Rom 10/12 AMPS 268 +4 418 PMPS 304 +3 191 +4 124Vet update

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You are trying to get the best for Rom, Sue, and you have every right to do so; you are his advocate.

Time to channel your inner Hacked Off Kitty Mama ...

iu


:bighug:

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Yes thanks @Critter Mom. I thought I liked it but must have been too busy writing all your arguments down!!! Very useful and I will certainly throw them all at her.

My vet is usually so nice @Tuxedo Mom I hate arguing with her as we get on really well, but she is just so damn stubborn over this insulin, but I am doing this for Rom and if that means getting a second opinion or changing vets, I will.
 
Sue484 said:
but she is just so damn stubborn over this insulin
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Although Rom has shown some positive responses to Caninsulin, after this length of time, they are not consistent enough for the vet to think that this is the right insulin. Rom's numbers now are not much different than a year ago, so this should signal the need to at least try something else. The line of reasoning is that since Caninsulin is not providing a consistent control then what harm could it be to try something else that just might. Why stick with the thought that" if it isn't working don't fix it"..totally reverse way to how the vet should be thinking. At the very worst, if the change to a new insulin doesn't change the glucose pattern, then Rom is no further behind than he currently is. If a change makes a big difference then Rom (and you) are the winners. No brainer from where I sit.

Good luck!! :bighug: :bighug:
 
When I was enquiring about Prozinc recently one of our vets told me that they did not yet have any patients on Prozinc. I sensed a degree of nervousness in the vet about this and I got the feeling that there might be a reluctance to prescribe it instead of Caninsulin because they're familiar with the latter and would prefer to work with the latter for that reason alone (not a good justification, IMO - I'm on exactly the same page as Mary Ann).

Just wondering whether your vet might not yet be familiar with Prozinc? Might that be behind her hesitation to prescribe it?


Mogs
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@Critter Mom My vet did mention it in our phone call last week, so I'm keeping my fingers crossed that she will try it. I would hate to leave as she has saved Frankie's life twice and also my previous cat's too, so they are good, just not about diabetes. Plus it's 24 hours, so if there is an emergency or if they are in the hospital, you can go visit at any time. I just feel she is not familiar with diabetes at all, as before ProZinc was authorised she still refused to prescribe Lantus.
 
I am not sure how the cascade system there works. but you have a definite case for switching from Caninsulin. I wonder if the vet could/would consider using Lantus..if it is possible to jump from Caninsulin directly to Lantus, without trying Prozinc....since you already have 1 1/2 years experience in using it with Frankie??
 
@Tuxedo Mom I don't think it's possible under the Cascade system, you have to use animal products first, but I am certainly mentioning the fact, especially as it is working so well for Frankie, and she can't argue with the figures!!!
 
Sue484 said:
@Tuxedo Mom I don't think it's possible under the Cascade system, you have to use animal products first, but I am certainly mentioning the fact, especially as it is working so well for Frankie, and she can't argue with the figures!!!
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I was thinking that if she is not comfortable with Prozinc, because she is not as familiar with it, then she should be more at ease with Lantus (as you would be as well) because of your long history of use with Frankie.

Good luck for your visit!! :bighug:
 
Sue484 said:
I seriously doubt she has ever prescribed Lantus as she was always wanting to refer me to the RVC to get it.
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But she has your history and data from Frankie, so she knows that you are experienced with it, even if she is not. She would have the ability to compare when Frankie was on Caninsulin to Frankie on Lantus so she has a perfect case history to refer to (along with you) if she wants to study how Lantus works. Either way even if the vet will only give Prozinc, it has a much better chance of levelling out Rom's numbers than sticking with the Caninsulin.
 
I hope you're right @Tuxedo Mom, but she treats me as if I know nothing, then whatever I say to her one visit she quotes to me at the next!!! I am thinking if I get no joy I will just use Frankie's insulin on him without her knowledge. I got a stock last time I was on holiday and it was sold OTC, so I have no need for her or the pharmacies extortionate prices!!
 
Sue484 said:
I hope you're right @Tuxedo Mom, but she treats me as if I know nothing, then whatever I say to her one visit she quotes to me at the next!!! I am thinking if I get no joy I will just use Frankie's insulin on him without her knowledge. I got a stock last time I was on holiday and it was sold OTC, so I have no need for her or the pharmacies extortionate prices!!
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If need be you could always do that and then show the vet the results in a few months time. If Rom gets good results with Lantus, it would be very hard to argue with the facts. Although it would be better if the vet was on board with you, and I would never suggest this to another member who did not have all the experience with Lantus that you do, it is another alternative.
 
Tuxedo Mom said:
I am not sure how the cascade system there works. but you have a definite case for switching from Caninsulin. I wonder if the vet could/would consider using Lantus..if it is possible to jump from Caninsulin directly to Lantus, without trying Prozinc....since you already have 1 1/2 years experience in using it with Frankie??
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Since Prozinc was approved for FD treatment under UK cascade rules vets are now legally required to use either Caninsulin or Prozinc first. (I've confirmed this with our vets.) The Prozinc approval has actually made it even harder to get a Lantus or Levemir Rx over here, Mary Ann. :banghead:

Re external referrals, I don't think Langford are very au fait with Lantus either, Sue.


