6/15 Zoe --Oh boy I had a bad experience with the vet

[Sybil and Zoe]

Sigh. Zoe was acting a little strange whining more the other night and the next morning and being a little restless like she was pre diagnosis with a UTI, so I took her in Wednesday afternoon to the vet. He couldn’t get urine out of her to test (bladder was small) so he said they could give her some fluid under skin to stimulate her to pee. (If they did it-and I sure paid for it- she was never there long enough for it to work and wasn’t tested!!!). He gave me Clavimox to give prophylactically.

In the meantime I had my laptop with spreadsheet and printed info about the TR protocol so I could discuss her treatment with this vet since I hadn't really talked to any of them since her switch to lantus. He looked at the spreadsheet because I had it open and was showing him, but had typical MD type behavior over the printed internet information---which was to dismiss it completely, plus he wasn't happy I was using human meter either. He didn't know how her bs was running because "of my use of human meter" (though he never offered to check it himself). He wasn't interested in the protocol because it wasn't vet ordered or designed and based on science , instead on "just a bunch of pet parents". I am in healthcare and I recognize the egotistical behavior. Long story short I was in and out in 10 minutes with an antibiotic to treat possible UTI and a $132 bill. It makes me rethink my vet. Needless to say, when I got her home she seemed fine and didn't display anymore odd behavior, so I just put the clavimox in the refrige and never gave it to her.

I have been upset since my trip to the vet, and it has put me in a funk She is not really responding yet to the Lantus increases and I take spells like others here and get discouraged. I haven't seen yellow in many days now. I'm following the TR protocol. After my trip to the vet I decided to hold her at 5u for 5 days instead of 3 to see what she would do--which was nothing I went ahead and bumped her to 5.25 this morning. Her readings are always around the time she gets extra food and I can't help but wonder what they would be without food-but she is so hungry!!. (she gets fed at 6am after amps, then 9, 11, and 2, and then nothing until after pmps at 6p, then the same, 9p,11p and 2 am.) I just feel lost because I don't have a vet that supports my managing her but yet has never offered any real guidance. "Here is the diagnosis, give her this and feed her DM or any weight management dry because of the fiber content is higher. Bye! And now I really don't feel like I can ask for their advice! I am going to look into switching care even though the other vet who typically sees Zoe since diagnosis really likes her. A cat specific clinic here in town has a link to the felinediabetes.com website on their web page which is a very good sign.
I don't know if this is typical vet response to diabetic cat self management, just had to vent.

 

[J.J. and Phoebe Squeak]

All I can say is - I feel your pain in terms of the doctor's response!!! I have had the same experience with vets several times and it's so upsetting! I am meeting Dr. #4 on July 7 in hopes that the fourth time is the charm for Phoebe Squeak. I really hope you find someone who gets it. Hang in there! We are rooting for you and Zoe!

 

[Marje and Gracie]

There is a possibility that Zoe has a high dose condition like IAA (which is self limiting after a year but which we can help treat faster) or acromegaly. Have you read information on these conditions on the acro forum of this board? You mention she’s ravenous; does she have a pot belly (not all acro cats do)?

We recommend you test for IAA and acro when the dose gets to 6u bid. Keep doing what you are doing by taking the dose up per the TR protocol. However, when she hit 4.5u, you needed to be taking it up by 0.5u increases as the TR protocol states dose increases should be 0.5u for nadirs over 300 and that’s where she is. She had one cycle on 5u with a yellow nadir but I’d have still increased by 0.5u. IMHO, even though you just increased her dose today, I’d take her up to 5.5u tonight and see if that helps. If you don’t more than one yellow or lower nadirs, I’d increase to 6u bid after six cycles.

And I strongly urge you to not delay the testing for high dose conditions beyond 6u. Knowledge is power and there are things we can do to help the BG. There are also treatments for acro such as SRT (radiation) and cabergoline.

@Wendy&Neko is our acro expert and she’s out of the country now but should be back soon. Perhaps you want to call your vet about the testing and arrange an appt.

The tests for both co diatoms are done at Michigan State University, Here are the testing links:
Acro (IGF-1)
IAA

Paws crossed.

 

[JoyBee&Ravan]

It took me a really long time till I found a vet who was open minded & willing to listen to my ideas.

Trust the advice you get here from the long time advisors. They have a lot more knowledge than most vets about diabetes & other diseases our Kitties get. (Sad that Zoe probably got the diabetes from the steroids.)

Hope you keep searching for a more open minded Vet,but as I said it wasn't my vet that helped me with Ravan it was the people here.


