10/12 Oberon PMPS 318/6.5, +1 313, +2 303, +3 270, +4 306

Wasn't planning to test him until we got back from the vet, but he just came and plopped down in front of me, so I figured why not. 406 at +1.75... really, dude?
 
Happy the vet visit is over!! Good luck with the increase.....and MORE reading :bighug:!
Any thoughts about tapping a brain at UPenn or Cornell? I’m a diver with the literature but I also like to go to the sources of that literature when possible, either direct or vet to vet if that’s the only way to make it happen, to find out the latest....if there is any “latest” diagnostics or treatment or management strategies.
 
Paws crosses for good results from the blood draw.

Every once in a while I search for new articles on IAA (admittedly been a little while). All I've seen is two older ones, with conflicting results (many cats have IAA, it is rare) from studies on very small numbers. It doesn't seem to make it to the top of the research worthy articles pile. MSU is, I think, the only place in the world that tests for it. When Sandy got Black Kitty retested years later, she got in touch with MSU and there wasn't really anything new at the time. Just found another article - warning, info overload on detail. It's about insulin resistance, and mentions antibodies.
 
:p
Paws crosses for good results from the blood draw.

Every once in a while I search for new articles on IAA (admittedly been a little while). All I've seen is two older ones, with conflicting results (many cats have IAA, it is rare) from studies on very small numbers. It doesn't seem to make it to the top of the research worthy articles pile. MSU is, I think, the only place in the world that tests for it. When Sandy got Black Kitty retested years later, she got in touch with MSU and there wasn't really anything new at the time. Just found another article - warning, info overload on detail. It's about insulin resistance, and mentions antibodies.


It is interesting because it is similar in some respects to the neurotransmitters in the brain....receptors, binding affinity and issues that can occur along the way.

I do know that Dr Mark Peterson out of NYC, who is an older but very well respected vet endo, has done quite a bit of work and co-authored journal articles and books which address the topic. Unfortunately, when I attempted to reach out to his practice for a consult last year when T was first diagnosed, they told me he now limits his clinical practice to thyroid vs general endo :(.

I just ordered the textbook “Feline Endocrinology” by Feldman, Peterson and Fricassi. It’s the first book fully dedicated to endo in the cat :). Drs Feldman and Fricassi are both based out of UC Davis, which has a strong endo group/research Dept.

I was able to access some of Feldman and Nelson’s Feline and Canine Endo book online. It was published in 2004 so I’m not sure how much the info has changed. They do discuss the pre receptor, receptor and post receptor issues that occur as well as concurrent disorders that will cause issues. Very informative—especially the concurrent disorders piece.

Let me know if you have issues accessing the pages online (I was happy those particular pages weren’t omitted in the “preview”)and once I get the newly released book I will share any “new” info from I find. However, I would like to know what are they studying, discovering RIGHT NOW. What has someone tried that may be different from previous practice and did it work?

A couple of questions that came to mind after reading the info from the older Endo book:

1) What effect is the triaditis potentially having with the BG? I can’t wrap my head around how the vet said & thinks that the inflammation seen on US is probably not an “active” problem. Just because a cat is not demonstrating overtly obvious clinical symptoms like vomiting or pain, doesn’t mean the inflammation that is significant enough to show up on US isn’t “active”. Of course it’s active!! Inflammation of the intestines, let alone pancreas and liver, causes all sorts of disruption for glucose regulation and is a major factor for both humans and pets with Type 2 DM.

2) In the older book, they mention....... “Switching from the recombinant human insulin preparation to beef/pork-source PZI may improve control of glycemia if circulating anti-insulin antibodies are the cause of the insulin ineffectiveness.”
Has anyone tried this?

Again, I will let you know what changes, if there are any, in the new textbook that is feline specific and was published 2019 vs the feline/canine book 2004. I will get the book by Thursday :).

Add “Endo Roundtable” along with the magic viewer to that Christmas list :D!!!
 
PMPS 318, but ketones up to 6.5; not sure whether that's from being in the 400s earlier today or if it's vet stress or something. In any case, I think I'm going to go ahead and give him 1 U of R on top of his 7 U of Lantus. Really want to keep him a bit lower...
 
OK... finally finished writing my midterm for tomorrow so I have time to do more than the bare minimum here. :D

First off, my daughter just did Oberon's +3 BG check all by herself, with me watching. Perfect the first time! So we now have three people in the house who can test. BG seems to be coming down, so hopefully the ketones will follow. I'm also encouraging food a lot and I'm wetting it down again. May do fluids again tonight; I had stopped when his ketones dropped really low after his most recent BG dip.

