? - Cabergoline and specialist | Feline Diabetes Management Board

? Cabergoline and specialist

Mimi & Kumo

Mimi & Kumo

Member
Hi All

My name is Mimi, and I’m new here. I’m reaching out about my 17-year-old female kitty, Kumo, who recently received an IGF-1 result of : 1200ng

I have been reading everyone's posts and you are all so knowledgeable about acromegaly, so I wanted to ask for your insight. I’ve consulted with several veterinarians, including a Japanese vet in Japan, who suggested trying cabergoline (a human medication commonly used for Parkinson’s disease) for Kumo's treatment before SRT.

I’m not against pursuing SRT treatment in Colorado, but I’m very interested in trying cabergoline first. That Japanese vet mentioned that:

  • One-third of cats no longer require insulin,

  • One-third need a reduced dose, and

  • One-third show no change.
Anyone have any experience with cabergoline? If so, I’d really appreciate it if you could share your thoughts or experiences.

Also, I’m located in California and have had trouble finding a specialist who is truly familiar with feline acromegaly and Cabergoline, my vet told me there is no cure for acromegaly and I have to find somebody else. Do you know of anyone in California, or possibly nearby states like Utah or Arizona,,, any State!

Thank you so much for your help in advance!

Best regards,
Mimi
 
Hi Mimi, good to see you found your way over here. The vets with the most experience in cabergoline are a group of research vets in South America. Here is a link to their 2022 paper on Cabergoline Treatment in Cats. I think their study is more than 50 cats now. Here is a quote from one of our members who speaks Spanish and reached out to one of the authors.
Not sure if you are doing a Sticky on Cabergoline, but I reached out to Dr. Elber again on behalf of X and wanted to share his reply with the group. I contacted him through ResearchGate which I have a subscription for through work. Here is his latest information:

Hello, thanks for sharing and for the interest in the use of cabergoline in cats with acromegaly. In Argentina it is currently the only treatment available. We have a group of 25 cats with HS/acromegaly of which 19 also had diabetes mellitus. We did not find a significant decrease in IGF1 with cabergoline, but a better glycemic control with lower fructosamine and insulin doses. Seven of the diabetics achieved remission. Therefore we believe that cabergoline is useful in the control of diabetes mellitus especially in cats with smaller pituitary glands and IGF1 closer to 1000. Adverse effects observed in the 6 month period were hypoglycemia and moderate increase in liver enzymes in very few cats. We have not evaluated survival with cabergoline, so we do not know if it significantly extends life, but yes, improving glycemic control improves quality of life.
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Note, I've also see a post from someone in the UK who has an acrocat that is not yet diabetic (it is a later stage symptom) where there is a study going on to see if cabergoline can help those cats, and perhaps prevent the progression of the condition.

There are knowledgeable vets in California. What part of CA are you in? UC Davis has a good veterinary program. Dr. Jessica Timian at West LA (VCA) hospital was our internal medicine vet at Colorado State University. Honestly though, your best bet is to find a vet who has dealt with an acrocat before and open to learning about other options. In my time, my vet and the clinic owner called them "exotic tests" when I wanted to test for it. But my vet was willing to learn and work with me. I used FDMB to find out about treatment options and make contact with CSU. We have a ton of papers we can give you if you find a vet willing to learn.
 
Hi Wendy,

Thank you so much for your replyand information!!

Is the doctor you mentioned Dr. Jessica Timian?
Meet Dr. Jessica Timian, Englewood Veterinarian

So far, I haven’t been able to find a vet with experience treating acromegaly in cats. My current vet only works once a week and told me there is no cure for acro. I really feel I need to find a more knowledgeable vet. I’m currently in Palm Springs, CA, but I’m willing to travel to any vet who is open to prescribing Cabergoline.

It’s frustrating because I’ve read so many of your posts and know that others have been able to use Cabergoline successfully, but I can’t seem to find a vet who’s willing to help me with it.

