Reflections on One Acro Cat's First Year after Diagnosis

[julie & punkin (ga)]

I've been thinking for a while that i would like to share some of punkin's story, in the hopes that it might help some future cat diagnosed with acromegaly. it's been a very educational year for us - i've learned a lot and have only one regret about the choices i've made along the way.

Punkin was diagnosed with acromegaly within a month of 3 other cats all using Lantus: Gus, Tommy & Guinness. Before the diagnosis was made, all of us were following the TR Protocol, trying to push our cat's BG into the 50-100ish range. With each diagnosis, others with acro cats would pass on what they understood about treating a cat with acro. Bev, Lauren, Linda & I all heard the same comments:

"Blue numbers are an acro cat's greens."
"Acro cats have a working pancreas. They can't go below 100. If you give them high carbs, their pancreas will kick in, pushing the BG even lower."
"You can't pull up the BG of an acro cat with a small amount of carbs. If he goes below 100, open a can of high carb food and give him the whole thing."
"don't give an acro cat pills."

Like the others, I was devastated by the diagnosis and confused by all of the advice. I'd been following TR and pushing punkin down into lower BG's and he seemed to come up just fine with a little bit of high carbs. Was he suddenly different because of the diagnosis? Did he read his condo like everyone joked about and would he now respond differently to carbs?

It didn't make sense to me, but I treasure the little guy, and above all else wanted to keep him alive. So when the diagnosis arrived, i immediately let his BG numbers drift upward. Holding them between 100-200 was pretty impossible, so i settled for letting him go as high as he went, but trying to get the nadir to about 100. As with everything with feline diabetes and cats, easier said than done.

At first we were just going to increase the dose as he needed, but as i have written about in the post on Punkin's SRT, we changed our minds and took him to CSU to be treated in September 2011.

Since that time i've done a lot of research on acromegaly and especially on Feline Diabetes & Glucose Toxicity and exactly what happens in the cat's body with diabetes. I've also studied many spreadsheets of cats with acromegaly to see what different tactics people have taken.

Tommy's IGF at diagnosis on 5/14 was 313. He was 15yrs old. Lauren left the forum and has managed Tommy's care on her own. Lauren continued to follow the TR Protocol, and Tommy has seen green numbers under 100 pretty much every day since that time. The highest dose he got to was 12u, in a combination of Lantus and a small amount of R (1unit or less). he is currently getting 4.75 units per dose. Tommy's SS

Gus was diagnosed on 6/1 with an IGF=220. Bev also continued to follow the TR Protocol, although like me, she backed away from the green numbers. The highest dose Gus had was 11.5u. He passed away in February at the age of 16 of unknown causes, not diabetes-related as far as is known. At his death he was on a dose of 7units. Gus' SS

Punkin was diagnosed on 6/1 with an IGF=281. I did not follow the TR Protocol, but instead kept punkin above 100 all the time. Not quite 4 months later when Punkin had the SRT done, he was at a dose of 15.5u. I learned more about the risks of high numbers and more about the consequences of glucose toxicity in January 2012, and returned to following the TR Protocol at that time. Seven months after the SRT, punkin is on a dose of about 7units and he is daily in green numbers. Punkin's SS

Somewhere in the past couple of years the idea came up on FDMB that cats with acromegaly can't go under 100 because their pancreas still works. This was based upon the idea that if the pancreas still worked, when you gave a cat high carbs, their pancreas would go into overdrive, pumping out insulin, which combined with the insulin you've injected would cause a cat's BG to drop even lower. This was the source of the advice we received when our cats were diagnosed.

I have searched for spreadsheets showing evidence of this and have not found any.

If this premise were true, cats with acromegaly would never see a food spike. you would feed them and their BG would drop. it wouldn't just occur when the cat had low numbers, it would occur all the time. scientific evidence is a test that is repeatable with the same outcome. I have been unable to find any evidence of an acro cat's BG dropping from being fed.

To the contrary, I've seen many repeated examples of a cat exhibiting a food spike when eating. Punkin always does. There are cases where a cat is simply on a freight train with their BG going down, usually when they are clearing a bounce. Outside of that particular situation,I have not seen cats whose BG dropped upon eating, acro or not. As best as i have been able to ferret out, I believe this idea came from a situation where one cat had an experience that scared the owner, and the warning was repeated until it became a rule.

The simple way to determine this for your own cat is to try it out. give your cat high carb food and see if it will counter the effect of the insulin and increase the BG. If the BG increases after eating, there is evidence for you that carbs bring up your cat's BGs. If your cat doesn't exhibit an increase in blood glucose from carbs, then perhaps you have a cat that is less carb-sensitive. It would benefit each of us to determine this for our own cats, including exactly what amount of carbs might be needed to pull their BG up if it goes low.

