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Dr. B.
Dr. B., Board Certified Veterinarian
Category: Vet
Satisfied Customers: 17086
Experience:  General practice veterinary surgeon with extensive experience in a wide range of species.
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our diabetic cat is not responding to insulin and today readings

Customer Question

our diabetic cat is not responding to insulin and today readings up to 38, despite insulin injection 6 units twice a day, and now using a human insulin. His weight is pretty stable at 6.5kg (he isn't fat, he is a very large cat), A friend who is a vet and has experience of diabetic cats today suggested acromegaly and thought there is now a blood test available. He is not showing visible signs as mentioned in the online article, but maybe does sometimes have a problem eating as dishes have teeth marks. However, he does eat ferociously. He is 6+ ( we got him from CP over 2 yrs ago).
The online articles I have seen suggest confirming diagnosis difficult but all over a year old, do you know if now a test.
Submitted: 1 year ago.
Category: Vet
Expert:  Dr. Michael Salkin replied 1 year ago.

Aloha! You're speaking with Dr. Michael Salkin
Yes, we can now measure growth hormone concentrations at the University of Minnesota in the USA and Utrecht University in the Netherlands. In cats, serum growth hormone > 10 ng/mL has 95% specificity and 84% sensitivity. There are limitations to its use, however. Growth hormone concentrations can be elevated with diseases other than acromegaly in cats such as diabetes and so results should be interpreted in consultation with the laboratory.

There are other differentials to consider for insulin antagonism/resistance such as hyperadrenocorticism (Cushing's disease/rare), infection, drugs (e.g., glucocorticoids, progestins), hyperthyroidism, chronic pancreatitis, renal insufficiency, obesity, or problems with the insulin type, storage, or administration. Can you upload a copy of his test results to our conversation? I understand that you might not have a copy of the results at home but his vet should be able to give you one which you could scan into your computer and give me the link or you can photograph the page(s) and upload the images by using the paperclip icon in the toolbar above your message box (not if you're using the chrome browser) or by using an external app such as imgur.com or dropbox.com.

Customer: replied 1 year ago.

Hello

I was under the impression I was contacting a UK website so was rather surprised to get a vet in the US, as I would not have asked the questions as I would not expect you to know about tests available in the UK, especially as I understand this maybe newly avail;able here. but thank you for you answer.I do not think worth pursuing with you as I really need to pursue this in the UK.

Expert:  Dr. Michael Salkin replied 1 year ago.
I understand. I'll opt out which will allow other vets to enter our conversation. Please don't reply to me or leave a rating - both of which will dissuade other vets from responding. I'm going to contact a colleague of mine in the UK for you now.
Expert:  Dr. B. replied 1 year ago.

Good evening,

Dr. Salkin has contacted me in regards ***** ***** question, as I am veterinary surgeon that was trained and is located in the UK. As I am sure you can appreciate, as this is an international website as people worldwide need assistance at all times of the day and night. Therefore, by working with with American vets, we can ensure no one is left without aid even in the wee hours.

Now in regards ***** ***** test your friend mentioned, I suspect they meant the Insulin-like Growth Factor-1 (IGF-1). This is still the main test that is used here in the UK when we are trying to rule acromegaly in or out. It is offered at most laboratories (ie Axiom, Nation Wide Labs, etc) and your vet will be able to advise you to which lab they use for this type of test.

Otherwise, we can use the growth hormone assay mentioned by Dr. Salkin. Even though we do not have a UK based lab with this test, your vet can still send the blood sample to the veterinary laboratory at the University of Utrecht in the Netherlands. This is something we often do here, since we are in a much smaller country with less vet schools and labs then what they have in the US.

Finally, I would just note that if you are struggling to regulate Zorro and possibly live local to London, you may want to contact the RVC vet school regarding ongoing studies that you could get involved with. Specifically, I would just note that Dr. Niessen at the RVC vet school specializes in both diabetes and acromegaly of the cat. He actually runs a London based Diabetic Remission clinic for cats and if your vet and yourself are struggling with Zorro, he would be someone to contact about how to help your lad. You can read more about him +/- contact him via HERE.

