11/26 My vet is insisting I switch Lucy back to DM

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kalyv

kalyv

Member Since 2011
I finally had a chance to start Lucy's spreadsheet this week so I am posting on the Lantus board for the first time so hi everyone.

I have been reading as much as possible on this board, but I feel like I still need some advice from you guys.

I have successfully switched Lucy over to canned food but she is still eating a lot, according to the vet.

She lost a huge amount of weight and was practically emaciated by the time she was diagnosed. So I have pretty much been feeding her whatever she wants to get her weight back up. It's working and I think she is about her normal weight again.

Right now, between the two cats, they get fed 1.5 368-gram cans of various Friskies pates. (One large can is just the equivalent of 2.1 six ounce cans.) That seems reasonable to me since they used to graze on dry food all day long as well have half a can of FF each in the morning and the evening.

They were getting two full cans until about two weeks ago. At that time, Lucy was on 4 units of Lantus and her BG was pretty good but she dipped below 5 a couple of times. When I talked to the vet about this and sent him her BG curve, he kind of freaked out and asked what I was feeding her. I told him about the low carb Friskies pate but he said I had to feed her the DM in order to regulate her BG properly. He said she should not be eating more than one 6 oz can of DM per day, so I was feeding her too much despite the fact that she had lost so much weight. He also said I should cut her back to 3 units.

I cut her down to 3 units immediately, and cut their food down from 2 to the 1.5 large cans a day but have not switched back to the DM because I had just bought a case of Friskies which I did not want to waste and to be honest, I cannot afford the DM. More importantly, I have seen on this site that you guys have had a lot of success with Friskies and Fancy Feast.

But anyway, when I explained the cost issue, the vet said that I am just paying for moisture with the commercial cat foods. When I pointed out that the DM has the roughly the same amount of moisture (about 78%) he said that DM is better a stablizing levels because it releases the carbs at a steadier rate. If I believed that the DM would be better for her, I would certainly switch her over despite the cost, but I am not really convinced since when she was on the DM, her BG was just as unstable. But that was also when she was first diagnosed so maybe that had something to do with it.

So I would be interested in any advice on whether or not I should switch to the DM. I personally feel that only one 6 oz can a day is way too little for my cats. Even on 1.5 large cats a day, they seem to get overly hungry.

Sorry this is an incredible ramble, but I would also appreciate it if you guys could take a look a the spreadsheet and tell me what you think.

Lucy's BG is still erratic, depending on how much she eats, I think. I just cut her down to 2.25 units today to see if I could avoid those sudden dips into the 5's. How worried should I be about that? Right now I am working at home so I can keep an eye on her but I will be back to office work the week after next and that number makes me very nervous.

Right now I only have about a week of results on the spreadsheet so I don't know if that is enough to point out any true patterns but I would appreciate any advice you Lantus experts can give me with regards to her insulin dosage, the amount of food she is eating and whether or not I should switch her back to the DM canned food.

Thanks again. I don't know what I would do without this board.
 
IMHO, I would not feed DM. The %calories from carbs is about 8% and most of us stick to feeding below 5% calories from carbs. I don't agree with your vet about DM being able to better control BG. There are plenty of us feeding much better, lower carb foods with decent BGs. Also, the ingredients in DM and the other prescription diets are horrible.

This is from Dr. Lisa Pierson's website (she is a fabulous feline nutrionist) found at www.catinfo.org:

Feeding a diabetic cat a high carbohydrate diet is analogous to pouring gasoline on a fire and wondering why you can't put the fire out.

This rationale also applies to any of the prescription dry diabetes diets such as Purina DM, Hill's Prescription w/d and m/d, and Royal Canin DS. These diets are not only poor quality diets, they are still too high in carbohydrates and contain several species-inappropriate, hyperallergenic ingredients such as corn, wheat, and soy.

It is very important to address the carbohydrate level in a cat's diet but it is 'tunnel vision' nutrition to stop there. We need to also address the quality of the ingredients in the foods that we feed to our cats - not just the carb level.