On the other hand, it is entirely possible & likely that the larger the dose of insulin being injected into a cat, the more carbs it might take to raise their BG, and the longer it might take. Lantus and Levemir are both longer-acting insulins that form a depot in the body and slowly release. The larger the dose, the larger the depot, the longer it might take to work through low numbers. This would be a factor of dose size, however, not whether or not the cat is acromegalic. Personally, the size of the dose concerns me far more, in regards to treating low numbers, than the fact that a cat has acromegaly. the larger the dose, the more care i would take. In fact, the desire to avoid a large dose would be enough for me to be aggressive in keeping punkin's BG under 100 as much as possible, if i had it to do over again.

after Punkin's SRT, we experienced sudden drops in the growth hormones put out by the acro tumor, causing an immediate drop in the amount of insulin needed. That process caused by that radiation mimics the natural process of the tumor pulsations, in effect, causing the same issue that might arise if a cat's tumor pulsations "shut down" some. At least what we experienced was not so sudden that it isn't manageable.

There is also some evidence that by keeping a cat's BG consistently down, one may avoid Glucose Toxicity, in which the cat's body becomes accustomed to higher BG numbers and develops a resistance to the insulin. This causes a need for greater and greater volumes of insulin in order to pull the BG down. Sustained high blood sugar also contributes to the failure of the pancreatic beta cells and amyloidosis. It is worth reading and learning about these complications for cats.

I have wondered what the reason might be that acro cats who are kept on Tight Reg with their numbers mostly under 100 seem to maintain lower doses. Do their pancreases supplement the insulin being injected? Do the lower BG's simply prevent glucose toxicity and the need for greater and greater doses? I don't know. But the evidence was there that if we had not had the SRT, by allowing punkin to be in higher numbers, we were on the path to much larger doses.

The flip side of this is that while acromegalic cats would have had a working pancreas initially, any cat who remains in high numbers long enough will suffer irreversible damage to their pancreas. The research by Rand indicates "at a blood glucose concentration of 30mmol/540mg, insulin secretion is minimal by 3-7 days in previously normal cats" http://www.uq.edu.au/ccah/index.html?page=43391&pid=0

It is worth noting that many cats with acromegaly follow the Tight Regulation Protocol developed by Rand Roomp with good success. Here are some spreadsheets that give examples of that:

Porscha
Buckwheat
Chika
Boo (had SRT)
Milo (had SRT)

From the German Katzen Forum, which follows the Tilly Protocol, essentially identical to the TR Protocol:
Kimba
Josey

I think it's helpful to remember that ECID isn't just a slogan - it's the truth when it comes to cats. Every Cat Is Different. That includes cats with acromegaly or other high dose conditions.

If there was one thing I would've done differently in this journey with punkin, i regret that i spent 7 months being afraid of letting him go below 100. I wish i had continued with the TR Protocol the entire time and believe he would be better for that. I look at Tommy's spreadsheet and see a spreadsheet that is enviable among cats with acromegaly.

I understand that people give advice based upon their understandings and I truly believe all advice given to me was well-intentioned. But my primary failure was in not remembering that the burden was upon me to know my own cat. Punkin could go below 100. Punkin's BGs could be raised with high carb food. Punkin can take pills without trouble.

Blanket statements do not serve anyone well. Nothing applies to every cat.

For what it's worth, I hope this serves those to come in the future who are faced with decisions on what to do after a diagnosis of acromegaly. Doing it over again, I would have stayed the course with the TR Protocol.

 

[Grayson & Lu]

Thank you Julie! You really put a lot of thought and research into this! I'm still hoping this is not the result we end up with, but if we do, I'll be more comfortable with it because of what you've shared. From me, and all the others that might find themselves here, this is a tremendous resource! Thanks for sharing your experience and hindsight!

Lu-Ann

 

[julie & punkin (ga)]

if you do get the diagnosis of a high dose condition, it's not what anyone wants, but it's not the end of the world, either.

i'm glad it was helpful, Lu-Ann. if only i'd known then what i know now . . . but that's how life is. you can only go forward. for today, punkin is healthy and happy. i couldn't ask for more than that!

 

[OptOut]

Julie, I did follow the TR protocol even after Boo was diagnosed. However, my concern was simply keeping Boo under the renal threshhold; as we all know, an acro-cat's pancreas doesn't need to heal because it's not broken...if it doesn't need to heal, it doesn't need to be kept in "normal" (and therefore healing) numbers. Instead, we want to balance the risk of kidney damage against the risk of a hypo...surfing in the 100s is a good balance. Boo died from kidney damage...I wish I had been able to get her diagnosed and in good numbers much quicker (I'm sure someone will pop in here and say kidney damage takes a long, long time to occur...I say that kidney damage seems to be the main cause of death in a diabetic and common sense tells you that it happens quicker than you think).

