12/29 Oberon PMPS 388, +2 351, +4 318, +5 331, vet update

Sandy and Black Kitty said:
Something is fueling the high BGs.
Is he FIV+?
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Not so far as I know. He was tested before we adopted him (nearly 10 years ago) and he's indoor only (as are the other three cats), so the odds are pretty slim. I'm wondering about dental issues or something. If his regular vet doesn't turn anything up, maybe I'll go back and consult with the internist.
 
Hmm, here's one more thing I just thought of. His IGF was normal (47, normal range is 12-92), but I think I remember seeing that you're not supposed to do that test until 90+ days after starting insulin. His test was about 2 months after starting insulin (started insulin 7/27, tested 9/25). Maybe we should get that test rerun just in case?
 
Lisa & Oberon said:
Not so far as I know. He was tested before we adopted him (nearly 10 years ago) and he's indoor only (as are the other three cats), so the odds are pretty slim. I'm wondering about dental issues or something. If his regular vet doesn't turn anything up, maybe I'll go back and consult with the internist.
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Will he let you pull back the skin covering his teeth to get a good look at his gums to see if there’s any redness visible?
Lisa & Oberon said:
Hmm, here's one more thing I just thought of. His IGF was normal (47, normal range is 12-92), but I think I remember seeing that you're not supposed to do that test until 90+ days after starting insulin. His test was about 2 months after starting insulin (started insulin 7/27, tested 9/25). Maybe we should get that test rerun just in case?
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That’s a question for @Wendy&Neko
 
Lisa & Oberon said:
Hmm, here's one more thing I just thought of. His IGF was normal (47, normal range is 12-92), but I think I remember seeing that you're not supposed to do that test until 90+ days after starting insulin. His test was about 2 months after starting insulin (started insulin 7/27, tested 9/25). Maybe we should get that test rerun just in case?
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DEFINITELY get the test Re run!!

The way the HST experts interpret these results have changed. While over 92 increases specificity, elevated levels (especially if the test is done early before the cat has been treated with insulin for 6-8 weeks), are a red flag. The levels in Europe are different, cut off is 1000, but Niessen recommends investigating it if the level is over 600.

I am currently helping with a rescue & we had the ability to run the test early. My endo let me know if that early test was elevated, that would be helpful info. It came back well over the 92, but even IF it had been under, but elevated early, that would be a red flag that HST may be the issue.

This particular cats test came back at 145 & the MSU endo read on the report was “questionable” yet, because we were blessed to have an endo who has done work with Niessen & knew to skip over the repeat based on the 145, we moved forward with the CT. CT confirmed HST.

Teeth are also a great idea to have checked but in addition to the repeat testing:). I know sometimes there are issues seen only by X-ray though vs being able to see anything when looking. If you get a cleaning they will be able to get the X-ray. I’m not sure what your timing is but I believe February is Pet Dental Month and many practices give discounts.
 
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Information on the research study saying you should wait at least 73 days after starting insulin before testing IGF-1 is here, see the second paragraph.

Neko ended up going to a dental specialist. Even he missed stuff on visual inspection that showed up on x-rays - which of course he always did.

Paws crossed for a good vetty appointment.
 
Could someone remind me what the best test is for pancreatitis? I know there's an in house test that's not as specific, and another one they have to send out. I'm wondering whether checking that would be good, even though he isn't showing major symptoms.
 
Given that there was a prior suspicion of Triaditis based on his ultrasound (if I am remembering correctly), get what is called the TAMU Full GI Panel done. This would include the Spec fPLI, but would also include the folate, cobalamin & TLI levels which would all be important info.
 
Yep, the ultrasound suggested possible triaditis. He's also missing a kidney and the other one is slightly enlarged, so I want them to run the renal numbers again. If he starts to have renal problems I'd like to catch it early.

He's on Zobaline, which includes both methylcobalamin and folic acid. I'll make sure the vet knows that since it would affect how we interpret those numbers.
 
Any point in redoing the IAA test? I know Black Kitty's IAA % dropped after he was in remission, but don't know if there's any point in testing now.
 
