I’m not sure what’s up w/ acro Snuggie: SS review please

Jay Dee

Jay Dee

Active Member
Hi all, Snuggie was Dx with acro in late June and started cabergoline in early July. He’s on an every other day dose. We were at 8u Levemir 2x daily at the time and he seemed to be doing great on it, then we tried a vacation dose/dose reduction that failed. Since then we have had to keep increasing dose. I’m not sure what to think at this point, he has a vet appt in a week and I’ll ask about more cab but I just don’t know what to think right now. Is his insulin dose too high? No where near high enough? Is the tumor just growing too fast? He’s acting 100% normal aside from not being the lap accessory that he used to be prior to his diabetes Dx last year. Thanks in advance.
 
Wendy always says that the tumor can pulse at times and raise the BGs. She said this happened with Neko and she felt like she was chasing those numbers and couldn’t keep up.

Once you hit 10 units then you can do full unit increases as long as you are not seeing numbers under 200. I think Wendy is out of town. Hopefully she will check in when she gets back. I will tag her now so hopefully she will see it. @Wendy&Neko

Having an Acrocat is tough. Snuggie is still doing better than he was before overall.
 
Suzanne & Darcy said:
Wendy always says that the tumor can pulse at times and raise the BGs. She said this happened with Neko and she felt like she was chasing those numbers and couldn’t keep up.

Once you hit 10 units then you can do full unit increases as long as you are not seeing numbers under 200. I think Wendy is out of town. Hopefully she will check in when she gets back. I will tag her now so hopefully she will see it. @Wendy&Neko

Having an Acrocat is tough. Snuggie is still doing better than he was before overall.
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Thanks for the reply. I knew the tumor could grow and shrink and affect BG but this feels like his dose is too high now looking at his +8 from the most recent cycle (480). So I’m not sure if I should hold, decrease (if so, when) or increase (if so, when).

this IS really tough, I wasn’t expecting it to be like this. Thanks for being there and for the reply!
 
From January 2, 2010. Post #13 of my condo about Darcy, Wendy said...

"A couple reasons numbers go higher as the dose goes higher. One, the higher insulin dose is bringing more lower numbers than he is used to, so he's bouncing more. When I finally started getting numbers over 500 :rolleyes:, I knew the insulin was finally working to bring Neko down. Holding doses too long, especially in presence of secondary conditions causing insulin resistance - brings both glucose toxicity and lets the antibodies have a field day. If there is acromegaly, the tumour can ramp up - see Neko 2015, mid July when it really took off. I'd increase to catch up and the tumour kept on racing ahead of me."

I thought this might be helpful. Let me take another look at Snuggie's spreadsheet now that I am on a real computer and not a phone. :bighug::bighug:
 
You may be seeing new dose wonkiness today as well. Darcy always went higher on an increase at first - especially the second day or about the second/third cycle, he would go higher. For the most part, it looks like you are doing everything correctly.
 
I don't want you to make the mistakes I did. I was told (NEVER ON THIS BOARD) many times that Darcy was probably getting too much insulin... and that I needed to make sure by going back down and holding my doses for a long time because some cats just take longer to settle into a dose, etc. We lost valuable time and he went DKA to boot.

Do you test for ketones? I'm sorry if I already asked you that before and if I asked if you have a blood ketone meter (which is definitely my preference.)
 
@Suzanne & Darcy thank you so, so much for taking the time to look into all this with me. I’m not even exaggerating when I say it brought a tear to my eye. :bighug:

Yes I too have been a victim of the “too much insulin” advice (elsewhere) early on and we landed at the vet on an emergency basis one week into a dose reset which was when the CKD was discovered and then the near death experience with critically low potassium. But I digress…

we do test for ketones (none detected as of yet at any time we have tested), we have the urine strips for now, altho if this is going to be a “thing” with super low numbers rhen super high numbers a blood meter may be a good idea to have on hand. Got a recommendation on brand?

Thank you again!
 
Jay Dee said:
@Suzanne & Darcy thank you so, so much for taking the time to look into all this with me. I’m not even exaggerating when I say it brought a tear to my eye. :bighug:

Yes I too have been a victim of the “too much insulin” advice (elsewhere) early on and we landed at the vet on an emergency basis one week into a dose reset which was when the CKD was discovered and then the near death experience with critically low potassium. But I digress…

we do test for ketones (none detected as of yet at any time we have tested), we have the urine strips for now, altho if this is going to be a “thing” with super low numbers rhen super high numbers a blood meter may be a good idea to have on hand. Got a recommendation on brand?

Thank you again!
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I ordered the Nova Max blood ketone meter from ADW Diabetes Supply. They will "give" you the meter for "free" if you order the test strips. The test strips are expensive at about 1.80 a piece. When I knew Darcy's ketones weren't that bad anymore, I would not test every day - usually every other day - and later every two days or so (when he was in better BG numbers.) I liked the fact that the blood ketone meters can detect ketones before they show up in the urine and I liked getting a numerical value for the ketones. Some cats in high numbers do not seem to get high ketones. I was just looking at Kathleen and Fred's spreadsheet and Fred has ketones that don't seem to go above .3, even though he gets some really high preshot numbers. I'm happy if anything I can say helps at all. Sometimes it's just nice to know people are around and care!
 