Boo, and all of the kitties you listed, were lower-dose acro cats and many of us did continue to follow TR, but we were more cautious when shooting the lower numbers than we would have been if we had a "normal" diabetic. I felt comfortable in the lower numbers because I wasn't shooting enormous amounts of insulin; also, since I don't have the type of job where I could postpone shooting or stay home and watch for two hours, I took every opportunity to shoot low evenings and weekends so I would know what to expect if I had to make a decision at 6:30 in the morning.

I imagine that as the dose increased, my "threshold comfort level" would also have to increase. So, I'm guess I'm saying that while I personally felt comfortable following the TR protocol, with more caution in the lower numbers, I would advise anybody doing this with an acrocat to be very, very cautious.

Your theory about the higher doses being caused by the higher numbers is interesting, but I'm not sure it's valid (it would make a great study). I say this because the reason Lantus Land was so good at identifying acro-cats was because we all started with TR; these cats did not respond as the others did. Lorna and Carolyn didn't post much when Boo and I were around, so I don't know their progression or when they stopped following TR. However, think of Brent and Perry - they stayed in LL for a while after diagnosis and their dose just continued to climb. It seems to me that the tumor is what causes the dose to increase (and also decrease...Carolynn's baby went OTJ many times).

Just my opinion...it would be nice to get input from some of the other old-timers.

 

[OptOut]

One more comment...Carolyn has had many diabetics, both "normal" and acro. She's also used several insulins and has been around for quite a while. Her input would be very valuable in understanding at what point she feels more comfortable being very cautions versus aggresive.

 

[Blue]

I agree with Heather's post, and I just posted over on Ceenka's thread, but should possibly have posted here as it's the same issues.

Pretty much the acros noted, as Heather said, are low dose acros, but none of the higher dose ones seem to be mentioned. Perry and Brent are good examples, as are Ingrid's TC and others with doses closer to 30u, 40u, 80u, and over 100u. The acros who joined FDMB upon FD dx, all started following the TR protocol, and I can say for my two acros, I followed it TO THE LETTER with guidance by Jojo, Carolyn, Lorna. We followed the protocol tighter than people do now, and it was before the resurrection of that SLGS method.
The Lantus forum was TIGHT. All that we followed was based on data and experience, not just on how one cat reacted.

Here's my post from Ceenka's thread.

I think the difference between lantus and levemir is really just about personal preference, although we have seen great results in cats who "dive" fast and furious on lantus (hit their low point 2 hrs after their shot) will sometimes even out on lev. lantus has a slightly acidic base and some cats seem to feel a sting. not every cat though - my cat was unphased by it at 15+ units per shot, twice a day. punkin's had a great response to it and i like lantus, but i think lev is a great option too. if it had bothered him, i would've tried lev. lantus onsets in about 2 hours after the shot and usually peaks about 4ish hours later. lev onsets in about 4 hours after the shot and peaks about 4 hrs after that. if one doesn't work, try the other. Lantus vs Levemir

Sorry, but the difference between the two insulins is not just about personal preference.
I know for a fact, first hand experience and observations, that some cats are not good on Lantus, but are fine on Levemir. There are also vets who once recommended Lantus to their diabetic clients, but have switched to Levemir. The Canadian vet mentioned in the story of Tilly the cat, on which this Tilly protocol is based, has switched her recommendations to diabetic animals from Lantus to Levemir. I would be worried if a vet made such a major change based on a personal preference. The vet states her reasons for the change as well.
Why? Because there is a very noticeable difference, especially to many HIGH DOSE cats.

I can speak for one acro cat better on Levemir, and there are others who will speak of marked improvements in their cats when switching to Levemir, many owners of acro cats as well as owners of normal diabetic cats. I think a major consideration is the sting which occurs at higher doses, and when you are approaching doses in the 40s and upward of 100 units BID, sting matters.
It is not about personal preference as has been suggested by Julie.

Onset for Lantus and Levemir did not differ for either of my two cats; the changes were in how Shadoe acted, not the onset. The first choice for use by any cat who tests positive for acromegaly, IAA, or both, should be Levemir.

the Rand/RoompTR protocol is about pushing cats into the 50-120 range, most of the time under 100, on human glucometers, so that their pancreas will heal. Punkin got to 49 today and lived to tell the tale. he was there yesterday too. That is what Tight Regulation is about - keeping them tightly regulated in the normal cat range. There are a lot of people on this site who don't seem to grasp those are the good numbers and are afraid of having their cats go under 100. some people celebrate their cat getting into the 200's - and i just clench my teeth on those comments. those are numbers to move down from, imo. a lot of people don't seem to realize that the dangers of higher numbers are as great as from lower numbers, just slower acting but still damaging.

