? dosing advice on cabergolin

Akro Jeanne

Akro Jeanne

Member Since 2024
Hello everybody,
my cat Jeanne was diagnosed with Diabetes in November 2023 and with Acromegaly in March 2024. She gets Cabergolin since mid-March. We started with ProZink, but switched to Lantus by the end of December 2023.
I'm getting advice from the German Katzendiabetes-Forum, founded by the owner of Tilly, which has been highly helpful so far. (Un)fortunately there is nobody with experience with Acromegaly currently.
As the BG of Jeanne seems to have a big turnaround since a few days, I'm really unsure how to proceed further. Is what I'm seeing just the right dose of Insulin or is it the Cabergolin finally working? Should I reduce the dose - and if yes, how fast - or should I still hold it, wait and see.
Our routines have been already flipped totally and I'm really on edge as to not put her on risk of hypoglycamia.

Here is the link to her BG curves, please don't mind that the notes are in German: https://docs.google.com/spreadsheet...ouid=107508085908141364691&rtpof=true&sd=true
I'll try to put the link in my signature as well, just give me a few minutes.

Many thanks in advance for any thougths and advice!
Nadia
 
Hello and welcome. Are you following the Tight Regulation protocol on the Katzendiabetes forum? One of the things people who are getting the acromegaly treated (radiation therapy or cabergoline) have done is modify the point at which a cat earns a reduction up to 70 if they are following TR here. That gives you a little bit more safety from risk of hypoglycemia due to the larger depot.

It's hard to say whether the cabergoline is now working, or whether you've hit a good insulin dose. Our spreadsheets are also colour coded - which help us identify patterns, so it's harder for me to read Jeanne's numbers.

How much cabergoline is Jeanne getting? Is it daily or every other day?

The other thing about cabergoline is that we have seen a wide range of responses to it. It's supposed to help the best if a cat has a small pituitary tumour, but most people don't get a CT scan as it's not worth the expense unless it's needed for other treatment. We have seen anything from 2 cats on less than 10 units of insulin going into remission in 7-10 days, to cats taking longer to respond, up to three months. We have had about 5 cats go into remission on cabergoline, some on more than 10 units, but it took longer. Almost all the cats on cabergoline at some point see the insulin dose go down, and some reduction in acro symptoms.

In the cats for whom cabergoline works well, it can work really quickly and people have had to drop dose much faster than the protocol calls for, sometimes skip doses or give half doses to keep their kitty safe. It's very important to be cautious in insulin dosing.

To answer your specific question on dosing, yes I would reduce the dose as she's gone below 70 on both this dose and the 21 units. You will have to learn what works for Jeanne, but I would start with the conservative approach of reducing if she goes below 70 and see if that works to bring her into numbers below 100.
 
Thank you Wendy for taking the time to look at my sheet and share your experiences.
Yes, I'm following the Tight Regulation protocol. But I got the feeling that it might not be the best approach for Jeanne now that she is hitting lower numbers. As we had a higher number this evening, I'll probably stick to the dose tomorrow but I had already considered lowering it.
Jeanne gets Cabergolin every day, a dose of 5 mcg per kg. She did not have a scan as I don't plan to get her radiation or operation. So, I really have no idea how big her tumor is. She already has some organs enlarged and is breathing somewhat noisier unfortunately.
In general, Jeanne was well over 350 since she was diagnosed, sometimes considerably higher. I had the impression that numbers where coming down a bit since a few weeks. But the drop mid-week came as a surprise and has our routines upside down.
I just hope we stay as low as such, I could really see how much better she was feeling.
I'll proceed with caution as you advised. Thanks again!
 
Last edited:
One more question, how much would you lower the dose right now? 0,5 or 1 or even 2?
I wanted to go for 0,5 - but with 70 as the new safety line, I might need to reconsider that.
Granted of course, that Jeanne is in better numbers tomorrow morning. I keep my fingers crossed over night...
 
The Royal Vet Clinic started cats on either 5 mcg/kg or 10 mcg/kg and saw much better progress with the larger dose. That's something you can consider changing if you need to later. I think all the cats here are now 10 mcg/kg. I've heard several members say their cat's breathing got quieter after some time on cabergoline.

General guidelines for our larger dose kitties, increases and decreases at 10-15% of the total dose. So that would be 2 units at this point. Again, there is some variability for cats. My acro never got above 10 units, but she was very sensitive to small dose changes. She had radiation, not cabergoine (which wasn't out yet when she was diagnosed) but had some similar sudden drops in dose required, followed by plateaus with very little changes, then drops again. Since Neko, I've observed quite a few cat on cabergoline do similar.

Not long ago that 279 wasn't considered a "high" number. :) Definite progress for Jeanne.

One more thing on dosing, if you see a cycle where she goes a lot lower than you want her to and she earns a reduction, you could shoot 1/2 or 2/3 of the dose the following cycle to help drain the extra large depot. Start with 1/2 and see how she does on it.

Since you mentioned larger organs, has she had an echocardiogram? Heart issues are common with acros, often with little warning. Heart issues can come on suddenly, but if diagnosed early there are medications that can help.
 
You're right, that's progress. I'm just getting a little greedy ;)
I talked to her doctor about checking her heart, but we haven't done so yet. I'll keep that in mind.
Not quite sure if I grasp the logic about shooting half the dose next cycle, but I'll read it again tomorrow when I'm not half asleep.
The last days really have drained me. But I'm very happy and hopeful that Jeanne indeed turned the corner *knockonwood*
 
After a reduction, the depot of the larger dose can influence 4-6 cycle, more for larger doses. Meaning if you get a low one cycle, you might see more the following few cycles. Giving a half dose one cycle can give you a break from that.
 
Alright, I think I got that.
Since the numbers were around 200 today, I did not reduce the dose. I can monitor closely tomorrow, so depending on the numbers, I will stick with the 22 a little longer.
I can't help it, I'm thinking all day "Hodor. Hold the dose" - if you were into Game of Thrones...
But as soon as Jeanne dips near 70 - or if in doubt and no way to monitor her all day because of work - I will change that approach.
Thanks again! I'll certainly come back for news and more advice.

Maybe one more question, as I'm still thinking about it: you said Cabergolin may reduce acro symptoms and that breathing might get better. Which other symptoms are you referring to?
I understood, that the heavy breathing is caused by tissue growth. So are you saying that Cabergolin can turn that back, decreasing the extra tissue?
 
Thank you for the link. I had read it, but mainly for dosing advice. I revisited the thread for symptoms.
Still, I find it very diffcult for some of the symptoms to decide if its caused by Diabetes or Acromegaly. For some it's clear, of course, but for others like the hunger not so much.

Jeanne clearly has earned her reduction. I wish I had reduced the dose this morning already. Now I'm sitting here, almost +1, waiting to poke my dear kitty again and finally hopefully shoot.
I was debating with Jeanne before +11 if I should really reduce the 10% or maybe only 1 IE. I guess the answer is clear now.
Thanks for the advice again - even if I did not follow it promptly. But without it, I would probably be at loss for a lot longer.
Hopefully, Jeanne adapts well to the change.
 
You must log in or register to reply here.
Back
Top