2/23 Jack: 249@amps, day 7 on 9units- Acro/IAA question

[Jack & Mopem'sMom]

Back in the yellow zone this morning after his trip to the pink bounce house yesterday afternoon, after a nice run of blue. I just don't know why he bounces after numbers in the 100's I have to go to Brooklyn tomorrow so won't be around to monitor, and Jack had that illegal kibble incident this week, so planning on holding 9units until Monday. Hope everyone has a peaceful weekend and the kitties all behave!

Anyway, question for anyone familiar/having experience with Acro/IAA: Jack is currently on 9 units of glargine and following the SLGS protocol. We seem to go through this 9 unit nonsense every year, and looking back, I see we actually hit 9.5 units at one point back in 2022. I did have him tested for Acro/IAA back in July of 2022 and he came back negative: Insulin-like Growth Factor 1 (RIA) [RANGE 12-92 mmol/L] result=68 (neg) and Insulin Autoantibody [RANGE </= 20] result= 2 (neg). I remember those tests were expensive, and it was an argument with the vet clinic to: 1. get them to do the tests, and 2. over the mark-up they put on them. I really don't want to go through that again, but if anyone thinks there is value in that, I'd like to know. I think 9 units is A LOT of insulin, the vet doesn't seem to think so, and is telling me he can have 15 units without cause for worry . Thoughts? Advise (other than continuing to try to get him to give up the Elsey's/Ziwi Peak kibble mix in the morning, which he won't eat any wet food without??) THANKS IN ADVANCE!

Yesterday: https://www.felinediabetes.com/FDMB/threads/2-22-jack-103-amps-156-2-132-3.286945/#post-3155086

 

[Staci & Ivy]

Back in the yellow zone this morning after his trip to the pink bounce house yesterday afternoon, after a nice run of blue. I just don't know why he bounces after numbers in the 100's I have to go to Brooklyn tomorrow so won't be around to monitor, and Jack had that illegal kibble incident this week, so planning on holding 9units until Monday. Hope everyone has a peaceful weekend and the kitties all behave!

Anyway, question for anyone familiar/having experience with Acro/IAA: Jack is currently on 9 units of glargine and following the SLGS protocol. We seem to go through this 9 unit nonsense every year, and looking back, I see we actually hit 9.5 units at one point back in 2022. I did have him tested for Acro/IAA back in July of 2022 and he came back negative: Insulin-like Growth Factor 1 (RIA) [RANGE 12-92 mmol/L] result=68 (neg) and Insulin Autoantibody [RANGE </= 20] result= 2 (neg). I remember those tests were expensive, and it was an argument with the vet clinic to: 1. get them to do the tests, and 2. over the mark-up they put on them. I really don't want to go through that again, but if anyone thinks there is value in that, I'd like to know. I think 9 units is A LOT of insulin, the vet doesn't seem to think so, and is telling me he can have 15 units without cause for worry . Thoughts? Advise (other than continuing to try to get him to give up the Elsey's/Ziwi Peak kibble mix in the morning, which he won't eat any wet food without??) THANKS IN ADVANCE!

Yesterday: https://www.felinediabetes.com/FDMB/threads/2-22-jack-103-amps-156-2-132-3.286945/#post-3155086

Hope Jack slides down gently today, Christine
Holding your dose sounds like a good idea. Have a safe trip to Brooklyn tomorrow. Hope all the kitties at home behave.
Wishing you a very, very boring and peaceful day

 

[Mikanmama (Mikan GA)]

Hi Christine,
Bounces ARE frustrating and discouraging. I hate them!
But it's the process I guess of our kitties getting used to the better number. Jack's getting more blues - soon or later, his body will get used to it. I don't know about Acor/IAA much at all.
I'll tag @Wendy&Neko.
Drive safely to Brooklyn. Hope the day goes well!

 

[Diane Tyler's Mom GA]

Hi Christine , I hate that you have to drive to Brooklyn again .
Hopefully Wendy will give you some advice .
Drive safely
I can also tag @Suzanne & Darcy for you

 

[Wendy&Neko]

When a kitty is newly diagnosed, the guidelines it to wait at least 73 days after starting insulin before testing the IGF-1. Or you can get a false negative. But looks like you had at least 4 months on insulin before getting the tests done. There is something about starting insulin that causes temporary lower IGF-1 to be produced. Side note, MSU just last month changed the type of assay they use to test for IGF-1, and it's supposed to be a cheaper cost now for them. I just checked the website, they are charging $72 at their end, so no change. The other thing about changing the assay type, is that supposedly other labs can now do the test. I don't know if anyone else in North America is doing it yet, but that is happening in Europe. I just checked the Idexx on line price list, and they are charging $101, but that's probably just to forward it onto MSU. The MSU IGF-1 units type has also changed, so the range is completely different now.