I would hope that Julie could mention that her cat has gone for SRT and so is in a different category than other acro cats. After SRT, I would imagine that your goal IS to get off insulin because of the treatment. Pushing her cat to the 50s may be fine if the treatment has altered how the tumor is acting and affecting hormone secretion.
Pushing an acro cat who has not gone for SRT is not the same as pushing an acro cat who has had SRT.

There is no point in speaking about a healing pancreas because cats with acromegaly and IAA do not have any problems with their pancreas, but rather an issue with growth hormone secretion. When the hormone excess is stopped, the cat no longer needs insulin, as in the case of one of my acro cats, who was at 37u, then dropped to 21u within 6wks, and then off insulin 10days later. He is still off insulin, since the start of this year. His pancreas is fine.
The 100 BG cutoff is relevant for cats with acromegaly. If you have not had a cat who has consumed FIVE 5.5oz cans of high carb food, been given karo, and still have the BG numbers keep dropping, you may speak lightly of that cutoff line. I do not; I have experienced just such a scare and it is not fun. I was terrified. After that day, I stayed clear of the any number under 100 because I had seen what can happen and you can't stop a drop in some cases.
Why is that? Well, because the acro cat has a functional pancreas, and what happens with food? The food test to check if the pancreas is working is to test, feed, and then test again in an hour or so. The 2nd test will be a lower number with a working pancreas, so feeding mass quantities of high carb food CAN have the opposite effect on an acro cat's dropping numbers. Shooting an acro cat down to the 50s could be harmful, and is foolhardy.
The goal is to get your acro cat's BG numbers under 250 at all times, and aiming for low 100s. You have NO influence over the acro cat going off insulin without surgery or possibly after SRT treatment. There is no point in pushing your cat to numbers that could possibly be dangerous.... 100 - 250 is a decent range for an acro.

There is no remission for cats with acromegaly unless your cat has surgery to remove the tumor. In all cases of removal, the need for insulin stopped immediately, and not a single cat needed insulin shots again, indicating that every pancreas was functional. Other medications were needed but insulin was not one of them. There is no healing of the pancreas required.

Acromegalic cats are not diabetics in the usual sense; they just happen to have diabetes more like a side effect of the tumor, so get rid of the tumor or cut off the flow of hormone secretion, and you have a non diabetic cat.

If you want to speak of the other resistance issue, IAA, you are into a whole different area.
With IAA, you MUST push the cat's numbers to the 50s and even to the 40s, because IAA can be temporary and the condition is much like a tug of war, or arm wrestling. You cannot let up and you have to push for low numbers to beat back the resistance. It's up to you if you want to work hard at the possibility of defeating the antibodies, or you can maintain an approach similar to those following the Rand protocol.

The third combination would be if you test positive for both acromegaly AND IAA. In this case, acro trumps IAA.
Oliver tested positive for both and I was able to defeat the IAA by June6/2010, after which time, he as what I would consider just an acro cat. His dose on June6th was 21u Lev and 7uR BID and he then started his drop down to 6u BID 10 days later. His IAA was considered broken at that point as no amount of R was needed to fight high numbers after June6th.

Please know that TR may be fine for many cats, but it's just not followed for high dose cats.
Feline diabetics are standing on dry land, with a faulty pancreas, and getting a helping hand with insulin shots.
Insulin resistant cats have a functional pancreas but are in a boat, and their dose depends on how choppy the waves are that will affect their dose. There may be days you will have calmness and may chop the dose by 10units, while other days, you have huge waves and are finding the need to increase the dose by 4u and also use R maybe 4times a day.
Turbulence vs terra firma. Apples and oranges.

 

[Blue]

viewtopic.php?f=9&t=55682&p=603019#p603019

The potential for the tumor to turn down/off combined with the size of the shed that will keep on giving is the reason many of the people with acro cats use Regular insulin in combination with Lantus or Levemir. R can knock down the higher numbers without building up the shed, so you're decreasing the risk from the giant shed.

So . . . the potential problem that i'm seeing that causes me to drop the dose: at any point, any cat with acromegaly could have the tumor shut off production and the cat's shed would continue giving insulin that would now be dramatically more than a cat could ever need, potentially causing a hypoglycemic event that would be extremely difficult to counteract. Combine that with punkin's apparent lessening need for insulin from the SRT. If he's had a run in the under 100's that tells me he's needing less insulin, I drop the dose in half to let the shed drain some, then return to a slightly reduced dose. I hold it there til he seems to need less again, and repeat.

