Ozy 12/17 IAA test 68% help please

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Hi Donaleen - I am sorry the results came back positive. IAA by itself is not as commonly seen but it does happen. I got Neko's positive IAA results (52%) before I got her acro test result. The strategy with an IAA cat is to be more aggressive with dose increases until you start getting a breakthrough. I have heard that IAA can be a self limiting thing, in that it can eventually go away after around a year.

IAA was never as big a deal with Neko - the acromegaly is more important to treat. At some point, Neko just started getting more greens. I do find I have to dose her to keep getting greens, or she'll keep bouncing. And until June this year (1.5 years after Dx), her bounces were usually to the reds. Now she'll occasionally pop up to pink but I think 2 years after her FD Dx, the IAA is essentially gone. I think she just likes to bounce now.

If you are interested, you might want to look at Blacky Kitty's SS. He had IAA 84%, and not acro. Black Kitty has been OTJ for 4 years now. Sandy also used R insulin to help keep BK in lower numbers. I never did use R. I wanted to at one point but never got a response to my PM request at that time, and then Neko's bounces started clearing too fast to use R. R is something you shouldn't start without advice from an experienced person.

The acro/high dose board is very quiet. There is information there, but very few posts.
 
Thanks, Wendy and Ann. I don't have the acromegaly results yet... that test will not be run until tomorrow and I don't know when the results come back. I am hoping for just IAA... acromegaly is very scary to me. I have not yet talked to the vet. I called and got the results before she called (I expect to hear from her later).

I have read everything I can find. Most of the posts are on the old side and there isn't much on the web anywhere. I did read that IAA means dosing aggressively. It sounds like IAA plus acromegaly is even harder... stay in the greens for IAA, stay in the blues for acromegaly. I have read both that Levemir is better and than insulin doesn't matter. I've seen R recommended for IAA. I've also read that some people thing IAA is meaningless.

Here is one of the best posts I found on IAA.

http://www.felinediabetes.com/FDMB/viewtopic.php?p=38127

I guess that with IAA, most of the insulin is useless. You need a high dose to get through.
 
There's been considerable debate over the "stay in the blue" approach. Libby (of Libby and Lucy) opened a condo some time ago in the hopes of spurring discussion on the topic. Here's the link to that condo. At one time, there were several very vocal people with acro cats who took a very aggressive stance with regard to "no green numbers" for cats with acromegaly. With a few exceptions, they rarely post here and do try to draw people over to another site to get their help. Historically, no one is quite sure where their position came from since if you look at the SSs that Libby linked, many members who pre-dated that group largely used a modified Tight Regulation approach with their cat. What I do suspect is that with any high dose cat, it's important to know your cat. Dosing is different with these cats especially if you need to give rapid dose reductions. Likewise, dose increases may be larger if the cat is on a big dose of insulin since the proportion of a dose increase needs to be enough to have an effect (i.e., if your cat needs a dose of 15u to have decent numbers, an increase of 0.25u doesn't make sense).

Sandy's kitty BK (or Black Kitty) is the "legend" when it comes to IAA. Here's a link to BK's SS. If you can track down BK's OTJ condo, there were several posts that recapped BK's story.
 
Sienne,

I looked at the SS... cannot find the condos. I can see a scary amount of insulin and lots of R and a long time before coming down. The SS starts in Feb 2008, his insulin climbs to at least 13 units plus using R, then a year later he is down to 6.5 units of insulin and it's bumpy and he continues to come down until October of 2009. Sounds like a nail biting time to me.

Carefully reading the other link on dosing.

thanks
 
I found something more recent on the web recently on IAA - I'll dig around to see if I can find it again. When I asked my vet about the IAA/acro results, she just tried to book me a vet visit with an internal medicine specialist ($250) for diagnosis and a treatment plan. I already knew what the diagnosis was and FDMB gave me the treatment plan.

You should get the acro results sometime Friday through Monday. Results are emailed back to the vet. I got mine on Sunday cause that's when my vet was working.