I also read about Neko’s SRT journey—it gave me hope. I saw she had some heart issues but was still able to undergo radiation therapy.I think you wrote they did one time anesthesia instead of three times(?). I’m considering SRT for Kumo as well if she’s accepted, or even removal surgery by Dr. David Bruyette(?) but in the meantime, I would really like to try Cabergoline.

I’ll reach out to Dr. Timian and ask if she may be able to help. If you know of any other vets who might be familiar with treating acro-cats, I’d be so grateful if you could share their names.

Also, you think which Insulin would work for Acro? Lantus or Prozinc....?

Thank you again for everything.

Warmly,
Mimi
 
Mimi & Kumo said:
Hi Wendy,

Thank you so much for your replyand information!!

Is the doctor you mentioned Dr. Jessica Timian?
Meet Dr. Jessica Timian, Englewood Veterinarian

So far, I haven’t been able to find a vet with experience treating acromegaly in cats. My current vet only works once a week and told me there is no cure for acro. I really feel I need to find a more knowledgeable vet. I’m currently in Palm Springs, CA, but I’m willing to travel to any vet who is open to prescribing Cabergoline.

It’s frustrating because I’ve read so many of your posts and know that others have been able to use Cabergoline successfully, but I can’t seem to find a vet who’s willing to help me with it.

I also read about Neko’s SRT journey—it gave me hope. I saw she had some heart issues but was still able to undergo radiation therapy.I think you wrote they did one time anesthesia instead of three times(?). I’m considering SRT for Kumo as well if she’s accepted, or even removal surgery by Dr. David Bruyette(?) but in the meantime, I would really like to try Cabergoline.

I’ll reach out to Dr. Timian and ask if she may be able to help. If you know of any other vets who might be familiar with treating acro-cats, I’d be so grateful if you could share their names.

Also, you think which Insulin would work for Acro? Lantus or Prozinc....?

Thank you again for everything.

Warmly,
Mimi
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We usually recommend Levemir for acro cats but I believe it’s no longer available in the US. Many members bought theirs from Mark’s Marine in Canada and I’m not sure what the status of that is with all this tariff stuff. @Wendy&Neko might know since she lives in Canada. There was a post on the regular board about it but I can’t seem to find it right now.

On surgery…you are talking about removing the pituitary? I know of one member who had that done and her cat’s personality was never the same as long as she posted. I can also see if I can find that post but it’s been a while.

Edited to add: Found the post on pituitary surgery. It’s worth the read.
 
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Thank you for the link, Marje and Gracie. I just finished reading most of the thread. It made me sad to see that all the cats had passed by the end, but I did get a lot of valuable information. I’m just wondering why those some people underwent surgery instead of SRT. I'm sure there is a good reason for it. The reason I’m considering surgery and cabergoline is because my KUMO is 17 years old, and I’m not sure if CSU would accept her or if she can handle multiple rounds of anesthesia. I’ll continue to research more. This board has so much helpful information, and I’m really glad I found you all;)(y)
 
If I lived in the UK, I might consider surgery. How well the cat does depends on the experience of the surgeon, and not that many surgeries are done here. There are some experienced people at Washington State U as well. There was one member on FDMB who had two cats go there, but there were complications with both. One needed I think it was, a month to recover there? Both cats ended up getting SRT as well because the surgery didn't get all the tumour. Both cats also had the tumour come back after both hypophysectomy and SRT. If the surgery works well, it is curative. They have a better track record at the Royal Vet Clinic. Even then, the expected life span isn't a lot longer than SRT - these are typically older cats anyway, we still lose some to the usual old cat conditions.

There was a recent paper on caregiver experiences with acro cats, and the question on how they felt about treatment types, SRT and cabergoline rated fairly close. Not all cats travel well, not all people can afford the cost of SRT which has gone up a LOT since Neko had her first SRT. The only downside to cabergoline is that it doesn't do much if the tumour is too large. SRT can treat all of them.