This tactic seems to be working for punkin. I don't know how others have done it. There have only been a handful of kitties have the SRT - it's only been available for a couple of years. The gravest danger for any of these cats is for them to get too low and you not to be able to pull them up. I want to avoid that. This is the main reason that cats with high doses avoid the green numbers - it gives a safety margin for our little ones. if his tumor is killed he *shouldn't* need insulin. Unless, of course, his beta cells have been too damaged by high numbers to become functioning again - in his case i doubt that's happened because his numbers haven't been sky high for any sustained length of time.

Above is the link to your earlier posting about concerns with dropping dose and taking precautions, that seem to differ from your more current take on lower BG values.
Maybe it is possible that you have found something different with just your cat that does not apply?

Dropping low is a state that should be avoided; better safe than sorry.

 

[julie & punkin (ga)]

of course, the entire point to my post is that every cat is different. each of you has offered what your experience with your cat(s) has been.

i continue to think that keeping a cat under TR will reduce the size of the dose. I am hesitant to speak of particular cats that have ended up with spectacularly large doses, like 80-90 units per shot, but i will address Tigger/Brent since you brought up that particular cat. Brent never followed TR. I was there at the very beginning with him and know. he gave lantus and then levemir, he posted on that forum, but no, he never followed TR.

Lauren/Tommy is an example of a cat whose bean was aggressive about following TR, did not have any treatment done, had a higher IGF (output of growth factor hormone) at diagnosis than many other cats, and has done wonderfully.

i'm flattered that you've saved my post from last fall to be able to quote it back to me, gayle. that must take effort. :lol: but no, i don't see an inconsistency with what i'm saying now.

 

[Marje and Gracie]

Julie

I found your post to be extremely informative and I appreciate you taking the time to write it. I don't think that we can ever overstress that ECID whether that cat is acro or not.

Thank you for taking the time to put this together along with the SS links.

 

[hnkstr]

Just browsing around and saw the Acro chatter.
I'm confused here, I followed what I was told when i got to FDMB and TIgger just kept climbing.

Going up small units slowly, following the protocol, wasn't doing anything. If you look at my spreadsheet Tigger didn't hit yellows on a regular basis until I started going up 2units every 5th shot. And that wasn't enough, I then went up 3 units and finally got him to level off.

I took away dry food and dosed what I was told to dose on a daily basis. I'm confused what protocol I followed here if it wasn't the TR protocol?

 

[Blue]

Brent followed the protocol to the letter as did I with both Shadoe and Oliver.... maybe if you can quote the part of the TR protocol that you feel was not followed, it would help us to understand what we missed.
I would truly be interested to know where I did not follow protocol.
Just to be clear, is the below portion of the protocol where we did not follow correctly?

"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

 

[Carolyn and Spot]

One more comment...Carolyn has had many diabetics, both "normal" and acro. She's also used several insulins and has been around for quite a while. Her input would be very valuable in understanding at what point she feels more comfortable being very cautions versus aggresive.

Hm.. no I don't think I have anything in particular to add to this. Slack dosing leads to slack numbers. Every cat is the same in that regard.

 

[Patti and Merlin]

Dear Julie,

thanks for posting all your thoughts - what a great post! So glad your Punkin is doing good- he is as handsome as ever!

As always I am late to this thread and don't know that what I have to say really has any relevance.

there has ALWAYS been VERY HI dose and lower dose acro kitties since we first started keeping records back in 2006. That was back in the days when PZI was always used. Beth and Pickles used up to 100units of PZI and R boosters - Merlin used "only" 45 units of PZI and R boosters. There was no SRT then - nothing of any sort to "influence" the picture then.

It was a different insulin so yes some of us did try to keep our cats <100 then but the insulin was shorter acting and we were able to treat any lows quicker too. And we were also all in the learning stages then as there was no documentation of anything then. No group to help us - no background information - nothing about anything about acro. Some tho could NOT get their cats anywhere less than 200 no matter how much insulin was given even with R boosters. Again the old "ECID"!

My feeling FWIW - is that you have to know your cat - what you are comfortable with - whether YOU are available when shooting those lower numbers - and...

it comes down to the cat itself - and the tumor in that cat. There WILL BE those acro cats who do not need a lot of insulin and those who will need a lot - it's a physiological happening. WE can compare all our cats - and that IS what we did in the past to come up with some of the info we now have about our acros. But the info we came up with does not mean it happens in each cat.

Some cats have difficulties undergoing anesthesia and intubation (Carolynn's Fletcher) - others have no problems. Some have lots of pain from spinal degeneration (my Merlin) - others do not - I don't mean to drag things on here - but the purpose of listing all the issues that can happen is so each individual who has a cat with this can be aware of what some of the scary issues can be.