I do not use any of the prescription diets - even in the canned form - since there are better - and often less-expensive - choices in the over-the-counter (non-prescription) market.
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You can insist to your vet that you are Lucy's advocate and you want her to have a higher quality diet than DM and you want her to have less carbs. Most vets get very, very little education in feline nutrition but get the sales pitch from these companies. You can nicely remind him that Lucy is your cat and you have found she does much better on a diet other than DM. She IS your cat...not his :-D :-D
 
There are two simultaneous threads that Kaly inadvertently posted. Here's the link to the other thread.

Please keep all of the posts in one place. I'm copying my post here:
Sienne and Gabby said:
First, the amount you feed should be based on the number of calories per day your cat needs. If you know your cat's "ideal" weight, Lisa Pierson's site on feline nutrition provides a formula for calculating calories per day. Calories are important because each type of cat food has a different number of calories per can. The formula Dr. Lisa provides is:
Required calories per day = [13.6 X optimal lean body weight in pounds] + 70​
For example:
Friskies Beef & Chicken Special Diet (4% carbs) is 183 calories per 5.5 oz can - or 33.3 cal/oz
Friskies Special Diet Turkey & Giblets (5% carbs) is 175 calories per 5.5 oz can - or 31.8 cal/oz
Purina DM (7% carb) is 194 calories per 5.5 oz can - or 35.3 cal/oz

So, you have the diet suggested by your vet that is higher in carbs and calories and way more expensive than what you can buy anywhere. The Friskies is lower in carbs and calories and is probably a better quality food than DM. (You should compare the ingredients.) Basically, I think your vet is would like yout to spend your money buying food from him. I had a similar discussion with my vet. The discussion ended when I pointed out that I could spend a lot less money buying human grade food (e.g., Wellness) that was obviously better quality than DM and was lower in carbs. She could not argue.

Thanks for getting your SS up and running. Is there any way you can use the version of the template that will automatically convert your numbers to the US system. I just can't sit and do the conversions for one SS. There should be a format where the world values are on one tab and the US are on another. Alternatively, if you want to post in US numbers, this conversion program will help you to convert the numbers. We use the US numbers on the Board.

Also, what meter are you using? I'm not sure why your are concerned with Lucy's numbers dropping below 90 (i.e., 5 mmol/L). We don't become overly concerned about low numbers until a cat drops below 50, unless you are using an AlphaTrack meter or other meter that is calibrated for animal use only. (In that case you would use a cut off for reducing a dose at 80 or 4.4 mmol/L.)

Lucy's numbers are not that erratic. I don't think the variables that are effecting her numbers are how much she's eating. I think one of the issues is that you are not sticking to keeping shots 12 hours apart. An early shot acts like a dose increase. A late shot acts like a dose reduction. Shooting early then shooting late doesn't cancel things out -- all it does is mess with the shed and give you wonky numbers. Also, Lantus dosing is NOT based on the pre-shot number. It's based on the nadir. Numbers below 50 (i.e. 2.8 mmol/L) qualify for reducing your cat's dose. You have been raising and lowering Lucy's dose. This is also contributing to erratic numbers. When you change a dose, you need to let it "settle" for several days. I'd encourage you to read over the Tight Regulation Protocol sticky so you have a better sense of when to raise or lower Lucy's dose.
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What would be the best for you Lucy would be to feed a low carb wet food like fancy feast, or one of the low carb food listed in our Binky's food lists http://binkyspage.tripod.com/canfood.html
Please read all the Stickys, & especially the one with the tight regulation protocol..print it for your vet to read..
As Marge said, we here ALL have FD cats & with the newest veterinary knowledge & studies to date.
We all study the best food & treatment opportunities for our fur babies--WE have a vet on board here
Dr Lisa and Rebecca the Webmaster who started this site is a pet health educator..
Thousands of diabetic cats have passed through this website, many many lives were saved here including my own cat, and almost 200 cats on lantus have gone into remission since 2008..
So what I am saying is the cumulative knowlegde, love & commitment here will halpe your cat to have a better life & get well---NOT With DM! I know your Lucy will do well here
 
Welcome to LL! You are in terrific hands here and I know some of the experts will be chiming in soon. You already have some great advice from Marje...she has helped me so much with my two kitties. When Simon was first diagnosed, the vet insisited I feed him Hills W/D and then started him at 3 units of lantus and increased to 4 units after one curve done at the vet. Thank goodness I found FDMB & started hometesting right after he was put on 4 units because he would have hypo'd if I kept him at that high of dose. Most people here suggest starting at a little lower dose of lantus in the beginning and I'm glad I listened to them instead of continuing with the 4 units and no home testing.

