7.2.13 Lucy AMPS 273...More conflicting info from my vet

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LucyCat

LucyCat

Member Since 2013
Back to the yellow...any ideas about increasing the dose to 2.25?

Wanted to share with you all another e-mail from my vet...this was in response to Dr. Lisa's article about wet food only diets in cats with diabetes:

"Becky,
Everybody has their opinion. I am more practical. There are some cats that can be controlled with a low carb diet only. However that is when they are initially diagnosed and you are far beyond that point. What is more important that the cat eat while on insulin. I do not believe in blanket statements like this author makes in the article. Every case and every owner is different. Most cats get adapted to a particular food and when on insulin, unless they are hard to control, it is better to leave the food alone unless the owner overfeeds, etc.The author is entitled to her opinion, but that's what it is. Feed the Iams, make sure your control the amounts, get the Lantus dose adjusted to get the BG most of time between 80-180 and we should be fine. Remember, just because it is on the internet doesn't make it fact...."

He is saying to control the amounts versus what I was doing, free feeding. It's interesting that so many vets have such differing views. You would think if people are voicing their "opinions" about a disease such as diabetes, it would be research based and even concluded from actual tests or observations of cats with diabetes...

Lucy was diagnosed with diabetes around March of this year...is it too late to regulate her because we aren't in the initial dx stage?

Thanks,
Becky
 
Hi Becky -
I'm pretty new so I don't feel comfortable giving any advice (I'm still struggling to get my kitty regulated), but my vet AND my diabetes specialist say the exact same thing - it's frustrating. I think it's like the medical field for humans though. I think a lot of doctors have different opinions about treatments. My vets both say it's more important that Bob eats while on insulin, which I do agree with. I'm having a really hard time transitioning his food so I've had to go back to feeding him the PurinaDM dry. However, if he would eat the canned food, I would transition him in a heartbeat. If you look at some of the ss's on the site, you can see where people changed the food and it immediately made a difference. You have to be careful though and listen to what the advice givers on the site have to say. I think most people on this site have dealt with vets who don't agree with this protocol.

Bob and I wish you luck!
 
sorry, I haven't been to you condo before so I'm not up on Lucy and her food but, Lucy has only been Dx for 3 months, we have seen many cats got into remission after much longer than that, even close to 2 years!

Low carb food is always a big factor for any diabetic, cat or human. Even in remission a cat must always stay on a LC diet. Why handicap your efforts by leaving a major tool out of the toolbox? A wet LC diet will give Lucy the best chance for lowering her BG even if she doesn't go into full remission. Dry food is also hard on a cat's kidneys and can lead to CRF in the future, the kidneys need plenty of moisture to function properly. BTW Dr Lisa isn't just on the internet, she has been published in major veterinary journals!
 
From your vet. There are some cats that can be controlled with a low carb diet only. However that is when they are initially diagnosed and you are far beyond that point. What is more important that the cat eat while on insulin
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Yes, we agree with your vet that is important that your cat eat while getting insulin.

We are not talking about using a low carb diet only to control the diabetes. We are talking about a low carb diet in addition to the insulin to help control the BG numbers.

Switching to a lower carb diet, even months after diagnosis and treatment with insulin can make a difference. My foster cat Wink is an example of that. He was on insulin, high carb diet for about 4.5 months before I took him in. Didn't take long to not only get him regulated but in remission.

He is saying to control the amounts versus what I was doing, free feeding.
Click to expand...
Yes, we agree with controlling the amount of food fed. We differ on limiting those controlled amounts of food to 2 times a day. You can spread it out more over the course of the day, 4 meals, 6 meals, whatever works with your life and schedule.

Lucy was diagnosed with diabetes around March of this year...is it too late to regulate her because we aren't in the initial dx stage?
Click to expand...
No, it is absolutely not too late to regulate her. That is get her numbers below renal threshold and getting her to feel better. There is still a possibility of remission also. Diet controlled status. Best chance of that is in the first 6 months although it has happened up to 2+ years later.

