Hi New Acrocat

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Ken and Sneakers

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Hi
I am an old timer who use to work on the board way back when. I struck out on my own to help people and for the first time in maybe 10 years, I am working with someone whose cat has acromegaly. We just got the test results back and the number was 492 with 92 suppose to be the high. The diabetes is not controlled yet. I wanted the diagnoses confirmed before going higher in dose. I am thinking of shooting tid instead of bid (lantus)
https://docs.google.com/spreadsheets/d/1WWiZkilBJXWQZ8xh0IeKV6T9s4Wwcw62O2Fj3xlRnOk/edit?usp=sharing (sheet may be used differently then in the forum)

I guess the reason I am here is cause I am wondering if there has been any advances in treatment over the last 5/10 years?. I see on the board there is some experimental drug being tried overseas but that is it.

The owner is thinking about getting an MRI. Any reason to?
Anything else to do besides trying to get the numbers as low as safely possible?
Thank you
 
Even Acro cats need regulated blood sugar and insulin - to reduce glucose toxicity. You have some nadir readings but they are sporadic. When Leo had his high insulin demand (18 units/dose), I was trying to get him to 120-180 during nadirs to reduce the excess glucose issues...and keep his weight up.

If you look at some of the top 10 threads in the acro forum, you'll see a couple discussions about Cabergoline - a drug for Acro.
Leo got SRT (radiation) at Ft.Collins in Sept 2016. You can read about it in his thread or ask me any questions. It was an effective treatment, but expensive.
There is also tumor removal via hypophysectomy. Also expensive. A recent forum member had that done in Britain and it was successful.
 
Hi
Thanks for answering.
The owner is going to look at cabergoline.

As far as numbers go, Now that we just got a confirmed diagnosis, we will be much more aggressive in lowering the numbers
 
Hi Ken and Squeaky,

Bodie was diagnosed with acromegaly. His number was 505. I got some good advice from JeffJ and also from Wendy and Neko. Wendy suggested with such a high acro number you may not need an MRI and go straight to the CT scan (if you end up considering SRT). I mentioned that to the vet and he agreed although the oncology vet said he may need to do an MRI to get a better look at the tumor. But that would be after the CT scan. I have been looking for alternatives to SRT in Chicago but had no luck so far. Bodie's scan is scheduled for October 23rd. And possibly SRT following that.
 
Did the caregiver get testing done for IAA (insulin auto antibodies)? A fair number of acros have that as well, and it can impact how aggressive/careful one is when making dose changes.

I don't think TID dosing is a good idea. Especially with the amount of testing being done at this point. And it's very hard on the caregiver. If the caregiver can be convinced to step up testing and you have the experience with R (regular) insulin, it can be a good addition to the toolbox. If you don't have R experience, encourage the caregiver to post here and we can help. If you want longer duration, Levemir is often a better choice. Especially for higher dose kitties as Lantus can sting at higher doses. A good target is getting the blood sugar below renal threshold as much as possible.

The MRI is not required IMHO, especially with that spreadsheet and IGF-1 test number. CSU told me the same before I took Neko to SRT. If there is any sign of a heart murmur, an echocardiogram may be a good idea. If nothing else, it gives a baseline. Heart conditions can sneak up on you and are common enough with acros.

As for treatments, there are a number of American kitties trying cabergoline and one Canadian that has gone OTJ on it. Hypophysectomy or surgical removal of the pituitary is the gold standard treatment, but not very many places offer it and it is spendy. There are other medical treatments (pasireotide or Signifor) have seen better results than cabergoline, but it is way more expensive.
 
Hi Lyresa, good to see old timers still here. Thanks again Jeff and Bodinator
Thanks everyone for answering. Let me address this informative post from Wendy

Did the caregiver get testing done for IAA (insulin auto antibodies)?
No, just the igf-1

I don't think TID dosing is a good idea. Especially with the amount of testing being done at this point. And it's very hard on the caregiver
It is husband and wife team so more testing can be done. I had requested them to spread out the spot checks to different times but have not asked for more tests.
FWIW in most cases at least of regular diabetics, I don't need 1/3 of the spot checks to be safe and get a cat regulated as is done on the board. I also disagree about scale dosing to get to the normal range (I use it with doses over 3 bid) but that is for another discussion

I have plenty of experience with R insulin but sine I have only worked with a few acros, I did give this boards info to them as I am not up to date. As far as R goes, have used it with success on a few regular diabetic cats to break serious toxicity and with 2 acros way back when. The thing I remember though is that with one person where with the numbers it seemed to help, she was not happy with how when using the R it seemed to wear her cat out even though numbers never got lower then say 150. With this cat, since the difference in numbers between the low doses and the top of 13 bid that we got to before diagnosis is negligible, and since it seems like this cat will need much more then 13 bid, we will try to do tid for a month or so to see how that works. The chart link is above if you anyone wants to follow as it will be new info.

A good target is getting the blood sugar below renal threshold as much as possible.
Absolutely and that is always the target although with normal diabetics the target is to get all numbers in normal range

The MRI is not required
I will inform them and copy paste this post with your post to them and again tell them to come to the board

cabergoline
I do have this question. If they start the cabergoline, what do you do with the dose? Cut back at first? Keep it the same for how long? raise as normal?

I don't know and will tell them but don't think they will go to surgical removal. I know they were going to lsu and were going to get an MRI but will inform them of the better choice.
If they are not getting it surgically removed and will only treat with insulin, is there any reason to get a cat scan or mri?


Thanks for responding and your time
Ken
 
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Ken and Sneakers said:
cabergoline
I do have this question. If they start the cabergoline, what do you do with the dose? Cut back at first? Keep it the same for how long? raise as normal?
Click to expand...
Responses to cabergoline have varied by cat. It seems to have taken at least two weeks to start showing impact, with most longer than that. My recommendation to those using it is to proceed as normal and keep a close eye on the BG numbers as response can be sudden. When it does happen, there have been some dramatic drops in insulin dose required. Honestly, there haven't been a lot of cases, not enough to firmly establish patterns. Caution is key. I am still trying to figure out if the response when IAA is involved changes things but need more data.

I would not use R dosing and TID. Actually, I wouldn't use TID at all, especially since IAA has not been tested for. Too much unpredictability possible. Neko was also an IAA cat, and her nadir varied all over the place. I had to test more to catch the lows.
 
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