Good Luck to you & Zoe

 

[Sue and Luci]

My first vet was useless - his advice when he diagnosed her with diabetes was to 'put her down' - I decided I'd try to help her! The second vet was only a little better - at least he said 'we need more pet parents like you!' who care enough about their pets to try to help them - I shared my SS with him - however his knowledge of the disease was limited - he prescribed some expensive DM food, 2 units of Lantus 2 x a day! and of course bring her back for this and that testing - 3rd vet did her dental and looked at the SS - but of course wanted me to bring her back for 'advice on dosing' (REALLY?) after looking at the SS she could see that I'd already been changing her dose as needed....oh well...I take what they say with a grain of salt. I ask for and get the prescriptions for Lantus, do the usual vaccines and then go about my business...

My conclusion is that the vets are under-educated about the specifics of feline diabetes - I accept that and move on. This group is far more knowledgeable about FD - listen to the people here and you'll fare better in the long run than what a collection of vets can SELL or tell you...

Hang in there...

 

[Squeaky and KT (GA)]

protocol because it wasn't vet ordered or designed and based on science

Oh good golly - wish you'd had the Roomp & Rand study/publication at your fingertips. That would have sidetracked that statement completely! The TR followed here IS fully approved medical based. Here's a link for your fingertips:

Roomp/Rand Protocol

Unfortunately I have a vet like that....we agreed to disagree on diabetic treatment long ago.

 

[Sybil and Zoe]

Oh good golly - wish you'd had the Roomp & Rand study/publication at your fingertips. That would have sidetracked that statement completely! The TR followed here IS fully approved medical based. Here's a link for your fingertips:

Roomp/Rand Protocol

Unfortunately I have a vet like that....we agreed to disagree on diabetic treatment long ago.

Thanks for the info. I tried to pull up the document on the german group study that is published in Feline Surgery Journal but I didnt have internet access and you have to pay $75 for access to the full journal article and not just the abstract. The closest vet school is 1 1/2 hour away and I am not sure the hospital library locally will carry vet journals. I feel like the Cat Clinic will be a lot more helpful once I get her switched. I just liked that this one was 24 hour Vet/emergency clinic. But I am burned on them.

 

[Sybil and Zoe]

There is a possibility that Zoe has a high dose condition like IAA (which is self limiting after a year but which we can help treat faster) or acromegaly. Have you read information on these conditions on the acro forum of this board? You mention she’s ravenous; does she have a pot belly (not all acro cats do)?

We recommend you test for IAA and acro when the dose gets to 6u bid. Keep doing what you are doing by taking the dose up per the TR protocol. However, when she hit 4.5u, you needed to be https://www.animalhealth.msu.edu/Bin/Catalog/Catalog_Test.exe?Action=Print&ID=1494taking it up by 0.5u increases as the TR protocol states dose increases should be 0.5u for nadirs over 300 and that’s where she is. She had one cycle on 5u with a yellow nadir but I’d have still increased by 0.5u. IMHO, even though you just increased her dose today, I’d take her up to 5.5u tonight and see if that helps. If you don’t more than one yellow or lower nadirs, I’d increase to 6u bid after six cycles.

And I strongly urge you to not delay the testing for high dose conditions beyond 6u. Knowledge is power and there are things we can do to help the BG. There are also treatments for acro such as SRT (radiation) and cabergoline.

@Wendy&Neko is our acro expert and she’s out of the country now but should be back soon. Perhaps you want to call your vet about the testing and arrange an appt.

The tests for both co diatoms are done at Michigan State University, Here are the testing links:
Acro (IGF-1)
IAA

Paws crossed.

Thanks so much. I have been wondering about it but haven't read the article yet. I do think she is developing the pot belly, now that you mention it. I wasnt sure if it was just her maturing age. Of course no mention of that from the vet . As I worry about her weight (which hasnt really changed at all) with all the food she consumes, I have noticed when walking behind her that her hips are slimmer than her abd area. (speaking of food--lol--she lays around a lot on the floor. She is bright but yet kinda of lethargic, but just let the timed feeder go off and she jumps up and races to the food bowl like a kitten!

I will raise her tonight. I appreciate so much your experience!

 

[Bobbie And Bubba]

I am sorry you were so dismissed at the vets today. Maybe it's time for you to dismiss your vet and find someone that will work with you and not against you. Maybe the cat vet clinic will be a better fit. I had to switch vets after Bubba's DX as my vet was not knowledgeable with Lantus and I wanted to switch from ProZinc AND he didn't want to teach me to test.....said he would teach me after we get Bubba regulated. That's a big oxy-Moran. How can you do that without knowing the numbers and guess he never heard about a cat going hypo. Geez. Good luck to you. Don't stay somewhere that isn't working you and Zoe.

As far as the testing times and her being hungry, how about it you split up her meals for every 3 hours through the cycle and test first before giving the small meal. That way her BG reading won't be food influenced. That's how I do it with Bubba.

