10/05 Cooper AMPS 163 +2 151 +4 111 +6 92 +8 91 Missed PM shot +2 73

I have managed to get back online again...its been very patchy.
Looks like another good cycle coming up today and not too big of a bounce...antijinx.
Very pleased he's eating and keeping it down

I wonder what's up with it, it's still been intermittently glitchy for me as well!

Thanks for the anti-jinx! ;)
 
I have managed to get back online again...its been very patchy.
Looks like another good cycle coming up today and not too big of a bounce...antijinx.
Very pleased he's eating and keeping it down
I’ve had some problems posting replies several times on here. Wonder what’s up with that.
 
I’m sorry in advance that this update will lack brevity, but I am going to try my best. I applaud anyone that cares to read to the end lol.

I took Cooper to the vet today to see about his nausea, vomiting, as well as discuss the possibility of acromegaly and IAA.

This vet is still fairly new to me since I switched vets after having a bad experience with the vet that diagnosed Cooper. The first time Cooper went this new vet, my mother took him for me since I had to work. The most recent time I went was in August. I didn’t realize that the vet that I saw at that appointment was a “relief vet” and not the actual vet of the practice.

Today, I saw the “actual” vet (for lack of a better term). I explained everything I’ve been doing with Cooper, what has been going on, his dose, etc. The vet was very impressed with my testing and the spreadsheet, and encouraged me to keep at it. He was concerned because he tested Cooper while we were there and Cooper’s BG was at 77…mind you, we had already missed PM shot time by about an hour at the time they tested him because they were behind on appointments. (We waited there for 2 hours before we were seen—apparently there had been a ton of emergencies. I hate that we missed shot time after he’s been doing so well!)

When I was showing him my spreadsheet, he was saying all the green numbers were too low and he didn’t like to see cats go below 100. I do understand where he is coming from since I’m sure most people are probably not home testing and/or not very diligent with monitoring how low the cat is getting. So while I do understand what he is saying, I’m wasn’t too worried about Cooper being green. Though I was surprised he was that low at that point in time, that was definitely odd.

He went on to say that Cooper is very flat throughout the day and to him that indicated that the insulin wasn’t affecting him as it should. He said it should be a bell curve. He was worried that by giving Cooper such a high dose of insulin, I could be essentially making him insulin resistant. He explained it the same way we explain “bouncing”, but said that that was a sign that it was actually too much insulin. He did not think Cooper had acro because he said in his experience those cats have trouble even coming down from the 500 BG level.

All of this to say that he wants me to basically start this entire process over…he wants me to go to 1 unit, keep him at 1 U for 2 weeks (provided that Cooper doesn’t shoot up into the 500s or higher), do a curve each week at home, and then come back to see him with results. I am so upset that I’ve done all of this work for nothing, and also mostly terrified that Cooper will react very badly to this.

I will say he did seem very knowledgeable, open to my opinions, and I do want to keep him as my vet. I’d still love to hear opinions from you all because I still agree with everything I’ve done so far. He said that if Cooper is not reacting well by the time we get to about 3 U, he is thinking there might be something else at play. We will likely do full bloodwork when I go back in 2 weeks as well, just to see.

He did feel a mass in Cooper’s belly, but said it could very well have been stool. He is going to feel again when I go back in 2 weeks, and if he still feels it, we are going to get an ultrasound done. I’m trying to brush this part off because I have been worried about this very thing. Trying not to worry until I have to. He gave me an appetite stimulant and nausea medication.

Sorry for the novel.
 
What a bummer of a vet visit.:bighug::bighug:
he didn’t like to see cats go below 100
Remember, he also probably thinking pet meter numbers.
He went on to say that Cooper is very flat throughout the day and to him that indicated that the insulin wasn’t affecting him as it should. He said it should be a bell curve.
Lantus(and Levemir too), if working well, gives great flat curves, especially in lower numbers. That bell curve he likes means a cat is in higher numbers and losing duration, because they are always above 100. Take a look at spreadsheets of other cats here.
by giving Cooper such a high dose of insulin, I could be essentially making him insulin resistant.
OK, he clearly doesn't get FD. :banghead: All he needs to do is read a few articles on causes of insulin resistance. Having a high dose is not on that list, but a few conditions that can require a cat to need more insulin are on the list. And by the way, bouncing is NOT a sign that he's on too much insulin.

