11/22 Minner AMPS 114 +5 201 PMPS 155 dose incr .125, +5 64

[MinnerPip]

Yesterday

Yep, there is indeed a tipping point. At least for this moment in time. Will see how going back to 6.25 (tiny .125 unit increase) affects AM overnight cycle which has usually been fairly insulin resistant, much less action recently.

 

[Wendy&Neko]

Sweet little 76 popped up tonight. Patience is rewarded.

We've had a few other kitties here with stomatitis and diabetes. When was Minner's last dental? Did the vet do dental x-rays

 

[Mary & Jude]

So Jude’s dental was 9 months ago and needs another! And you use those cloth finger wipes on his teeth daily? I am sorry about his FIC. How do you manage that? It looks like it can be idiopathic. I know pred can cause diabetes but if you already have diabetes and pred can reduce inflammation from other things I wonder if it can be appropriate course of action.

I am, in fact, NOT using those finger wipes daily because I'm a bad mommy, and I forget to do their teeth daily (bad mommy). I did just purchase a toothpaste that is supposed to help with the gums; I'll TRY to remember to use it going forward, once I get Jude through this inappetence issue. The vet didn't seem too worried about twice a year dentals; he said diabetic cats have bad teeth, and it's just a common issue he runs into with them.

Jude has both UTIs and FIC flares. Every time he has a flare, which has been about four times this year, I have to take him to the vet for a cysto/culture/sensitivity to the tune of ~$400 per test. But, it's important to try to determine what we are dealing with: UTI, which gets an ab, or FIC, which doesn't. The very strange thing is this: the times he hasn't had a bacteria (the test came back negative yesterday), his numbers continue to rise gradually, like they would if an infection were present, and while the vet is waiting for the culture/sensitivty to come back they start him on an ab, which almost immediately begins to result in lower bg numbers. So, the vet is somewhat confused about this, and said it's possible that the test is not picking up some infection. It is also completely possible that this is simply FIC, which flares are often one week in duration, and the ab action could simply be coinciding with the waning of the FIC flare So last Monday, when he reached the 300s, the vet did a cysto/culture/sensitivity and put him on two weeks of Clavamox--one week longer than normal this time to see if we can knock out any recurring infection, if that is, in fact, the cause of the rising numbers. Sadly, the Clavamox is giving Jude an upset tummy and inappetence, so we're battling with that and with giving him an anti-nausea med and an appetite stimulant. In terms of ongoing, daily treatment of the FIC issue, he takes supplements to try to keep the inflammation down in the bladder, we use Feliway dispensers, I am in the process of moving him to a non-clumping litter, and when he has a flare, he goes on Gaba and Prozacin. I'd like to say it's exhausting, but then I think of others on this forum who have MUCH more complicated issues, and I tell myself to shush.

 

[Seth&Bell]

Laura! Sorry you are struggling here. I can assure you I'm a disaster as well . Bell has never been stable enough to see any difference with micro-adjustments to her dose. The way I look at Bell's numbers are two-fold: 1) Bouncing Bell - When I see this, I just ignore her numbers until the bounce breaks. Nothing I can do once she is bouncing can change those high numbers, so I use those nights to get some extra sleep. It is stressful and I hate it, but I can't do anything about it. 2) Non-bouncing Bell - this is where I can actually evaluate the dose. Bell is constantly going back and forth between those two states. It is far from ideal and I'd give a whole lot to have a stable cat, but she is what she is.

Because of the depot and Bell's bounces, I kinda look at each dose change as an investment. A lot of times it is going to take some time for me to see the effect. My issue is knowing when to cash out my investment ( ). Bell hasn't seen greens in 6 cycles, so tonight I had to make a tough call on holding a dose that has been very effective or increasing it. I never know what to do in those situations...

It’s wild that 0.125 of a unit at this high of a dose can be a tipping point, but it sure looks that way.

I'd be curious what a more experienced person's thoughts on this statement. I think it is a definite possibility that the bump up to 6.25 was enough to push Minner into that flat cycle. But I also think it is possible that you would have had a very similar cycle sticking with 6.125. I hate not knowing both futures!!! I think the human brain has a tendency to attribute causation to things its human can control (like dosing). Early on I was fully convinced my insulin was bad, which just turned out to be the IAA. My advice is to look at the general trends of the last 3 or 4 days, rather than focusing on a single day or cycle. Looks like Minner was having fewer bounces on the higher dose. I've seen this trend with Bell as well. If a dose isn't quittttte strong enough, she'll bounce for more than 50% of the time but still hit the lower greens on the bounce breaks. If I increase, she'll still bounce, but they won't last as long and seem to break faster. The downside to the higher dose is I lose sleep . You can see that if you compare Bell's performance on 5 units vs 5.5, this month.

I'll caveat this that I'm still not comfortable giving dosing advice, so don't take anything actionable from what I said. This is more of what I've observed with Bell and her IAA.

