IAA kitties

[Howiesmom]

For those who have IAA kitties, how long did your kittie take to finally break through the antibodies and how much insulin were they getting at their peak (or are still getting)? Howie was diagnosed around Sept. 30 and is already up to 16 units twice a day. I’m going through levemir pens very quickly now. He seemed to have better numbers when he was on Prozinc so am wondering if I shouldn’t have switched him now.

 

[Wendy&Neko]

Neko got to 8.75 units before it broke, and that was 9 months after her original FD diagnosis. She also had acromegaly and treatment for it around the same time, just to muddy the waters.

He seemed to have better numbers when he was on Prozinc so am wondering if I shouldn’t have switched him now.

Completely characteristic of IAA kitties. They seem to have good numbers, then it fades away as the antibodies take a hold again. I called it "the dose going stale". You need to get to a dose as soon as possible with greens in it. That seems to help keep the antibodies at bay.

One option for you, but you'd have to post more often, is to use R as a bolus. This should only be done with the assistance of someone else who has used R to coach you how to use it. It's important to learn both when to use R, but more important, when not to use it. R helps take the numbers down a bit (ideally no more than 100 points) to give the Levemir better numbers to work with. The bonus of using R, is that if the antibodies break, you don't have as large a Levemir depot to worry about. Have you ever looked at Oberon's SS? @Lisa & Oberon started using R not quite a couple months ago.

 

[Howiesmom]

Neko got to 8.75 units before it broke, and that was 9 months after her original FD diagnosis. She also had acromegaly and treatment for it around the same time, just to muddy the waters.

Completely characteristic of IAA kitties. They seem to have good numbers, then it fades away as the antibodies take a hold again. I called it "the dose going stale". You need to get to a dose as soon as possible with greens in it. That seems to help keep the antibodies at bay.

One option for you, but you'd have to post more often, is to use R as a bolus. This should only be done with the assistance of someone else who has used R to coach you how to use it. It's important to learn both when to use R, but more important, when not to use it. R helps take the numbers down a bit (ideally no more than 100 points) to give the Levemir better numbers to work with. The bonus of using R, is that if the antibodies break, you don't have as large a Levemir depot to worry about. Have you ever looked at Oberon's SS? @Lisa & Oberon started using R not quite a couple months ago.

I've never heard of it before. Is there somewhere I can read more about it? Who on here would be coaches that could possibly help me? THANKS!

 

[Lisa & Oberon]

Oberon was initially diagnosed last December and was on Lantus for about 2 weeks, but a diet change to all LC food put him into remission. Rediagnosed in late July (pancreatitis apparently kicked him out of remission), then diagnosed with IAA (83%) in late September when his numbers just wouldn't come down despite being up to about 5 U of Lantus. We added in R (only used under certain conditions, and sometimes not even then) in early October when he was at about 6 U of Lantus. He got as high as 10 U of Lantus + 1.5 U of R (Nov 3). Now it looks like his antibodies are starting to break. He's diving to low numbers pretty much like clockwork ever 6 cycles and earning a reduction each time. New dose tonight, a month after his dose started decreasing, will be 5.5 U. I'm barely using R anymore.

Humulin R is a short-acting insulin; you can use it very carefully to bring really high numbers down enough that the longer-acting insulin has better numbers to work with. I've been guided by Wendy and a couple of other people here. I definitely found it helpful.

 

[Howiesmom]

Oberon was initially diagnosed last December and was on Lantus for about 2 weeks, but a diet change to all LC food put him into remission. Rediagnosed in late July (pancreatitis apparently kicked him out of remission), then diagnosed with IAA (83%) in late September when his numbers just wouldn't come down despite being up to about 5 U of Lantus. We added in R (only used under certain conditions, and sometimes not even then) in early October when he was at about 6 U of Lantus. He got as high as 10 U of Lantus + 1.5 U of R (Nov 3). Now it looks like his antibodies are starting to break. He's diving to low numbers pretty much like clockwork ever 6 cycles and earning a reduction each time. New dose tonight, a month after his dose started decreasing, will be 5.5 U. I'm barely using R anymore.

Humulin R is a short-acting insulin; you can use it very carefully to bring really high numbers down enough that the longer-acting insulin has better numbers to work with. I've been guided by Wendy and a couple of other people here. I definitely found it helpful.

