GA Chewie - newly diagnosed - cabergoline advice

Virginie & Chewie (GA)

Virginie & Chewie (GA)

Very Active Member
Chewie's IGF-1 test came back at 283 yesterday (she was not tested for IAA). I just picked up her cabergoline, which was prepared by a compounding pharmacy in town. I have a 10mL bottle, and the concentration is 0.25mg/mL.

Our vet has never used it or prescribed it before, so she used what she thought is a standard starting dose of 0.2mL every other day - so 0.05mg every other day.
Does that sound good to you, experienced acrocat caregivers?

ETA: Do you give it with food or between meals? I know it can cause diarrhea, so if you have any tips on how to start this smoothly, would love to hear them :cat:
 
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How much does Chewie weigh? Standard dosing most start out with is 10mcg/kg of cat.

I've heard of people adding it as a liquid to meals, giving it via syringe. It can cause GI upset, but ECID, not all get it.
 
I googled after posting here and saw that when used to induce estrus (weird), it was recommended to give with food to avoid vomiting, so I gave it to her right before giving her dinner.
 
Virginie said:
Do you think I should increase by making a “fat” measure?
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Do you mean insulin or the cabergoline?

I assume you mean the cabergoline (since a fat insulin dose wouldn't make sense in her situation), I would just leave it at 0.2mL, it's close enough. If your oral syringes have the finer markings, 0.22mL is technically what you want.

Most people here tend to start every other day and do that for about 6 weeks, then consider daily.

Mr Kitty is not really the norm here, but we started seeing results on day 3-ish in terms of BG (if looking at spreadsheet, July 1 2021 is when we started). You test enough you should catch anything drastic, but the majority of the time it takes a little while to see any changes. And sometimes it isn't changes in BG, but rather some of the other acro symptoms.
 
I did mean the cabergoline. I will check the syringe markings tomorrow, to see if we can measure 0.22 :)
Giving it 6 weeks at once every other day sounds great. I’m so glad I work from home. If her numbers start getting funky or going down fast I will definitely see it and be able to manage it.
I will also keep an eye out for any signs of diarrhea… Chewie’s GI mishaps are rare, but they’re stinky enough to put hair on your chest (or wake you up from a deep sleep, true story) :p
I will take a look at Mr Kitty’s spreadsheet - perfect bedtime reading. Thanks for all this info!
 
My Snuffles has been on 10 mcg/kg (0.25 ml of 300 mg/ml ) once daily for almost 2 years. It took months to see a decrease in insulin needs but I also got better BG control (overall lower BG) too. I can maintain his BG below 120 most of the time. Not hi is on 6 units twice daily. I get Snuffles cabergoline for Wedgewood compounted in an almond oil base. I add it to his food. I wrap tape around the barrel of the syringe at the 0.25 ml mark so I do not have to squint each time a draw up the dose.

zIf yours in compounded in oil the oil tends to swell the black rubber plunder in most syringes so they do not last long. Wedgewood supplies 2 syringes with the cabergoline but those are orange and have a very small black rubber o-ring and the o-ring does not swell in oil.
 
Darcy was started on a daily dose at the 10 mcg/kg. He did very well on this with his BG. Really started to come down into amazing numbers (he was at over 40 units at one point.) He didn't respond as well as the "Amazing Mr. Kitty" of course! :-) I hope Chewie will have a good response to Cabergoline and no GI problems. Keep up the good work!
 
Larry and Kitties said:
My Snuffles has been on 10 mcg/kg (0.25 ml of 300 mg/ml ) once daily for almost 2 years. It took months to see a decrease in insulin needs but I also got better BG control (overall lower BG) too. I can maintain his BG below 120 most of the time. Not hi is on 6 units twice daily. I get Snuffles cabergoline for Wedgewood compounted in an almond oil base. I add it to his food. I wrap tape around the barrel of the syringe at the 0.25 ml mark so I do not have to squint each time a draw up the dose.

zIf yours in compounded in oil the oil tends to swell the black rubber plunder in most syringes so they do not last long. Wedgewood supplies 2 syringes with the cabergoline but those are orange and have a very small black rubber o-ring and the o-ring does not swell in oil.
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So glad Snuffles has been doing so well on it! Being under 120 most of the time is a fantastic achievement, I bet he feels so much better too.
My local pharmacy also compounded it in oil (although I have no idea what kind) and I think the vet asked for chicken flavor? Chewie didn't seem to mind at all when I gave it to her orally before dinner.
They marked my syringe so I wouldn't have to squint, which is really nice because my eyesight is getting worse every year, and it's tough enough squinting at the insulin syringe twice a day... Thanks for the tip, I'll keep an eye on the o-ring. The pharmacy is only a ten minute drive, so if the syringe gives out early I'll just go ask for a second one (and maybe ask for two next time).