 

[Sybil and Zoe]

All I can say is - I feel your pain in terms of the doctor's response!!! I have had the same experience with vets several times and it's so upsetting! I am meeting Dr. #4 on July 7 in hopes that the fourth time is the charm for Phoebe Squeak. I really hope you find someone who gets it. Hang in there! We are rooting for you and Zoe!

Same goes for every one rooting for Phoebe Squeaks!

 

[Olive & Paula]

Ahh Drs. Been there as many of us have. I had to change Ollie to a new vet to get her acro med . Because Dr nor I have any experience with it, I had to sign a liability release and agree to a few conditions such as routine fructosamine tests. She had her first fructosamine and they haven't done one since. After a few visits and getting to know me, I guess she is comfortable letting me dose insulin as needed. And now comfortable if I think the acro med needs a tweek. She does admit Ollie is a challenge for her, she has instructed her office to get me in if I call saying she needs to be seen. She also keeps the associate Dr up to date with Ollie in case she isn't in and the associate needs to see her so she is familiar with her. We do discuss everything, she listens, we don't always agree but we find a happy medium. She loves the ss although it's a copy of this one, it has much more info on it. Certainly more expensive than previous vet.

Even when you find one that will work with you, sometimes you have to smile and nod. What you do at home they don't know until you tell them. We do need them for meds, illness, sometimes tests, etc.

 

[Sybil and Zoe]

I am sorry you were so dismissed at the vets today. Maybe it's time for you to dismiss your vet and find someone that will work with you and not against you. Maybe the cat vet clinic will be a better fit. I had to switch vets after Bubba's DX as my vet was not knowledgeable with Lantus and I wanted to switch from ProZinc AND he didn't want to teach me to test.....said he would teach me after we get Bubba regulated. That's a big oxy-Moran. How can you do that without knowing the numbers and guess he never heard about a cat going hypo. Geez. Good luck to you. Don't stay somewhere that isn't working you and Zoe.

As far as the testing times and her being hungry, how about it you split up her meals for every 3 hours through the cycle and test first before giving the small meal. That way her BG reading won't be food influenced. That's how I do it with Bubba.

That is pretty moronic to say he will show you after regulation. SMH I do think it is time for a change. I am due to take a few days at the 4th of July holiday to go to the beach and I will have to kennel her so I may have to depend on them until after that. At least the one vet who works nights knows her and likes her a lot.

As far as the feeding goes, I do always test feed shoot in the morning and pm and have tried to keep the extra food between the am shot and nadir and same with the pm. Thank you for your support!

 

[Ti-Mousse (GA) Pepe (GA)]

Sorry about your vet experience! It's not easy to find a vet that knows about FD who is willing to treat kitty with you, using the new methods !
When Ti-Mousse was diagnosed, my vet asked if I wanted to put him down or treat him, what a question.. She sold me all her DM junk and told me to be back in a month for a curve and new dosing (no home testing needed); I was not happy, found the Forum and sent her the Roomp and Rand protocol that I had started to follow, together with my spreadsheet, hoping she would be interested and we could work together! She thought it was very interesting but did not have time to follow Ti-Mousse anymore... So since then, my vet is the Forum...and I can't find a better one!!

 

[Marje and Gracie]

Thanks so much. I have been wondering about it but haven't read the article yet. I do think she is developing the pot belly, now that you mention it. I wasnt sure if it was just her maturing age. Of course no mention of that from the vet . As I worry about her weight (which hasnt really changed at all) with all the food she consumes, I have noticed when walking behind her that her hips are slimmer than her abd area. (speaking of food--lol--she lays around a lot on the floor. She is bright but yet kinda of lethargic, but just let the timed feeder go off and she jumps up and races to the food bowl like a kitten!

I will raise her tonight. I appreciate so much your experience!

Apologize that I didn’t directly answer your question but I knew others were and I felt I’d be remiss if I didn’t give you some guidance on the dosing and also provide you some thoughts on the high dose conditions. Normally, if someone told me the hips were smaller than the belly, I’d wonder if it was muscle wasting that we see in older cats or cats with CKD. But she’s too young for the muscle wasting that comes with age and I’m making the assumption she doesn’t have CKD.

I’ve seen vets say and recommend some pretty crazy things here over the years. Early on, I even had a vet tell me I was killing Gracie because she was dropping into the 70s on a human meter and that she wasn’t diabetic. Well.....I did drop her a dose a tiny bit and she went sky high. She was diabetic 5.5 years. I see that vet around town sometimes and want to show her Gracie’s SS again but I don’t. Thankfully, I found our current vet right after that and she has always been a true blessing.

 

[Sienne and Gabby (GA)]

I'm attaching the actual journal article on the TR protocol. Feel free to e-mail it to your vet. The study was published in a leading veterinary journal. So much for your vet being up to date with the literature -- especially since the protocol was published in 2013. Jacqui Rand, DVM is no slouch when it comes to feline diabetes research.

