Feline diabetes and acromegaly

RE: Feline diabetes and acromegaly

Sarah Keir — Sat, 05 May 2018 12:54:00 GMT

There is one big clinical sign that we as the patient's vet, can monitor and that is its weight.

RE: Feline diabetes and acromegaly

Martin Atkinson — Fri, 04 May 2018 09:35:16 GMT

[quote user="robloxley"]My feeling is that curves are useful for investigating animals not doing well, but I prefer good clinical monitoring and don't advocate routine glucose curves[/quote]I repeat, my experience is that those cats whose owners agreed to regular monitoring and we adjusted the dose accordingly lived longer than those where this was not the case. You cannot rely on owner's observation of clinical symptoms we know they are often not that observant and suffer from caregiver placebo syndrome. OK if its drinking gallons that might alert you that something is amiss but a cat which seems clinically normal may be on the verge of a Somogyi overswing.

PS before DM or anyone else comes in and says this is just anecdote 'provide the evidence' - no I don't have the statistics to back this claim up.

RE: Feline diabetes and acromegaly

Gillian Mostyn — Thu, 03 May 2018 19:51:07 GMT

[quote user="robloxley"]My feeling is that curves are useful for investigating animals not doing well, but I prefer good clinical monitoring and don't advocate routine glucose curves[/quote]

Ditto

RE: Feline diabetes and acromegaly

Rob Loxley — Thu, 03 May 2018 17:01:13 GMT

[quote user="Martin Atkinson"]However, IMO you are on very thin ice depending on fructosamine alone. You may get raised levels because of a chronic Somogyi overswing and then if you raise the dose even more are in danger of precipitating a hypoglycaemic crisis. I think regular glucose curves are essential[/quote]

[quote user="Kate Richardson"]Interesting JSFM article a while ago about monitoring diabetic cats and if I recall correctly, managing based on clinical signs alone is as good as any form of blood glucose monitoring[/quote]

My feeling is that curves are useful for investigating animals not doing well, but I prefer good clinical monitoring and don't advocate routine glucose curves

RE: Feline diabetes and acromegaly

Kate Richardson — Thu, 03 May 2018 16:34:58 GMT

Interesting JSFM article a while ago about monitoring diabetic cats and if I recall correctly, managing based on clinical signs alone is as good as any form of blood glucose monitoring

RE: Feline diabetes and acromegaly

Cool — Thu, 03 May 2018 16:18:57 GMT

I see your point there and I agree totally. I just find doing their glucose curve in practice not very helpful as stress tends to increase their serum glucose as well. i have always been very careful of my insulin dose adjustments in cats though and I am yet to have a hypo. i have had hypos in dogs despite the use of glucose curves and fructosamine.

RE: Feline diabetes and acromegaly

Martin Atkinson — Thu, 03 May 2018 16:13:18 GMT

[quote user="Adebowale Ajao DVM, PGCertSAM, MRCVS"] I generally wont bother with glucose curves in a cat and in cases of concurrent diabetes and acromegaly. I generally rely on fructosamine [/quote]I can't comment on controlling insulin in acromegalic cats, I have little experience of them and the only one I've treated with the phenotype didn't require massive doses to manage it.

However, IMO you are on very thin ice depending on fructosamine alone. You may get raised levels because of a chronic Somogyi overswing and then if you raise the dose even more are in danger of precipitating a hypoglycaemic crisis. I think regular glucose curves are essential for monitoring.

RE: Feline diabetes and acromegaly

Cool — Thu, 03 May 2018 16:06:51 GMT

Somatostatin analogues and growth hormone antagonists have been used in several clinical studies without much joy for treating acromegaly. I had a case a while ago and my patient was in a similar situation i.e finance was a limitation. I managed him for over two years with increasing dose of insulin and diabetic diet. I generally wont bother with glucose curves in a cat and in cases of concurrent diabetes and acromegaly. I generally rely on fructosamine and I have had a lot success stabilising my diabetic cats using their serum fructosamine as a guide. If the cat is in good body condition I found in my case that the diabetic diet helped reduced the insulin requirement. hope this helps.