We will be trying out hardest to help you get Lucy to where she can be, regulated for sure, remission is the unknown goal.
 
Your vet is right...every cat is different, and everyone is entitled to their opinion, including you. But, as Ann said, Dr Lisa isn't just stating her "opinions"; she is a very accomplished vet with sound, scientific support behind her statements. She has dedicated and devoted a lot of time to cats and their special, unique health needs.

I know it's confusing and conflicting and frustrating, but it sounds like you are a very proactive owner, and I would suggesting formulating your own opinions on the course of treatment you want to take with Lucy. If you want to feed wet LC food only, then go that route. (Honestly, I don't like that you have been "ordered" to feed Iams...but I also don't like being told what to do :lol: !) That is the route I would go, because it gives the best chance for good regulation, if not remission. It seems counter-intuitive to not follow "vet's orders", but this is one disease where I think being an involved and proactive owner gives you a lot of control over your kitty's health. What harm can it do to feed a low carb diet to a diabetic cat? It can only do good, whereas following the order to "feed Iams" and increase dosages too sharply/rapidly could possibly cause more health problems than generate good results.

And yes...also as Ann has said, we have had cats here go into remission after several years. Anything is possible. Personally, I'd still consider 3 months to be newly diagnosed.

Please keep chatting with us here...we'd like to help you sort out your thoughts on all of this.
 
Morning Becky, ~O)

My ss is a good example of how dramatically the diet change can make a difference. Take a look.


Here is a shortcut list of canned foods with their carb values. shortcut list

I have no idea why your vet is so hung up on Iams.
He's not at your house so he won't know what you are feeding unless you tell him. ;-)


One of our favorite things around here is to make great progress and go show them after the fact.

Lucy is still in the window of possibilities of going into remission and definitely able to be regulated.
Look at her numbers already.
The cats that have lower chances are the ones stuck in the higher numbers and even those cats sometimes make it.

The more time Lucy spends in lower good numbers.... the more her pancreas can heal.
 
I also have to agree with the others. First, Dr. Lisa is well known as a feline nutritionist. I would believe what she says ANY day over a general practice veterinarian. It isn't just her opinion...it is her area of expertise.

One thing we do here is live and breathe FD 24/7. Yes, ECID and every caregiver is different. But I would much rather feed a high quality, low carb canned diet to my cat and use LESS insulin than feed a poor quality, dry diet to my cat and have to use MORE insulin to keep the BG in normal numbers. And I would also opt for the health of my cat's kidneys long term by allowing them to get as much hydration as they need to through wet food and drinking water on their own to the extent that they will.

Here is what I posted on your condo yesterday regarding an increase:

I would not raise the dose tomorrow. From the Tight Regulation protocol:

General Guidelines
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Not only is she in the initial dosing stage but she also has dropped below 200 so let's give her more time.
Click to expand...

Lantus requires patience. She needs time to build her depot (she's already responding nicely). I know when we are new, we ALL expect that if we give so much insulin, the cat will respond in a commensurate way. But insulin is not a medication; it's a hormone and there are many external factors that can influence it. Studies show that from shot to shot, absorption "may" differ by up to 50%.

We have several pair of patience pants that we rotate around among the members of the Sisterhood of the Travelling Patience Pants.
 