Please do what you think is right for your kitty. The low carb less expensive food is definitely better than the Hills. I ended up switching Simon to another vet because the vet that diagnosed him was not an advocate on hometesting and also insisted I continue feeding him the Hills. Simon's new vet told me that the Hill's W/D was the "old school" thinking and that store bought canned low carb food is better. He is also thrilled that I hometest and thinks of me as some kind of expert now (I have him fooled!). If you don't feel comfortable with your vet and she doesn't want to at least work with you, you might want to do some shopping around for another vet.

As far as the amount of food, I would be a little nervous cutting back food if Lucy recently lost a lot of weight and just started getting back to her normal weight. You don't want her losing too much, too quickly. Simon eats a little over 3 small cans/day (around 9-10 oz). He is about 14.5 pounds. I hope some more expert eyes will be here soon to give you better help with the food issue.

Once again, welcome!!
 
While I was in the middle of typing my post, it looks like Roni and Sienne already answered you. They are the experts so definitely follow their advice.
 
Is Lucy your cat or the vet's cat? That DM food is lousy, and none of my cats would touch it. Stick to the Friskies and fancy feast pates; they are just fine.

Let your cat eat; until regulated, you will see more of an appetite. My two cats were eating around 30oz and 24oz before regulated, but now, they are eating around 10oz and 6oz a day.

I am also in Toronto and my new vet never interferes with what dose I give my cats or what food I am feeding. He can see by our spreadsheets that whatever I am doing, it's working great. And that's a new one; the DM food has some time released magic in it? That's funny. Seriously, when she gets regulated, she will eat alot less. I think your vet is just pushing the food for profit. If you want to get some better foods, check out t ones on Binky's list, but forget about the DM.

That's alot of insulin, 4u BID. With the food change to low carb wet food, I bet you are going to need alot less insulin.

For feeding, you can pick up a Pet Safe auto feeder and section up her daily food evenly into 5 portions, and be sure to have no food available for the 2hrs before shots.

I haven't looked at your ss but will take a look.
 
Welcome to Lantus Land! :YMHUG:

Diabetes is a starving disease, because although the cat eats a lot of food, he/she can't metabolize it into energy and keeps eating because he/she needs more energy. Once the diabetic cat starts to get regulated he/she will naturally want to eat less. A full 12.5 oz can does seem like a lot, but Lucy is still getting regulated. And Marje is right, start reading the labels of the cans to look for ingredients. Friskies is actually a better food than many think, especially compared to the prescription diets. Dr Lisa Pierson has a lot of good information on how to evaluate canned cat foods. i would read the rest of her pages as well. Also, many cats reject the RX diets. The only food that does a cat any good is one that they will eat!

The important factor in how much you feed your cat is calories not volume. Depending on where you look cats need between 20 and 40 kcal/lb. The range depends on the age of the cat and activity level (younger/very active cats more calories : older more sedentary cat lower calorie needs). Foods, too, range in the number of calories per can. There is a great resource here, Janet and Binky's list.

First determine Lucy's ideal weight, determine how many kcal/pound she needs, multiply by ideal weight, and feed as many ounces of the food as needed to give the proper numbers of calories. Different food will need different amounts. Sorry, you'll need to do the metric conversions yourself. FWIW, my Tess is only 8.5 lbs and she eats about 180 to 200kca a day.

I would do the research and go back to the vet with all the info in hand . They can't force you to buy anything from them.
 
First of all, let me say that you guys are truly awesome and thanks for your patience with me! :YMHUG:

Sorry about the double post. I am not sure how that happened. I will try to delete the other post but if only an admin can do that, please feel free.

I have also switched out my spreadsheet link for the US version so that should make things easier to read.

