternatives for ProZinc that were best for acro cats needing higher dosing?

Whether Lantus stings depends on the cat. I've seen acro cats doing OK on 20+ units of Lantus. There are other insulins out there like Tresiba(degludec) but we have limited experience with them, and no acros that I know of. Toujeo is another in that category except have sen even less cats on it.

 

[Madm4444]

We are doing our research & trying to figure out next steps for Buster's acro treatment. In the meantime, we are still battling his numbers.

We have been at 9.5u for 2 days. The Libre was due to expire so we had it replaced yesterday. Unfortunately, it malfunctioned so we only have few points of data. We got another replacement today so hopefully we can get info on this dose.

Question: Once you get this high in dose, U-40s are getting difficult to use. What is the next step in syringes?

 

[JL and Chip]

Question: Once you get this high in dose, U-40s are getting difficult to use. What is the next step in syringes?

You still use U-40 syringes (U-40 is the “strength” of the insulin, not how much the syringe holds), but you can simply get U-40 syringes that hold more insulin.

From your question, I’m guessing you’re using 3/10cc U-40 syringes. Those hold 12 units of insulin.

You can purchase 1/2cc U-40 syringes, which will hold 20 units. Here’s an example: https://www.chewy.com/ulticare-vetrx-insulin-syringes-u-40/dp/206320

if you continue to go up in dose, you can also get 1cc U-40 insulin syringes, which will hold 40 units.

Note that 3/10cc (or 1/2cc, or 1cc) is the volume of insulin that the syringe holds.

Important: Just make sure that you get U-40 syringes. I’d also opt for half-unit markings.

 

[Wendy&Neko]

A general comment on dosing. If he sees numbers under 100, as he did on the PM of the 23rd, I'd hold the dose a little bit longer. His body isn't used to greens so bounces afterwards. Is it the vet getting you to increase every 4 cycles?

 

[Madm4444]

You still use U-40 syringes (U-40 is the “strength” of the insulin, not how much the syringe holds), but you can simply get U-40 syringes that hold more insulin.

From your question, I’m guessing you’re using 3/10cc U-40 syringes. Those hold 12 units of insulin.

You can purchase 1/2cc U-40 syringes, which will hold 20 units. Here’s an example: https://www.chewy.com/ulticare-vetrx-insulin-syringes-u-40/dp/206320

if you continue to go up in dose, you can also get 1cc U-40 insulin syringes, which will hold 40 units.

Note that 3/10cc (or 1/2cc, or 1cc) is the volume of insulin that the syringe holds.

Important: Just make sure that you get U-40 syringes. I’d also opt for half-unit markings.

Thank you! That's exactly what I needed to know.

 

[Madm4444]

A general comment on dosing. If he sees numbers under 100, as he did on the PM of the 23rd, I'd hold the dose a little bit longer. His body isn't used to greens so bounces afterwards. Is it the vet getting you to increase every 4 cycles?

No, not a specific number of cycles, just high numbers.

However, after reading the information here, I was concerned that they increased too quickly in the early days when he was in the hospital. Given that, we have been trying to do a minimum of 3 cycles at a dose. We have gone longer but he's so miserable in the high numbers.

I have just updated his spreadsheet with data from the new Libre. What are your thoughts about holding this dose?
Thanks.

 

[Wendy&Neko]

When a cat bounces, it can take 6 cycles to clear the bounce and get him back to better numbers. Increasing too soon means you don't see if that dose will take him back to those numbers again. One way to think about it is "how low does this dose take my cat?". The tricky thing with acro and IAA, unfortunately, is that you are fighting against them and can't hold a dose too long. Tagging @Suzanne & Darcy for more details on dosing Prozinc.

I wouldn't bother with fattening the dose at all. Over 5 units, increases should be by 0.5 units at a time, unless he's seeing a lot of under 100 and you just want to tweak the dose.

 

[Madm4444]

When a cat bounces, it can take 6 cycles to clear the bounce and get him back to better numbers. Increasing too soon means you don't see if that dose will take him back to those numbers again. One way to think about it is "how low does this dose take my cat?". The tricky thing with acro and IAA, unfortunately, is that you are fighting against them and can't hold a dose too long. Tagging @Suzanne & Darcy for more details on dosing Prozinc.

I wouldn't bother with fattening the dose at all. Over 5 units, increases should be by 0.5 units at a time, unless he's seeing a lot of under 100 and you just want to tweak the dose.

Yesterday afternoon didn't result in much drop but at least he stayed under 400 most of the day. I could also see that he felt better.

Unfortunately, he was right back up AMPS this morning and the Libre has been reading HI until now (+7). Slight drop to high 300s just started. We kept the dose at 9.5f today (I saw your comment about fat doses but I've already been doing that so kept it the same) but, based on how things are going today, I'm not sure if we should wait or increase. Could this still be a bounce from 1/23?

He's not feeling as well today but, in addition to his high bg, I think he is also a bit constipated so we will include some Miralax in his PM meal & increase the amount in tomorrow morning's meal. There sure is a fine line finding the right amount!

Any input would be appreciated. Thanks!

 

[Wendy&Neko]

Bounces are typically over by 6 cycles or 3 days. This is not due to the 23rd.

 

[Madm4444]

Bounces are typically over by 6 cycles or 3 days. This is not due to the 23rd.

At this stage (Libre 379 +8), what increase would you recommend for PM?

 

[Wendy&Neko]

Let's see if Suzanne pops in - she knows more about Prozinc dosing. If you don't hear from her, I'd wait until morning to consider an increase.

 

[Madm4444]

Thanks, Wendy.

@Suzanne & Darcy