Mogs
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Critter Mom said:
The Prozinc approval has actually made it even harder to get a Lantus or Levemir Rx over here,
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That is such a shame. You would think with the RVC trials they have been doing with Lantus that it should have made the list of acceptable insulins for kitties.
 
From speaking to a vet doing the RVC trials, it seems the are concentrating on ProZinc now. Even they cannot escape the Cascade rules.
 
Critter Mom said:
When I was enquiring about Prozinc recently one of our vets told me that they did not yet have any patients on Prozinc. I sensed a degree of nervousness in the vet about this and I got the feeling that there might be a reluctance to prescribe it instead of Caninsulin because they're familiar with the latter and would prefer to work with the latter for that reason alone (not a good justification, IMO - I'm on exactly the same page as Mary Ann).

Just wondering whether your vet might not yet be familiar with Prozinc? Might that be behind her hesitation to prescribe it?


Mogs
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I'm a client at a large practice with anywhere from 12 to 14 vets on the roster. They also run one of the few 24 hour ERs where I live. I'm the ONLY client using ProZinc for her diabetic cat in the practice. Lantus didn't work well for my kitty and it was my (most excellent!) vet who suggested ProZinc even though she'd had no experience with it. She also trusts me to be hands on with Teasel's treatment and she views the vet-owner relationship as a collaboration. I'm SO lucky because this is the way it should be ...

Yesterday, in fact, we had a long phone conversation to discuss me having adopted the FDMB way of doing things. I'd emailed her the ProZinc Advanced Dosing Sticky link and my SS link. She's fully on board with this because she's aware that she can't possibly address every up and down in Teasel's BG and dosage personally. She's willing to be a "background" resource for me.
 
You have to remember most diabetic cat owners (according to my vet) are not very hands on and not many do testing at home, so they can be understandably nervous about leaving it all to the owner. I spoke to someone who used to have a diabetic cat, did no testing and accepted that at times he would fit from hypoglycaemia, I was shocked! This is what a lot of vets have to deal with so I am not surprised many prefer to be a bit more hands on with care and monitoring, I would be if I were a vet. The only way is to work with the vet and gain their trust - you have plenty of evidence you are a responsible owner, use it to your advantage, I don't believe in confrontation but you having looked into and used different insulins enables an opportunity for a mature conversation whilst steering it towards your desired outcome.
 
Well, she didn't want to, and really tried to avoid it, but I wore her down and got Rom on ProZinc!!!! The really annoying thing is once she agreed it, she said she had already ordered it and it was in the fridge waiting!!! How annoying. She still thought that several months ago Rom was well controlled and wouldn't have given it then, but she seemed to be talking as if she was doing me a favour. I was relentless and threw all Mogs' points at her, but she still would not give in gracefully. There was no major fight though, so all good. He had bloods taken in case his increase is due to infection, and she was unconcerned with the low nadirs with the 1.5 units. She just said he would eat. I said I have to force him to eat when he's low, and I as I live with him I know him a bit better!!! Anyway, long story short he is now on ProZinc 2 units twice a day. She worked it out per the guidance with the bottle as he is. 17lb cat. Thank you for all your good wishes. Your presence helped me in the consult room.
 
Sue484 said:
I forgot to say she also said only test before injection for 5 days as he is going to be all over the place. Like that is going to happen!!!!!
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HA HA HA!!! Your vet is a real comedian!!!


Glad to see that she finally gave you the Prozinc....if she has already ordered it and it was waiting for you, then why the attitude?? Oh well. at least you have it now.

Good luck with the change over...fingers crossed for some smoother, more consistent numbers with the Prozinc.
 
Nadir with Prozinc is usually +5-+7, so there is still some time Rom may continue dropping. Since this is all new with this insulin, I would suggest getting a +4 in and see what Rom thinks of Prozinc ;)
 
Sue484 said:
I'll do my best to get a +4.

I'll still do a condo here each day seeing as most don't on the ProZinc forum.
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Since Prozinc is a more gradual insulin with a later nadir than Caninsulin it would be good if you could try to manage a couple more tests tonight. Although the PMPS to +3 is not a major drop it is still a good size drop. Usually if you are seeing a 50% drop before nadir it would be good to get another test or two in. Since this is all new territory having Rom on Prozinc, I would try to get those tests tonight, to give you an idea of what you might expect with Rom
There are a number of people that post daily on the Prozinc forum, and the experienced users will always check in daily so it might be an idea to post a condo on the Prozinc as well and see what attention you are getting. The Prozinc "gang" is a pretty tight group and do watch out for questions and concerns. :bighug:
 
He is dropping a lot considering there is still another few hours left until "usual" nadir time. I would give him some LC and retest in 1/2 hour

ETA The starting dose of 2 units of Prozinc might be too high but at this point you don't know so close monitoring for this cycle would be in order
 
There's a possibility that there may have been a little bit of carryover from the previous dose of Caninsulin influencing tonight's numbers but you won't be able to tell until you get a few cycles worth of Prozinc data.

It's certainly a better response in the early part of the cycle. Fingers and paws crossed for good things for Rom with his Prozinc.


Mogs
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