AMPS 217 and good Vet visit!

Cinnie Cole

Cinnie Cole

Member Since 2019
So happy to have a Yellow AMPS this AM, and a very good Vet visit for Zoot!

No ketones and 200+ glucose on keto diastix. Vet recommends reducing Lantus dosage by .25u, so back to 1.0u 2X day. He gained a few ounces (to 23.8 lb) so we are going to reduce food a little and monitor. She monitors our spreadsheet and the only bone of contention is she just does not want us to test so often (just morning and evening pre-shots). She suggests if we want to test frequently that we invest in the freestyle libre system, so we are going to research that a bit.

This group has been incredibly helpful in us understanding what diabetes is and why we need to monitor.

Zoot! thanks you all.
 
Hi Cinnie!

Congrats on the yellow AMPS! PROGRESS :D It's so nice to hear you had a positive vet experience. I'm not sure why your vet is so against testing but There have been a few posts that I had noticed around the forum about the Freestyle libre from first hand experiences. I have posted a few below :)

http://www.felinediabetes.com/FDMB/threads/freestyle-libre-meter.204048/#post-2389259
http://www.felinediabetes.com/FDMB/...r-answers-to-questions-ive-been-asked.215627/
http://www.felinediabetes.com/FDMB/threads/freestyle-libre-sensor-removal-info-w-photo.215820/

Have a great day!
 
Don't know why she wants to reduce the dose, Zoot clearly needs it. Other than the fact most vets want to keep kitties above 200.

IM at the ER I saw with Smokey, wants their diabetic kitties in the 300's, needless to say never saw her again.

Have no opinion on the libre meter. Frankly I wouldn't be able to afford the every 2 week cartridge change with all her others meds which are more important. Olive loves to air her belly and she wouldn't be able to do that with meter attached to her back.
 
Thanks AmandaE I was just looking at one of the posts (answers to q's I been asked). Dr. Kenny is great, but she sees I am struggling with ear pricks (poor Zoot! I read and use the sock and massage and use vasoline and I still have to do multiples. I may try to do freehand, but I do have shaky hands so that is why I have not stopped using the lancing device. Our cat sitter (who is a vet tech at an animal hospital) is coming by tonight to give use tips, so that will be helpful too!
 
Not getting mid cycle tests to assess the nadir shows a suspicious lack of understanding of how lantus works. I don’t understand lowering the dose either. When I started lantus I didn’t want to rest. My vet convinced me to do it. I bought the meter but hadn’t tested myself. I went to my vet a couple times a week around suspected nadir. When I saw a 50 at +7 I started testing myself. So lucky Max never had an active hypo. Just my two cents.
 
Olive & Paula said:
Don't know why she wants to reduce the dose, Zoot clearly needs it. Other than the fact most vets want to keep kitties above 200.

IM at the ER I saw with Smokey, wants their diabetic kitties in the 300's, needless to say never saw her again.

Have no opinion on the libre meter. Frankly I wouldn't be able to afford the every 2 week cartridge change with all her others meds which are more important. Olive loves to air her belly and she wouldn't be able to do that with meter attached to her back.
Click to expand...

I am leaning toward NOT doing a libre meter; and good as it sound in theory, cats are not humans and so thinking that it would be easier (given what I have seen in these forums) is probably not realistic. Not ready to go there at all. As far as the testing, we are at an impasse, I am not certain how to address, but I am also not yet willing to leave a Vet practice that I trust over this disagreement. Re: the insulin dose, all signs point to good results, and I feel comfortable with that recommendation for now.
 
tiffmaxee said:
Not getting mid cycle tests to assess the nadir shows a suspicious lack of understanding of how lantus works. I don’t understand lowering the dose either. When I started lantus I didn’t want to rest. My vet convinced me to do it. I bought the meter but hadn’t tested myself. I went to my vet a couple times a week around suspected nadir. When I saw a 50 at +7 I started testing myself. So lucky Max never had an active hypo. Just my two cents.
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She has suggested we could see a specialist; is that what you have done? How do you get your vet to accept the protocols this group recommends? I mean, I need to have a vet, right - can't get the insulin without one? My vet is clearly discussing our situation with all the Drs. at her group (a VCA clinic) and I think we may need to find a happy medium. We switched vets just 3 years ago to this practice because it is considered one of the best in the area. And we finally found Drs that we trust, so I am having a really hard time reconciling the few negative comments here with my experience with this practice in general.
 
I wouldn't advise you to leave your vet if you trust him. There are many member who go to their vet for everything except their cat's diabetes management.

Here's my 2 cents. Most vets don't have clients who are willing to home test. In that way, the people on this Board are outliers. As a result, vets encourage people to run their cats in higher numbers which allows for a greater margin of safety if you're periodically bringing your cat in for a curve or the vet is running a fructosamine level. We're more encouraging with regard to home testing because we know it allows you to keep your cat safe and have much better control over dosing. Vets would much rather have a cat in numbers around 200 or above so there's a much slimmer possibility of hypoglycemia. It also means they don't have to be available 24/7 if your cat drops into lower numbers. There's a trade off, though. If cats are in numbers above 200, it's likely that the cat is above renal threshold and there's an increased chance of kidney damage, since FD is hard on a cat's kidneys. It also means that it's unlikely that a cat will go into remission or become tightly regulated.

I'd encourage you to read over the dosing methods we use here. See if one of the approaches fits for you. You're Zoot's caregiver and it's your choice with respect to how to manage his diabetes. What I can say is that this Board has been in some way responsible for getting hundreds of cats into remission.

We get vets to accept Tight Regulation by handing them the journal articles that have been published on the topic. I'm not at home and can't upload the article. There's a link to the abstract in the Dosing Methods sticky. Jacqui Rand, DVM has published a good deal on topics related to the Tight Regulation Protocol of which she is one of the authors. Her work is published in one of the leading veterinary journals. We let the data speak for itself. With my first vet, I gave her the article and she converted her entire office practice to it's use.
 
Sienne and Gabby (GA) said:
I wouldn't advise you to leave your vet if you trust him. There are many member who go to their vet for everything except their cat's diabetes management.

Here's my 2 cents. Most vets don't have clients who are willing to home test. In that way, the people on this Board are outliers. As a result, vets encourage people to run their cats in higher numbers which allows for a greater margin of safety if you're periodically bringing your cat in for a curve or the vet is running a fructosamine level. We're more encouraging with regard to home testing because we know it allows you to keep your cat safe and have much better control over dosing. Vets would much rather have a cat in numbers around 200 or above so there's a much slimmer possibility of hypoglycemia. It also means they don't have to be available 24/7 if your cat drops into lower numbers. There's a trade off, though. If cats are in numbers above 200, it's likely that the cat is above renal threshold and there's an increased chance of kidney damage, since FD is hard on a cat's kidneys. It also means that it's unlikely that a cat will go into remission or become tightly regulated.

I'd encourage you to read over the dosing methods we use here. See if one of the approaches fits for you. You're Zoot's caregiver and it's your choice with respect to how to manage his diabetes. What I can say is that this Board has been in some way responsible for getting hundreds of cats into remission.

We get vets to accept Tight Regulation by handing them the journal articles that have been published on the topic. I'm not at home and can't upload the article. There's a link to the abstract in the Dosing Methods sticky. Jacqui Rand, DVM has published a good deal on topics related to the Tight Regulation Protocol of which she is one of the authors. Her work is published in one of the leading veterinary journals. We let the data speak for itself. With my first vet, I gave her the article and she converted her entire office practice to it's use.
Click to expand...

Thanks! Very useful understanding what Vets look at higher doses as standard. I have read the Tight Regulation info and will send off to my vet.
 
I love my vet too. She was amazed I took such good care of him and loved his SS. She left it all in my hands as she could see that I wasn't hiding what I was doing from her but was going to do it my way. I wasn't doing him harm...so she left it alone. The information she gave me had this website on it.
 
Cinnie Cole said:
Thanks AmandaE I was just looking at one of the posts (answers to q's I been asked). Dr. Kenny is great, but she sees I am struggling with ear pricks (poor Zoot! I read and use the sock and massage and use vasoline and I still have to do multiples. I may try to do freehand, but I do have shaky hands so that is why I have not stopped using the lancing device. Our cat sitter (who is a vet tech at an animal hospital) is coming by tonight to give use tips, so that will be helpful too!
Click to expand...
Cinnie, I read your thread and sympathize with your struggles to test Zoot!'s BG. It took us a long time to become "mostly" proficient. I noticed you said you had shaky hands, and I don't know if that's because you are nervous doing tests or if it's something else. I remembered a thread by a new member that had Essential Tremors and wanted to provide you with a link to that thread. Something in it might be helpful. :)
http://www.felinediabetes.com/FDMB/threads/essential-tremors-anyone-using-lancet-pens.206925/
 
Hi Cinnie, and a belated welcome to you and Zoot,
If Zoot doesn't like the rice sock, you could try a warm baby washcloth (dampen it, put it into a baggie, and microwave for about 15 seconds). It would be smoother because it is in a smooth baggie , is easier to wrap around the ear, and might help him to be calmer. In time he'll get used to his tests and regard them as another part of his routine (cats like routines), especially when you give him a treat afterwards.
With regard to testing, I don't see why your vet would object to a mid-cycle test in the daytime cycle and a bedtime test in the evening cycle. After all, that's only 2 more tests per 24-hour period. We want to keep our kitties safe, so we have to know how low a dose might take them. In order to placate your vet you could vary the times of your daytime mid-cycle tests so that over the course of a week you would have bg numbers for, e.g., +5, +6, +7. This would fill in some of the blanks and give you an idea of when the nadir might occur (realizing that that nadir doesn't always occur at a particular time, like clockwork!). Our dosing protocols for Lantus and Levemir are based on the blood glucose number at the nadir (the lowest number of the cycle). These insulins are "depot" insulins and are treated differently from the older, "in-and-out" insulins that many vets learned in vet school to prescribe for feline diabetes. So with Lantus or Levemir mid-cycle tests are essential in determining if and when to change the dose..

Of course it would be nice to be able show everything to a vet you like and have him/her approve of what you are doing, but most vets don't have time to delve into the details of our spreadsheets. Therefore many of us here have trusted the feline-diabetes knowledge of the experienced people on this board and relied on our vets for all other health issues. We live and deal with feline diabetes 24 hours a day, 7 days a week. Vets don't have that luxury!

Keep on reading the "stickies" and asking questions. Everyone here wants the best for Zoot.
 
Hi Cinnie & Zoot! As you can tell from Tacos SS , I AM A TESTAHOLIC:rolleyes: The reason I & my daughter test so much is because Taco has proven over and over again that when he decides to go low, he decides to go low!!And he takes his time coming back up:arghh: AND YES!! his ears are beautiful , we wipe them down once a week with witch hazel, or more often if we tested more in a day, if that's possible. We just may be lucky on that end, but, we have never had a problem with his ears looking bad.After a poke we hold the tissue between our fingers and his ear and put pressure so not to bruise. That is all we do;)

Please look at 06/18/2019, looks great right,? and could have left the house after his +3 BG 169 and if I had something to do that day I would have, but, look what happened 2 1/2 hours later. BG 51, boom out of nowhere:nailbiting:
Had we not been home , who knows? But I don't think it would have been pretty. Taco does NOT seek food out when he drops. He does nothing but act like himself.

This is not to scare you and I surely am not telling you to test like we do. Taco has someone with him 24/7, only because we can.He has 2 reliable testers, myself and Tacos mom, my daughter. When my daughter and I get cabin fever, we ask my husband to test, but, after 2 years he still doesnt have it down quite right;)

He called us the other day saying Taco was at 41, of course we panicked, but, told him to try again, get food ready, and he called us back with a 218, he didnt get enough blood on the strip.

Now, for my vet that cares for our 7 pets. 4 small dogs and 3 cats. He has not seen Taco since last year. He was against putting Taco on Levemir, because he knew nothing about it:(
He also told me he didnt want to see the SS, he called it my coloring book.:mad::mad: This year he has made 0$ from Taco. The office makes about 2.000.00 from all our other pets. We have an understanding that I will take care of Tacos diabetes, all he does is prescribe the Levemir, in which he wrote for 100 refillso_O

So, I'll stop here and tell you that home testing is the best thing you can do for Zoot! and you don't have to show or tell them how much you test. You take care of Zoot, day in and day out. They don't. They do not love Zoot like you do :) Keep trying it will come and it will be the best thing you can do for Zoot! :bighug::bighug::bighug:
 
Piling on for the need to test more than preshots. We have seen kitties start in the reds or even blacks at preshot, dive down to earn a reduction then zoom back up for the next preshot. Neko earned her first reduction when starting the day at 430. :eek: Without mid cycle tests. I would have thought she needed an increase, instead of the decrease. Yes testing is hard at first. :bighug: I am one who has trouble with seeing blood, but after many tears, I did what was necessary to keep my girl safe.

At the vet clinic, I was the first client to home test, the first kitty on Lantus, then Levemir, the first cat that tested positive for acromegaly, then first to get treatment. Thankfully, my vet liked to learn, in spite of some disagreements at first. We built a partnership in care.
 
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