Mister has very high IGF-1, what are my options?

From this post, starting dose is usually 10mcg/kg per day. RVC tried 5 mcg to start but found 10mcg was more effective. The South American group has used every other day dosing, but most people here who started EOD ended up on every day. The post I linked has examples of what people paid and pharmacies used, though it's a few years old now.
 
Around 17lbs last I checked.

So you don't start with a more conservative dose with Cabergoline, you just go straight to the dose required for his weight right off the bat?
I suppose that's really up to you and your vet. Like Wendy mentioned RVC found 5mcg/kg to be less effective, but the south American study did use it.

I started every day but my vet wanted me to back it down, so I did for his comfort level (since he humored me, after all).

After he went into remission I started to slowly back him off it. Before his hyperthyroid diagnosis, I had him well maintained (still in remission, no other symptoms) on 5mcg/kg every 1.5 weeks. As far as I know I'm the only one to have done/tried that though.

Edit : to clarify, the hyperthyroid med (methimazole) is known to interfere with cabergoline in humans, no data on cats. After starting methimazole, BG started to climb back up so we upped the cabergoline to 5mcg every other day.
 
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We've also seen a couple cats with bad GI side effects where the caregivers backed down to every other day for a while, then increased back up.
 
"A single Levemir 10ml vial is $382 (100u per ML)". Is there a generic that is cheaper, or is this the normal price?
I don't know if this has already been answered, but I got five pens of Levemir from Mark's Marine Pharmacy for $160. I still have several unopened pens, would you like to have them or have you already ordered some? They don't expire until July 2022, so that could give you a chance to try it before buying more. They have been stored under very good conditions in the refrigerator all the time (at about 40 degrees Fahrenheit).
 
How much does he weigh?

I'd double check the dose. The standard dose is 5-10mcg/kg, every other day. I think a lot of us start at 10mcg/kg every other day.

Mine is compounded at 250mcg/mL, 16mL bottles (so it's 4mg cabergoline total in there). Mr Kitty is about 5kg, so it's 64 doses in there. Every other day, that's 6+ months. I pay about $35 for the pills and extra $10 to compound. From what I understand the vet is essentially doing it at cost for me

@Suzanne & Darcy did you get yours from wedgewood?
Yes. My Cabergoline was compounded by Wedgewood Pharmacy. The strength was 200 micrograms per mL. He received .4 mL daily, so he was getting 80 micrograms per day.
 
I want to say chewy is a bit more expensive
Do not order compounded medication from Chewy. One of our members here had some thyroid medication compounded by Chewy's pharmacy and the medication was worthless and the cat's thyroid levels skyrocketed! Jade (the cat) was really hurt by this. After a vet visit confirmed the skyrocketing thyroid values, Jill (the member) had the medication compounded by Wedgewood Pharmacy. The new medication is working very well and after one month Jade's thyroid levels are back to where they should be and she's feeling much better. I just wanted to warn you about having medication compounded by Chewy. I use Chewy for getting regular medication because it's less expensive, but I would not used them for compounding because of Jill's experience.
 
Strength: 100 micrograms per ML
Dosing: 75 micrograms orally every 48hrs

It's $120 for 40 days worth via Wedgewood Pharmacy. Does that price and dosing seem right?
At this strength -- which is kind of weak... you are going to have to give a much greater volume of liquid in an oral syringe to your cat. My cat was large, like yours, so my vet requested that the Cabergoline be compounded at a strength of 200 mcg/mL per my earlier post. .4 mL was 80 mcg (which is close to what your cat needs as well, I believe.) As I recall, I paid between $120 and $140 for it from Wedgewood. Oh, and it was for a 60 mL bottle.
 
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I don't know if this has already been answered, but I got five pens of Levemir from Mark's Marine Pharmacy for $160. I still have several unopened pens, would you like to have them or have you already ordered some? They don't expire until July 2022, so that could give you a chance to try it before buying more. They have been stored under very good conditions in the refrigerator all the time (at about 40 degrees Fahrenheit).
Dang, I already ordered some from Marks or I might have took you up on that offer.
 
