1/15, Bell, AMPS 86 +2 120 +4 157 +8 290 PMPS 421, Positive for IAA, Negative for IGF-1

bluesunshine

bluesunshine

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Yesterday

So I think this is good news? Her IAA was 82% and her IGF-1 was 174. My vet suggested the only next steps she was aware of is to switch insulins or to just increase the dose until we break through (7.5 units has seemed promising here lately altho it looks like we may be bouncing). I asked about a dental being done and she agreed that that was a good next step, but I wanted to research a little bit and ask for some advice here before going through with that.

@MinnerPip: you called this way back! We must have sister cats!

Tagging Wendy as well @Wendy&Neko
 
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Seth, I am soooooooo happy to hear the IGF-1 is so low. That is super duper awesome news. Jumping up and down and wooping!!

Bell and Minner are indeed now verified IAA sisters. You might want to peek back at some posts where Wendy was sharing IAA knowledge with me and I was asking questions. This post is when it started. I asked her about switching insulin, if that would help. Maybe briefly, but not really. I read somewhere that fish insulin would not be affected by IAA but there’s nowhere to get that in US from what I recall, plus not sure I’d want to gamble in unchartered waters unless it was last recourse. I thought about trying Levemir but decided not to further explore that unless we get in double digit dose size with Lantus. I’d be interested in discussing thoughts more on all of this.
 
Yes, this is good news. :) The IAA is quite a bit higher than Neko's. It is so odd to have two recently just IAA cats with Minner too.

A dental is absolutely next on the agenda. Fixing any source of infection/inflammation seems to really help IAA kitties. Black Kitty, our first IAA kitty here eventually went OTJ once Sandy got his dentals done. He actually needed two dentals. Treating Neko's acro helped her IAA.

There isn't really a good insulin option to switch to right now and the effects of an insulin switch on the antibodies can be temporary. They learn and adapt. :mad:

Sandy learned a lot about IAA. Black Kitty's spreadsheet and more discussion can be found in this post:
IAA - Ruminations - join the conversation The following is a quote from her:

IAA is idiopathic-it arises spontaneously. Check out Doodles ss, January into February 2016 for an example.

A massive depot is one element to consider. There are 2 additional unpredictable variables to consider. The first is that when resistance breaks, previously bound insulin is released back into circulation. How much and when is anybody’s guess. The second variable is that spending more and more time in the healing numbers (50-120) with a little luck can result in the pancreas healing and a returning to the job of producing insulin. So you have contributions from the depot, previously bound insulin that’s been released and maybe the pancreas starting to sputter.

Insulin resistance due to IAA is much different than glucose toxicity. It’s not a matter of reaching the magic dose and breaking the resistance. Its giving your kitty enough insulin to try and stay below renal threshold while keeping your antenna up to spot signs that the IAA is letting go.

The way it works is that a cat starts producing a crazy amount of antibodies toward the insulin. The antibodies grab insulin before it gets to do its job.

When insulin sensitivity returns, it can happen quite suddenly and large amounts of insulin previously bound to the antibodies may be released. Due to the half life of the antibodies insulin needs can fluctuate for several weeks. Add a large depot (the gift that keeps on giving ) to the mix and it gets more interesting. On BKs ss you can see some of the aftermath first 3 weeks of February 2009. I had very little sleep.

For starters, below you will find some important information about IAA-
  • Injected insulin first gets bound to the antibodies. Any insulin that does not get bound goes toward metabolizing sugars. 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.
· Its self limiting and generally lasts about a year
    • When insulin sensitivity returns, it can happen quite suddenly
    • At these times, large amounts of insulin previously bound to the antibodies may be released, so avoiding hypoglycemia is a major concern.
  • The release of insulin from the antibodies can happen at inopportune times
As far as BCSs go, keep in mind that with IAA you are more likely to see the effects in the cycle following the cycle of the BCS.
 
Awesome info, looks like I have some reading to do this weekend!

