1/13 Crystal - vet visit update, needing advice please

Status
Not open for further replies.

suki & crystal (GA)

Member Since 2014
Good morning everyone
Bit of a long saga to report from yesterday's vet visit. Crystal and I went along yesterday afternoon to our vet, primarily for the IAA test. However, the vet phoned about 3 hours before we left saying that she wasn't able to do this test as there was nowhere, in the whole of France, that was able to do this test for me. First disappointment. She had phoned the vet college at Nantes (the equivalent of the RVC in the UK) and spoken to 2 vets there, one of which was her old Professor I think and he had told her that "this cat is drowning in insulin" that the dose was too high and too much insulin was counter productive, all this without even seeing the cat or her SS. Second disappointment. What we have here is a country that has first class human medical research and a medical service second to none but is way down the list as far as diabetes and acromegaly research in cats is concerned, as I've said before, they are not particularly a nation of animal lovers and cats particularly get a raw deal. Anyway, I still went ahead with the appointment even though we were not having the IAA test done as I thought a heart to heart conversation was needed.

We went over all of Crystal's tests and she reconfirmed that her liver and kidney function were okay, checked her heart for murmurs, which was okay and also had a good look at her eyes and could detect nothing wrong. The echographie and x-rays that were taken back in October didn't show any tumours, just a lot of gas in the intestine.

Crystal's weight has increased from 4.8 to 5.4. and the vet noticed an increase in her facial features, especially her lower jaw, her paws have also got bigger. We also discussed changing to Levemir when my current Lantus pens run out and she gave me a prescription and advised that the dose should start at 4u BID. We talked about the possibility of using "R" insulin at some time in the future but for the moment, that's on hold.

So, my dilemma now is that I have a vet who I trust and like but unfortunately doesn't have any experience of acromegaly and perhaps is being influenced by her old college. I actually asked her what she would do in my position and she couldn't answer me. Unfortuantely I don't think she has had time to read all the articles that I had given to her from the FDMB prior to our visit, but she had read the TR protocol and conceded that, for some cats, the high doses seem to work. She agreed that I was at least doing the increases safely by testing regularly. I further endeared myself by asking about the one other cat with diabetes in the practice who is also on Lantus (2u BID). When I asked what he was being fed the answer was, predictably, diabetic prescription kibble, to which I replied that if the owner stopped feeding that the cat would probably reduce its insulin anyway - silence.

Anyway, sorry for the long rant but I was obviously a bit stressed out by it all, so much so that I completely forgot to give Crystal her PM shot last night, despite doing a couple of tests. I didn't realise until this morning when I found the full syringe, s....! I've just gone ahead as normal with her 13u but perhaps I should delay an increase for a few more cycles?

Would like to hear your comments /advice on any of the above. I'm still going ahead with the TR protocol but it sounds as if Crystal and I will have to rely solely on you guys for support and guidance. One last question, how important do you think it is to have an IAA test as I could try contacting the RVC to see if they could help.

Suki & Crystal
 
How frustrating! One thought is to get some spreadsheets of other kitties with acro and share them with your vet. This will be proof that Crystal is not "drowning in insulin." Another option is to ask your vet to consult with Dr. Niessen at RVC which may be one way of getting your vet more current an supportive of your approach. Of course, you could always arrange for a consult and speak with Dr. Niessen yourself.

The bottom line is that you are at home with your kitty and you are the one who has her hand on the syringe. You see Crystal every day. You know when she's feeling good, or not. There are many people here who manage their cat's diabetes on their own and use their vet for other issues. Unfortunately, most vets are not experts on everything that could effect every animal in their practice. You're doing what's right for Crystal.
 
On the plus side you don't need to rely on anyone else but here for the diabetes you are in the best hands :) The only involvement my vet had with Vyktor's diabetes (after initial treatment for DKA) was writing the prescription :)

Oops on the missed shot but these things happen. My mum tested fed and forgot to shoot a couple of weeks ago. I don't have specific experience with high dose kitties but I would think that if Crystal was due an increase then missing a shot wouldn't be cause to delay it.
 
What is the nearest country that might be able to do the test? Germany? Switzerland? Maybe could get it done out of country.
Or, another thought - is it similar to the test in humans and might a human lab be able to test for it?
 
Last edited:
There is no where in Canada that does the IAA test (or IGF-1 for that matter). I had to have the sample sent to Michigan State in the US. A bit more complicated sending blood across the border, but doable. If RVC does the tests (where was Cyrstal's IGF-1 done), maybe it could be send there too?

As for dose of Levemir when you start it, the rule of thumb here is to start at 70% of whatever your current Lantus dose is. Some kitties have an immediate reaction to Lev, so we start at a lower rate. Some kitties need more or less Lev than Lantus, so you may need to fast track up. If Crystal was still at 13U, she's start at 9U of Levemir.

Sorry about last night's skip, especially since she had a great preshot! Oh well, you are not alone in doing that.:bighug: Since you skipped the dose, you'll have to wait longer at 13U to get the depot back up again before increasing.

And I just have to comment on "drowning in insulin" and "too much insulin is counterproductive" - is it better to have the cat way above renal threshold all the time? And it's time those professors read some of the latest papers on acromegaly - it's a growing area of research. Think of all the future vets they are misinforming! I guess I was lucky with my vet in that she had a cat on 10U of Caninsulin (ugh!) at the time, so didn't freak out at Neko's dose.

