10/20 Asia AMPS 216, +4 166, +5 202 dose increase and new vet

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Stacy & Asia

Stacy & Asia

Member Since 2017
http://www.felinediabetes.com/FDMB/...-348-raw-food-question-ss-help-please.185626/

Asia AMPS 216 on the Glucocard human meter. I got the human meter strips in the mail yesterday afternoon, but decided to wait for a new line item this morning to make the spreadsheet less confusing. Any assistance merging the two spreadsheets appreciated. I tried to merge some cells and note the new meter. Have an iPad and no mouse, so some things are tricky to do this way.

Bit of a busy day today, like yesterday. Going to try to test when/where I can if I can pop home in between appointments. I doubt she hit any blues yesterday while I was out, the numbers seem pretty even, maybe a drop of yellow in there, but we will never know. Asia has acupuncture today, so she's looking forward to that.

Gathered all of my lab work and vet records to share with the new vet I'm interviewing today. Was comparing blood glucose and UA glucose of her past year and half labs from 5.14.16/95, 12.24.16/165, 1.13.17/215, 9.20.17/467. I'm confident she didn't have diabetes any earlier than the new year and leaning towards the onset was around August/September. The most recent labs in September are the only ones that showed glucose in her urine as well and all the other labs except 5.14.16 had a UA as well. I'm pretty sure we diagnosed this relatively early, she was only showing symptoms (interested in all food, even human food for the first time ever) about 2 weeks prior to her September vet visit. That makes me feel better. What made me cry was reviewing the one time ER visit on Christmas (she had a UTI) where they punctured her bladder to get a sample, the tech notes said "several sticks, traumatic" :arghh:. Poor girl.
 
Good luck with the vet interview today. I'll tag @Marje and Gracie to help with merging the spreadsheet but think she's out of town for a bit. It's clear on your SS for now and also make a note in your signature about switching to the human meter. For you, the new reduction number is 50:)
 
HI Stacy, I have an iPad also, just practiced merging cells. To make a line all one cell:
1. Select the entire line by touching the number to the left of the line i.e. 100.
2. The entire line should hi light in blue, then along the upper command bar you will see a box that has two arrows pointing inwards towards the center. Tap on that and the verticle cell lines should disappear. Now you can start typing and also select a color to change the cell to high light it. Hope that helps.
 
MyTitan said:
HI Stacy, I have an iPad also, just practiced merging cells. To make a line all one cell:
1. Select the entire line by touching the number to the left of the line i.e. 100.
2. The entire line should hi light in blue, then along the upper command bar you will see a box that has two arrows pointing inwards towards the center. Tap on that and the verticle cell lines should disappear. Now you can start typing and also select a color to change the cell to high light it. Hope that helps.
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Ah thanks! That worked, you're the best! :)
 
Taught my older daughter how to test Asia, so she can catch some numbers if she's home and I'm not. That's useful.

So I met the vet today. Some good things, some not awesome things, but overall I got good vibes and think I will be taking my cats to this practice from now on.

The good:

  • One doctor practice, don't have to have a revolving door of different doctors, just one that will hopefully know my cats
  • Cat only practice
  • Proponent of home monitoring
  • Gentle approach (doesn't want to man handle my cat like she's a tiger trying to eat him, like that last place I went did)
  • Perfectly supportive of not giving Asia any more vaccinations (I only got rabies when she needed to be in hospital as a CYA, she's indoor only, rabies risk pretty much nil and it's not great for her immune system to be needlessly bombarded for no good reason)
  • Has treated many cats with diabetes, is aware of the TR protocol
  • Has special needs vet practice cats, like one with hind end nerve damage from a car accident that has to wear a diaper (I.e. Those are good peeps!)

I went over some labs with him since her dx of CRF. He wasn't positive on the diagnosis because the numbers have improved and said there could be other things going on to make those numbers high and we could rule out/in with a sonogram (which he calls in a specialist to perform, I appreciate that). So that's some good news, maybe no CRF? But maybe a tumor or something else not so awesome. He agreed that previous labs didn't indicate a good case for diabetes, so most likely onset is sometime between February-September, and I suspect closer to September. Her most recent lab mentioned something about potential pancreatitis (that other vet never mentioned it to me, it was spelled out in the lab results), he said that could be investigated with a sonogram as well. My gut says Asia has something else going on that precipitated the diabetes, it would make sense.

