7/16 - Mačka AMPS 696 after lows last evening BUT NO PANCREATITIS

Penelope and Mačka

Penelope and Mačka

Member Since 2019
http://www.felinediabetes.com/FDMB/...-now-low-amps-533-2-404-5-582-pmps-92.216870/

OK, so.... After his spectacular hypo right before the evening shot, Macka stayed high during the night. I could sleep 3 hours, not more. I think he is bouncing, but let's see what the numbers say today. Vet said that maybe the fluids activated the insulin under the skin a little late? can this be a possibility?
He's on a reduced dose of 1.25.
I would like to bring him back to his regular schedule. Can I move the shooting time of 15 minutes backward without any harm? I really want to play it safe.

He had an ok appetite today, and solid stools. I think he might have had a Tiki stix overdose, because yesterday he hardly had any, and today his transit is better. Or it could just be the fluids at the vet.

This is what the other vet wrote to me this morning, it couldn't be more confusing and in contradiction with everything I read on this forum. It makes me feel bad that I have two vets giving me advice, but I am not following any. Who knows best?

VET => "Once a day dosing seems like a good idea for now, although with the caveat that I think it may help a little bit with regulation but not solve things definitively. I would keep him at 1.75U for once a day dosing. His pancreatitis level is still pending, we'll let you know when that comes in. "

Also, he has his appointment with an Specialist Vet on Thursday morning. Will they tell me again something completely different?
 
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Too bad you couldn't get better sleep last night but 3 hours is better than 0 hours :P

I don't think it was very good advice that your vet gave you about once a day dosing. I wonder how familiar they actually are with Lantus? Because it's a depot style insulin, it is very important to use twice a day dosing, otherwise the depot doesn't have a chance to build and the insulin wont take full effect. Additionally, the duration of Lantus is typically only 12 hours so by using once a day dosing you would basically be ensuring that Macka will always have high BG levels at night. One other important piece to this puzzle is that Macka has recently suffered from a DKA event, not enough insulin isn't really an option for him, he needs insulin consistently right now to prevent another instance of DKA. You have to do what you think is best, and what you're most comfortable with, I recommend doing some research on how Lantus works as an insulin in cats, so that you can make your own confident decision on what to do :)

What great news that Macka has had some positive results about his pancreas! That must be such a relief for you, you have done such a great job for Macka! he's so lucky to have you!

You can definitely move Mackas dose time back 15 mins! move it back 15 mins each day until you're back on the schedule you want :)

Congrats again on the good news about Mackas pancreas :D
 
Thank you @AmandaE !
Despite all the darkness in here, I feel so relieved his pancreas is not inflamed. It was a month ago!
Little baby will just bounce for three days again I guess, and then we will see how effective the new dosage is. There was so much bouncing in the last month that I actually never saw a normal curve and the real effect of insulin on him, apart from maybe three times?

I honestly don't understand my vets, after what I've been learning here. I feel bad contradicting them and admitting I am not going to follow their advice, so I haven't replied to their email yet... ^^;
Still, I will read some more about Lantus and try to understand how they came up with this idea. For now, I feel comfortable enough giving him his 1.25 dose time a day.

I was thinking of starting Dasuquin for his joints (yes, arthritis, poor baby limps). It worked well for him in the past. Is there any contraindication with diabetic cats?
 
Yay no pancreatitis!!!! This is great news!!

Penelope, as you know I'm very new to this too, so I don't have a lot of knowledge relatively speaking. I can only share my anecdotal experience. My vet told me to shoot only once a day and I tried it for two days. It was a terrible decision and seeing the results completely broke my confidence in her advice. I will never go back to her. I really believe she does not understand lantus. Fig's SS shows the results.

This was my first post in the lantus ISG! "Bad dosing advice from vet??" :facepalm: http://www.felinediabetes.com/FDMB/...-372-at2-s-bad-dosage-advice-from-vet.216410/
(I can't believe that was less than two weeks ago only...)

