3/25 Jupiter AMPS 315 need opinions!! Please read!!

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Jamie & Jupiter

Jamie & Jupiter

Member Since 2013
Here is the link to my condo from yesterday viewtopic.php?f=9&t=91678

Jupiter is doing okay today- still seems pretty thirsty lately - On Wednesday I will start giving him the 1.25U doses.



Just wanted to let you all know that I am offering coupons (also posted this in the supply closet)

I have a ton of coupons for Tidy Cats - cat litter, Fancy Feast Canned foods, Fancy Feast appetizers.

If you use any of these brands please let me know if you would like me to mail coupons to you.
 
Re: 3/25 Jupiter AMPS 315 need opinions please!!!!

So Jupiters vet just called. I called him the other day as I would really like to work with him as well as the people here to treat Jupiter's Diabetes. I told him that I started home-testing. He said he doesnt think I should test Jupiter more then 2 times a day because of scar tissue building up. (And he said eventually once Jupiters numbers are more stable then I should only be testing him 1 time a week then just watching out and making sure he is eating and feeling okay) He also said people tend to get obsessed with the numbers and not with how their cat looks and feels. I told him I am still paying attention to how Jupiter is doing. I told him that on days the numbers are a little lower - Jupiter seems more playful and less thirsty.

I asked him about increasing the dose. He said to give 1u in the morning and 2u at night or vice versa. I asked if I could do 1.5u twice a day instead and he acted like he really didnt want me to do that. He said that its hard to get the dose that accurate and I told him that my syringes have the 1/2 markings but he said its still hard to do it accurate and he doesnt want Jupiter to end up getting 2u twice a day. I told him I was confident that I could measure an accurate dose. He said I see how involved and organized you are and I think you could give him the correct 1.5u dose too but what if someone else needs to give him the dose when you are not home. I told him I have 2 other people that Jupiter is comfortable with and that we are also teaching them everything incase we are not home and we need someone else to give him the dose.


So here are my concerns: I want my vet to take a part in Jupiters treatment, but I do not agree with him on some things. The most I will give Jupiter at this point is 1.5U 2 times a day. (I was only going to increase his dose to 1.25U as that is what someone suggested I start with.) I am going to keep hometesting as I agree with everyone else on this site that it is really important - and I dont want Jupiter to end up having a hypo. (When I told vet I was concerned with a hypo attack - he said "I have never had a pet have a hypo after only increasing the 1u once a day")

If you could all please give me your thoughts on this I would really appreciate it. Thanks!!
 
No, Lantus needs to be dosed at the same dose at both shot times. Do not give 1U in the morning and 2U at night. Your vet does not know what he is talking about, Lantus is not dosed like that.
Wait till the others come along and give help with proper dosing advice. Oh and my vet told me the same thing not to test my kitty just to give her the insulin which I did not listen to. Its funny she said the same thing that people get obsessed with the numbers. I did not test her as many time as I should have but I did test her.

Terri
 
My strategy with some vets is to do the, "Oh! Look at what I found. There's this really good article in a vet journal about Lantus and Tight Regulation. I made you a copy if you've not already seen it."

Here's the article:

This article is the research behind the TR Protocol that we use. It also has the protocol included.

What the research indicates is that you do not want to be overly aggressive with dose increases because you can skip over what would be a good dose. While the TR Protocol is relatively aggressive, it is also safe because you are raising and lowering doses systematically. Dose changes are based on the lowest point in the cycle (the nadir). For a cat like Jupiter with nadirs mostly below 300, you increase the dose by 0.25u. You then hold that dose and evaluate it for 3 days (6 cycles) unless Jupiter's numbers drop below 50. Should they drop below 50, you then reduce the dose by 0.25u. Most of the time, dose changes are done in 0.25u increments. Doubling your PM dose could easily throw Jupiter into very low numbers. This is not something I would do with my cat nor is it something I would recommend to anyone else.

