Cabergoline update/progress & advice needed

[Breanna H]

Previous acro post

Hello all! We just started into Tigger's 8th week on 0.4ml of 200mcg/ml cabergoline every day. However, as you can see from his spreadsheet, his numbers are actually getting worse, by a decent amount. We haven't seen a blue number in forever. It also is really playing a toll on his mobility. His neuropathy seems to be getting worse by the day. His litter box is now upstairs in the dining room because he is unable to make it down the basement steps anymore. The amount of cleaning that goes into maintaining a litter box in your dining room is crazy. I spend almost 20 minutes a night on it, emptying it and vacuuming the box it is in since Tigger flings the litter all over the place.

We are also up to 18u per dose. I have to order insulin every month pretty much as a 5 pack of pens only lasts me 41 days. That's 200 dollars per order (from Mark's). I love Tigger so unbelievably much but this is just so exhausting and I feel so burnt out. I just don't know what to do.

I know I haven't been doing mid-day checks every day. His numbers have just been so consistently high that I don't see a point in torturing myself, my husband or Tigger.

I have had so much going on in my life from work, issues with my family and my health. I feel guilty but checking Tigger's sugar has really been on the back burner. I try my best but I can only do so much. If his numbers were proving to be better, I wouldn't have an issue checking more. It's just so discouraging to get a high number constantly.

Has anyone noticed higher numbers on cabergoline initially? I really was hoping this is what would do it for Tigger and bring down his insulin requirements. I just don't know what else to do. I've tried looking through other's spreadsheets but haven't really seen anything similar to Tigger Could his dose of cabergoline be too high? Should I back down to every other day like the vet wanted?

I think I'm going to take him to the vet maybe this week. He has a cyst on the back of his neck that has been there for over a year but has been getting bigger, now about nickle sized. I was trying to put it off due to expense, however, it can't be ignored any longer. I really don't think this has anything to do with his numbers. Like I said, it has been present for a year now.

Thanks to everyone in advance for the advice!

 

[Wendy&Neko]

Has anyone noticed higher numbers on cabergoline initially?

For some people it has taken a couple months before they start seeing effects. Depending on what the tumour is doing in the mean time, it could mean the dose has to go up. I doubt his cabergoline dose is too high.

If you hold a dose too long that isn't getting him where you want him to be, glucose toxicity will set in, and that will mean higher doses. Plus your dose increments are too small. 0.25 units is like a drop compared his dose. Over 10 units, you can increase by 1.0 units at a time.

 

[Breanna H]

If you hold a dose too long that isn't getting him where you want him to be, glucose toxicity will set in, and that will mean higher doses. Plus your dose increments are too small. 0.25 units is like a drop compared his dose. Over 10 units, you can increase by 1.0 units at a time.

I was doing that for a while but I'm just at a point now where I can't increase anymore. I'm not sure how people afford to go up to 30 to 50u in a dose for their cats. Like I said, I'm spending basically $200 a month just on insulin for Tigger. I unfortunately have to draw a line somewhere

 

[Larry and Kitties]

I'm not sure how people afford to go up to 30 to 50u in a dose for their cats. Like I said, I'm spending basically $200 a month just on insulin for Tigger.

Since you are not getting much drop on the Levemir alone, you might want to consider adding some less expensive insulin like R or N from Walmart.With my first definitely diagnosed aero cat, MurrFee, I started using N in addition to Levemir. I was up to 50 units or so insulin twice daily. I was using half N and half Levemir. MurFee's internist agreed with that use. With my present aero Snuffles I am using a little more than half N. I started using the N for Snuffles before he was diagnosed since when I go to 5 units Levemir I noticed very little drop in BG and BGs were in the mid 200's so I went and bought some N from Walmart for $25 or so for 10ml and substituted some N for the Levemir. I saw very much improvement in BG and now Snuffles in on 5 units Levemir and 8 or so units N twice daily.

 

[Howiesmom]

Hi Breanna, I understand your pain in the cost of a high dose kittie. Howie was up to 55 units twice daily so a pen wasn’t even lasting me 3 days and I was trying to figure out how I was going to keep affording that. And then POOF we broke the glucose toxicity and he’s down to 33 units twice daily. Still not a fun bill to pay...believe me. I just did a $500 order from Marks earlier so I could save on shipping costs. Howie has been on cabergoline since early Feb and I’m pretty sure I haven’t seen the effects of it yet but I have to pray it’s coming!. Luckily, he doesn’t have neuropathy issues. Do you have Tigger on Methyl B12? That’s what I see most people using for neuropathy instead of Zobaline as it’s much cheaper. I know you can get it online from Vitacost for cheap and just mix it in his food.