Happy the vet visit is over!! Good luck with the increase.....and MORE reading :bighug:!
Any thoughts about tapping a brain at UPenn or Cornell? I’m a diver with the literature but I also like to go to the sources of that literature when possible, either direct or vet to vet if that’s the only way to make it happen, to find out the latest....if there is any “latest” diagnostics or treatment or management strategies.

Definitely keeping it in mind... right now I'm mostly just trying to keep my head above water (cat, family, work) and get the basics down.

Wendy, thanks for that paper! It's a really good overview of insulin resistance. I'd found a couple of others, but none that discussed it quite that way. It's got the most detailed explanation about IAA I've seen so far.

Amy, I just added that book to my Amazon list so I can remember to get it (or see if my campus library can get it through ILL).

Reading through the various reports again, I think the vet actually does have concerns about triaditis, but it didn't really come across in our conversations. It's the reason she wanted him to do 28 days of Baytril, which then got switched to 7 days of Veraflox when Oberon showed aversion to the Baytril taste. But Veraflox can have effects on WBCs, so I was hesitant to use it and have been sort of dragging my feet until we get the anemia recheck back. I think really I just need to learn how to pill Oberon, because then I can give him the Baytril. Watched a video a few days ago and I'm ready to give it another go.

I've been thinking more about those random big dips. Still wondering what's causing them. One idea I have is that they could be caused by random overlaps in antibody and insulin cycles. Hypothetically, if antibody levels fluctuate (they have a lifespan of ~7-10 days, apparently? and they get used up when they bind insulin) and insulin levels fluctuate because of the Lantus cycle, dose changes, pancreas function, etc., then there may be points where just by coincidence there's higher insulin and lower antibodies at the same time, and boom! Dunno if that's really what's going on, but it's interesting to think about.
 
Hi Lisa, can you please fix your typo in your title, +3 ...I darn near had a heart attack :woot:, will read through the rest of your condo when I learn how to breathe again!

Dang it! The character limit always gets me. I type but forget to check to see that everything shows up! Sorry for the heart attack!

Morning numbers for reference: +10 340, AMPS 385/3.5, +1.75 406, +4 394, +7.5 339
 
Good for your daughter! Awesome to have a third hand around. How old is she? BTW, might want to remove the AMPS numbers from the subject line to have room for that last digit of the +3 test. :eek: Ah, I see Christie posted before me.

“Switching from the recombinant human insulin preparation to beef/pork-source PZI may improve control of glycemia if circulating anti-insulin antibodies are the cause of the insulin ineffectiveness.”
Has anyone tried this?
I haven't seen any cat with IAA go from PZI/Prozinc to any of the L insulins. I have seen the other way though, to Levemir specifically. Cats with IAA will often have a strong reaction to an insulin switch. One made a serious U turn in dosing, here is Cobb's SS, see early August 2014. He wasn't tested for acro just IAA, but caregiver thought he was. He was originally on Prozinc. Jack was another kitty with a drastic reaction from Prozinc to Lev, see end of May 2016 - until the antibodies got wise to what was happening. Kitty was also acro. Can't think of an IAA only kitty that made the switch - they are uncommon enough as is.
 
Good for your daughter! Awesome to have a third hand around. How old is she? BTW, might want to remove the AMPS numbers from the subject line to have room for that last digit of the +3 test. :eek: Ah, I see Christie posted before me.

I haven't seen any cat with IAA go from PZI/Prozinc to any of the L insulins. I have seen the other way though, to Levemir specifically. Cats with IAA will often have a strong reaction to an insulin switch. One made a serious U turn in dosing, here is Cobb's SS, see early August 2014. He wasn't tested for acro just IAA, but caregiver thought he was. He was originally on Prozinc. Jack was another kitty with a drastic reaction from Prozinc to Lev, see end of May 2016 - until the antibodies got wise to what was happening. Kitty was also acro. Can't think of an IAA only kitty that made the switch - they are uncommon enough as is.

She's 16 and hates needles, so this was kind of a big deal. Totally her idea, too.

I've started to try to read up on different insulins just to get an understanding of where the differences are... cat insulin is most similar to bovine (one amino acid different, compared to four for human vs. cat), so on the face of it it seems like that might be least likely to provoke an immune response. But then you have to factor in the benefits of long-acting insulins (human insulin with some bells & whistles) and all that. I'm already considering a switch to Levemir at higher doses just because of the acidity. I wonder if the antibodies would react differently.
 
Coming back up a little at +4 (306), and he was Mr. Crankypants when I tested him... wonder if he was watching that cougar video over my shoulder!
 
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