If you are worried about dose accuracy, you can get calipers which will help you to calibrate the small doses. Personally, I don't use them. Marje and several others here swear by them and they can help you if you want to go that route.

I agree with Terri. Lantus dosing needs to be consistent. What your vet is suggesting may work with shorter acting types of insulin but giving different doses at AM and PM shot times doesn't work with a depot-type of insulin. If you give different doses throughout the day, you'll end up with wonky numbers. The depot has to adjust every time you make a dose change. This is why Lantus is long-acting and it is why the doses are cumulative in their action. So, if you give less in the morning and more at night, the depot never has a chance to stabilize. The result is that the numbers will be all over the place. It sounds like your vet is much more familiar with shorter acting types of insulin. Many vets make the mistake of treating Lantus like those types of insulin. Lantus (and Levemir) is very different and requires a very different approach to dosing.
 

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totally agree with what has been said so far.
do not know how to convince your vet and cats certainly can hypo. I would print out what sienne linked to and just drop it off. can say something like, I am more comfortable increasing in smaller doses. I am watching the numbers and the cat as a whole.

something like this also. would you give yourself or your child insulin and only test 2 tomes a day? how do you know how well the insulin is working.
I really want to work together as a team but I also want to feel comfortable in what I am doing. or whatever. I am a little more forceful with my old vet. my new vet listens to me and asks me questions
 
Yeah I just dont want my vet to think I dont trust him and things like that. He acted like he knew what he was talking about and didnt seem to care what I had to say - I feel like he just thought he was right so kept pushing his opinion on me and didnt take mine into consideration much. I told him that I am getting the advice from others who have diabetic cats, who have also worked with veterinarians in treating their cats, and I told him that a lot of the cats are doing great.

I trust the opinions of those on this site - and would rather go that route. But, I also feel there could be problems - for example: when I go to the vet to get a new prescription for Lantus and syringes - I am worried he will say he will not write the prescriptions because I am not following "as prescribed". What if I take Jupiter for a checkup when I need the new prescription - and he asks how much insulin I am giving?
 
well, after the vial is done, you have the pen I gave you and that will last 6months to a year . that is what i get out of mine. by then, you will have your spreadsheet as proof of what you are doing.... IF jupe is not OTJ by then
 
My vet was pushy initially but, with 3 cats, I was giving them so much work (and money) that they settled down and let me do what I wanted to do.

Regarding the testing - so funny about the scar tissue.
Honey's ears are beautiful - not a mark in site. And imagine what some people's cat's ears would look like if that were true :o

And we do look at the whole cat - when you see them eating and drinking normally, playing again, able to walk and jump and have a silky coat - you know kitty is doing well.
 
My vet originally started me on Caninsulin and even after a locum got me started on Lantus, still wanted me to do lower doses at night. That's what they recommend for shorter acting insulins, because they don't expect people to be awake or testing at night. (and weren't familiar with how Lantus works). I gave my vet the protocol and started sharing my spreadsheets and told her what I was doing. I have always told them my goal is remission and the protocol gives the highest chance of achieving that. Remember the vet works for you. Have you asked your vet how many diabetic cats in their practice have done into remission? My vet was OK with supporting what I wanted to do, but wanted to be kept in the loop with the spreadsheets to make sure things were going OK.
 
Yes that could be a problem, and I went through the same thing with me vet. I took matters into my own hands and dosed my cat based on what I thought was right. She did get an attitude with me like she was the vet and she knew what she was talking about. But at the start if I had done what she told me and started my cat at 2U twice a a day my cat would probably went into a hypo. She was a little kitty.
My cats numbers barely ever got above 220 or maybe at the highest I remember 250. Its your cat and you pay him. I have seen many instances on this board where what the vet told the person was just wrong.
Had a person on health that had to have his poor kitty PTS because the vet kept telling him not to give the cat any insulin even though the cat was in high 300`s and low 400`s. Poor kitty went into DKA. Or the vet was just dosing the cat cat way to high.
If the vet does not cooperate you might have to find one that is willing to work with you for the sake of your kitty.