I have not posted a lot here lately (mainly because I have so many other sick kitties at home now) - there are so many new acro mom/dads. It seems to be tho when reading posts - that some of the leanings are away from helping higher dose parents get tested. It reminds me of the thought process that was back in 2005 and we were encouraged to do everything else but get tested for acro. Dentals - etc - which I agree are very important - please don't get me wrong - but sometimes - it seems that we are ignoring other evidence that is being overlooked.

Excuse me for rambling - and I did not mean to take over your thread Julie - guess I've just held a lot in recently and reading your post brought out a lot of emotions for me. With so many acrocats out there - and your very thoughtful post - please let us not step back to those days where we encourage people to spend so much money on tons of other testing, etc and not just do the test that is needed - the IGF-1 and IAA.

Thanks for letting me post my thoughts
Wishing all of you a good day!
Patti

 

[Blue]

of course, the entire point to my post is that every cat is different. each of you has offered what your experience with your cat(s) has been.

i continue to think that keeping a cat under TR will reduce the size of the dose. I am hesitant to speak of particular cats that have ended up with spectacularly large doses, like 80-90 units per shot, but i will address Tigger/Brent since you brought up that particular cat. Brent never followed TR. I was there at the very beginning with him and know. he gave lantus and then levemir, he posted on that forum, but no, he never followed TR.

Lauren/Tommy is an example of a cat whose bean was aggressive about following TR, did not have any treatment done, had a higher IGF (output of growth factor hormone) at diagnosis than many other cats, and has done wonderfully.

i'm flattered that you've saved my post from last fall to be able to quote it back to me, gayle. that must take effort. :lol: but no, i don't see an inconsistency with what i'm saying now.

so sorry, julie, but I had not saved your post from last fall or any other time; credit goes to another acro owner who found it, and did not have it saved.

I had asked where you felt that Brent had not followed TR, but have not seen your reply yet. I believe Brent also asked you, but still we wait for your proof to back the statement that Brent never followed TR.
It looks to me like Brent followed the protocol suggested back in June 2011, but this protocol is certainly not aggressive like in Tilly.

 

[linda and guinness]

I realize this thread is a little old and my post may not get seen here, but I feel I need to be part of this discussion. Guinness is now at 18 units of Lantus and it agonizes me each time I have to raise his dose. I have tried all things suggested to me since he came out of remission a year ago and then was finally dx with acro. I also stuck to the protocol at the beginning, but his numbers never reacted. I've shot low to stay low, I've changed his dose based on his nadir. Back in the beginning I was told at times I was not raising his dose often enough and then at the same time was being told my changing his dose so frequently was maybe causing his insulin resistance. I decided to go rouge and stop posting and just concentrate on my family and my cat. I think there is merit in everyone's ideas and approaches, but I don't think anyone can say for certainty what will work in any situation. I agree with Patty that I think some of the signs are there with these larger or insulin resistant cats and they should be encouraged to get the cat tested for acro and insulin resistance earlier. I spent over $2,000 on thyroid scans, dentils, heart scans, MRIs, etc before finally going for that test. The money I have already spent stops me from even considering the SRT therapy at this point.

 

[julie & punkin (ga)]

Brent, i'm wishing you the best at CSU and hoping Tigger responds well & quickly to the SRT. For a cat that followed the TR protocol, the spreadsheet would have a mid-cycle check to see how low the dose was taking the cat and in the case of high numbers, an increase every 4-6 cycles. hopefully this will be a turning point for him.

The point of this post was to offer to others some thoughts - that's what i've done. other forums don't back away from aggressive dosing with acro cats. The German Katzen forum and Dr. Hodgkins' protocol - both continue to push cats under 100. I see merit in that & wish i'd done it for punkin, unless there is some reason not to do it for that individual cat.

If it were simply a matter of the tumor output (IGF) determining dose - then by any logic Punkin would never have had a higher dose than Tommy.

If i had a cat respond as you've described with oliver, gayle, then i would also be more cautious about lower numbers. I would attribute your experience to the size of the dose and the action of the shed rather than the pancreas. have you considered the point i made above about a food/carb spikes and acro cats?

