12/23 Willie +10.5~67, ... +21~371 Need Advice!

Yesterday’s Condo


My boy is determined not to make this easy for me! His +7 was a 115, so the 67 is a surprise. Because of our trip, we're skipping our morning shot anyway. Going to feed raw only this morning since it may be a rollercoaster day. Will be able to get a +11 and a +12 as I'm heading out the door to work. My sister is going to try to get over here by +13 to keep an eye on him until I get home.

We had a puke this morning... tummy juices and unclumped fur. He's been grooming pretty aggressively, so that isn't a big surprise.

Hope all of LL has a good day, and safe travels over the holiday!

Re: 12/23 Willie +10.5~67 (no AM shot today)

Good morning! Nice morning number willie .. sorry to hear about the upset tummy ... have a great day!

Re: 12/23 Willie +10.5~67, +11~102 (no AM shot today)

Thanks!

Fed mix of raw and canned (Wellness) at +10.5, +11 food bounce to 102. Gave him 1 tbsp of canned and 2 tbsp of raw, mixed with water until it had a stewlike consistency (my raw recipe comes out pretty thick). He ate 1 Tbsp raw with his supplement (to make sure he gets it down!) and then ate maybe half of the remaining mix. We have first breakfast and second breakfast! LOL and with his weight low, sometimes a third....

Re: 12/23 Willie +10.5~67, ... +14~300 Need Advice!

Just got off the phone with the vet. Ended up not talking to the one I prefer, so I'm confused and frustrated. Keep in mind, this advice came without the knowledge of Willie's most recent number (+14), which was 300.

She thinks he's dipping into the 60s because he's getting too much insulin. She believes that the low numbers are proof that he is rebounding and that his liver is dumping sugar into his system in reaction to the low numbers. She recommended going to from 1.5 units BID to 1 unit once a day, or maybe 1/2 unit BID (but she seemed surprised when I said I strongly preferred the twice daily option). She said I shouldn't worry so much about getting spot checks for him, but should dose off of the pre-shot number and not worry about the mid-cycles (?!?). If he is 120 or below, she says I should skip the shot altogether.

She is also insisting I do a $250 pet food consult on petdiets.com. I've read over the woman's info who runs the site, and I frankly hold little to no stock in her judgment. The highlights include "under no circumstances you should ever feed your pet a raw diet," and "you shouldn't use foods from smaller companies because the products from the Big 4 are clearly more nutritious, safer, and are just all-around vastly superior to anything else." The vet is convinced that the raw diet supplemented with Feline Instincts is nutritionally imbalanced. I told her that with all the costs I was accruing with the diabetes monitoring and treatment, a $250 pet food consult simply wasn't in my budget at this time, and she seemed less than pleased.

Once we get through the trip today, if he's still shooting in the 60s at the +12, I'm not sure what to do. It seems like going from 1.5 BID to .5 BID is not the best idea (to put it mildly).

I'm heading home from work now... will likely post one more number before we hit the road and will update once we arrive and settle in tonight.

Thank you to everyone. I feel tremendously blessed to have found this community. In moments like this, I honestly don't know what I would do without you. Please know that your kindness and assistance is deeply appreciated.

Re: 12/23 Willie +10.5~67, ... +14~300 Need Advice!

She thinks he's dipping into the 60s because he's getting too much insulin. She believes that the low numbers are proof that he is rebounding and that his liver is dumping sugar into his system in reaction to the low numbers. She recommended going to from 1.5 units BID to 1 unit once a day, or maybe 1/2 unit BID (but she seemed surprised when I said I strongly preferred the twice daily option). She said I shouldn't worry so much about getting spot checks for him, but should dose off of the pre-shot number and not worry about the mid-cycles (?!?). If he is 120 or below, she says I should skip the shot altogether.

Click to expand...