Overall, it is the IGF-1 test that we still use to diagnose acromegaly here in the UK. So, that would be our first point of call. Of course, as Dr. Salkin has noted Utrecht does offer the GH test and this too would be an option. But whichever you choose, if you are struggling or acromegaly is confirmed, then you may want to have your vet reach out to Dr. Niessen for guidance on how to help Zorro.

Please take care,
Dr. B.

Customer: replied 1 year ago.

Thank you -most helpful. We are not near London,being in North Yorkshire, but my husband is now wondering if we have had a problem with the insulin, using it for longer than recommended after first use, and keeping it in the frig after opening rather than in a dark cupboard. Anyway, we have started a new bottle but I am not convinced that will solve it as it is the 3rd type of insulin tried. Our local practice although very good, has not had much experience with diabetic cats. Our friend has, but I am hesitant to make a habit of asking her for free advice!

Anyway, he is speaking to our vet again today, who I know is trying his best but I think it may be a learning curve for him too.

Expert:  Dr. B. replied 1 year ago.
You are very welcome,

Issues with the insulin is always a concern if we have treatment failure in a diabetic (which is the same for people). That said, we do tend to keep our insulins in the fridge, so I'd not advise keeping it in a dark cupboard. If you have been, then that would be a worry. But if there is any doubt on how it has been handled, it is important to review that before undertaking testing for acromegaly.

Otherwise, if your vet is really struggling to guide you here, then you may want to gently suggest they contact Dr. Niessen who I mentioned before. He can advise them if they are struggling. Otherwise, you could consider a referral to an internal medicine specialist that only handles medicine cases like diabetic kitties. Your vet will have the best idea of your local referral practice but I would note that Calder Vets in Dewsbury are very good (though I do appreciate are in W.Yorkshire). So,that would be an option if they are out of their depth and he continues to be unstable despite your addressing the insulin situation.

All the best,

Dr. B.

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Customer: replied 1 year ago.

Thank you again. Ref storing the insulin, we had been keeping it in the frig, it is the leaflet with it that says to keep in a dark cupboard rather than the frig after opening. Insulin trade name Lantus, a human rather than animal version.

Anyway, Zorro went to the vet today and is going to have a blood test on Wednesday. He also had wondered about acromegal, but Zorro isn't really showing any other symptoms. Also wondered about cushings although very rare in cats.

Anyway thanks for your help. Zorro was a CP cat we agreed to foster, and, you know how it is, he just stayed. Sadly not insured!

Expert:  Dr. B. replied 1 year ago.
You are very welcome,
I know how it is with the foster kitties that stay for life. :)
From what I have read about the lantus, it seems that storage is flexible. So I'd just advise checking to see how your vet stores it and consider at least keeping it it's box between use to ensure its kept in the dark when not in use. That way we can rule out the insulin storage being an issue.
Otherwise it sounds like are on the right track for wee Zorro.
Please let me know how Wednesday goes,
Dr. B.
Customer: replied 1 year ago.

As you asked me to let you know how test went - we got results today as the vet tested for cushings first as he thought more likely, but all clear. now testing for acromegly. Strange thing is, if you just met Zorro you would think he was fine, except for mad eating. He got a chunk of Danish Pastry wrapped in cling film tonight - think he probably at the cling film too.

Expert:  Dr. B. replied 1 year ago.

Hi again,

I am glad to hear that he was clear for Cushing's, especially as it is quite a rare one in kitties. That said, it sounds like you are the right track testing for the acromegaly now.

Furthermore, I do just want to say that acromegaly cats do look normal and that is why it can often be missed. The majority tend to be big boned lads (sometimes owners will compare old photos and notice that they have thicker jaws or limbs then they used to) but often these cats just come to light when we find it particularly difficult to regulate their diabetes. So, I have to admit that what you have told me so far does turn my thoughts to acromegaly with Zorro. So, I do think this next test will help us get to the bottom of Zorro's wee mystery.

All the best,
Dr. B.

Customer: replied 1 year ago.

I will let you know. He is a huge cat, weighing in at 6.8kg, yet not fat. He has only been with us 2 years and was thought to be about 4 then.

Expert:  Dr. B. replied 1 year ago.
Thats grand. :)
I will keep my eyes peeled for further news on Zorro.
Speak to you soon,
Dr. B.
Dr. B., Board Certified Veterinarian
Category: Vet
Satisfied Customers: 17086
Experience: General practice veterinary surgeon with extensive experience in a wide range of species.
Dr. B. and other Vet Specialists are ready to help you
Customer: replied 1 year ago.

