9/12 Mo - AMPS 362, +6 297, +8.5 346, PMPS 293, +3 304

katy and mo (GA)

katy and mo (GA)

Member Since 2020
Yesterday's post

I didn't have any coconut oil lying around to help with the hairballs but I did put half a teaspoon of olive oil into his dinner. Will do that again tonight. Hopefully that will start to get things moving! It's warm and muggy again here today. I get home and it's 25 degrees inside (77 for you US folk)! That's pretty warm for where we live, let alone it being that warm inside while the humidity is high. Poor Mo isn't enjoying the heat. I keep brushing him to help get his winter coat off him. Hopefully it cools down soon. Or at least gets less muggy.

Mo still seems a lethargic. Although I did get home from work and found him outside on his own accord. So that's nice at least! He's grooming himself as we speak so that's a good sign too.

In terms of his dose, my vet has pushed me again using TR so I have to wait until I get the all clear from them to increase his dose. I need to book an appointment with them so I can have a proper discussion about it with them. I've sent them the paper on it so hopefully next time I go in, they'll be more open to the idea of it especially with me and Tim constantly monitoring him.

As suggested by Wendy, I'm also going to ask them how many other sugar kitty parents are testing at home because they are probably not used to people willing to do at home testing. This probably influences their thinking on me upping his insulin myself.

I would increase his insulin myself without their permission but I'm worried that they might get mad at me and force us to go find another vet. I really like them and they've done so well with Mo that I really want to stick with them and figure out a compromise.

Hope you're having a great day!
 
I've just sent this email to my vet clinic:

Hi there,

Please find attached a screenshot of Mo's blood glucose spreadsheet, which goes back to the 28th of November.

I was wondering if it would be best to discuss his insulin dose over the phone with a vet or if I should come in to discuss it (With or without Mo)? I would prefer to not bring Mo in every time I want to discuss his insulin dose just to avoid any extra stress for him as I am testing him 4-5 times per day at home.

I was previously following the Tight Control method of dosing, but I was advised against it in my most recent visit with Dr Janie. I don't feel comfortable having to wait 2 weeks to up his dose as he has had relatively high glucose levels for a while now and based on the research I've done and the other diabetic cat parents I've spoken to, they have had great success regulating their cats with the Tight Control method.

I also frequent this site which has been extremely helpful to me and where I have met others with poorly diabetic kitties. https://felinediabetes.com

Sorry, this is a lot of information. If you could pass this along to a vet (preferable Dr Janie or Dr Margaret), that would be greatly appreciated!
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Hopefully I get the response I'm looking for...;)
 
I got a call back from the vet! SO...

She said all the vets at the clinic discussed Mo's case this morning and said that given my home testing, they will allow me to increase his dose every seven days as long as I contact them each week to let them know how he is going and for them to give me the all clear. I can increase 0.5u at a time as he is now above 5 units. They just don't believe that 3 days is enough to establish whether a dose a working or not.

At least I don't have to wait 2 weeks to increase which is better than a poke in the eye...especially with a lancet :P

On another note, I have a feeling that Mo's food is affecting his glucose levels throughout the day. His lowest levels today were 6 hours after his meals. I'm tempted to trial going back to feeding him 2 times a day at shot time to see if this is the case. Thoughts?
 
katy and mo said:
I've sent them the paper on it
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which document did you give them? Was it the one detailing the method for TR (TC)? or the actual paper that was published in the Journal for Veterinary medicine

It might be helpful if they read the paper written in the journal of Veterinary medicine on the Romp Rand Protocol (giving you the link here) That link is for a 2009 paper, I think there might be a more recent paper published ??? @Wendy&Neko am I just imagining this

I wonder what they are basing their 7days to be able to tell if the dose is working for him??


It's great that they want to work with you, but essentially waiting a week is taking it quite slow (SLGS rather than TR), if Mo were mine I wouldn't want to be doing that at this point. They seem very conservative, perhaps you will be able to win them over.
 
Table 3 in this document shows the faster increases we do here: Management of Diabetic Cats with Long-acting Insulin - summary published in 2013. The link is from the Dosing Methods Sticky Note. Table 2 in that document, closer to SLGS as we have it documented, dose the increase per week. Given where Mo is now in terms of numbers, I would definitely choose the faster method of increases until he starts regularly seeing better numbers.

I used to ask my vet about increasing each time, in the beginning, but my girl was stuck in high numbers and I got frustrated waiting for answers. I showed my vet the protocol document and gave her weekly updates on my spreadsheet until she was confident what I was doing was safe.
 
I'm at a loss of what to do. I can't really go against my vet's wishes as they're the ones that supply me with the insulin. In NZ you can only get the insulin from your vet and they're the best vet clinic in the area I live in. I worry that if I go against what they say that they will remove me as a client from their practice.

Yes, I sent them the paper from Romp and Rand. I have no idea what they're basing their 7 days on. They initially wanted me to wait 10 days. Given they were telling me to increase his insulin by 1 unit at a time, if I were to use TR and increase every 3 day at 0.25u, it would take me 12 days to actually go up to the unit increase they are requesting, which is nearly 2 weeks. Surely TR is safer in that case than going up 1 unit at a time?

OK, as I'm thinking, this is my plan going forward. Continue to increase his insulin at 0.25u instead of 0.5u and increase every 3 days. That way, It'll take 6 days to increase him by 0.5u. By that time, I will be "discussing increasing his dose with the vet". So, we increased Mo to 5.5u on Sunday the 6th. I will increase him to 5.75u tomorrow morning. Then by the time next Monday rolls around, we will be discussing his increase to 6u. Boom. Still an increase, but smaller increases than recommended. Does this sound ok? If it makes sense at all :confused:
 
At the size of dose that Mo is on now, we recommend 0.5 units increases, unless you are seeing greens. Think of the increase as a percent of the total dose. At 1 unit, a 0.25 unit increase is 25%, but at Mo's dose size now, it's less than 5%. At Mo's size of dose, the smaller increases aren't that effective.
 
Wendy&Neko said:
At the size of dose that Mo is on now, we recommend 0.5 units increases, unless you are seeing greens. Think of the increase as a percent of the total dose. At 1 unit, a 0.25 unit increase is 25%, but at Mo's dose size now, it's less than 5%. At Mo's size of dose, the smaller increases aren't that effective.
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I just don't know what to do :( I don't want to risk angering my vet :arghh:
 
Increase by 0.5 and hold longer for now? Or option B, hold this current dose for 7 days. So that's two more days. If you see no change in the numbers (which you won't), that'll be proof that holding longer isn't getting you anywhere. Then increase by 0.5 units.

At some point, I just told my vet "I am going to follow TR". She was stuck in high numbers, I needed to increase faster, both for her and for me.
 
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