New IAA diagnosis

Howie's IAA and acromegaly test results just came back from MI State. His IAA test was high at 63 (normal is 20) but thankfully the acromegaly results came back normal. I would love to connect with any other sugar kittie family members who have IAA just to know tips, things I should know/watch out for, anything you've had to do to keep things under control, etc. I just don't find a lot of research or information out there about it (I mostly find info on Cushings and acromegaly). We are switching Howie over to Lantus from Prozinc as soon as it comes in at the vet (I wish I knew he had to order it or else I would have gotten it from Mark's!). Based on his SS, what would the experienced Lantus users recommend for a starting dosage? My vet wants to start him off at 1 unit as he says you want to start low with Lantus. Does this sound right? Thankfully his ketones have cleared up for now.

Finally, I feed Howie mini meals at +2 through +5 each cycle with an auto feeder. However, he has started skipping meals which I find baffling as he scavages for food normally. Anyone else have this happen? Not sure what this is about! He had his highest-ever BG this AM with his AMPS (387) and am wondering if he didn't eat his +5 meal (1:10am CST) until close to the time of his breakfast (so within the 2-hr window before his shot). I don't want to restrict food as I am trying to put some weight on him, but I also don't need to be wasting food or having him eat (unsupervised) when he shouldn't be! THANKS!!!

 

You may want to post this on the lantus forum also

 

Tagging @Wendy&Neko and @Sandy and Black Kitty for you.

 

DUMB ? What is IAA?

 

No....when the cat's been on a different insulin, we take the dose they were on into consideration when recommending a starting dose for Lantus. Since Howie was up to 5.5U of ProZinc, you'd start Lantus at no less than 5U. Be sure to test frequently over the first several days because although it's uncommon, occasionally a cat will react quicker to the insulin change.

If you were to drop all the way back to 1U, you'd just be wasting weeks of time working your way back up.

The good news? IAA is usually self-limiting. At some point (usually within about a year) you'll get to a dose that breaks through the resistance and the BG will start tumbling down.

 

Is it too late to change that Lantus to Levemir? His dose is getting up there and higher doses of Lantus can sting due to it’s acid base.

More later.

 

No dumb questions, insulin auto antibodies. One of the acronyms Neko had. It’s a secondary endocrine condition that can cause some cats to need higher doses. It’s sort of like an allergy to the injected insulin. Antibodies trap the insulin, making it unavailable to the cat’s bodies. And unfortunately release it at seemingly random times.

The thing about the antibodies, you will have to be somewhat aggressive about dose increases. It helps if you can keep green nadirs in the picture. If you can swing following Tight Regulation, I strongly recommend it.

Don’t worry about that two hour window if he’s always in higher numbers, more a concern if lower.

Tagging @Amanda and a Loudogg who also has an IAA only kitty, though she’s not a regular poster. Lou never got very high in dose.

 

That was my first thought, Levemir would be a better choice for high dose kitties.

 

Thanks Wendy

 

@Wendy&Neko would you please check out Peters thread about Peeka and I'm worried about them
Peeka 10/1 Throwing up multiple times today

 

IAA= insulin auto antibodies. His body is fighting the insulin so he’s a higher dose kittie.

 

I told my vet about Levemir but he just ordered Lantus which he doesn’t keep in stock. When we talked about Levemir, he said he’s never worked with it. How do I tell him (without offending) I want to use a different insulin than what he’s prescribed and ordered for me?

 

Can someone who works out of the home and is gone for 8-12 hrs/day do TR? I’m not sure that fits in my reality. I really appreciate the info and I’m sure I’ll have more questions!

 

Thanks for the dosing info! That is really helpful to know!

 

Here's some information on "Is TR possible with a full time job?" There's some good idea's there!

And yes, TR is possible even with a full time job!

 

I suppose he doesn't try new drugs that come onto the market then with that logic?

It's well-known that glargine (Lantus) can sting in large doses due to the acidic makeup, it's seen in humans as well as cats. A quick google search brings up endless comments from diabetics about the sting. I'm not sure if @Wendy&Neko know of any studies or anything to share with your vet about it. Lantus has a pH of 4 which is fairly acidic.

As for TR, do remember that Howie would have to be dry-food free in order to follow the protocol, I see you have Dr Elsey's in your signature.

I'd get a script and order from Marks Marine Pharmacy.

 

We'll have to wait for a definite answer, but Dr. Elsey's kibble only comes in chicken or salmon. No turkey kibble that I know of (Dr. Elsey's also has canned foods)

 

Nice catch, I didn't even realize Dr. Elseys made wet varieties! Thanks Chris

 

Never buy insulin from the vet. Get a prescription from the vet and fill it yourself. Tell your vet you've been in contact with other caregivers of kitties with IAA and that is their recommendation. Ask him how many IAA cats he's seen in his practice. If he's not familiar with Levemir, there are articles about it. This one on LANTUS and LEVEMIR: What's the Difference? and the article on Management of Diabetic Cats also mentions it. That document is attached to this Sticky Note. Essentially, the insulin action on both is very similar, except the onsets and nadirs are typically a couple hours later with Levemir.

 

No advice here, just posting to say Hi because we're in exactly the same boat. Oberon's IAA came back at 83 yesterday and I'm working on getting up to speed. I just ordered a bunch of Lantus from Marks (darn it!) but I'm going to talk to the vet about Levemir and R.

OK, one piece of advice, maybe. Do you have a ketone meter? If he's going to be hanging out in those high numbers you might want to be able to check that occasionally.

 

Thank you...ALL of you.