In the absence of that experience, i think telling people before their cat is even diagnosed to stay away from lower numbers isn't appropriate. each person's job is to know their own cat. as long as a cat can be brought up from low numbers, i think all effort should be placed on getting that cat between 50-120 - and i'm talking specifically about cats that are newly diagnosed or not yet diagnosed. cats that are getting 20units or more - yes, i'd be more cautious as well. as long as they are in lower doses, however, i think that there is some evidence that keeping them lower numbers keeps glucose toxicity away and contributes to keeping their dose lower.

patti, i'm not sure exactly what you're referring to. i wonder if it's about the cat getting 2units of prozinc, whose bean wondered if she should have him get tested for a high dose condition because he wasn't going anywhere. 2 units per dose suggests a cat might be high dose???? that cat's dosing hasn't been good (ie, likely glucose toxicity from holding the dose too long and the cat staying too long at high numbers), the vet had already said the cat had gingivitis & needed a dental, and the cat was also steroid-induced diabetic. i said she was better off saving the cost of the testing and addressing the other needs first.

i've also recently seen cats getting steroids for asthma being encouraged to get tested for high dose conditions.

there has been no time that i've said not to increase doses if the numbers warranted it however. the test doesn't solve anything - and focusing on the BG numbers rather than the size of the dose is, in my mind, always the appropriate tactic.

there are multiple factors that can affect the BGs - not just acro/iaa: glucose toxicity, poor dosing (backing away from a blue preshot, for example and reducing the dose), dental issues, asthma, effects from other meds, etc. it makes a lot of sense to ask people questions to find out the whole story, check out all of the factors and not just focus on one possibility before suggesting having a cat tested. until a cat is above 6-7units a dose and has looked into the rest, i don't understand encouraging people to spend the money on testing. it's not cheap and if they have problems in those other areas, they aren't going to go away until they address them as well.

linda, i don't remember that much about advice given you with guinness, but i agree that it sounds like too much other testing went on before the acro test.

when i had punkin's blood tested in may 2011, it cost $170. the vet billed me after the fact, based on what MSU charged him

$11 blood draw
$61.25 Insulin-Like Growth Factor -1
$18.75 Insulin Autoantibody
$75 Fed Ex postage & handling

I don't think the vet padded the bill. perhaps MSU increased the cost above what is linked in the stickies. We all know this is a very expensive disease and most people don't have endless money.

perhaps what you've seen, patti, is where i've suggested looking at everything going on with the cat rather than just one area. as a nurse, i find it hard to believe you would think that's a mistake.

 

[Carolyn and Spot]

Brent, i'm wishing you the best at CSU and hoping Tigger responds well & quickly to the SRT. For a cat that followed the TR protocol, the spreadsheet would have a mid-cycle check to see how low the dose was taking the cat and in the case of high numbers, an increase every 4-6 cycles. hopefully this will be a turning point for him.

The point of this post was to offer to others some thoughts - that's what i've done. other forums don't back away from aggressive dosing with acro cats. The German Katzen forum and Dr. Hodgkins' protocol - both continue to push cats under 100. I see merit in that & wish i'd done it for punkin, unless there is some reason not to do it for that individual cat.

If it were simply a matter of the tumor output (IGF) determining dose - then by any logic Punkin would never have had a higher dose than Tommy.

If i had a cat respond as you've described with oliver, gayle, then i would also be more cautious about lower numbers. I would attribute your experience to the size of the dose and the action of the shed rather than the pancreas. have you considered the point i made above about a food/carb spikes and acro cats?

In the absence of that experience, i think telling people before their cat is even diagnosed to stay away from lower numbers isn't appropriate. each person's job is to know their own cat. as long as a cat can be brought up from low numbers, i think all effort should be placed on getting that cat between 50-120 - and i'm talking specifically about cats that are newly diagnosed or not yet diagnosed. cats that are getting 20units or more - yes, i'd be more cautious as well. as long as they are in lower doses, however, i think that there is some evidence that keeping them lower numbers keeps glucose toxicity away and contributes to keeping their dose lower.

Quoting Dr. Hodgkin's website, you may have been remiss in noting that this site uses a short duration insulin, one that does not have overlap. The action of BCP PZI, PZI Vet and Prozinc have absolutely no correlation to the action of Lantus or Levemir and since you have no experience with any of those insulins, I can not expect you to understand what you are recommending to people with your comments that these acrocats should be kept between 50 and 120 while on Lantus and Levemir - and I find it intensely frightening that you are attempting to make some sort of cross the line comparison.

As you have clearly not been present when an acrocat has been rushed to the vet hypoing, which we recently were, and have several times over the years we have been here treating acrocats, we find it inappropriate to push below 100 without solid and intellectual warning to the owner. We are not the person at the other end of the syringe, we are merely a support system. We are not going to ever advise an owner to do something so dangerous as to be fatal, nor should anyone. Above all, do no harm.

I find it remarkable that your research has not informed you of the actual aggressiveness of the dosing of the current acro owners who no longer post here or you would not refer to their off-protocol dosing as "not aggressive enough" when their aggression has included dose increases of 5u and more at a time, every 5th cycle, something I'm certain most members here would have heart palpitations just thinking about it. In fact, this group of acro owners are who initiated and implemented the 5th cycle increase, per advice from Jojo, someone you would do well to meet and chat with to add to your most extensive research.

