Virgil probably has acromegaly-- how to proceed?

[ProfCat]

I spoke with our vet today about Virgil's numbers just not budging. The chart is here. She believes he has acromegaly because he is a LARGE cat and his toes and paws and nose have grown more prominent in the past year (he's always been big, but it's moreso now-- he is 11 years old). And he snores terribly. He also had entropic eyes suddenly last summer, and that is a sign of acromegaly. Then, after that surgery, he wasn't healing well, so we had bloodwork done and found out he was diabetic in November.

Our vet used the dog protocol and originally had him on ProZinc, and we increased the dose too fast. She also wanted him fed only 2x a day, 12 hours apart, with his shot. I showed her the research and protocols for cats, and she agreed to try Lantus and increase slowly, and also that he can eat low- to no-carb food at any time (excluding 2 hours before AMPS and PMPS). We've used our vet for over 10 years, and I love the fact that she listens and learns.

She did some research on acromegaly, the bloodwork, and the treatment. She didn't think we need to bother with the bloodwork as treatment would basically be increasing his insulin dosage until we find what works. I can push her on getting the blood work done if it makes sense, but it was a quick phone call before I was teaching, so I didn't have a chance to get into the details. We could never afford the surgery, so I'm not sure it's worth it to go as far as an MRI etc. We just want as much quality of life as possible.

She said, assuming he has acromegaly or has some other kind of insulin resistance, we could go up quicker on the Lantus. We are at 4 units now, and she said to go to 5 instead of 4.5. And to increase by 1 unit every 5 days rather than every 7 days. We want to see the numbers changed, so I am tempted to follow her advice. Thoughts?

Otherwise, Virgil is acting fine. His bloodwork was great, other than the diabetes. He drinks a lot of water and pees a lot, but no ketones. He eats great and acts like he feels good overall.

 

[Wendy&Neko]

I would encourage you to get the vet to get two blood tests done. One is for acromegaly (the IGF-1 test) and the other for insulin auto antibodies (IAA). Both tests are blood tests send to Michigan State University. We have seen a few cats have just IAA and not acromegaly, though some have both. IAA can get better over time on it's own, but has no specific treatment. Acromegaly has several types of treatment. There is one, a medication called cabergoline, usually compounded in a liquid, that is given every day or every other day. It is a lot cheaper treatment and the most common option used now here. We've seen a handful of cats go off of insulin and several have their insulin doses go down a lot. But you really need to know that you are dealing with acromegaly first - hence the blood tests need to be done. MRI or CT scan only worth while if planning surgery or radiotherapy (such as SRT or stereotactic radiation therapy), and usually done as part of that treatment instead of done separately.

There also some dosing tweaks we recommend if we know a cat has either IAA and/or acromegaly. But again, done with knowledge of what we are dealing with. I had to really work on my vet to get the tests done, asked her to humour me, and was so glad when I was right.

Note, normally we suggest people get these tests when a cat gets to 6 units, and one of those conditions is very likely if the cat is eating an all low carb wet or raw food, doesn't need a dental, or have any other medical conditions. But we've also seen some cats with those conditions under 6 units.

If it was possible for you to get at least two tests in the AM and PM, we could go with faster increases, which is a better solution than larger dose increases. Many cats go lower at night, getting a test before you go to bed if at least 2-3 hour after the PM shot, will tell us if he's going lower at night.