Makita IAA of 66%

Hello there,

I recently tested Makita for acro and for insulin autoimmunity. His IGF is 100, so that is not an issue. But his IAA came back at 66%. He has been on Lantus for over a year, gradually increased from .5 based on nadir testing. His current dosage is 5 u bid and his blood sugars are often over 350 at nadir. A recent frucosamine came in at 449 (borderline fair/poor control).

Does anyone have any experience with insulin autoimmunity?

Thanks,

Claudia

 

Do not rule out the acro because the range for normal is 12-92, making 100 over the cutoff mark.

Shadoe registered at 120.

Oliver is acro and IAA, with his numbers as 325 and 60%

Others will have more to say, but I think you can consider Makita as having both.

With the acro, the number you get on a test is like a snapshot, and depending on GH output, that number will fluctuate. If you had the test run again, you may get a completely different value.

if a cat is just IAA, you aim to squish and aim for green numbers, under 100. I think IAA is a temporary condition and you can break it.

if a cat is acro only or acro and IAA, you are aiming to keep the numbers above 100. These kitties have functioning pancreas, so feeding a low number won't bring it up like a regular FD where the pancreas is not 100% functional. And acro is forever, unless you go for the SRT at csu I think.

the others will have better info for you.

 

Gayle,

Both vets that I've consulted do not think he has acromegaly. They do think he is insulin resistant and that I should consider changing insulins.

Thanks for your input.

Claudia

 

The "queen" of IAA was Sandy & Black Kitty. She was super aggressive on the dosing; Black Kitty went into remission. You might try looking for her spreadsheet.

Jan/Buddy and Sharyn/Fiona also have IAA. Sharyn has done a lot of research, although there's not much out there. You might PM her.

 

What does the lab interpretation say? 100 is outside the reference range, just barely, but I think it is safer to assume that Makita might have acromegaly AND IAA until you're able to do more testing. You don't want to find yourself in a low numbers situation and be unable to control it. University of Minnesota has a test for Growth Hormone, or you can do an ultrasound of the brain to look for a tumor, or you can test IGF-1 again at some point. My vet said the only way to know for sure is the ultrasound.

Lots of the IAA kitties here do well on Levemir, so it's true that switching to Lev might help. That, and becoming really aggressive with dosing. IAA can be a temporary condition. You have to give enough insulin to overwhelm the antibodies, and react quickly when numbers change.

Here is BK's spreadsheet: http://spreadsheets.google.com/pub?key= ... P-SWuUD1Ew
and Fiona's: http://spreadsheets.google.com/pub?key= ... oPJYlKieAw
and Buddy's: http://spreadsheets.google.com/pub?key= ... utput=html

 

Hi Claudia, sorry about Makita's Acro/IAA test results. Good for you for getting both tests! Fiona was dx'd w/IAA in Nov 2008.

I'm not sure we can say for sure that IAA is a temporary condition. One cat, BK, resolved the IAA (without changing insulins) and was able to go OTJ. I don't know of any others. But I'm not on the board much these days so I could have missed it. If a cat is predisposed to staying diabetic, I think IAA might always be an issue. Just because BK went OTJ doesn't mean Fiona will, even though I'm as aggressive or more so with her dosing.

There is very little data out there, well none really regarding IAA in cats. But I haven't looked in over a year, so that may have changed.

Everyone I talked to vets, endo vets, researchers, authors, say change the insulin - but NO ONE I talked to has actually tried this - NO ONE. Logically it makes sense, built up antibodies to this insulin, try a different one. There is one article that says in humans changing insulin doesn't make a difference. But it's only one article. More articles say to change insulins but again, I can't find anyone who's successfully tried this. Buddy evidently changed insulins in July and is currently getting reductions. BK didn't change insulins and got good results. I tried changing Fiona to Levemir but she had a reaction to it. No one else I know has had a similar reaction, but that's why we didn't switch insulins. The "professionals" says change insulins to something closer to the cat's own insulin, like PZI. There are huge differences in opinion regarding PZI, especially regarding duration. I think Levemir is genetically closer to Lantus than PZI so is it different enough to work as a resolution for IAA? Only the shadow knows.

If you are going to change insulins, do it while still at a lesser dose rather than waiting. Less nerve racking. Knowing what I know now, I would have liked to have tried a different insulin to see if it made a difference. Even knowing BK went OTJ on the same insulin. But since Fiona does get dose reductions on Lantus, as BK did, we know the antibodies can be overwhelmed without changing the insulin. Can they be overwhelmed enough in every cat for IAA to be called a temp condition? Again, ask the shadow.