I'm definitely willing to try. I'll be home/not working for 2 weeks over the holidays (Dec. 19-Jan. 3) so it would be great to get it started and see how it works while I am at home constantly. What do I need from my vet? I currently order my insulin from Marks in Canada. I just found an old post on here about R and folks get it from Walmart I see. At 32 units/day now, I am going through pens like crazy and had to put in a double order that I just got. I will definitely need to rely on lots of experts!

 

[Howiesmom]

Neko got to 8.75 units before it broke, and that was 9 months after her original FD diagnosis. She also had acromegaly and treatment for it around the same time, just to muddy the waters.

Completely characteristic of IAA kitties. They seem to have good numbers, then it fades away as the antibodies take a hold again. I called it "the dose going stale". You need to get to a dose as soon as possible with greens in it. That seems to help keep the antibodies at bay.

One option for you, but you'd have to post more often, is to use R as a bolus. This should only be done with the assistance of someone else who has used R to coach you how to use it. It's important to learn both when to use R, but more important, when not to use it. R helps take the numbers down a bit (ideally no more than 100 points) to give the Levemir better numbers to work with. The bonus of using R, is that if the antibodies break, you don't have as large a Levemir depot to worry about. Have you ever looked at Oberon's SS? @Lisa & Oberon started using R not quite a couple months ago.

Is there anything you can see in Howie's spreadsheet that I should adjust (mini meal times, etc.)? His nadir has been around his PMPS some times but other times it is earlier. He gets his last mini meal at +7. If there is anything else in addition to this newest suggestion of using R as a bolus that you recommend I try/do, I'm all ears! I was lucky and got him up to 12 pounds when he was at the vet a couple weeks ago with his ear inflammation. He currently gets 450 calories/day, but that has also helped keep his ketones at bay (mostly). Does too much LC food impact him? He only gets freeze-dried treats. Could I be causing this by overfeeding him now? UGH...this disease is so nerve-wracking!

 

[Lisa & Oberon]

I'm definitely willing to try. I'll be home/not working for 2 weeks over the holidays (Dec. 19-Jan. 3) so it would be great to get it started and see how it works while I am at home constantly. What do I need from my vet? I currently order my insulin from Marks in Canada. I just found an old post on here about R and folks get it from Walmart I see. At 32 units/day now, I am going through pens like crazy and had to put in a double order that I just got. I will definitely need to rely on lots of experts!

I took forever to get around to getting it because I thought I needed a prescription for it. Turns out you don't need one. I got mine from CVS but I think it's cheaper at Walmart. You use the same syringes as for the Lantus. When you give it, there are initial rules for when you can and can't use it, and you need to be able to track hourly for a few hours after you give it at first until you learn how he responds. More experienced users can help you get started; I'm happy to share my experience but I'm not qualified to really guide you.

 

[Howiesmom]

I took forever to get around to getting it because I thought I needed a prescription for it. Turns out you don't need one. I got mine from CVS but I think it's cheaper at Walmart. You use the same syringes as for the Lantus. When you give it, there are initial rules for when you can and can't use it, and you need to be able to track hourly for a few hours after you give it at first until you learn how he responds. More experienced users can help you get started; I'm happy to share my experience but I'm not qualified to really guide you.

You just go to the pharmacy and tell them you need insulin? With no prescription? Or how do you ask for it/find it? Thanks so much for these tips! I guess I should have posted this well before he got to 16 units. He hit blues at 8.5 units in mid-November but that was the last color change I've seen out of pinks/yellows. 7 days on Tresaderm didn't help either for ear inflammation!

 

[Lisa & Oberon]

You just go to the pharmacy and tell them you need insulin? With no prescription? Or how do you ask for it/find it? Thanks so much for these tips! I guess I should have posted this well before he got to 16 units. He hit blues at 8.5 units in mid-November but that was the last color change I've seen out of pinks/yellows. 7 days on Tresaderm didn't help either for ear inflammation!

I called in advance to make sure they had it in stock; it's at the pharmacy in the fridge, so you have to ask for it at the counter, but they didn't ask for a prescription. You need to make sure to specifically get Humulin R U-100, not U-500 and not Humulin N or Humulin 70-30 (a mix of R and N).

 

[Wendy&Neko]

Different processes in Canada where we don't need a prescription for insulin for cats. But I just walked up to the counter and asked for Humulin R (some places sell the same thing but call in Novolin R). I only ever needed one vial of it, cost around $25 Canadian.