At this strength -- which is kind of weak... you are going to have to give a much greater volume of liquid in an oral syringe to your cat. My cat was large, like yours, so my vet requested that the Cabergoline be compounded at a strength of 200 mcg/kg ) per my earlier post. .4 mL was 80 mcg (which is close to what your cat needs as well, I believe.) As I recall, I paid between $120 and $140 for it from Wedgewood. Oh, and it was for a 60 mL bottle.
So wait, should I have them change that to 200mcg/kg strength then? Is that what everyone else does on here?
 
So wait, should I have them change that to 200mcg/kg strength then? Is that what everyone else does on here?
"200mcg/kg strength" is not a "strength". An "X"mcg/kg would be a dose. A standard dose is 10mcg/kg of body weight once a day. A strength or concentration of the med is in mcg/ml.
Snuffle's cabergoline is 300mcg/ml from Wedgewood. I give 0.25 ml which results in a dose of 10 mcg/ml.
 
Well, I called it strength instead of concentration in order to be understandable. It is the amount of Cabergoline contained in a mililiter of the liquid medication once it has been compounded (not a kg, which would be the cat’s weight.). I only mentioned this because I believe that you said yours was going to be compounded to 100 mcg per mililiter. I’m sorry that I wrote kg instead of mL (I noticed it and thought I had corrected it.). But you have the right idea…. the greater the amount of Cabergoline in each mililiter of liquid medication, the less volume you will be required to squirt into Mister’s mouth each day. Now, I have a friend who recently tried to have Wedgewood compound Cabergoline and they were giving her a hard time about making the stronger compounded liquid (they wanted to do 100 per mL). But you could ask your vet and see if they can get you the more concentrated med. My vet had no problems but that was in 2021.
 
So it looks like my options from Wedgewood are:
  • 200mcg/ml (dose 0.35 ml) price ~$260.00 for 30 ml bottle ($8.67/ml)
  • 100mcg/ml (dose 0.75 ml) price ~ $160.00 for 30ml bottle ($5.33/ml)
I'm double minded here.
 
I would go for the one where I only have to give him .35 mL. It’s a small bit of liquid. But, of course it’s going to cost you one hundred more dollars :(
 
But I am going the route where I mix it in his food, so does it matter then what the concentration is then?
I don’t know. It depends upon his tolerance for having stuff mixed in his food? Will he eat it? ALL of it (lick the plate clean?). With the more concentrated stuff, it would be less yucky stuff mixed in the food. Sure, they flavor it, but I obviously never tasted the stuff so I don’t know what it REALLY tastes like.
 
I would not price compare on per mL basis (because the weaker one is basically just more water/oil) - I would compare on the actual cabergoline itself, or a per dose basis. So with the 200mcg concentration you're getting twice as much medication for $60 less than if you bought two-100mcg ones.

The 200 bottle is about 85 doses, or $3 per dose. The 100 bottle is about 40 doses, or $4 per dose (also the doses should be half/double the other, not sure why one is 0.35 and one is 0.75...so one should be 0.7 or 0.37 ish (I can measure that fine on the syringes they gave me anyway))
 
I don’t know. It depends upon his tolerance for having stuff mixed in his food? Will he eat it? ALL of it (lick the plate clean?). With the more concentrated stuff, it would be less yucky stuff mixed in the food. Sure, they flavor it, but I obviously never tasted the stuff so I don’t know what it REALLY tastes like.
No idea, I guess we'll find out soon. I hope to God he'll just eat it mixed in with his food.
 
I ordered from Marks two weeks ago and it still hasn't shipped. My ProZinc is running low, PM sent Suzanne, I might have to buy a couple pens from you after all.

All orders from Marks are getting sent to Los Angeles first, where they can experience another 7-10 delay due to customs.

There's almost no point in even getting an ice pack if you order from Marks, lol. All that does is buy you three days at most no matter how much ice they put in there.
 
I'm so sorry. I already had another "taker" on the Lev pens. I do hope that your new insulin will arrive soon!
Oof, thanks for the offer. That was my fault for not accepting it earlier.

