Just got results, Pumpkin has IAA - what now?

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Pumpkin's Mom

Pumpkin's Mom

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WE got back the results. Thankfully no acromegaly, but he does have IAA. My vet takes care of a lot of diabetic cats, but has not see this much. Pumpkin is on 9 units of Lantus AM and 9 units PM right now. He is acting normal, not lethargic like before we started giving him insulin. He is even jumping and wrastling with my 4 yo cat. The vet says we should start slowly increasing him but his body will fight it off.

Anyone else with a cat with just IAA have any advice? Does switching insulin help? Thanks!
 
Did the blood work say what the IAA percentage was? It's in a range of 0-100, with anything over 20 being positive for IAA. Neko's IAA was 52%. The one good thing about IAA is that is is supposed to be self limiting over time, around a year. That means at some point his insulin needs may decrease rapidly. Some IAA kitties have benefited from a switch in insulins, specifically to Levemir.

I wrote a post to another member at one point, which was a collection of articles and posts I know about IAA. Here is that post. IAA is less common than acromegaly and a lot of vets don't even think to test for it, so it's no surprise your vet has little if any experience with it. But we have seen more of it here, so we can help.

The first piece of advice I'm going to give you is that you need to test more. Kitties with IAA can have insulin needs change drastically, so we need to know how well a particular dose is doing and to be able to react quickly if the dose suddenly becomes too much insulin. Correspondingly, the antibodies are constantly fighting back and you need to occasionally be agressive in dose increases, but you have to do it safely. In order to do that, you need to test before each shot, and ideally at least one additional time each cycle, including the PM. Many cats go lower at night. From looking at Pumpkin's spreadsheet, I have no idea how low 9 units is taking him.
 
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Sorry to hear the diagnosis but at least you know what you're dealing with.

Doodles had IAA & not acro, @Doodles & Karen. Jack has both @saltycat. Wendy, Karen, Sandy, Julie & Wes can give you some great insight dealing with IAA.
 
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Thanks for the information. Seeing the information gave me hope that Pumpkin may be OTJ some day. It makes me so sad to see the kitties that didn't make it like Neko, but I so appreciate the help. I am going to test more. The vet had said to give him a break since we were waiting for test results and he was pretty steady. I will ask the vet the % on the IAA test tomorrow. We will be testing pre-shot tomorrow and texting the vet. My vet is very cautious. He doesn't increase the dose without a period of testing. He also says it takes a while for Pumpkin to process the new dose. The vet said there were studies where they did a continuous monitor on diabetic cats and they found that their blood sugar ranged wildly throughout the day depending on what the cat was doing. He wants us to test pre-shot AM and PM and 6-8 hours after the shot on the weekend. He also is going to research IAA more.

I felt encouraged by this. Maybe he can break out of the diabetes. He has lost quite a bit of weight as well which should help once the IAA breaks out.
 
Pumpkin's Mom said:
he was pretty steady.
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I would second Wendy's suggestion about testing more often. Cats change in their insulin needs. You said your vet isn't very familiar with IAA - I wonder how familiar he is with Lantus.

Lantus dosing is based upon examining the data on a dose and being able to answer the question "how low is this dose capable of making my cat's blood sugar go?" That's an essential question in order to keep a diabetic cat safe. We've had many cats here that are capable of going from 400 to 40 in 3 hours. I'm not trying to frighten you, but knowing what is going on after the insulin goes in is really so important.

I'm so glad you are open to doing more testing and that your vet is suggesting it! That's great! Adding 2 tests per day would add a wealth of information. I'd suggest both preshots and grabbing a test right before you go to bed every night. If you can add one more, add a test sometime in the day cycle in between the 2 shots. Varying the times can be more helpful & revealing than always testing at the exact same time.

The issue with only testing on the weekends is that diabetic cats "bounce." Not sure if you're familiar with bouncing, but it's described in the 2nd post in this thread. Once a cat's body is accustomed to high numbers, it's pretty common for a cat to go from one bounce to the next, with only a few hours lower in between. If that's happening with Pumpkin, which is likely, and he's bouncing on the weekends, you might think he needs a dose increase when he doesn't.

Punkin didn't have iaa, only acromegaly. Sounds like Pumpkin got the acro test too - if you're asking the vet for test results, would you ask for the IGF-1 result too? That's the one for acro. Sometimes the test won't be positive but is elevated, and it can be good to know if it's the case.

This is a marathon, not a sprint! It's perhaps even more applicable to those of us with high dose kitties.

Scritches to Pumpkin. Now you know what you're dealing with and knowledge is power. Hang in there!

By the way, if you don't have the "Where Can I Find?" thread, you may want to bookmark it. Lots of good links in there related to high dose kitties. Take a look.
 