Fiona's high on Lantus was 29u BID. We're down to 17u (again) :? We can't get below 14u for some reason. I just took her back up to 17u on the 4th. Her IAA seems to wax and wane with regards to insulin resistance but I haven't found a pattern as to why. Her three IAA tests have been high 70's or low 80's, but we haven't rerun it in over a year.

The way I explain it to people is that I pretty much have to overdose Fiona on insulin to overwhelm the antibodies. Once we do that, we start lowering the dose. When this happens she's pretty much in Somogyi rebound constantly, but nothin' I can do about it. If she rebounds for too long the IAAs seem to gain ground again. (sigh)

For Fiona, I can't lower her dose more than .50u at a time. I've tried three times reducing by 1.0u but she's stalled and lost ground each time. I raise her insulin by at least one unit. Half a unit does nothing for her and I fear it gives her body time to make more antibodies. I've raised it by .50u then .50u again with no results. So I went to 1.0u as SOP. The most recent raise was 1.5u and I've done 2.0u - HOWEVER I have almost two years of data on her BG's and I work from home so I can keep an eye on her. You're not new to diabetes so I'm sure you realize every cat/human is different and what works for one might not work for another.

There's a really good explanation about IAA from a woman, Monique & Spooky, that has several antibody issues http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=4646&p=45837#p45837.

Learning how to use Humulin R saved Fiona's life (thanks to JoJo). Fiona is prone to ketones and we couldn't raise her Lantus fast enough because you never know when it's going to be too much. Plus I didn't have the data then I have now or even an IAA dx. I've also found using the Precision Xtra to test for ketones via blood instead of urine has made my life so much easier. Best strip prices on ebay.

Another note, Fiona is overweight. "Big as a house" my vet says. :roll: That certainly doesn't help and may be contributing to her inability to get below 14.0u. She's on a diet but not having much success. Even had her thyroid tested but she's not hypo. She does have a very slow metabolism. It can take her 48+ hours to rebound.

I hope this helps. I wish you and Makita all the best! You can always PM if you have questions.

 

wow, thanks Sharyn, I'm going to bookmark this post for future reference.

 

Ack....I'm not happy with my previous post. I think I slighted you Sharyn!!!!! Please forgive me.

Sharyn provided me with a ton of information when Boo's results indicated IAA. There's very little information out there, but she's found the bits of information that are out there and shared with me and others. I think I should have said we have two queens...Sharyn, the Queen of Knowledge and Sandy, the Queen of Hope.

 

Hello Claudia and Makita,

I'm sorry you have to "join" our group yet so glad you have alot of support too.

I just wondered why your vets "don't think he has acromegaly". Please - I'm NOT trying to force the acro issue at all - but am questioning your vets response to the IGF-1 of 100. It's so very typical of many vets to not believe the IGF1 at all and base everything about acro on the physical symptoms. So was curious about why they said that. Like Libby and Lucy mentioned - a growth hormone test would be VERY interesting. It could be that your Makita is just now presenting in the early stages or even better - yes - no acro and yes - strictly IAA. But it's equally possible that Makita is positive for both.

Please I hope you won't think I'm being difficult. I'd hate to see you suffer along a long road only to find you are really dealing with 2 separate issues. So many kitties are diagnosed sooner with either one of these diagnoses and it would be great for you to know what you are truly dealing with.

WE keep an acro sticky updated at the top of our group. There are some links in there and tons of info. I'd like to add your names to the IAA group if that's ok with you?

Wishing you the best. And looking forward to hearing updates about Makita!

 

Claudia and Makita,
As others have mentioned my Buddy has IAA. He was dx'd diabetic 9-2009, and then had the Acro and IAA test done in Dec of 2009.
His number for IGF1-68, and IAA-72. It has been a long ride. Started using Lantus first and it was a roller coaster ride, then finally switched to Levemir 7-2010. With the help of many at the beginning that are very knowledgeable in the use of Lantus, then help and guidance from an angel on Levemir Buddy is progressing great. Take a look at his SS and you will see the difference.
I don't feel comfortable in giving advice, other than to say that I think switching to the Levemir was the best thing I could have done for my Buddy. As we know ECID, and Buddy does not have any other medical problems other than being a little over weight.
So I hope with all the other opinions your getting you will be able to make the decision easily. I will be watching your progress.

Good Luck
Jan and Buddy