Wendy&Neko said:
Information on the research study saying you should wait at least 73 days after starting insulin before testing IGF-1 is here, see the second paragraph.
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I do not see a link to the study. The most recent by Niessen (2015: Studying Cat (Felis catus) Diabetes: Beware of the Acromegalic Imposter

Stijn J. M. Niessen1,2*, Yaiza Forcada1, Panagiotis Mantis1, Christopher R. Lamb1, Norelene Harrington3, Rob Fowkes4, Márta Korbonits5, Ken Smith3, David B. Church) that is going to be repeated at WSU in the near future only required that a cat be diagnosed as diabetic. There was no required amount of time on insulin and with statistical analysis in the study, they actually found little differences within the groups with respect to IGF-1 measurements & time on insulin. Therefore, there was no recommendation made in conclusion of the study other than that newly diagnosed cats be screened for IGF-a. It will be interesting to see what the repeat study finds.

What I shared is literally coming from these groups. IF a pet parent is able to financially manage the test, run it because early results are often helpful. With the case I am involved with it was extremely helpful /life saving and allowed the team to be proactive & move diagnostics, as well as treatment options, & insulin changes along which has given the cat a chance. Otherwise, there is a very good chance this cat would not have made it, so please recognize the importance of this info. It could save a life.
 
Lisa & Oberon said:
Any point in redoing the IAA test? I know Black Kitty's IAA % dropped after he was in remission, but don't know if there's any point in testing now.
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I can only share what I was told about IAA when I recently asked about it.....:many cats will have antibodies and it is not an issue or the issue. The diagnosis with respect to it being noted as the cause for complications with managing DM is only made as a diagnosis of exclusion. All other causes of insulin resistance are eliminated first, such as HST, Cushings, Triaditis, dental issues (to name a few) because they have found that it is these disease states that cause insulin resistance vs antibodies.

Again, I am only sharing what I was told very recently because I made sure to ask the question given the seriousness of a rescue cats situation. I found it very odd that it was not mentioned at all in the Feline Endo textbook or in the latest publication, conferences. While it is an endo textbook, issues like Triaditis, dental disease, etc are immune mediated diseases & yet, they are all discussed at length as very necessary investigations when there is insulin resistance. So, I had to inquire about the IAA & where it fits or doesn’t fit because I wanted to understand what the latest thought process is.

I will be interested in any additional info you are able to get. Knowledge is power.....at least sometimes :rolleyes:.

I really hope & send many prayers that it is a bad tooth or something that, in some way, is more easily addressed than other issues. You have worked hard and have been doing an amazing job with Oberon :bighug:. Best with the vet appointment!
 
OK... back from the vet. Things went well overall. His weight is up (12.2 lbs; he was 11.7 last time), so that's good. She took blood and urine for routine panels and the fPL add on. She also added on a PT/PTT test for the dental precheck, and also fructosamine, which we didn't actually discuss beforehand, but whatever. (I'm thinking I should start a betting pool... just how high will it be this time?) The TAMU GI panel has to be a fasting test, so we need to schedule that for later. I think we may have had a miscommunication about the IGF test. When we talked after his exam, she said everything I'd requested on the written note I sent in with him sounded good and we'd do it, but I don't see it specifically listed on the bill. I'll follow up. We can do it at the same time as the GI panel if it didn't get done.

We talked about the dental cleaning and she said she's not surprised that doctors have been hesitant to recommend it for a diabetic cat with one kidney. Hopefully the bloodwork will show no issues and I can get them to do it if they're comfortable, or find a dental specialty clinic that can handle it. There are a few board-certified dentists within an hour or so of me.
 
Dental specialist sounds ideal. I had the IGF retested when Ollie was on cabergoline for 1 year. Even though her symptoms subsided, the value went up about 70 points.
 
Morning data: +8 341, AMPS 424 (1.75 R), +2 410, +4 347, +6 371, +9 362/1.1

388 at PMPS; another 1.75 U of R and 5.5 U of Lantus. Unless something dramatic happens overnight, Lantus bumps up to 6 U in the morning.
 
Lisa & Oberon said:
Any point in redoing the IAA test?
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None at all. It'll be about the same. It took BK 5 years off insulin before it changed. There have been very few studies on percent of cats with IAA. I have seen papers for two, both on way too small a sample size. One study said it's common, the other said it's uncommon. :rolleyes: Knowing a cat has IAA absolutely impacts dosing, and also awareness as you approach the time they might be breaking the antibodies - again, dosing.

Tomlin said:
I do not see a link to the study.
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There is no paper yet that I know of. What I saw was a presentation by Dr. Woolhead. She is at RVC and worked with the others there. The video for the presentation was located on the Royal Veterinary Clinic Feline Remission Clinic FB page.
 
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