24Feb2020/Maxi/URGENT QUESTION/Vet advised decreasing dose/What to do now?

Ignore the vet and go with whatever the TR protocol says. A lot of vets aren't well-versed in feline diabetes. Mine is a genius in everything but FD!

Did she give a reason for asking for the reduction?

ETA: Saw your SS. Stick to 2.75 for 10 cycles. Reduce only if Max falls below 50 as per TR protocol.
 
She saw the streak of good numbers at the 2.5 dose and thought I should have stuck with that for 10 full cycles to see if his body settled in to that dose and liked it.
 
I'm going to have to give him his shot now. So, I guess I'll give him 2.75, but I would like more input from all.

It does seem to me that the vet has a point, especially after my having read comments in my previous threads about holding on the 2.5.

Thank you
 
OK, I have given him 2.75.

But could someone please provide me with a brief paragraph explaining why reducing back to 2.5 now is a bad idea, so that I can give it to the vet when she next sees his spread sheet?

Thank you!
 
here's my two penny worth. and maybe a more experienced member can chip in.

you were beginning to see nadirs under 200 with 2.5 and should probably have held it 10 cycles. since you didn't and increased to 2.75 and have already finished 4 cycles on it, you might as well continue down that path. if you keep changing doses so frequently without just cause, you will not know which dose has yielded what numbers. if 2.75 is too high for maxi and he falls below 50, you can take a reduction immediately.

also, vets don''t necessarily want cats to go into remission or show normal numbers. mine was happy to let Bandit stay in the 150 to 300 range!
 
I don't " explain " things to my vet...
Your vet works for you - first and foremost and with you to care for your pet and provide services.

No one's vet should be angry or annoyed when you are home testing and trying to keep your pet out of glucose toxicity , not to mention below the renal threshold. Especially since most - not all- vets don't even explain those things to clients and don't push home testing.
Just my 2 cents as someone who worked in Veterinary medicine for more than a decade....
We used to tell clients, " you are the expert on your pet...".
Not saying you have to act dismissive to your vet - you just don't need permission... I have great relationship with my vet , but he absolutely knows that I will do what I think is best.
Here is the flow chart my vet gave me for how they " manage" diabetes....Bhooma is right- regulation- not remission is the goal.
 

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Si am cat mom said:
I don't " explain " things to my vet...
Your vet works for you - first and foremost and with you to care for your pet and provide services.

No one's vet should be angry or annoyed when you are home testing and trying to keep your pet out of glucose toxicity , not to mention below the renal threshold. Especially since most - not all- vets don't even explain those things to clients and don't push home testing.
Just my 2 cents as someone who worked in Veterinary medicine for more than a decade....
We used to tell clients, " you are the expert on your pet...".
Not saying you have to act dismissive to your vet - you just don't need permission... I have great relationship with my vet , but he absolutely knows that I will do what I think is best.
Here is the flow chart my vet gave me for how they " manage" diabetes....Bhooma is right- regulation- not remission is the goal.
Click to expand...

Thanks, Ari.

The vet wasn't angry. She's very nice. I would just like to explain to her the reasoning behind my decision not to decrease dose as she suggested.
 
I quit trying to explain anything about FD to my vets - yes, plural because we have a vet in Michigan and one here in Florida...

It did take me a little while, but after various discussions with vets about feline diabetes I discovered that none of them knew as much as the people on this forum did. The years of experience here outweigh anything that vets have learned while they were in school. And unless they've spent all of their free time learning and reading the literature that's written about FD they just can't possibly keep up with what the best treatment is for kitties with FD. I don't think it takes away from your vet's ability to treat other things, but they just don't know what they don't know!

Max had ONE good day on 2.5 and then didn't...it's possible that her pancreas sparked to life for that day...but then grew tired and went back to where ever they go when they're not functioning well. It takes time for that pancreas to rebuild. And it takes as much insulin as it takes...increasing until you see a steady flow of numbers under 100 is the objective. If you don't see them you'll need to increase and possibly decrease when her pancreas decides to participate...and then increase again until she's able to handle it all on her own...

It's one reason why it's called the sugar dance...we go up/down, up/down and up/down on the dose until that pancreas is fully functional and they don't need any more help from us...

I'm glad your vet was nice about it all...but trying to teach her everything you've learned about FD...well that could take hours.