I know Larry uses Novolin N. @Wendy&Neko suggested Howie go on Novolin R to help bring BGs down before the Levemir kicks in (and even a mid-day dose if #s are flat or rising). I don’t know the difference between the two but I’m sure someone can explain it. I’m still working to find a good dose but it has helped. You don’t need a prescription for it at Walmart and it’s about $25.

Keep the faith and know that Tigger loves you for anything and everything you’re doing to help him. Life is so complicated these days and adding feline diabetes on top exacerbates it. Know we’re all here for you!

 

[Breanna H]

so I went and bought some N from Walmart for $25 or so for 10ml and substituted some N for the Levemir. I saw very much improvement in BG and now Snuffles in on 5 units Levemir and 8 or so units N twice daily.

How did you decide how much to swap out? If he is on 18u of levemir would I just start with 17 of levemir and one of N/R and see how it goes and work from there? You give it all with their AM/PM doses or in the middle of the day?

Do you have Tigger on Methyl B12?

I currently have him on Zobaline. But I will look into the B12. Is it a special kind for cats or can they take the human form?

 

[Larry and Kitties]

R is faster action/less duration than N. N lasts maybe 8-10 hrs while R 4-6 hours.

How did you decide how much to swap out?

With the high dose and relatively high BG with little drop you are currently experiencing I would just with adding 1 unit and see what happens. N and R are in-out insulins so there is no depot to fill so you see almost the full effect with the first dose. I use N because it lasts longer.

 

[Wendy&Neko]

If you want to use R (or N), we strongly recommend you get an experienced person to help you with dosing for it. Larry is the only person here currently using N as a bolus. Due to his pack of diabetic cats, he doesn't have a spreadsheet for you to look at and see how it would work. We have several people who have experience with R.

Do NOT start with 1 unit of R. What a cat needs for R is very unique to the cat. I have seen a 30 unit cat need no more than 0.5 units of R.

 

[Howiesmom]

How did you decide how much to swap out? If he is on 18u of levemir would I just start with 17 of levemir and one of N/R and see how it goes and work from there? You give it all with their AM/PM doses or in the middle of the day?


I currently have him on Zobaline. But I will look into the B12. Is it a special kind for cats or can they take the human form?

You can just use people methyl b12. The only difference between that and zobaline is that you need to also add in folic acid. You can get 400 mg of human folic acid and give a half tablet. I did have Howie on methyl b12 and folic acid for a while as I thought he had some neuropathy issues. Then he started having GI issues so we ran the GI panel and his folate was really high. So I just took him off everything. Methyl B12 is water soluble so kitties just pee out what they don’t need. But folic acid isn’t. I think I paid $17 for methyl b12 (Vitacost brand) and $6 for folic acid. If you do a search on this FD site for Methyl b12, you’ll see posts about it.

 

[Breanna H]

If you want to use R (or N), we strongly recommend you get an experienced person to help you with dosing for it. Larry is the only person here currently using N as a bolus. Due to his pack of diabetic cats, he doesn't have a spreadsheet for you to look at and see how it would work. We have several people who have experience with R.

Could you point me in the direction of someone who might be able to advise me? Going up on the levemir really isn't an option anymore so I'd be willing to give this a try to see if I could get Tigger a little better managed until maybe his Cabergoline kicks in. Thank you!

 

[Wendy&Neko]

I can send a message around to a few knowledgeable people. What time zone are you in (EST?), and what time is preshot in your time? R is usually given initially the same time as the Levemir dose, and you have to start out monitoring closely. We suggest getting tests in at R+1, +2, +3 and +4, until you find out when R onsets and nadirs in Tigger, then you can ease back the testing a bit. There are a number of guidelines to learn about when to give, and more importantly, when not to give R, so we try to find someone who can "sit" or be online with you the first few times you give R.

In general, you will have to step up testing a bit. No preshots without testing and ideally a second test each cycle. For some cats, the effects of R can be seen in later cycles.

Start by talking to your vet about using R and obtaining it. I've heard Humulin R at Walmart is the best price. I am in Canada so not totally up on that. Novolin R is another brand.

 

[Breanna H]

We suggest getting tests in at R+1, +2, +3 and +4, until you find out when R onsets and nadirs in Tigger, then you can ease back the testing a bit. There are a number of guidelines to learn about when to give, and more importantly, when not to give R, so we try to find someone who can "sit" or be online with you the first few times you give R.

Unfortunately, due to my work schedule, other than in the evenings, I really can't get that many tests in I know I have been slacking off on the testing lately so I could be doing more if necessary but I'm honestly not sure I'm able to tackle that much testing right now. I knew it would require more but I guess I wasn't realizing how much. I will definitely think about it though. I love Tigger so much, I just am feeling so burnt out from the care he requires