Anyone else willing to send a couple Levemir pens if I send you a prepaid label? Marks still hasn't shipped it yet and it's Friday, so I am for sure going to run out of prozinc. I can do PayPal or crypto.

edit: nvm, I had to buy some more ProZinc. It's amazing how fast the bottle goes once you get past the halfway mark.
 
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My Cabergoline is here. It only came with one syringe and the instructions from Wedgewood say the syringe is disposable and to not reuse...

Where do I buy these weird syringes from? I can't find them online, I don't know what they're even called.

I suppose that's really up to you and your vet. Like Wendy mentioned RVC found 5mcg/kg to be less effective, but the south American study did use it.

I started every day but my vet wanted me to back it down, so I did for his comfort level (since he humored me, after all).

After he went into remission I started to slowly back him off it. Before his hyperthyroid diagnosis, I had him well maintained (still in remission, no other symptoms) on 5mcg/kg every 1.5 weeks. As far as I know I'm the only one to have done/tried that though.
So you settled on 5mcg/kg EOD regarding the bold sentence above? That was your recipe for success? Any details on the steps you took would be appreciated.
 
My Cabergoline is here. It only came with one syringe and the instructions from Wedgewood say the syringe is disposable and to not reuse...

Where do I buy these weird syringes from? I can't find them online, I don't know what they're even called.


So you settled on 5mcg/kg EOD regarding the bold sentence above? That was your recipe for success? Any details on the steps you took would be appreciated.
...I reuse them. Pretty much til the dosing lines wear off from washing....it's only in that syringe like 30 seconds with the way I do it so I'm not too worried about the plastic or rubber

What's the dose? You can buy pretty much any small 1mL syringe, I get my spares from Amazon though I wouldn't recommend the ones I currently have. I'm sure they make reusable ones if that's what you want.

No, I did 10mcg/kg every other day since that is what vet was comfortable with (I had started daily but he was uncomfortable with that). It worked very quickly for us and Mr Kitty actually had some mild hypoglycemia after going off insulin - so at that point I started to further taper it.
 
So he scarfed down the fish flavored Cabergoline from Wedgewood mixed in with his Fancy Feast. I did include a good dusting of Fortiflora just to make sure the first impression was positive for him. I think he actually likes the flavoring, because he usually doesn't eat it that fast.

This was such good news because there's no way I'm force feeding him that, he hates doing that, getting him to eat Laxatone through the syringe was impossible.
 
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I also reuse the syringe till the markings wear off. I also wrap tape around the syringe barrel to mark the dose and therefore I do not have to look at the small lines every day.
I used some syringes that had big black rubber plunger tips. The oil vehicle for the cabergoline tends to swell the black rubber resulting the plastic plunger shaft pulling out from the black rubber tip. This does not happen with the orge syringes supplied by Wedgewood.
 
@FrostD how many days did you have your cat on the every single day dosing? I am thinking I want to just mirror exactly what you did. What you did is almost like a sliding scale dosing.

For example, would your cat even have went into remission had you not started off with the every day dosing? Only God knows, but what's your feeling on this?
 
@FrostD how many days did you have your cat on the every single day dosing? I am thinking I want to just mirror exactly what you did. What you did is almost like a sliding scale dosing.

For example, would your cat even have went into remission had you not started off with the every day dosing? Only God knows, but what's your feeling on this?
10 days - my SS in July 2021 documents everything

Yes, I think he would have gotten there regardless. It was a pretty immediate reaction to it, and it works by suppressing growth hormone production - so I think end result would have been the same if not a little slower.
 
Currently reading everything I can on this. What about Cryohypophysectomy, which destroys the tumor? Why is there next to no info on this?

Or SRT? I wonder if the University of Minnesota does SRT.

I will email my vet right now to ask about Levemir prescription.

edit: Such a crying shame regarding Transsphenoidal cryohypophysectomy. The doctor who pioneered that surgery passed away in 2008: http://www.dasiesurgery.ca/DASIE/Holmberg.html

I can't find any info on that besides his study. Does anyone know anywhere in the WORLD that does this surgery/procedure?

