Re: 8/23 Tigger AMPS 377
Hi Brent!
Well, one puzzle piece in place, one to go. Your vet will likely not know how best to proceed. That's OK - we do.
A couple things you should know about IAA:
It's idiopathic (no known cause)
It's self limiting - it will come to an end one day - the antibodies will give up the ghost - that's the good news. However, close monitoring is required - the anntibodies bind to the insulin , so Tiggers body is not able to use it. How much gets bound up - who knows. When it breaks, whatever antibodies are around release the insulin that was bound to them and that's what you have to be alert to. Insulin sensitivity can return at any time, and it's a crazy slide down the dosing ladder. Although a positive Acro result will trump IAA - knowing he is IAA as well is critical - you have to be mindful that there are antibodies with insulin bound to them and they may release it without warning.
In the mean time it's a BG beat down to keep Tigger in a safe number range. I think Lantus is great - worked for us :mrgreen:
I'd stick with .5 increases. You can also add Humlin R (what we refer to as "R") to the mix. it's a fast acting, short duration (this can vary due to binding to/release from antibodies), powerful insulin. It helps to set the stage for Lantus onset. Say you have a PS of 450 and Lantus onset is 2 hrs. The R can bring that PS down to something easier for the Lantus to pick up and run with.
Take a look at BKs ss, back around Sept/Oct 2008 or so (heck look at the whole thing - there's a happy ending :mrgreen: ). You'll see how we worked the 2 insulins. It's a process to figure out an optimal R dose and schedule, what we call an "R scale". I've started to add BKs old R scales onto the 2nd tab of his ss - sill working on it. The R scales continualy evolve and change. I'll be happy to help you with it all.
FYI - BKs vet and internist where both completely freaked out at the amount of insulins I was pushing into him.The only thing that somewhat calmed them was they could clearly see by his ss that we where monitoring very closely and getting results. And when he went OTJ - they were dumbfounded.
ETA- It's going to be a balancing act finding the optimal dose of Lantus and R. You don't want the Lantus dose too high, because when the resistance breaks it's easier to simply cut off the R and the effects of that are immediate, since R has no shed. As an example, when BKs IAA broke - stopping the R at that time was equal to something like a 12u decrease (can't see his ss from tbp right now).