Dr. Pierson is best known as a practitioner who has an avid interest in feline nutrition. Her counterpart in the veterinary research world is Deborah Zoran, DVM. How about sharing this article from the Journal of the American Veterinary Medical Assn with your vet. Please take note of not only the section dealing with carbohydrate metabolism but especially the section on diabetes.
Deborah Zoran said:
High-protein, low-CHO diets and low-fiber diets are highly beneficial in the management of cats with diabetes, resulting in a reduction of >50% in the amount of insulin required in 8 of 9 cats in 1 study. In another study, complete cessation of insulin administration was reported for one-third of the cats. In another study, researchers reported that contrary to what is observed in dogs, cats fed diets containing soluble or insoluble fiber had altered glucose tolerance. Another study reported that feeding typical adult maintenance diets to cats resulted in development of greater postprandial hyperinsulinemia, even in cats with normal body weights, compared to cats consuming a high-protein diet. Persistent hyperinsulinemia may lead to decreased mobilization of nonesterified fatty acids (or possibly re-esterification of fatty acids); thus, it could potentially lead to weight gain or obesity in cats consuming typical maintenance (high-CHO) diets. In obese diabetic cats, high-protein, low-CHO diets reduce postprandial hyperglycemia but also decrease the overall insulin requirement. Furthermore, canned high-protein, low-CHO diets result in weight loss that will ultimately reduce obesity-induced insulin resistance.
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So, what's this mean? Basically, feeding a cat a species inappropriate diet (i.e., a diet that is lower in protein and contains unnecessary fiber or carbs) can contribute to insulin resistance by itself or contribute to weight gain. Weight gain also contributes to insulin resistance. This is in contrast with a high protein diet that can result in lowering the amount of insulin needed, remission, and/or weight loss.

Your vet is correct in that every caregiver and cat is different. He may be more conversant with nutrition and diabetes in dogs. His information about feline nutrition and diabetes is dated. Feeding your cat a dry food that is 40% carb would be like a human diabetic eating cookies and ice cream at every meal and then injecting 50u of insulin to compensate. It's not a good solution. Could you imagine your vet's pediatrician telling him that rather than having the vet's child throw a tantrum, he should feed his diabetic child spaghetti, birthday cake, candy, and ice cream at every meal. The vet would think the pediatrician was crazy. Yet, this is in essence that the vet is telling you.

We have seen cats go into remission after 2+ years. The greatest chance of remission is closer to when a cat is diagnosed. The longer a cat is diabetic, the chances of remission progressively decrease. We've also seen many cats become tightly regulated. Lucy is still in her honeymoon and remission is very much a reality. Her best chance of remission, based on research data, is if she's on a low carb diet and follows the Tight Regulation Protocol. Roughly 80% of newly diagnosed cats are capable of remission on this protocol.

I don't mean to slam your vet. No vet can be an expert in every single condition that effects every species of animal they deal with. We eat, breathe and live feline diabetes here. Several of us have access to medical and veterinary libraries and have the skills to do review the literature and to understand what the research means. The resources on this board are amazing. We're not spouting wacko internet info. We're basing our information on research data that's been published in reputable veterinary journals along with the data that's culled from the hundreds of cats that have passed through this forum. Can you trust everything everyone says -- of course not. It's why we frown on backchannel or PM advising. We try to review each other's comments so you do get as accurate information as possible.
 
Lucy was diagnosed with diabetes around March of this year...is it too late to regulate her because we aren't in the initial dx stage?
Click to expand...

Absolutely not. Your vet's statement that "There are some cats that can be controlled with a low carb diet only. However that is when they are initially diagnosed and you are far beyond that point." A better way of saying that might have been...."When first diagnosed, some cats are able to be controlled just by switching to a low carb diet." HIs first advice to you should have been to switch to low carb food. Some cats do become strictly diet controlled, before being started on insulin.

But no matter how long a cat is diabetic, a switch to low-carb canned food is going to help control the numbers. If you were to do so, Lucy would likely need less insulin to control her numbers.

What I find more incredible is your vet's attitude regarding the information on Dr. Lisa's site. How any vet can read her pages, especially if they then take the time to review her credentials, and still insist that dry food is okay to feed ANY cat - diabetic or not - is beyond comprehension to me. No, everything you read on the internet can't be taken as "fact". But in this case, I would have said "Yes, and by the same token, just because you're saying it, it can't be taken as fact either."