Perhaps you could share this article with your vet:
http://www.rednacionaldeveterinaria...e3X8DkPw8DH5JZE-gHwHI16ISGvjOus0lGURGpp5ibXt4


Best to you :)
 
Last edited:
bambinaki said:
I would just like to explain to her the reasoning behind my decision not to decrease dose as she suggested.
Click to expand...
You are following the Tight Regulation protocol. Your goal is remission, not just regulation, and TR gives you a better change to achieve both. Especially with early stage CKD in there, you really do want to get Maxi to the point where he is spending the majority of his time under rental threshold. That means you need him regulated. TR says to reduce if you get below 50 (for newly diagnosed kitties). You were no where near that. Technically you could have held the 2.5 unit dose another day, but that's water under the bridge now.

As an aside, not part of the response to the vet - I see a couple nights, like last night, with no second test in the PM cycle. Is that something you are occasionally unable to do? If so, we might tweak how long you hold doses.
 
While I think it's promising that your vet seems to understand our spreadsheet to some degree, I also agree with what everyone else has said. You've got 4 cycles of 2.75 under your belt....might as well hold it and see what happens.

The way our methods work here is we make our cats "Earn" their reductions.....they can earn a reduction by dropping below 50 (on a human meter) or by staying in normal numbers for 7 full days (between 50-120)

The hope is that eventually, they earn their way all the way down to zero insulin!
 
Sue and Luci said:
I quit trying to explain anything about FD to my vets - yes, plural because we have a vet in Michigan and one here in Florida...

It did take me a little while, but after various discussions with vets about feline diabetes I discovered that none of them knew as much as the people on this forum did. The years of experience here outweigh anything that vets have learned while they were in school. And unless they've spent all of their free time learning and reading the literature that's written about FD they just can't possibly keep up with what the best treatment is for kitties with FD. I don't think it takes away from your vet's ability to treat other things, but they just don't know what they don't know!

Max had ONE good day on 2.5 and then didn't...it's possible that her pancreas sparked to life for that day...but then grew tired and went back to where ever they go when they're not functioning well. It takes time for that pancreas to rebuild. And it takes as much insulin as it takes...increasing until you see a steady flow of numbers under 100 is the objective. If you don't see them you'll need to increase and possibly decrease when her pancreas decides to participate...and then increase again until she's able to handle it all on her own...

It's one reason why it's called the sugar dance...we go up/down, up/down and up/down on the dose until that pancreas is fully functional and they don't need any more help from us...

I'm glad your vet was nice about it all...but trying to teach her everything you've learned about FD...well that could take hours.

Perhaps you could share this article with your vet:
http://www.rednacionaldeveterinarias.com.uy/articulos/endocrino‏/intensive_glucose_control_glargine_cats.pdf?fbclid=IwAR2pfqQsf02W1Te3X8DkPw8DH5JZE-gHwHI16ISGvjOus0lGURGpp5ibXt4


Best to you :)
Click to expand...


Thank you, Sue. I ask for only a few brief lines to share with my vet the reasoning behind not returning to 2.5. I think we should take every opportunity to educate vets if they are willing to listen. My vet is the one who directed me to felinediabetes.com. I strongly believe everyone who practices medicine should commit to staying up to date. It's very time consuming. That's why they get paid the big bucks. This is a thorn in my side about doctors in general. Too many don't take the time to read the current literature about what they are treating, which is their responsibility.

Thank you for the link. The article is over 10 years old. Is all the info still currently correct as far as you know?

Thanks again!
:-)
 
"I see a couple nights, like last night, with no second test in the PM cycle. Is that something you are occasionally unable to do? If so, we might tweak how long you hold doses."

Yes, I am occasionally unable to test in the PM (and the AM) cycle. (Isn't everybody?) Last night, though, was a case of deciding not to test to give Maxi a break after having seen his numbers on 2.75 during 3 cycles and having decided to hold the 2.75 for 10 cycles. And to give me a break. Maxi's PM cycle begins at 9:30 (due to my work schedule).

How do you think the doses (time held) should be tweaked?

Thank you
 
I would try to get six at least cycles with data and evaluate the dose based on that. So it just means holding the dose a little longer to make sure you aren’t missing anything. Especially now that you have started to see blues. Same concept if you see greens and lower blues, get 8-10 cycles of data.
 
Wendy&Neko said:
I would try to get six at least cycles with data and evaluate the dose based on that. So it just means holding the dose a little longer to make sure you aren’t missing anything. Especially now that you have started to see blues. Same concept if you see greens and lower blues, get 8-10 cycles of data.
Click to expand...

OK, I will.
Thanks, Wendy.
 
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