Diabetes & New adrenal issue - Any Trilostane users out there

Could not get Pantera's insulin regulated since Oct 2023 and now the Ultrasound shows one adrenal enlargement. Not sure if that means tumor or not. She will get the dexamethasone test this friday. march 1 2024. I guess to confirm Cushings??

Specialist did mention liquid compounded Trilostane, but I see some threads that say it doesn't work on cats with adrenal, but those seem kind of old, plus I have read not to use it on cats with the pituitary tumors.

What else is there? All the others I read about are for dogs and NOT cats. Not many studies on cats. I have only found a few. Unfortunately, the 2 new ones Bexacat and the other CANNOT be used once you have used insulin. Will be great for new DM's and it is liquid so no more shots.

Would love to hear of others with DM and Cushings and your results with Trilostane.

 

Good luck with the Cushings testing today.

I'm linking a couple stories from people who've had cats with ADH (adrenal Cushings), the first one used trilostane:
https://www.felinediabetes.com/FDMB/threads/petras-cushings-story-adrenal-tumor.225817/

https://www.felinediabetes.com/FDMB/threads/adrenal-based-cushings.211686/
More info about Roxi's treatment in the first thread.

Trilostane does have success in kitties with pituitary Cushings. A couple papers talking about it:
A one cat study using Trilostane, with pictures.

This article talks about Trilostane and surgery option, you can download the full PDF:
Scudder CJ, Kenny P, Niessen SJM. (2015) Treatment of canine and feline hyperadrenocorticism: trilostane and the alternatives. Companion Animal 2015 20:4, 230-23

 

Thank you Wendy!! Will get results Monday or Tuesday. (march 4 or 5th 2024)

 

We got results of the dexamethasone test. It was negative so supposedly no Cushings and we will NOT be starting Trilostane. The plan is to continue measuring glucose levels at home and I'm pretty sure we will be increasing the Vetsulin dose from 4 units 2x a day to 5 units pretty soon. She is not textbook 'insulin resistant' yet until you are giving more insulin units than body weight. In this case she is 10 lbs.

So now the question is, did we just not use enough insulin yet? She did have an enlarged adrenal in the ultrasound tho so I still think something is going on.

 

Thank goodness for no Cushings!

Have you talked to the vet about using a better insulin for cats?

You definitely need more home tests before you can say she needs an increase, as that 140 today told you.

Let me guess, older vet? Newer research (not that new now, published 2015) shows 1 in 4 diabetic cats has acromegaly. Not saying Pantera has that, just an example that "recent" knowledge of insulin resistance has changed.

We say to get extra testing at 6 units, regardless of body weight. But we've seen cats with secondary endocrine condiions (insulin auto antibodies, acromegaly, and Cushings) at 3 units. It's just that over 6 units, if on all low carb food (which Pantera is not) and teeth OK, the likelihood of those secondary conditions is very high. My vet used to say Neko needed to get to 10 units before testing. She had both conditions and topped out at 8.75 units. That was in 2012.

I think Pantera has two things going against her. The first is the higher carb m/d dry food. The second is the insulin type.

 

Hey Wendy. They are both younger female vets. We had talked about acromegaly on our first visit to the specialist. She didn't think Pantera had that. no weight gain, or enlarged features, or lethargy, etc. Her heart and eyes were great. Her behavior is normal, appetite is fine. Only thing I can tell is muscle wasting and poor coat, which she has always had and dandruff.

The specialist had mentioned that the adrenal releases 4 different things, mentioned sex hormones or estrogen, and I can't remember the others. There was one that starting with an A that she didn't think was the issue. (aldosterone)
I think she mentioned hyperaldosteronism and we said how it's rare upon rare in cats. I think some of the tests out there aren't very conclusive for some of the diseases it could be.

It's still within range isn't it? Some days she will eat some wet food with it. (food off your wet food list, Friskies with liver, or fancy feast, or wellness)

As for the insulin, if we are starting to get it under control with a higher dose, it wouldn't make sense to start over with glargine would it? Keep in mind we started with Lantus for over 2 months. Granted, it may not have been long enough, but we
were just following the vets orders and agreed that we didn't think it was working. (i didn't know anything back then. lol)

At any rate, she wants to watch our glucose chart. For some reason she can't get into it anymore so i will share again. I have to say the specialist welcomed the chart and loves that we do it. My regular vet, not so much.
I guess we will see what the specialist, Dr Rose wants to do as we get more data on the readings.

 

Same study above showed only 35% of acrocats had clinical signs on diagnosis. But seldom muscle wasting, so not likely. Our acros are little football players with excess IGF-1. Guess the young vets just aren't up to date, not a surprise.

Adrenal also sends out cortisone. hence the Cushings test.

If you switch to glargine, you wouldn't start back at the beginning in dose. Without home testing you can't say how the Lantus was working in the beginning.