Feedback from Ozzy's Vet - Thoughts?

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Ozzy Pawzbourne

Member Since 2016
After playing phone tag with Ozzy's vet over the last few weeks, we finally were able to connect today. Below is the feedback I received and I'm curious your guys' thoughts. Appreciate any feedback. Thanks in advance!
  • His first comment was that based on Ozzy's numbers and that with us giving the lower doses of insulin and him still maintaining relatively the same numbers overall, he thought Ozzy was headed for a partial or full remission. WHICH IS EXACTLY WHAT WE WANT! I am trying not to get excited and know we have a ways to go and that this still may not happen, but STILL....isn't that what we ALL want to hear?
  • He also thought Ozzy was responding well to the Vestulin and that he sees a lot of cats on this insulin and usually they still have a lot higher numbers just a few weeks in. He said he was really impressed with Ozzy's numbers and he is headed in the right direction. He would like to see him with more blues and greens though.
  • He was very impressed with the spreadsheet and the amount of data we have collected over the last few weeks. SHOUT OUT and THANK YOU to FDMB for this assistance and guidance in helping me get this set up and able to monitor.
  • I asked if he thought Ozzy was bouncy to the insulin and he did not think so. He said normally you will see a very high PS number followed but a steep drop and then a high rebound number. We specifically discussed the AM cycle on 12/23 and he said the steering with food was good advice but overall he did not think that cycle was overly concerning.
  • I asked him about the TR protocol and he was honest andadmitted he had never heard of it. He also says he does not base dosing on nadirs or PS alone- he looks at the entire cycle and curve to make a judgment on what dose seems most appropriate. He said there are other protocols out there as well.
  • I also asked him about doing the ear pokes and if there are any concerns about the number of times we are testing (could we damage any vessels in his ears) or infection. He stated that cats normally do well with ear pokes and he understands us doing this so frequently now as we are trying to get Ozzy regulated, but he said long term we should think about our kitty's quality of life and if poking him 10xs a day is ideal for our kitty's happiness. He stressed that many kitties are given insulin and their owners don't test at all. It was something for me to consider, I have to say. Of course this is when we have Ozzy regulated. I guess my question after hearing this feedback is...where do we draw the line between testing for safety and being obsessive?
  • We also talked about switching insulins and he said he likes lantus and would be willing to write me a script if this is what we wanted.
  • He also talked about the importance of trying to hold Ozzy at the same dose for a period of time (he recommended a week). The vet said with us jumping around with doses, it's hard to tell where an increase or decrease is necessary until we can see how Ozzy responds to a particular dose for a period of time.

His overall recommendations moving forward were:
  • Stick with the same insulin for the next week. He thought switching up will only confuse things since we have not really had Ozzy on the same dose for any length of time to see how he is responding.
  • Give Ozzy .75U of vestulin for the next week.
  • Curve Ozzy this coming weekend. And we can discuss next steps then.
 
He stressed that many kitties are given insulin and their owners don't test at all.
Next time perhaps ask him how many diabetic children are given insulin and their parents don't test at all?

Real party-line stuff on the testing. (I have other compliments and criticisms but I'm feeling very drained tonight, Jo, so can't do a decent reply just now. Will look in again.)


Mogs
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Not sure I understand this comment

She means his comments are the same ones we hear from a lot of vets....that testing too much will somehow make them hate us, run from us, have a poor quality of life....He's giving you the "party-line"

If you look at China's profile, you'll see almost 4 years of testing....she still comes when I call her or when I start getting the testing supplies out....that's not a cat that has a "poor quality of life"

Yes, as you get better regulated and learn more about how Ozzy responds to both food and insulin, you'll be able to test less

As for your vets opinion on continuing the Vetsulin and not worrying about the diving and bouncing, I couldn't disagree more, but I guess if he's willing to let you try lantus after 1 more week, I guess that's OK

The sooner you can get Ozzy into "healing numbers" (50-120) and he can stay in those numbers as long as possible, the better his chances of remission are.

I also think your vet is one that is happy with 200's as "regulated".....depending on Ozzy, renal threshold (the point at which there's too much glucose for the kidneys to filter out and it spills over into the urine) can be as low as 150....the longer that he's over renal threshold, the more damage it's doing to his kidneys. Renal threshold varies from cat to cat but can be anywhere from about 150 to 250'ish.

Our cats weakest point is their kidneys....even for non-diabetics, so protecting kidney function is one of the most important things we can do for a longer lifespan.
 
How can I tell/measure what Ozzy's personal renal threshold is?

I have to admit this is confusing and overwhelming. I am remembering it is a matathon not a race- but I feel a little lost here. What would you do if my adorable Ozzy was your sweet kitty? Switch insulins? Or give vestulin more time? I only have 6 days left here before I go back to work full time and I will then only be able to monitor Ozzy for the +2 and +4s in the PM cycles only and on weekends. If we are going to switch insulins, I would like to do it now so I have a few solid days to see how he adjusts. I am really confused right now...:(
 
How can I tell/measure what Ozzy's personal renal threshold is?

You can use urine test strips that test for both glucose and ketones and compare the glucose results with the blood glucose results.....when the urine glucose is negative, he's been under renal threshold (it can take a lot of testing to find an exact number)

But generally, we use an average (because not everybody has the time/energy to do that much urine testing)....generally speaking, if he's under about 220, he's probably OK

I'll be totally honest here....and this is just my opinion....if he were mine, I'd switch insulins because Lantus just has such a better track record with getting cats into remission
 
How can I tell/measure what Ozzy's personal renal threshold is?
Worth mentioning regarding renal threshold...
Depending on the source, veterinary literature defines renal threshold as 200 mg/dL, 240 mg/dL, or 250 mg/dL. These numerical values are based on lab results. When taking the differences between between human meters and lab values into account, those numbers will be lower when using a human meter.

For example, I used a BG meter calibrated for humans with Alex. I was interested in protecting her kidneys, because like Chris said, "protecting kidney function is one of the most important things we can do for a longer lifespan." After running a lot of comparisons between meter readings and diastix, I was able to determine her renal threshold (the point where glucose spilled into urine) was somewhere between 140 to 180 mg/dL on a human meter.

 
was able to determine her renal threshold (the point where glucose spilled into urine) was somewhere between 140 to 180 mg/dL on a human meter.
Oh wow! Ozzy has rarely been in those number ranges in the past 3.5 weeks since we brought him home from hospital. Are we not doing enough for him? Now I am even more concerned. :confused:
 
Oh wow! Ozzy has rarely been in those number ranges in the past 3.5 weeks since we brought him home from hospital. Are we not doing enough for him? Now I am even more concerned.
Oh gosh, don't ever think you're not dong enough for Ozzy! Regulating a kitty is a process. It doesn't happen overnight. All one can do is continue plugging away at it!
 
(I have other compliments and criticisms but I'm feeling very drained tonight, Jo, so can't do a decent reply just now. Will look in again.)
@Critter Mom , when you have time and are back online, I've been really curious to know what you think. ??? I was a little concerned by your initial comment and have been wondering what your thoughts are. When you have time, of course. Thank you!
 
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