Introduction Bowdoin/Suzan and New England treatment options?

I'm so glad to finally be here. I've copied our introduction below and I'm sure I'll have tons of questions. I've already gleaned some great information on treatment options from reading previous posts but was wondering what options are available in New England, specifically SRT type. I know we'd have to go to NY for surgery and that's still an option. We are in southern Maine. (I noticed there was another Mainer on this forum!)

Also help in dosing and understanding our spreadsheet numbers would be most appreciated.

Thank you!

(Sorry, this is a long one!...)

Hi, Bowdoin my 10yo male Maine Coon Cat (we also live in Maine) was diagnosed with diabetes at the beginning of December 2018. It was a surprise to all of us because I brought him in for increased appetite/weight gain and noisy breathing at rest/snoring. His labs showed a blood glucose of 286 at the vets which she thought could be attributed to stress. So we brought him in for a urinalysis and he tested over 1,000. She started him on 1u Basaglar/glargine. We are currently at 8u of Lantus/glargine, I switched over to take advantage of the discount card. Unfortunately he is still unregulated, really hungry, drinking and peeing a lot, not himself. It's been almost 4 months and I just want him to feel better.

I initially went into research mode and got totally overwhelmed so didn't post here. I thought I'd never be able to home test. I still have a lot to learn but feel a little more comfortable. I know I could have done some things better but I'm hoping with help from all the knowledgeable people here, that I can get on track.

I did stumble upon acromegaly and thought it sounded like what he presented with. We started sporadically home testing with a pet meter/AlphaTrak2 (which I would like to transition to a human meter) but I needed someone to help me hold him at the beginning so we tested when we could and we still had a lot failures and tears. I'm happy to say that I can now do it on my own with only a few failures here and there. After 3-4 pokes with no blood, I give us both a break. I try to get at least pre-shots and occasional curves with a mid-day when I can but need help with timing, interpreting and dosing. Our vet had us going 2 weeks before increasing dose .5 at a time and then 1 week and most recently the internal medicine specialist told us to go up 1u every 3 days. Which is what I think I read was ideal for timing, not sure about dosing since he is acro.

We finally got the official acro diagnosis this past week. About a week after diagnosis we saw the internal medicine specialist who did an ultrasound and lab work including the IGf-1 that I requested. He tested at 207 (Ref 12-92) but she didn't want to call it until she saw insulin resistance. We just redid the test and he came back somewhere over 300. I have some other information that I'll save for the acro board and I really need help there to come to a decision on what treatment option to pursue.

Diet wise, he had a renal cyst and one kidney removed when he was 2 so he was on Purina NF renal diet, mostly canned with a little dry. Until his appetite increased and then he got more dry. After diagnosis we went to strictly canned but both my vets weren't sure how to balance the renal diet with the diabetic (and pancreatitis) so I had an in depth consult with the Clinical Nutrition Service at Tufts University. The Board certified Veterinary Nutritionist came up with some options for a low phosphorous, medium protein, medium carb diet for his particular needs and I am comfortable with that. It's currently canned Royal Canin Aging 12+. However I do need help with frequency. All vets suggested twice a day at insulin time and a mid day if he absolutely needed it.

I'm not sure if the spreadsheet I've been using is the one that you use here, I think I found it on FB. I still need to input the labs/testing and flesh out the comments. I have my own spreadsheet that I use and had to transfer all the information from. This is currently for a pet meter (which I'd like to change) and Lantus. H.

So point me in the right direction for my next steps and any other information you may need and hopefully I can turn things around and learn even more to help my best bud.

Thank you!

 

Hello Suzan, and welcome to you and sweet Bowdoin. Can I ask how he got his name?

Sorry about the diagnosis, but one in four diabetic cats has acromegaly, so it's not unusual. Any chance the IM vet got testing done for IAA (insulin auto antibodies) too? Test is also done at MSU. Some cats, like my girl, have both conditions and it can make a difference in dosing strategy. Neko also eventually got kidney disease, and I just gave her low carb, low phosphorus food, raw in her case.

Do you know what the carb% is in the food you are feeding? Are you feeding all wet now? If not, you should be. Feeding does not have to be just twice a day, multiple small meals is better. Ideally in the first half of the cycle after the shot. The two meals idea goes with the harsher acting insulins, not the long lasting ones like Lantus or Levemir.

