2/18 Mary Grace AMPS 306 + 2 305 PMPS 346

[marygracemom]

Happy Tuesday LL!
Still drinking coffee even though it is afternoon here! Finally things are getting back to normal after our "blizzard"

Yesterday's condo: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=113888

Mary was on the pink floor this morning, bouncing from last night's blues. Guessing I am going to have to make arrangements for the arocat and insulin resistance tests. :YMSIGH: I was really hoping after we got back 6 or 7 units we would get her dose, but it is looking like its just another increase after increase. I have printed out the forms, I guess just take them to the vet and they will know how to ship it correctly. I can only go on Saturday and my vet only works every other Saturday so it still may be a few weeks out.

Hope everyone has a good day.

 

[Sandy and Black Kitty]

Re: 2/18 Mary Grace AMPS 306 + 2 305

Hi there

Glad to hear you will be getting Mary Grace tested for a high dose condition,
Best to know exactly what you are dealing with so that you can be confident that your treatment strategy is appropriate.
No use wasting time barking up the wrong tree.

It's not a big deal, just a simple blood draw same as any blood work.

The info from msu does specify how the blood samples are to be shipped.
Acro
IAA

Is your vet familiar with these conditions? If not you may want to fax copies of the info to her ahead of your appointment.
This way your vet can contact MSU with any questions as well as figure the costs for you.

I can speak to IAA in that my Black Kitty tested 84% which is extreme insulin resistance.
I believe he was the first LL kitty to be tested for IAA -it was a last ditch effort to find out why he was a big gulper after the Acro test came back negative.

He has been OTJ for 4 years now

Let me know if you have any questions.

 

[Angela & Blackie & 3 Others]

Re: 2/18 Mary Grace AMPS 306 + 2 305

I hope that she's not a high dose kitty. This new dose that you've got her on is starting to show some improvement in the #s, though. I hope that the next dose gives you even lower #s. Hang in there. :YMHUG:

 

[marygracemom]

Hi Sandy and Angela, I got a good chuckle, you both have black kitties too! Thanks for the visits and replies.
Sandy- I guess I am confused and I have read everything on here about the high dose conditions, but what I am gathering is that there is nothing really to do differently if they are dx with acro or iaa? Please tell me what I am not understanding. Is it a possibility that she is not even diabetic and just has one of the conditions like iaa or acro that are mimicking FD? So I thought if she tested positive for either condition than it was just for knowledge only. Is there a different treatment plan. Like I said, I have read all the links I have been provided by Wendy and Julie, and others I'm sure, but it didn't seem like there was anything to do about it. With you telling me yours has been otj, gives me hope. But also is barking up the wrong tree mean all of this effort trying to get her regulated might have been for naught? So confused... :YMSIGH:

Angela- I pray every time I test her that this will be the dosecrease that will be the right one and will start to click. I love seeing these lower blue numbers but just cringe when they bounce right back up after.

Thanks again for the visits. I am thankful for the support.

 

[Wendy&Neko]

Evening Elizabeth - sorry for the long post, maybe it's a black and white cat thing. :lol: Good plan on getting the tests. Knowledge is power and I felt a sense of relief when I got the test results back positive for IAA and acromegaly. It answered a lot of questions I had. I can't remember if I've mentioned that vets are sometimes reluctant to do the tests as they used to be taught the high dose conditions are rare. Mine thought we had to get over 10 units before testing - we got as high as 8.75.

Cats with acromegaly have a benign tumor on the pituitary that is sending out excess growth hormones, which in turn cause extra insulin like growth factor to be produced which competes with the bodies insulin. The tumor can and does wax and wane, so the amount of insulin needed is a moving target. The goal with an acrocat changes slightly from trying to heal the pancreas and earn deductions (mostly green), to one of giving the cat enough insulin to try to keep her in normal below renal threshold numbers as much as possible (blues and greens). For those who can afford the time and money, there is a treatment available called stereostatic radiation therapy that neuters the tumor cells. Neko had SRT a year and a half ago and has been playing around with a less than 2U dose for the last year. Some SRT cats do go OTJ. Even without SRT the amount of insulin needed can change. Lauren had Tommy down to 1U last year.

