? Upp'ed dose with small response

NadineTheodore

NadineTheodore

Member Since 2023
Hi,

We upped Theodore's dose to 2.5 and it seems the dose didn't have a huge response. I know Lantus is slow to work but I am wondering if this is normal, should I look at getting a new vial? I forgot to put it away 1-2 times in the fridge. I purchased it last week of May 2023.

Also specialist vet brought up Acromagley testing again yesterday. Is it something I should start thinking about to test for?

https://docs.google.com/spreadsheets/d/12xCz_cP0ZAXkPKv3s_0DG4mAJv1WbMn77XQ-mkr5nbA/edit?usp=sharing
 
Hi Hendricks,

Both specialist and family vet said to increase yesterday. I had my follow up with the specialist yesterday and he said we needed to increase then touched base with my doctor as I wanted to loop her in with what they told me.

it would be Start Low Go Slow (SLGS) but we didn’t wait the full time based on doctors advice
 
Lantus is a depot style insulin, meaning it can take a few cycles for you to see what the dose is capable of. One of our sayings here is that Lantus teaches you patience. Never my strong suit! May is still a young vial. Next time you might want to look at getting a 5 pack of cartridges. That way if you leave one out or it goes bad, it's less insulin wasted.

NadineTheodore said:
Also specialist vet brought up Acromagley testing again yesterday. Is it something I should start thinking about to test for?
Click to expand...
Did the specialist say why they thought it was worth testing for? My girl had it, and studies have shown about 1/4 of diabetic cats do, but it's quite an expensive test in Canada. The blood goes to Michigan State University, the only place in North America that does the test. We typically don't suggest people get the test done until the dose is closer to 6 units, unless there are clinical signs that are indicative of it. I see some poop emergencies on the spreadsheet. Megacolon is a symptom some acros get, as is enlarged organs, which I see he also had. The large clinical study that showed 14 of diabetic cats has acromegaly found a number of such cats on doses as small as 1 unit so his size of dose is not a reason to hold off on getting the test.

If you go ahead with getting the test done (might be a good idea), I would also get a test done for IAA (insulin auto antibodies), which are sort of like the bodies allergic reaction to injected insulin. My girl also had that condition. It can change some of our dosing strategies. The IAA test is a cheap add on if getting the acromegaly (IGF-1) test done.
 
Wendy&Neko said:
Lantus is a depot style insulin, meaning it can take a few cycles for you to see what the dose is capable of. One of our sayings here is that Lantus teaches you patience. Never my strong suit! May is still a young vial. Next time you might want to look at getting a 5 pack of cartridges. That way if you leave one out or it goes bad, it's less insulin wasted.


Did the specialist say why they thought it was worth testing for? My girl had it, and studies have shown about 1/4 of diabetic cats do, but it's quite an expensive test in Canada. The blood goes to Michigan State University, the only place in North America that does the test. We typically don't suggest people get the test done until the dose is closer to 6 units, unless there are clinical signs that are indicative of it. I see some poop emergencies on the spreadsheet. Megacolon is a symptom some acros get, as is enlarged organs, which I see he also had. The large clinical study that showed 14 of diabetic cats has acromegaly found a number of such cats on doses as small as 1 unit so his size of dose is not a reason to hold off on getting the test.

If you go ahead with getting the test done (might be a good idea), I would also get a test done for IAA (insulin auto antibodies), which are sort of like the bodies allergic reaction to injected insulin. My girl also had that condition. It can change some of our dosing strategies. The IAA test is a cheap add on if getting the acromegaly (IGF-1) test done.
Click to expand...

The specialist brought it up to rule out possibilities. He has slightly larger than normal organs such as liver, spleen and one kidney but he is also slightly larger of a cat. He was a stray cat and binge eats. He had constipation issues since 2019 as he had a love affair with dry. He is also FIV+. I never knew how bad dry food is until my late cat got a ureter blockage and died after trying surgery to correct this issue at a specialist. It was one of the hardest things I had to go through. about 10 days before Max's ureter surgery, Theodore had dental work (90% of his teeth removed). His tooth was bad and kept getting infected, certain antibiotics gave him allergies, skin allergies, diarrhea, it was hell. He had diarrhea for a straight month. This was a different vet that I really did not like as they would brush everything off and they kept him on antibiotics until his surgery in December. He was infected mid October. In my opinion he should have never been on antibiotics that long. We put him on an all wet diet and this is where my issues with megacolon started. The vets initially brushed it off, said he needed a high fibre diet and sprinkle of restoralax. They said anesthesia constipates people and it's normal. It finally was confirmed as megacolon in April 2022. That said our vet had X-rays since 2019 showing larger than normal organs. The specialist didn't say where they were sending it but the quote was $500-600 for the test and my family vet doesn't think it is worth testing for as of yet. She said to wait 5-7 days on new dose before rushing to decisions. Next step she suggested a new bottle then after that then upping dose to 3 units THEN testing for acromagley. She stated they send it off to Michigan and it's around $400 CAD. I don't quite understand what Acro is. If diagnosed with Acro, what does that mean? What's the long term picture look like for my Theodore? The poor guy has so many issues as is and he is only 8