Good to hear that Crystal's organ functions looked good at the check up. That's the one that worries me the most.
 
Thanks Sienne, Serryn and BJ for your support and advice, I really appreciate it. I did actually give my vet a copy of Suzanne's & Cobb's SS and case history to read and also pointed her in the direction of some of the other acrokitties so she could check their histories and SS but whether she did or not I don't know. I seem to be coming up against a stone wall here but if, and when, I get some good results with Crystal, I will certainly make sure the results get back to Nantes.

I hadn't realised Dr Niessen was at the RVC, that may well be a good idea to follow up and I'll look into it. I know the RVC recently did some research on agromegaly, does anyone know if the result was published, I think Wendy might be the one to ask.
 
@Wendy&Neko
Looks like our posts crossed, I knew I could rely on you to check in on us, thanks so much. When I come to changing to Lev I'll check here as to what the dose should be. I thought you might be interested in the comments made by the Prof. - I wholeheartedly agree with you but I doubt if I can manage a one woman crusade against the whole French vetinerary establishment but I'm sure going to make a nuisance of myself to get more understanding!
If you know about the RVC study on acro, can you point me in the right direction? Do you think it important that I have the IAA test done or just carry on without a diagnosis? Thanks for all your help.
 
How frustrating for you!

The pro to having an IAA test is that IAA is self limiting...meaning it can go away without warning. I also, personally, think it can be insulin specific. So if you switch insulins, the antibodies might not attack the Lev like they do the Lantus.

It has been helpful knowing Cobb is IAA because I was more comfortable being more aggressive in my dosing. And when the IAA broke, I knew why we were flying down the dosing scale.

But you work with what you've got. If you can't get the test, you can't get it. Hopefully you can find somewhere that can help!
 
Part of that document is on Cushing's (hyperandrenocortocism), you don't have to read the entire thing! :)

Here's a link that describes some of Dr. Niessen's research and his contact info:

If you can't get the IAA test, then that's OK. Like Suzanne mentioned, it is useful to know because at some point it can break. And when it does, the dose can change quickly downward. You test enough to be on top of it - but it can lead to exciting times. Suzanne switched Cobb to Levemir August last year - see what happens to the dose not too long after then when his IAA breaks. Using R can be useful for IAA. It's a short acting insulin and you don't need to worry about the longer term effects of a depot when a dose is changing quickly.
 
Argh, suki, I'm frustrated on your behalf. It is extremely common to have vets not really up on dosing diabetic cats, unfortunately. It's even worse with kitties that have high dose conditions.

I wouldn't drop the dose to 4u when you switch to Lev, I'd go with the 70% formula and be prepared to increase rapidly if needed. Her blood glucose tests will guide that decision. Starting too low will just put her in high numbers more than she needs to be.

Hang in there! We're with you all the way.

By the way, are you on Facebook? There is a page that Dr. Niessen is assopiate with and it's worth looking at if you are interested. Let me know and I'll get the link for you.
 
@Suzanne & Cobb @Wendy&Neko @julie & punkin (ga)
Thanks ladies for getting back to me. I'm going to make enquiries with the RVC for an IAA test to see if its possible but if not, I'll just have to carry on without it as best we can. Thanks Wendy for Dr Niessen's contact info, I wish we had someone of that calibre here in France. Julie, I'm not on Facebook, or any type of social media for that matter, and have been resisting it, this is my very first foray into joining a forum of any type and I can just about manage this! Also I'm worried about too many conflicting opinions. Having said that I'm very interested in what Dr Niessen has to say so perhaps you can send me the link, just so I can have a look.
 
:bighug::bighug: How frustrating. I hope you can get the test done, for your own peace of mind. It's one more tool for you to work with. If you can't get the blood test sent, any chance you can take a "vacation" w/ Crystal?

BTW, I don't think you need to join Facebook to look at someone's page. But even if you do, you don't need to get any more involved than you want to.
 
Hi Ann, I don't think it's an option taking Crystal to the UK, she is a notoriously bad traveller and the stress would probably kill her. I just have to hope I can get a test through the post. Thanks for letting me know about Facebook, I don't want a lot of people coming out of the woodwork wanting to be 'friends' , apart from Dr Niessen of course!
 
If you join you can just ignore friend requests, if you do no one will be able to post to your wall. Just deny or ignore. You don't need to join any groups either. Maybe just friend Dr. Niessen to get updates on his posts.
 
I have a love/hate relationship with facebook, so i know what you mean. I see Wendy gave you the link to that page - i thought it was interesting too, and it doesn't look like you have to be a member of facebook to see it.
 
@julie & punkin (ga) I followed your discussion about the bad advice given on Facebook regarding feeding with interest, I too am trying to educate all my kitty loving friends about the benefit of wet food against the horrors of dry kibble but I still think it falls on deaf ears. I really have to resist talking to complete strangers in the supermarket when all I see in their baskets is the cheapest, crappiest kibble for their kitties, let's hope the kitties are able to supplement it with a few fat mice!
Sorry Julie, it was Susanne's post about feeding (similar photos Cobb and Punkin)
 
Last edited:
heehee, yes they do have simliar pictures. I feel the same way about the food, though. Even my naturopathic doctor, who is really into the perfect human food, feeds her cats dry food. I told her a little about it and her response was that she buys good quality dry food. I'm going to send her a link to catinfo.org and hopefully she'll educate herself about the importance of her cats' food.
 
Status
Not open for further replies.
Back
Top