6/7 Mr Kitty +6 74, +8 80, positive for IAA acro unknown
- Thread starter FrostD
- Start date
Diane Tyler's Mom GA
Member Since 2018
Diane Tyler's Mom GA
Member Since 2018
Sorry about the insulin getting lost, I pray you get it in time 
Diane Tyler's Mom GA
Member Since 2018
You are welcome
FrostD
Member Since 2020
Got the IAA results back, Mr Kitty is at 63% whereas the cutoff is 20%. Vet said he's not sure what to do with that information right now.
Still waiting on acro test.
@Wendy&Neko sorry to keep tagging you, I just can't recall who else has dealt with the IAA/acro/high dose stuff. Any resources I can provide to the vet? Or for myself. All I can recall is that it usually goes away on its own within a year, and can be a quick trip down the ladder if/when it does. Does it change my dosing strategy at all?
Still waiting on acro test.
@Wendy&Neko sorry to keep tagging you, I just can't recall who else has dealt with the IAA/acro/high dose stuff. Any resources I can provide to the vet? Or for myself. All I can recall is that it usually goes away on its own within a year, and can be a quick trip down the ladder if/when it does. Does it change my dosing strategy at all?
Lisa & Oberon
Member Since 2020
Oberon has IAA; feel free to check out his spreadsheet to see an example. Wendy can also give you some other names. Oberon has been out of remission for about 10 months now, and IAA was diagnosed in early October. He has come partway down the dosing scale twice now and then back up again, and right now he's in the middle of a third drop. I'm hoping this one might be for real. My best advice is to use TR if possible, and just follow his numbers, but be prepared for anything. If he's into really high doses, Humulin R can be a useful tool to get some more flexibility as his dose needs change.
Other positive IAA kitties active here are @Lisa & Oberon (though Lisa is supposed to be on holidays!), Oberon is IAA only. @Howiesmom was thought to be IAA only at first, but his acro test was done too early and also discovered to be acro. I seem to recall Amethyst was too, but that was years ago so could be gone now. Also Chickamonkey, and possibly others I'm forgetting right now.
I'm going to quote something that Sandy (&Black Kitty - first IAA kitty diagnosed here, who also went OTJ) sometimes says:
For starters, below you will find some important information about IAA-
·Its self limiting and generally lasts about a year
IAA can spontaneously appear. Even though Mr. Kitty got his diagnosis in Feb 2020, we don't know if he had IAA then. He seemed to go off the rails in July last year, but until we hear the acro results, it's hard to say if that was part of it. We had another kitty here (Doodles) who was marching towards remission when he got heart disease and IAA entered the mix and all of a sudden his dose needs skyrocketed. So we've had IAA only kitties (less of them) and some with IAA and acro.
As for dosing strategies, it's good to keep them at doses with some green in it, or it seems the antibodies get ahead of things. If kitty does turn around and antibodies break, then caution is key and your reduction strategy can change - back to back reductions, larger reductions, all part of what needs to be considered. Take a look at what Oberon is doing now - figures while hubby is doing things solo.
I'm going to quote something that Sandy (&Black Kitty - first IAA kitty diagnosed here, who also went OTJ) sometimes says:
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
IAA can spontaneously appear. Even though Mr. Kitty got his diagnosis in Feb 2020, we don't know if he had IAA then. He seemed to go off the rails in July last year, but until we hear the acro results, it's hard to say if that was part of it. We had another kitty here (Doodles) who was marching towards remission when he got heart disease and IAA entered the mix and all of a sudden his dose needs skyrocketed. So we've had IAA only kitties (less of them) and some with IAA and acro.
As for dosing strategies, it's good to keep them at doses with some green in it, or it seems the antibodies get ahead of things. If kitty does turn around and antibodies break, then caution is key and your reduction strategy can change - back to back reductions, larger reductions, all part of what needs to be considered. Take a look at what Oberon is doing now - figures while hubby is doing things solo.
FrostD
Member Since 2020
Thank you!
I must admit I'm trying to find the "method to your madness" with reductions. It appears for the most part you're still following TR reduction guidelines for newly diagnosed cat, with the occasional depot-drainer? You've had some rough days/nights in there!
Edit: just got to Wendy's post about the back to back and larger reductions, makes sense!
FrostD
Member Since 2020
Ah, thank you!Other positive IAA kitties active here are @Lisa & Oberon (though Lisa is supposed to be on holidays!), Oberon is IAA only. @Howiesmom was thought to be IAA only at first, but his acro test was done too early and also discovered to be acro. I seem to recall Amethyst was too, but that was years ago so could be gone now. Also Chickamonkey, and possibly others I'm forgetting right now.