It just seems the only luck we get is bad luck and he's honestly such a wonderful cat. I had trouble getting the hang of Theodore's Megacolon meds for months when I finally got the right mix. Lactolose would make him sick, I read that restoralax (miralax in USA) is bad for their heart so I was trying to avoid it but it works for Theodore and he drinks tons of water. Finally in December I realized mixing it into a catit tube treat he would take restoralax no problem vs me syringe feeding it with water. Now I wonder if all those catit treats morning and night are the reason he's diabetic. :(

Lastly - it's funny you bring up patience because it clearly is not in my DNA, I am on the ball with my kitties so seeing all my effort and stress with high numbers stresses me out all the time. I've jokingly asked my vet to give me a prescription for gabapentin LOL

I used the pens initially but preferred the vial.
 
Must say I'm impressed by the specialist. So many vets need convincing to run the tests. And if it is positive, there are treatments and the sooner the better. Acromegaly, more properly hypersomatotropism - but that's too bit a mouthful, is a benign tumour on the pituitary gland, that causes excess growth hormone to be output. The result of the excess GH can be growth in both soft tissue and bones/organs. Often these cats are super foodies, think of growing teenage boys. The treatments range from surgery (high end) to radiation therapy (all that was available at the time for my girl), to a newer daily medication called cabergoline. Life spans are definitely shorter without treatment. Growth of organs such as kidneys and heart are hard on them. But we've also seen some kitties go off of insulin with treatment. And everywhere in between. Seems there aren't really two cats and side effects that are alike. Neko was always on insulin, but she got to some really tiny doses and a lot better QOL after treatment.

Instead of Catit, have you tried Churu? They are low carb and cats usually love them.

Definitely make sure you leave time for yourself, and doing things you like to do. I too remember the stress at the beginning, and my exercise is what kept me (sort of) sane. Especially if they are having a high numbers day.
 
I ended up switching to fancy feast wet treats but I’ll switch to churu. Didn’t know they were a good option.
Just so I understand correctly, there’s a do cats that respond to low units of insulin?

Which treatment did you opt for and would it change given the new medication available? Surgery would be a hard no for me. I don’t think that’s fair to him given all his issues
 
I think it's premature to discuss treatments, before we have a diagnosis. Treatment choices are really personal. There are big cost differences and radiation and surgery also require travel, unless you happen to be lucky enough to be near a centre that has the skills/equipment needed. We travelled three days each way to Colorado for treatment, which I was worried about cause my girl complained bitterly on the 10 minute drive to the vet. She got to be a better traveller after our long trip, and we even took her on trips away after that. I'm still wary about surgery too - there are very few vets in North America that are trained on it, and of those, not a serious track record. Compared to the Royal Vet Clinic in London UK which the gold standard. This paper, second case study, has a table comparing the options: (2020) Updates in Feline Diabetes Mellitus and Hypersomatrotropism. Of note, the experience with cabergoline has grown even more since the paper was written, including a large scale study in South America. The paper also does not differentiate between conventional radiation therapy and SRT, and there are huge advantages of SRT - just fewer locations able to do it.

One thing on testing for acro, research at Royal Vet College in London has shown that it's best to test at least 73 days after starting insulin. Before then, about 1/3 of the cats in their study had a false negative. We had one person here who tested too early and tested negative for acro, but positive at a later test. I think today is day 68 for Theodore?
 
I think day 66 so we are a little premature for testing for Acro then. His number this morning was 32.2 but he got to the dry food we had left higher for the others so I am sure he binged on that. Dry food always spikes him plus we had a contractor come fix our security cameras come on by so I decided I am not testing him until the evening. I know it will be high as today is a hard day for him.

Did I share with you the ultrasound results?
 
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