 

Dr. Elseys CleanProtein is their wet food. It is 4-5% carbs and additive free for sensitive bellies!

 

Hiya Howie's Mom! Wendy is right, I don't check on here often. My buddy Lou finally got regulated last year, so we just go with the flow now. I wish I'd get an email when I'm tagged, so I know I'm needed and hop on. I am so sorry to hear about Howie's IAA diagnosis. As Wendy indicated, Lou is also an IAA-only kitty, although he weirdly never got too high in dose (highest was 4.25u). We've tried all insulin types except for Prozinc.

I've found the autoantibodies made his cycles last longer, sometimes even 8-12 hours on an insulin that was supposed to last 4-6 (Vetsulin). That's hard to get used to, but what made me feel better about the whole thing was the testing let me get to know how Lou was handling his insulin, which really helped make those tough dosing decisions. We switched from Vetsulin to Basaglar (glargine similar to Lantus) and were following SLGS. We switched to TR the day after his diagnosis. At the time, I was the only one testing. Lou wouldn't let my husband do it, but I told him he'd have to figure out how if we were going to make this work. We're lucky in a way that we have almost opposite schedules, so we can test Lou more frequently then most. I never had to deal with the Basaglar stinging at higher doses because we never got too high. I had wanted to switch to Levemir because it seemed a more gentler option, but my vet had suggested Lantus first. So we tried it for 6 months and then requested a prescription for the Levemir. Lou was on it for 4.5 months before the antibodies finally broke and he's been tightly regulated for the last year and a half.

With IAA, you can't sit back too far on dose increases, because if you give those antibodies time, you'll have to increase the dose even more to reign the BGs back in. I would absolutely try to switch to TR protocol. The article Chris shared helped me immensely in the beginning. I would also definitely get yourself a blood ketones meter. The strips are stupidly expensive, but it's so much easier to test the ketones via blood at will then to try to wait around the litterbox to dip the urine. I would test the ketones regularly when he was at higher numbers (weekly I think) to ensure I was keeping on top of them. I used the Nova Max blood ketones meter, which I got from ADWdiabetes.com HERE.

IAA-only kitties still face a rough road, but at least there is light at the end of the tunnel. I will try to check back here and there to see how you and Howie are doing. I wish you both the best of luck!!!

 

Thank you so much for your message! For the ketones meter, do you just use that to check ketones and not his glucose too? He’s been sitting at 15 mg/dL ketones since early September (verified with 2 urinalysis by the vet) and I can’t get rid of them. I give him sub q fluids twice a week and increased his food (and obviously insulin). He’s up to 6.5 units of Prozinc as of this AM. I’m waiting on my shipment of Levemir from Marks to come this week and then will make the switch. Unfortunately it’s just me taking care Of Howie. With COVID, I work some at the office and some at home. So consistent/frequent testing is not feasible when I’m at the office. I’ve been following the modified SLGS with Prozinc, so I hope TR is doable. How many cycles were you monitoring him before deciding to increase his dosage?

 

I only use the ketones meter to check ketones and I keep a separate meter for BG checks. The strips are so much cheaper (I use a Relion Prime right now). I went 6 cycles (3 days) before increasing, which is normal for TR and the amount we tested. I hope you can make TR work for you too. The biggest things here are getting to know when Howie's onset and nadirs are, which will be different once you start using the Levemir. Remember everything doesn't have to be perfect, it just has to work for the both of you. It'll take time, but it does get easier.

 

I just looked at Howie's spreadsheet and it's interesting- I feel like I'm seeing the same sort of pattern as Oberon. Stuck in high BG values despite high insulin doses (for Howie, mostly high 200s, for Oberon, mostly mid 300s), but every so often (maybe every 10-14 days) there's an abrupt dive into the blues/greens, then right back up again. I'd love to know what triggers those dips, because it doesn't seem to be clearly tied to a dose increase. If it's the antibodies temporarily "giving up" it would be great if we could encourage that!

I've been monitoring blood ketones daily lately. The pattern for Oberon is that they're consistently elevated (2.4-5 mmol/L), except after a dip. There's a bit of a lag, so during the dip itself ketones are still high, but then they come down while BG is shooting back up, so I get some readings where BG is high but ketones are still low. Then they creep back up and we start over.

 

Thanks! I will look into the ketone meter. I don’t like the strips! I appreciate all your suggestions and experience as this is all so new and scary. My vet has not had a kittie he knows of with IAA. We are learning together!

 

This is really good to know. I looked at your SS and it is quite colorful! I will reach out again, I’m sure!

 

Also, you probably don't need to do a second poke to get blood for the ketone meter. I do BG first and usually end up with some excess on the top of the glucose strip. Then I just touch the ketone strip to that drop instead of bugging the cat again. (Also, pay attention to the units being used... you reported your numbers in mg/dL but the meter I have uses mmol/L. Make sure you're not comparing apples and oranges.)

 

What made you check for IAA?
Maybe I should have Mauer checked for that

 

High-dose conditions are only really checked for when they hit 6u.

 

Yet ones kitty was at "only" 4.25.
I'm just considering everything that could effect the lack of the insulins efficiency.

And just as I cry wolf she's blue

 

The reason I don't like the phrase "high dose" conditions is because not all cats with these conditions have high doses. The study that showed one in 4 diabetic cats has acromegaly found cats on as low as 1 unit, average of 7 units. Most of Neko's diabetic life she was on 3 units or less in spite of having acromegaly and IAA.

 

Thanks!! The Relion ketone urine test strips I use right now are mg/dL.