Christie: this sounds like the exact same conversation I had with a feline Internal Medicine vet a week or so ago. My regular vet had sent Gracie's SS over to the IM vet just to talk to her about what actually happens with cats on lantus and the IM vet told my vet that she'd like to talk to me so I went in to talk to her thinking she might have something educational for me. Instead, she told me that Gracie did NOT need insulin, that she was having Somogyi rebound, that any time I *let* her go below 50 I was killing brain cells, etc etc. I was also freaked and all the LL special people jumped in to tell me that it's the same old song, second verse. On a subsequent conversation with that vet, she couldn't explain to me why, if Gracie was getting too much insulin, that she had not dropped below 90 in the 3-4 prior cycles but that she was not up in high numbers...in other words, it wasn't a Somogyi curve. Needless to say, we did not take Gracie off insulin and did not reduce her dose but increased it. When I showed that vet the protocol...she said there were many universities with protocols blah blah blah. Anyway..if you could provide your vet with the protocol and information that we base our doses primarily on the nadir with some consideration given to PS but we do not base it on PS solely. I think many of these vets don't want us doing tight regulation because of possible liabilities so they advise us to keep the cats above 120 or 150 or +1 urine glucose.

On the food...well she can insist all you want but what you feed your cat is your business. I find 95% of vets have no clue on nutrition. You should call her back with Dr. Lisa's website www.catinfo.org and insist that she read through it. The IM vet also told me that feeding a raw diet is "dangerous" due to salmonella and E coli. My NRT vet pooh poohed that and said she gets about 5x's more cats in her office with gastric problems from commercial canned/dry diets than from raw.

Re: 12/23 Willie +10.5~67, ... +14~300 Need Advice!

Most (sadly, probably 90%) of vets don't know that much about home testing and don't recommend it, and are not used to people who do home test, and don't have very much knowledge about Lantus and Levemir. The vets are used to seeing higher numbers, because normally, their patients come into the vet's office for BG tests, and the cats (or dogs) are stressed from the vet visit and generally have higher numbers. I think vets do not commonly see a BG of 50 or 60, when presented with a diabetic pet to test in the vet office environment. So, to them those numbers are very low. And, I think the vet you were talking to is more used to other insulins like PZI, which is very different than Lantus and Levemir.
Other people with better writing skills than I, will be able to explain it better than I can.
Listen to the people on the board, the ones with lots of experience. These people have way more accumulated knowledge about Lantus and Levemir and dealing with diabetic cats, than most vets do. Vets are general praticianers and know a little about a lot (they learn to treat all kinds of species with all kinds of problems and deceases, and don't really specialize). The people on this board, know a lot about diabetes. I recommend going with what information you get from here. I wish vets would learn more, but I guess they just don't have the time, ya know?

Re: 12/23 Willie +10.5~67, ... +14~300 Need Advice!

Hey no problem to do that consult! But insist that the vet pay for it!

I don't know about you or the others, but if 1u is too little and 1.5u is too much, giving you numbers too low, then why not try 1.25u?
My civie tested 53 the other day, so I don't think that vet is very knowledgeable on numbers. There's nothing wrong with 67.
And saying to go to 1u only once a day pretty much proves it. I think I'd try 1.25u BID if that 1.5u is giving you big drops, but others are better at reading ss and giving dosing advice.

Re: 12/23 Willie +10.5~67, ... +14~300 Need Advice!

hi, guys!

you're getting good input, so just wanted to say have a safe and wonderful trip!

celi & binks

Re: 12/23 Willie +10.5~67, ... +14~300, +15~340 Need Advice!

Thanks, all. I agree with the split-the-difference 1.25 BID approach. I think we'll likely start that tonight.

Safe travels to all, whether across town or cross country!

Re: 12/23 Willie +10.5~67, ... +14~300 Need Advice!

Most vets do not encourage their clients to push for tight regulation. As others noted, this is no doubt because the majority of people caring for a diabetic animal don't home test. You can't push for remission or tight regulation if you don't test. In order to get to either of those end points, your cat has to have BG in a normal or close to normal range. For most vets, since people aren't testing, they will encourage you to keep your cat above 150 or 200. For a vet to see numbers in the 60s, they will assume your cat is having hypoglycemic episodes because they also don't realize that we know how to manage the curve using food. Or, they seem to forget that a non-diabetic cat may have "normal" BG levels in the 40s or 50s. The skill set you are developing here will keep Willie safe and in good numbers.