The concerning thing was he mentioned some cat's he treats are on once daily Lantus (every 24 hours), I haven't seen evidence that it works that way in cats, but maybe in rare exception it does last that long? He said he had one dosed every 36 hours, so at least that means he's thinking and trying to dose each cat based on what that cat is showing, and that's a good thing over a one size fits all. And he also suggested an ad hoc dosing strategy, like increase or decrease the dose each AMPS or PMPS based on what's there right now. It's not my understand that Lantus works like that, that sounds like a shorter acting insulin strategy, but I've obtained all my knowledge in the past few weeks, so I really can't say for sure. He also suspects she maybe be a "brittle" diabetic, which I took to mean difficult to regulate. I countered that it may be too soon to tell (especially if her therapeutic dose for now is higher than 1.5 and we just haven't reached it yet). He agreed it may be too soon to tell. He didn't seem keen on Levemir, he likes Lantus, but you never know, maybe that will change. I have in the back of my mind to switch if Asia doesn't respond well to Lantus, the fast acting insulins scare me a bit. He also was mentioning keeping her in a non euglycemic range, but trying to keep it under 300? I think was his number. I said if it's above the renal threshold I'm not crazy about that approach, since I have the resources to do TR and he seemed at least open to it. Overall I found him to be caring and knowledagble. I have to forgive the not being TR saavy as I think the bar is too high and that might disqualify 99% of vets from what I'm reading. Being open to the discussion is much more important.

I think the FDMB link maybe came from Frankie's Feline Fund, vet had cards for them at the front desk. It's a diabetic cat/senior/special needs rescue.
 
Sounds like a vet improvement. One that will listen and work with you is a keeper.

I have seen just a couple of cases of kitties, on really small doses, that are dosed as needed or every 24 hours. Interesting as a theory, but not relevant to Asia now. I would stick with the consistent dosing for now. We have seen it work for so many kitties here.

I wouldn't call Asia a brittle diabetic, but rather just a new one. It's very common for cats to take time to learn to work insulin. I agree that it can take a while yet before you decide that Lantus isn't working for her. Personally, I preferred Levemir, but very few vet's have experience with it.
 
Toebeans said:
Being open
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That's hugely important.

It's not he experience on the board hat lantus has that long of a duration, to make testing every 24hrs recommendable for most cats. I haven't seen any on the board, maybe some of the older members have.

With the depot in play with lantus the approach taken on this board is one of dosing consistently, letting the depot settle and making dosing decisions based on how low the dose actually takes a cat, and it has worked well for George and many others. Dosing based on amps pmps is more typical for the fast action g insulins.

Is he familiar with the TR approach we use here? (Romp/Rand) there's a link somewhere on the site to the published paper, perhaps if he is willing you can let him have a copy??
 
Wendy&Neko said:
Sounds like a vet improvement. One that will listen and work with you is a keeper.

I have seen just a couple of cases of kitties, on really small doses, that are dosed as needed or every 24 hours. Interesting as a theory, but not relevant to Asia now. I would stick with the consistent dosing for now. We have seen it work for so many kitties here.

I wouldn't call Asia a brittle diabetic, but rather just a new one. It's very common for cats to take time to learn to work insulin. I agree that it can take a while yet before you decide that Lantus isn't working for her. Personally, I preferred Levemir, but very few vet's have experience with it.
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I don't think he was suggesting it for Asia at all, and I agree, not relevant to her, we were just having a discussion on his approaches and experiences with diabetic cats. Ultimately, I'm going with the science. TR study was a study, it had results, and it continues here and other boards like this one. So many moving pieces and things can happen how they are going to happen, but at least there is data to back up these methodologies as appropriate and useful. That speaks to me. No doubt, some vets get results with blind dosing too, but the science proves this can be deadly and dangerous, so I'm going to bet on the better odds, TR.
 
Gill & George said:
That's hugely important.

It's not he experience on the board hat lantus has that long of a duration, to make testing every 24hrs recommendable for most cats. I haven't seen any on the board, maybe some of the older members have.

With the depot in play with lantus the approach taken on this board is one of dosing consistently, letting the depot settle and making dosing decisions based on how low the dose actually takes a cat, and it has worked well for George and many others. Dosing based on amps pmps is more typical for the fast action g insulins.

Is he familiar with the TR approach we use here? (Romp/Rand) there's a link somewhere on the site to the published paper, perhaps if he is willing you can let him have a copy??
Click to expand...
I will send him the info for sure. And I agree, I suspected it was a fast acting insulin approach. I asked him if he had anything I could read up on regarding his ad hoc dosing approach with Lantus (not because I'm interested to switch to that, but because I am curious more than anything), so we will see what he says.
 
Oh! I also forgot to add, he said the top endocrinologist in the country (for animals, I assume) is just down the street and an expert at all this stuff. He's happy to refer me if he can't figure this out. That's reassuring, and I deeply respect people, especially doctors, that know and can admit to their limitations for the betterment of those in their care.
 
No dose increase just yet, right? Hold for 3-5 days if nadir less than 200 (some cycles less than 200, others more). After 3 days if nadirs are greater than 200, but less than 300, increase by .25

How do I split the difference if nadirs are half and half? 3 cycles under 200, 3 cycles over 330 (and just barely, I probably missed the lowest point on a couple of those days).
 