I fall in the camp that there's nothing wrong with greens for my little acro/IAA kitty. We had our first solid green cycle a few weeks ago, and I was so proud of her and she was feeling great. As the post Sienne linked says, the big thing is knowing how carbs work for your cat. I give LC at meal times and only give HC when she is low. Anything else in between is unpredictable, although I'll give a bit of LC at the end of the cycle to pull her PS down. There are still a few high dose kitties here (on LL) mostly following the TR protocol.

On the Lev vs. Lantus discussion, some kitties find it stings at higher doses so it is better for some high dose cats. I didn't switch until we got back down to 1 unit. It does make Neko's cycles flatter, but that doesn't happen for all cats who make the switch. If you can handle a later nadir, it is worth making the switch on the chance you might get better cycles. I should have done it sooner.
 
It may be that the OTJ condo was on the old Board and isn't accessible any more. Let me just say there was a PARTY when BK went OTJ. He had a really rough start with one of the members who was geographically close to where Sandy lived, meeting her at an ER to help out with the costs for BK getting emergency treatment. I think Sandy may have been the first person with a kitty that's IAA only. At the time, 13u was viewed as a huge dose -- not so much any more. Again, at the time there was far less known about high dose conditions.

Currently, the only kitty I can think of that's IAA only is Lisa's Do Lou. Lisa's last post was in May and Do Lou's SS isn't up to date.
 
Tiggy was never tested for IAA but was diagnosed with acromegaly - although I am still not 100% convinced he has it- but that doest change how I treat him. He was diabetic for a while before we even tested so I was used to greens and had no issues continuing to keep him there once the diagnosis came in. Check out his sheet.

Wendy
 
Another IAA only kitty is Harley (Pattie) - here is his SS, although it's not kept up to date either. He got up to 10 units before turning around.
 
6.5 units seems like a lot of insulin to me....I sure hope someone can study his SS and help me because it seems to me that my dosing changes have taught his body to resist the insulin. Very discouraging.

When he goes low like he did a few days ago (68 at AMPS) and won't eat much, it gets scary to shoot so much insulin. Several times I've dropped his dose because the low pre-shot number scared me. Each time he seemed to get more insulin resistant.

Here are some things I believe about Ozy:

--Ozy has long slow bounces and reactions.
--Ozy needs a .5 dose increase to make a difference in his glucose these days (.25 is too small a percentage to matter).
--Ozy can lose his appetite when his numbers are low and it can be hard to feed him to raise his numbers.
--When Ozy bounces up he never comes down as low again on that dose.

And I hope hope hope he doesn't also have acromegaly. Oh, how I hope.
 
6.5 units seems like a lot of insulin to me....
Click to expand...

It's all a matter of what you've seen. Perry's cat, Sooty, is an acro cat. There were times when Sooty was up to over 100u of insulin. FWIW, Sooty is OTJ. Like I said, it's a matter of perspective as to what constitutes "a lot" of insulin. The bottom line regardless of whether or not your cat has a high dose condition is that you give the amount of insulin that a cat needs to get the numbers where you want them. That means that a good dose could be 1.0u or 100u. ECID.

You're right. With IAA, you really have to hammer away at the numbers. The goal is to get ahead of the resistance. Every time you increase the insulin, there's the chance of the insulin auto-antibodies catching up with the dose. I would not reduce unless Ozy drops below 50 and I would encourage you to not stick with a dose unless you are seeing nadirs that are consistently in normal range. If you stick with a dose and the nadirs are not where you want them, the insulin resistance will catch up and you're back to square one. This is why many people will use R to help bring down pink numbers.
 
Well, I need a more effective hammer. And I think I need to change insulins. He is becoming sensitive to the Lantus. He is doing better with it now but he has periods of time when it hurts him. Also given his tendency to auto-immune issues, I wonder if he will get along with Levemir better than Lantus. Of course there is the chance that it will be worse.

I don't understand how to use R with Ozy. Would I have used it in the last cycle when he went high? At one point would I use it?
 
you were planning to switch after the dental, so i would say that anytime you want to switch, go for it. the dose to start with Levemir is usually about 70% of the current Lantus dose.