I really hope Minner's mouth redness is not stomatitis. Give her a hug for me! You are doing wonderfully, Laura. Be kind to yourself!

 

[Wendy&Neko]

I think Minner’s IAA is wreaking some havoc as well. I discussed her entire situation with ChatGPT and was very impressed with the feedback. I’ll copy that dialog into a file and share on Google drive for anyone interested.

OK, read it through. Would love to know where it gets it's information. There is extremely little written on cat IAA, more on human IAA, but cats are not little humans. I have seen two papers talking about how common IAA is, both on relatively tiny study groups. One said it's quite common, the other said uncommon.

The stuff on acromegaly is mostly garbage. In the US, positive for acromegaly is IGF-1 over 916, not over 500 as ChatGPT said. Even with the old system of measurements, the positive was over 92. Again, maybe using human figures? Doses do not go only steadily up with acromegaly, they can wax and wane along with the tumour cells. We had one acro kitty get up to 55 units, then eventually go OTJ on her own. That was a one off case, but still proof it can happen. I've more often seen cat (not IGF-1 tested) go OTJ, then come back and when gets to high doses be tested and be positive. More than likely they were acro the first time, the tumour faded, then came back.

One solution Chat GPT suggested was switching to determir/Levemir. Lovely idea, but Levemir is discontinued in most of the world and will be in the remaining parts by end of next year.

This is an interesting statement:

This can worsen IAA activity because immune activation of any kind increases antibody production.

It's something I've suspected as a possibility, but have seen absolutely no papers describing this in cats. Would love to know where that bit came from.

Regarding tiny adjustments, Neko responded to 0.125 unit changes, though mostly under 5 units total dose.

 

[Wendy&Neko]

My advice is to look at the general trends of the last 3 or 4 days, rather than focusing on a single day or cycle.

Wise words from Seth.

 

[MinnerPip]

I did just purchase a toothpaste that is supposed to help with the gums;

Mary, absolutely opposite of bad mommy. More like epitome of great mommy. I still tell people about my diabetes forum friend who took her diabetic cat to work with her on a university campus to make sure she could monitor his levels during a certain time!!!!

If you dont mind, pls share the toothpaste name. I need to research b/c Idk if there are ingredients in some that a diabetic should not have. If u have already determined a certain paste is appropriate I will want to get it and try using on Minner.

 

[MinnerPip]

I think the human brain has a tendency to attribute causation to things its human can control (like dosing). Early on I was fully convinced my insulin was bad, which just turned out to be the IAA

Thank you sooooo much Seth for sharing your insights. 100% with you on the control statement AND the past suspicions on insulin integrity. Been in that spot too.

I’m getting closer to your mindset when dealing with bounces. The lack of control was consuming me and my life. Letting go was/is hard, but more & more I’ve been better at it and looking at how she is behaving (thankfully almost always good — knock on wood) vs stressing over the high number I can’t do anything about in the moment.

Thanks again for the response, encouragement, and being a great role model. Bell is the best.

 

[MinnerPip]

The stuff on acromegaly is mostly garbage.

Wendy, greatly appreciate you taking the time to read through the ChatGPT dialog. Full disclosure, it was the first time I ever used it, so I’ve not learned yet to decode what may be junk. I did print out a copy and took it with me to Minner’s vet appt on the 17th and he read through it, and on the acromegaly number stuff, he basically said “I don’t know that this is accurate”. I also seemed to recall there being a big change in the measurement basis. I am very relieved to see your strong statement that it’s mostly garbage. I had felt very relieved that Minner’s IGF-1 tests had ruled it out firmly, so the proposal that she might still be developing it was worrying me again.

Re: the statement about immune activation of any kind increasing antibody production and wanting to know source, here is ChatGPT’s response when I asked specifically:

Great question. I don’t think there’s a direct study (in cats) showing that a dental injury or “immune activation” always or reliably increases insulin autoantibody (IAA) titers. But the logic is grounded in broader immunology and autoimmunity research, plus some more specific precedent. Here are the sources and reasoning backing up that statement, plus its limitations:

Then it listed numerous human based references and studies and acknowledged what you already said about there being few studies in cats, and inferring from human studies. I’ll spend some time reading through it during the day, it’s almost 230am, about to check Minner’s +2.

 

[Seth&Bell]

Thank you sooooo much Seth for sharing your insights. 100% with you on the control statement AND the past suspicions on insulin integrity. Been in that spot too.

I’m getting closer to your mindset when dealing with bounces. The lack of control was consuming me and my life. Letting go was/is hard, but more & more I’ve been better at it and looking at how she is behaving (thankfully almost always good — knock on wood) vs stressing over the high number I can’t do anything about in the moment.

Thanks again for the response, encouragement, and being a great role model. Bell is the best.

Beautiful last two cycles!