Right now Lucy weighs 9.8 lbs which seems about right from my layperson's viewpoint but I will research that a bit more. I will do the calculations to see if I am feeding her too much or too little, but I tend to agree that at this point, I am happy to feed her as much as she wants. She is definitely less ravenous than she was when she was first diagnosed but she is still eating everything I put out for her and also stealing her brother's food whenever she gets the chance. (I don't worry to much about that because he definitely needs to lose weight.)

Also, what meter are you using? I'm not sure why your are concerned with Lucy's numbers dropping below 90 (i.e., 5 mmol/L).
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Sienna I am using the one touch mini, Canadian version, I guess. I was worried about dropping below 5 (90) if it was the pre-shot number because then I worry about how low her nadir is. But I have not managed to catch the 6 or 7th hour on days when gets to 5 (90) and it seems to be fairly random on when that happens.

Lucy's numbers are not that erratic. I don't think the variables that are effecting her numbers are how much she's eating. I think one of the issues is that you are not sticking to keeping shots 12 hours apart. An early shot acts like a dose increase. A late shot acts like a dose reduction. Shooting early then shooting late doesn't cancel things out -- all it does is mess with the shed and give you wonky numbers. Also, Lantus dosing is NOT based on the pre-shot number. It's based on the nadir. Numbers below 50 (i.e. 2.8 mmol/L) qualify for reducing your cat's dose. You have been raising and lowering Lucy's dose. This is also contributing to erratic numbers.
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OK this makes sense. I did read the tight reg protocol but I think I got it mixed up with the low number stickie. I will go back and read both again. But it is good to know not to mess with her dose unless her nadir is below 50. That was the key piece of info that I seemed to have missed.

So basically, even if her pre-shot BG is at 4.8 for eg., I should give her the same dose and just try and keep it as close to 12 hours as possible? And of course, do a BG test at the midway point, if possible?

In terms of dealing with my vet, I think I am going to start shopping around for someone else. I am not sure if we are having communication issues or what but he seems to freak out a lot and that freaks me out a lot.

But I am happy to see that Lucy's numbers are not as erratic as he seems to think they are and that she seems to be doing reasonably well on the lower dose. I am hoping that is a sign that her pancreas is slowly starting to become more efficient again. She was diagnosed in September so I think we are doing fairly well, all things considered.

Once again, thanks to everyone who chimed in.
 
:lol: :lol: :lol: Welcome, Lucy & Kaly!!!

I love the sentence in your signature...

"Kaly has only had one major freakout so far"

we've all had our share...welcome to the group!

celi & binks
 
If you send Gayle a PM, she may know of vets in the Toronto area that are good (or you should avoid).

Just a word of caution. You don't yet have a lot of data on your SS. (You may have more but that's what's we can see.) Until you have sufficient data, we generally suggest that you do not shoot if you have numbers lower than 150 (8.3 mmol/L). If you look at the info on shooting low numbers, you have several options when this occurs. What I would suggest is that you post and ask for input if you test and get a pre-shot number that is 150 or below. Just a bit of preemptive information, if you do shoot a lower than usual number, you will need to get a +1 and +2 test. In addition, always have a supply of strips and high carb (usually the foods that have gravy) food on hand. When you run into lower numbers, you will need to stay on top of things and testing allows you to do that -- hence the need for strips. We also steer the cycle with food which is why it's important to have high carb (HC) food stocked up. These are foods that are greater than 17% carb. The first time you see low numbers during the cycle let alone a low pre-shot, it can be unnerving. All of us have been there and we are happy to walk you through when this happens.

Based on Lucy's weight, it sounds like she would be fine on around 200 calories (or a little less) per day. You may be over feeding. To some degree, Lucy's appetite will decrease as she becomes better regulated.
 
Welcome, Lucy & Kaly!!!

I love the sentence in your signature...

"Kaly has only had one major freakout so far"

we've all had our share...welcome to the group!

celi & binks
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Thanks for the welcome celi & binks! I should probably update that to "two" freakouts now. LOL!

Edited to add:
Just a word of caution. You don't yet have a lot of data on your SS. (You may have more but that's what's we can see.) Until you have sufficient data, we generally suggest that you do not shoot if you have numbers lower than 150 (8.3 mmol/L).
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Sienna, yes this is what I was trying to do when I was shooting later. Generally I waited until her BG was back up in the teens a couple of hours later. But maybe it is better to just feed her some of the higher carb canned food, instead of waiting. What do you think?
 
