12/4 Minner amps 301 - high flat for months

[MinnerPip]

Last post: https://www.felinediabetes.com/FDMB/threads/help-11-5-minner-amps-236-pmps-117.295493/#post-3218587

Is there such a thing as being stuck in yellow? It’s been 5 months and Minner’s numbers stay in yellow almost all the time.

I’m moving toward TR now. Testing more. Off the dry food and on all LC wet for over a month now. Seems her numbers are slightly worse since diet change.

I keep searching for what I am doing wrong so I can fix it … I have huge magnifying glass to carefully measure dosing in the Ulticare 5/16 length syringes. I’ve studied injection technique and do the tent across her shoulder blade to side areas, sniffing after to check for leakage.

I had her tested in august for IGF-1 and autoantibody. My vet said these are normal (?) but I wonder if either has progressed. Should I get her tested again?

What else should I do?

 

[Heather & Shooter]

If you're already on LC wet food only and are home enough to check fairly regularly, I'd say TR would be a good idea.

 

[tiffmaxee]

I would try TR as written now and take increases every 6 cycles if you don’t see green. I’d give it 10 cycles if you do see green. If in doubt start posting more often. I am glad the tests were negative.

 

[MinnerPip]

Thank you. I am declaring TR then.

I was freaking out after going to 5U two nights ago and having 301 this morning and higher numbers really the past 24 hours. I see some truth potential in that new dose wonkiness theory. Then her pmps tonight came down to 238 so hopefully we are past that.

At this point I would be delighted with blue …. Green is my new scary. Will keep all posted.

 

[Wendy&Neko]

I see that Minner tested positive for IAA (insulin auto antibodies). The result was 77 and anything over 20 is positive. Neko's was 52. That is definitely a reason for higher doses and the not being able to hold onto good numbers. Though we have seen one IAA kitty who maxed out around 3.5 units. The good news is that typically IAA will self limit after a period of time, maybe around a year.

I am glad you are going with TR. In future you will have to keep on top of increases. IAA seems to do best when you have a dose that is seeing quite a bit of green. If not, the antibodies seem to overwhelm the injected insulin and mean you have to keep increasing the dose.

How is Minner's health otherwise? Has her mouth been checked to see if she needs a dental? Treating any other medical condition seems to help the IAA. When Neko's acromegaly got treated, it also helped with the IAA. Not all IAA kitties have other conditions though.

What day was the blood draw done for the IGF-1 and IAA tests? Research out of the UK shows that most false negatives happen if the blood was taken within 73 days of starting insulin.

Have you been testing Minner regularly for ketones?

 

[MinnerPip]

Oh Wendy, thank you for looking at her IAA and explaining. I have thought for a while that it seems like dose increases initially get better numbers but then she falls back to the same yellow range, as if her body refuses to allow anything but yellow.

Knock on wood, her overall health is good. I don’t think she needs a dental but my vet did say she might start to need dental care because I stopped the dry food. I’ll get her last bloodwork added to her spreadsheet, but my vet told me that other than her glucose it was all normal. That was about 3 weeks ago. Did urinalysis too, no ketones. She’s been tested at vet office 3 times for ketones over past 4 months, negative. I have never tested ketones at home. I don’t know how to get a urine sample in litter. I tried once to use aluminum foil in litter box and she avoided it. I need some help and guidance here. I will try to find notes on this. My vet told me he wasn’t concerned about ketones with her numbers mostly below 300. I also weigh her each monday since diet change 5-6 wks ago and she has so far maintained a constant 15 or 15.1 pounds.

The one health item is a hairless slightly raised area in her lower back size of a dime that seems inflammatory. She’s had it her whole life. It waxes and wanes. Sometimes it really bothers her and she tries to get around and lick it and pull out hair around it. Vet says we can remove it but requires anesthesia which is complicated now that she is on insulin so I have kicked that can down the road.

The IGF and IAA tests were done about 30 days after starting insulin because I felt like I wasn’t getting results fast enough. Sigh. Based on your 73 day data point, I need to have her re-tested now that it’s been 5 months. Should I have both tests redone or only IGF ?

