? Switching insulin? 6/19 Puddin AMPS 348, +4 388, pmps 222, +3 281

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I'm curious lately about the idea of switching insulins. I've heard a few people going from Lantus to Levemir and noticing improvements. Today I read about Peter whose story sounds similar to Puddin's (receiving a depo shot and weeks later was down many lbs). From what I've understood, Peter's switch to Levemir from Lantus helped him go into remission (I don't know what dose he was on with Lantus)...I'm curious about this. As Peter's story goes, the higher the insulin dosage, the numbers never really improved - but the cat seemed to feel better...same story with Puddin.

Does anyone have any insight on this? Could it be worth it to switch insulin already - or, rather, what would give me signs that Lantus isn't working as well as another insulin?

 

The results for IAA and Acromegaly came back - these are the values the vet told me over the phone, I will receive a printout/email later on.

IAA: 4
IGF-1: >1200 (vet said they don't test above this so he is above 1200)

Vet is putting in a referral to an internist at NC State, I believe - or around those parts. I'll weigh the option of actually going. I don't intend on doing surgery or radiation, so I'm not sure what their options are.

@Wendy&Neko
@kthondragon
@JLS12

 

NC State internist doesn't have appointments until the end of August

 

Ouch... that's terrible! Are there any other ones you can see?

 

I think they're the closest, but I might ask if there are others, that's a great idea.

 

Sorry about the results, but now you have answers and a path forward. Side note, thank goodness no IAA, that's just another complication you don't have to deal with. Above 916 is positive for acromegaly, you don't really need an exact number if above that. The IGF-1 number doesn't tell you anything more than it is positive.

The most important thing to remember, Puddin doesn't know he has acromegaly, he's the same cat he was before this diagnosis.

One of our recent members had problems getting into NC State too (was already a client there), but got in faster by going on a wait list.

Another thing to consider is how much your general practice vet is willing to do. NC State does SRT. Surgery closest to you is New York City. The remaining treatment option is cabergoline which is a medication your vet can prescribe. Many people get their regular vet to prescribe it, rather than an IM. The one good thing about the folks at NC State is they've done lots of research on acromegaly so very knowledgeable about it.

 

I mentioned Cabergoline to this vet, he had never heard of it, so he did a quick search and wasn't sure how to appropriately dose it or how to obtain it in the correct dosage (he only found it provided in .5mg dosage and said cat dosage would be around 1/17 of that). He did mention this would be a learning journey for both of us.

Do you have any articles I could provide him to review that mention Cabergoline in this use or dosage - I think this might help him be more confident in providing me a prescription.

Is there anything I need to be more aware of with Puddin in relation to how the tumor can affect him?

Also, are there any links to this being hereditary? Puddin is one of six siblings, of which I have all.

 

I don't have anything helpful to add, but I'll be following Puddin's story.

 

See the paper I attached in post 6 on this thread: New paper on: Cabergoline treatment in cats with diabetes mellitus and hypersomatotropism
Note this paper suggests Cabergoline every other day, but the Royal Vet Clinic (much smaller and shorter study) did every day. People here have done both. EOD can help with any GI side effects if they have it, every day may mean it works faster.

Get the cabergoline compounded, lots of people talk about where to do that in this post:
Cabergoline as a possible treatment for acrocats: discussion
It's great your vet is willing to learn with you. Mine did too.

As for what to expect, it really is ECID. This paper gives a good idea what is happening inside.
Feline Comorbidities: Hypersomatotropism-induced diabetes in cats

My suggestion is to continue on with regular blood work. Kidney issues happen to a fair number of these cats. As can heart issues (enlarged heart due to growth hormone). If the vet detects any murmur, and echocardiogram would be a good idea. There are some common conditions that may need treatment, such as arthritis from bony growth. GI issues are not uncommon (constipation, IBD, some get megacolon). Note, all of the ones I've listed can take years to show up or may not at all for an individual cat.

This is one of those not well known things. Speculation is that it's caused some of the chemicals we have around. I've also heard there may be a family connection, but have seen people with family member cats and only one acro. Then there is Jodey with her Eddie and Blue (GA) who were brothers.

Regarding the question about insulin, unfortunately Levemir is being discontinued in the US at the end of this year. I think it's a great insulin for cats. Tresiba might be another option, but we don't have a lot of experience (or dosing methods) with it here.

 

Thank for all of this information, Wendy. I'll be reading through it all.