Yes, that is the correct Dr. Timian - really enjoyable lady to work with. Neko had SRT twice. Dr. Timian was her IM vet for the first SRT (3 days) but not the second time 3 years later (1 day SRT).

It'll be hard to find a vet who has prescribed cabergoline before. The question is whether you can find a vet willing to learn - the paper I linked has helped others if given to the vet. I was my vet's first cat on Lantus (then later Levemir), first cat with acromegaly, first cat with IAA, first cat to have treatment with SRT. Is there an internal medicine vet anywhere near you that your vet can recommend you to? IM vets should be more clued in on acromegaly. Dr. Timian is an IM vet.

As far as insulin goes, I don't keep track of how the US tariff's Canadian goods. If you contact Mark's Marine pharmacy (Google them), try contacting them for details if you want to try Levemir. They are a bricks and mortar pharmacy about 25 minutes drive from me, but I've never dealt with them in person, no need to. We do have a number of people with acrocats using Lantus now. It seems to have better results than Prozinc, though there is one cat who recently had SRT and still on Prozinc.
 
Hi Wendy!

I reached out to Dr. Timian, but it seems she is now running her own practice in Colorado and is no longer with VCA in West LA.
Since Dr. Lunn at CSU requires a local California-based vet to coordinate follow-up care such as bloodwork(make sense), I’m now in urgent need of finding a local vet who is willing to work with CSU.

In the meantime, I’ve been looking into Levemir and was able to find a few pharmacies holding Levemir inventory expiring in 2027'ish viral. Unfortunately, none of the vets I’ve seen are willing to prescribe it 🥺—they so not want to work with treatments outside their comfort zone. Currently, I’m using a combination of Lantus or ProZinc, and a very small amount of Bexacat occasionally to manage her blood glucose and heart issues.

Sadly, neither my regular vets nor the local specialist have any experience treating Acromegaly... In fact, even the endocrinologist told me that there was "no treatment" for Acromegaly—which I found quite shocking. There are few options obviously reading this board! it seems she’s not keeping up with current developments.😞

At this point, I’m leaning more toward SRT than surgery, thanks to all the valuable insights I’ve gained from your posts. I think SRT is good. I understand that SRT won’t happen overnight, so in the meantime, I really need to find a vet who is willing to at least prescribe Cabergoline.
Thank you again for everything you’ve shared. It’s been a huge help during this emotionally overwhelming time😭

Warm regards,
Mimi K
 
I've been going through some of the posts to see if I can find someone who lives in California, had an acro and had it treated. This forum is so new that we don't really have much acro traffic yet. If you go onto FDMB and try PM'ing someone, you may get an answer. One person I found and her user name is Karen&Rocket. Rocket is sadly no longer with us, but she did take him for SRT. Another user from LA was called "Malachai", though I think her kitty is gone too. Another thought is to post on the Welcome and Main Forum here with a post titled something like "looking for diabetes knowledgeable vet in <name of area> California.

Did you follow up with the West LA VCA and see if they have someone else knowledgeable about acro?
 
Thank you again for doing the search. I’ll check "Karen" and "Malachai" on the old board for now.
I reached out to CSU directly and asked the tech if they could refer me to any vets who graduated from CSU and are currently practicing in California. They found Dr. Kellyi Benson in Ontario CA, who is a CSU graduate, and I have a consultation scheduled with her next week.
I’m not entirely sure if she’ll be able to help with the medication, though—she’s an internal medicine specialist, not an endocrinologist—so I don’t know if she’ll feel comfortable prescribing something in the meantime while I prepare for SRT.
I’ve also scheduled consultations with a few endocrinologists next week, so I’m hopeful I’ll find the right one soon.
I’ll definitely keep you posted! Thank you so, so much again for all your support, Wendy. I’m still digging through FDMB for more information as well.
If you have time, I’d really love to hear more about when Neko received SRT—especially I believe that you mentioned her heart block but still able to receive SRT..? You wrote something about USU did a single-session SRT for her instead of the four-session protocol? Only if it’s not too hard for you to talk about—Because Kumo's heart got enlarged(not thicken) possibly due to acro, so I am just curious;)
 