Many people here consult with their vet for things other than their cat's diabetes.

I agree with Marje. I would get Zoe tested for a high dose condition. If your vet gives you a hard time, suggest that he "humor" you. Acromegaly is far more common that what most vets were taught in school.

 

[Bron and Sheba (GA)]

It's such a shame that many vets have such closed minds when it comes to new ways and new treatments. The whole medical profession is very resistant to change. If it were not for trailblazers who stuck to their guns for change and advancement we would still be in the dark ages. We have a brain surgeon here in Australia who is blazing a new trail by treating patients when other brain surgeons won't touch them, and having success, but he is being howled down by the medical profession.

I think your vet, by refusing to look at your SS and TR is showing disrespect to you. If he was really interested in FD he would grab the chance for new ways and information. You need a vet who will work with you in partnership and not be a dictator.......those days are long gone now that the general public is better educated.
My vets handed me the Roomp and Rand literature plus another information sheet when Sheba was first diagnosed and they used to consult it all the time religiously. This was pre forum days for me and we got Sheba OTJ after 3 months. 2 1/2 years later she fell out of remission and it was much harder to get the numbers down the second time around. Then I found the forum and my vet was very open to all I told him and would read things I sent him.........one of the other vets was sceptical about how often I tested but I just didn't discuss FD with her much but I liked her a lot and I am sure she has learned a lot from Sheba.
I would suss out the vets with the link to FD.
@Bobbie And Bubba I had to laugh at the vet who would teach you to test after Bubba was regulated. Talk about putting the horse before the cart and how little he knew about FD!

 

[Sybil and Zoe]

Apologize that I didn’t directly answer your question but I knew others were and I felt I’d be remiss if I didn’t give you some guidance on the dosing and also provide you some thoughts on the high dose conditions. Normally, if someone told me the hips were smaller than the belly, I’d wonder if it was muscle wasting that we see in older cats or cats with CKD. But she’s too young for the muscle wasting that comes with age and I’m making the assumption she doesn’t have CKD.

I’ve seen vets say and recommend some pretty crazy things here over the years. Early on, I even had a vet tell me I was killing Gracie because she was dropping into the 70s on a human meter and that she wasn’t diabetic. Well.....I did drop her a dose a tiny bit and she went sky high. She was diabetic 5.5 years. I see that vet around town sometimes and want to show her Gracie’s SS again but I don’t. Thankfully, I found our current vet right after that and she has always been a true blessing.

Her labs have been ok kidney wise unless something has happened just recently. I think the hip belly ratio is minor but I don't know. I don’t want to add worries right now. I read the information on the acro kitties and I pray that is not going on. She doesn't appear to have any of the growth issues like facial features or large feet. It could be early yet. I might start measuring her “waist”. I do think her diabetes was steroid induced though she never got more than 3 shots a year. Weirdly enough, she has not been troubled by allergies or the constant licking and gnawing since her diagnosis. It makes me think it most likely food induced since diet is the only real change even though it did seem to be seasonal when it would flare.

I definitely will be looking elsewhere for vet care. I would love to give them copies of the studies.

 

[Sybil and Zoe]

It's such a shame that many vets have such closed minds when it comes to new ways and new treatments. The whole medical profession is very resistant to change. If it were not for trailblazers who stuck to their guns for change and advancement we would still be in the dark ages. We have a brain surgeon here in Australia who is blazing a new trail by treating patients when other brain surgeons won't touch them, and having success, but he is being howled down by the medical profession.

I think your vet, by refusing to look at your SS and TR is showing disrespect to you. If he was really interested in FD he would grab the chance for new ways and information. You need a vet who will work with you in partnership and not be a dictator.......those days are long gone

I agree 100% about the medical profession’s resistance to change. Nutrition is another area they have practically zero experience or instruction and you would think with the explosion of obesity and diabetes more would pursue it.

There is a possibility that Zoe has a high dose condition like IAA (which is self limiting after a year but which we can help treat faster) or acromegaly. Have you read information on these conditions on the acro forum of this board? You mention she’s ravenous; does she have a pot belly (not all acro cats do)?

We recommend you test for IAA and acro when the dose gets to 6u bid. Keep doing what you are doing by taking the dose up per the TR protocol. However, when she hit 4.5u, you needed to be taking it up by 0.5u increases as the TR protocol states dose increases should be 0.5u for nadirs over 300 and that’s where she is. She had one cycle on 5u with a yellow nadir but I’d have still increased by 0.5u. IMHO, even though you just increased her dose today, I’d take her up to 5.5u tonight and see if that helps. If you don’t more than one yellow or lower nadirs, I’d increase to 6u bid after six cycles.

And I strongly urge you to not delay the testing for high dose conditions beyond 6u. Knowledge is power and there are things we can do to help the BG. There are also treatments for acro such as SRT (radiation) and cabergoline.

