Bingley mostly in the yellows, vet says he's fine. I'm confused.

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Li & Bingley

Li & Bingley

Member Since 2022
Hi! Bingley has been on insulin for 8 weeks, and I just started testing last week. So far his numbers have been mainly in the yellows. I shared the spreadsheet with my vet (before I increased by 0.25, heh), and she emailed back saying he was "clinically fine," to keep the dose for another month, and then do another 12-hour curve, but please use AlphaTrak instead. Then we'll see next steps.

I have no idea what "clinically fine" means, and keeping his dose would mean 3 total months of no adjustments. Plus, we did a fructosamine test 1+ week ago and he was at 497. Her treatment plan seems...casual? Or am I reading it all wrong. I don't want to miss our chance at going into remission.

Can anyone tell me what all the yellows indicate? How is he fine if his numbers are still high?

PS I hated that my vet relayed this treatment plan to me via the front desk person who handles scheduling. She just read off the vet's notes and could not answer my many follow-up questions. The vet would speak to me if we did zoom call for an additional charge. wtf.
 
I’m sorry to say that’s pretty much the response of most vets to feline diabetes. They look at the preshot numbers mainly and they don’t want to adjust insulin regularly. It felt too casual to you as it should because it is. Sadly, they don’t share our passion and sense of urgency. The vet who suggested I do the curves at home who was one of the best vets Minnie ever had, said to me when I started testing her daily and sharing the results, that I was going to drive myself crazy. I think what she really meant is that I was going to drive her crazy by running those test results by her lol. That’s pretty much when I stopped asking for advice from her and came here with all my questions instead. Here, I could get a response within minutes if I wasn’t sure about a pre shot number and her shot. My vet would sometimes take days to get back to me :(
 
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You’re getting a lot of tests in which is great but you don’t have a lot of data just yet. I think the increase is fine especially if you’re following TR. In fact, I think on TR you’re supposed to increase every 3 days if I’m not mistaken. Tagging a few people here. You may also want to post on the Lantus forum as there are more expert members there that can best advise you on dosage.

Btw, Bingley is on wet food only right?
@Sienne and Gabby (GA) @Bron and Sheba (GA) @Diane Tyler's Mom
 
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Yes he's only on wet food, although I give him 1/2tsp of YA Mature Zero as a treat.
I have been posting on the Lantus forum (hence the bump in dosage), but was hoping I had enough data and info for a more macro view of how he's doing so far. It's good to know I need more data. I have not been happy with my vet throughout this journey!
 
I was able to email back and forth with Minnie’s vet, but whenever I called I got messages relayed via the front desk too. I also want to point out most vets treatment plan for feline diabetes is not focused on remission, but management, hence the laid back attitude.
 
If you've been posting on the Lantus board, I'd encourage you to continue posting there. Once you have the basics -- a signature, spreadsheet, are comfortable with home testing, and have your cat on a low carb, canned food diet -- it's often best to post on one of the insulin specific boards. Lantus is a busy forum and there are members around pretty much 24/7. Health is also busy but takes the brunt of new members and members who are using insulins other than Lantus. (The other insulin specific boards aren't as busy.)

Chances are that your vet is not conversant with TR. It seems like many vets treat Lantus like other insulins which is problematic in that it's pharmacologically different. In defense of your vet, they have a huge task. They are expected to know about all conditions across all species of animals. There's no way to know how many diabetics they see in their practice let alone how many diabetic cats they treat. We're all about feline diabetes all the time.

I'd encourage you to find a different treat. Young Again is considered a dry food. You can't use TR if you're feeding dry. There are plenty of options. With TR, you evaluate the dose every 3 days/6 cycles unless a dose reduction is warranted.

At least based on the data on your spreadsheet, Bingley is doing fine. You're seeing an expected pattern. Your kitty is dropping into blue numbers and then bounces up to into the 200s or 300s. The numbers come back down after a couple of cycles. If your plan is to follow TR, you could increase your cat's dose at your PM shot.
 
I was just going to day what Sienne said if you are feeding any dry food you have to follow SLGS
For treats that you can give and still follow TR are
Freeze dried treats
https://www.chewy.com/halo-liv-littles-grain-free-100/dp/29214

You can give her any freeze dried treats for a snack
most members give freeze dried treats , they are low carb, you can probably find them in some local pet stores also
I did a search for you on here and copied what some members said they use,

When testing you can give them a treat so they will associate after testing they will get a reward, any freeze dried treats are ok such as
PureBites Freeze-Dried Cat Treats with Chicken Breast 2.3 oz ()https://www.amazon.com/dp/B071P

Also chewys has freeze dried treats also


The freeze dried treats you can get at petsmart, petco and order from chewy. Purebites is popular (cheaper if you buy the dog food ones). My crew like vital essentials it's dehydrated freeze dried raw comes in flavors

freeze dried minnows, made by Vital Essentials. I also buy the ones made for dogs. They're the same as the freeze dried minnows for cats. just cheaper. They also carry other freeze dried treats. I ordered mine through Amazon.