Mimi & Kumo said:
Thank you again for doing the search. I’ll check "Karen" and "Malachai" on the old board for now.
I reached out to CSU directly and asked the tech if they could refer me to any vets who graduated from CSU and are currently practicing in California. They found Dr. Kellyi Benson in Ontario CA, who is a CSU graduate, and I have a consultation scheduled with her next week.
I’m not entirely sure if she’ll be able to help with the medication, though—she’s an internal medicine specialist, not an endocrinologist—so I don’t know if she’ll feel comfortable prescribing something in the meantime while I prepare for SRT.
I’ve also scheduled consultations with a few endocrinologists next week, so I’m hopeful I’ll find the right one soon.
I’ll definitely keep you posted! Thank you so, so much again for all your support, Wendy. I’m still digging through FDMB for more information as well.
If you have time, I’d really love to hear more about when Neko received SRT—especially I believe that you mentioned her heart block but still able to receive SRT..? You wrote something about USU did a single-session SRT for her instead of the four-session protocol? Only if it’s not too hard for you to talk about—Because Kumo's heart got enlarged(not thicken) possibly due to acro, so I am just curious;)
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Good luck! 🤞🏻🤞🏻
 
We have people here who have gotten cabergoline through their regular GP vets. It doesn't take an endocrinology stamp which is a branch of internal medicine.

Kumo will need an echocardiogram before getting SRT, it's a prerequisite. Neko had one too which gave the all clear, which is why the heart block was so surprising. Marje got a panicked phone call that night. She helped calm me down. That was Neko's second SRT, the one 3 years earlier was a non event. It was one day of CT scan and 3 of SRT. Second time was 1 day CT (when the heart block happened), then 1 day of SRT several days later.
 
Whoops — Kumo had her cardiac echo on 5/13/25 (attached), and her heart was found to be enlarged, possibly due to acromegaly. It might be temporarily enlarged since she had pleural effusion on 5/9/25 and was still recovering around the time of the echo. The heart is not thickened at all just larger.
I really hope she can still be accepted for SRT. It feels like a chicken-and-egg situation: her heart is enlarging because of GH, so we need to stop GH in order to keep the heart from getting bigger.

Wendy-- When Neko had her FIRST SRT, you mean did you have to go back and forth to Colorado four times(one day CT and 3days SRT)? Or was it one day for the CT scan and another day for three SRT sessions in one day ? I’m sorry—it's been a bit hard for me to understand the timeline.
 
Mimi & Kumo said:
Currently, I’m using a combination of Lantus or ProZinc, and a very small amount of Bexacat occasionally to manage her blood glucose and heart issues.
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To be clear, you’re using insulin and Bexacat simultaneously?

And also alternating between Lantus and Prozinc?

This might be concerning — would be great if you could clarify.
 
Update with good news:

I finally found a vet knowledgeable about Cabergoline at the CAT Clinic in Rialto, and she prescribed it for us! She is not endocrinologist but feline specialist. Wendy was right about telling me that the vet does not have to be endo to prescribe cabergoline. ;)

Also, I heard back from CSU. They mentioned that Kumo could be a candidate for SRT!


Here’s the dilemma::unsure:

They said I need to stay there for a minimum of 2 weeks, starting with a ①CT scan to confirm the tumor → ②then a last-minute echo cardiogram → ③and then evaluation by the anesthesia team to determine

Even though they said Kumo could be a candidate, I completely understand that they probably don’t want to fully confirm until after the last-minute echo for her safety.
It would be really hard for Kumo to go all the way to CSU and then be turned down though. So now I’m wondering—would it be possible to do ①the CT scan to confirm the tumor could be done in locally first, that way maybe I could shorten the stay in CSU to 3-4 days, but I still don't know why they need us to stay min 2weeks.