@Wendy&Neko is our acro expert and she’s out of the country now but should be back soon. Perhaps you want to call your vet about the testing and arrange an appt.

The tests for both co diatoms are done at Michigan State University, Here are the testing links:
Acro (IGF-1)
IAA

Paws crossed.

I did the increase. As you can see my last check was at +6 she was 307 from pmps 329. This morning she has climbed at +3 to 395 from amps of 347. I have to ask this question and since you are so knowledgable I wanted to ask your opinion. When she was switched to Lantus I ordered a vial from Canada pharmacy. Because I didnt want to wait for it to arrive, I purchased 2 pens from a member. They are clear and give me no reason to suspect they have gone bad except for the lack of yellows in her ss. I notated when I started a new pen on the ss. Here is my question. They were shipped from here in the US and arrived 2 days after shipping, but they were not packed in ice so they spent a day or two in high 80's heat through mail delivery. I don't want to waste them ( I did start the 2nd pen before 1st one was depleted ) if they are good, and I dont want to puncture the new vial too soon. ( I also have 5! vials of unopened lantus that my aunt gave me since she has switched to basaglar, but the exp date was 3/19, so I am uncertain about them as well.They have always been refirgerated). Do you think that there is a possibility that the insulin is not good by looking at her ss? Or is it more likely just a case of her insulin resistance and being a hard nut to crack. I dont want to start the new vial since at 5-6 units it will only last about a month

 

[J.J. and Phoebe Squeak]

@Bobbie And Bubba I had to laugh at the vet who would teach you to test after Bubba was regulated. Talk about putting the horse before the cart and how little he knew about FD!

Here's another one you that may give you a laugh... Dr. (After I explained I wanted to test BG) "The goal is finding the right dose for her so you never have to test again. Most people never test at all. They just give the shots and their cats are fine."
This was the doctor I met after the other doctor who took one look at the SS and said there was no need to "micromanage" Phoebe Squeak's diabetes. And no need to test for keytones unless she was acting sick.
I'm still searching for the right one. I feel like I need a dating app for vets!

 

[Sybil and Zoe]

Here's another one you that may give you a laugh... Dr. (After I explained I wanted to test BG) "The goal is finding the right dose for her so you never have to test again. Most people never test at all. They just give the shots and their cats are fine."
This was the doctor I met after the other doctor who took one look at the SS and said there was no need to "micromanage" Phoebe Squeak's diabetes. And no need to test for keytones unless she was acting sick.
I'm still searching for the right one. I feel like I need a dating app for vets!

OMG!! lol

 

[Marje and Gracie]

I agree 100% about the medical profession’s resistance to change. Nutrition is another area they have practically zero experience or instruction and you would think with the explosion of obesity and diabetes more would pursue it.

I did the increase. As you can see my last check was at +6 she was 307 from pmps 329. This morning she has climbed at +3 to 395 from amps of 347. I have to ask this question and since you are so knowledgable I wanted to ask your opinion. When she was switched to Lantus I ordered a vial from Canada pharmacy. Because I didnt want to wait for it to arrive, I purchased 2 pens from a member. They are clear and give me no reason to suspect they have gone bad except for the lack of yellows in her ss. I notated when I started a new pen on the ss. Here is my question. They were shipped from here in the US and arrived 2 days after shipping, but they were not packed in ice so they spent a day or two in high 80's heat through mail delivery. I don't want to waste them ( I did start the 2nd pen before 1st one was depleted ) if they are good, and I dont want to puncture the new vial too soon. ( I also have 5! vials of unopened lantus that my aunt gave me since she has switched to basaglar, but the exp date was 3/19, so I am uncertain about them as well.They have always been refirgerated). Do you think that there is a possibility that the insulin is not good by looking at her ss? Or is it more likely just a case of her insulin resistance and being a hard nut to crack. I dont want to start the new vial since at 5-6 units it will only last about a month

Unopened Lantus is fine as long as the temperature does not exceed 86 deg F. At 4.5u, she only had one yellow and that was before you started the pen. I wouldn’t use the expired insulin from your aunt. It might be fine and I’ve seen other members use expired insulin with no issue provided it’s been properly stored and cared for. However, if I could afford unexpired insulin, I wouldn’t use expired.

Zoe’s SS is “interesting” from the standpoint that she was seeing more yellow at lower doses but she’s not overdosed because you’ve been very careful about increases. Even with the yellows she was getting, with meter variance, she was still pretty flat. She had a little variation, but not a lot. So we know that overdosing is not an issue for all the pink.

If you look at Pig’s SS (acro), 2018 tab, you’ll see he sometimes went higher with an increase (e.g. look at increases after 18u). Likewise, the same thing happened to Crystal. You can also look at BK’s SS. He had severe IAA. Sometimes he went higher with dose increases.

