I will also start cabergoline for Raymond James

Reading these threads about cabergoline, is educating me. My vet and an endocrinologist has offered options for acro. Surgery or radiation to the tune of $12,000. Raymond James is on basaglar at 25 units X2. His growth factor is 521, very high. Everything I need to know has been on FDMB. RJ will be on 60mcg, capsule once a day, compounded through wedgewood pharmacy.
The vets said to lower his insulin to 6 units X2 when starting cabergoline. Agree?
I will need to monitor his BG closely as I am working now. Scary......... Thanks!!!

 

Wow. Cutting the dose from 25 units to 6 is too much, in my opinion. If you look at the spreadsheets of those of us who have used Cabergoline, you will see that it takes several weeks for most cats to begin to respond to the Cabergoline. I would not want Raymond James to have high glucose (which will happen if you cut him back to 6 units.). He could be in danger of going into DKA or just spending lots of time above the kidney threshold. Most people do not cut the insulin dose at the start of Cabergoline but adjust their dose down gradually as the need arises. If you really are nervous and want to cut his dose, I would not cut it more than 70 percent. The reason I use this number is because it is used when we have a cat that is being switched over from Lantus to Levemir — in case there is a strong reaction to the Levemir. Then, if there is not a strong reaction, the dose is rapidly increased back up to that last good dose. @Wendy&Neko what was the earliest that the have seen Cabergoline start to result in lower BG?

I know that some more folks will chime in here about how many weeks it took to start seeing changes in their cat’s BG.

 

In my case, we started Cabergoline March 6. I also switched to Levemir a little bit later. I did start seeing a few lower numbers after a couple of weeks, but I was also using R insulin (a pretty high dose) to bring his numbers down. Later when the Cabergoline really started to do its thing, we didn’t usually need the extra R — his numbers were beautiful.

 

I would not reduce dose cold turkey. Your SS shows a relatively HIBG. I would only reduce basked on BG values showing a reduction is in order.
I did not start seeing a reduction in Snuffles BG values until about 6 months on cabergoline. He has now been on it for 10 months and insulion needs are slowly decreasing while getting better BG control PS' are now usually 95-115

 

Agree wholeheartedly with Suzanne and Larry. I would not reduce until you start to see some BG movement that indicates you should - and I would always post and ask Wendy for her opinion. It may be necessary to do BCSs (big chicken shots) to drain the depot if moving fast, use different reduction thresholds, etc

I used 70 as a reduction point (rather than 50) while following TR, that is permissible when cats have certain other conditions.

We were an unusual case - my first reduction was Day 2. By Day 5 I was really having a fun time. Temporary reductions/depot drainers turned into the new dose, and down we went.

I have no idea if it is related but we were also on a "smaller" dose than many acro cats to begin with (13U at the time cabergoline started).

 

Thanks. I read that cabergoline works within two hours of dosage. Guess all cats are different. Will give cabergoline when I'm home. don't want Raymond James going too low when I'm not home for 9 hours..
Thanks... Trial and error...

 

What is depot drainers? Thanks...

 

How do I know what to shoot at what BG level?? Nadir is 350 around +6 amps.. That's as low as he goes. Thanks...

 

Thank you all. Myself and Raymond James greatly appreciate your expertise. I have learned soooo much here. My vet tries to save me money. How about buying walmart insulin, ReliOn novolog?? And, as I mentioned, when do I decrease cabergoline at what BG and when...
Thank you, thank you.. FDMB knows more than vets and specialist....
You know what we are going to ask before we type...LOL!!!

 

Agreed with all the others, do not reduce the dose. In fact, keep following the dosing method on increases until you start seeing some greens. It can take a week to several months before you see action. Reactions really vary by cat. You really don't need to hang around watching him.

One thing that will be absolutely essential once you start cabergoline, is getting a before bed test each and every night. I have no idea by looking at the spreadsheet whether Raymond James dose is too low or too high (going low and bouncing). Data is what will allow you to keep him safe.

A depot drainer is a half dose to 2/3 dose after a reduction is earned, before starting the new reduced dose. That can help reduce the depot of the larger dose. I have seen a lot of variety on reaction to cabergoline, some have been a lot of decreases in insulin dose in a short period of time.

Not with the amount of testing you do. That wouldn't be safe. Using R insulin requires stepping up your testing game a lot. For some people, that's just not possible. If you want to save money, maybe think of insulin Semglee? It's biosimilar to Lantus like Basaglar but might even be cheaper. Might be worth shopping around to see what prices you can find.

You don't decrease the cabergoline, unless he has GI issues that make it difficult to keep the same cabergoline dose.

 

Oh

yes

Hi. A depot drainer is when your cat is on a really high dose of insulin and has a substantial depot of insulin — and when you need to drain off some of that depot you can shoot a very low amount of insulin (like maybe a half dose or even just skip a shot) in order to reduce the depot of insulin stored in the cat that can influence several cycles in the future. Sometimes you need to do this if your cat is dropping low and simply reducing the dose a unit or a few units won’t be enough because of the stored insulin in the cat that will still be working to reduce BG.

 

I think perhaps cabergoline works within two hours for primary intended purposes in cats - stopping lactation as well as some...sadder...uses.

