Blue AMPS 402 10/12

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Well, I'm not shooting tonight. I might try the 1 unit since they already screwed up all we have done. They also want to see him in a week for another curve. I don't know what to do. It's a dilemma because that's my vet. I need them. I just don't think they know what they're doing.
 
Patty and Blue said:
They also want to see him in a week for another curve.
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Why?

It would be better for you to run the curve at home and email the data to them. If it's run at the vets it is likely to be stress-influenced (inferior data and an unnecessary expense).

Patty and Blue said:
I don't know what to do. It's a dilemma because that's my vet. I need them.
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They have put you between a rock and a hard place.

Patty and Blue said:
I just don't think they know what they're doing.
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Sadly, neither do I, Patty. Neither do I... <sigh>

What's even more upsetting is that I think their treatment plan is more likely to reduce chances of achieving remission.

Questions:

1. Was this the clinic that set Blue on a starting dose of 2IU Lantus BID?

2. Roughly what did Blue weigh at time of diabetes diagnosis?

3. Did they recommend Lantus or did you request it?


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I just saw labs. They ran a SNAP in house for pancreatitis. It seems to show possible virus but I don’t see any sign of infection requiring antibiotics.

The fructosamine shows he’s not controlled as far as diabetes but not sure how valid since he’s been high and not getting proper insulin dosing the last few days.

Do you remember what happened when you gave too high a dose when we first met? I’m concerned.
 
Yes this is the same vet. Dr. Johnson was who wanted to give 2 units twice a day. While speaking with Dr. Bruno he said he starts at 1 unit twice a day. There's a conflict right there. It's like a guessing game.
He weighed the same. 7 lb. And I thought he would gain as much as he eats.
No, I knew from nothing about any kind of diabetes so didn't request Lantus.
 
Patty and Blue said:
Yes this is the same vet. Dr. Johnson was who wanted to give 2 units twice a day. While speaking with Dr. Bruno he said he starts at 1 unit twice a day. There's a conflict right there. It's like a guessing game.
He weighed the same. 7 lb. And I thought he would gain as much as he eats.
No, I knew from nothing about any kind of diabetes so didn't request Lantus.
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First up, starting dose (from FDMB TR/SLGS Dosing Methods sticky, based on published Roomp-Rand study):

How to determine an initial starting dose for glargine or detemir when following the Tight Regulation Protocol:
  • the formula is 0.25 unit per kg of the cat's ideal weight [every 12 hours]
  • if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
  • if the cat was previously on another insulin, the starting dose should be determined by taking prior data into consideration
Blue was underweight so that's what his starting dose should have been based on.

* Weight at time of Dx = 7lb = 3.2kg

* Starting dose = 0.25 x 3.2 = 0.75IU q12h (rounded down to nearest quarter unit).

Is it Dr. J. that is insisting you give the dose of 1IU once a day and made all the other comments about Blue's response that you mention above?


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Critter Mom said:
First up, starting dose (from FDMB TR/SLGS Dosing Methods sticky, based on published Roomp-Rand study):

How to determine an initial starting dose for glargine or detemir when following the Tight Regulation Protocol:
  • the formula is 0.25 unit per kg of the cat's ideal weight [every 12 hours]
  • if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
  • if the cat was previously on another insulin, the starting dose should be determined by taking prior data into consideration
Blue was underweight so that's what his starting dose should be based on.

* Weight at time of Dx = 7lb = 3.2kg

* Starting dose = 0.25 x 3.2 = 0.75IU q12h (rounded down to nearest quarter unit).

Is it Dr. J. that is insisting you give the dose of 1IU once a day and made all the other comments about Blue's response that you mention above?


Mogs
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It's both. They're tag-teaming me. She works for him so I get it.
 
Patty and Blue said:
I've done two curves already for $100+ each time and I ask myself why I'm doing it.
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Patty, you've probably got a better testing technique than they have. They're well aware that you are perfectly capable of doing the necessary tests. The readings you take at home provide a much more reliable picture of Blue's response to his insulin dose. Perhaps suggest that if they wish to re-examine Blue after a week you'll be happy to bring him in for a check-up but you want to do the curve at home for the reasons outlined here. If they then say the check-up isn't necessary, it's one less car trip for Blue.


