? New Acromegaly dx for Rudy, so many questions :/

[SweetGreyRudy]

Hi all,

1st post on this forum. Our sweet guy Rudy was just diagnosed with Acromegaly after being diagnosed with diabetes in March 2024. We don't have the exact result of his IGF-1 test, we just know it was on the higher end. We don't plan to do a CT scan so can't say for certain how big the tumor is. He currently gets 15U Glargine 2x/day and is on a LC wet food raw diet. No other medications.

After much searching for a vet who will try Cabergoline, we finally found one. I am looking for some guidance here on dosing and best practices, as we have no idea what we're doing!

1. Rudy is 16lbs, what dose should we request? Should we dose every day or 48 hours? Also, Rudy hates pills and won't touch them in food. Is there Cabergoline in injectable form?
2. We do manual BG testing so that won't be an issue, but should we continue with TR insulin dosing schedule? (i.e., don't shoot if his PS is below 100, increase dose every 6 cycles, etc.)?
3. If his BG numbers start to drop, what's the process for decreasing the insulin dose? Does the Cabergoline dose stay the same?
4. I've read that Cabergoline is hard on the kidneys, and that a high protein diet can be hard on the kidneys as well. We don't want Rudy's kidney functioning to get worse, but obviously have to keep him high protein, low carb for his diabetes. Any experiences here with managing food to support the kidneys with this new medication?

So many questions, but thank you for your time and feedback. We couldn't do any of this without the support of this community. It's just crazy how little vets know about these diseases. Our vet told us a solution was just to feed Rudy more, and that 300 range BG numbers are "normal"

 

[Wendy&Neko]

Sorry to hear about the diagnosis. But now you have an answer as to why he's been needing a larger dose. And you can work to get him better. Good for you on finding a vet willing to help you get started with cabergoline.

The one thing someone said to me at this point that I found really important - Rudy doesn't know he's got acromegaly - he's the same sweet cat he was before the diagnosis. Don't treat him any differently.

Was he tested for IAA (insulin auto antibodies) too? Some cats have both. Blood goes to the same place as the IGF-1 testing. Let us know the IGF-1 value when you see it. Though it doesn't really have anything to do with the size of tumour.

Lots of discussion about cabergoline, including from people who used it, dosing and where to get it, in this thread:
Cabergoline as a possible treatment for acrocats: discussion

1. 10 microgram per kilo of cat. Rudy is 7.2 kg, so his dose would be 72 microgram. Most people get cabergoline compounded in liquid form, could be mixed in with his food. I hear good things about bacon marshmallow flavour. Some people start every day dosing, some start every other day. Some cats show some mild GI systems to start. Those on every day might back off to EOD if so, then back to every day. The South American study did every other day for all cats. I'd say pick one, and see what works for Rudy.

2. Cabergoline can take a while to take effect. I've seen it as short as 7-10 days, as long as 3 months.

don't shoot if his PS is below 100,

That is not TR. TR is don't shoot below 50 on a human meter. One thing you are really going to have to do is step up your testing game. Your spreadsheet shows increases with nothing but preshot tests. That won't work with him on cabergoline. You will need to be vigilant, especially when cabergoline starts to work. TR says at least 2 tests per cycle, the preshot and one other, including the PM. I have seen cabergoline hit hard and fast, or slowly. You won't know in advance.

3. I've seen a couple cats start and be completely off insulin inside two weeks. What I would suggest for a cat on cabergoline, is to take reductions at below 70. And with a larger depot, it's OK to do a half dose to drain the depot after a reduction. Please post fairly regularly, especially if his numbers start coming down. We can help you dose safely. For the most part the cabergoline dose stays the same, unless the cat weight changes. But I've also seen people raise it a bit if the effects seem to be wearing off, and also people reduce the frequency if kitty goes into remission. There isn't a book written on this. Just experience watching others and trying what works for you cat.

4. Where did you read that cabergoline can be hard on kidneys? Has Rudy been diagnosed with kidney disease? It's only in later stage kidney disease that lower protein is recommended. Until then, you want good quality protein and lower phosphorus.

 

[SweetGreyRudy]

Thank you so much for this! I feel way more confident in starting this with him. He was tested for IAA but I'm pretty sure the vet said he doesn't have that. I can request the test result. We will definitely improve his testing. We we're doing ok with it for awhile but then really fell off! We're going to start the Cabergoline after Thanksgiving since we have a Rover sitter, but we'll get back to a regular schedule of testing/posting.

I don't remember where I read that Cabergoline is hard on kidneys, just somewhere online. I'm glad it doesn't sound like much of an issue. He doesn't have kidney disease, we just want to be preventative since he's dealt with so much this year We'll continue with high quality LC wet food.

Sorry to hear about the diagnosis. But now you have an answer as to why he's been needing a larger dose. And you can work to get him better. Good for you on finding a vet willing to help you get started with cabergoline.

The one thing someone said to me at this point that I found really important - Rudy doesn't know he's got acromegaly - he's the same sweet cat he was before the diagnosis. Don't treat him any differently.

