Possible High Dose Cat

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micheleoboe

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My cat Afeeni was diagnosed 9 months ago. Since then we have gradually been increasing her insulin dose under the guidance of the vets, but she is still unregulated. She is now on 6 units twice a day of Prozinc. The past several days I've been getting BG measurements in the upper 400s (on my Alpha Trak) both before her insulin doses and mid-cycle. In fact, her BG doesn't seem to really seem to come down 5-7 hours after insulin. Her biggest dip seems to be 9-10 hours after insulin, but that yesterday was 451. BJM responded to my original thread in the Prozinc forum and mentioned acromegaly. There is a lot that fits: she has a wheezy kind of breathing now, but the vets can't figure out why. She is losing vision and is therefore sensitive to light. She gains weight even when eating measured portions of the canned, high protein food recommended in Dr. Pierson's chart. There have been changes in her walking, which the vets think may be correlated to the vision. I have not noticed physical changes, but the page said that is not always apparent. She is a larger cat (13 pound female) with bigger paws, but not huge. There are times when she doesn't feel well - when she shakes - but we have not yet been able to correlate that with a change in blood sugar. It certainly has never been low when measured although just a few weeks ago we were able to get some readings down in the 100s range 9-10 hours after insulin. Thanks for any advice on where to go from here.
 
Hello and welcome. My kitty Neko has two high dose conditions, acromegaly and IAA (insulin auto antibodies = think allergic reaction to the foreign insulin). We suggest getting kitty tested for that if they are on low carb wet food, have gone up the dosing scale safely (overdose cats can also have high flat curves), have no infection (when was Afeeni's last dental?) or other thing causing inflammation such as pancreatitis, and are up to 6 units of insulin. Recent research has shown that as many as one in four diabetic cats have acromegaly. There is a third high dose condition, Cushing's, but it's much less common in cats. You might want to talk to your vet about getting blood tests done for acromegaly/IGF-1 test and IAA. The blood samples have to be sent to Michigan State University in North America. Where are you located?

Neko was 13.5 lbs at diagnosis and is now 14.5, but she's got some Maine Coon in her and has always been a big girl. Her face doesn't really show any differences, and a recent study showed that a lot of cats with acromegaly have no significant head differences. It can be hard to determine by looks whether a cat has acromegaly. Neko's first symptom about 3.5 years ago was incessant hunger and eating inappropriate foods (banana bread, muffins). She also was a little shy of bright light. Neko now has arthropathy (arthritis) which is common in acrocats. She is on fish oil for inflammation and a maintenance dose of daily buprenorphine for the pain, and it really seems to help. Wheezing breathing (called stridor) in acrocats can be caused by soft tissue growth in the larynx.

One more bit of reading for you is a current article I found. I've meaning to add this to one of the posts, but am organizing all the new articles I found: 2013 article on acromegaly. This article also talks about treatment options.

In your other post, you mentioned later nadirs (low points). That's not uncommon in cats to have a different nadir time than average.. I've seen some cats nadir as early as +2, and Neko once had her nadir after the next shot time (13 hours after injection).

One other thought for you, some higher dose cats do better on Levemir, although we also have some on Lantus too.
 
Thanks for all of this! Afeeni just had a longer, 12-hour curve and it actually came out pretty well, so we are keeping her on the same insulin dosage. They also gave her something for the arthritis, and she seems to be feeling better overall. Urinalysis/dental/bloodwork came out well. I want to read this whole article - looks very interesting. And if she starts shooting up again I'll definitely request the blood be sent to MSU. I'm keeping my fingers crossed that this is a good sign for getting things under control for a while! I appreciate all of the support! Michele
 
The second condition mentioned in the article is a lot rarer, and there's a lot of technical stuff on testing so you can skip that bit. What is she getting for arthritis? Neko has that too. It's actually fairly common with older kitties here. Glad to hear that Afeeni is doing better and feeling better!
 
She is getting Duralactin. She seems to be doing well and is getting up and down stairs now. Hopefully some increased activity will further help with the blood sugar!
 
I just want to add a little encouragement -my cat had acromegaly. we have several kitties on the Lantus and Levemir support group with high doses. it can improve blood sugar control to use a longer lasting insulin Like one of those two. when you get through your current supply of Prozinc, I'd seriously consider switching to Levemir.
 
Hi Julie, This is interesting. I'm curious: could it potentially help to use a longer-lasting insulin even if her nadir is unusually long after insulin (9-10 hours)? It hasn't seemed like the problem has been a short duration but rather a long response time. This is all new to me, though, so I'm interested to hear your response. Thanks! Michele
 
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