I guess if Chewie responds to the cabergoline I got locally, then there's no reason to try Wedgewood, right? I would try that only if she didn't respond, in case the compounding done here wasn't great?
The pharmacy charged me $66 for 10mL, a 90-day supply, that seems pretty good? I like not having to depend on shipping.
 
Suzanne & Darcy said:
Darcy was started on a daily dose at the 10 mcg/kg. He did very well on this with his BG. Really started to come down into amazing numbers (he was at over 40 units at one point.) He didn't respond as well as the "Amazing Mr. Kitty" of course! :) I hope Chewie will have a good response to Cabergoline and no GI problems. Keep up the good work!
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I just looked at Darcy's spreadsheet, and the cabergoline/levemir combo really looks like it helped tremendously. I am so sorry you lost him though :bighug::bighug::bighug:
All of these stories from members' kitties give me hope that maybe Chewie's quality of life can be significantly improved... I really hope she can have more time with us while just being her happy, bossy old self.
This subdued, sleepy version isn't her at all.
 
Posting here since this is more about acromegaly and cabergoline than about insulin… Chewie started EOD cab on 11/16, so 18 day ago. Her numbers are already showing signs of improvement with much needed greens, but her clinical signs are not. Her stridor/dyspnea are still as present as ever, and her level of activity and appetite have really declined over the past week or so. She almost entirely stopped coming downstairs for food or to nap on the cat tree or the couch, I have been feeding her on the bed upstairs most meals. She spends her time stretched out on the bed or in her carrier in her closet, with stints on her upstairs cat tree in the sun, but her spunk has gone. She doesn’t look comfortable. She is the most vocal cat I have ever seen, always has an opinion on everything, and she barely even “mwacks” at us anymore.

My brain has been spinning all over the place trying to think this through… The list of side effects of cabergoline in humans is pretty daunting, looks like it would make you feel pretty shitty overall. Could she be feeling this way because of the drug? Of course not being used to lower numbers is also a possibility, but she started moving less when she was still in blue numbers, so it doesn’t really add up.

I’m torn, and spend literally 90% of my day worrying that I am either torturing this poor cat by keeping her around as a ghost of herself, or giving up on her too fast and should be more patient in waiting for improvements of her clinical signs and daily QoL.

I guess I am hoping to hear your stories - did you feel when you began treatment that your cat wasn’t going to make it, only to be proved wrong a few weeks later? Do you wish you had given your cat some grace and a peaceful exit sooner? I am going nuts at the uncertainty, and the impossibility of making a fully informed decision, and it would really help to have at least some elements of comparison.
 
Forgot to conclude that I am considering weaning her off the cab to see if it impacts how she feels. I would rather have her on higher doses of insulin and with higher BGs if it means she can feel better for a few months, even if it means saying goodbye sooner.
 
Looking back at my notes, I actually thought Mr Kitty was having a bout of pancreatitis within 2-3 days of starting cab. That lasted about a week, but he was on max dose daily. It's hard to say whether it was actually pancreatitis, the cab, the new to low numbers, or a combination.

So far, the only side effect in cats I've seen is diarrhea/GI upset. All the literature says cabergoline is tolerated by cats pretty well.

He did also develop idiopathic pleural effusion shortly after ...I do still wonder whether that was something the cab set off, or just another one of his laundry list of issues.

While I am not sure how long it takes to see results for the side effects, I'd hazard a guess two weeks isn't enough. @Howiesmom if I'm remembering correctly, Howie had some acro side effects that improved on cab, how long did that take?
 
Virginie said:
Posting here since this is more about acromegaly and cabergoline than about insulin… Chewie started EOD cab on 11/16, so 18 day ago. Her numbers are already showing signs of improvement with much needed greens, but her clinical signs are not. Her stridor/dyspnea are still as present as ever, and her level of activity and appetite have really declined over the past week or so. She almost entirely stopped coming downstairs for food or to nap on the cat tree or the couch, I have been feeding her on the bed upstairs most meals. She spends her time stretched out on the bed or in her carrier in her closet, with stints on her upstairs cat tree in the sun, but her spunk has gone. She doesn’t look comfortable. She is the most vocal cat I have ever seen, always has an opinion on everything, and she barely even “mwacks” at us anymore.

