Worried my cat has acromegaly

Hey all. I am worried about my cat, Sufjan. I posted about him here before. He was diagnosed with diabetes on October 2020. We quickly got his BG under control and he went into remission after about two months. Unfortunately in April, he got into some dry food while we were out of town and relapsed. We got him under control again with an average dose of 1.5u, twice a day. That controlled well so I eventually decreased my testing rate to every few days. Eventually, I noticed his BG trending upwards so we have him closer to 2u to keep him below 150. Then, somewhat quickly, he started reading above 200. We thought maybe his insulin had lost its effectiveness. It was 3 months old so we got some new insulin. It wasn't any better. By this time he was measuring BG in the high 300s.

We brought him to the vet and they gave him some antibiotics and fluids in case he was fighting an infection. His levels came down quite a bit that day so I gave him only 1u to be safe in case the built up insulin all kinda hit him at once. Unfortunately, the lower BG was likely just because of the fluids making him more hydrated. I've bumped him up to 3u for a couple days but he's still in the high 300s. He does show some response, hitting low 300s at the nadir, but I can't seem to get any consistent decrease in the overall trend. I know it hasn't been that long, but I had months of handling his BG, so I know how he normally reacts to insulin and it's just totally different. And it all happened pretty fast.

So now I'm concerned he has acromegaly. He's always had some respiratory issues, having coughing fits occasionally and just bring a kinda noisy breather. But recently he's also started making little grunting and chirping type noises when he breathes and purrs which he never did before. I know this is a potential symptom from growth in respiratory tissue. That and the seeming complete resistance to his insulin at doses that used to work is concerning me. His weight has been consistent around 11.5 lbs. His belly is very rotund and compact seeming for lack of a better term, but it's always been like that. He has an appointment with a specialist, but that's not till August 9th.

Can anyone chime in here or just let me know what to expect if he does have acromegaly? How long can I expect him to maintain a happy life? I'm just very stressed about my best friend.


I also backfilled the readings from when he relapsed in April, till his levels increased in early July. As you can see, it was quite rapid.

Historical Readings

 

Have you had his heart checked out? That can be the culprit with the respiratory issues. Not trying to scare you of course but that was what was going on with my civvie.

 

I have not. Can you elaborate a bit on what would be up with his heart? Would that also impact his response to insulin?

 

I'm sorry, I can't seem to open your spreadsheet, would you please double check the link? Without the more recent BG data and dosage, it would be impossible to determine what may be going on, although by the sounds of it, you are possibly changing the dosage in 1u increments? With Lantus, we often find that dose adjustments are best done with 0.25u increments generally, but again a SS will be helpful.

I found this previous post, for continuity, LAST POST

which is where, after reading through, I see Sufjan is on Lantus. It would be ideal if you could set up a signature, since we have many different posters, who use different insulins on this forum, so setting up a signature helps, so people don't ask redundant questions:

• On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback. There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.

• Add info we need to help you:
  • Caregiver & kitty's name
  • DX: Date
  • Name of Insulin (do not include dose or frequency)
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.

Sienne mentioned in your previous post that time that sometimes kitties run up against some glucose toxicity, which happens when they get a bit too comfy in higher numbers, but again, seeing the SS will help a great deal in giving you advice.

As for your question regarding Acro, there are tests that can be run, but my recollection is that this is usually recommended when a kitty needs more than 6U of insulin. I have seen kitties here who need more insulin as a result of pancreatitis, hyperthyroidism, and heart conditions, but my recollection is that those kitties weren't above 6U. Did your vet happen to run any blood tests at your last visit? anything out of the ordinary in those results that you can share?

I'll tag @Wendy&Neko who has much more (direct) experience with both Acro and IAA.

This subforum has a bit of additional information for you: Acromegaly/IAA/Cushings

 

I see you have added a SS in your signature, while I was mid-response, thank you! It does appear that you are making too many dose changes too quickly, in both directions .

Ideally you want to hold a dose for at least 6 cycles (three days). With Lantus, we dose based on the nadirs (how low the dose is taking the kitty), not preshots. You may want to try holding the 3U since you've been doing this now for 3 cycles, and continue to get a before bed test each night, we often suggest a before bed, since many kitties like to go lower at night (although at the moment Sufjan does seem to be stuck).

