New Member: Bexacat and Insulin?

[PhifeKat]

Hi my cat Phife was diagnosed with diabetes back in May. After months of struggling to manage his blood sugar he was diagnosed with acromegaly after an IGF-1 test.

Phife is currently on 5u of insulin and his blood sugar ranges from 300-380. He also just started Cabergoline yesterday. I had to take him for an emergency visit last week as he was having diarrhea multiple times a day for 5 days in a row. During the visit they tested his ketones and said they were a little high but not high enough to admit him. My vet suggested that we start him on Bexacat in addition to Insulin. This alarmed me because everything I’ve seen said do not mix the two. My vet admitted he has never tried this before and said the biggest concern would be that his blood sugar could go too low and to make sure I monitor him throughout the day. Which is something I’m already doing on a daily basis with an alpha trak.

Has anyone tried using both Bexacat and Insulin at the same time? My vets reasoning for this is that it seems like every time we increase his Insulin his blood sugar also increases, which I’ve definitely noticed. It also seems like every time we increase his Insulin he also gets an upset belly and diarrhea which seemed to happen last week when we went from 4u to 4.5u then 5u.

I’m a bit stuck here on what I should do. Would love any thoughts/ opinions or if anyone has tried this.

 

[Wendy&Neko]

Have you seen this post: New Treatments for Feline Diabetes. Diarrhea is a common side effect of the drugs. Presence of any ketones is a contraindicator for starting the SGLT-2 drugs.

This post is from a member who started their acrocat on Bexacat before knowing kitty had acromegaly. New Member. It in I posted a link to a paper describing a small study on acrocats on insulin who got Senvelgo (also a SGLT-2 inhibitor). The paper does make one statement that I disagree with "Anecdotal evidence suggests a low propensity to ketosis and diabetic ketoacidosis (DKA) in this patient population". Due to their needs for larger doses of insulin, it's not uncommon for cats with acromegaly to show ketones or get DKA. I strongly suggest regular testing for ketones should you move ahead with Bexacat. Yet more reading: Ketones, Ketoacidosis and Diabetic Cats: A Primer on Ketones.

Have you every tried s. boulardii for the diarrhea? Dosing and about on this page: Probiotics – IBDKitties. Side note, temporary side effects of cabergoline are GI issues, like vomiting or diarrhea. Some people move to every other day dosing if doing it every day, at least for the first while, if GI issues are more than minor.

it seems like every time we increase his Insulin his blood sugar also increases, which I’ve definitely noticed.

That's very common with acromegaly, The pituitary tumour can wax and wane. You just have to give however much insulin is needed. Sounds like Phife needs more. 5 units is a pretty low dose of insulin. The ketones being present also is an indicator he needs more insulin.

 

[Danielle & Booger]

Here for solidarity, but unfortunately don't have an answer for this. My cat recently started on Lantus after failing Bexacat and only just got increased to 3u and my vet just brought up the same thing last week. I was immediately hesitant to use both based on what I have read about Bexacat. With that said, I am very much a beginner at all of this and am just trying to keep my head above water with all of the information out there!