The Royal Vet College in London does the surgery but it is very expensive and also risky. A lot of suffering involved and the cat will still need drugs to compensate for no pituitary gland.

So, I started my cat on Cabergoline (Galastop for dogs, 50 micrograms per ml; 1.6ml = just under 10 micrograms per kg every 48hrs). That gave him diarrhoea and vomiting so we reduced it to 1ml (50 micrograms for an 8.6kg cat). No adverse effects. Water intake has come right down and blood glucose finally dropping after 2 weeks of treatment. All under Vet supervision of course.
 
His numbers have never been worse than the last week or so. His BG numbers were literally better before I started giving him any insulin at all. Unless the Cabergoline and/or Levemir does something, SRT or surgery is the only actionable items left.
 
IAA of 64 is reasonably high. The nature of insulin resistance is that you are often chasing after the numbers. I once had it described to me as chasing after a speeding train with those increases. Levemir by itself will not battle insulin resistance, but could give you flatter, more predictable numbers and a better strategy for increases. Cabergoline could help with the resistance.

Any GI symptoms from the cabergoline so far? I'm also wondering if you are missing some lower numbers causing him to bounce.
 
Your spreadsheet says 37mL, might want to correct that

Like Wendy said, you're fighting a battle on two fronts - the growth hormone is blocking insulin from getting to his cells, and his body's antibodies are going after the insulin as well. So you just have to keep on truckin' with increases as needed. I didn't see any wiggle until about 11.5U, but we've definitely had cats hot much higher than that. They need what they need - you can't control how much hormone the tumor is secreting (though hopefully cabergoline helps), nor can you control how much of the insulin the antibodies are tying up. It's frustrating, we know.
 
Any GI symptoms from the cabergoline so far? I'm also wondering if you are missing some lower numbers causing him to bounce.
He's occasionally dry heaving now again, presumably due to hairballs due to the weather finally warming up and him shedding. But the occasional dry heaving, along with the lethargy, were two symptoms that were happening before he was even diagnosed with diabetes, in fact those were two of the big reasons that led us to bring him into the vet initially. So there's no way to know if the Cabergoline is causing it or not.

There's always that wonder of if I am missing a nadir, not sure this can ever be solved even if I were to test him 3x every midcycle.
 
His numbers have never been worse than the last week or so. His BG numbers were literally better before I started giving him any insulin at all. Unless the Cabergoline and/or Levemir does something, SRT or surgery is the only actionable items left.
Baxter (my cat) has had increasing high blood glucose despite increasing doses of Prozinc

We only test weekly at the vets but his blood glucose went from 25.1 (452) to 21 (378) after dosing him every 48hrs for 2 weeks. 10 micrograms per kg is likely to cause GI upsets as it did with Bax so we've dropped to just under 6 micrograms per kg and he has settled down. Next test is on Tuesday. At least with Cabergoline you are potentially stopping the progression of acromegaly but just changing the insulin won't do this. My vet is cautiously optimistic. It's worth a try but only change one thing otherwise you won't know what is causing any change. Before starting this my vet did a general screen (liver and kidney function etc) to get a baseline.
 
What should it say? That's what the vet said to do and what you also mentioned here.
37 mL can’t be right as that would mean you were squirting 37 cc into his mouth (or in food) every day. That’s a LOT. I think the units are wrong. Mcg? How much do you draw out of the bottle with the syringe that fits into the bottle cap/stopper? What do the markings on the syringe say? Must be a units problem or a decimal point that’s missing.
 
@MisterBillie I hate to interrupt your post, but I need to make a PSA.

@ClaireBaxYK I strongly suggest you learn how to home test, for Baxter's safety. I've seen a couple of cats here go from needing more insulin to completely off of insulin in 7-10 days after they started cabergoline. Even for those who took longer to react to cabergoline, dose needs can change quickly. Testing only once a week at the vet has a high potential for him to go hypo. I you cannot home test for some reason, please get a Libre installed on him.
 
@MisterBillie I hate to interrupt your post, but I need to make a PSA.

