8/27 Minnie PMPS 223 +2.5 212

Liz & Minnie

Liz & Minnie

Member Since 2021
Last post 8/23

Had a lot going on. Increased to 4u last night when she surprised me with a PMPS >300. Briefly considered keeping the dose and giving R but decided on the increase instead since it's clear the 3.75 wasn't working.

Thanks again for all the input regarding the IAA diagnosis. Our IM said
"As I understand this result, it suggests she has type 1 and not just type 2 diabetes. This fits with her long term dependence on higher dose insulin and her non-obese condition, but you are correct, it does not change the day to day goals which include keeping her in a healthy glucose range with insulin."
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I'm interested in thoughts on this from @Wendy&Neko @Lisa & Oberon or anyone else with IAA experience! And yes, I'm interested in more details. Based on my limited current understanding (haven't done any research yet) I just go on with treating as I have been and monitor for a ?sudden? drop as the antibodies wear off? And should I expect that it's possible for her to go into remission once the antibodies have gone away? Or just that her insulin requirements will go down. I could go on with more questions but will hold off for now :)

Hope all well with the sugarfamilies!

ETA - Looks like I'd already bookmarked some IAA info so putting the link here :) https://felinediabetes.com/FDMB/threads/6-7-mr-kitty-6-74-8-80-positive-for-iaa-acro-unknown.248345/

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
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.

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.​
 
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There have been IAA kitties go into remission, Black Kitty being the first IAA and first in remission. Removing bad teeth was the key to breaking his resistance. With Neko, treating her acromegaly seem to get things moving. She never went into remission, though got to doses under 1 unit. Was it the IAA or the acromegaly that kept her diabetic - who knows. IAA kitties an still earn reductions, as you have seen, but when you see a string of them close together, that's more of a sign the antibodies might be fading. I have seen a few IAA kitties go from higher doses down to lower doses and stay there. ECID of course. Not sure this means type 1 vs. type 2, or just a type 2 with a pancreas that's gone far enough it can't completely recover.
 
Thanks for the info. Unless I'm misreading between the lines here, having a confirmed IAA diagnosis doesn't seem to make any difference at all then?! Business as usual for me and madam.

She has most bizarrely had a virtually static BG all day - 238@+3, 239 @+6 and 239 again @+9. Dropped a touch at PMPS so maybe she has a wild Friday night in store for me. :cat: Saucy little minx that she is.
 
There are some differences for IAA. If a dose isn't getting you green, don't hold it overly long. IAA kitties seem to do better with as much green as you can safely do. You may have to experiment with reductions. Not sure if you are doing the once under 40 or three times between 40 and 49 method? Once the antibodies break, then you do have to become more cautious with reductions, as they can come fast and furious.
 
You've got your research cut out for you. But knowing you and your spreadsheet, you'll be an expert on IAA shortly ;)
 
Wendy&Neko said:
There are some differences for IAA. If a dose isn't getting you green, don't hold it overly long. IAA kitties seem to do better with as much green as you can safely do. You may have to experiment with reductions. Not sure if you are doing the once under 40 or three times between 40 and 49 method? Once the antibodies break, then you do have to become more cautious with reductions, as they can come fast and furious.
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Got it, thanks. I know I have held onto doses longer than needed, sometimes because of circumstances (going out and not able to monitor and feeling very cautious still!) As for 'method' - so far she has always dropped below 40 before ever reaching 3 times between 40 and 49!
 
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