The vet you spoke with is not familiar with long-acting types of insulin like Lantus or Levemir. The information she provided (i.e., that you shouldn't worry so much about getting spot checks for him, should dose off of the pre-shot number and not worry about the mid-cycles checks, and if he is 120 or below skip the shot altogether) is not consistent with how Lantus is used. Her information IS consistent with other types of insulin where dose, etc. is based on the pre-shot number. To the extent that this vet is open to new information, a copy of the Queensland/Rand protocol might be educational for her.

As for the nutrition info, that site is not educational. It is strictly for profit. I'd also be curious what the vet you spoke with considers a nutritionally "balanced" diet that a raw diet with a pre-mix omits. I have a hard time with blanket statements that aren't backed up by either research data or specifics.

Re: 12/23 Willie +10.5~67, ... +14~300 Need Advice!

I wonder also whether some vets not familiar with use of human meters for home testing may misinterpret a result of 50. Their feline-calibrated meters can test as much as 30 points higher than human meters. 50 on their meter would sound like a 30 or lower to someone using a human meter.

Re: 12/23 Willie +10.5~67, ... +14~300 Need Advice!

Hey all! We have made it to our destination safe and sound, and Willie is now roaming the (much larger) house, assessing his new kingdom. We had a brief encounter with my brother's lab (dad didn't think about poor Willie. grr.) 30 minutes after arrival (+21), he was at 371. Going to hold out for another 30 minutes to an hour to shoot as I need a decent night's sleep and really don't want to have to get up before 7am to do our morning routine.

He did pretty well on the trip. There was a lot of moaning and carrying on, and one brief bout of hyperventilating, but for the most part, he did well, especially if he was in someone's lap. Wasn't the safest option, but it was what my nerves needed.

As for the vet, I'm still miffed. I'm actually using the Alphatrak (at my vet's insistence), so my numbers would match theirs. I'd forgotten to pass along the vet's other gem... that in a few weeks, we'd resolve this and he'd be off insulin altogether (um, not if you're having me shoot 1 unit once a day and he spikes back into the 400s!!). As for her diet comments, it was infuriating. She's convinced the petdiets.com site is run by a vet who also had some sort of degree in clinical pet nutrition. Funny, if that were the case, I'd think she'd be touting that on the website, yet her credentials are.... (wait for it)... nowhere to be found. Go figure. The vet claims that I have to go there because she just has no knowledge of pet nutrition so she needs some one consulting to fill in the gaps. Yet apparently, she has enough knowledge to definitely state that raw diets are the devil and that what I'm doing is most likely not nutritionally sound. Which is it? The crazy thing about the insulin is that 1) they highly recommend hometesting (alphatrak only, though, please), 2) they all take the same approach (so presumably, if the other vet prescribed Lantus...), and finally, it is a cat-only clinic with a significant geriatric/diabetic clientele. That's why I'm just so baffled by the advice she hands out. At one point, when I refused to take Willie off supplements, she said that she knew of a homeopathic vet that might better meet my needs. I declined as I had liked the first doctor I saw and have no real aversion to western/allopathic vet care... I just believe in keeping all options open and am very leery of people who claim to not have knowledge of stuff yet slam it every chance they get .she was against me giving him standard process supplements, though she guessed that it wouldn't hurt (because, after all, they're worthless). I may end up taking her up on the referral to go elsewhere unless I can guarantee that Willie isn't seeing her.

I'm going to shoot 1.5 tonight and maybe tomorrow morning and then start the 1.25 tomorrow night. I'd like to get him up into consistent triple digits going into New Year's as I'll be out of town and he'll have a sitter (and my sister stealthily stopping by).

Sorry for the rant. After a stressful weekend/week, this bean is tired and cranky.

If we didn't have this site to rant on, we'd all go nuts!

I completely relate to the vet issues. Our first vet was a feline-only clinic, and we got horribly bad diabetes advice. You are trusting your own research and your own instincts, with great input from experienced people. You're in a position to make the best choices for Willie.

Enjoy your holiday. Just keep Willie out of the fruitcake! :mrgreen:

venting totally allowed!

hoping you and wee willie have a good night

celi & binks