I will start increasing by .25 every 6 cycles if no green. I have been trying to test at +4 and 6 in both am and pm. Sometimes also at 8 or 9. Should I be doing 3/6/9 instead?

I will also start posting more because I know I’m going to need help because I’m so scared of shooting at lower numbers. Will likely want validation at each increase. This is going to be hard but I need to be more aggressive to save her. Tomorrow night will mean a dose increase to 5.25.
Thank you for the help. This community is truly a life saver.

 

[Wendy&Neko]

I have thought for a while that it seems like dose increases initially get better numbers but then she falls back to the same yellow range, as if her body refuses to allow anything but yellow.

Neko's happy place was more like the pinks. . She'd see a brief glimpse of nice numbers on a dose, then nothing. I called it the dose going stale.

Dry food helping teeth is a bit of a myth. Do you eat biscotti to help your teeth? At one point I gave Neko raw bones, chicken neck pieces or wing tips. And also some nice freeze dried meats that were tough enough she had to tear at them. Slightly cooked chicken gizzards were another one I gave.

Have you seen this post: Tips to catch and test a urine sample Neko wasn't shy - I could just walk up to her and stick a ketostix into the stream. She was also pretty predictable about when she went. We have seen ketones in kitties in the 200's here. Maintaining weight is good.

To bad on the blood test timing for IGF-1. You don't need to retest the IAA - once positive it stays that way while diabetic.

Regarding testing, mixing it up is good. A cat's cycle is not always the same. Nadirs can change, especially if bouncing and with IAA in the picture.

A quote from Sandy and Black Kitty - the first IAA kitty diagnosed here:

A few important things to know and keep in mind-

With IAA injected insulin first gets bound to the antibodies. Any insulin that does not get bound goes toward metabolizing sugars and delivering energy to the cells of the cat's body. How much goes to antibodies and how much goes to metabolizing sugars is anybody’s guess and a moving target

IAA can retard the initial rise of available insulin after an injection.

IAA can lead to an increase in the half-life of free (unbound) insulin in circulation because some bound insulin gets released into circulation. The increase in half-life can lead to prolongation of action.

Most importantly when it does break, the release of insulin from the antibodies can happen at inopportune times.

 

[MinnerPip]

This new info and awareness of IAA changes a lot from my perspective. I’m bothered my vet is not more knowledgeable of feline diabetes and did not say anything about the IAA result and its meaning / impact. I don’t think my vet clinic had ever even tested a cat for IGF or IAA. They use IDEXX when they can’t test in-house and even though these tests goto michigan, they don’t have account setup at michigan so they go thru IDEXX and had to lookup these tests. It also makes it grossly expensive with a middle man. Anyway, maybe its good I didn’t know 4 mths ago b/c it took 4 mths to break her dry food addiction so I would not have been able to do TR yet.

The info from Sandy is hitting home. This likely explains some of the random bizarre behaviors …. Random, late cycle nadirs a few times and very unexpected drops. Plus, this release of insulin from the antibodies “at inopportune tines” would suggest much greater risk of hypo, especially when driving to get her to green by staying on top of dose increases (??).

Could it be better / safer to ride out the yellow to get closer to the 1 year timeframe when it is thought that the IAA reaches the “self-limit”? I guess that limit may not mean the random release stabilizes. Thinking out loud.

What about insulin type? With IAA, are the antibodies specific to human insulin? I’m wondering if she might have better results or stability with a non human insulin …. Or perhaps it doesn’t matter and once you have IAA to one kind of insulin, you’ll have it for others?

I will read the urine sample tips. Thanks. I ordered the ketostix last night. I also ordered a blood ketone kit made by KetoBM. I need to learn what I would even do if I were to get results indicating ketones. That’s next on my list.

My life has become consumed with this. Hoping for some kind of rhythm soon. Going to 5.25 at shot time tonight.

Big thanks for all the info and past experience sharing. Very helpful. I’m looking into the chicken gizzards and chewy meats!!