Many things can affect the BG including absorption differences (which can vary more than we realize) and even changes to barometric pressure.

I’ve changed pens before when I thought the numbers seemed higher and it wasn’t the pen. I did have one instance where it was. It’s hard to really know. Instinctively, if the insulin is not cloudy and doesn’t have floaties, it’s most likely Zoe. But I don’t have a way of guaranteeing that so it’s up to you as to whether you want to try a different source for the insulin. Wish I had a better crystal ball!

 

[Wendy&Neko]

I just got back in town and am catching up on tags (and laundry, bills, etc! ).

One in four diabetic cats has acromegaly, it is not uncommon. You think vets don’t know much about diabetes, you should test their knowledge on acromegaly. I had to. Any vet taught before 2015 was mostly likely taught “this is acromegaly, it is so rare you will never see it”. Research showing how common it is is recent.

Today is cycle five on this dose, unless you see blue tomorrow, I would increase to 6.0 units tomorrow night. The thing with insulin resistance, IAA or acromegaly, or both as Neko had, is that you have to keep on top of the increases. Either the action of the antibodies, or the benign pituitary tumour that causes acromegaly can change over time, changing the amount of insulin needed. It is not uncommon to get better numbers on a lower dose then to need more insulin and possibly see worse numbers for a bit. For me, sometimes it felt like trying to catch a speeding train, as my mentor Julie called it.

 

[Bellasmom]

I think we have all had bad experiences with a vet, I switched my vet because he had me crying saying I didn’t care about Bella because I wasn’t bringing him in for curves, I showed him my ss and he basically snubbed his nose, I walked out and never returned, I have an awesome vet now!
So sorry you had to go through that

 

[Sybil and Zoe]

Wow.thank you both. Wendy I appreciate your knowledge on this matter. I try not to get discouraged but I do. I dedicate almost all my waking hours -that is not spent in working -to this cat and I can’t help her. Numbers are unchanged and ketones normal but she lays around on her side on the kitchen floor almost all the time now even sleeping there. I feel the warm spot when I come down in the mornings. She comes when I call her and gets up to get her poor little ears pricked (i see the bruising When light is behind them). Her fur sometimes looks raggedy if that makes sense. She is such a sweet kitty. Her begging is much less now and I think that it in part to the feeding about every 3 hours. Perhaps her attachment to the kitchen floor is waiting for the timed feeder to open. I just don't think she feels as good lately though I have nothing more to go on. Bowel and bladder habits seem the same and no vomiting.

I am going to have to kennel her for the 4th through the weekend while I am away. I don’t want to change vets before then. My usual vet who works nights a s weekends I feel will be more open but I cant be sure. I will go this time armed with the Romp and Rand study I have printed and ask about the insulin antibody test and acromegaly. (I hope this is ok- i typed on iphone and its hard to proof read. Lol)

 

[Olive & Paula]

Sybil, I remember feeling that way. Before we knew of any issues Ollie had except for the diabetes. Vet said to give her time to settle in (she just arrived to me), let the insulin build up (only had starting dose a few days).

But Ollie continued to look awful, miserable, no stamina, flopped side to side constantly trying to get comfortable. It seemed no one was interested in trying to help her and I didn't know what to do anymore. 3 vets who flatly refused to help unless I did their way only. There were days I was ready to give up, many days in tears, thinking free from all of it would be best. FDMB has been here for us, boosted me up when needed, firm but gentle pep talk when needed. Cheers when she hit a good milestone. Breathe, keep trying, keep moving forward, vent, we are all here for you.

 

[Sybil and Zoe]

Thank you Paula. I can't imagine what it would be like if I had not found FDMB! It truly is a Godsend.

 

[learjetta]

I feel like I need a dating app for vets!

OMG YES!

 

[Sybil and Zoe]

Today is cycle five on this dose, unless you see blue tomorrow, I would increase to 6.0 units tomorrow night. The thing with insulin resistance, IAA or acromegaly, or both as Neko had, is that you have to keep on top of the increases. Either the action of the antibodies, or the benign pituitary tumour that causes acromegaly can change over time, changing the amount of insulin needed. It is not uncommon to get better numbers on a lower dose then to need more insulin and possibly see worse numbers for a bit. For me, sometimes it felt like trying to catch a speeding train, as my mentor Julie called it.

I think I blew it this morning and gave another fur shot, so the 6pm test will be jacked up. I use the roll method. I was giving it on her side and even though I roll her skin though I rarely see skin even if she is a short haired cat. It's the worst time to make this mistake (#6 out of the cycle). She was hungry and ate her food, but I was shocked to see she didn't eat her 3am feeding nor the 12 am. She may have eaten a little but usually she has cleans her plate. That is unlike her. Her BS was 329 this morning. I didn't check for ketones Her poo was a little softer this morning but I gave her some coconut oil last night and I figure that may have been what caused the softer poo.