With acrocats, there are a couple of other things to be aware of. One - these cats can have a working pancreas. That means when the cat gets down to normal numbers, you have to be more cautious with food. Careful experimentation is required regarding %carb food. For Neko, I have discovered that 8-9% carb food causes her pancreas to kick in, which can be a bad thing when she's already low. :shock: So, I mostly stick to high carb food. You may see regular diabetic cats getting regular LC when they are low to help them surf - not something you want to try the first time an acrocat gets below 70.

The second thing to be aware of is the effects of an over production of growth hormone. For example, organs including hearts can get enlarged so need to be monitored more closely. We had an echocardiogram last year as Neko has a heart murmur. Soft tissue growth in the throat means smaller diameter intubation if acrocats have to have surgery. For Neko, knowing that she had acromegaly saved her canine tooth. Regular vetty saw red gum and thought tooth extraction. Dental vetty thought soft tissue growth on the gum and just filed the tooth back a bit. Cheaper and saved a tooth.

Cats with just IAA have a compromised pancreas (like regular diabetes) but also have the insulin auto-antibodies binding to the injected insulin so higher amounts and a more aggressive approach with insulin are needed to overcome the antibodies. The goal here is as much green as possible but it's harder to get there than with regular diabetes. Sandy is our expert on that condition.

It looks like you are into doing research. I was looking around the internet recently and found a few new ones that may be of interest.
http://zimmer-foundation.org/sch/csf.html and http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=824935&pageID=1&sk=&date=

On Insulin Resistance in Cats: http://www.2ndchance.info/diabetescat-insulinresistance.pdf

 

[Sandy and Black Kitty]

Hello again

You are right - the black kitties are hanging out in your condo today!

Sandy- I guess I am confused and I have read everything on here about the high dose conditions, but what I am gathering is that there is nothing really to do differently if they are dx with acro or iaa? Please tell me what I am not understanding.

There are indeed different strategies depending if the dx is IAA, Acro or both. Below is from a discussion on the topic we had in Cobbs condo yesterday, which should clarify:

The foundation of a safe and effective treatment plan is to know thy cat

With IAA, the focus is pretty much BG beat down. However one must always be mindful of the following:

•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 back into circulation. Any increase in half-life can lead to prolongation of action.

•The release of insulin from the antibodies can happen at inopportune times

Neko is both IAA and Acro which provides a bit of a conundrum for me on strategy. Sandy has described nicely what you do for IAA and it means being aggressive to spend time in green. For Acro, since there may well be a working pancreas, the goal is not to earn reductions and heal the pancreas but rather to keep kitty in healthy numbers as much as possible. For me, that means keeping Neko at a dose where she is below renal threshold as long as possible so as much blue and green time as I can. However, due to the IAA component, I do try to keep Neko seeing some green, because I've noticed she bounces more when she's not which results in time above renal threshold. For me, a dose that gets nadirs in the 70s seems to do the job. The tumor in an acrocat can wax and wane, so it is a moving target. But sometimes it holds steady - last year I held a dose for a couple months.

A second part of strategy that varies based on test results is how to handle low numbers. I do have to be cautious when Neko is in low normal numbers, because food can cause her pancreas to kick in and lower the numbers further. For Neko, that means using HC. I still have to test MC, but she refuses to do a nice mid level surf during the day where I can experiment while I'm awake. :roll: I know that a higher % carb LC does NOT work and can cause her numbers to tank. When acro kitties get into reduction level numbers we do have to be extra cautious. Kitties with just IAA or "regular" diabetes may be able to get higher LC or MC to bring them up. This is where careful notes and experimentation can be your friend. Just in case, be cautious the first few times Cobb hits the 60s or less.

And lastly, if Cobb tests positive for acro, there are some side effects of the excess growth hormone that you'll need to be aware of and monitor. For example, organs including hearts can get enlarged so need to be monitored more closely. Soft tissue growth in the throat means smaller diameter intubation if Cobb has to undergo surgery. For Neko, knowing that she had acromegaly saved her canine tooth. Regular vetty saw red gum and thought tooth extraction. Dental vetty thought soft tissue growth on the gum and just filed the tooth back a bit. Cheaper and saved a tooth.

Is it a possibility that she is not even diabetic and just has one of the conditions like iaa or acro that are mimicking FD?

High BGs are a side effect of Acro, since there is a pituitary tumor releasing hormones that interfere with a kitties naturally produced insulin. So first comes the Acro, then the high BGs.

In the case of IAA it develops in a diabetic kitty over time -- after diagnosis and after treatment with insulin has started. kitty produces antibodies against injected insulin.