 

[Heather & Shooter]

I don’t think she needs a dental but my vet did say she might start to need dental care because I stopped the dry food.

I've always found this interesting when they say it, because in the past, I've never found that any of my cats actually chewed the hard kibble. They just swallow it. And it all came back out that way when they would vomit. lol

 

[MinnerPip]

I've always found this interesting when they say it, because in the past, I've never found that any of my cats actually chewed the hard kibble. They just swallow it. And it all came back out that way when they would vomit. lol

Heather, funny you say that. Minner’s mom who passed a year ago, had very bad stomatitis. I had to put in feeding tube and then she had full mouth extraction at texas a&m. It cured the stomatitis! But point is that she was on a prescription diet (royal canin gastro response) … it kept her pooping despite pelvic opening qtr size of normal due to likely pelvic fracture from getting hit by car (guessing, she was a stray who showed up pregnant). It’s also why minner was csection baby, no fitting thru that tiny opening!

ANYWAY, i digress. She totally ate that dry kibble after the full mouth extraction. No issue eating it at all. So yes it had to be swallowed whole.

 

[Wendy&Neko]

Could it be better / safer to ride out the yellow to get closer to the 1 year timeframe when it is thought that the IAA reaches the “self-limit”? I guess that limit may not mean the random release stabilizes.

Nope - IAA needs to see green to help heal the pancreas, which will help with the IAA,. Otherwise you will see the insulin dose go much higher. Having a very high insulin dose (and corresponding depot) when the IAA breaks comes with it's own set of challenges, and much scarier. It's also not like you see 12 months time frame and things magically get better. Neko was closer to 9 months but corresponded with radiation therapy kicking in for her acromegaly. I've also seen it take longer. And sometimes it just means you get to a steady state on the dose - after all, the IAA cat still has the underlying diabetes to deal with.

IAA can also spontaneously occur. One cat, named Doodles, was solid green and close to remission, then he got a heart condition and his insulin needs soared. The caregiver tested and he was very positive for IAA.

Hoping for some kind of rhythm soon. Going to 5.25 at shot time tonight.

You will get there. . Over 5 units, and if not seeing green, I'd go with a 0.5 unit increase. Think of increases as a percent of the total dose, and you want to go 10-15% of it. With IAA, this is a battle, and you have to be the one to take the fight. As one of the early members here who was a vet tech said (sadly before my time) - "be the tank, the tank gets where it's going."

What about insulin type? With IAA, are the antibodies specific to human insulin? I’m wondering if she might have better results or stability with a non human insulin …. Or perhaps it doesn’t matter and once you have IAA to one kind of insulin, you’ll have it for others?

Changing insulin sometimes help, sometimes temporarily. I've seen a cat on Prozinc (cat insulin) in higher BG numbers, then drop to his first ever green when he switched to Lantus. It didn't stick, the antibodies got wise to it. I've also seen another cat on around 30 units of Lantus switch to Levemir and finally start going down the dosing scale. But he also had acromegaly and kidney troubles crept in. All this to say that switching insulin is not a magic answer.

 

[MinnerPip]

Thanks Wendy. I already gave Minner the 5.25U tonight and only now seeing your advice to increase by 0.5U given she is at a high dose already. I can change that in the morning.

yes, I am terrified of all the bad things that can happen when/if we break the resistance. It feels like being between a rock and hard place. The alternative isn’t working so not doing this isn’t really an option. All i know to do is be vigilant, test 5-6x a day and be ready to react if she nose dives. Unfortunately keeping a libre on her is near impossible, otherwise that would be a bit of help and warning. She’s just a big ole challenge.

 

[Wendy&Neko]

Libre's weren't invented yet in my time. The old fashioned way worked just fine. The resistance doesn't break all at once. It's not like you go from 8 units to 2 units overnight. If just means you have to be vigilant might have to break a few of the reduction rules. Once I figured Neko was on a roll, I took reductions at 70 instead of 50. Depending on size of dose, some people do a half dose after a reduction is earned to drain the depot. When you get there, we can help you out so Minner is safe.