Magic's condition has deteriorated to such an extent that on balance I feel my hand is forced and that neurosurgical intervention is the only realistic hope of curing or improving her diabetes and giving her a reasonable quality of life. Making this decision has been very hard. This surgery is fairly new and I am sharing our experience for anyone facing this situation.
Magic's illness became apparent on Friday the 13th in June 2014 when I realised she was non-specifically 'wasn't right' and took her to our own vet. She was so good/ill that I was able to get her to settle for an unsedated xray and the presumptive diagnosis was Hypertrophic Cardiomyopathy (HCM) and treated as such. Three more visits over the next few days saw her get sicker and sicker, stop eating and I was beside myself with worry.
This marked the beginning of a huge learning curve for me as her carer. At first she needed fed twice a day through an oesophageal tube, given an impressive schedule of drugs, blood glucose testing and given insulin injections.
Things improved, the tube was removed after a few weeks, her blood sugars settled, her organs began to improve and she needed less and less insulin. She also tolerated my little handmade neck warmer that stopped her scratching the tube wound on her neck.We were on the road to remission and recovery and could put this whole distressing incident behind us. Summer looked sunny.
In a few weeks Magic was on a half unit of insulin which was so small I could barely see to draw it up in the morning but she was showing blood sugars and fructosamine results which were entirely in the non-diabetic range. Then within a fortnight her readings got higher and higher until she reached 30 on the 2nd of Sept which is a dangerously high level. This began our intense battle to gain any kind of control. Her insulin was switched from Caninsulin to the human Insulin Glargine also known as Lantus which has a reputation for a more even glycaemic control and less risk of hypoglycaemia. We explored the option of Magic as a candidate for the Diabetes Remission Trial at the Royal Veterinary College in London but the attendance schedule would have been prohibitive and not in her best interest.
As it became clear the insulin resistance was not a blip or phase we began further testing starting with an Insulin-like Growth Factor-1 (IGF-1) test for acromegaly test. After a nailbiting wait, as the test is only run in Cambridge weekly, her result came back at 2000. An IGF-1 result of 1000 is considered diagnostic of acromegaly. This gave a reason for her insulin resistance but opened up some pretty scary treatment options including surgery and radiotherapy which I didn't even wish to have to contemplate.
This was my summary of the four main treatment options:
Escalating insulin therapy to achieve control-this is the most common route particularly as surgery has not been an option until very recently.
Drug therapy with human drugs- this has a poor impact as there are issues regarding how well the drugs cross the blood/brain barrier. Some newer human drugs are apparently showing some promise.
Radiotherapy - This involves 20 sessions with an accompanying anaesthetic each time. This can have side effects post therapy and results can be variable. There are newer protocols with only 5 or 10 sessions.
Surgery- Transpenoidal Hypophysectomy, removal of the pituitary gland through an incision in the mouth to access the skull and the pituitary gland, is an emergent treatment option. It has shown good success in bringing about either complete remission or a return to insulin sensitive diabetes. For cats who survive the surgery the outcomes have been positive. Only a small number of cats have been treated in this manner, the surgery is not without risk and the recovery needs to be intensively managed.
I read every research article that I could find and had a number of long conversations with our own vet in Glasgow. My decision was to pursue the most common option of increasing insulin doses to try to get to a level where response occurs. This is what we've been doing and frankly it has barely shown an impact on her blood sugar level which I test at least twice a day. My sweet little cat was receiving 21units of insulin twice a day with a negligible effect as her blood sugar generally remained around the mid-twenties.
Disclaimer: I am the owner/servant of my beloved cat, Magic, who has a diagnosis of insulin resistant diabetes due to acromegaly. I have no veterinary experience and share this series of posts purely as my personal experience of the condition and treatment and not as any kind of veterinary advice.