Chester - yes, diabetic remission possible with acromegaly

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So, Chester was re-diagnosed this year with acromegaly, His IGF-1 values were similar to last year's numbers (I think he said 255 or 205). Either way, Chester was in remission for nearly nine months with absolutely no insulin.

Now, several months after realizing he'd slipped back into a diabetic BG level, he still isn't regulated on Lantus (12.0 units), and the vet has mentioned warnings not to go higher because the tumor could suddenly stop producing the excess causing the diabetes. He did mention using Levemir as a possibility, but either way, honestly, I'm concerned about the possibility of a prolonged hypoglycemic episode, even if I am testing regularly.

The question now is whether I want to have the expensive MRI to determine for sure that there is a pituitary tumor, and then, decide whether radiation or surgery is an option. A neurologist here has been doing surgery on dogs, however, my vet is not at all sure whether he'd be interested or feel comfortable performing the surgery on a cat. I'm not sure I can afford any option, though.

He told me the MRI would run $1400-1500, and the radiation would be at least $5000. I've already spent lots more than this, and honestly, am still trying to make up what I spent last year.

I'm not sure that I'm asking for advice here... I just want people to be aware that their acromegalic cat could, indeed, suddenly go into diabetic remission for month on end.
 
Re: Chester - yes, diabetic remission possible with acromega

Hi there,

A couple of comments....

1) Have you looked into the drug trial that Dr. Lunn is doing? It's not a long-term solution, but it could help for the duration of the trial (6 months?). I think the costs are minimal.
2) The SRT treatment at CSU is about $5000, which includes the CT scan. However, the CT scan must be done at CSU. So, if you are thinking of treating at some point, you don't want to get a CT scan in advance. Normal radiation + MRI will probably cost more than going to Colorado, yet is much, much harder on the cats.

Joan/Madison is in Chicago. She's very nice and would be happy to talk to you.
Carolynn's Fletcher went on and off insulin many times.
I'll try to get some of the current higher-dosers over here. They are also very easy to contact on Facebook.
 
Re: Chester - yes, diabetic remission possible with acromega

My question is this: The MRI will tell you yes or no, but will it matter if you cannot afford the expense at the moment of taking any action? What if the MRI does not pick up a tumor?
It is known to be possible for OTJ with acro; I think Carolyn's Fletcher went OTJ 4 times.
If there is no secretion, then there would be no need for insulin because the pancreas was always functional, yes?
I think that the acromegaly caused the diabetes, which makes acros the opposite of reg FD that have pancreas issues.

I am not clear about keeping insulin no higher than 12u; If you are monitoring, then you would be able to manage any fluctuations of output by adjusting the dose. I am currently giving Oliver 18.75u BID but he was up to 26u, then dropped slowly down to 13u BID. He's been slowly working upward now, but I give him what he needs.
I do not worry about any sudden hypo; if a test were to show a low, I just treat it like any other hypo - I slap down a can of HC and monitor. I've had a few periods of lows, as have others, but it's just the nature of the game. The alternative would be to hold insulin low and keep BG high, which will just cause other medical issues.
If you have a no shoot number and aim to stay above 100 and hopefully around 250 or so, you should be fine.

Were you planning to switch to Lev from Lantus? It is said to be preferred at higher doses as there is no sting with Lev but there may be some with Lantus.

I believe when Fletcher first went OTJ, the period was longer than the following ones.
 
Re: Chester - yes, diabetic remission possible with acromega

Hi. :)

I agree with Gayle re: Chester's insulin requirements. I think your vet's advice just doesn't make much sense, frankly. If Chester's insulin needs suddenly drop unexpectedly, does it matter if he drops from 20u to 12u or from 12u to 6u? Either way, if you're not monitoring, you could be asking for trouble. I suggest continuing to monitor frequently, and let the dose go where does. Chester needs as much insulin as he needs.

You can look at the spreadsheets linked in Gayle, Heather or my signatures to see how we've all dealth with changing insulin requirements in acro cats. If you test often, it really can be managed.
 
Re: Chester - yes, diabetic remission possible with acromega

I just realized something ... you mentioned that Chester is still not regulated and getting 12u, so I went to look at your ss and you don't have one linked to your signature. Do you have a ss of your BG numbers to link to your post here?

I consider my two cats as regulated even though their doses fluctuate and are quite high; what sort of numbers are you getting when testing Chester? What numbers were you getting when not giving insulin during his OTJ period?

A hypo for a cat on Lantus from a dose of 2u is no less than one from 12u; the numbers will still be the same sort of low, and each could last as long as 16hrs. I don't think more insulin which lasts about 12-14hrs is going to make a longer hypo incident.

You know, a better and more interesting question is what are the effects and timeline if secretion were to stop as if turned off like a light switch; thinking about it makes me realize how little I know.

If the secretion stops, how long does it take for what had secreted before, into the body, to be cancelled out by insulin?
I think of a car where you keep topping up the gas tank so that you always have a certain amount making up for what's used when driving. If you stop topping up the tank, how long will it take for you to run out of gas?

Just because the secretion stops suddenly, would there still be some bits running around the body? Wouldn't those bits be like a buffer, giving you time to decrease dose? Or skip a shot? I think we've all done that, and I know I had a period of time where I was decreasing on every shot and sometimes even skipping shots, what a freefall THAT was! But never was there a hypo because of monitoring and dose adjusting.

If I'm seeing this wrong, please let me know!
 
Re: Chester - yes, diabetic remission possible with acromega

Heather found me and asked me to check your post... so here I am.

What the others have said is true. Fletcher went off insulin 4 times over 3.5 years as a confirmed acrocat. You're monitoring, there won't be a sudden hypo from like one preshot to the next. You'll notice that the numbers are lower overall (we don't aim for low numbers with an acrocat--- 80 is low enough--- under renal threshold-- which is generally about 250--- is a good goal) and you'll start to reduce the dose, maybe by a unit or two, or more. It depends on the numbers.

I'm sorry..... I know there's so much more to say and more support to give... but I don't have my boy anymore.... and this is just too hard... I'm sorry. I thought I could do this but I can't. I'm sorry.
 
Re: Chester - yes, diabetic remission possible with acromega

When Chester was OTJ, his numbers were consistently between 60 and 80. I never recorded them online, actually, since he was the same for so long. Over the summer, he had some around 100, then 130, then suddenly 350.

As far as his current numbers - we're still in the 500 range. The lowest I've gotten in months is 450. Time is irrelevant - I almost always have flat curves when I do multiple numbers throughout the day. Most of these are on pieces of paper in my box o'insulin tools. I started a google spreadsheet, but was discouraged by all the high numbers, so I haven't updated it much. Honestly, there isn't much to look at except flat lines of super high BGs.

I haven't called the vet back to discuss the next step, but I don't think I'm planning on doing an MRI at this point.

Would we have to start all over at the bottom with Levemir? I haven't seen ANY reaction yet to the Lantus and it's been months (we're actually at 13 units, and I'll probably go up again after doing another curve).

I have not looked into the trial recently - how would I get in touch with Dr. Lunn?

Thank you, everyone, for your support! I can't always bear to check in here, to be honest. Sometimes I get quite disheartened.

Does anyone have any advice on cat-sitting for cats in this situation? Just in case?
 
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