Suzanne & Darcy said:
I ordered the Nova Max blood ketone meter from ADW Diabetes Supply. They will "give" you the meter for "free" if you order the test strips. The test strips are expensive at about 1.80 a piece. When I knew Darcy's ketones weren't that bad anymore, I would not test every day - usually every other day - and later every two days or so (when he was in better BG numbers.) I liked the fact that the blood ketone meters can detect ketones before they show up in the urine and I liked getting a numerical value for the ketones. Some cats in high numbers do not seem to get high ketones. I was just looking at Kathleen and Fred's spreadsheet and Fred has ketones that don't seem to go above .3, even though he gets some really high preshot numbers. I'm happy if anything I can say helps at all. Sometimes it's just nice to know people are around and care!
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:bighug::bighug::bighug:

Thank you again. Your help and caring mean a literal ton to me right now!
 
Just chiming in to agree with what Suzanne has said. The best you can do is keep on top of the increases as soon as they're warranted. You're seeing some recent green nadirs so it's not all bad!

What dose of Cabergoline are you using, and are you doing it every day or every other day? The last paper we saw showed a cat had to be tapered off to every few days/lower dose (I can't remember which right now) to prevent hypoglycemia, logically I would think the opposite is true too - that some cats may benefit from every day doses or increased doses.
 
@FrostD thank you! His bottle says 50 mcg/ml and he gets 1 ml every other day. He has a vet appt next wed and I’m going to ask about an increase.

we did get two blues this cycle @ PM+8 (104) and +9.5 (115). YAY! So, we are changing today’s plan so I’m back to monitor by +7/8 instead of all cycle.

if we see more blues or a green, should I hold this dose and for how long?
 
Jay Dee said:
@Suzanne & Darcy @FrostD which sticky here discusses increases? I’ll print it out for reference! Thanks!
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There isn't anything to my knowledge that discusses increases, there just aren't a whole lot of studies (3 that I'm aware of).

The paper linked here discussed a cat that had to be tapered off of it. My thought process is that if some cats need reduced dose, perhaps some would benefit from an increase, but not sure.
 
Jay Dee said:
@FrostD thank you! His bottle says 50 mcg/ml and he gets 1 ml every other day. He has a vet appt next wed and I’m going to ask about an increase.

we did get two blues this cycle @ PM+8 (104) and +9.5 (115). YAY! So, we are changing today’s plan so I’m back to monitor by +7/8 instead of all cycle.

if we see more blues or a green, should I hold this dose and for how long?
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That 104 makes me want to say hold that dose to see what happens over the next few cycles. Have you read the “Using Lantus/ Levemir with an Acrocat” sticky on the Acromegaly forum? It doesn’t really talk about decreases, but about nadirs and increases with Acrocats. But right now you want to know about holding the dose for how long. The only thing I can find that relates to your situation is this from the TR protocol:

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
 
Suzanne & Darcy said:
That 104 makes me want to say hold that dose to see what happens over the next few cycles. Have you read the “Using Lantus/ Levemir with an Acrocat” sticky on the Acromegaly forum? It doesn’t really talk about decreases, but about nadirs and increases with Acrocats. But right now you want to know about holding the dose for how long. The only thing I can find that relates to your situation is this from the TR protocol:

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
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Thank you! This is helpful. I’ve read both but really good to see the snippets that apply and not have to read thru the whole sticky :cat: His yesterday cycles were back to his usual higher numbers … so while he’s seen lower numbers in the past, they’re few and far between now, so maybe I’ll give it two more cycles then bump again based on what his nadirs are. THANK YOU!
 
Jay Dee said:
Thank you! This is helpful. I’ve read both but really good to see the snippets that apply and not have to read thru the whole sticky :cat: His yesterday cycles were back to his usual higher numbers … so while he’s seen lower numbers in the past, they’re few and far between now, so maybe I’ll give it two more cycles then bump again based on what his nadirs are. THANK YOU!
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That’s what I would do, too!
 
I'm back from away where even cell coverage was spotty. :) And my first time seeing humpback whales.:joyful: I digress.

Looks like the 0.25 unit increase experiment was not a success. Some acros respond to smaller changes, some don't. Tuck that bit of knowledge about Snuggie away for next time. If you don't see green by tomorrow, I'd increase by 0.5 this time.
 
Wendy&Neko said:
I'm back from away where even cell coverage was spotty. :) And my first time seeing humpback whales.:joyful: I digress.

Looks like the 0.25 unit increase experiment was not a success. Some acros respond to smaller changes, some don't. Tuck that bit of knowledge about Snuggie away for next time. If you don't see green by tomorrow, I'd increase by 0.5 this time.
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Hi Wendy and welcome back! So happy you had fun and saw humpback whales - what an experience!!

sorry I haven’t responded Til just now. We saw a good run of greens on 8/12 but we are cruising back up, of course when I saw the 4xx last evening I said - yea we will be going to 10 tomorrow and of course he’s throwing me a blue today! I’ll check again while we still have some time in his cycle before his AMPS. But I think we will be going to 10…
 
@Suzanne & Darcy is this the right ketone stuff to order? The kit is just Nova Max and has 20 strips and the refills are Nova Max Plus, 10 per box. How many strips should I get and how often should I check for ketones (or when?)
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