Cleo on cabergoline

Cleocatra said:
Sorry, here's the note:
Mr. Hasek,
In response to your questions yesterday. Dr. Stiller said the following: no to Gabapentin for Cleo. It will just cause her to be more sedate and unsteady on her feet. It does not seem like the Cabergoline is taking effect. It is not recommended to increase insulin every 3 days. We need to give the body more time to adjust. There is high risk to making quick changes to insulin these could cause death.
Thank you,
(dr. Stillers assistant)
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Chris, your vet has some old school thoughts. What dose of gabapentin is your vet talking about? Most vets give high dose to calm a pet before a visit. Is this what your vet is thinking?

Low dose, low dose, low dose. Ask vet for 12.5 mg every 12 hrs to start with. Give it 1-2 weeks for cat to adjust (first couple of days they can be more quiet).

This is the second time Ollie is on gabapentin. AND she is on bupre. She is definitely not a kitten and her legs would certainly give her trouble if she climbs our 13 steps, but since the gab has been restarted, her legs are less wobbly, shaker and she walks a little further before dropping to lay down and rest.
 
Chris, here are a couple spreadsheets of cats on more than 50 units of insulin. First, Crystal's SS. She only got up to 60 units of Levemir per shot, but was also getting up to 26 units of R at the same time. Started on Caninsulin (in France), moved to Lantus, then Levemir around 16 units, and started to see some movement around 45 units per shot. Her caregiver Suki started adding R at 52 units. Suki didn't want to go over two syringes of Lev (30 units per syringe or shot) per cycle, so limited herself to just 60 units. That still meant 3 syringes at each preshot time, 2 of Levemir and 1 of R. Crystal did not have any treatment. Nothing was available in France.

Pig had SRT done in May 2018. Here is Pig's spreadsheet. He switched from Lantus to Levemir at 30 units Lantus. We start at a slightly lower dose after the switch because some cats have a strong reaction to the change. Pig saw his first blues at 59 units of Levemir. Sarah was giving a couple units R too. Pig never got above 59 units of Levemir. Unfortunately she stopped filling in the spreadsheet partway through last year so don't know how he's doing.

If you ever look at the Acrotracker spreadsheet, link in the "What we know" sticky note, you'll see cats on even higher doses, though not all have links to spreadsheets. A quick glance and I saw one at 120 units of Levemir per cycle, plus 15-18 shots of R. Unfortunately no spreadsheet for the cat is listed. Take a look at Sooty's SS. He got up to 90+ units, had Cyberknife treatment and eventually went OTJ. The high doses are May-June 2011 timeframe.

Having given you the extreme high ends of doses, they aren't that common. More cats max out around 30 units, then you see some that max in the teens. We've even seen one acrocat that needed more than 4 units. The study Judy referenced found acros with doses from 1-30 units, average of 7 per shot.
 
@Wendy&Neko

I think Pig crossed over last year. Not positive, but pretty sure I read it. I tried searching here and in Acro group and couldn't find any posts. Her tag doesn't show up here anymore nor the acro group.
 
My vet said she would support updosing by 1U bid every 5 days. She stressed safety and said we may never get her regulated, but I countered that I'm willing to take some risk to keep ramping up until I see the BG's dropping. We are only at 5U bid on Prozinc rt now. Remember, we were up to 9U bid on the Lantus previously.
Gayle Charambura on the Facebook Feline Acromegaly group mentioned shooting Novalin R as a midday boost. I passed this along to my vet but I haven't heard back yet.
 
You using R is a very bad idea. Yes some people use it, but you would have to test about 10 times the number of times you do now in order to use R. It can be a very dangerous thing if used incorrectly.
 
Wendy&Neko said:
You using R is a very bad idea. Yes some people use it, but you would have to test about 10 times the number of times you do now in order to use R. It can be a very dangerous thing if used incorrectly.
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Just got a reply back from Dr. - yes, dr said she doesn't want to add regular insulin to long acting insulin so we won't go there. She'll keep updosing after 5 days based on a curve.
 
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