I think that, overall, it sounds like he has more knowledge about FD than most vets and (which is probably even more important) is willing to listen to you. That's a pretty good start in my book.... and much better than the responses that many of us got (which oftentimes consisted of a lack of knowledge, but an unwillingness to learn or listen to the caregivers).
 
As she is new to blue I think holding a little longer to see what she does with the dose would be sensible. I see that she's gone to blue again tonight, I wonder how far she will drop?

From the TR sticky.


INCREASING THE DOSE:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • After 3 days (6 consecutive cycles)... if nadirs ar upe greater than 200, but less than 300 increase the dose by 0.25 unit.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
 
Gill & George said:
As she is new to blue I think holding a little longer to see what she does with the dose would be sensible. I see that she's gone to blue again tonight, I wonder how far she will drop?
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I read and re-read my print outs yesterday when I was trying to figure this out. She's not "new" to blue, unless I'm misunderstand what is meant there. Is it new to blue ever? New to blue on current dose amount?
 
Yes she's not 'new' to blue, when I posted there was just that 160 in the pm cycle, I wondered if she was going to drop much lower. From the later readings, it doesn't seem like she did, so you could take her up tonight, unless she sees green, I think there's room for her to take a dosecrease.

Some cats can have an initial strong reaction to an increase, so you could wait till morning to take her up. George wasn't one of those, he usually took 3 cycles before I saw the new dose working.
 
Toebeans said:
Oh! I also forgot to add, he said the top endocrinologist in the country (for animals, I assume) is just down the street and an expert at all this stuff. He's happy to refer me if he can't figure this out. That's reassuring, and I deeply respect people, especially doctors, that know and can admit to their limitations for the betterment of those in their care.
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Oh Stacy I wonder if he's referring to Dr Mark Peterson. He has a practice in the city and in Bedford Hills. I saw his clinic in Bedford by accident and nearly crashed my car I got so excited. Unfortunately he limits his practice now to thyroid disease only. If for any reason he sees patients in his Manhattan office for managing FD please let me know:). I called the Bedford office twice almost pleading if he would see Beenie. They referred me to the Animal Specialty Hospital in Yonkers. I'm considering taking Beenie to a specialist now more to help manage her Acro. Anyhoo if it Dr Peterson here's his website
The Yonkers animal hospital's website in case you are in need or interested.
 
He said his name, but I forgot it, that may be him? I can ask next time I speak to the vet and I will let you know.
 
Toebeans said:
Oh! I also forgot to add, he said the top endocrinologist in the country (for animals, I assume) is just down the street and an expert at all this stuff. He's happy to refer me if he can't figure this out. That's reassuring, and I deeply respect people, especially doctors, that know and can admit to their limitations for the betterment of those in their care.
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Hi Stacy, your new vet sounds as if he will be willing to work with you ( so many of us here have had to nod when the vet recommends something and then just follow the protocols here on the Board).
The "top endocrinologist" is probably Dr. Mark Peterson. (HypurrCat; he developed the I-131 radiation treatment for Hyper thyroidism in cats). Oh, I just read Michelle's post. Sorry for the duplicate info. In 2010 our diabetic kitty Stu was going to have the I-131 at Hypurrcat, but he was too sick and too weak. Dr. Peterson is a wonderful, caring man. He sent us to the Katonah- Bedford Vet Hospital In Bedford Hills ( close to his Westchester office), where the IM specialist we saw there was excellent.https://vcahospitals.com/katonah-bedford

Good luck with the new vet. Thanks for your thoughtful card.

:bighug::bighug:
 
Ella & Rusty & Stu(GA) said:
Hi Stacy, your new vet sounds as if he will be willing to work with you ( so many of us here have had to nod when the vet recommends something and then just follow the protocols here on the Board).
The "top endocrinologist" is probably Dr. Mark Peterson. (HypurrCat; he developed the I-131 radiation treatment for Hyper thyroidism in cats). Oh, I just read Michelle's post. Sorry for the duplicate info. In 2010 our diabetic kitty Stu was going to have the I-131 at Hypurrcat, but he was too sick and too weak. Dr. Peterson is a wonderful, caring man. He sent us to the Katonah- Bedford Vet Hospital In Bedford Hills ( close to his Westchester office), where the IM specialist we saw there was excellent.https://vcahospitals.com/katonah-bedford

Good luck with the new vet. Thanks for your thoughtful card.

:bighug::bighug:
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I hope he's willing to work with me, I saw some good signs, but we will see. At least I'm confident he's not going to manhandle my cat, and that's pretty huge at this point. :(

Sounds like that is probably the guy then, unless there are 2 top endocrinologists on the UWS! Hopefully I will never need his services, but it's good to know he's here.

You're welcome, thanks for the monitor, I like it!
 