I'm going to quote something that Sandy (&Black Kitty - first IAA kitty diagnosed here, who also went OTJ) sometimes says:
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.
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.
- The release of insulin from the antibodies can happen at inopportune times
IAA can spontaneously appear. Even though Mr. Kitty got his diagnosis in Feb 2020, we don't know if he had IAA then. He seemed to go off the rails in July last year, but until we hear the acro results, it's hard to say if that was part of it. We had another kitty here (Doodles) who was marching towards remission when he got heart disease and IAA entered the mix and all of a sudden his dose needs skyrocketed. So we've had IAA only kitties (less of them) and some with IAA and acro.
As for dosing strategies, it's good to keep them at doses with some green in it, or it seems the antibodies get ahead of things. If kitty does turn around and antibodies break, then caution is key and your reduction strategy can change - back to back reductions, larger reductions, all part of what needs to be considered. Take a look at what Oberon is doing now - figures while hubby is doing things solo.
I had a moment of...I don't even know what...and forgot there's an entire forum for IAA/Acro/etc
@Lisa & Oberon your husband is doing much better than mine would
Any number below 90 is immediately turned over for me to handle haha Ever since we hit 6U I swear we have the "you passed the right dose for him you need to try going back down" conversation once a week. Thankfully his numbers now and this diagnosis is proving my stubbornness paid off
Lisa & Oberon
Member Since 2020
Yep. The first couple of times down, I think I was a little too quick to reduce, and it let the antibodies grab hold again. I'm not totally sure that's what was actually going on, but it seemed like it. Maybe he was going to trend back upwards no matter what I did. But now I'm trying to follow TR a little more closely (including the rules for reductions for long-term diabetics). Except this week! Going down in leaps and bounds right now, of course while I'm out of town. (This morning's shot just about gave me a heart attack... shooting a 78 when he was in the 40s overnight and everyone was going to be out of the house for most of the day... I held my breath until I saw that +5 number.)
If you like graphs, check out my "BG vs. date- all" tab for a big picture overview of the past 10 months. You can see the Lantus dose (red, righthand Y axis scale) rise and fall. BG (blue) looks like a seismograph tracing, but you can see the overall trends (pink line). Green is R; you can see how I tend to use it along with Lantus as the Lantus dose increases, then stop when the Lantus dose starts to come down.
FrostD
Member Since 2020
What exactly does the result itself mean? as in scientifically, 63% what? Increase in antibodies over a normal cat? The MSU catalog description isn't exactly helpful.
Is there anything I can/should do that will help the forum in general with regard to IAA cats? In terms of data/remarks in spreadsheet, anything. I'm pretty lazy with it aside form entering BGs and ketones. I can't find a lot about IAA in cats, either on the internet or forum. Which is frustrating to me because I like to know and understand things inside and out, but I see it as an opportunity to help future kitties if needed.
It sounds like my vet has never actually had this test come back positive I've (affectionately) described him as a super nerd, so I'm 98% sure he's up researching right now and will be calling people tomorrow.
Is there anything I can/should do that will help the forum in general with regard to IAA cats? In terms of data/remarks in spreadsheet, anything. I'm pretty lazy with it aside form entering BGs and ketones. I can't find a lot about IAA in cats, either on the internet or forum. Which is frustrating to me because I like to know and understand things inside and out, but I see it as an opportunity to help future kitties if needed.
It sounds like my vet has never actually had this test come back positive
I've (affectionately) described him as a super nerd, so I'm 98% sure he's up researching right now and will be calling people tomorrow.
Howiesmom
Member Since 2020
Howie has been flat for some time now, for which I am thankful. He got as high as 55 units BID twice and came down the dosing scale. The first time was fast, the second time a little slower. Now he’s hanging out around the 30 unit BID mark give or take. I agree with a Wendy that staying at a dose that keeps him in some green each cycle is best with the ultimate goal of keeping him between 80-120. If the antibodies get ahead of you as you didn’t do increases at a steady rate as needed, it’s shocking how much insulin you can administer. The biggest thing to remember with these special case kitties is that they need as much insulin as they need (at that time.) ask lots of questions...we’ve all been there!
FrostD
Member Since 2020
You should see what that looks like on my phone...
All your tabs actually make me very happy, I love all the analysis and I know that takes awhile to get it presented the way you want. The ketones vs BG one is strangely satisfying.