Was he tested for IAA (insulin auto antibodies) too? Some cats have both. Blood goes to the same place as the IGF-1 testing. Let us know the IGF-1 value when you see it. Though it doesn't really have anything to do with the size of tumour.

Lots of discussion about cabergoline, including from people who used it, dosing and where to get it, in this thread:
Cabergoline as a possible treatment for acrocats: discussion

1. 10 microgram per kilo of cat. Rudy is 7.2 kg, so his dose would be 72 microgram. Most people get cabergoline compounded in liquid form, could be mixed in with his food. I hear good things about bacon marshmallow flavour. Some people start every day dosing, some start every other day. Some cats show some mild GI systems to start. Those on every day might back off to EOD if so, then back to every day. The South American study did every other day for all cats. I'd say pick one, and see what works for Rudy.

2. Cabergoline can take a while to take effect. I've seen it as short as 7-10 days, as long as 3 months.

That is not TR. TR is don't shoot below 50 on a human meter. One thing you are really going to have to do is step up your testing game. Your spreadsheet shows increases with nothing but preshot tests. That won't work with him on cabergoline. You will need to be vigilant, especially when cabergoline starts to work. TR says at least 2 tests per cycle, the preshot and one other, including the PM. I have seen cabergoline hit hard and fast, or slowly. You won't know in advance.

3. I've seen a couple cats start and be completely off insulin inside two weeks. What I would suggest for a cat on cabergoline, is to take reductions at below 70. And with a larger depot, it's OK to do a half dose to drain the depot after a reduction. Please post fairly regularly, especially if his numbers start coming down. We can help you dose safely. For the most part the cabergoline dose stays the same, unless the cat weight changes. But I've also seen people raise it a bit if the effects seem to be wearing off, and also people reduce the frequency if kitty goes into remission. There isn't a book written on this. Just experience watching others and trying what works for you cat.

4. Where did you read that cabergoline can be hard on kidneys? Has Rudy been diagnosed with kidney disease? It's only in later stage kidney disease that lower protein is recommended. Until then, you want good quality protein and lower phosphorus.

 

[SweetGreyRudy]

@Wendy&Neko just want to confirm that we are dosing correctly! The Cabergoline is .05mg/ml suspension. We were prescribed to dose him .05mls (25mcg) every 12 hours. So, you'd recommend .072mls (72 mcg) daily, not every 12 hours correct?

Sorry to hear about the diagnosis. But now you have an answer as to why he's been needing a larger dose. And you can work to get him better. Good for you on finding a vet willing to help you get started with cabergoline.

The one thing someone said to me at this point that I found really important - Rudy doesn't know he's got acromegaly - he's the same sweet cat he was before the diagnosis. Don't treat him any differently.

Was he tested for IAA (insulin auto antibodies) too? Some cats have both. Blood goes to the same place as the IGF-1 testing. Let us know the IGF-1 value when you see it. Though it doesn't really have anything to do with the size of tumour.

Lots of discussion about cabergoline, including from people who used it, dosing and where to get it, in this thread:
Cabergoline as a possible treatment for acrocats: discussion

1. 10 microgram per kilo of cat. Rudy is 7.2 kg, so his dose would be 72 microgram. Most people get cabergoline compounded in liquid form, could be mixed in with his food. I hear good things about bacon marshmallow flavour. Some people start every day dosing, some start every other day. Some cats show some mild GI systems to start. Those on every day might back off to EOD if so, then back to every day. The South American study did every other day for all cats. I'd say pick one, and see what works for Rudy.

2. Cabergoline can take a while to take effect. I've seen it as short as 7-10 days, as long as 3 months.

That is not TR. TR is don't shoot below 50 on a human meter. One thing you are really going to have to do is step up your testing game. Your spreadsheet shows increases with nothing but preshot tests. That won't work with him on cabergoline. You will need to be vigilant, especially when cabergoline starts to work. TR says at least 2 tests per cycle, the preshot and one other, including the PM. I have seen cabergoline hit hard and fast, or slowly. You won't know in advance.

3. I've seen a couple cats start and be completely off insulin inside two weeks. What I would suggest for a cat on cabergoline, is to take reductions at below 70. And with a larger depot, it's OK to do a half dose to drain the depot after a reduction. Please post fairly regularly, especially if his numbers start coming down. We can help you dose safely. For the most part the cabergoline dose stays the same, unless the cat weight changes. But I've also seen people raise it a bit if the effects seem to be wearing off, and also people reduce the frequency if kitty goes into remission. There isn't a book written on this. Just experience watching others and trying what works for you cat.

4. Where did you read that cabergoline can be hard on kidneys? Has Rudy been diagnosed with kidney disease? It's only in later stage kidney disease that lower protein is recommended. Until then, you want good quality protein and lower phosphorus.

 

[Wendy&Neko]

Most people just give it once a day, not twice a day. Some give every two days. So yes, twice a day is too often. You could even give him 75 mcg as it's a nice multiple of 25mcg, so .15mls.