Ella & Rusty & Stu(GA) said:
Hi Stacy, your new vet sounds as if he will be willing to work with you ( so many of us here have had to nod when the vet recommends something and then just follow the protocols here on the Board).
The "top endocrinologist" is probably Dr. Mark Peterson. (HypurrCat; he developed the I-131 radiation treatment for Hyper thyroidism in cats). Oh, I just read Michelle's post. Sorry for the duplicate info. In 2010 our diabetic kitty Stu was going to have the I-131 at Hypurrcat, but he was too sick and too weak. Dr. Peterson is a wonderful, caring man. He sent us to the Katonah- Bedford Vet Hospital In Bedford Hills ( close to his Westchester office), where the IM specialist we saw there was excellent.https://vcahospitals.com/katonah-bedford

Good luck with the new vet. Thanks for your thoughtful card.

:bighug::bighug:
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This is great to know!!! I didn't realize there was a clinic in Katonah. That is much closer to me than Yonkers. With having a cat that doesn't travel well the less time in the car the better. I'm so happy you posted this. Plan on getting Beenie to a specialist and this looks like the place. If Dr Peterson recommends it I'm in:)
 
Wow! I think it's great that you found a vet that is, at least, open to different ideas and options, and willing to work with you!

I love the vets I work for, but I still find certain areas of their knowledge to be minimal, and it's so frustrating for me because I have always gone above and beyond to make sure I am doing the absolutely best for my furkids. They're not at all familiar with home monitoring, so I just went ahead and sorted Darwin out on my own (and, of course, with FDMB!!). I'm hoping that when his labs there come back great; they'll be more interested in learning more!!
 
Tasha & Darwin said:
Wow! I think it's great that you found a vet that is, at least, open to different ideas and options, and willing to work with you!

I love the vets I work for, but I still find certain areas of their knowledge to be minimal, and it's so frustrating for me because I have always gone above and beyond to make sure I am doing the absolutely best for my furkids. They're not at all familiar with home monitoring, so I just went ahead and sorted Darwin out on my own (and, of course, with FDMB!!). I'm hoping that when his labs there come back great; they'll be more interested in learning more!!
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I hope they will too! They should definitely take notice! Most of the stuff I'm reading where actual vets are speaking of feline diabetes, remission is not something they see too often, and it's not as high as the studies suggest it can be. Maybe they will think Darwin is a one off, or a lucky one, but then you can point them to @Fluffles and all the others near remission, in remission or just well regulated. :)

I'm coming to realize from the 5 vets I've spoken to since Asia's diagnosis, that either vets have the perception that humans won't want to go through all the trouble with testing and all that (and thus those cats would be surrendered or euthanized) or that it's actually true in their experience...I'm not sure which scenario is worse. :( With that in mind, I have to empathize. I think they are honestly trying to do what's best for the cat but in the parameters of what is easiest/doable for most of the humans. A questionably regulated, blind dosed diabetic cat with a forever home is probably preferable to another one dumped at the shelter in their eyes. I just wish there were a way to present the options (like TR), without scaring off the people that would rather not bother and just blind dose. That's the challenge.
 
Toebeans said:
I'm coming to realize from the 5 vets I've spoken to since Asia's diagnosis, that either vets have the perception that humans won't want to go through all the trouble with testing and all that (and thus those cats would be surrendered or euthanized) or that it's actually true in their experience...I'm not sure which scenario is worse.
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I have often wondered that too! It seems the first approach is - here is some high carb food and a dose that gets increased quickly and no real pressure to home test. The whole hope is to substain that 200-300 range of numbers. They begin to freak out a bit when you push for normal numbers.
 
Tracey&Jones said:
The whole hope is to substain that 200-300 range of numbers. They begin to freak out a bit when you push for normal numbers.
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Because it sounds insane to push for normal numbers, or at least it did for me...at first. You're increasing the risk of hypoglycemia substantially, some would say unnecessarily. The reason it's not as risky as what I initially thought is that with TR, we are testing our cats so frequently, and hopefully have a general idea of what they typically do and will be on top of it should their numbers drop. That's about as "safe" as diabetes can be IMO. I've known type 1 humans that have responsibly managed their diabetes and have died from it anyway; it's not a "safe" disease. Cats that are blind dosed, even with occasional curves at the vet, can certainly have hypo events too, because things change and the less you know what's going on, the less prepared you are to do anything about it.

Sustaining numbers in the 200-300 range seems like a much safer approach (hypo wise) and is probably considered "harmless enough" (they are just cats after all, right :rolleyes:). If you read the data with the human study and hypothetically apply it to cats: risks for eye, renal and nerve damage are pretty much nonexistent in the euglycemic range...very appealing. As well, in the actual cat study, the significant percentage of remission (compared to anecdotal data from vets) is a motivating factor.
 
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