? DOSING ADVICE NEEDED PMPS 586 +9 430 AMPS 463

Maestro's Mom

Maestro's Mom

Member Since 2018
10/26/18 acro dx. BG was in yellow range a few days ago, then began creeping back up. Increased Lantus to 4.5, then to 5.0; Last few cycles:
AMPS:406; +2/202; +10/262; PMPS 586; +9/430; AMPS 463. Really concerned about these high numbers. Should I increase dose again or wait it out? Not sure if he is bouncing.
 
Sue,

Sorry to see the acro dx. Although its not what you want to hear, you know know why Maestro is running high. Now you do things a bit differently. Has vet offered any suggestions on treating? There are a few options, @Wendy&Neko can explain them so much better than I.

I see your ss has the 4.5 units for 4 cycles then the the 5 units. I would keep the same dose tonight and increase dose tomorrow. In other words follow the same schedule. 4 cycles of same dose, increase, 4 cycles of that dose, increase, then 6 cycles so depot can catch up. So 4 cycles, 4 cycles, 6 cycles. Repeat

Be back in a few minutes. My breakfast is here.

ANY LURKERS THIS IS FOR SUE AND MAESTRO ONLY. CONFIRMED ACRO DX. PROTOCOL CHANGES.
 
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Paula,

Yes, I jumped the gun on 4.5 to 5.0. Still trying to figure this all out. I don't understand the depot concept.

Because Maestro is an acrocat, I need to understand how this impacts dosing protocol with Lantus. @Wendy&Neko

Getting ready to go to church. I'm in Michigan so will be back around 12:30 pm EST. :bighug:

Thank you very much for reaching out.
 
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I don't think you jumped the gun. When Olive was dx. It's what Wendy and few others suggested in order to get a handle on it and get her into safer glucose levels quickly. I will leave the technical stuff and fine tuning to Wendy. I don't get it all either.

We started medical treatment using cabergoline 22 days ago. It is helping, although finding a vet willing to try took 4 months.

You will manage this. I edited a bit in my 1st response, you might want to reread it.
 
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We sympathise with the acro diagnosis. Having no experience with long acting insulin in cats I must defer to the knowledgeable Paula. I can understand your desire to get the BG numbers down, but a little caution is in order . We bumped up TITAN s dose much faster than our vet wanted, but we were using prozinc which doesn't build a depot.
 
@Wendy&Neko I'm tagging Wendy. She may not be around until later, though.

How aggressive you are may be a practical issue. If you are around most days and can monitor would allow you to be more aggressive with dosing. If you're out of the house for long periods, safety is always the primary concern. I'd encourage you to always keep a supply of high carb food and extra strips on hand.

Some time ago, a member who rarely posts now, started a discussion about whether you could follow TR with an acro kitty. It was a time when there was some controversy around what numbers were safe for a cat with acromegaly. We've gotten well beyond those issues but the outcome from some very close observation and evaluating as many spreadsheets as possible was that following TR was safe with an acro kitty. Some modifications to TR do occur. For example, once a dose exceeds 5 or 6 units, the dose is increased by 0.5u (rather than 0.25u). It's a matter of what percent of the total amount of insulin an increase reflects. For a cat whose dose is 10u, a 0.25u increase is a drop in the ocean so a greater amount is needed to get numbers to move.

I do think you're seeing some bouncing. It may help to keep in mind that Maestro was diagnosed with FD just a bit more than a month ago. Your kitty, in all likelihood, isn't used to dropping into relatively lower numbers. To be honest, I'm impressed that you thought to get Maestro tested for acro so early. While the results aren't what you were hoping for, you know what you're dealing with. You'll find a great deal of knowledge and support here.
 
I am retired and am a full-time kitty mom, so can monitor him closely.

Kudos to my vet for recommending the IGF-1 test so early. Am waiting on the IAA test until he has been on insulin longer.

I am considering taking Maestro to AMC in NY for surgery to remove the pituitary while there are still funds available to subsidize a substantial portion of the cost. Wondering if there is an effective alternative. Any thoughts on that from this community are welcome. We have an appointment at Michigan State University on November 7th for ultra sound and consultation.
 
Maestro's Mom said:
I am retired and am a full-time kitty mom, so can monitor him closely.

Kudos to my vet for recommending the IGF-1 test so early. Am waiting on the IAA test until he has been on insulin longer.

I am considering taking Maestro to AMC in NY for surgery to remove the pituitary while there are still funds available to subsidize a substantial portion of the cost. Wondering if there is an effective alternative. Any thoughts on that from this community are welcome. We have an appointment at Michigan State University on November 7th for ultra sound and consultation.
Click to expand...

Maybe @Amanda & Shmee can answer some questions on the surgery. Shmee had it not long ago.
 
Since you are seeing yellow, let’s give this dose 6 cycles. Sorry for the short reply, physically exhausted from wrangling high school novice rowers yesterday. Will be around more tomorrow.

Hypophysectomy is gold standard treatment, check out high dose forum for stories. It does have some risks associated with it. The other non medical treatments are expensive as are some of the medical ones. Cabergoline is cheapest treatment option, though not all cats see benefits.
 
Hiya Sue, I am so sorry to hear about the acro diagnosis, but I know it'll be so much better knowing what you're dealing with. If you'd like some basic information about the surgery at AMC, check out Amanda's (@Amanda & Shmee ) surgery thread for Shmee on the Acro/IAA forum HERE. I think it has almost all the information you'd need except direct contact information for Dr. McCue. Sue (@sbluhrs ) also posted a thread HERE for her Sophie's surgery, which happened not long after Shmee's. Obviously one of those ladies can get you contact information, but I figured you'd want to read up on the process, if you haven't found those already. Sending you and Maestro plenty of hugs! :bighug::bighug::bighug:
 
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