I just got home from work and she was eager to eat. She ate her other mini meals at 12 and 3 pm. I checked her BS and it was 366 which is not different than what it has typically been running. I feel sure her fur got more insulin this morning than her skin. I felt wet and smelled the insulin. Which brings me to my question. As I have mentioned I have my vial unopened from Canada and been using a pen I just opened 6/7/19.Then pens came through the mail and may have been exposed to heat as it was not insulated or cooled and the temps were in high 80s at that time I believe. Since I am perplexed by her BS this evening not being different if she went without insulin this morning. I am considering opening the new vial but here is my fear: what if the insulin pens were degraded and lost potency. The only Lantus she has had since switching from Vetsulin was from the two pens. I am scheduled to go up to 6 units tonight as I have completed the 6 cycles at 5.5 (though this morning may have been fur shot). What if its full potency and the pens were not? Geez I am a little hesitant for that reason. What do you think about her BS this eveing not being higher than it has been? I am going to wait a short bit to seek advice from others before I shoot her insulin (she has just finished eating). Does it surprise anyone if she missed her insulin this morning that her numbers are not much higher????

 

[Sue and Luci]

Here's another one you that may give you a laugh... Dr. (After I explained I wanted to test BG) "The goal is finding the right dose for her so you never have to test again. Most people never test at all. They just give the shots and their cats are fine."
This was the doctor I met after the other doctor who took one look at the SS and said there was no need to "micromanage" Phoebe Squeak's diabetes. And no need to test for keytones unless she was acting sick.
I'm still searching for the right one. I feel like I need a dating app for vets!

I second the OMG! Can you imagine? With what I know now - it's so very obvious that the vet in question here has no knowledge whatsoever about diabetes. Sometimes I wish they'd just say ' I just don't know anything about diabetes in felines, so I can't give you any advice - why don't you Google it'! That would be better than the bad (deadly)advice they give their patients - and then have the audacity to ask for payment for that very same bad advice. Better none at all than bad...thank you very much.

Getting down off my soapbox now.... sheesh...

 

[Sue and Luci]

What do you think about her BS this eveing not being higher than it has been?

One thing that came to my mind with this question is that Lantus is a depot drug. It tends to build up with each dose - when hopefully a good level is reached in the depot, the BG's come down - it's hard to say where the depot is - because unlike a measuring cup, we can't tell how full or empty it is at any given time. Sometime when we give insulin kitty will go too low even after lowering the dose or missing a dose due to the action of the depot - all the more reason to keep testing. I have heard various comments about the effectiveness of Lantus - some people use it past the expiration date, some have left it out of the refrigerator - and I understand that people carry their pens in their pockets and purses (although for hoomans the pens are not intended to last as long as for our kitties)....I tend to lean to keeping product longer than manufacturer expiration dates - and take those as a suggestion rather than a 'use by' date. I've often wondered why manufacturers won't put the date something was created at the factory rather than when they think it's going to expire - especially when they don't know how the product was maintained (some things last longer frozen, refrigerated, etc. than sitting in someone's purse!)...

Based on Zoe's SS, I don't think you've gotten to the sweet spot just yet...however, there are others here who may offer a different view of things. I was wondering if you are in a position to purchase just one Lantus pen at the store - bring it home and give it a try - keeping the others in the fridge - see if there's any change in Zoe's BG without changing anything else.

The FS's are going to make it even more difficult to determine the efficacy of the insulin - but I tend to think for the most part the insulin isn't to be blamed..just my two cents.

 

[Sybil and Zoe]

One thing that came to my mind with this question is that Lantus is a depot drug. It tends to build up with each dose - when hopefully a good level is reached in the depot, the BG's come down - it's hard to say where the depot is - because unlike a measuring cup, we can't tell how full or empty it is at any given time. Sometime when we give insulin kitty will go too low even after lowering the dose or missing a dose due to the action of the depot - all the more reason to keep testing. I have heard various comments about the effectiveness of Lantus - some people use it past the expiration date, some have left it out of the refrigerator - and I understand that people carry their pens in their pockets and purses (although for hoomans the pens are not intended to last as long as for our kitties)....I tend to lean to keeping product longer than manufacturer expiration dates - and take those as a suggestion rather than a 'use by' date. I've often wondered why manufacturers won't put the date something was created at the factory rather than when they think it's going to expire - especially when they don't know how the product was maintained (some things last longer frozen, refrigerated, etc. than sitting in someone's purse!)...

Based on Zoe's SS, I don't think you've gotten to the sweet spot just yet...however, there are others here who may offer a different view of things. I was wondering if you are in a position to purchase just one Lantus pen at the store - bring it home and give it a try - keeping the others in the fridge - see if there's any change in Zoe's BG without changing anything else.