You want to learn how to use R with someone who is experienced at the beginning. I used it in two different ways - one was to cut a bounce off at the knees as it was beginning, the other was when I wanted to fairly immediately bring down numbers.

With acro and iaa, some people will use a lower dose of the Lantus/Lev and combine it with a varying dose of R because it works more quickly and is out of the body quicker. The L insulins are called the Basal insulin (think forming the base) and the R, which i used Humulin R (regular) is the "bolus" insulin, meaning added on. The dose and the timing are both important. I'd be glad to help you with it, donaleen. We'd decide when to inject and then you'd be checking the BGs every hour after that to see what it does. Unlike the L insulins, where you dose based upon the nadir, with R you dose based upon the number you have right now and the expectation that the curve is either going down or going up.

Lantus and Levemir, What's the Difference

This is a great article on exactly what's going on in the body with iaa. It explains the strategy for using R with it as well.
Extreme Insulin Resistance

We'll just go one step at a time. It's all manageable. :YMHUG:
 
mmm, about when in the last 3 days you would've used R on Ozy, when you saw that 243 yesterday at +9 it would've been perfect. Then if it didn't bring him down enough, you could have shot more last night or this morning.

how much would you have shot? we'll figure that out by doing trials, beginning with a 0.1u dose, then a 0.25u dose, etc., to determine how much each brings him down. I typically shot somewhere between 0.25 and 1u.

you can buy a bottle of it at Fred Meyer, or BiMart, without a prescription. You'll use your same syringes. It costs around $65, if i remember correctly, and the stuff lasts forever. you don't have to refrigerate it, even, although i did. it's not as delicate as the L insulins.

Let me know when you have the R and I'll walk you through it.
 
Thanks, Julie. I don't understand this part of the article:
***************************
Davidson's recommendation is based on The Good News: insulin resistance
is self-limited and only lasts a few months to a year. He simply uses
as much insulin as is needed in the meantime. U-500 concentration is
available for this purpose. The antibodies delay the action, so even
though U-500 is regular insulin it acts like a lente or semilente in
resistant patients. For unknown reasons, much less U-500 is needed than
the equivalent amount of U-100, 50% to 75% less. Since the situation is
difficult to manage and is temporary, Davidson advises not trying for
good bg control, but just avoiding ketosis and the overt symptoms of
hyperglycemia (thirst, excess urination, infections).

When insulin sensitivity returns, it can happen quite suddenly.
Davidson starts reducing the high insulin doses when fasting bg is
under 200 mg/dl (11.0 mmol/L). At these times, large amounts of insulin
previously bound to the antibodies may be released, so avoiding
hypoglycemia is a major concern. The return to normal sensitivity will
take at least several weeks due to the half-life of the antibodies, and
insulin requirements may fluctuate a great deal during this time. A
fast response to U-500 insulin (2-4 hours from injection to measurably
lower bg) may indicate the decline of insulin resistance.
**********************
What does that mean? I am not supposed to keep his numbers low? That seems at odds with getting ahead of the antibodies.... or is this paper saying it is self limiting and you just wait it out? Confused here.....
 
what it means is that the antibodies get bound to the insulin, and when the insulin resistance breaks the insulin can be freed suddenly. Sandy had really great explanation of it - i'll search and find it when she explained it to Linda/Weezer. I might not be able to get it posted til late tonight, but i will do it asap.
 
But what about the first part where he says not to worry about control? I thought control was necessary to stay ahead of the antibodies....
 
I did spend some time looking at SS's for those cats you listed SIenne BUT without a story line, I find the SS's not so useful. Why did they decide to raise and lower the dose like they did? Even if the condo trail exists, it is pretty hard to read a year or two of condos and I think impossible to find specific dates and see what was going on then.

I mean I need help with the now, not the past. Hindsight is much easier than foresight. I still feel surprised by what Ozy does next. The past is only a rough guide.
 