Wendy, I remember you stayed at CSU for just 4 days—right?
Did you do the last-minute echo in Canada or at CSU?
I know Neko’s CT was done at the last minute due to the unexpected heart block, but I’m guessing your originally planned cardiac- echo to determine anesthesia was done in Canada?

I hope my question making sense or am I misunderstand something ? Let me know your thoughts- Thank you in advance!

Mimi
 
I did the echocardiogram with a board certified cardiologist before we left for CSU, as well as recent blood work. I had a long trip, I wanted to make sure it was worth leaving. And it was the requirement back for her second SRT. I had the echo the week before hand.

The problem with doing the CT scan before you leave is that you'll have to have it repeated when you get there. They have special software that uses their CT scans to plot where the radiation beams go. CT scan = anaesthesia which is can be a risk with acros. Hence the echocardiogram and blood work first. You can always ask them if they will use someone else's CT scans, but that would only save you one day (and one anaesthesia session). Also ask them why two weeks.

Neko had 4 days for her first SRT, one day CT plus 3 days radiation therapy but I stayed in Fort Colins longer, just in case things got delayed. The machine does occasionally need servicing. And sometimes they decide the cat needs a break in the middle. Since I was driving the first time, I was flexible when I left.

Can you tell me what insuin dose Kumo is on? Better yet, if you could put together a spreadsheet showing his blood sugar values. I've looked a lot of spreadsheets and have a good idea what an acro spreadsheet looks like. The information on how to do that is in the Sticky Notes on the top of the Welcome and Feline Health forum.
 
I sent a follow-up email asking why a 2-week stay is required. It seems they were including IMRT as part of the treatment plan.
From their email:
"Stereotactic radiation is between 3 to 5 fractions. However, if she requires Intensity-Modulated Radiation Therapy (IMRT), that is usually around 20 fractions."
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I replied and explained that I don’t plan to proceed with IMRT, especially considering Kumo’s heart condition. So it seems the minimum stay might be around one week instead.

Dosage: A lot of irregular things have happened since Kumo started insulin — changing dosages, switching insulin types, surgery, dramatic diet changes, etc. Her dosage has ranged anywhere from 3 to 9 units, and we’re currently trying 4–5 units.
However, regardless of the dose — whether it’s 1 unit or 7 units — her blood glucose doesn't change much. It seems like her GH is most active around 4–6 a.m., and her AMPS at 6 or 7 a.m. is usually over 400, duaring the day 300-400
During the day, higher doses can sometimes bring it down to around 250, but that’s when her heart starts pumping fast. Then by 4 a.m., her BG spikes again, and her heart beats harder. At this point, I’m more concerned about her cardiac reaction than the blood glucose numbers themselves. Right now, I’m just trying to keep her BG between 300–400 to avoid extreme fluctuations. The day she experienced heart failure, I believe I gave her 7.5 units and went down to 200'ish.

I do keep a spreadsheet to track everything, though it's formatted differently from the ones typically used on forums. I wasn’t aware such great resources existed. I can upload a few sample entries if that helps. The pattern has been quite consistent — BG between 300–400 throughout the day, with AMPS always over 400. Once we start Cabergoline next week, I’ll try to convert the records to the standard format everyone uses. Pls let me know what you think!! Thank you!!
 
Hi Wendy,

Thanks so much for checking in on KUMO.
I went to the SRT consultation at the Culver City (LA) cancer center, and I’m also in touch with CSU. I have an appointment at the beginning of July. Colorado mentioned that if KUMO doesn’t require IMRT, we can probably complete everything within a week or so.
However, KUMO had her second episode of pleural effusion earlier this month, and her kidney values have worsened significantly in just a month or two—probably due to the high-protein diet I was trying for her blood sugar. She is doing fine now though.