That sounds like it doesn’t bode well for my back in office mandate :p.

Dumb question: what are BCS’s?
 
So that means that if I were to say, give her a half dose the morning of a dental, I’d see her BG skyrocket in the PM? So would it make sense to give the half dose the evening before the dental?
 
The BCS is a technique for higher dose cats (typically 1/2 ish dose) when they are on the downward slope for dosing. This allows you to drain some of the larger depot, which can be a real pain for several cycles! Note, I only BCS'ed once, but Neko was a reliable bouncer. When a higher dosed kitty starts down dose, I strongly suggest being conservative at first.

bluesunshine said:
So would it make sense to give the half dose the evening before the dental?
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Maybe, it's an ECID thing. It does mean a single reduced dose is not a guarantee they'll stay higher the cycle of the reduced dose. And you would be reducing to half dose in the AM. You have to look at how she's doing on the dose and whether she's toying with a reduction and you want to play it safe. With Neko's first dental, she was largely in higher numbers and I didn't see her going down during that day, ditto with her SRT days which also involved anaesthesia. She actually went down more at night. Her last dental I did a token dose in the AM because I didn't trust her and she still got to almost reduction point.
 
Glad you have some answers Seth. And glad the news was somewhat good news.
You’ve got this and Bell is in your very capable hands. She has the best Dad to watch over her.
:bighug::bighug::bighug::bighug:
 
Wendy&Neko said:
The BCS is a technique for higher dose cats (typically 1/2 ish dose) when they are on the downward slope for dosing. This allows you to drain some of the larger depot, which can be a real pain for several cycles! Note, I only BCS'ed once, but Neko was a reliable bouncer. When a higher dosed kitty starts down dose, I strongly suggest being conservative at first.


Maybe, it's an ECID thing. It does mean a single reduced dose is not a guarantee they'll stay higher the cycle of the reduced dose. And you would be reducing to half dose in the AM. You have to look at how she's doing on the dose and whether she's toying with a reduction and you want to play it safe. With Neko's first dental, she was largely in higher numbers and I didn't see her going down during that day, ditto with her SRT days which also involved anaesthesia. She actually went down more at night. Her last dental I did a token dose in the AM because I didn't trust her and she still got to almost reduction point.
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Oh wow, I have much to learn... Thank you Wendy, will start researching tomorrow night.

If anyone has any dental advice I'd appreciate. I'm going to write out my thoughts to them tomorrow regarding the dental.

Follow this guideline:
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Make sure they monitor her during the procedure. Do a half dose the AM of (and maybe the PM before depending). Feed 2-4 hours before with her half insulin dose.

Regarding the IAA specific, I would want them to do a dental xray to make sure there's nothing going on below the surface.

Let me know if I am missing anything in that communication.

Appreciate you all so much
 

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Staci & Ivy said:
Glad you have some answers Seth. And glad the news was somewhat good news.
You’ve got this and Bell is in your very capable hands. She has the best Dad to watch over her.
:bighug::bighug::bighug::bighug:
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Thank you Staci! The more I think about this, I think it is really good news. It is a little scary, especially with my job stress, but I don't have to deal with the acromegaly and we have some idea of her high dosage needs.
 
I went to a dental specialist vet. He was more up on the current dental practices, but more important for me, there was extra monitoring during the anaesthesia. Plus it turns out he was tuned into acro soft tissue growth possibilities.

We still see lot of people get told by the vet that there is to be no food after 10PM or midnight.
bluesunshine said:
Regarding the IAA specific, I would want them to do a dental xray to make sure there's nothing going on below the surface.
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Not IAA specific, same for any cat getting a dental. If they are undergoing anaesthesia, make sure everything gets taken care of at once.
 
Hi Seth, happy to read the IGF-1 was negative! Sounds like a lot to dive into to deal with IAA. But you got this and I am sure, you will manage great. Happy you got answers what is going on with Bell. That must be a relief. :bighug::bighug::bighug:
 
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