I got some very helpful opinions here: http://www.felinediabetes.com/FDMB/threads/7-8-figaro-amps-456-10-364.216564/#post-2402488
Edit: thanks @AmandaE :)

For me, I just decided, whatever I have to do, maybe I have to offend a vet, I need to do what's best for Figaro to the best of my capability. I'm not saying you should blow off your vet necessarily, but do remember Macka is your cat and you can be his advocate :bighug:
 
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Insulin is not a drug. It is a hormone. Since the pancreas has stopped producing that hormone, it is important to find the right dosage, increase and decrease in small increments to find that right dosage, AND to dose twice a day to create a depot and prevent massive fluctuations.

Your goal with Lantus is to eventually get to blue and high green numbers on a regular basis. I know it feels scary to you right now, but blue numbers are perfectly safe. So are high greens. High greens are lovely. The next time your cat is in blues or high greens, feed LC and post if you are worried. Someone will come along and help you learn how to keep your cat surfing along happily in the blues for as long in the cycle as possible.
 
Penelope and Mačka said:
Thank you @AmandaE !
Despite all the darkness in here, I feel so relieved his pancreas is not inflamed. It was a month ago!
Little baby will just bounce for three days again I guess, and then we will see how effective the new dosage is. There was so much bouncing in the last month that I actually never saw a normal curve and the real effect of insulin on him, apart from maybe three times?
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It's no problem! I am happy to be as helpful as I can :)

I think what you need to work most at is just getting comfortable with Blue and green numbers, they're healthy and exactly what you want for Macka. As time goes on you will gain this confidence :) With time, as Macka experiences more and more lower numbers he will potentially bounce less.

Penelope and Mačka said:
I honestly don't understand my vets, after what I've been learning here. I feel bad contradicting them and admitting I am not going to follow their advice, so I haven't replied to their email yet... ^^;
Still, I will read some more about Lantus and try to understand how they came up with this idea. For now, I feel comfortable enough giving him his 1.25 dose time a day.
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I think a dose of 1.25 2x/day (BID) is better than 1.75u 1x/day...I just don't agree with that course of action!

Having conflicting information between the vet and the board is hard, but like @Figaro's Liz said, typically experience will lead you toward the board. That's what happened to me too. Mowgli had started on Caninsulin, they started him on 5u. Everyone here said it was a high starting dose so I looked it up on the caninsulin webpage and sure enough it stated that beginner doses shouldn't start above 2u. Even the very most basic research showed me that my vet hadnt done the due diligence on the insulin Mowgli was on. It became an easy decision for me to trust people here more ;) Of course, some vets are amazing and open minded... i forget who it was... maybe Carla? who brought information about tight regulation into her vet and the vet was so impressed that she adopted as the treatment for vets at her practice!

My favorite advice from that initial post of Liz's is was from @Sue and Luci who said:
Yes, it's nice to have a vet for other things - but you don't have to have a confrontational relationship with a vet who doesn't understand feline diabetes - just say, yes, uhm...thank you, uhm...etc. Go along with what they say about other things and don't get into a big conversation about the diabetes...there's plenty of literature here on the forum that you could print and give to your vet - if you think she's interested and wants to learn...
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Amazing!

Penelope and Mačka said:
I was thinking of starting Dasuquin for his joints (yes, arthritis, poor baby limps). It worked well for him in the past. Is there any contraindication with diabetic cats?
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I have no experience at all with this, it might be a good idea to post that question in the main health forum where there are more eyes with more experience with cats :)
 
Figaro's Liz said:
This was my first post in the lantus ISG! "Bad dosing advice from vet??" :facepalm: http://www.felinediabetes.com/FDMB/...-372-at2-s-bad-dosage-advice-from-vet.216410/
(I can't believe that was less than two weeks ago only...)

I got some very helpful opinions here: http://www.felinediabetes.com/FDMB/threads/7-8-figaro-amps-456-10-364.216564/#post-2402488
Edit: thanks @AmandaE :)

For me, I just decided, whatever I have to do, maybe I have to offend a vet, I need to do what's best for Figaro to the best of my capability. I'm not saying you should blow off your vet necessarily, but do remember Macka is your cat and you can be his advocate :bighug:
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Wow @Figaro's Liz look how far you have come already! it's such a steep learning curve but you picked it up quickly :D I too think you made the best decision when you ditched the emergency vets advice!