I think the vital essentials are more of a crunchy texture than the purebites

If you cat likes any of these you can buy the bigger bags for dogs they are the same ,you will get more for your money just break then up into smaller pieces
.

You can Google freeze dried treats and see what other ones there are and different flavors
Just make sure that is the only ingredient in them meaning turkey, chicken, minnows etc

Here is another one , I see you can get these in different flavors also just look
You may have to break any freeze dried treats in half if they are too big
https://www.amazon.com/Vital-Essent...ocphy=9003521&hvtargid=pla-630511512365&psc=1
 
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Li & Bingley said:
Yes he's only on wet food, although I give him 1/2tsp of YA Mature Zero as a treat.
Click to expand...
If you are going to continue to feed the Young Again dry you need to add that to your signature
Tap on your name then signature add it and tap save
Then also change TR on your signature and replace it with SLGS and on your spreadsheet
If you decide to feed the freeze dried treats only you can leave TR
You might want to read the 2 dosing methods again :cat:
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/
 
I would also encourage you to post on the Lantus forum where everyone uses a depot insulin. As Sienne says, the main forum is also very busy but has a variety of insulins being used, so you will get more help on the Lantus page.:)
 
Bron and Sheba (GA) said:
I would also encourage you to post on the Lantus forum where everyone uses a depot insulin. As Sienne says, the main forum is also very busy but has a variety of insulins being used, so you will get more help on the Lantus page.:)
Click to expand...
I did too and per her comment above “I have been posting on the Lantus forum (hence the bump in dosage), but was hoping I had enough data and info for a more macro view of how he's doing so far.”
 
Sienne and Gabby (GA) said:
At least based on the data on your spreadsheet, Bingley is doing fine. You're seeing an expected pattern. Your kitty is dropping into blue numbers and then bounces up to into the 200s or 300s. The numbers come back down after a couple of cycles. If your plan is to follow TR, you could increase your cat's dose at your PM shot.
Click to expand...

Thanks for this reassurance! Just needed to know we’re on the right track and I’m seeing what I’m supposed to be seeing. Bummer about vets, but I’ll cut mine some slack.

I won’t give Bingley any YA anymore. I have plenty of freeze dried treats for him already.
 
as others have stated, what you are experiencing is very common. The general approach from most vets is to get the cats BG down into the 200s and keep it there. This is often considered success from the vet's perspective.

In their defense the clinical definition of a well-regulated diabetic feline is indeed getting the BG to be generally below 200-250:
  • Not treated - blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs
  • Treated, but not regulated - often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs
  • Regulated - generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia
  • Well regulated - generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia
  • Tightly regulated - generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin
  • Normalized - 60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin

However, that approach is not likely to produce remission. Many studies have shown that if you can get the cat's BG into the tightly regulated zone for an extended period of time, where they spend most of their day in that range -- their pancreas can actually heal and may even begin to produce insulin again.

That is the goal most of us here at the FDMB have in mind so we tend to take things further than most vets would.
 
Hendrick Cuddleclaw said:
as others have stated, what you are experiencing is very common. The general approach from most vets is to get the cats BG down into the 200s and keep it there. This is often considered success from the vet's perspective.
Click to expand...

This is very good to know and I assume what my vet means by him being "clinically fine." I'm going to tell her remission is my goal and see if she'll work with me towards that...
 
I will just add that part of the reason for that approach by most vets is there is lower risk of a hypo. When you start trying to keep kitty's BG down in the 100s or lower, of course the risk of a hypo is greater and vets do not want to be held responsible so they play it safe.

Here at the FDMB, pre-shot testing and mid-cycle testing are encouraged heavily so that any incoming hypo condition is detected and averted quickly. Vets, for the most part, don't expect a pet owner to go to those lengths (and most cat owners they see probably wouldn't, let's be honest)
 
The only other thing I'd add is that if you're "lucky" enough that your vet keeps up to date with the AAHA guidelines (they're better than nothing but not quite what we follow here) - that's likely why your vet is maintaining dose. The current AAHA guidelines specify that if nadir is 80-150 (pet meter) + ideally below 300 at all other times you hold the dose.

Our more conservative dosing methods (SLGS) state something similar (90-150 you hold) BUT most caregivers try to push that nadir down closer to 90 to bring the overall numbers down. The more aggressive methods (TR) are targeting nearly non-diabetic numbers in a strong push for remission and/or simply a desire to keep their BGs as normal as possible for health, etc reasons. All depends on the caregiver's goals and physical/financial/etc ability to manage FD.
 
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