What are his credentials specific to feline nutrition and feline diabetes? If he's that brilliant, why doesn't he create his own web page? Opinions are one thing. Opinions based on years and years of practice and research carry a bit more weight, in my opinion.

I would hope he cares what the AAHA recommends, especially if his clinic is "AAHA Certified":
Canned foods are preferred over dry foods.Canned foods provide:
- Lower carbohydrate levels.
- Ease of portion control.
- Lower caloric density; cat can eat a higher volume of
canned food for the same caloric intake.
- Additional water intake
Click to expand...
 
So do people on here tell me what to do with the dosing because they are checking out my SS on a daily basis? I keep asking about the dosing because I am/was under the impression that I would need to raise it up.

We're in the blue right now...good stuff.
 
LucyCat said:
So do people on here tell me what to do with the dosing because they are checking out my SS on a daily basis? I keep asking about the dosing because I am/was under the impression that I would need to raise it up.

We're in the blue right now...good stuff.
Click to expand...

Partly - but also read, print out, and use the Tight Regulation Guidelines to help you make decisions on dosing, too.
 
You can have dosing advise any time you want.

Each day we start a new condo. and if you need attention... just put it in your subject line....

7/3 Lucy amps ___ Need Dosing or Question???

There are post icons you can use too such as the question mark. ( candles and rainbows are for those who have passed)
 
So do people on here tell me what to do with the dosing because they are checking out my SS on a daily basis?
Click to expand...
When I make a suggestion about a cat's dose, I only do so after I've looked at the cat's SS. If there isn't sufficient information on the spreadsheet, I will not make a dose recommendation if I'm not comfortable with the amount of test data. I don't necessarily look at every cat's SS every day but if you ask for help, the first thing I do is open your cat's SS.

If you want to follow the Tight Regulation Protocol, you will need to transition Lucy to a low carb, canned food diet. I know we keep harping on this point but it will be very difficult to get Lucy regulated on a dry food diet like the Iams you've been feeding. The protocol is based on several requisites that are outlined in the starred, sticky note that I linked.
 
If you post daily, then people will see your updated spreadsheet daily, and they will use that data to help you with dose advice. But they won't "tell you" to do anything. The protocol is pretty clear cut once you understand it and have been making decisions based on it.

Right now you're in the "first 5-7 days" time.

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...

You'd see what the nadir numbers look like after 5-7 days, and then adjust up or down (or not at all) based on that data.
If things continue like they have been going, and the nadir number is between 200-300 for the majority of the time, then you'd increase by .25u as the protocol suggests.
 
Hi Becky,

My cat Angie was diagnosed in August 2012 and the vet put her on lantus and Hills dry food, "specially formulated for diabetic cats". Seven months after diagnosis I found FDMB, started home testing and switched her to low carb wet food. It took 10 days from switching her food till she was off insulin!

She's back on insulin again but she had a very stressful period with a couple of house moves in a row and she had a sneaky high carb meal. Almost a year after initial diagnosis I think that she's not far off another OTJ trial too.

I hope that gives you hope. :-D

Grace
 
Lucy is on wet food only and has been for since this past Friday...that is noted on her SS. Thanks
 
Lucy is definitely looking good in those blues tonight. Since she is off dry food, eating LC canned, and is responding well to the juice, I personally would be inclined to hold the current dose for just a little longer. It can take a cat a little while to settle in to a dose. It is possible she may need a small increase, but for now, I would watch and see what happens. You don't want to give her more insulin than she needs, since that is dangerous. The tests you have gotten to day are awesome, because they indicate that Lucy MAY tend to nadir late....very good to know info.

We follow a rigid protocol here, but it is one based on safety...the goal is to get the kitty into healing numbers as much as possible, without putting them at risk for a hypo. Yep, anyone who makes any sort of dosing suggestion will do so based on the data in your spreadsheet, so it is definitely important to keep that up-to-date.