There is a fine line here, and you're posting about your own experience with an SRT treated cat which has absolutely no bearing whatsoever on a non-treated SRT cat. One should bear in HEAVY RESPECT that one's research may hurt someone else's cat and remember not to offer such flippant advice without thoroughly informing an owner of what this proposed thought can do. It is simply irresponsible.

 

[Blue]

If i had a cat respond as you've described with oliver, gayle, then i would also be more cautious about lower numbers. I would attribute your experience to the size of the dose and the action of the shed rather than the pancreas. have you considered the point i made above about a food/carb spikes and acro cats?

Sorry, I just noticed this question.... no, Oliver is OTJ and doing just fine.... all greens.

I suppose I should add that since money is a big issue with many people, I would highly suggest having the two tests done for acro and IAA which would cost a couple hundred dollars as it's alot cheaper than a thousand dollars for a dental. Sure, you may still get the dental.... I did both for Shadoe, got the tests done and also the dental.... but if you want to eliminate something, why not go for the cheaper option? It's just a couple tests and is not as invasive as a dental, so in the case of a dose of 6-7u BID, spend $200 on the tests, and do the dental next.

Putting off the tests for a dental is just avoiding the issue. Shadoe's dose was up to 14u BID by the time her dental was done and her dose dropped to 2.5u BID. If I had waited till after the dental to test her, I may have NOT tested her, all because of a false thought that it was just a bad tooth..... I had her tested before the dental, got the positive result, and still did the dental. No time was wasted, and I knew before the dental to mention of the special precautions needed for her dental, so testing before is the better and cheaper way to go, rather than spending hundreds on all sorts of needle in a haystack testing, finding nothing, and then testing for acro and IAA.

 

[julie & punkin (ga)]

In the absence of that experience, i think telling people before their cat is even diagnosed to stay away from lower numbers isn't appropriate. each person's job is to know their own cat. as long as a cat can be brought up from low numbers, i think all effort should be placed on getting that cat between 50-120 - and i'm talking specifically about cats that are newly diagnosed or not yet diagnosed. cats that are getting 20units or more - yes, i'd be more cautious as well. as long as they are in lower doses, however, i think that there is some evidence that keeping them lower numbers keeps glucose toxicity away and contributes to keeping their dose lower.

 

[Blue]

In the absence of that experience, i think telling people before their cat is even diagnosed to stay away from lower numbers isn't appropriate. each person's job is to know their own cat. as long as a cat can be brought up from low numbers, i think all effort should be placed on getting that cat between 50-120 - and i'm talking specifically about cats that are newly diagnosed or not yet diagnosed. cats that are getting 20units or more - yes, i'd be more cautious as well. as long as they are in lower doses, however, i think that there is some evidence that keeping them lower numbers keeps glucose toxicity away and contributes to keeping their dose lower.

Are you talking about IAA or acromegaly? I think you are talking about IAA.

I am not quite sure how you would go about getting a cat into that range..... I followed TR to the letter for both my cats, but it did nothing to lower the dose or get to that range.
By following TR, which is not aggressive, it did not take long for Oliver to reach 21u BID and 7uR QID, yet he remained in a much higher range.
It's one thing to say do what is needed to keep them in that range, but you first must GET to that range.
What is called TR around here, is not TR at all, and a much more aggressive approach would be needed.
You can say what you like about keeping numbers low, but an acro will take action despite the owner's reactions. Oliver dropped from 37u BID down to 21u BID in about 6wks, and then to OTJ in another couple weeks; no change was done in my dosing methods.

 

[Carolyn and Spot]

In the absence of that experience, i think telling people before their cat is even diagnosed to stay away from lower numbers isn't appropriate. each person's job is to know their own cat. as long as a cat can be brought up from low numbers, i think all effort should be placed on getting that cat between 50-120 - and i'm talking specifically about cats that are newly diagnosed or not yet diagnosed. cats that are getting 20units or more - yes, i'd be more cautious as well. as long as they are in lower doses, however, i think that there is some evidence that keeping them lower numbers keeps glucose toxicity away and contributes to keeping their dose lower.

I think it is not appropriate to tell a person you suspect has an acrocat to push into green numbers without fear since there is no diagnosis. Anyone who has ever had an acrocat can tell another acrocat by the time they reach 3-4u following LL TR protocol, so it's not like YOU don't know, even if the owner doesn't know. A cat is no less susceptible to hypo without a positive acro test and there are plenty of low dose acros. Since a newly diagnosed diabetic cat owner can not possibly "know their own cat", then it is your job to teach them what they should know about their own cat.

I can not understand why we would just throw out some neat theories to someone and then say "go ahead and try this and if it doesn't work, you should have known your own cat."

Above all, do no harm.