R is short acting, in and out in about 4-6 hours. We get people to start on really small doses, observe closely (testing every hour for 4 hours at first), then increase as needed. You need to learn the R onset and nadir and duration, just like you do for Lev, so you can layer one on top of the other safely. Often people will have an R scale. Meaning if BG is a certain number, then that determines the dose. The size of R dose varies by cat, a lot. Neko never got more than 0.5 units. I saw a cat on 30 units get no more than 0.5 unit. I've also seen a higher Lev dose cat get 20 units. Very much ECID.

If you so want to go ahead, I'd suggest posting on the Lantus forum, which gets more eyes of those who have used it, though it's still just a small number of peeps. Just cause we'd want someone to "sit" with you the first few times, what time zone are you in and when is preshot time?

Tagging @Sandy and Black Kitty the poster child IAA kitty who used R.

And also @Amanda and a Loudogg who also has an IAA only kitty but much smaller dose.

 

[Larry and Kitties]

At 32 units/day now, I am going through pens like crazy

At that dose you can get a 10ml vial of Levemir. Per unit, a vial should be less expensive than the pens. At the dose you are using you should be able to easily use up the entire vial. I used vials with my aero MurrFee who was up to 25 units BID of Levemir.

 

[Howiesmom]

At that dose you can get a 10ml vial of Levemir. Per unit, a vial should be less expensive than the pens. At the dose you are using you should be able to easily use up the entire vial. I used vials with my aero MurrFee who was up to 25 units BID of Levemir.

Marks from Canada only sells levemir in pens. Where did you buy it in vials?

 

[Amanda and a Loudogg]

Hello Howie's Mom! As Wendy indicated, my buddy Lou is an IAA-only kitty as well. I never had to use R, as Lou was a "high dose" kitty, who never really had a truly high dose. The highest dose he's ever been on was 4.25u. It took him about 8 months to break through the antibodies. He did it and went right into tight regulation, which he's stayed in for over a year and a half now.

The biggest thing I noticed with Lou's IAA is it took him longer to start putting his insulin to use. When he was on Vetsulin, which usually lasts 4-6 hours, it would start around 4 hours in and last 8-9 hours. On the Levemir, he still starts at about +4, but sometimes he would go to +12 (preshot) or even an hour or so later. The key was getting him on a dose that gets him into greens, and then trying to keep it. If you wait to long to increase when needed, you end up needing to chase the dose (meaning I'd need to increase more than I thought I'd need to to get him back into greens). Those antibodies will make it feel like the insulin is not working, or that your kitty is actively working against the insulin. Super frustrating, but I can tell you how relieved I was to have a reason for it. I had been noticing problems for a bit before going in and getting the test done.

I'm not completely sure about how much to feed, as I sometimes wonder if I feed Lou too much. I reckon his weight stays pretty steady, so I just keep doing what I'm doing. For basic monitoring, we check Lou 4-8x/day. I do +3/+6/+9 checks, and it gives me a pretty good idea how he processes his insulin. I have heard that some folks feed most of the food in the beginning of the day and not feed anything past a certain time because it can push up the next preshot number. I personally have not had this issue with Lou. I feed him smaller meals at every BG check, so he's fed 4x/cycle, like a tablespoon each sitting (we use the big Friskies cans and it's 1/8th of the can per meal, feeding 1/4th of a can at preshots). I have no idea of the calories, but it seems to work and I haven't seen a reason to change it. I think it's helpful to come up with a routine and work the insulin around that. I'm not seeing anything on Howie's spreadsheet that would warrant an obvious change. He stays pretty steady actually, just has higher BGs.

I hope you can get a protocol with the R that brings Howie's numbers down. I wish you both nothing but the best of luck!!

 

[Howiesmom]

Hello Howie's Mom! As Wendy indicated, my buddy Lou is an IAA-only kitty as well. I never had to use R, as Lou was a "high dose" kitty, who never really had a truly high dose. The highest dose he's ever been on was 4.25u. It took him about 8 months to break through the antibodies. He did it and went right into tight regulation, which he's stayed in for over a year and a half now.