Once you start seeing Lucy's patterns, before you know it, you will feel comfortable making most - if not all - dosing decisions on your own. (I never ever thought I'd be doing it on my own...but it does eventually happen!)
 
Looks like Lucy's nadir was at +10 today......what does a late nadir mean? Is that good?
 
As Sienne always says, the nadir can be a moving target. I can't say whether a late nadir is good or bad...but it IS good to get a general idea when Lucy's nadir is. That can help you determine dosage changes and such (With Lantus, dose adjustments are made primarily based on the nadir, not on pre-shot values.). Unfortunately, because it a moving target, even within one cat, one can't completely bank on the timing of it. But, that's why we like to gather as much data as possible, especially early on in this dance...so trends and patterns become apparent...the more data you have, the easier it is to see how things play out, and the easier it is to determine when and how to make dose adjustments.
 
do people on here tell me what to do with the dosing because they are checking out my SS on a daily basis? I keep asking about the dosing because I am/was under the impression that I would need to raise it up.
Click to expand...

I'm sorry....I don't understand your question. I based my dosing advice last night (and reprinted it this morning on this condo) on her SS and the protocol. I never give dosing advice without looking at the SS. Sometimes the protocol needs a little modification for a specific cat and that's why it is really important to look at the SS. I think several of us have said the same thing today on the dose. We're happy to help you with the dose any time you have a question about it. Just let us know.
 
Hi there, I'm new to your condo. I'm SO glad you decided to stop feeding Iams dry indoor weight/hairball control. That is EXACTLY what I fed my kitty for 6 years (and he was on Science Diet dry the 3 years before that). Uggh - If only I could go back and undo all that!!!

Personally I think those of us who used to feed Iams dry and now have diabetic kitties should write letters to Iams telling them to STOP MAKING OUR CATS SICK!

(Sorry, it just makes me mad that I was such a mindless consumer back then :evil: )
 
Hello Becky!
Nice to meet you!
My diabetic cat is also Lucy.
What does your Lucy look like?
I'd love to see her photo some day!

I joined LL around the end of May, so I'm fairly new too!
People here are really wonderful, very knowledgeable and supportive.
I am not confident to make dosing decision by myself, so I always ask for an advice here before any change.
I do re-read the protocol every time I wonder about the dose change, just to make sure I will not ask what's already explained clearly.
I also try to make it visible in the subject that I have a question.

I don't really consult my vet about my Lucy's insulin dose any more.
I simply told them that I'm trying to regulate Lucy somewhere between 50 - 100 because she feels better in that range, and I home-test a lot and that I am very careful about not letting her go too low.
I like all Lucy's doctors and techs and nurses very much and have a lot of faith and respect in them (despite the V-B12 thing that happened recently which some of you may know), but when it comes to FD (and so much more), I find this place much much better :-D
 
Hi Becky :)

I haven't visited your condo either before, and I'm slowly making my way to other kitty condos. Pretty new here too, about 6 weeks into this sugar dance.

I imagine it's disheartening getting the conflicting info from your vet. My question to the vet would be how many of his/her feline diabetic patients have gone into remission on his/her regimen? If your vet can give you one example, my next question would be if I could contact that other bean and kitty, but that's me.

In my personal opinion, I think it might be harder for some cats to transition from dry to wet is because they have been given dry for so long. My kitty too had been on dry since I got him, although I was also feeding him wet 2x's a day, but it was the high carb gravy stuff ohmygod_smile

I was fortunate that he transitioned easy. When I found out he had FD, I immediately threw out all dry (after reading how bad it is, and before he started insulin). Removing the dry from his diet decreased his BG by 100 within a few days.

As with each one of us, we all have to do what we feel is best for our furbaby. Each situation is different, just like each kitty, each owner, and each vet. It's surely a balancing act sometimes.

If you have a pic of Lucy on your computer, you can upload into your profile/signature line. And there is also a link here somewhere, I think in a sticky, how to create a profile for you two.
 
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