Unfortunately, we see way too many vets who haven't been keeping up with feline diabetes. Not surprising, they deal with a lot of animals and lots of conditions for each of those types of animals. Starting back at the beginning, what we call a "reset" is absolutely the wrong thing to do. We've seen cats go DKA because of that bad advice. Have you read this new post that Marje put up?
NEW!!! Chronic Somogyi Rebound: Myths and Facts

He gave me an appetite stimulant and nausea medication.
Which meds specifically, and what doses?

Could you put "skip" in today's PMPS dose, so we know you didn't just miss the entry.[/QUOTE]
 
Remember, he also probably thinking pet meter numbers.

I did let him know that I use a human meter, and of course he recommended a pet meter for more accurate results. I plan to stick with my Relion as my test was similar to what they got anyway.

We've seen cats go DKA because of that bad advice.

This is exactly what I was afraid of when he told me. I asked him, and he said, "Well, you can expect him to go into the 400s, I'm sure. Any higher, call me and we will adjust the dose immediately." But I am so scared it might be too late if we do it this way? Thank you for posting that thread, that is the word he used: Somogyi. *sigh* So what should I do? I'm running out of vets in my area lol.

Which meds specifically, and what doses?

He gave me Mirataz ointment to be given in alternating ears every 24 hours. And Cerenia tablets, half a tablet every other day. I just gave Cooper one because he was acting like he felt sick and won't eat. He started salivating like mad, I'm guessing it tasted awful. Still won't eat. :(
 
Give the Cerenia first. What size are the tablets? It can be given every day, though ondansetron is a better drug for nausea, Cerenia does works just not as well, and is better if there is vomiting. Yes, Cerenia tastes awful. Best given in a blank gel cap if you can.
So what should I do? I'm running out of vets in my area lol.
Any chance you think the vet would be open to reading research papers? The Roomp and Rand papers are a good start. A large number of vets, of a certain age, were taught that Somogyi was a thing. I guess the question is do you think this vet is willing to learn. My vet started us on Caninsulin, had never used Lantus, etc. Didn't think I should test for acro/IAA cause the IM vet she talked to said you needed to be at 10 units to test for that. I asked her to humour me. Several times, before she ran the tests. I earned a lot of cred with being right. On the other hand, the vet was great with Neko's other conditions and willing to let me run with the diabetes treatment. We learned together about acromegaly. As for dosing, I'd do what you have been doing.
 
What size are the tablets?

The bag says 16mg. They are very tiny. I don't think I have hope of him eating tonight, he won't even take baby food. His BG is up at 152 now, so I hope he'll be okay. Probably stressed from the vet. :(

Any chance you think the vet would be open to reading research papers?

Honestly, I could see him being open to it. He is younger, probably 30's or so. I have nothing against older vets, I'm just saying they seem a bit more set in their ways in my experience. I think the biggest issue will be me because I am an extremely shy person. I will feel very odd trying to tell him, basically, how to do his job that he studied for LOL. Especially since I'm also young. But I really do have concerns that this will end badly for Cooper if I do what he is suggesting. Perhaps I will just stick with my dose of 6.5U and when we go back in 2 weeks I'll bring some of the research papers and just ask him to—as you said—humor me.
 
Hi Gabrielle, I agree with everything that Wendy has said. Although she has probably said it on a much nicer fashion than I would have!:p

Please, please no not go back to 1 unit. Resetting never works and can certainly end badly with such things as insulin resistance and DKA, and weeks wasted with Cooper in high numbers again. If the vet looks back at the beginning of Coopers SS he can see what 1 unit did. Why would he want to go back there? Unfortunately he knows very little about FD.
Before I joined FDMB I was all at sea with Sheba's insulin. My vet didn't know what else I could do either and he was man enough to admit it and was willing to learn with me.
I ended up ringing a vet in Queensland named Rhett Marshall, who I found online and (unbeknownst to me at the time) was very involved with FD at Queensland Uni with Roomp and Rand. He has a PhD in Feline Diabetes and has written many papers on FD. He spoke to me for more than 20 minutes on the phone, told me I was testing enough to know that I was not giving too much insulin and said to just keep going up slowly until Sheba responded. He gave me so much confidence and empowered me to keep going. He said he would be happy to talk to my vet if he needed help. If only there were more like him around.

