Jack 04/01 - AMPS 351, +5 261, +7 283 - Questions about IAA and Levemir

AngelaMiao

AngelaMiao

Member Since 2019
Yesterday

Have only been on Lantus for 2 months but a few people have mentioned that Jack looks like he could do good on Levemir (both on the FDMB and the 2 Facebook groups I follow). What indicators would suggest that a cat might be a better candidate for Levemir, how long should I stick with Lantus for (and why) and is there a way for me to improve his experience on Lantus (I still have 4 pens left so I'd like to avoid switching). Also, let's say I get up to a high dose of Lantus, I know it can burn more than Levemir but can I split the dose into 2 shots so that it burns less?

Second question was that a couple of people on the Facebook groups I follow have mentioned that Jack looks like IAA but other people have said he does not. Do you think he looks like he might be and what should I be looking for as a suggestion that he may have it. Another person mentioned acromegaly but if I understand correctly, up to 25% of diabetic cats have it and, it's not worth checking unless it's causing enough problems to need high doses and R insulin (in that case you can consider SRT) but that some Acro cats present as "regular" diabetic cats that are managed as usual or do not have diabetes at all. For IAA, I really don't know much about.

Just needing some clarification! I'm feeling a bit discouraged with his numbers and I'm scared to go back to work once my maternity leave ends (I still have 2 months left but I'm worried about going 9hrs without testing once I go back).

Thank you guys :)
 
Also, I'm having a hard time finding his Nadirs. I've noticed that lately his +3 will be similar or higher to PS, suggesting a flat cycle or bounce but then he'll go low much later on in the cycle (on the days that he does go into blues and greens). I almost want to skip his +3 tests but when I look back earlier on into his journey, he was having pretty normal cycles where he would have a lower +3 and average Nadir between +5 and +7 (and a few cycles that looked like it was overlapping from the cycle before and starting off with a lower number, but those usually resulted in bounces).

I've been trying to feed the curve by not feeding past +6, so I'm not sure if that's what's causing the difference? It's making it hard for me to monitor him because I have no idea what's going on at night while I'm sleeping.
 
I'm tagging @Sandy and Black Kitty who has had a great deal of experience with IAA and @Wendy&Neko who has a great deal of experience with acro.

I think it's very premature to start thinking about whether Jack has a high dose condition. There's a lot that can happen between your current dose and reaching a dose of 6.0u which is where we suggest getting the tests for IAA and acromegaly run.

I would also offer a word of caution. The Facebook group is largely made up of people who are new to FD, don't look at your spreadsheet, and may or may not follow a dosing method. There are very few seasoned members there. I would take most of the input from FB groups with a large grain of salt.

With regard to nadirs, you've changed a couple of Jack's doses in quick succession. This can make it hard to sort out where the nadir is or how well Lantus is acting. He's also a bit bouncy which can make it hard to sort out where his nadir falls. I'm leaning toward thinking he has a late nadir, though.

 
He has to be on insulin minimum 73 days to get a accurate IAA reading. Olive was up to 7 units of lantus when it started to bother her. She started getting aggressive when I had to give it.

Olive is bouncy even on lev, and she doesn't have the late nadirs lev is suppose to have. So there is no guarantee. But Olive does have acro and that alone puts her in the category of what is normally normal isn't normal.
 
Actually, it’s suggested you be on insulin a minimum of 70 plus days before testing for acromegaly. Before that, up to one third of acro cats get a false negative result.

As for insulin, typically we suggest waiting six months before switching. Unless you get a situation like Ti-Mousse who was reacting to the Lantus sting. Speaking of which, not all cats notice the sting, and of those that do, the size of dose when they notice it varies. ECID of course. I haven’t seen people split the dose to avoid sting, more because the dose got above 30 units. Lev does help a lot of bouncy kitties, but not all. For recent switches, check out the spreadsheets of Ti-Mousse and Ming. Ti-Mousses biggest improvement came with the dental.

As for not bothering to test for acromegaly if you suspect it but the dose is low, that’s rubbish. The same side effects can be seen if kitty is on low dose or high dose of insulin. There have even been recorded cases of cats with acromegaly who are not diabetic but were discovered because of heart conditions, likely caused by the acro tumour.

I also have experience with IAA in my girl. Nothing in Jack’s SS screams IAA to me, rather, a kitty who hasn’t gotten to a good dose yet. Possibly some glucose toxicity is present . Follow TR, increase when it says to. Don’t linger on a dose or you’ll add to the glucose toxicity. You WILL find a dose that moves Jack.:bighug:
 
Thank you guys! I'll wait and see how it goes before looking into other options.

For the Acro, what other symptoms would there be other than needing excessive amounts of insulin? I don't notice anything in particular with him other than he has a longer face than he used to and family members comment on it. It's easy to read the symptoms online but I have no idea which of them are more common or most apparent.
 
Acro symptoms are also ECID. Only something like 35% of acros have clinical symptoms at time of diagnosis. And they can vary across cats. Other than Neko’s dose and ravenous hunger, her only symptom was one I found out later was due to acromegaly. One eye teared due to soft tissue growth in the tear duct. Some acros have a pot belly, some have noisy breathing, those are amongst the more common symptoms. Neko had neither.
 
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