the vet specialist recommended a few options and is putting a plan together.
Here is the letter that I received from the vet.
Wow, what a lot of bad advice! Let's start with food. First of all, there is nothing magic about the DM food, other than helping fund the vet's childrens education plans. The ingredients aren't the best and many kitties grow tired of it. You can choose any low carb commercial wet or raw food to feed Paris. Check out this
list of common commercially available foods, and look for something under 10% in carbs. And please get rid of the DM kibble - it's too high in carbs for a diabetic cat and will make regulation very difficult. It sounds like Paris is very hungry, my girl would steal food if I didn't hide it.
Very common with acros. Instead of two meals a day, feel free to spread out her feedings in the first six hours or so after her insulin shot. Human diabetics spread out their food into mini meals as it's easier for the pancreas to handle. The same principle works for cats on long lasting insulin like Lantus or Levemir. I used an automatic pet feeder, the Petsafe 5 to feed the mini meals. It meant Neko's attention moved to the autofeeder from me, and also meant I could leave the house and know she would be safe because meals would be presented to her. The one meal before shot is a relic from the old fast acting insulin days.
Next topic is testing. Here, testing your cat is strongly recommended. At a minimum, we test before every shot to make sure it's safe to give the shot. We also determine how to change the cat's dose based on how low the dose takes the cat. Those lows are somewhere in the middle of the cycle, so we recommend spot checks. That includes a test before bed, as many cats go lower at night. I've lost track of the number of times I've seen people start home testing blood sugars and realize their cat is way overdosed and about to hypo. Testing will keep Paris safe, and allow you to get to a good dose faster. Cats need as much insulin as they need. We have had some acros need over 50 units. I was lucky that Neko maxed out at 8.75 units per dose.
Do you have any recent blood test data on Paris? I don't see anything for this year in the spreadsheet. It's very important for you to try to get to an insulin dose where Paris spends most of her time below renal threshold, ie. mostly below 200, in order to give her kidneys a break. Acromegaly is hard on kidneys by itself, you need to do what you can to ease their load. Over on the
Lantus/Levemir forum, we have a couple of dosing methods that you can use if you want to be more in charge of getting Paris to a better insulin dose sooner. One of the dosing methods, Tight Regulation, requires more testing, but also allows you to make dose increases every few days, depending on what sort of numbers you are seeing. We can help you over on the L/L forum if you want to go that way. My Neko, and many other acros have been well regulated and much happier that way. It also reduces how hungry they are.
OK, now to treatments. SRT and hypophysectomy (done in New York) and both rather costly. There are other places that do SRT (stereotactic radiation therapy) than what they listed. I had SRT first done for Neko back when it was around $4000 and that included the CT scan. Now it's double or more that price. I wouldn't do what they called the definitive or non stereotatic radiation therapy option the vet mentions, too mady side effects from numerous radiation sessions. SRT is 1-3 radiation sessions.
Hypophysectomy costs more, though AMC in New York did have a large donation and were doing some for minimal cost last fall. Not sure if they still have some of that donor money available. There are some posts in this forum describing people's experiences with the surgery. Pasireotide, the medical solution, is out of this world expensive, even the long lasting one which has been available for a few years in the USA. To date, I know of no one who has tried it. I talked to the folks at the Royal Veterinary College (RVC) in London, where the original research was done on pasireotide, and they too had no one try it due to cost and availability. I did explore that option (I am in Canada) and it would be several thousand per month.
There is one possible treatment the IM vet did not talk about, and that is a medication called cabergoline. Discussion post
here. Results are mixed, but we have had three cats go off of insulin while taking cabergoline. Most of the acrocats on it see clinical improvement and lowering of doses. If your vet gives pushback on trying this drug, I can try contacting one of our other members who is a vet in Michigan, has an acrocat herself, and using cabergoline. Might be someone your vet can talk to. RVC has researched this drug and published a paper saying results were mixed. Which they are, but the costs are something people can actually afford. If money is not an issue, then SRT or hypophectomy could be an option. We have had more cats on FDMB try cabergoline than were in the RVC trial.
As for neuropathy, the thing that will help best is getting Paris into better blood sugar numbers. In addition, get some Zobaline, a pill that can be crushed and put on her food. It can take several weeks to see improvements but has helped many kitties.
Sorry for the novel, that letter had me shaking my head.
The acro diagnosis means a lot to take in. Keep asking questions.