Dosing with high dose cats doesn't always follow the TR rules. That's one reason to look at those SS. The other reason is to see that the "avoid green" approach isn't always the prevailing wisdom. Much of dosing decisions rests on what you know about Ozy -- and what you'll learn about Ozy and what the dose at any point in time is. If a reduction is needed, it may not be in 0.25u increments. All of this will be a learning process.

FWIW, I've never seen anyone here use a U500 insulin. Lantus is a U100 insulin. U500 would be 5 times more concentrated than Lantus (or Lev).
 
i thought that article was more valuable for its thoughts about how the iaa works - not for the u500 idea.

I'm still looking for things, donaleen. i've gotta head for bed, but will look again when i get home from work tomorrow. i'm getting close - going backwards through posts by particular people!
 
This condo is a good starting point.

1/23 Weezer

Weezer was diagnosed with both iaa (60 something %) and acro about a month before this condo. I think if you click open the links to previous posts, you can read the posts especially from Sandy about iaa and R. Libby's got some good info in there as well. I like to click open the links each in a new tab, so i have a zillion tabs open. then you might want to go back to the diagnosis at the end of December (or the first post with a lot on iaa on 1/8) and read forward in time to the present January 23, 2012.

I think it will make more sense if you read forward in time - just like reading any story from the beginning to the end, rather than backwards. but our links all work to previous posts, so unfortunately, i don't know any other way to read the story in order.

also, you'll see "TOR" mentioned - that means a "touch of R."

here's the first post from Sandy to Linda with a lot of good info about iaa in it. I think it answers some of your questions about the difference in insulin duration with an iaa kitter. 1/8 Weezer

ok, now i really am going to stop and go to bed. :YMHUG:
 
Hi - just popping in to offer my 2 cents. Grayson is Acro/IAA. We were on ProZinc from Jan to May of 2012. Got his dx's in April, but due to travel/petsitters, we didn't switch to Levemir until May 31.

We fought the resistance. 6-7u is a high dose, but IAA kitties are often 30u+. G went up to 50u + 3u R; we're now at 7.5u. Since we weren't regulated when we went for SRT in July 2012, we continued to climb. Best numbers started showing up in October 2012.

You've already gotten a lot of good advice - especially that you need to be aggressive to break the resistance. .25u or .5u is nothing when you look at the percentage to your dose. I generally increased 20-25%. That's HUGE, and I freaked a lot of people out in the process (increasing 5-6u at a time). But if you're at 1u and increase .25, that's 25%. If you're at 10u, a .5u increase is only a 5% increase. The resistance will just laugh at you! You have to stay on top of it.

I've seen a number of people this past year (and even this past month) in the acro group on facebook go from all black/reds to consistent yellows. Their success is due to their aggressive dosing... but you have to be able to check on the kitty regularly. Same with using R (I bought my vial at Walmart w/o a script for $25 - like anything else, shop - or phone - around!). I was very reluctant to use it, but found it jumpstarted him by dropping his preshot, so by the time the Lev kicked in (abt +4), it was starting at a lower baseline. IF you use R, you need to test every hour for the first 4 or more hours to see how they respond. And ONLY use it if you'll be around to bring him up if needed. One time I was pouring Karo syrup on HC Fancy Feast to jack him up. It can be very scary... especially, if, like me, you've lived in the pinks/reds for months.

Some kitties will respond to barely a sniff - I've seen some drop with .25u; while Grayson barely moved for less than 3u. ECID. Look over our SS (several tabs, all ID'ed) and you'll see where we climbed. THe t-1 or c-.5 is food... I saw quite a spike on ProZinc from food, and continue to log his intake.

If I can answer any questions, let me know - either here or in a PM. I'll check back.

Lu-Ann
 
Thanks Lu-Ann. I appreciate you taking the time to share all that information you've gleaned. I have to say though, I cringe at even the idea of doses that high.

I was trying to use just maple syrup to bring him up because he gets asthma from grain. However, twice recently I used Fancy Feast and it seemed to bring him up faster and be easier to "dose". I hope it doesn't bring back his asthma.
 
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