I have seen guidance that if there is any other concerns about acromegaly, such as physical signs, to retest IGF-1. However, one of the common signs is polyphagia or insatiable appetite due to the excess growth hormone. Neko was never picky about her food! Unlike Jack. She raided ours if we weren't careful. Has Jack gained much weight since he was first diagnosed as diabetic? Does he have a pot belly? Not all acros do (Neko didn't) but it is common. Any change in sound of his voice/breathing?

Yes, 9 units is quite a bit of insulin for a cat that is on pretty much all low carb food, even if some of it is dry.

 

[Jack & Mopem'sMom]

When a kitty is newly diagnosed, the guidelines it to wait at least 73 days after starting insulin before testing the IGF-1. Or you can get a false negative. But looks like you had at least 4 months on insulin before getting the tests done. There is something about starting insulin that causes temporary lower IGF-1 to be produced. Side note, MSU just last month changed the type of assay they use to test for IGF-1, and it's supposed to be a cheaper cost now for them. I just checked the website, they are charging $72 at their end, so no change. The other thing about changing the assay type, is that supposedly other labs can now do the test. I don't know if anyone else in North America is doing it yet, but that is happening in Europe. I just checked the Idexx on line price list, and they are charging $101, but that's probably just to forward it onto MSU. The MSU IGF-1 units type has also changed, so the range is completely different now.

I have seen guidance that if there is any other concerns about acromegaly, such as physical signs, to retest IGF-1. However, one of the common signs is polyphagia or insatiable appetite due to the excess growth hormone. Neko was never picky about her food! Unlike Jack. She raided ours if we weren't careful. Has Jack gained much weight since he was first diagnosed as diabetic? Does he have a pot belly? Not all acros do (Neko didn't) but it is common. Any change in sound of his voice/breathing?

Yes, 9 units is quite a bit of insulin for a cat that is on pretty much all low carb food, even if some of it is dry.

Thanks for your response! Jack is picky, and will walk away from his food, so not a candidate for the insatiable appetite. He's a big boy, 17 pounds, his weight is pretty stable since diagnosed in 2022. I'll send a note to the vet clinic about what his weight has been each time he went, and about the new testing parameters. I'll see what the vet says. Thanks again!

 

[Wendy&Neko]

Excess growth hormone from acro usually causes weight gain, unless something else is happening. Stable weight makes acro less likely. I had to draw the line at 15 lbs for Neko and told her she had to stay under it! Her vet wanted her at least 13lbs. I think getting treatment also helped reduce the growth hormone for her so she was stable after SRT.

I forgot to mention, if he tested neg for IAA before, he'll still be negative. No need to retest it. His spreadsheet doesn't say IAA to me, nor does it scream acro. One other thing that can cause the need for higher doses is Cushings, but typically they have pot bellies, hair loss or thin on the tummy and elsewhere, and you'll see things like freckles or other skin conditions. I've heard their liver numbers might be out too, but that's not Jack.

More reading if you want: MSU reference range changed for IGF-1 (and paper)

 

[Jack & Mopem'sMom]

Excess growth hormone from acro usually causes weight gain, unless something else is happening. Stable weight makes acro less likely. I had to draw the line at 15 lbs for Neko and told her she had to stay under it! Her vet wanted her at least 13lbs. I think getting treatment also helped reduce the growth hormone for her so she was stable after SRT.

I forgot to mention, if he tested neg for IAA before, he'll still be negative. No need to retest it. His spreadsheet doesn't say IAA to me, nor does it scream acro. One other thing that can cause the need for higher doses is Cushings, but typically they have pot bellies, hair loss or thin on the tummy and elsewhere, and you'll see things like freckles or other skin conditions. I've heard their liver numbers might be out too, but that's not Jack.

More reading if you want: MSU reference range changed for IGF-1 (and paper)

Jack is a chubby fellow, but no hair loss/thinning, or pot belly. He does need to lose weight, but I have prioritized the diabetes regulation and changing his diet. It's strange that he hasn't lost weight since being on it, he's getting less carbs. Oh well, I sent a note to the vet clinic earlier; at the speed at which they move, it will be a month before I get a response! THANKS AGAIN for responding, and for the link, I'm hoping to read it Sunday.