Hi there :cool:

Its good that you tested for high dose conditions and now know the reason Pumpkin is a "big gulper" I am curious as to the actual test result %; Black Kitty was 84%, which is considered extreme insulin resistance.
Pumpkin's Mom said:
My vet takes care of a lot of diabetic cats, but has not see this much
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Ask him if he has ever seen it at all.
Pumpkin's Mom said:
Anyone else with a cat with just IAA have any advice? Does switching insulin help?
Click to expand...
BK was the first FDMB kitty to be tested for IAA, the first FDMB kitty to be positive for IAA and the first FDMB IAA kitty to safely navigate the eventual return of insulin sensitivity.
He was also the first FDMB IAA kitty to go OTJ. :D


Here is what we know 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.
IAA requires close monitoring because-
  • The release of insulin from the antibodies can happen at inopportune times
  • 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.
I'll leave it there for now. Please ask any questions you may have about the above info.
Hang in there and hang in here :cool:
 
Sorry about the IAA but agree, at least you know :bighug::bighug: My Doodles became IAA only at 78% in March 2016. He required close monitoring (testing). He was on Lantus but we did switch to Levemir in April 2016 because Lantus was clearly stinging him and he did a bit better on Levemir. You can peak at his SS (never copy, just for reference)to see the difference and how fast & often his insulin needs changed. I agree that we can't be sure your sweet Pumpkin is at the right insulin dose. Lantus & Levemir are dosed based on how low they go, not the preshot or how high they get on a dose. High numbers can also be caused by too much insulin. You're probably feeling overwhelmed but this is the best place to be for help with Pumpkin. Keep posting and asking many questions, we're happy to help. Reading the stickies at the top of the page will give you a good start. Understanding What is the Insulin Depot was a key piece for me.

You've received great information from those who gave Doodles and I the most valuable support. Without @Wendy&Neko and @Sandy and Black Kitty Doodles and I wouldn't have made it as far as we did.
 
Sandy and Black Kitty said:
Hi there :cool:

Its good that you tested for high dose conditions and now know the reason Pumpkin is a "big gulper" I am curious as to the actual test result %; Black Kitty was 84%, which is considered extreme insulin resistance.
Ask him if he has ever seen it at all.
BK was the first FDMB kitty to be tested for IAA, the first FDMB kitty to be positive for IAA and the first FDMB IAA kitty to safely navigate the eventual return of insulin sensitivity.
He was also the first FDMB IAA kitty to go OTJ. :D


Here is what we know 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.
IAA requires close monitoring because-
  • The release of insulin from the antibodies can happen at inopportune times
  • 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.
I'll leave it there for now. Please ask any questions you may have about the above info.
Hang in there and hang in here :cool:
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Thanks! It is really interesting how IAA works. I am hoping Pumpkin can follow in Black Kitty's footsteps :)
 
Bronx's dad said:
Take a look at Black Kitty's SS, it is amazing and gave me hope for Bronx who was stuck in high numbers for what seemed like an eternity.
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Yes, it totally gave me hope that Pumpkin could be OTJ one day too! It just scares me that it will happen when I am on vacation. I go to Mexico in a few weeks. A vet tech takes care of my kitties when I am gone so I told her to watch for it.
 
Pumpkin is at 12 units of Lantus and still 350+ . Next step 13. What should I look for if he starts to beat the IAA? It seems as if 13 or 13.5 is where many do it.
 
I see zero mid cycle tests and few if any PMPS tests on the spreadsheet. I have no idea how you decided the increases were warranted. Preshot tests are not enough. Neko finally earned her first reduction (below 50) in the middle of a cycle where she started the day at 430 and ended in the pinks. No way I would have known she had gone too low without mid cycle tests. I STRONGLY suggest doing a curve or several cycles with spot checks in the middle of the cycle before you increase. Punkin could be in fact on too high a dose now. Too much insulin can look like too little with as little data as you have. Neko started breaking her IAA at 8.75 units.

What you look for if the IAA is beaten is him earning numerous reductions by going low.
 
Wendy&Neko said:
I see zero mid cycle tests and few if any PMPS tests on the spreadsheet. I have no idea how you decided the increases were warranted. Preshot tests are not enough. Neko finally earned her first reduction (below 50) in the middle of a cycle where she started the day at 430 and ended in the pinks. No way I would have known she had gone too low without mid cycle tests. I STRONGLY suggest doing a curve or several cycles with spot checks in the middle of the cycle before you increase. Punkin could be in fact on too high a dose now. Too much insulin can look like too little with as little data as you have. Neko started breaking her IAA at 8.75 units.

What you look for if the IAA is beaten is him earning numerous reductions by going low.
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I am following what my vet says. He was 414 this am after his first dose of 13 last night. He is very peppy today. Our vet says that cats blood sugar jumps around quite a bit during the day and that this is how to be consistent. My vet takes care of many diabetes cats, but IAA, only a few, most with acro, which Pumpkin does not have. I am mostly worried that he will drop while I am at work. That is why we do the increases on the weekend since it takes a while to work at the new dose. Hopefully, like you saw, he will drop over time so we can dose adjust.
 
Sorry, but I disagree with your vet's idea of testing. He is right that the blood sugar numbers can jump around, but wrong that such minimal testing will keep Pumpkin safe. You need to get some mid cycle tests to see how Pumpkin is doing on this dose.
Pumpkin's Mom said:
That is why we do the increases on the weekend since it takes a while to work at the new dose.
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Neko could occasionally work the new dose the first cycle of an increase. But I knew that because I was home testing regularly.
 