You have done such a really great job with getting Cooper up to this point, don't go backwards. Remember you are Coopers advocate, you are paying the vet for advice...and you don't have to take it. :bighug:
 
Gabrielle, I'm so sorry to hear about the stress with the vet. It's very disappointing and brings up a lot of anxiety when we have to confront "authority" that are supposed to be on our side.

I want to share with you my experience both with vets and in here. As both @Bron and Sheba (GA) and @Wendy&Neko and @Bandit's Mom were very active in my case and said similar things. I don't share any advice but solely my experience which hopefully will be helpful.

My vets had zero appreciation or even an interest in what I was doing. none! if anything, I got either very typical neutral looking faces or judgments that were difficult to disguise. I too was told that raising the dose too quickly will lead to smoggy, that Fistuk will get insulin resistance, that I should be using pet meters bc the meter I'm using is not reliable and there are no research blah blah blah and that after they put a libra sensor on Fistuk which is also human meter. When I brought that out I got silence as a response.

Mind you, even when he started being in green I was told "...when he gets to good numbers..." and when I posted out he's in normal range, that even showed I blood tests they conducted, I got the silence again.

They basically used scared tactics to show me how wrong I am and obv being novice to FD I was afraid I'll do the wrong thing.

Fistuk BG was constantly high. Here's what I can tell in reflection when looking at Fistuk's SS now: If I had waited a week each time to raise a dose Fistuk would have been 4 weeks!! behind. His body probably would have gotten too used to staying in glucose toxic and who knows if I'd had ever the chance to go down in dosing like we do now after he broke glucose toxicity tanks to TR and the guidance I've received here.

I was quite hesitant to using anti nausea medications but I did follow Wendy's and Bron's suggestions as well as for dose with Ondansetron and Mirtazapin and eventual Fistuk broke through his nausea and he's eating really well now.

The vet raised a very high eye brow to my Onda dose and almost didn't give me more when I asked for. Same for insulin!! I started looking for alternative ways to get insulin bc they made sounds of not giving it to me bc I'm going my way (TR)

Also, thanks to the advice and guidance here I knew what tests to ask for, what questions to ask and what to demand for. Being completely at their mercy they have missed on a lot, misguided me, even when they did diagnose chronic pancreatitis I was told his pancreas was fine!

I become an angry lioness when vets are abusing their power and trying to scare me or offer ridiculous advice for how to treat Fistuk. Might not be everyone's style but I do agree that we are our kitties mouth and at the end of the day the vet is being paid to give a service which I assure you they would love to be kept on your bills. I know the feeling of running out of vets. I learned to use them for what they can offer and not what they can't - which is tests. The interpretation and guidance I do here.

Where Fistuk is now is the greatest testament for the advice we're getting here. There were many times I was afraid to simply follow and how happy I am that I did.

You're doing a great job with Cooper. Keep it up Gabrielle. You're a great mum. Take time to destress from that episode and keep on with what you're doing here. Cooper will turn a corner :bighug::bighug::bighug:
 
You're doing a great job with Cooper. Keep it up Gabrielle. You're a great mum. Take time to destress from that episode and keep on with what you're doing here. Cooper will turn a corner :bighug::bighug::bighug:

I appreciate you sharing this with me so much. It helps to know others have gone through or are going through the same, and that you were able to do right by your kitty in the end!

It is so silly when you try to give them logic and reason (such as the Libre also being a human meter...yet that one is somehow just fine), and they don't want to relent. I'm hoping my vet will be receptive and not try to withhold insulin as that is a major fear I have in trying to reason with him. He doesn't seem the type, but I've only met him the one time.

Thanks again for sharing, it helped a lot. :) I'm so, so glad Fistuk is doing so well and that you stuck to it! I'm definitely going to do the same because I can see the improvement in Cooper's health.
 
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