Kazi weighs between 9 and 9.5 lbs.... she is offered 9oz of food every day. She is fussy and not a big eater but she will still consume around 7oz total a day. Some days more, some days a bit less...and she maintains a steady and healthy weight. Cats, like people, require different amounts depending on their activity levels and metabolism. If she is maintaining a good weight why the heck would you cut her food? ohmygod_smile Makes no sense to me why your vet would demand that!
 
My thoughts too Amanda. Right now she is probably eating about 11 to 12 oz which is probably more than she needs at her ideal weight. I guess, I don't want her to get too overweight since that will probably just exacerbate the diabetes. But she is only just recovering from and drastic weight loss so I will see how it goes.

Sienna, Just in case you didn't notice, I edited my last post to respond to you. Thanks.
 
I saw your reply -- thanks.

I wouldn't suggest feeding HC if you're able to stall. Here's the deal. If you get a pre-shot number that's less than 150, you can stall. However, you don't want to feed low or high carb. If you feed, your test data will be skewed due to the influence of food on BG levels. If you get a shootable number when you next test, you won't know if the number you're getting reflects the effect of food or if numbers were rising on their own. So if you opt to stall, don't feed.

Stalling can be complicated. If you do wait until numbers are rising, your next shot is 12 hours from whatever time it was that you shot. If you are on a tight schedule, this may not work. If you are off schedule, you can move shots by 30 min. once a day or 15 min. per shot time until you are back on schedule.
 
Besides Binky's food chart, there's also this newer chart that lists some of the higher end brands that may not be on Binky's.

DM is pretty high in liver content. Too much liver can cause a vitamin A deficiency in cats. It's been discussed here on FDMB before if you want to search for the posts.
 
OK so I just did Lucy's PMPS and the meter is reading 554 (30.8).

She ate her evening meal about 5:30 (just under two hours ago.)

As I mentioned in my first post, I reduced her dose this morning from 2.5 to 2.25.

Should I go back to 2.5 or should I just hold on 2.25?

This is the highest he BG has been in a really long time and the only variable I can think of is the reduced dose.

ETA I am over the 12-hour mark now so I went ahead an made the call of going back to 2.5.

I will be offline for the next few hours, but will check back in later tonight. Thanks everyone.
 
EDIT Just read about the high BG#--can't help with that but sure someone will come along soon. EDIT

When Pinky was diagnosed my vet recommended DM canned and dry.

I had 8 cats at the time and NONE of them would eat DM canned.

My vet had never heard of anyone hometesting nor was he experienced with Lantus. He was agreeable to writing me a prescription which I very much appreciated but he really couldn't help beyond that.

PInky wasn't responding all that well and I eventually got tired of explaining that Lantus was supposed to be better for feline diabetes compared to Humulin N (his preferred insulin).

I switched to a friends vet when I found out that her vet had prescribed Lantus to her. New vet even encourages home testing.
I told her I feed low carb canned and that Pinky wouldn't eat canned DM. Much longer drive to the new vet but it is worth it.

Best wishes. Elaine and Pinky
 
Jill, our site moderator and the most knowledgable person we have in LL (and FDMB), wrote this on another condo regarding feeding an unregulated FD:

as far as feeding an unregulated cat as much as they want...
i'm afraid that statement is a product of repeat speak rather than fact. here's a post from Dr. Lisa referencing a previous post from Hillary & Zug (GA) on why the amount food fed should be somewhat controlled.

Here's a really good explanation of why NOT to overfeed/feed until "satisfied":

In general, brain cells do not need insulin to utilize glucose. A specific area of the brain, called the appetite center (in the hypothalamus), monitors the amount of glucose that circulates in the bloodstream. The lower the blood glucose level in the cells in the appetite center the greater the appetite. Unlike most of the brain cells, the ability of glucose to enter the cells of the appetite center is dependent upon insulin. In diabetes mellitus, with its lack of adequate insulin in the bloodstream, these appetite center cells don't monitor glucose levels properly, thinking the blood glucose is low. as a result, the pet develops polyphagia to correct for this perceived problem. The additional food that is then eaten further increases the blood glucose level.