I would encourage you to ask your vet how many of the cats she has treated for FD were on Lantus or Levemir. It sounds like she does not understand this kind of insulin.

You absolutely should be testing before giving insulin, every time. By shooting blind at night, and increasing the dose without knowing how low Pumpkin is going mid-cycle, you are putting your cat's life at risk. Sorry to state it that way, but it is the truth. We have seen more than one instance here of cats who were giving insulin without testing who had a hypo event. I'm sorry to say, some of these did not end happily. As was stated above, the BGs of a cat on too high of a dose can look a lot like a cat on too low a dose. The people here are not vets, but we have years of experience with FD, and some, like Wendy, Julie and Sandy, have years of experience with high dose cats. They didn't see them every few months - they lived with it 24/7. Please take heed of what they are telling you. We care about you and Pumpkin.
 
Like Tricia, I tend to not sugar coat my input. Before I comment, I want to reiterate what Sandy/Black Kitty posted above:
IAA requires close monitoring because-
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  • The release of insulin from the antibodies can happen at inopportune times
  • 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.
Click to expand...
Testing at pre-shot times only, let alone once a day, with any cat prescribed Lantus and Levemir is a recipe for a symptomatic hypoglycemic episode. Lantus and Lev dosing is based on the lowest number in the cycle and not on the pre-shot test. If you are worried about Pumpkin's numbers dropping while you're at work, what's the rationale for not getting a PM test or any tests during the cycle when you're home? Should the IAA break and you continue to test at the same frequency, you could come home or wake up to a disaster. Testing is the ONLY way to keep your cat safe. Look at Black Kitty's spreadsheet. It will give you a sense of how Sandy managed BK's IAA.

I'd also suggest posting on the Lantus/Lev forum. It's busier and you'll get more help.
 
We've all been in your shoes and our only intention is to help you help Pumkin. I too followed my vets advice. In the beginning we didn't home test at all for the first few months. Eventually I woke up to the disaster we're all warning you about. We ended up in the ER and almost lost Doodles. Who knows how many times in those months of not testing I almost killed him frankly. After that episode we still followed the vets advice and were only testing at pre-shot and adjusting his dose based on that. Again, another ER visit. I'll also note Doodles had bad neuropathy during this time and could hardly walk. Finally, we found this board. Once I started "hearing" and "listening" to the advise here Doodles recovered from neuropathy and became a fairly regulated kitty. IAA is very unpredictable and extra caution/ testing is required.

Here is a very unfortunate story of what not testing can result in. Chewy
 
Pumpkin's Mom said:
Thanks! It is really interesting how IAA works. I am hoping Pumpkin can follow in Black Kitty's footsteps :)
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It's gonna take more than hope.

Here is a visual of Black Kittys insulin needs over the 21 months he was on insulin:

BK insulin graph (640x359).jpg
(click to expand)

Here is a snip of BKs ss, from the 'rainbow' period:

bk snip.JPG

Here is a snip of Pumpkins ss
pumpkin ss 6-04-2017.JPG

Pumpkin can't do it on his own.
 
I'm sure at this point you feel like we're ganging up on you. I just want to make sure you understand it's only because we've all seen what can happen in this kind of a situation, and we don't want it to happen to you. Please learn from other's mistakes.
 
Colin wasn't tested for IAA, but I believe he had it because of the way he came tumbling down in dose. He was in fairly high numbers consistently, until one night he wasn't. I had actually began to think it was impossible for him to have a hypo! If I hadn't been testing before bed I'm not sure what would have happened as he went into low 40's and I had a lot of trouble getting him back up. I've had him be in 300's at +3 and 40's @ the next PS. IAA is a tricky thing and testing is the only way to keep Pumpkin safe.:bighug:
 
I do appreciate your help, but my vet has lots of diabetic cats, most on Lantus. We are keeping a good eye on him and test every day. My biggest worry is the IAA freefall.
 
Pumpkin's Mom said:
We are keeping a good eye on him and test every day. My biggest worry is the IAA freefall.
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The only way to detect the IAA freefall, is by getting mid cycle tests. My Neko was once in the 20's, and showed no visible signs. Just "keeping a good eye" on him, is not enough. The most common cause of death of high dose cats is hypoglycemia - dose needs can change quickly. Sorry to be so blunt, but it's not something I like to see. Our motto here is "safety first".
 
Some good advice on this thread. I scanned thru the "Chewy" thread. It is really disheartening to me to see hypo's happen.

The good news is you know it is not Acromegaly. I also agree with Sandy that your vet may not have experience on this. My vet was up front and said she had no experience in Acro. Literally I read all the articles here, and a lot of people helped me (well helped Leo)...then he got SRT radiation to fix it. I can see from your chart that you are self-educating which is fantastic.

on Black kitty - Holy Smokes! That is quite an insulin dosage curve for an IAA kitteh.
 
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