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Patty and Blue said:
Another thing, and this is crazy...they said if he gets lethargic give him syrup and even gave me a syringe of it. No test just guess :(
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That is crazy! Blue doesn’t mind testing. If he did he would hid3 from you. You mentioned before you need a new vet. I agree. I don’t mean to stress you more but give a sugar baby sugar if lethargic? You have seen what hc does to him.
 
tiffmaxee said:
That is crazy! Blue doesn’t mind testing. If he did he would hid3 from you. You mentioned before you need a new vet. I agree. I don’t mean to stress you more but give a sugar baby sugar if lethargic? You have seen what hc does to him.
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Yes. When they told me that all I thought about was you telling me the sugar high wouldn't last long. The other day he was very low for a couple of hours and I was feeding high carb food along with honey. The way they want me to proceed is go in blind.
 
tiffmaxee said:
No high white count. Maybe I am missing something.
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The only things (apart from the expected high BG and abnormal Snap fPL) that I could see off were the elevated BUN (possibly due to high protein diet) and the platelet results (which machines sometimes have problems counting due to clumping).


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Patty and Blue said:
They said he was over 600 and they were okay with that.
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This is fundamentally wrong. And I'm assuming they were measuring this on a pet meter.

In my considered opinion, any vet with a basic understanding of feline diabetes would not be OK with a cat being this high. At minimum they should be looking to see Blue loosely regulated, i.e. below the renal threshold for the majority of the time while minimising risk of hypoglycaemic episodes. Per the Merck Veterinary Manual, the renal threshold falls in the range 250-290mg/dL (pet meter) - a far cry from their 600mg/dL!

When BG is above the renal threshold there is greater risk of damage to the kidneys and also increased risk of UTIs developing due to the sugar in the urine (nourishment for bacteria).


Mogs
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Patty and Blue said:
Another thing, and this is crazy...they said if he gets lethargic give him syrup and even gave me a syringe of it. No test just guess :(
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Again, utterly wrong. If there's any concern about whether a cat may be hypoglycaemic the best thing you can do is check its blood sugar level. It's not rocket science.

I do have a theory that some vets have very poor testing technique which would, of course, be stressful to the cat and they then automatically assume that the cat's human is equally challenged in the testing department. At the practice where Saoirse was first diagnosed I brought her in to them for a couple of curves (got no support for home testing) and they made mincemeat of her ears. I was in the hospital area when they were doing the last test. It took three people to get the test, and they were poking in the wrong part of the ear. When mishandled like that, of course a cat's going to be stressed out of its mind. At home, it wasn't long before Saoirse started sitting at her testing station, waiting for me to do her sugar check. Single-handed.


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This is a picture of Saoirse waiting for her sugar check:


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She look stressed to you?


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Critter Mom said:
Again, utterly wrong. If there's any concern about whether a cat may be hypoglycaemic the best thing you can do is check its blood sugar level. It's not rocket science.

I do have a theory that some vets have very poor testing technique which would, of course, be stressful to the cat and they then automatically assume that the cat's human is equally challenged in the testing department. At the practice where Saoirse was first diagnosed I brought her in to them for a couple of curves (got no support for home testing) and they made mincemeat of her ears. I was in the hospital area when they were doing the last test. It took three people to get the test, and they were poking in the wrong part of the ear. When mishandled like that, of course a cat's going to be stressed out of its mind. At home, it wasn't long before Saoirse started sitting at her testing station, waiting for me to do her sugar check. Single-handed.


Mogs
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That terrible. Poor baby! I feel bad testing a lot on Blue. His ears get red but not as bad as that sounds.
 
When Saoirse went in for curves to the vets she was under at time of Dx they tested from the ears, the same way as we do (albeit clumsily). After we moved to our current practice, any time she was in with them for something they also would test from the ears.

Patty and Blue said:
Was she part Bombay? The round eyes look like it.
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I have no idea, Patty. I adopted Saoirse and Amadán, her brother, from a local rescue shelter and on their papers they were down as domestic shorthairs (moggies, in essence). Amadán was a tuxedo.

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Thanks, Patty.

Impossible to tell what's going on without recent readings and also the possible resolution of inflammation in the mix. We know that a 0.75IU dose with a bit of a depot built up is enough to take Blue down to the lower limit of the normal range. What worries me now is that we don't know whether Blue has been going lower earlier in the cycle on a 1IU dose than the 66 reading you just took. Bearing in mind that they set the 1IU dose in a situation where stress could have been elevating Blue's numbers, that's a concern.

I hope you can get the dosing information and BG readings from the vets tomorrow, Patty. I think you really need to see what has been happening to Blue's levels while he was at the clinic in order to be in a position to make properly informed, evidence-based decisions about how to proceed.

What do you think yourself?

BTW, if they say that the dose wears off after 18 hours, I'd suggest a spot check after that point to see how much Blue's BG might be rising.

(Sleep meds kicked in while I was in the middle of typing this. Sorry! :oops: :rolleyes: )


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