My brain has been spinning all over the place trying to think this through… The list of side effects of cabergoline in humans is pretty daunting, looks like it would make you feel pretty shitty overall. Could she be feeling this way because of the drug? Of course not being used to lower numbers is also a possibility, but she started moving less when she was still in blue numbers, so it doesn’t really add up.

I’m torn, and spend literally 90% of my day worrying that I am either torturing this poor cat by keeping her around as a ghost of herself, or giving up on her too fast and should be more patient in waiting for improvements of her clinical signs and daily QoL.

I guess I am hoping to hear your stories - did you feel when you began treatment that your cat wasn’t going to make it, only to be proved wrong a few weeks later? Do you wish you had given your cat some grace and a peaceful exit sooner? I am going nuts at the uncertainty, and the impossibility of making a fully informed decision, and it would really help to have at least some elements of comparison.
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Hey!
The dosing I've come across has said every 48-72 hours, maybe it'd be worth trying every 72 hours? I'm pretty new to all this also, but my cat has had an improvement on his demeanor not in his numbers yet. He s been on it almost three months. I will say, as rare as it is that my cats numbers get down to the 100s, he does act different and not as spunky, he gets decently lethargic actually. It makes no sense but he seems the most 'normal' when he is in the 200s-400s. He is a tough case it seems. Anyways, maybe run a full blood panel if you haven't in a while also just to double check everything. Its slightly defeating but keep trying!!
Good luck,
Kelly
 
KellyMac said:
Hey!
The dosing I've come across has said every 48-72 hours, maybe it'd be worth trying every 72 hours? I'm pretty new to all this also, but my cat has had an improvement on his demeanor not in his numbers yet. He s been on it almost three months. I will say, as rare as it is that my cats numbers get down to the 100s, he does act different and not as spunky, he gets decently lethargic actually. It makes no sense but he seems the most 'normal' when he is in the 200s-400s. He is a tough case it seems. Anyways, maybe run a full blood panel if you haven't in a while also just to double check everything. Its slightly defeating but keep trying!!
Good luck,
Kelly
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Thanks so much Kelly for sharing this - I am so glad your cat seems to be doing better on it. What changes have you observed so far? Was he ever uncomfortable/had side effects at first?

I'm suspecting that the GI side effects were bothering her yesterday, as well as the breathing issues. She kept shifting her body trying to sleep and I could tell she just couldn't breathe comfortably.
She was still at a very low BG this morning (68 at PMPS :confused:) but was brighter, came downstairs to ask for food and ate her entire breakfast.
I might switch to every 72 hours like you said, see if that makes a difference.

I have a vet appt for her brother tomorrow, I'll take her instead and do bloodwork to check her kidneys, as well as have the vet check her lungs again.
 
FrostD said:
Looking back at my notes, I actually thought Mr Kitty was having a bout of pancreatitis within 2-3 days of starting cab. That lasted about a week, but he was on max dose daily. It's hard to say whether it was actually pancreatitis, the cab, the new to low numbers, or a combination.

So far, the only side effect in cats I've seen is diarrhea/GI upset. All the literature says cabergoline is tolerated by cats pretty well.

He did also develop idiopathic pleural effusion shortly after ...I do still wonder whether that was something the cab set off, or just another one of his laundry list of issues.

While I am not sure how long it takes to see results for the side effects, I'd hazard a guess two weeks isn't enough. @Howiesmom if I'm remembering correctly, Howie had some acro side effects that improved on cab, how long did that take?
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Thank you Melissa for taking the time to read and respond :bighug: I went through your old posts about Mr Kitty, I'm so sorry about his pleural effusion, poor bub that must have been so tough.
For now I'm keeping a very close eye on the symptoms that worried me so much yesterday (I truly thought if she kept worsening overnight I would have to have her put to sleep this week... we spent hours crying on the couch petting her). She is brighter and more normal this morning, so paws crossed that spacing out the doses will help and the vet doesn't find anything awful tomorrow.
 