Terri
 
Hi Jamie,

My vet clinic has several vets... and the one who owns the practice sounds just like yours. didn't need to test so much... pats you on the head and says see you
in a week or two.... just do what I say.
You are dealing with this 24/7, not him.
He works for you ... you employ him.

I agree with the others that your vet is dosing like the older insulins that he is used to. And he may know those well enough but he's not familiar with Lantus
obviously since he is telling you incorrect ways to dose. He is obviously not paying attention to the latest research ( and this
research is not that new) . Most vets aren't seeking remission for cats... they are only seeking regulation numbers. They aren't used to clients willing to do so
much. In fact, my vet told me most clients here opt to put the cat down. (it's too costly, too much work, and a huge commitment)

My own vet told me how shocked they were that I took the ball and ran to the other end of the field for a touchdown for Shadow, so to speak.
I was seeking remission and once I started here, I never called the vet again until I was ready to show her Shadow's spreadsheet and they were amazed.
They had never had a client get so involved, and learn so much and take matters into her own hands.
Some folks may get too focused on numbers but I don't think we do here. We still focus on the whole cat report. Not everyone gets remission since it's
a very individual thing for each cat.

I would trust Sienne's or Marje's recommendation over my own vet any day. They seem to even know the better medications. (cerenia Convenia is a good example
here, so many vets still giving it for the wrong infection ) correction.... Convenia as Sienne pointed out.... I really need some sleep :o

I hope that you have enough competition in your town that there are other vet options... if he gives you that hard of a time about it.
I think as Jupiter feels better, you'll be able to take his spreadsheet or give your vet the link to view it and watch.


Once Shadow got to under regulation numbers, she stopped drinking water. I haven't seen her take a sip from a bowl since then ( I add it to her canned food- about
1 Tablespoon per meal)
She also had a lot of scabs on her ears early on... ( you can see how much I tested when we were on insulin) and her ears look wonderful today. She's fairly
healthy now.

He's probably more worried of something going wrong and he gets blamed. If only he realized his dosing advise could lead to something going wrong.
I'd nod my head , and go home and continue as you have been doing.
He's not really going to know the difference anyway until all is said and done IF you share results with him.
 
Rhiannon said:
(cerenia is a good example here, so many vets still giving it for the wrong infection )
Click to expand...

I think you mean Convenia. (Cerenia is a very good anti-nausea/anti-vomiting med.)

I think if you take a wander over to the Health board, you'll find that many people hear the same recommendation from their vet. There seems to be some "urban legend" that testing too much is bad for the cat, will cause your cat to run from you, is stressful, etc. While there are a few cats where this could be the case, they are the exceptions. For whatever reason, most of our cats really do understand that whatever it is that we're doing to them is causing them to feel better. And, they get treats.

The easiest and best solution is to not give your vet the full spreadsheet (SS) if, in fact, the vet even wants to see the SS. One thing to keep in mind, though, is that Jupiter is your cat. He's not the vet's cat. You can test as much as you like. As for scar tissue, I've been testing Gabby for almost 4 years on the same ear and in virtually the same spot. Her ear bleeds just fine. If there's scar tissue, it's not a problem.
 
Re: 3/25 Jupiter PMPS 324 need opinions!! Please read!!

I think I am going to have a hard time with the amount - 1.25U. Since I am going to start giving Jupiter the 1.25U on wednesday I want to make sure I am able to give him an accurate dose. I would really appreciate any advice/tips/help regarding this issue.

Thank you to all who have replied to my post. I appreciate your help so so much.
 
Jamie:

This is what a 0.25u dose looks like. (Just set things up the same with 1.25u.)

025unit-1.jpg


There are photos of other micro doses in the New to the Group sticky at the top of the board if you should need them.
 