Depending on the BG tests you get over the next 3 cycles, you're welcome to come over to the Lantus, Basalgar and Levemir subforum, those of us who are experienced with Lantus can help you further regarding questions on dosing. May I also ask, what are you feeding Sufjan, ie. exclusively canned food (or raw diet) or are you feeding any dry food at all?

 

The current thinking is that 20-25% of diabetic cats has acromegaly. Many don’t have symptoms, my girl didn’t have any initially but her dose and extreme hunger from the growth hormone. Oh, and one tears eye from soft tissue blockage of tear duct. I didn’t find out that was a symptom until much later. Her breathing only got slightly noisier five years later. We have also seen acros on less than six units, and there have been cases of ones not yet diabetic.

To answer the question on what to expect, it really varies. Getting tests done to know what you are dealing with is the first step. There are treatment options if confirmed. I realized later my girl had acromegaly at least six months before her diabetes, so lived over five years with it.

 

I've updated the signature with more info. But he's on a wet food only diet (fancy feast pate). And I know you're supposed to stick with a certain dosage for longer, so I'll do that from here on. Just in the past, he was much more responsive to dosage changes such that you didn't need several days to notice the difference. He is not newly diagnosed. I had months of treatment experience with him, getting to know how his body responds. Only recently did his BG go from controlled to not controlled. Now he does not seem responsive at all. Is it normal for a cat to suddenly need twice the dosage as before? Again, he went from <150 to >300 in about a week. I think that's the most puzzling thing to me. I know some cats are difficult to control when first beginning treatment, but this went from easy to control to impossible...

 

I did also manage to open the historical readings, and saw there were some recent numbers in the 100s. The trouble is it is hard to see possible patterns with the data there, since it looks like you've had sporadic tests until recently. I do wonder if the dose hopping is a good part of the reason in the recent trend. However, I've seen kitties with dental issues go from good steady numbers to all of a sudden out of control, due to infection/inflammation/pain. But you mentioned you were at the vet a few months ago? Did the vet have a look at Sufjan's teeth? Any chance he's got something going on there?

 

Yes, in the historical document you can see that he was controlling in the low 100s for some time, then abruptly around 7/9, jumped to 300s. I also tested my own blood to rule out a busted meter.

Sufjan was at the vet last Friday. I don't know how close they inspected him, but she had mentioned dental possibility beforehand as well as possible UTI. Regardless, she gave him some antibiotics to account for either scenario. She said if that was the culprit he should improve quickly, but if he hadn't by Monday, she would refer me to a specialist which is exactly what happened. So he is scheduled to see a specialist on August 9.

 

Ity is hard to tell because of the relatively low dose. With Snuffles are was concerned when dose got to about 5 and I say little reduction is BG between cycles. You are seeing little change in BG.
What I did was to go to Walmart and get some N insulin (no script required and 10ml cost about $27) to see if I could get a good drop. I used N since I could quickly increase dose. I did see a drop as N increased . This was like I experienced with my first confirmed aero MurrFee. I expect no that my first diabetic Grar Ghost also had acromegaly but that was 20 years ago and no one wanted to increase dose.

IN you case I wouod increase dose and see if you can get a good drop. If that happens at 6 or so units I wouod get him tested for both acromegaly and IAA (insulin autoantibody)

 

You've got some great, much more knowledgeable answers than I could give but regarding the breathing and his heart, when a cat has heart issues, fluid can get inside his/her lungs, making it difficult to breathe. My cat with the heart issues, congestive heart failure to be precise, did not have diabetes so I am unsure if it can effective insulin or make a cat insulin resistant but I would get the heart checked out for sure regarding those breathing issues. Good luck!!

 

@Cyrus I would caution against using any N insulin at this point. That is a specialised field and you would need to have reached other milestones before thinking about using N insulin which is an aggressive approach. And you would need to have experienced members helping you.
I would ask the vet again if he checked the mouth thoroughly as many cats have raised BGs because of dental issues. An antibiotic may not necessarily solve the problem.

 

I too would caution against using Novolin N at this time. You want experienced members who have done that to lead you and I don't know of anyone other than Larry currently using N with Lantus. I would start with picking one of the dosing methods we use here, and following it for a while to see what happens.