I have a couple questions about the spreadsheet before I say anything on dose. And yes, it is the FDMB spreadsheet. First, are you giving two shots a day? I don't see any amounts recently in the PMPS units cell. Second, do you do any testing at night? Many cats go lower at night. We determine how to dose the cat based on how low that particular dose takes the cat, hence the interest in night time tests. A test just before bed is a good one. For more on dosing, start by reading the Stck6 Nites atop the Lantus/Basanglar/Levemir forum, particularly the one on dosing methods. If you can manage the testing requirements (4 per day minimum), then in my opinion, the Tight Regulation protocol is best for acros.

No problem if you want to switch to the human meter. Most people here use them for two reasons, first the strip cost, and second, the dosing methods we use here were written with human meters in mind.

 

Hi Wendy, thank you. Bowdoin is named after a Maine college in keeping with the Maine theme. Our Maine Coon mix is named Baxter after Baxter State Park and our former Maine Coon was named Angus (King) after our former governor and current Senator.

Unfortunately the IM vet didn't get testing done for IAA. Do you think we can wait for our next visit (not yet determined since we were there last week) or go to our regular vet sooner and get it done?

I am feeding all wet and have been since his diagnosis. The current food recommended by the Veterinary Nutritionist to address his kidney issues and diabetes has 3.8 carbs g/100 kcal and protein of 11 g/100 kcal per her report. And I also just noticed that she did say we do have some flexibility on multiple meals. It's a very detailed 3 page report so I must have missed it before. "Consistency is important for diabetes regulation – ideally, you want to feed the same diet every day at the same times, and in the same amounts. There may be some flexibility for multiple meals throughout the day in cats on glargine, but it is still important to feed a consistent diet and monitor intake."

Yes, I am giving two shots a day. I didn't fill in the PM units because it's been the same as the AMPS for that day. I guess as we get closer to being regulated that will change? I have done some testing at night but it's been so high that I wasn't sure if it was warranted. I'm still working on increasing the number of test times per day and will go take a look at the Tight Regulation protocol. Thanks.

 

I like your name theme.

As for IAA testing, that is not surprising. Many vets discount it and many don’t “bother” with the testing, even when requested. Don’t worry about it for now. If you ever need more bloodwork done at MSU, it’s one to add to the list.

I rotated four proteins for Neko, she still managed to get reasonably regulated. She would have been bored with the same thing all the time. As for amounts to feed and when, that is something you may have to play with. Some cats dive hard at onset, so for them, getting some fresh carbs on board before onset is beneficial to slow the dive. Hard fast dives in blood sugar can cause bouncing. If I use terms you aren’t familiar with, take a look at the New to the Group Sticky Note on the Lantus/b/Lev forum. And if your cat ever goes low, you will have to feed extra to bring up the blood sugars. You don’t have to be as hard and fixed as the report says. Monitor his weight regularly, and use your scale to help you decide on overall calories per day. Then divide that into mini meals.

The numbers from the nutritionist, are they “as fed” or “dry matter basis”. The numbers you have don’t tell us %carbs.

Please fill any and all data you have on the spreadsheet. Start with the last two weeks as they are most important. With no PMPS units entered, I assume one shot a day. With no night time data, I assume no tests were done then. We are very data focussed here, and the more you have, the better. That doesn’t necessarily mean going crany with testing, but rather learning your cat’s patterns on Lantus and when to strategically test. With the dosing methods we use here, we shoot the same dose AM and PM, unless you are deliberately increasing or decreasing the dose.

 

Your boy is one BIG beautiful boy. I bet when he is hungry, everyone knows about it!

Sorry to hear the Acro diagnosis. There are some of us here with active Acro kittehs. My Leo had SRT (radiation) in 2016, and that resolved much of it.

You may want to consider regular posting on the Lantus/Levimir sub forum for keeping up with dosing. It doesn't look like Bowdoin is regulated yet. So there will be continued issues until you get some nadirs below 200.

Kudos to you on using the spreadsheet and taking care of your big boy.

 

Thanks Wendy and Jeff. I've been having some bad brain days (I have MS) so I hope to update my SS and get on the Lantus/Levimir forum this weekend.

 

I'm sorry to hear about the MS. In that case, it may be even more helpful to be on the Lantus subforum. People are really helpful there, even though the forum is busy.

 

Suzan, please take care of yourself while you are taking care of Bowdoin, and doing all the rest of the daily activities.