10/7 Oberon +9 287, PMPS 320/1.8, +3 335, +5.5 306/1.7; dose increase to 6.5; IGF = 47 so no acro!

Definitely down a bit at +3 and +4, but I really can't say whether it's the R or just his normal fluctuations. I'll check again at +5 just to see what's happening. My guess is that he needs a bit more to really show a response.
 
Down 60 points, not bad. You don't want to drop more than 100 over the time, so he got a little nudge at least. 0.75 might be the next move, after the Lantus increase.
 
That's what I was thinking. So I'll increase Lantus tonight, and assuming he's not in the middle of a big drop after that I could try 0.75 U of R tomorrow morning or tomorrow evening.
 
Just noticed I made a typo in my title... he was 350 at AMPS, not 370. (It's correct on his SS.) So his drop was only about 40 points, about the same as last night.
 
287 at +9, interesting. Lowest he's been in about a week and a half. I wonder if the small R dose gave the Lantus a bit of a boost.
 
I think I mentioned it previously, but the impact of R can sometimes be seen in later cycles, especially in IAA kitties. Another reason to not shoot R tonight and see what he does with this. :)
 
Vet update! IGF results are in: 47 (normal is 12-92). So we're thankfully not dealing with acromegaly on top of the IAA.

So... summing up what we've learned in the past couple of weeks:
  • FD with IAA, leading to persistent elevated blood glucose and bonus ketones. (No acro, no Cushing)
  • Mild nonregenerative anemia + decreased WBCs, cause unknown.
  • One kidney missing and the other slightly hypertrophied, but renal bloodwork is ok.
  • Some signs of inflammation of pancreas, GI, and liver, but probably not active problems.
I told her I started testing out R, and the results we have so far. Her recommendation is actually to hold the Lantus dose at 6.0 and increase R to 1.0. I'm still not sure how much she understands about IAA, though. What do you think, @Wendy&Neko? My leaning is to stick with the current plan and see what this morning's R + more Lantus does for him.

She also wants me to take him back to my regular vet and get an in-house PCV done to check on the anemia, then follow up with a CBC if it's still low. I totally forgot to ask about the antibiotics. :facepalm:
 
This morning's data, for reference, before I update the title: +9 360, AMPS 350/4.8, R trial: +1 335, +2 348, +3 320, +4 311, +5 331, +9 287
 
OK, at PMPS BG is back up to 320, but ketones are 1.8. Lowest since the dexa test last Monday, and under the DKA threshold. Yay!
 
Lisa & Oberon said:
but ketones are 1.8
Click to expand...
Woohoo!:woot:
Lisa & Oberon said:
So we're thankfully not dealing with acromegaly on top of the IAA.
Click to expand...
Double woohoo!!:woot::woot:

OK, one less variable in the mix. The pulsing of the acro tumour can have you chasing higher and higher doses so at least there's not that in the mix, just those darn antibodies. And they should be self limiting after a period of time. But that period of time is still quite a ways away. "typical" for whatever that means is about a year. Neko was at 9 months, but she also had her acro tumour zapped then so I think it was a double whammy. Anyway, R is a really good tool to be using when those antibodies slow down. As we talked about before, you just stop giving R and automatically lower the dose without the higher depot headache.

Glad you increased - we do want to get to a better Lantus dose as well as using R. A good Lantus dose will have longer BG lowering effects than the combo of Lantus + R.

Good idea to check the anaemia, his HCT (aka PCV) was low. Neko's bounced around a bit too. My vet was always about getting a second test to make sure the first wasn't a fluke.
 
Wendy&Neko said:
Woohoo!:woot:

Double woohoo!!:woot::woot:

OK, one less variable in the mix. The pulsing of the acro tumour can have you chasing higher and higher doses so at least there's not that in the mix, just those darn antibodies. And they should be self limiting after a period of time. But that period of time is still quite a ways away. "typical" for whatever that means is about a year. Neko was at 9 months, but she also had her acro tumour zapped then so I think it was a double whammy. Anyway, R is a really good tool to be using when those antibodies slow down. As we talked about before, you just stop giving R and automatically lower the dose without the higher depot headache.