Back in April or May, her renal numbers weren’t too bad:
  • Creatinine: 2.1
  • BUN: around 20
  • SDMA: 24
But now they’ve gone up to: 😭
  • Creatinine: 3.1
  • BUN: 64
  • SDMA 29
The good news is her heart seems very stable now and BG has been much better since starting cabergoline. Sometimes her BG even drops under 200, which is nice since her comfort zone is usually around 200-250. When I see those lower numbers, I’ve been mixing k/d food instead her regular very high-protein food to help improve her renal values even little bit before she goes under anesthesia.

By the way, have any of your acro cats or any cats ever screamed or shout like crazy? I’ve noticed that when her GH activity seems high, she screams and shouts nonstop, sometimes all night. It doesn’t seem like pain—she’s still walking, jumping, acting active—but more like confusing or restlessness, more like,,, nagging..? I don’t think it’s a side effect of cabergoline, because she used to do this even before starting the medication. Appreciate if you could think of something.
There’s a lot to worry about, dont know how this thing will go but I’m also excited (and nervous) to finally head to Colorado after the holiday :giggle:
 
Any chance Kumo was dehydrated for those second blood work tests? Is she on any medications for her heart, the pleural effusion? Some can impact kidney numbers.

I don't think you need to worry about BG under 200. In fact ideally she's spend some time in the 100's, as that's probably under renal threshold and easier on her kidneys. Above that, her kidneys have to work harder to remove the sugar from her blood.

Neko used to scream for food in higher numbers, or lower numbers before she was used to them. It wasn't non stop though.
 
Wendy&Neko said:
Any chance Kumo was dehydrated for those second blood work tests? Is she on any medications for her heart, the pleural effusion? Some can impact kidney numbers.
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-Yes, it’s definitely Furosemide for her heart. KUMO takes 12.5 mg every day. I tried reducing the dose by half, but she had another episode of pleural effusion. So I might want to try giving her 3/4 of the original dose and see how her heart responds to that amount. And with high protein diet.
Wendy&Neko said:
I don't think you need to worry about BG under 200. In fact ideally she's spend some time in the 100's, as that's probably under renal threshold and easier on her kidneys. Above that, her kidneys have to work harder to remove the sugar from her blood.
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-KUMO's heart reacts strangely and her respiratory rate increases when her BG drops below 200. I think she is very sensitive to low BG, both time when she had pleural effusion when her BG went down suddenly. It seems like she starts having glucose in her urine when her BG goes over 230. So my target range for her BG is between around 180'ish and 230.
Wendy&Neko said:
Neko used to scream for food in higher numbers, or lower numbers before she was used to them. It wasn't non stop though.
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-:cry: I hope its not because of her tumor

I'm sorry, it’s not the right time for me to convert my spreadsheet to FDMB format, but here’s mine. I like to emphasize daily activity, But if you have any suggestions or ideas, I’d really appreciate hearing them!
 
Has Kumo been started on cabergoline yet? I'll admit I'm having a hard time parsing the spreadsheet, cause it doesn't list doses or let you know what time of day the shots were given. Our format also lets me see patterns across days. Though yours does have some useful information for you.

Cats react differently to cabergoline, but Tiger is one who just recent started it on June 14th. Here is Tiger's Spreadsheet. See what is happening to his insulin dose. It's in the U or Units columns. Tiger is having a rather strong reaction to the drug. I've seen this a few times, and is why I always suggest monitoring and caution.
 
Hi Wendy,

I hope you all had a relaxing holiday!

All the medication information is listed in the "Meds" section of my spreadsheet—usually around Row 10. As noted, the insulin dose for today is Lantus 7 units. You see l7.If you see C is cabergoline. Cabergoline is working to reduce BG but I think its random and since I changed some K/D food then BG went up little bit in this month.
I’ll share more details soon about what happened at CSU.
Thank you as always for your support!

Best regards,
Mimi
 
I'm in Canada, different holiday.

Without seeing more than one day's information on one page, I can't figure out what is happening with the blood sugar numbers. I've been looking at our spreadsheets for over a decade, and that's the way my brain is wired now.

Looking forward to hearing about CSU, hope it goes well.
 
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