You've already gotten lots of good info. I'm sorry to hear the diagnosis, but the good news is that you know what it is while she is on a relatively low dose. This tells you why ProZinc seemed to not work, and why your initial weeks on Lantus seemed also to be doing nothing. Now you know that she needs more insulin than others might - but if you look at spreadsheets in this ISG, the dosages are all over the map, from 0.1u to close to 100u. The focus is not on the size of the dose, but upon the blood sugar numbers. You already know all of that, but I'm saying it as much for lurkers - anytime someone posts "acro" or "iaa" in the subject line, it brings lurkers from all over to see what the story is.
As far as moving ahead, you've got several balls in the air that you'll be balancing. The overall dose seems to be better controlled if the cat is kept in normal numbers. Just like a non-high-dose cat, if the cat spends a lot of time in higher numbers, glucose toxicity develops and you have to increase the dose to get action that moves the cat's BGs down. On the German Katzen forum, their kitties seem to peak out under 10u and they don't encourage people to test for high dose conditions. I think there is something to be learned from that. I like the way
Tilly's Diabetes page spells out some of the Tight Reg guidelines. On the other hand, an acro tumor's production can ramp up or down, putting out more hormone requiring more insulin, putting out less hormones and then requiring less insulin. With iaa, the insulin is bound up (think taken captive) by antibodies, which then release the insulin after a period of time. As others have said, it seems to be self-limiting and we've seen a few times that is has been visible on the spreadsheet when the iaa has broken.
One thing that can seem to help that is adding R into your toolbox. With using a depot insulin, you know that the depot can continue to give out after the dose is reduced, or a shot is skipped. One strategy that Sandy began using under Jojo's guidance (former adviser here and vet tech) was to hold the Lantus dose steady and fluctuate the R dose. The advantage of that is that if the iaa breaks and releases insulin, you have less of a depot to continue giving out. Suzanne did that with Cobb - basically she refused to go over 1 syringeful (31 units) and instead held that and adjusted the dose by using R. When cats build antibodies, it seems to be to a specific insulin. When Punkin was being treated at Colorado State, Dr. Lunn said that most cats do develop some level of antibodies - you're injecting a foreign substance into them. Adding R into the mix is introducing an insulin that wouldn't have antibodies created to it yet.
R - which is Humulin Regular insulin (or I think also Novolin R) can be bought at drug stores typically without a prescription. It's inexpensive and it lasts for ages. I bought 1 vial of it for punkin for something like $35 and it lasted the rest of his life and then I passed it on to another FDMB member. If you want to learn how to use it, say so and we'll arrange it so an experienced R user is with you while you're using it to help. They can also help you understand the test results you get. The goal of R isn't to replace the depot insulin, but to provide a quicker response when you have high numbers. It typically lasts in the body around 4 hours, although with iaa it can last longer. It's the speedboat that can turn quickly, as opposed to the depot insulin, which is a barge. Make a small change to adjust the direction, then wait to see where you're going!
Back to treatments - Wendy's updated that link in the bottom of the "New to the Group" sticky and there is a bit about the newer treatments in there. Dr. Lunn (from CSU) started the SRT program at CSU and then moved to North Carolina to start a treatment program there. She has my deepest respect - when I was trying to figure out how to move ahead with punkin, she talked to me multiple times on the phone, explaining all the details. So if I had the chance, I'd to go her.
There is also a newer treatment that is actually surgery to remove the tumor. One FDMB member, Perry, had Sooty who had the biggest dose I've ever seen - more than 100u per shot. He opted for the surgery and Sooty did go OTJ within a very short time.
Not everyone can afford to treat the acro, however, and Dr. Lunn did tell me that it was acceptable to just give the cat the amount of insulin they need. When Punkin was diagnosed, Lauren's Tommy was diagnosed at the same time. Lauren opted to just give him insulin, and she kept him tightly controlled for years. Literally. He lived 4 years after becoming diabetic and he died at the age of 20. That's pretty amazing.
Punkin had the SRT (you can look in my signature line to the links that include all of the details on SRT, including my daily condos while we were at CSU) and his insulin needs dropped considerably, but he didn't go OTJ. He was at 15.5u while we were at CSU and dropped to about 4-5u, although then we started back up again. He lived 20 months post-SRT, a total of 29 months after being diagnosed with diabetes. We think he was about 15 when he passed away. He didn't die from diabetes or acro, however, but most likely from cancer. His heart was enlarged from the acro, but probably not much of a factor in his death. The tumor's hormones cause the body to continue to grow, and soft tissue is easiest to grow first. Eventually even the bones try to grow, typically causing the lower jaw to grow out and the forehead to come forward and be more vertical than it was before. Punkin's feet became "clubbed" and large, he developed megacolon . . . it's not a pretty picture. I suspect he had headaches, but his tumor, at that point at CSU, was the biggest one they'd seen.
Dr. Lunn was on vacation when we were at CSU, but the entire team there was amazing. I can't say enough good things about them. I imagine she's set up the same sort of team at N. Carolina. I don't know much about the other potential treatment places, although I'm sure we can pull in people who have used them to help you.
Which by the way, my understanding is that the IGF-1 number isn't indicative of how "bad" the acro is. Punkin's was 281, if I remember correctly, and his tumor was big. After the SRT we had his IGF-1 rechecked and it was over 300 at that point. Apparently it doesn't come down after the SRT, although the growth hormones do decline. They used to have a test specifically for growth hormones, and that declined, but no one does that test anymore.
I do want to clarify one thing. I specifically asked Dr. Lunn if punkin was considered a true diabetic, since the acro caused the diabetes. She said absolutely. Diabetes can be caused by any number of things, from steroid use to obesity and dry food, and acro is simply one more of the causes. Acro cats are considered type 2 diabetics. They need insulin and have the same potential issues as other diabetics.
I've written a small book - hopefully others will add their experiences.
@Suzanne & Cobb(GA) I'm trying to tag Lu/Grayson but not getting the right thing, so I'll send her a msg on facebook. She has a wealth of experience also. As you know, there are many cats here with acro, iaa, or a combination of the two. You'll have lots of help.
Hmm, i'm looking for Tommy's ss for you and will have to look further. In the meantime, let me just get this posted for you.
Hang in there, Anne. I'm just glad you know what you're dealing with.