As for what to shoot at what BG - like Wendy said, follow the dosing method guidelines. If/when you start seeing dropping BGs, especially blues and greens, I'd post and ask for advice. But like Wendy also said, that will require more testing than you're currently doing

 

I am sure that Cabergoline becomes “bioavailable” within two hours, but it will take a little time to work on that pituitary tumor. You should continue with following the protocol that you have chosen - either SLGS or TR. Wendy will be able to help you a lot with your specific dosing needs and when you have questions about reductions. Which dosing method are you using?

 

Here’s the sticky note about the insulin depot

https://felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/

 

And here’s a sticky note about the dosing methods.
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

Have you read these before? If you look there are a bunch of really informative sticky notes on the Lantus, Basaglar, Levemir group. And there are some on this Acromegaly forum too. Sorry to ne inundating you.

 

I don’t know what you are paying for your Basaglar insulin currently but I did check prices through Marks Marine in Canada online and it dropped my insulin price in half. So you might want to check it out - it was recommended here and a great recommendation. Just takes a little time to get the prescription just right and all the i’s dotted and t’s crossed.
I started Bootsie on Cabergoline EOD this week and nothing has happened to her at all as of yet. BG still in the 300’s but she has only has 2 doses and I am following TR

 

Dosing method? just keep increasing the basaglar which is getting expensive. Raymond James is blowing through a pen every two weeks.

 

I would change to Semglee, with GoodRx you can get 5 pens for about $160. It is a generic glargine (Lantus) like Basaglar, I know a pharmacist can,w/client approval, dispense Semglee if a script says Lantus but I do not know if they can do that if script says Basaglar. I am using Semglee for my Wiggles.

 

I feel your pain. I had the same problem -- very large doses. When did Raymond James start the Cabergoline? I looked at your spreadsheet but didn't see the date (perhaps it was in the notes and I was looking for the long bar across the sheet saying Started Cabergoline. It wasn't that long ago was it? I have a friend who started about 6 weeks ago and she is starting to need to do reductions with her boy. It seems to kick in suddenly and just keep going. That's what happened with my Darcy, too. At one point, I was using Novolin R as a supplemental insulin because I just couldn't afford any more Lantus. @Lee cuzz

 

I started the Cabergoline 10/21.

 

@Lee cuzz how is Raymond James doing?

 

The same, thanks for asking. Gonna try levemir. Do I start with the same dose as basaglar? 30+ units. Need to raise the dose again. Carbergoline doing nothing so far... UGGG. what a tough case we have....!!! Next syringe is 50 units?? As we are well over 30 units..
Thanks for everything... @Suzanne & Darcy

 

I’m sorry that not much has changed. I had to use two syringes at one point. When starting Levemir, it is recommended to start at 70% of the current Lantus/Basaglar dose. Some cats have a strong response to Levemir, so this is a safety precaution. You will know fairly quickly if your kitty is one of them. If not, then you can increase the dose back up fairly quickly to get back on track. Post when you get the Levemir so you can get help with the initial doses and to fast track him back up of necessary. @Wendy&Neko
How long has it been on Cabergoline now? I didn’t see a notation on your spreadsheet of when you started.

 

You have only been on cabergoline a couple weeks. Some cats take longer than others.

You are holding Lantus doses too long. If you aren’t getting nadirs below 300, you should be increasing every six cycles of data.

If you switch to Levemir, note that onset and nadir will be later than on Lantus, so might have to change testing times for mid cycle.

 

My Darcy took about a month of Cabergoline to start needing reductions.

 

For Darcy: Snuffles has been on cabergoline for almost 11 months, after starting dose continued to increase but slower than before. Also, I was able to get overall BG down. Maybe at six months dose stated going down from max af about 20 units BID to current of about 7 units. What was surprising was that Nov 2 was election day in VA and I work at the polls and was too late (~6 hrs late) to shoot so I just fed with no shot or BG testing. Next morning at normal time BG was only 90 which was just a little lower than Normal. I gave reduced dose of 5. For some unknown reason I got a step reduction of about 4 units from Nov 2.

 

Ollie started reductions around the 4 week mark. She was on 9 units. Got down to 4.5 units and stayed there awhile. Then pancreatitis and she went back up to 9 units. Got back down to 4.5 and that's where she stayed. Just couldn't get lower, but thats okay.

 

Bootsie and I started her Cabergoline on 10/21/21. We are still using TR and increasing by 1u every 3 days and are up to 14. I have seen some numbers below 300 but certainly not with any consistency. Since we are almost a month on Cabergoline I hope to see something change in her BG’s soon but patience seems to be the key. She has had no side effects but I do notice drainage occasionally from her left eye, clear serious drainage. I think someone mentioned it can be associated with the Acro and the pituitary tumor or did I imagine that?

 

You are right. Wendy’s Neko had this problem from soft tissue growth in the tear ducts, I believe. @Wendy&Neko

 

@Jackie55 & Bootsie I am very happy to hear that she’s not having negative side effects from the Cabergoline!

 

Yes, Neko had it, and I've seen a couple other people report it. It did go away when she was in better numbers after SRT. Occasionally showed up later on when in higher numbers. It wasn't a huge volume of liquid. It also showed up 6 months before she was diagnosed as diabetic.

 

That is sort of exactly what I have seen with Boots. The other thing I noticed is the top of,her nose is white fur now. She is old but? I just wish her sugars would come down a bit more. I worry about her kidney function which seems ok but over the long haul I know the high sugars are not good for her.