Glad yours has a bit of improvement today! Prior to the cabergoline he would have days where he would just lay there like a log , super zoned out. He loves playing with tape from packages and hadn't done that , but now is back to it. Also, he would try to mew but it would be silent? and now his voice is back. Super weird. His strider hasn't really improved. I've read for that issue the cabergoline could potentially stop the overgrowth of the nasal pallet. but won't reverse it. Usually when I hear his I try to get him to shift positions. The vet also thought maybe it could be some asthma. I've switched his litter to non-clay. Walnut shelled litter has almost no dust, and I've added an air purifier. I can't say if it's helped much but it didn't hurt to try all angles! I was definitely convinced that my time left with him was short before starting it. but now I have a lot of hope that he's got some solid time left. I'm much more confident in his quality of life. He did have a bit of loose stool for a bit. and occasionally he has a day or two of it. But it doesn't seem to bother him.
 
Ugh, poor bub. Chewie also used to have zoned-out days at the very beginning of treatment before we got her numbers down, but she also does when she is in the greens. She seems to be feeling her best between 150-200, like your kitty.
Over the years, long before any other symptoms and diagnosis, she had two episodes of "losing her meows" for a couple of months at a time. The vets were stumped and chalked it off to allergies. Her gurgly breathing and stridor were also chalked off to allergies, since she didn't have any asthma symptoms (except a little cough in exceptionally cold mornings). We do have air purifiers and unscented everything since her brother has had asthma since he was a baby. Like you said, it can't hurt!

It's giving me hope to hear that he's back to little things like playing with tape. Chewie used to be soooo opinionated and nosy, she was the bossiest of the house, would come howling in the living room demanding that one of us stop working and go sit on the bed so she could stretch out on our legs for a snuggle session. Those days are gone now, ever since she hurt her back in March (we could have been cause by acro too, we know now), she just can't seem to get comfortable on our laps. She needs to be stretched out, or curled up in the cat tree. She has just withdrawn so much socially since starting the cab, and especially over the past week. Breaks my heart.

I was leaning towards stopping the cabergoline entirely, but after hearing what it did for your cat, I think I will start by doing it every 3 days (since they have to be slowly weaned off anyway). Thanks again for the support :bighug:

@Howiesmom - curious to hear your experience with Howie
 
I’m trying to think back on Howie’s early days and what symptoms he had. Outside of the diarrhea issues in the first few days, there was nothing I really noticed besides his stridor when sleeping (no one can miss that!). He has slowed down a lot and doesn’t play any longer. In the past 6-9 months he was getting more ornery and we figured out he was pretty arthritic. Acro can really exacerbate arthritis. I started him on Solensia injections and he’s doing much better. Not as spunky but he’s moving better, doesn’t shift as much when laying on my lap, and has more energy. So maybe check in on that? I also give him fish oil every night with his supper. I hope you can get to some conclusions. I hate to think about you even considering putting him to sleep. Makes my heart cry for you both.
 
Thanks @Howiesmom - happy to hear Solensia is working for Howie! I want to get Chewie on it if this ends up just being a weird phase. Right now it's touch-and-go, but I'm hoping with all my heart that she rallies.
 
Chewie got her wings this morning. In the end her little body was just too tired to go on. She left peacefully, at home, in my arms, being told how much she was loved. Thanks to everyone for your support and advice, may you all have many more happy years with your kitties.
 
My heart is broken for you but Chewy definitely knows how much she was loved (and still is). I’m so incredibly sorry for you and your family. I’m positive that her journey over the bridge was beautiful and peaceful and she was welcomed by so many friends from this forum. My heart aches for you…
 
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Virginie & Chewie (GA) said:
Chewie got her wings this morning. In the end her little body was just too tired to go on. She left peacefully, at home, in my arms, being told how much she was loved. Thanks to everyone for your support and advice, may you all have many more happy years with your kitties.
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Oh no! I’m so sorry. I am just reading this and crying. I’m really really sad that we’ve lost one of our acro kitties and that Chewie’s light has gone out of the world and out of your lives. You have my deepest sympathy. I don’t know what else to say because this is just way too sad and deep for words, which are so inadequate. ❤️❤️❤️❤️❤️ :bighug::bighug::bighug::bighug::bighug:
 
I'm so sorry for the loss of your beautiful Chewie. There time with us is not anywhere near enough. You gave her a wonderful life & did everything you could for her ❤ my heart breaks for you & my thoughts & prayers are with you always :rb_icon::bighug:
 
Virginie & Chewie (GA) said:
Chewie got her wings this morning. In the end her little body was just too tired to go on. She left peacefully, at home, in my arms, being told how much she was loved. Thanks to everyone for your support and advice, may you all have many more happy years with your kitties.
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I am so sorry for your loss of Chewie. There are few thoughts beyond sending love to you that seem adequate. Godspeed little Chewie. :bighug::bighug::bighug:
 
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