Hello

As promised I would let you know, just got results today , definitely acromegaly. Still taking it in, but I think we will take the hard decision to put him to sleep within the next week. I have had a long chat with my vet friend, and will be talking to our vet in the next couple of days, but prognosis not good, so would rather he went before he deteriorates too much. We go away for 10 day soon, and would not want to leave him like this.

Anyway, thank you for your help. I rated you in a previous email.. I wonder if you are Scottish. My father-in-law and both brothers-in-law were vets (trained at the Dick in Edinburgh) but no help with this problem as 2 of them are dead and other brother in law large animal.

Best wishes

Jacqueline Rae

Expert:  Dr. B. replied 1 year ago.

Hi again Jacqueline,

Thank you the update. I am sorry to hear that our suspicions were confirmed but it does explain why he just couldn't be regulated with insulin. In regards ***** ***** plan of action, I know it is not an easy decision but I do think that is fair to prevent any chance of suffering. Especially as his poor diabetic control will be taking a toll and the disease can also affect other organs like the heart. So, if he has been struggling with this already, letting him go before he does feel poorly or suffers a complication (ie DKA, throws a clot, etc) may be the best choice for your lad.

Otherwise, you were quite close in your guess, though I trained in Glasgow (so I'd be their rival Wink) And its understandable that your brother-in-law wasn't in the know about cat diseases since I imagine that farmers would likely think acromegaly is a blessing for getting bigger cows. Finally,just in case, I do want to note to disregard any more emails asking for ratings, they are automatic from the website and I do know you were kind enough to do so already for which I am grateful. Smile

So, even though its not really the answer we'd have wanted, we have gotten to the bottom of Zorro's mystery. So, do enjoy the days to come with him and once you are ready you can let him go and prevent him from any suffering from this difficult disease.

Take care,
Dr. B.

Customer: replied 1 year ago.
Just to let you know the deed is done and Zorro is now buried in the garden with all our past cats. The house seems very quiet, which is surprising given that we have 3 other cats but indicates how much his condition and care was dominating the household. Our vets confirmed they had never seen a case of acromegaly in a cat before, even the oldest vet in his 50s. Our vet friend, also in 50s and a bit of an expert in cats obviously had seen it but rarely and not for several years. Have you ever seen it?
We know Glasgow vets as well, Alf Wight was my father in law's best friend, despite being neighbouring practices,, and his son Jimmy is a contemporary of my brother in law.
Anyway, thank you again for your support.
Best wishes
Jacqueline Rae
Expert:  Dr. B. replied 1 year ago.
Good afternoon, Jacqueline.

I am sorry to hear that Zorro is no longer with us, but I do think it was the kindest option under the circumstances. And while I am a bit surprised that your local extensively experienced vets hadn't seen acromegaly before; I assure you they will know when to suspect it with diabetic kitties forever more. It is one of those diseases that I suspect sneaks past people (perhaps mistaken as a difficult to regulate diabetic kitty) until they face it head on. In fact, when I was at a talk on acromegaly (given by Dr. Niessen at the RVC who I mentioned before), he noted that he suspects that up to 25% of cat diabetics are actually acromegaly cats in disguise. So, its out there and we are diagnosing it more often but it is still sneaking past some vets/owners that have not run into it before.

In regards ***** ***** personal experience, I have had 2 cases in the past few years. So, its not as common as primary diabetes, but it is out there. That said, I suspect I am particularly sensitive (and why I was agreeing with your suspicions from the start) because my first case was actually a diabetic cat that I took on when an owner didn't want to treat. Like Zorro, my cat was large boned, otherwise healthy, but as I tried to stabilize his diabetes I found him a real struggle. And like your vets I was unsure why I couldn't regulate his diabetes until I discussed my frustrations with a feline specialist I worked for. Just on history alone, acromegaly was his first suspicion. We testd as you did and he was right. (Sadly, he threw a clot due to Acromegaly precipitated heart disease and why I mentioned clots as a risk for Zorro before). So, it is one those uncommon sneaky diseases that slip by owners and vets until they have had experience with it, and then one is sensitive to it ever afterwards.

Take care & all the best to you and the other kitties,
Dr. B.

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