With you telling me yours has been otj, gives me hope. But also is barking up the wrong tree mean all of this effort trying to get her regulated might have been for naught?

IAA is not insurmountable, however the less time that a kitty has been diabetic the better the chances of regulation or remission. That being the case the sooner kitty gets to and spends time in the healing numbers (<120) the better the chance the pancreas will heal and start producing insulin again.

Although BK was a stray, I don't believe he was diabetic for long before we took him in. I have photos from 09/2007 and he appeared to be in fine shape. We took him in 01/2008 which is when he was diagnosed with FD. Unfortunately he had all sorts of other life threatening challenges, By the time we got to the IAA test 10 months had passed - as I mentioned no kitty in LL had ever tested for IAA and it was a last ditch effort. Had it been common knowledge then, as it is now, I may very well have saved his pancreas a few months of damage from relentless high numbers.

That's what I mean by 'barking up the wrong tree' - time wasted with a treatment that doesn't match the problem.

Keep asking questions-

(I'm usually more concise however DBF and I have been battling the flu since Thursday - today is the first day with no fever for both of us !)

 

[marygracemom]

Wendy and Sandy, thanks for the details. You both are a wealth of knowledge!! So I'm gathering that a more aggressive approach and to keep them out of the renal threshold numbers, is going heavier or quicker with the dosecreases? I am going to call the vet and make an appointment to get the tests done.
Going to go read the articles Wendy attached.
Thanks again and Sandy I hope that you and dbf feel better soon!!!
Big hugs
Edited because I just read the articles which reminded me of why I didn't want to get her tested after reading about all this prior. She doesn't have any of the symptoms except requiring a high dose and the hunger. She is definitely not losing weight and I am feeding her 15 oz of ff. I do understand better that it's best to get the tests done regardless.

 

[julie & punkin (ga)]

i second the "knowledge is power" comment. i think with higher dose kitties it becomes even more essential to know your cat. All diabetic cats have different issues to deal with - some have chronic pancreatitis, some have IBD or asthma - most of the daily posters kitters have something else to deal with. This isn't really different.

yes, she is absolutely diabetic. it is a fallacy perpetuated by a few that they aren't diabetic. most of our diabetic cats are diabetic secondary to something else - whether it is a steroid injection, pancreatitis, acromegaly, obesity or iaa. they require insulin - that makes them diabetic. i put that exact question to Dr. Lunn, who is the acknowledged expert in north america on treating cats with acromegaly and her answer was unequivocal. Cats with acromegaly are diabetic cats. The good news is that sometimes the tumor wanes and the cat has an OTJ honeymoon.

punkin had acro only, like Tommy (photosquirrel) - our kitties were diagnosed at the same time. Lauren continued being aggressive in dosing to keep tommy in green and i backed off to keep him in higher ranges. You can look at Punkin and Tommy's spreadsheets around june 2011 to see what happened with those tactics. Neko responds to carbs differently than punkin did. One more area where it is vital to know your cat. i found no evidence that punkin's pancreas drove numbers down when he ate - i used high carb and low carb in the same ways after his diagnosis as before. I think this is one more area where you need to pay attention to how mary grace responds. whatever she has going on now is the same thing she'll have going on after diagnosis. This is a big issue to keep in mind. She doesn't change because of a test being run.

when you can see by the dose that there is something going on, it is a huge relief to know what it is. putting a name to it gives you company - there are cats with both high dose conditions on here. it lets you know whose condos to pay special attention to. putting a name on it also gives you the battle plan. i know you're making the plans to do it. i think we know there is one of these two conditions going on in mary grace. when we know what it is, then we can be specific in the strategies that are most appropriate for her.

we're on your side and will help you learn what you need to know to help your little sweetheart, elizabeth. :YMHUG:

 

[Wendy&Neko]

I too read the articles and couldn't see symptoms in Neko, other than dose and hunger. Her heart murmur came 8 months later and the soft tissue growth in the mouth probably a year later. That plus all the articles talk about the typical acrocat being male and short haired - Neko being neither. Neko's weight was pretty stable - on 1/4 lb raw food a day, although she's gained a bit of weight this year.

Sandy, Julie, and I have all been where you are. I know this can feel overwhelming. Lean on us. :YMHUG: :YMHUG: And as Julie suggested, once I had a name for what I was dealing with, I could look at other cats like Neko and it gave me a bit of an idea of what to expect.