The FS's are going to make it even more difficult to determine the efficacy of the insulin - but I tend to think for the most part the insulin isn't to be blamed..just my two cents.

Thanks for your two cents! Every bit of advice is good and appreciated and helps me build on my knowledge.

I am going to discuss it all with the vet later because update: she is at the vet now. She was crying and acted like she was going to pee on something again-a plastic bag- and didn't (I think because she couldnt). I grabbed her up and took her to the vet. She has not received her pm insulin shot either but they know. I feel much better that the vet, who discovered her diabetes and has been treating her, is there ( he works nights and weekends) and not the one that made me SO ANGRY the other day when I took her in to have her checked for similar behavior. I took the Romp and Rand study this time and I think he will be more willing to listen to me. I came home to try and email them the link to her spreadsheet. Poor baby I hope she doesnt have a stone or something.

 

[Olive & Paula]

Keep us posted.

 

[Sybil and Zoe]

I am back and no UTI but her white count was elevated. ? pancreatitis brewing? All her other blood work looked great he said. Her glucose was ofcourse 456. He looked over the study and the spread sheet and felt like I was treating her appropriately. We talked briefly about her being hard to get under control and he did say it was baffling and his concern that there might be a tumor. At that point I brought up concern that she might have acromegaly. He said it could be a possibility. I forgot to bring up testing for IAA, but I feel sure he would be open to that.

I am off schedule now since I couldnt give her insulin until 9:30 . I did give her the 6 units. I will have to give her morning shot though at 8:00 right before I leave.

 

[Sybil and Zoe]

Based on Zoe's SS, I don't think you've gotten to the sweet spot just yet...however, there are others here who may offer a different view of things. I was wondering if you are in a position to purchase just one Lantus pen at the store - bring it home and give it a try - keeping the others in the fridge - see if there's any change in Zoe's BG without changing anything else.

The FS's are going to make it even more difficult to determine the efficacy of the insulin - but I tend to think for the most part the insulin isn't to be blamed..just my two cents.

I think you maybe right. After we got home from the vet and I was able to give her the pm dose of insulin after I rechecked her BG was 395 (6 units) @9:30. Her BG @ +2 was 291! but thats a fairly big drop.

 

[J.J. and Phoebe Squeak]

Wow, I have no advice to offer you but I'm sending support. I really hope this all gets easier for you and Zoe soon.

 

[Marje and Gracie]

Sybil

I’m glad she didn’t see too high of numbers with the FS. It happens to all so don’t fret. She recovered! I hope the 6u dose works for her. I saw he was open to considering that she might be acro but he didn’t go ahead and draw flood while she was there? Any idea when that might happen?

This condo is getting really long so would you mind, please, starting a new one every day We really appreciate it.

 

[nslade001]

I
I am off schedule now since I couldnt give her insulin until 9:30 . I did give her the 6 units. I will have to give her morning shot though at 8:00 right before I leave.

Hi, I'm just randomly reading threads and came across yours I'm not familiar with Zoe and have zilch experience with high dose kitties, and maybe you've done it before and are confident with her response...But I wanted to say that normally we wouldn't shoot more than an hour early in a day since it can act as a dose increase, unless you can monitor closely. (It sounds like you're planning on shooting 1.5 hours early tomorrow before leaving?) Unless you're planning a reduced dose? Sorry if I misunderstood Zoe's lucky to have you for a mom.
With love, Nikki

 

[Sybil and Zoe]

I have been dosing her for 8 months without much variance, so yes I did shoot early this morning. I didn't have a choice because i had to leave for work. She has been doing ok. I plan to shoot 1/2 hour early tomorrow to work her back to her normal times of 6&6. It would be nice to not have to get up at 530 every morning including weekends, and sleep to near 8 on a Saturday, but weekdays it doesn't leave me any room to do a spot check before i leave at 8, so I dose her normally at 6 and get a +2. She has been so resistant to any dose thus far. I know it can be risky but for 8 months she has been stubbornly unmoved through vetsulin and now lantus. I was about to give up feeling like nothing was going to work. But the increase has lowered her somewhat and at least it gives me hope the magic dose to get her into more normal range is not an impossibility. If i need to leave her at 8& 8 for a while I can but she has not shown any sign of dropping too low. I know that doesn't mean it can’t happen. Thanks

 

[nslade001]

I

Time adjustments are a bugger, and sleep is necessary. You're doing a great job It's sort of weird to almost hope for a disease diagnosis, but the knowing allows some relief...I hope Zoe has a breakthrough dose soon! With love, Nikki

 

[Pamela & Amethyst]

SO SORRY! I have had the same experience with Amethyst. We went thru 2 Vets and finally found an Angel of a Mobile Vet who completely agrees with everything here and her Cabergoline Treatments!!! Are you in Mass? If so look up Dr Cheryl Pickering