@ClaireBaxYK I strongly suggest you learn how to home test, for Baxter's safety. I've seen a couple of cats here go from needing more insulin to completely off of insulin in 7-10 days after they started cabergoline. Even for those who took longer to react to cabergoline, dose needs can change quickly. Testing only once a week at the vet has a high potential for him to go hypo. I you cannot home test for some reason, please get a Libre installed on him.
Also discussed here - https://www.felinediabetes.com/FDMB/threads/new-member-acromegaly-cat.261239/#post-2939054
 
Thank you again for raising this. I have been concerned about this but I'm at home all day with Baxter and the vets is ten minutes drive away. I've discussed this with the vet more than once and he feels it is stressful to home test. I'm monitoring the situation including water intake. If it goes below 500mls for 2 days running we will go to the vets.
 
37 mL can’t be right as that would mean you were squirting 37 cc into his mouth (or in food) every day. That’s a LOT. I think the units are wrong. Mcg? How much do you draw out of the bottle with the syringe that fits into the bottle cap/stopper? What do the markings on the syringe say? Must be a units problem or a decimal point that’s missing.
Oh I see, my bad. I meant 0.37ml
 
Thank you again for raising this. I have been concerned about this but I'm at home all day with Baxter and the vets is ten minutes drive away. I've discussed this with the vet more than once and he feels it is stressful to home test. I'm monitoring the situation including water intake. If it goes below 500mls for 2 days running we will go to the vets.
I wish all the very best for you and Baxter (would love to see a photo of your sweetie.) My boy, Darcy, did not get stressed from home BG testing. He absolutely loved his routine and would hop up onto the barstool where I would test him and give him treats. A lot of the time, he would go there in advance to wait for me! He loved his Pure Bites and other low-carb meat treats that he got when I tested his BG. I think the first week when I was learning to test he might have thought I was a little weird (I cried when I tried and failed to get blood -- but he was in high numbers then and I knew that I needed to learn how to test him if I was ever going to get him into safer numbers.) Learning to home test is the best thing I ever did for him -- and we bonded even more closely. I just don't think water consumption is necessarily a very reliable way to gauge blood glucose. Besides, you really want to get him out of the high numbers where he drinks excess water. The high numbers where a cat usually is drinking a lot of water are not healthy numbers for a cats to be in... it's not good for their organs. Also hypos can happen very fast, and brain damage can result quickly.
 
Phew! I thought there must be a missing decimal. :-) Good thing for Mister! How's he doing on the Cab?
So far the Cab has had zero effect, but I've only dosed him three times so far. Other than I got super lucky that he actually likes the way it tastes when mixed in his food. His insulin resistance has never been worse than it is right now, although this trend happened just slightly before the cab.

My Levemir supposedly will arrive tomorrow. The real question is, when and how to I transition to Levemir from ProZinc, and is that even a good idea given I just started him on Cab.
 
Cabergoline traditionally takes one to two weeks before you start seeing impacts. That might be enough time to start Levemir. The other option is to hold off until you've finished off the current vial of Prozinc. How much longer do you think you'll have on it?
 
So far the Cab has had zero effect, but I've only dosed him three times so far. Other than I got super lucky that he actually likes the way it tastes when mixed in his food. His insulin resistance has never been worse than it is right now, although this trend happened just slightly before the cab.

My Levemir supposedly will arrive tomorrow. The real question is, when and how to I transition to Levemir from ProZinc, and is that even a good idea given I just started him on Cab.
You’ve got the double whammy of IAA and Acro! That’s so rough. His tumor may be pulsing more growth hormone now ☹️ I hope things will improve soon!
 
My Levemir is here. Now what? No clue what the dosing should be or even how to use this pen. Do I need needles? Maybe there's a YouTube video showing it, I will look tonight.
 
Look at the top of the Lantus/Levemir forum, especially this Sticky Note: Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing which contains videos. No, you do not need the pen needles, nor want them. You do need U-100 syringes.

As for dosing, we consider the dose of the current insulin and how he's doing on it. Looks like 10 might be a good place to start. But I would do so when you can monitor closely the first couple of cycles. You might want to consider posting on the Lantus/Levemir forum, as it's a lot more active.
 
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