9/27 Max AMPS 391 +2 346 +4 237 +8 196 +10 230 PMPS 357

Wendy&Neko said:
Looking forward to hearing how the day went at NCSU. :bighug:
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Our visit went well. We didn’t get to see or talk to Dr Lunn because she’s not doing clinical right. Max had an echo, cardiac consult, abdominal ultrasound, and lots of labs. His labs were mostly WNL with the exception of hyperglycemia and mild electrolyte changes. His echo showed mild ventricular hypertrophic and left atrial enlargement. No medications needed at this time but they want to repeat echo in 9-12 months. His abdominal ultrasound showed mildly enlarged kidneys, mild liver enlargement, changes consistent with chronic pancreatitis, focal thickening of the small intestine suggestive of focal enteritis. He is a candidate for SRT. The cardiologist said that it was safe for him to have anesthesia. He will need to undergo anesthesia twice, once for the MRI, and again for the radiation on a different day. Oncology is supposed to be calling me this week for a telephone consult to discuss everything further. Everyone was impressed with the spreadsheet on Max. They were not happy that I changed to a human meter. They also want his nadirs above 100 and did not want me to increase his Lantus anymore right now based on what they were seeing in his latest BG. I questioned that but just like every other vet I’ve seen, they do not agree with what I’m doing here. I did get a prescription for Levemir but they want me to start at 4 units bid. They said to stop the sub Q fluids and also changed him from cerenia to ondansetron. They said the Flovent would affect his BG somewhat because a small amount does get absorbed systemically but we would adjust insulin based on what his needs are. I have to send some glucose curves in for them to review after he has transitioned to Levemir. They also want him to change his diet from Fancy Feast to Purina DM. I’m really tired because I keep getting more of the same from every vet I’ve seen about Max’s insulin dosing and his diet. His first vet wanted to keep him on Vetsulin so I changed vets to the one I’m at now who referred me to NCSU. He has pretty much told me that if I could not follow his recommendations or was dissatisfied with his care, that he will facilitate my transfer to another vet. I haven’t said anything about this earlier except in a private conversation, but he’s been upset with me since he found out I was following advice here instead of his advice. So I’m really exhausted from this constant push back I’m getting. I’m scheduled with another vet next week to transfer his care because I no longer feel comfortable with a vet who’s upset with me. That will be vet number 3 for us. It’s already emotionally draining in caring for a cat with diabetes, as everyone here knows. Wendy, I’m not sure what dose is recommended here to start Max on in his transition to Levemir so I’m interested to find out what you think. I’m really sorry for all of the venting. You guys have been great here but I can’t keep burning bridges with vets. If they prescribe the insulin they expect me to follow their instructions. I’m hoping the next vet is a little more understanding as I’m told she’s cared for acrocats before. Max, as expected kept dipping down last night and based on his history and the fact it takes a lot to bring him back up, I gave him HC food and went to bed after I saw he was coming back up some. I was just too exhausted to stay up last night with a potential hypo problem. Wendy, please let me know what you think about Levemir dose and also the Purina DM food. I may take a little break in posting for a while. I have to order the Levemir from Marks so it will be a little while before I switch anyway. Thanks to all of you who check on Max. You guys are truly great.:bighug:
 
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When I switched from Lantus to Levemir, we started with 70% of the Lantus dose because “some cats have a strong reaction to Levemir.” Darcy did not, so we fast tracked him up to a better dose - but it was the right thing to do to be safe. I know Wendy will come along later to advise. Her advice is the best!
 
Oh, and I forgot to say that I am so sorry about all the pushing and pulling that you are experiencing. You are really doing so much for Max. I will miss checking up on him (and you!). Hang in there. I have a feeling that you will work your way through these obstacles, but it may take some time.
 
Suzanne & Darcy said:
When I switched from Lantus to Levemir, we started with 70% of the Lantus dose because “some cats have a strong reaction to Levemir.” Darcy did not, so we fast tracked him up to a better dose - but it was the right thing to do to be safe. I know Wendy will come along later to advise. Her advice is the best!
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Yes I think Wendy is great. I’ve learned alot from her.
 
Suzanne & Darcy said:
Oh, and I forgot to say that I am so sorry about all the pushing and pulling that you are experiencing. You are really doing so much for Max. I will miss checking up on him (and you!). Hang in there. I have a feeling that you will work your way through these obstacles, but it may take some time.
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I will be back to posting really soon. I know by the time my Levemir gets here I will. I’ve just got to get my head back on straight. I’m just completely frustrated with what I discussed earlier.
 
Suzanne is right, we recommend that cats start a Lev dose at 70% of their Lantus dose. So that would be 7.25, or 7.5 if you want to be on the line. Levemir is a stronger insulin than Lantus, in dogs, not cats. The ultimate Levemir dose can end up the same, or a little bit higher or lower than the Lantus dose. ECID.

The echo results sounds good, and now you have a baseline. The follow up a year later is pretty standard. Thickening of the bowels is also pretty common with acros. Changing to ondansetron from Cerenia is a good idea, it does a much better job at fighting any nausea.

Sorry to hear the vets wanted to meddle in dosing. The ones at Colorado State University took one look at Neko's spreadsheet and said "carry on". And DM - really? After the FDA forced the company to change it to "dietetic management" from "diabetic management", cause it just doesn't. You can tell them Max tried it and didn't like it. End of story.

Good luck getting a vet that will work with you. I ended up sticking with mine, even though she wasn't used to Lantus (or later Lev), didn't know acromegaly, but because she was willing to learn and work with me.
 
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