I think your point about Macka being Penelope's cat is the very most important! You get to decide, Penelope, do your research and trust your gut, we will be here to support you and to give you feedback on how to potentially gain the support of your vet :)
 
A point of clarity, Macka was in normal numbers last night, not down where hypo symptoms could be present. We only call it a “hypo” if there are hypo symptoms. Otherwise it’s just a low numbers event, and Macka wasn’t even in low numbers. One day soon, I hope, you will wish for Macka to be in normal numbers as long as possible. That is where true pancreatic healing occurs.

A normal spec fPL (yeah!) does not mean his pancreas is healing, but rather that he does not have pancreatitis. That is excellent news, it is a painful condition.

I agree with the others, ignore your vet’s insulin dosing recommendations. They get less than a day on diabetes training, on cats and dogs. Depending on your vet’s age, they might not have gotten any training on depot insulins at all. I liked my vet for most things, but got better information on diabetes here. 1.25 units twice a day is what I suggest too. @AmandaE not Carla, she follows SLGS, but I have heard several others say their vets adopted TR.

Cats here have been on Cosequin or Dasequin with no impacts on blood sugar. I gave Cosequin for a while, but it didn’t do much for Neko’s arthritis.

You can move your shot time back 15 minutes a cycle, or 1/3 hour once a day. Last night I suggested you could move it up even more, just one time. He is so high. :( Those numbers aren’t good for his kidneys.
 
Correct me if I'm wrong, but I went through yesterday's post too. Did Macka display symptoms of hypoglycaemia? I was told that we use hypo when cats display hypo symptoms and are in low numbers. Just a small thing I'm picking on because I would act very differently if a cat was hypo or if a cat was just having very low numbers.

Edit: ah I see @Wendy&Neko beat me to it!

You can also move Macka's schedule back 30 minutes once a day or 15 minutes twice a day.

I saw an IM specialist as well. At the time, she was helpful with getting Ming started on Lantus (he was on PZI before) but her dosing techniques were incredibly crazy and those who were with me on the forum at the time, dubbed my introduction to Lantus as introducing Lantus ON FIRE. Lol!!! I think it would be beneficial to see if the Specialist will find any other underlying issues that might be making Macka feel bad. Or give you more options and open doors for you to other alternative supportive treatments (example: maybe the specialist will ok ondansetron and write you a prescription.)

Macka is your cat. You hold the syringe. Going against your vet sucks and I know it (I work with them!) but I've somehow gotten past it. My vet still pokes fun at me for changing up Ming's insulin but she sees Ming's results and is very happy with it so there's no argument there. I think once Macka gets in good numbers, it'll help you justify to yourself about going against vet orders. But again, ultimately. you hold the syringe and whether you decide to follow your vets advice, advice from FDMB, or a combination, it is your decision and you should feel good about it.
 
Just wanted to chime in here to say that after Phoebe Squeak was diagnosed and it was clear I was with the wrong vet, I actually met 4 other doctors and the 4th one was the charm! To be fair, number 2 admitted she did not know enough and sent me to a (very bad) specialist, but I then found another specialist who is wonderful and she's helping us follow TR which is my choice. And I'm keeping doc #2 as Phoebe Squeak's regular vet. I like that she sent me to a specialist, I just didn't like the one she sent me to.
Very long way of saying, it's not always easy to find the right doctor to work with after you find this site, because you become educated and don't blindly accept everything they say. At least that was my experience. The bad specialist actually said my goal should be to pick a dose and stick with it and never home test again! :banghead:
Trust your instinct and do what you feel is right for Macka after reviewing all your options and the advice you've been given. I really hope the specialist you meet on Thursday morning is the right fit for you & Macka.
 
I had a great specialist, after Neko's vet “fired” me for getting too complicated. She thought it best for Neko, and it was. My IM Vet was worried about dosing and me letting her get too low :rolleyes:. First day Neko was there for an ultrasound, I reluctantly agreed to let them blood test her “to make sure”.:I told him she would be between 100-200. She was a good girl for me and did have a flat blue cycle that day. After that he trusted me, and was fascinated by the spreadsheet.
 
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