RE: Feline diabetes and acromegaly

Beats — Thu, 03 May 2018 09:54:15 GMT

Just a question, not a suggestion, but can you use determir (Levemir) insulin in cats needing such high doses?

It's cheap and powerful and need only tiny volumes in big dogs. I would have thought accurate measurement without overdosing would be impossible in a cat, but if the issue is that you can't get enough insulin into the cat (and causing hypoglycemia with a long-acting synthetic insulin therefore seems less likely) then is determir an option?

RE: Feline diabetes and acromegaly

David Mills — Wed, 02 May 2018 23:12:32 GMT

You can get that thing you put under the skin for a few weeks if money available.

RE: Feline diabetes and acromegaly

ebedford — Wed, 02 May 2018 22:44:46 GMT

Unfortunately very doubtful that's something the owner would be able to do...

RE: Feline diabetes and acromegaly

Kate Richardson — Wed, 02 May 2018 22:37:14 GMT

Get them to do home glucose curves, saves heaps of money and more accurate

RE: Feline diabetes and acromegaly

ebedford — Wed, 02 May 2018 22:29:11 GMT

Thanks everyone! Unfortunately it is difficult to get accurate history from the owner so not sure how successful basing response just on clinical signs will be. I've been wondering about getting a single reading at the 8 hour point hoping to get the nadir, and just seeing what happens with this as the dose increases - we've been trying to do curves but cost adds up with these as well.

RE: Feline diabetes and acromegaly

Sarah Keir — Wed, 02 May 2018 22:20:46 GMT

I would go on clinical signs more than glucose measurements/curves/fructosamine - the cat is very unlikely to be perfectly controlled but enough to control its signs and give it a good QOL.

RE: Feline diabetes and acromegaly

Bill Nolan — Wed, 02 May 2018 22:19:56 GMT

One case so far, IGF1 1,700 at diagnosis. Swapped to PZI and started on Galastop (https://www.google.co.uk/url?q=http://www.felinediabetes.com/FDMB/threads/cabergoline-as-a-possible-treatment-for-acrocats-discussion.184012/&sa=U&ved=0ahUKEwjbote9-OfaAhXnCMAKHfJ7Ay8QFggNMAA&usg=AOvVaw0WA0xCXNWQAjRHemtqgD7C, https://www.google.co.uk/url?q=https://www.researchgate.net/publication/318947744_Pharmacological_treatment_with_cabergoline_in_three_cats_with_acromegaly&sa=U&ved=0ahUKEwjG3aO2-OfaAhVsAsAKHe7KAT8QFggQMAE&usg=AOvVaw3z-Lx-XfCZ1GvAWiNpt05V )

Repeat IGF-1 concentration should be coming in the next week or so (will keep posted), but fructosamine down from 800 to 400, less PU/PD and weight stable.

The evidence for cabergoline in acromegaly is anecdotal at best, but as its relatively affordable compared to other treatments i think that more routine testing and trial treatments could help generate the first opinion data needed.

RE: Feline diabetes and acromegaly

Kate Richardson — Wed, 02 May 2018 21:36:40 GMT

Yes just keep increasing until you hopefully find a dose that works. ‘‘Tis a bit scary using such high doses but have known cases (not my own) needing doses around 25 units bid

QOL most important as Sarah said

RE: Feline diabetes and acromegaly

ebedford — Wed, 02 May 2018 21:12:24 GMT

The cat seems to be doing ok - so did they just keep increasing the dose until try for a good response with glucose measurements? Can you remember what dose the cat was on in the end?

RE: Feline diabetes and acromegaly

Sarah Keir — Wed, 02 May 2018 21:00:22 GMT

I know of a colleague's case that was reasonably managed on insulin - just huge doses! I think it is more important to assess the quality of life - if reasonable and cat otherwise doing OK then keep going?