Glad you increased - we do want to get to a better Lantus dose as well as using R. A good Lantus dose will have longer BG lowering effects than the combo of Lantus + R.

Good idea to check the anaemia, his HCT (aka PCV) was low. Neko's bounced around a bit too. My vet was always about getting a second test to make sure the first wasn't a fluke.
Click to expand...

So the good news is that we probably have plenty of time to play with R and develop a dosage scale. I assume that once we get a better feel for that I won't be testing hourly after each R dose? I mean, I could, but I'm enjoying having an evening off from that right now.

Should I consider another R trial (at 0.75 U) tomorrow morning, assuming he's over 300? Or wait another cycle or two until the new Lantus dose settles in?
 
Once you know the pattern of R, you can change the amount you test. First to go might be the +1 test, if you know he never does R onset until +2. The choice of doing R or not is up to you. You have to be able to monitor. And you did mention he sometimes likes to show some action on the second cycle of an increase. Maybe the AMPS and direction he's going will give you a clue what to do there. This is no harm in not doing R, as long as those ketones stay down.
 
So here's another question... any relationship between the IAA test value and the max insulin dose needed before the antibodies give up? Right now I only have two data points- Neko's IAA was in the low 40s, and dose maxed out at 8 or so. Black Kitty's IAA was in the 80s, and dose peaked in the 40s. I'd be really interested to gather more data to see if there's an actual relationship. Seems like a higher antibody response would need a higher dose of insulin to get past it. I know it would be affected by different insulins, use of R, other conditions, and all sorts of stuff, but still...
 
I did at one point link Doodles spreadsheet - he was also IAA (72) only. As is Loudogg - here is his SS. I believe his IAA score was in the 80's too, never got to a high dose. His caregiver Amanda still posts occasionally. Ozy was also IAA only, spreadsheet here, IAA in the 60's ish. As you can see, no real correlation between IAA score and dose. FWIW, Neko's IAA was 52. There was also DoLou, but I couldn't find his spreadsheet. I could find some acro + IAA links for you, but in most of those cases, the acromegaly really influences the dose.

There are a couple of things that seem to help with IAA. First, if there is any underlying other causes of insulin resistance, treating that seems to help. Black Kitty had bad teeth, Ozy has skin granulomas, Doodles had heart condition - at best it could be controlled. His dose really went up when he got his heart diagnosis. Nothing with Loudogg as far as I know. DoLou had skin allergies. The second thing that seems to help is getting to a dose that gives as much green as safely possible.
 
Wendy&Neko said:
I did at one point link Doodles spreadsheet - he was also IAA (72) only. As is Loudogg - here is his SS. I believe his IAA score was in the 80's too, never got to a high dose. His caregiver Amanda still posts occasionally. Ozy was also IAA only, spreadsheet here, IAA in the 60's ish. As you can see, no real correlation between IAA score and dose. FWIW, Neko's IAA was 52. There was also DoLou, but I couldn't find his spreadsheet. I could find some acro + IAA links for you, but in most of those cases, the acromegaly really influences the dose.

There are a couple of things that seem to help with IAA. First, if there is any underlying other causes of insulin resistance, treating that seems to help. Black Kitty had bad teeth, Ozy has skin granulomas, Doodles had heart condition - at best it could be controlled. His dose really went up when he got his heart diagnosis. Nothing with Loudogg as far as I know. DoLou had skin allergies. The second thing that seems to help is getting to a dose that gives as much green as safely possible.
Click to expand...

52, right! I was remembering 42, but wasn't sure it was quite right, so I hedged. Serves me right for doing it from memory.

OK, so it sounds like there isn't really a pattern. I'm actually glad to hear it... I was worried that Oberon's high IAA might mean he was going to end up needing as much as Black Kitty. (I know he still might, but at least it's not predicted from his high IAA number.) I'll have to look over those other IAA-only spreadsheets, too. Thanks!

I keep asking vets about his teeth. They keep saying that they look ok for his age, and one of these days maybe he should get a cleaning, but it's not a big deal. Maybe I should push a little harder to get that done so we can more definitively rule it out as a possible problem. Other than that I think we've checked everything except maybe giving that course of antibiotics that I've been dithering about, in case there's some infection we aren't seeing.
 
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