The biggest thing I noticed with Lou's IAA is it took him longer to start putting his insulin to use. When he was on Vetsulin, which usually lasts 4-6 hours, it would start around 4 hours in and last 8-9 hours. On the Levemir, he still starts at about +4, but sometimes he would go to +12 (preshot) or even an hour or so later. The key was getting him on a dose that gets him into greens, and then trying to keep it. If you wait to long to increase when needed, you end up needing to chase the dose (meaning I'd need to increase more than I thought I'd need to to get him back into greens). Those antibodies will make it feel like the insulin is not working, or that your kitty is actively working against the insulin. Super frustrating, but I can tell you how relieved I was to have a reason for it. I had been noticing problems for a bit before going in and getting the test done.

I'm not completely sure about how much to feed, as I sometimes wonder if I feed Lou too much. I reckon his weight stays pretty steady, so I just keep doing what I'm doing. For basic monitoring, we check Lou 4-8x/day. I do +3/+6/+9 checks, and it gives me a pretty good idea how he processes his insulin. I have heard that some folks feed most of the food in the beginning of the day and not feed anything past a certain time because it can push up the next preshot number. I personally have not had this issue with Lou. I feed him smaller meals at every BG check, so he's fed 4x/cycle, like a tablespoon each sitting (we use the big Friskies cans and it's 1/8th of the can per meal, feeding 1/4th of a can at preshots). I have no idea of the calories, but it seems to work and I haven't seen a reason to change it. I think it's helpful to come up with a routine and work the insulin around that. I'm not seeing anything on Howie's spreadsheet that would warrant an obvious change. He stays pretty steady actually, just has higher BGs.

I hope you can get a protocol with the R that brings Howie's numbers down. I wish you both nothing but the best of luck!!

Thank you so much for your experience. I’m following TR already and so have been increasing his dosage every 6 cycles already. Nothing is helping and that is how he is at 16 units twice/day. So frustrating. Since switching to levemir on 10/16/20, he’s only seen blues about 3-4 times. I would love to get him back to that spot so we can start finding the greens!

 

[Sandy and Black Kitty]

Hi there

You can see BKs insulin needs over time in the graph below.
What was your kittys IAA test result number?
Also please tell us about the ear inflammation as well as the ketones.

The first thing that jumped out at me on the ss is that there is no data from PM+5 - PM +11. That’s 1/4 of the picture that is missing.

Like Wendy suggested, it would be best to start posting in the Lantus/Lev forum.

 

[Howiesmom]

Hi there

You can see BKs insulin needs over time in the graph below.
What was your kittys IAA test result number?
Also please tell us about the ear inflammation as well as the ketones.

The first thing that jumped out at me on the ss is that there is no data from PM+5 - PM +11. That’s 1/4 of the picture that is missing.

Like Wendy suggested, it would be best to start posting in the Lantus/Lev forum.

View attachment 58422

Howie’s IAA test was 63 on 9/30/20. The ear inflammation was out of the blue last month but has subsided. He was pawing at his ears so I took him in and the visiting vet diagnosed him and put him on Tresaderm instead of their normal treatment because of his diabetes. He seems to be better as I haven’t seen his ears bothering him. The ketones are a mystery. They first cropped up around Labor Day so I got sub q fluids I could administer at home. He has elevated levels every once in awhile, but nothing like they were in Sept. Besides lethargy, he’s never displayed any other symptoms of potential DKA (thank goodness). I did increase his food and had eventually switched to TR and got a blood ketone meter for better monitoring. As for PM testing, I do a +3 before I go to bed. I realize nighttime levels can go lower, but I have not seen any of his levels during the day or at +3 that indicate on a normal basis he would drop below 200 so have not gotten up. He’s had a pretty flat curve since being on levemir. When he did drop below 200 when he was at 8.5, I wasn’t sure what to do (knew the guidelines for Prozinc) so someone on the forum said to decrease his dose (bad advice I learned later).

 

[Larry and Kitties]

visiting vet diagnosed him and put him on Tresaderm instead of their normal treatment because of his diabetes.

Do you know what the normal treatment was? I ask since Tresaderm contains a very potent steroid. I have used Tresaderm in the past and it sure elevated my cas BG and required an insulin increase.

 

[JanetNJ]

following TR already and so have been increasing his dosage every 6 cycles already.

Is raise it every 3-4 cycles

 

[Howiesmom]

Do you know what the normal treatment was? I ask since Tresaderm contains a very potent steroid. I have used Tresaderm in the past and it sure elevated my cas BG and required an insulin increase.

It’s some sort of goop they out in the ears to absorb. The vet said it’s more of a systemic steroid vs a topical steroid that Tresaderm is.