from: lbah.com http://lbah.com/feline/diabetes.htm#Pathophysiology

Basically, a cat that's unregulated can't really tell what's going on with its appetite, and the high BGs make the cat even hungrier. It's something of a balancing act -- you want to be sure you're feeding sufficient food that the cat is getting the nutrition it needs, especially to help reduce the risk of ketoacidosis, but you don't want to overfeed (which often happens when the cat is "hungry"). The poor cat doesn't know if it really needs food, it just knows that its brain is saying "need food now!"
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To further prove that ECID, my Gracie is a small cat and weighs about 9 lbs. She eats only 2.6 oz of food a day.... and with the food I feed her PLUS her snacks, it's a little more than 100 cal/day. At that, she is a little chubby and if she gets more than that, she gains weight. And she is a fairly active kitty. So you see how they can differ.

Please do not change her dose in response to her pre-shot BG. She is most likely "bouncing" . A bounce occurs when the liver perceives BG levels lower than what it is used to. The BG does not have to be low to trigger a bounce...only lower than the liver is accustomed to. The liver then releases counterregulatory hormones and glucagon to bring the BG back to what it believes is a "normal" level. For a FD kitty whose numbers have been high, the liver has learned to adjust to those higher numbers and any low number triggers the bounce. Bounces can take up to 72 hours or six cycles to clear. You do not want to increase the dose during a bounce. It would have been better to leave her where she was because raising a dose on a bounce can put her into an overdose.

It's a lot to learn, Kaly, so take a step at a time and if someone doesn't get back to you right away, don't make a change. If you need help with a dose, then change your subject line to state "need help please" or "have ???"...something that gets our attention so we know you need assistance. That way, someone is more likely to get to you quicker.

Please let us know if you have questions.
 
For now, please keep Lucy's dose consistent at 2.5u. Lantus likes consistency whether it's the amount of insulin or keeping to a 12/12 schedule. Remember to get at the very minimum, one spot check during the AM and PM cycle in addition to your two pre-shot tests. This will help us to sort out if Lucy is bouncing. like Marje, I think that is the reason you are seeing some of these high numbers.

If it's not too much trouble, could you provide a bit of background on Lucy? You can complete a Profile which will fill in a lot of the gaps. When was Lucy diagnosed? Does she have any current medical issues? Any history of ketones? How did you arrive at your current dose? Has your vet been recommending the dose changes or have you been trying to follow the Tight Regulation Protocol?
 
hi kaly! you've gotten lots of great advice so i'll just say welcome to you and Lucy! I'd encourage you to open a condo (thread) in Lantus Land daily so we can help you understand this all one step at a time. It's not super complicated, but it's a lot to take in at once, especially if you don't have people helping you interpret.

We can help you unravel what's going on get Lucy stabilized. most of the time you can get an answer within a half hour or so unless it's in the middle of the night. even then, often someone is on. just post your questions and we'll help.

it gets much easier.

hugs, julie
 
Thanks again guys.

Lucy's +7 came down to 17.2.

I will fill out the profile tomorrow and try to absorb some of this info. It is a lot to take in but at least I feel confident in telling my vet that I will not be switching her to DM.
 
i didn't even tell my vet all that i was doing. people reminded me that the vet works for me, and i basically started telling him what i wanted from him. less than a perfect relationship, but it worked.
 
LOL! That seems to be a good strategy Julie.

I am not sure what to make of my vet. On the one hand, he prescribed Lantus and suggested that I do the home-testing. But on the other hand, he seems extremely wedded to the DM or some other prescription wet food and he suggested I go from 2 units to 4 units after about a month which is counter to the Lantus protocol posted here.

One thing I do like is that he does not insist that I bring her in and is happy to converse mostly through email or phone.

Ah well, I will figure it out eventually.
 
Vets are taught nutrition in a matter of days - by Hills Science Diet. The same company that gives them a discount for selling their food at their clinic. No surprise your Vet pushed the DM - mine did too and very obviously didn't think that the low carb Fancy Feast I was feeding could possibly be as good. I am just glad that I came across this message board...Kazi is better off for it, and so is my checking account!
 
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