We recently saw a new vet (at the same practice); she asked if we tested Trix "intermittently". We said "No. We test her at least six time a day." Whoa did her eyes get big! But, she couldn't argue. Trix has been diabetic for 2 years, and does not have scar tissue, does not mind being tested, and is doing great. The vet said, "I'll leave the dosing up to you, because whatever you are doing is obviously really working!" I guess sometimes it just take some time to prove it....

Likewise, I trust this board more than my vet...and I do really like my vet, but they are trained to deal with pet owners who aren't as involved as we are.

You're doing great!!!
 
I agree with everything that has been said here. Vets have to deal with many different--often acute--health issues and they tend to stick with what they learned about Feline Diabetes in vet school. The newer insulins (like Lantus and Levemir) are not treated in the old way. If your vet has such a domineering attitude, perhaps you should look around for another vet. Many of us here on the FDMB go to our vets for everything other than FD and rely on the help we get here on the Board in taking care of our diabetic kitties.

You will soon get accomplished at giving doses that are "between the lines" of the syringe. Don't over-worry about it. Just try to be as consistent as you can. It is something that we all have struggled with. I use the digital calipers and like them a lot, but I don't think that I would recommend dosing with calipers just yet. Get good syringes (Terumos or Monojects are good brands and tend to be fairly accurate), but always keep in mind that the lines can be "off" even in a good syringe from time to time. Get in the habit of inspecting a syringe before you use it. Find one that lines up the "zero" line with the end of the plunger and keep it as a "model" so that you will be able to see if a syringe that you plan to use is accurate enough. (Most humans use large amounts of insulin, therefore the companies that make the syringes are allowed quite a bit of variance. In large doses it doesn't make much of a difference.)

Good luck with your 1.25 unit dose. It will get easier and easier to do.

Ella & Rusty
 
Jamie..on dosing accuracy:

I started dosing with digital calipers and many members are now also doing it. Do you have a Harbor Freight near you? If you don't, probably any hardware store has them. These are the Digital Calipers I, and most members, use. Looks like H.F. will fedex them overnight for $6.99. Awesome price!!

Here is my post on Dosing with Calipers.

Of course, none of this tells you how to dial in 1.25u. The biggest thing is that you are consistent. If you get the calipers, then dial in your dose as accurately as you can; then measure it as shown in the dosing with calipers post; write that measurement down. Be sure you measure the distance in mm on the calipers of 1u and then divide that by the number of drops you get to the unit. Most people get 10 drops to the unit; some get 14 if their cat is sensitive to dose changes.

For example, if you measure that 1u = 2mm (just to make it simple). And if you get 10 drops to the unit, then every dose change = 1 drop = .2 mm change in the measurement. If he were on 1u (2 mm) and earned a reduction, then you would figure 2mm = 1 drop and there are 2.5 drops to a .25u change. 2 x 2.5 = .5 mm change on the calipers. Make sense?

Let me know if I've confused you.

I see Sienne sent you the pic for .25u so that should help you with 1.25u. Biggest thing is try and be consistent if you don't go the caliper route. Please let me know how else I can help.
 
Welcome to LantusLand! You are in the best place in the universe to help Jupiter be as healthy as possible. :-D I hope your vet has good intentions he doesn't know how to treat FD. Vets have tough jobs, treating so many different species and all the different conditions they can each get. I have great respect for good vets. But they don't know FD like we do. The people here live with FD 24/7/365 and some have become high level experts. I'd give them an honorary DVM if I ran a vet school. The rest of us are just wildly enthusiastic. :lol: :lol: Quite frankly, if your vet isn't willing to work with you to care for Jupiter, you will be happier if you find a vet who will. Whatever you decide to do, we will be supportive of you.
Liz, Zener's other mom
 
Thanks everyone. I will reread all of this tomorrow. I am pretty tired, so I think its best for me to go over it all again tomorrow
 
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