12/25 Ozy What does aggressive dosing mean?

Previous http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=110561

He just wants to be pink.

Everything I've read, here and elsewhere, agrees that aggressive dosing is needed with IAA to get ahead of the antibodies. But what does aggressive dosing mean for Ozy? We plan to raise Ozy's dose to 5.5 units tonight. That's after 4 cycles and that is half a unit. Part of me feels that is aggressive and part of me thinks that is not aggressive for Ozy.... even .5 units is a small percentage with this large dose.

I have been pretty aggressive in his dosing, particularly in the last few months. I've moved to .5 unit increases and I've increased sometimes in 4-6 cycles unless he had some green or something else happened like his dental. I have reduced in a few instances when he wouldn't eat and was very lethargic but I always had to go right back up.

I have been studying condos and SS's for the many links I've been sent. But there aren't very many IAA examples. And there are not condos to study for the best matches. Also, if a kitty was Acro and IAA and they have the SRT, does the IAA go away? It sure seems like many of them come down quite a bit pretty quickly (like Wendy's Neko). The long and the short of it is that I am not finding much that I find really applies to Ozy.

Have I caused his IAA to get worse with inadequate dosing? He used to go green at lower numbers and his numbers now, at 5 units of Levemir, are as bad as they were in the beginning. So what progress have I made or have I just made it worse? Yes, sometimes it feels that way.

And where do the antibodies put the trapped insulin? Is it stored in the injection site? Sometimes there is resistance when I try to push the needle under the skin. What is that resistance? Is it caused by antibodies?

And what do I do about bounces? And will R work for him given that his numbers don't swing as high/low as many cats. He just likes to be very pink.

 

The antibodies block where the insulin binds. This prevents it from working.

I believe you are OK with half unit increases, especially at the dose he is on, and every 6 cycles, increasing. The objective is to stay ahead of the resistance. There are some stickies in the high dose subforum here which may be helpful.

SRT only impacts the tumor, not the IAA. If your cat has both, it may make it less difficult to stay ahead of the IAA.

R may help get it down while the Levemir is slowly beginning to act.

The resistance when shooting could be that you are entering muscle or you are sliding through the skin, rather than under it.

 

Merry Christmas ;-)


I wish you the best of luck in beating this IAA. I was around when Sandy and Black Kitty were fighting it. It was a HUGE celebration when they beat it, and Black Kitty went OTJ. I hope you can do the same someday.

 

I sent an email to Sandy but haven't heard from her yet. I hope she will respond because she knows the most about the aggressive dosing.

I hope you and DH had a lovely Christmas.

 

Thanks BJM, Dyana and Marje.

As to Christmas, not so much. Just not in the mood. But not in a bad way. We had a lovely day. It was sunny. We went for a walk. I spent a lot of time looking for how to help Ozy.

I think I am just spinning my wheels. Sometimes things are that way when there is a lot to learn. The whole last six months have felt that way and it just gets steeper. Hard to figure what to do. I've definitely become the crazy cat lady.

I hope your Christmas was lovely.

 

I think aggressive dosing is what it takes to get Ozy into green, but doing it as safely as possible.

What do you think about adding R into the mix? He's only on day 5 of Lev and while the depot builds it would be good to have some help keeping his numbers down. The R can be a great tool.

 

I will get some R tomorrow.

 

First and foremost, do not beat up on yourself. You are doing a great job. Until a diagnosis is confirmed, you don't know how aggressive you need to be.

On the German Lantus forum website, their approach could be considered more aggressive than the modifications to the TR Protocol we use here. However, they are not addressing IAA or acro.

While we've seen more acro kitties, IAA as a solo condition doesn't seem to occur as often. Translate that to mean that you are in semi-uncharted territory. There isn't the equivalent of a TR Protocol for high dose cats. The most important factor is knowing your cat. That said, being aggressive, at least in my mind, implies increasing every 4 - 6 cycles. With IAA you want to do whatever you can to get ahead of the antibodies building up at any particular dose. (Maybe thinking about IAA like glucose toxicity on steroids will help the way you are conceptualizing the condition.) Unless you are in low green numbers, I'd give increasing strong consideration. It may take some experimenting to see when it's safe to increase vs. when you need to hold the dose.

For now, increasing by 0.5u makes sense. Depending on the size of the dose, it may mean increasing by a larger amount. That would also be considered aggressive.

One additional point -- when IAA breaks, you may need to come down the dosing scale in a hurry. Don't get complacent and keep HC in the house.

One additional SS to look at is Randi/Max's. Max was never officially diagnosed but most of us thought he had IAA.

 

((((donaleen))))

We all know they the FD dx is overwhelming enough and to add this in the mix....I can only imagine how you feel.

But remember what a great support group you have here if you choose to take advantage of it. Wendy and Julie have some very good experience with dealing with high dose kitties. Julie, Dyana, and I can help you with using R (by the way...if you buy it at Walmart...where it is called Novolin R...it is much, much cheaper). Several of us have helped as kitties have come down the dosing scale fast ...for whatever reason they did.

I am optimistic ...you have a dx. You have a support group. You have people helping you do research and suggesting different things for you to consider. There is hope.

I think it is a good idea for you to post daily if you can......sometimes it's hard to see the pattern when we are looking at our own cat's SS but here....you have many eyes.

 

I agree with Sienne: You are doing a SUPER job! Give yourself a huge hug and pat on the back. Feline diabetes is a tough disease and IAA is even tougher. You are doing everything you can to help Ozy be as healthy as possible. Your crazy cat lady credentials are quite secure. :lol: :lol: :lol:
Liz

 

Donaleen,
So sorry this feels like an uphill battle :sad:
But you are doing GREAT and have the best support and knowledge you could possibly get here.
Sending you lots of :YMHUG: :YMHUG: :YMHUG: