2/2 Mo - Specialist Visit update

[katy and mo (GA)]

Yesterday's instalment

The appointment with the specialist went soooooooooo well! She knew everything about everything. She checked him over. She is happy with what we are feeding him minus the air dried meat. She said to cook meat for snacks so we will be doing that - just to minimise the risk of any food-borne illness.

She discussed with us all the things that could be going on with Mo.
1. Chronic pancreatitis that isn't being picked up through basic blood tests
2. Somogyi effect
3. Acromegaly.
4. Stress-induced insulin resistance
5. Lantus may not be working and we will need to try Levemir

The next thing I'm going to mention is something people here are going disagree with. But I genuinely agree with her on this so please be kind....She wants us to stop home testing. This is because she believes that it is causing him stress to the point where he has stress induced hyperglycaemia and the insulin isn't able to help. Given how stressed and growly he is when we test him, I'm willing to give this a try. I talked to her about my spreadsheet and about when we saw the consistently lower numbers and that was when we were on around 3-4 units. So for the next 2 weeks, we are lowering him to 3 units and no ear testing. Instead, I will be testing his urine with a glucose dipstick regularly.

In the meantime, she took some of blood to do some thorough blood tests among other things. See below:
Doppler Blood Pressure Measurement
Feline Pancreatic Lipase Quantitative
B12 And Folate Analysis
Fructosamine
Fiv/Felv Inhouse Fast Test
Gabapentin 100mg Capsules (this is for him to take before our next appointment if they require more tests...I will explain shortly)
Total Annual Health Profile (Code Tahp)

She checked his eyes, blood pressure, weight and she's happy with it all. She has told us he can eat as much as he wants since he probably needs a lot more food than we are giving him. He was very happy to hear this

We discussed the Lantus "sting" which she does agree could be upsetting him but at 3 units, he will hopefully not feel it. But if after the 2 weeks, we get no improvement from the lack of testing and reduced insulin amount, we will be taking more blood for the Acromegaly test. She is unsure if we will be able to send it away to the US because she mentioned it has been tricky sending things overseas at the moment but we can do other tests here apparently. Some might say it would have been better for her to test for it now, but we couldn't afford any more than what we spent today.

Mo was very stressed at this appointment. He was in the car for 20 minutes to get to this appointment, which is far too long for him. Usually it's a 3 minute drive to our normal vet. So this stressed him out. Then there was basically an hour of poking and prodding. They couldn't get as much blood as they wanted because he was getting upset. They also wanted to take a urine sample but as he was getting more and more aggravated, the deemed it unsafe so decided to wait until next time. It's not particularly urgent as he has had a urinalysis done recently.

So basically I'm happy with how today has gone. We are giving Mo space. He had a pretty rough day and has slept for most of it. He peed in the cage on the way home and started panting like a dog. My poor boy has been through the wars.

The specialist will give me a call tomorrow with some of the results. Other results will take another week or so.

I was in 2 minds about posting this here today because I know some people here will have very strong opinions about this. But I'm feeling positive and we are finally getting the ball rolling.

 

[Hercule's mum]

I am glad you had a good visit and feel like you have a plan. Fingers crossed it works!

 

[carfurby (GA)]

I'm glad you liked the specialist. I hope the plan helps Mo. Not testing makes me nervous, but I know you will watch for any signs of hypo. I hope you can find a good plan that works to get him feeling better.

 

[Sue and Luci]

She wants us to stop home testing. This is because she believes that it is causing him stress to the point where he has stress induced hyperglycaemia and the insulin isn't able to help. Given how stressed and growly he is when we test him, I'm willing to give this a try. I talked to her about my spreadsheet and about when we saw the consistently lower numbers and that was when we were on around 3-4 units. So for the next 2 weeks, we are lowering him to 3 units and no ear testing. Instead, I will be testing his urine with a glucose dipstick regularly.

Good Morning Katy,

I'm glad you met with the specialist and I'll say this as gently as I can...based on this I'm concerned that your vet doesn't really understand much about FD. It's so very unfortunate and yet so prevalent I'm sad to say. So enough of that - however, what I'd like to see you do - if you're willing over the next week or so while you're trying this no testing routine, is to continue to pick him up and put him in the testing place - give him some loving and a treat - and let him go. No test. No poking. Just stroke him and tell him something or another...in a calm voice...and then let him go...keep doing that...and perhaps, possibly he'll calm down enough that once you do decide that testing is needed (and of course you know we all think it is)...then perhaps he'll associate the time and place with nice things and not get upset.

I had a heck of a time with Luci when we first started - I thought there was no way we'd ever be able to do this poking thing with this hellcat. She wasn't having any part of it and it took two of us a month or so just to get any kind of testing done. It was exhausting! She was mad and we were exhausted...but after every 'event' she got her snacks, some food or a freeze dried tidbit and soon she was a little nicer about the whole thing - because she knew she'd get something to eat! My girl is highly motivated by food...so perhaps give that a try...

I hope things will go okay for you over the next couple of weeks. Once the sugar starts to spill into his urine things will get even more urgent - he'll need the insulin and perhaps more of it, but it will be difficult to determine what's too much by using a dip stick. I was hoping perhaps the vet would recommend something like the Libre - which is attached to the cat and takes readings - some difficult cats are better off with that so there's less handling and poking - just something to consider I suppose.

Have a good day Katy! Best to you and Mo!

 

[Pamela & Amethyst]

Good Luck

 

[JaxBenji]

Hi Katy! Mo sure is lucky to have you all

I hope the gaba helps Mo next time - there's a good article here on Fear Free Vet visits - `https://fearfreepets.com/study-gabapentin-reduces-stress-cats-veterinary-visits/

Jax thinks the vet is attempting sorcery on him at Jax's dental consult last month, we did a gaba pre-dose (100mg 12 hours before his appt) and another dose 2 hours before his appt (another 100mg) - in both cases, I broke open the capsule and mixed in with his food - Jax did question his food with the gaba in it but ate it under supervision . At the dental consult, Jax still showed teeth and hissed at them (I wasn't allowed in due to covid) BUT she was able to do her exam and he was MUCH more relaxed after. You should watch for ataxia (stumbling, lack of coordination) - I kept Jax in a room and removed things he would jump on. All that to say, I hope you have success with it

 

[Olive & Paula]

I get the no testing, but how will you know if the 3 units is any better than 2 units or 4 units?

I think I would test before each shot minimum and then nothing in between, that would be my compromise.

Glad you found a new vet and have a plan.

 

[Katherine&Ruby]

Hello Katy, So happy you found a great doctor who gets it! While I absolutely understand wanting to spare Mo and his ears, I agree with @Olive & Paula. Testing before each shot would ensure some modicum of safety for Mo. Not sure if you saw the thread over the weekend in the Welcome/Main Health forum, but a CG didn't test before a shot because she got a high number the day before and her cat went hypo with seizures. It took the good part of a day with all of the mods here involved to get the cat to safer numbers. It scared me so much to watch this unfold, and I truly would not wish this to happen to you and Mo. You of course will do what you think is best, but this is the most loving advice I can give. Hugs to you and scritches to little Mo.

 

[Gill & George]

I was in 2 minds about posting this here today because I know some people here will have very strong opinions about this. But I'm feeling positive and we are finally getting the ball rolling.

I am glad you posted you know we are all here for you and want nothing more than to support you, don't ever feel you can't talk to us about it.

We are giving Mo space. He had a pretty rough day and has slept for most of it. He peed in the cage on the way home and started panting like a dog. My poor boy has been through the wars.

Poor Guy George hates long drives too. He get's really upset.

So for the next 2 weeks, we are lowering him to 3 units and no ear testing. Instead, I will be testing his urine with a glucose dipstick regularly.

Respectfully Katie, and with a lot of love, this is a really bad idea. I'm going to link a discussion in the think tank in which Kirsten (from romp rand protocol) and Dr Lisa take part, please take time to read it, no matter what you decide to do. It's in the think tank so many views are discussed and argued. Covers conservative dosing, rebound checks, home testing, using urine sticks, you name it. It's an old thread I came across just the other day.
https://www.felinediabetes.com/FDMB...re-i-feel-like-dr-hodgkins.18955/#post-189439

You have taken the dose up slowly, consistently and you haven't missed a good dose so this rebound check and best is going to be a waste of time, but at worst I fear it may be really bad for his health.

What I can't figure out is why the specialist thinks a rebound check is necessary seeing as you have taken the dose up consistently and have been home monitoring, I'm just not sure she's as familiar with FD, and more specifically higher dose cats as she could be. (TBH in the acro/IAA crowd, Mo is not such a big gulpler).

Mo has some insulin resistance that is clear, whether that is glucose toxicity, IAA or acro, it's impossible to say.

Please keep us posted.

 

[tiffmaxee]

No testing scares me. I’ve seen cats drop and go hypo way too often. Max was probably the most sensitive cat I’ve ever encountered. He didn’t mind testing at all. It did get stressed when taken to the vet enough to raise his BG a lot and cause his pancreatitis to flare. If the sting bothers Mo I would for sure switch to Levimer. We all care so I hope the no testing makes a difference but it REALLY scares me.

 

[thebigfuzz]

The vet that diagnosed Cosmo (not our regular vet) said we didn’t need to test and was super concerned it would stress the cat out when I said something. So glad we had OTJ kitty experience with Elie thanks to our regular vet and FDMB. 2 sentences later, he told us that they just had a severe hypo cat come in to the clinic the previous day I mean, I wonder why. I couldn’t get out of that clinic fast enough. Never been back.

Cosmo is a skiddish cat, but is fine with as much testing as we need to keep him safe. I think he enjoys it now

 

[Mariette]

Aww sorry he gets so stressed when testing. I can totally understand why you feel that could be influencing the numbers you're getting.
I know I've certainly felt that way when I didn't want to give Buddy food before testing and he was getting all worked up. We were just feeding each other's stress.
I don't think I've seen people talking about testing while sleeping. Not sure if it's something that's not advised? But Buddy hardly reacts to a test when he's sleeping. He might just do a little stretch or something after. Another plus is that the blood flows much better because his ears always seem to be warmer when he's sleeping.
I really hope you have success with the strategy and that he'll be a happier kitty

 

[Marje and Gracie]

Hi Katy

We all want the kitties here to do better and many of us seek the opinions of “specialists”. I did. She told me Gracie was experiencing Somogyi due to being overdosed and that I should immediately stop insulin because Gracie wasn’t diabetic. Thankfully, I listened to the experienced members here and did not stop insulin.

I just want to toss out my thoughts on what your vet said and others will as well. I only intend them to provide information from over ten years of experience here, 5.5 years with my own Gracie, and lots and lots of research.

1. Chronic pancreatitis that isn't being picked up through basic blood tests
Correct. It won’t be. You need to have a specfPL or snapfPL but even if those indicate pancreatitis, it still might not be conclusive. The most conclusive way is to have those tests plus ultrasound. As an example (and it’s not the only time I’ve seen it), Gracie’s specfPL always ran high but she never had one, single symptom of pancreatitis. Ultrasound did show inflammation in adjacent organs. Because they are adjacent, it can result in an increase in the pancreatitis-specific tests. If Mo has symptoms, I would suggest having the tests and an ultrasound done.

2. Somogyi effect
Has not been documented as existing in cats. This post has a lot of really great information and the link to published research.

3. Acromegaly. I will leave this for Wendy to address.

4. Stress-induced insulin resistance
I could not disagree more. Insulin resistance comes from either a condition like IAA or acro (an oversimplification in saying that) or from staying at high numbers too long because of a delay in diagnosis, treatment, or the dose just not getting to where it needs to be. The few minutes that it might take to test him would not be seen that fast in an elevation in the blood glucose. It takes time for stress to kick in and the liver to secrete hormones to raise the BG. @Mariette has a good suggestion. While Mo’s BGs are high, you can grab some tests while he’s sleeping and perhaps that will slowly get him more accustomed to it.

5. Lantus may not be working and we will need to try Levemir
My Gracie felt the sting of Lantus at 1.5u. I switched to Levemir and it definitely benefitted her and she was not an acro cat.

6. No hometesting and decreasing the dose. First, and I’m not trying to use scare tactics but just showing you reality. Over the years, we have seen these too many times in cats where the vet suggested no hometesting. The SS and condo speak for themselves.
Oliver’s SS
Oliver’s hypo

Decreasing the dose is called a “rebound check”. In a cat where the dose has been slowly and systematically increased as you have done, it’s one of the worse things you can do besides not test. It sets the kitty back and builds glucose toxicity. I know this firsthand based on my experience with the specialist when we were new. I had just enough doubt that while I was not willing to stop insulin, I did go against the recommendations here and did a rebound check. And I got the results the members told me I’d get. It just left Gracie at even higher BGs and I had to go to an even higher dose to reach a breakthrough.

I am definitely not trying to disparage your vet and I’m glad you felt it was a good visit. But, we’ve seen this same scenario over and over and over and over....and I could keep going with that. We all want the best for Mo.

 

[katy and mo (GA)]

I absolutely understand what everyone is saying about the testing, and the lowering the dose, etc etc. I get it and I knew there would be concern, which is why I didn't want to really post about it. But I understand everyone is worried about Mo and that sometimes the specialist doesn't know best....We are just ruling stuff out right now. The test for Acromegaly is still on the cards and will be done within the next month. At the next appointment, we will most likely be switching to Levemir. We already have a full vial of Lantus and with money short, we didn't want to waste it.

However, Tim and I did get into an argument this morning about me disagreeing on certain things that the specialist said. For starters, Tim suggested at the vet that we put down a bowl of dry food for him to graze on throughout the day. I didn't want this but both he and her agreed so we bloody came home with a packet of dry m/d didn't we? It's really hard to go against what the specialist says when Tim firmly will believe what she says. He said to me this morning that he trusts her more than the people on here. It's hard to go with the recommendations here when Tim flat out disagrees. He said this morning, "We are not allowed to test so we won't. We will feed him biscuits alongside his usual low carb wet food because the specialist said it's fine. I trust the specialist." I even discussed with him that when we took him off m/d, that was when we started to see yellows. It's there on the spreadsheet. We had only seen reds and purples before that. Then he said "well, the specialist said it's fine." (I know I'm making Tim sound like an absolute bastard here. He's usually very sweet and lovely. Just not when we don't agree on things...which isn't often thankfully.)

If I do a random test now, I feel like Tim would be mad at me. But to be honest, ok screw it, i'mma do it. +4.5 310. Well, i'm a bit surprised by this actually. I was expecting higher given he's grazing on biscuits AND on a much lower dose.......

On a more positive note, Mo is doing wonderfully today. He did 2 lovely poos this morning (did none yesterday AND the day before) and they weren't toxic smelling. He's happy he gets to eat as much as he likes. He's really enjoying the cooked chicken pieces I've been giving him as treats. Since we have seen poo, we will let him outside to play today

Thank you everyone for your concern. Honestly, you are all the best. I will continue to do spot checks of his BG. Thank you for your ongoing support.

 

[Marje and Gracie]

I absolutely understand what everyone is saying about the testing, and the lowering the dose, etc etc. I get it and I knew there would be concern, which is why I didn't want to really post about it. But I understand everyone is worried about Mo and that sometimes the specialist doesn't know best....We are just ruling stuff out right now. The test for Acromegaly is still on the cards and will be done within the next month. At the next appointment, we will most likely be switching to Levemir. We already have a full vial of Lantus and with money short, we didn't want to waste it.

However, Tim and I did get into an argument this morning about me disagreeing on certain things that the specialist said. For starters, Tim suggested at the vet that we put down a bowl of dry food for him to graze on throughout the day. I didn't want this but both he and her agreed so we bloody came home with a packet of dry m/d didn't we? It's really hard to go against what the specialist says when Tim firmly and blindly will believe anything she says. He said to me this morning that he trusts her more than the people on here. He really doesn't get it and I stormed out. It's hard to go with the recommendations here when Tim flat out won't let me. He said this morning, "We are not allowed to test so we won't. We will feed him biscuits alongside his usual low carb wet food because the specialist said it's fine. I trust the specialist." So yeah, I'm sitting between a rock and a hard place. I even discussed with him that when we took him off m/d, that was when we started to see yellows. It's there on the spreadsheet. We had only seen reds and purples before that. That kind of silenced him but then said "well, the specialist said it's fine." (I know I'm making Tim sound like an absolute bastard here. He's usually very sweet and lovely. Just not when we don't agree on things...which isn't often thankfully.)

If I do a random test now, I feel like Tim would be mad at me. But to be honest, ok screw it, i'mma do it. +4.5 310. Well, i'm a bit surprised by this actually. I was expecting higher given he's grazing on biscuits AND on a much lower dose.......

On a more positive note, Mo is doing wonderfully today. He did 2 lovely poos this morning (did none yesterday AND the day before) and they weren't toxic smelling. He's happy he gets to eat as much as he likes. He's really enjoying the cooked chicken pieces I've been giving him as treats. Since we have seen poo, we will let him outside to play today

Thank you everyone for your concern. Honestly, you are all the best. I will continue to do spot checks of his BG. Thank you for your ongoing support.

I’m sorry, Katy. My husband was an equal partner in Gracie’s diabetes treatment and we didn’t always agree either but we always managed to get to a consensus. I was lucky that my DH believed in this site more than the vets but he understood FD as well as I did. Still, there is always the conversation about increase or hold a few more cycles. I was more aggressive than he was. I certainly would never mean to add to the stress of being at odds with a spouse.

Perhaps you can get him to at least agree to test Mo before his shots. Ask him if you all had a child, would he shoot insulin blindly into the child.

 

[Wendy&Neko]

Hi Katy, give Mo some scritches from me,. Sorry about his traumatic visit to the vet. Neko hated her 10 minute vet trip too. I gave her some Rescue Remedy for Pets a couple hours before hand, and sprayed her carrier with Feliway spray. That seemed to calm her down.

Does Tim think diabetic people eat biscuits and cake all day? Sorry, he's just not right on those biscuits. You might want to accidentally put them out with the trash. Unfortunate waste of money that could have gone to better things. Just to let you know, we've seen all sort of partner/husbands be stubborn about "the vet knows best". Of course, we've also had a couple of vet members in the last few years who have learned things from us too. One even included a vet whose cat's number wouldn't move, in spite of being on a good diet per Dr. Lisa Pierson a vet nutritionist. Turns out her Floyd had acromegaly, something I spotted from his spreadsheet.

At some point when you do the acro testing, ask the "specialist" vet how many acrokitties patients she's had. In the about 9 years I've been focussing a lot on cats with those conditions that require higher doses, I'm pretty sure I've seen over 100 spreadsheets of cats with acromegaly. If she can't ship to the US, the UK is an option, you just won't get the IAA testing done there. I know there are a lot less flights in general going on now, so can understand how there might be issues.

It is great if you can find a vet that you think might work with you, hopefully one that will learn with you. I butted heads with Neko's internal medicine vet a bit of the first visit, then I proved to be right on a couple issues and we had a great relationship after that. I'm super stoked that you think Levemir will soon be a possibility. I think that will really help Mo. Lyane's Ti-Mousse was so bad on as little as 3 units of Lantus that she actually stopped shooting any insulin for several days until she got Levemir for him. So I think there is no guarantee that 3 units of Lantus will be any better from a sting point of view or changing his mood. But I think switching to Levemir will be a really good thing.

One thing no one has mentioned yet, and I think it's essential going forward on a smaller dose, you absolutely must test him daily for ketones. A cat with possible inflammation (chronic pancreatitis) and on much less insulin than he needs is at risk for ketones and worse. I have seen unfortunate things happen to cats when the caregiver resets the dose for one reason or another. FYI, Mo has been on over 3 units for over 2 months now. If over 3 units was too much insulin, he would have hypo'ed long ago. Sorry, don't want to beat that dead horse, but I was one of those helping that poor hypo'ing kitty over on Health forum a couple days ago. It's still fresh in me.

By the way, good for you sneaking in a test. Mo's 9.5 unit depot will influence the cycles for at least 6 cycles after a reduction, though the numbers should start rising somewhat in a cycle or two.

I will be stalking Mo's spreadsheet, whether or not you post, cause I care about you two.

 

[Christie & Maverick]

You are certainly in an unenviable position. Having been here for four and a half years, one thing I have come to discover is that nothing about feline diabetes is simple. You have received some very thoughtful and detailed information above, based on a lot of experience, I urge you to take some time to consider and weigh in comparison to the feedback you received from your vet. I'm particularly concerned about the likelihood that he may end up staying in even higher numbers as a result of the rebound check. Going from 9u to 3u is quite drastic, and may have serious consequences, IMHO.

I suppose from my perspective, I'd be curious what the specialist would consider a successful outcome by dropping the dose from 9u to 3u. Should you be happy if Mo stays within 300-400 consistently? Is that successful in proving that he has stress induced insulin resistance? Let's say for argument's sake he gets under 300 occasionally. Is that good enough? Most vets may be happy with that, but are you?

In all likelihood the numbers will actually be significantly higher. Which is not good over a prolonged period of time, since you may then encounter issues with neuropathy, increased risk of infections, cataracts, liver enlargement to name a few. And the stress on the kidneys with all the glucose being dumped can lead to a host of other problems.

I too am glad that the visit with the specialist went well, it seems like you are hopeful that somehow what this vet is proposing might actually be the magic ticket. I go back to my comment when I first started this post, one thing I have discovered about feline diabetes is nothing is simple. If it sounds too good to be true, it usually is. This process takes time, patience, a few tears, and support from people who get it and understand because they've been there.

I've seen people come and go from this forum, some people have it easy, cat gets diagnosed, dry food is removed, cat goes into remission. You, my friend, have it a little more on the complicated side, and for that I'm sorry.

I hope you continue to post and let us know how you and Mo are doing, we all truly want the best possible outcome.

 

[katy and mo (GA)]

I’m sorry, Katy. My husband was an equal partner in Gracie’s diabetes treatment and we didn’t always agree either but we always managed to get to a consensus. I was lucky that my DH believed in this site more than the vets but he understood FD as well as I did. Still, there is always the conversation about increase or hold a few more cycles. I was more aggressive than he was. I certainly would never mean to add to the stress of being at odds with a spouse.

Perhaps you can get him to at least agree to test Mo before his shots. Ask him if you all had a child, would he shoot insulin blindly into the child.

Thank you Marje. Hopefully I'll be able to actually get him on here to have a look around and read some of the posts. I really want him to understand that the advice here is from people who have experience with feline diabetes first hand and there are so many success stories!

I have a chat with him a bit later about testing before shots. Fingers crossed!

 

[katy and mo (GA)]

Hi Katy, give Mo some scritches from me,. Sorry about his traumatic visit to the vet. Neko hated her 10 minute vet trip too. I gave her some Rescue Remedy for Pets a couple hours before hand, and sprayed her carrier with Feliway spray. That seemed to calm her down.

Does Tim think diabetic people eat biscuits and cake all day? Sorry, he's just not right on those biscuits. You might want to accidentally put them out with the trash. Unfortunate waste of money that could have gone to better things. Just to let you know, we've seen all sort of partner/husbands be stubborn about "the vet knows best". Of course, we've also had a couple of vet members in the last few years who have learned things from us too. One even included a vet whose cat's number wouldn't move, in spite of being on a good diet per Dr. Lisa Pierson a vet nutritionist. Turns out her Floyd had acromegaly, something I spotted from his spreadsheet.

I 100% agree on the biscuits. What a waste of money. I will convince Tim to stop giving them to Mo.

At some point when you do the acro testing, ask the "specialist" vet how many acrokitties patients she's had. In the about 9 years I've been focussing a lot on cats with those conditions that require higher doses, I'm pretty sure I've seen over 100 spreadsheets of cats with acromegaly. If she can't ship to the US, the UK is an option, you just won't get the IAA testing done there. I know there are a lot less flights in general going on now, so can understand how there might be issues.

Ooooh yes I will ask her that, thank you. She did a look around of Mo and said from looking at him, she can't see physical signs of acromegaly but she's still keen to get him tested. That makes me feel good that she is still keen to check everything despite him not having the tell-tale signs.

It is great if you can find a vet that you think might work with you, hopefully one that will learn with you. I butted heads with Neko's internal medicine vet a bit of the first visit, then I proved to be right on a couple issues and we had a great relationship after that. I'm super stoked that you think Levemir will soon be a possibility. I think that will really help Mo. Lyane's Ti-Mousse was so bad on as little as 3 units of Lantus that she actually stopped shooting any insulin for several days until she got Levemir for him. So I think there is no guarantee that 3 units of Lantus will be any better from a sting point of view or changing his mood. But I think switching to Levemir will be a really good thing.

I read that thread about different kitties experiences with going from Lantus to Levemir and I'm excited to try it tbh. I just loved that the specialist brought up Levemir without me having to and that she talked about the pens and how they're a lot easier to use. She clearly knows her stuff about the different insulins in NZ, which my other vet didn't. This excited me a lot. When we go back for the next visit, I'll say that we will be switching Mo to Levemir from now on.

One thing no one has mentioned yet, and I think it's essential going forward on a smaller dose, you absolutely must test him daily for ketones. A cat with possible inflammation (chronic pancreatitis) and on much less insulin than he needs is at risk for ketones and worse. I have seen unfortunate things happen to cats when the caregiver resets the dose for one reason or another. FYI, Mo has been on over 3 units for over 2 months now. If over 3 units was too much insulin, he would have hypo'ed long ago. Sorry, don't want to beat that dead horse, but I was one of those helping that poor hypo'ing kitty over on Health forum a couple days ago. It's still fresh in me.

Yes I agree! I have fast posted some ketone dipsticks so hopefully they will arrive soon. I have been so slack on getting some but better late than never...right?
I totally fell for what the specialist said (her name is Prue, I'm going to call her Prue from now on ) when she talked about how Mo may be on too much insulin and explained why. She made it sound very convincing and I fell for it. Now coming back here, I kinda feel silly agreeing to do the dose reset. Ugh.

By the way, good for you sneaking in a test. Mo's 9.5 unit depot will influence the cycles for at least 6 cycles after a reduction, though the numbers should start rising somewhat in a cycle or two.

I will be stalking Mo's spreadsheet, whether or not you post, cause I care about you two.

That is so true! I will keep that in mind. I told Tim about my sneaky test and he just laughed so hopefully he continues to find my "random" testing amusing

Thank you, Wendy. Your support and advice means so much

 

[Bron and Sheba (GA)]

Hi Katy,
I agree with what the others have said, so I won’t add to it.
I just wanted to send you some big hugs from across the ditch, because you sure are between a rock and a hard place at the moment.
Being at odds over the treatment plan with Tim must be very stressful for you.
You obviously “get” what’s best for Mo better than the specialist and Tim. And I can understand Tim feeling that the specialist knows best. Mostly they do but when it comes to FD, sadly most don’t. But honestly the experienced people on this site know so much more about FD than most specialists.
When I took Sheba to an internal specialist, she was asking me my opinions about lots of FD stuff and it was obvious I knew a lot more than she did.....because I had lived it for years. She only saw an FD cat every so often.
Hang in there. You can always come here to talk and vent.
Trust your instincts and remember you are Mo’s advocate.
Bron

 

[katy and mo (GA)]

You are certainly in an unenviable position. Having been here for four and a half years, one thing I have come to discover is that nothing about feline diabetes is simple. You have received some very thoughtful and detailed information above, based on a lot of experience, I urge you to take some time to consider and weigh in comparison to the feedback you received from your vet. I'm particularly concerned about the likelihood that he may end up staying in even higher numbers as a result of the rebound check. Going from 9u to 3u is quite drastic, and may have serious consequences, IMHO.

I suppose from my perspective, I'd be curious what the specialist would consider a successful outcome by dropping the dose from 9u to 3u. Should you be happy if Mo stays within 300-400 consistently? Is that successful in proving that he has stress induced insulin resistance? Let's say for argument's sake he gets under 300 occasionally. Is that good enough? Most vets may be happy with that, but are you?

In all likelihood the numbers will actually be significantly higher. Which is not good over a prolonged period of time, since you may then encounter issues with neuropathy, increased risk of infections, cataracts, liver enlargement to name a few. And the stress on the kidneys with all the glucose being dumped can lead to a host of other problems.

I too am glad that the visit with the specialist went well, it seems like you are hopeful that somehow what this vet is proposing might actually be the magic ticket. I go back to my comment when I first started this post, one thing I have discovered about feline diabetes is nothing is simple. If it sounds too good to be true, it usually is. This process takes time, patience, a few tears, and support from people who get it and understand because they've been there.

I've seen people come and go from this forum, some people have it easy, cat gets diagnosed, dry food is removed, cat goes into remission. You, my friend, have it a little more on the complicated side, and for that I'm sorry.

I hope you continue to post and let us know how you and Mo are doing, we all truly want the best possible outcome.

Thank you Christie, I totally get what you're saying. No, I wouldn't be happy if Mo were to stay within 300-400 consistently with the odd number under 300, which is why we have gone to see a specialist. But yeah, you're right with the comment "If it sounds too good to be true, it usually is." I guess when Prue (the specialist) suggested that he may be too stressed with all the testing at home and that we we shall reduce back to where he was having good numbers to see what happens, I thought yesss that makes so much sense! But now having thought about it more, I think I was just super hopeful that it would be the easy ticket out of this mess. I would be surprised if that was the solution but by golly, wouldn't it be great if it was?

I truly appreciate your post and your support

 

[katy and mo (GA)]

Hi Katy,
I agree with what the others have said, so I won’t add to it.
I just wanted to send you some big hugs from across the ditch, because you sure are between a rock and a hard place at the moment.
Being at odds over the treatment plan with Tim must be very stressful for you.
You obviously “get” what’s best for Mo better than the specialist and Tim. And I can understand Tim feeling that the specialist knows best. Mostly they do but when it comes to FD, sadly most don’t. But honestly the experienced people on this site know so much more about FD than most specialists.
When I took Sheba to an internal specialist, she was asking me my opinions about lots of FD stuff and it was obvious I knew a lot more than she did.....because I had lived it for years. She only saw an FD cat every so often.
Hang in there. You can always come here to talk and vent.
Trust your instincts and remember you are Mo’s advocate.
Bron

Thank you so much, Bron! I will trust my instincts, thank you

 

[carfurby (GA)]

 

[katy and mo (GA)]

I asked Tim if he would come onto the forum and have a look around. He said he will!! YAY! I just want him to see all the great information on here and why I trust what you are all saying.

 

[Marje and Gracie]

I asked Tim if he would come onto the forum and have a look around. He said he will!! YAY! I just want him to see all the great information on here and why I trust what you are all saying.

Yay, Tim!!!!!! You can always PM my husband through my user ID if you have any questions from a husband’s perspective of the board