Pumpkin 9/17 AMPS 375 per usual range

Pumpkin has IAA no acro (thankfully) and we were all the way up to 14 U of Lantus with no real blood sugar change. The vet consulted with a University vet that does feline diabetes studies. He told us that as long as Pumpkin is acting fine and is happy we shouldn't be so worried about the "number".

We started curving him weekly to see what was going on. Interestingly enough, not much was changing throughout the day, so we started reducing dose. We are down to 6 now from 14 and it still is about the same. He did loose a lot of weight from the food change and portion control. Maybe the IAA is making his blood sugar go up from the insulin? We are continuing to monitor and reduce. It will be interesting when we get down farther. Maybe a different medicine? Maybe he doesn't even need insulin?

Meantime, he is happy and active. Time will tell.

I looked at a lot of other cats here and don't see similar numbers to Pumpkin.

 

Here's the link to your last post when you posted that Pumpkin was diagnosed with IAA. It'll give people some background.http://www.felinediabetes.com/FDMB/threads/just-got-results-pumpkin-has-iaa-what-now.176140/#post-1977348

As I said then, and so did others, you are not getting enough tests in. It's great that you have started doing some curves, but you have do also do the preshots tests for each and every time you give a shot. It's possible that one day Pumpkin's IAA will break and he will need less insulin, and the only way to catch when that happens and keep him safe when that happens is to test.

As for Pumpkin's dose, from what little I do see, he remains high and flat, which means his dose is probably too low. His blood sugar is almost always in the range that is doing damage to his organs. He probably feels good in this range of numbers, cause that's all that he is used to. He is losing weight because unregulated cats are not be able to properly process their food.

Most cats new to insulin start off high and flat like Pumpkin is, but then their caregivers follow one of our two dosing methods with the goal of getting the cat into better numbers. We have a number of high dose cats here that took a while to respond to insulin. If you are interested, I can give you some of their names so you can look at their spreadsheets.

 

I can't tell how much reading on insulin resistance you've done or whether you've misinterpreted what your vet said. Further, while many vets have experience with feline diabetes, I'd be very curious how much experience your vet has with high dose conditions. Most do not. We've seen more cats with these conditions on this board than most vets see in their lifetime.

I'm going to wax didactic so I'm going to apologize up front if this is information you're already familiar with but from Pumpkin's spreadsheet, I suspect you are not familiar with how to treat IAA nor is your vet. First and foremost, this is a condition that is time limited providing you are aggressive and dedicated to dealing with the antibodies. The presence of these antibodies limits or delays the action of exogenous insulin (i.e., Lantus or any other form of injected insulin). In a sense, the antibodies "defend" against a foreign substance preventing the insulin that you're administering from having the desired effect.

If you look at the whole of Sandy's Black Kitty's spreadsheet you'll see that the insulin dose needs to be increased in order to "get ahead" of the resistance. In BK's case, Sandy was augmenting Lantus with a short acting insulin (Humulin R). From your spreadsheet, you commented that it looks like the insulin is having "no effect." It's not but it's because the dose isn't high enough to be effective. The antibodies are preventing the insulin from doing it's job. You need more insulin to beat back the antibodies.

Because you need to get ahead of the insulin resistance, reducing the dose will only increase the resistance. Frankly, I would encourage you to go back and re-read the information in your post on the high dose forum. You are not monitoring closely and as you can see from BK's SS and Sandy's feedback, IAA can break and your cat can plunge into dangerous numbers. You are not testing at night. Many cats experience lower numbers in the PM cycle. Decreasing your cat's insulin dose is going to leave Pumpkin sitting in high numbers. The range where his numbers are sitting is well above renal threshold thereby increasing the likelihood of kidney disease developing.

Ultimately, you're the one with the syringe in your hand. You have one of the most experienced people who successfully navigated caring for a cat with IAA offering you guidance. Sandy got BK into remission at a time when most vets never even heard of IAA. It's up to you how you proceed.

 

Studies on IAA? Has he//she published any of those studies and their results?

Everything we have learned firsthand over the past 9 years about IAA has been provided to you, in great detail in your last post 6 months ago, where you asked "Now what?"
It appears, as the saying goes, it all 'went in one ear and out the other'.

We always place safety first. Always.
When we see unsafe practices we call them out- to not do so would be irresponsible.

That being said, I see only 5 dates with testing data for July and only 4 for August. Are we to understand that you shot 13 and 14 unit doses twice daily without first testing on the other 52 days?
And still not a single overnight test? Decreases in dose in the face of month upon month of numbers well above the renal threshold?

I'm totally flabbergasted.

That is not how we roll here.

So, all things considered my best recommendations today are that you read and reread and also print the information on hypoglycemia found here. Keep it within arms reach. Additionally, you should identify and become familiar with the travel route and time it takes to get to at least one 24hour emergency veterinary hospital near you, preferably two.

 

We are curving every week to get apples to apples. He actually had more success at a lower dose. He was all the way up to 14 and it didn't make any difference in his numbers. We are trying to reduce to see if maybe his body is fighting the insulin. Maybe we need to change insulins. I didn't see anything changing. I would think if he was getting worse, the numbers would show it. I am keeping an eye on him. He is doing well in general. If I didn't know he had diabetes, I would never guess.
I am open to seeing other similar spreadsheets. I was encouraged by Black Kitty's but it just wasn't happening.

 

Here are a few example spreadsheets. Phoebe has not been tested, so we don't know exactly what high dose condition(s) she has, but it'll give you an idea of how the numbers can look the same for a long time, before you finally get a breakthrough dose. Beenie has IAA (36%) and acro, and her numbers didn't change much on Prozinc, but she saw a good change on Levemir. Jack, also IAA (65%) and acro was a sea of pink and red. He switched to Levemir and had an initial great response as the antibodies got confused, then they figured out the insulin change and it was back to pink and reds for a while until he got to a high enough dose.

For all of the above spreadsheets, the lower numbers are showing up mid cycle. For those on Levemir (Beenie and Jack), the lower numbers can end up nearer preshot, but that's because they are on Levemir instead of Lantus which has it's nadirs closer to the middle. And again for all spreadsheets, the cats all bounce. If you pick the wrong cycle to do a curve, it's possible you'll see nothing but high numbers when the previous day was very low numbers.

Did you ever get the IAA % from your vet?

Think of IAA like an allergy to the injected. In some way the body is fighting the insulin - but the only solution is to get to a high enough dose to overwhelm the antibodies. Going lower just leads to high numbers because Pumpkin still needs insulin, and a risk of DKA, which is a very dangerous condition. I hope you are testing regularly for ketones.

Cats are great at adapting to their environment. They hide pain well.

 

Maybe an insulin switch makes sense. I sent the numbers to my vet. Beenie seems to do better on Levimar. These cats all has change for the better. Pumpkin pretty much stays flat.

 

Many people prefer Lev with high dose cats given that it is less acidic than Lantus. However, there is an exceptionally high probability that you may see a temporary positive response to Lev since it will be a new insulin and it will take the antibodies a brief time to regroup. As soon as the antibodies sort out that this is a new insulin, you will be back in the same situation with needing more insulin to get ahead of the antibody response. IAA does not go away until you break through the resistance. You need more insulin to do this. This is why insulin resistance is called a high dose condition.

Pumpkin is staying flat because you reduced the dose and he wasn't getting enough insulin in the first place. Right now, you are risking DKA and renal failure.