Lisa & Oberon
Member Since 2020
I'm a total data geek. With that one, I was trying to figure out if there was a threshold I could use to know when to expect ketones to be high. It's misleading, though. It makes it look like very high BG numbers mean that ketones will be low. But really that's because for Oberon the ketones take some time to develop, and most of his numbers over 400 were sudden bounces. So if he spiked really really high, ketones hadn't caught up yet. The real pattern that I found (not on the graph) is that once ketones were elevated, they cleared out very quickly if BG dropped below maybe 250 even just for a cycle or so. R was very helpful there.
There isn't a lot of research out there on IAA in cats. All the studies were on small numbers, and said either it was common, or not common in diabetic cats. 
Here is the latest paper I found:
Relationship between anti-insulin antibody production and severe insulin resistance in a diabetic cat
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111345/
It was a case study of one, but they did do analysis of antibodies in a number of other cats. This cat was DKA several times, ended up on a regime of Levemir and degludec (Tresiba), after trying R and for a while Lantus IV. Included in the treatment regime was prednisolone to suppress the effects of the antibodies. I have no idea whether this would work in general, but it is rather mind blowing. As is the idea of using determir/Levemir and degludec together.
The final conclusion of the paper was that insulin antibodies should be considered in cases of severe insulin resistance.
Here is the latest paper I found:Relationship between anti-insulin antibody production and severe insulin resistance in a diabetic cat
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111345/
It was a case study of one, but they did do analysis of antibodies in a number of other cats. This cat was DKA several times, ended up on a regime of Levemir and degludec (Tresiba), after trying R and for a while Lantus IV. Included in the treatment regime was prednisolone to suppress the effects of the antibodies. I have no idea whether this would work in general, but it is rather mind blowing. As is the idea of using determir/Levemir and degludec together.
The final conclusion of the paper was that insulin antibodies should be considered in cases of severe insulin resistance.
FrostD
Member Since 2020
There isn't a lot of research out there on IAA in cats. All the studies were on small numbers, and said either it was common, or not common in diabetic cats.
Relationship between anti-insulin antibody production and severe insulin resistance in a diabetic cat
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111345/
It was a case study of one, but they did do analysis of antibodies in a number of other cats. This cat was DKA several times, ended up on a regime of Levemir and degludec (Tresiba), after trying R and for a while Lantus IV. Included in the treatment regime was prednisolone to suppress the effects of the antibodies. I have no idea whether this would work in general, but it is rather mind blowing. As is the idea of using determir/Levemir and degludec together.
The final conclusion of the paper was that insulin antibodies should be considered in cases of severe insulin resistance.
1. That poor cat
2. That would have all been Greek to me a year ago, but now it reads like See Spot Run. Crazy.
3. I don't think I like that case study...it's like they threw the scientific method out the window. I understand with a cat in front of you trying to keep it alive (11mg/dL, unreal)...but I'm pretty sure my heart rate increased just reading all the changes
The prednisolone is curious though. Seems to me that over time/"long-term" treatment it may exacerbate things since it's a steroid.
Amanda and a Loudogg
Member Since 2017
Hiya Melissa! My buddy Lou is an IAA-only kitty, although he's also a weirdo who is a "low-dose" high-dose kitty, haha. He never went higher than 4.25u. After his IAA broke (about 10 months after diagnosis), he fell into tight regulation, which he's been in (for the most part) for the last 2 years. My two cents from our experience:
- Definitely switch to Tight Regulation (TR) method to keep in greens as much as possible.
- Lou's biggest IAA change was he seemed to process his insulin slower. He was on Vetsulin when diagnosed, which is a faster acting insulin (4-6 hours), and it would last 8-12 hours for him. Even after we eventually switched to longer lasting insulins (Basaglar, then Levemir), they seemed to last longer for him. Levemir seems to flow better with his natural insulin processing, so we don't notice as much of a change as we did on the Basaglar.
- Think of the IAA antibodies as something that drags the insulin down, like a hero in a story trying to get through a spiders web. You increase the insulin to overcome those antibodies, until the insulin overwhelms the antibodies (breaks through the spiders web). You want to keep ahead of changes in blood sugar so that the antibodies do not gain another foothold.
- Things can be weird. Sometimes an antibody holding some insulin dies off and you have a random low number. Other times, all you are doing is increasing and increasing. You will eventually get to know your cat and the data you gather will help you make those hard decisions easier.