? Does this sound like the best starting point for insulin therapy?

Hello,

Apologies in advance for some redundant info from our previous posts, but we have new info from our vet that we're struggling to absorb.

We have become relatively uncertain about following our vets recommended treatment for our beloved Mouse. Some of the information that she has provided is directly disputed by many other sources (including some from this helpful forum), the biggest being the notion that we do not need to test daily. While we accept the fact that neither of us have any training or education in veterinary medicine, we also know that there's a plethora of information available to others like us, that...just want to make the right decisions.

The numbers from our first Glucose Curve that we ran on Monday, produced numbers ranging from 22.8 mmol/L down to 14.7 mmol/L, so we knew that insulin would be the logical next step. She's showing no real signs of her newly diagnosed FD. She went from huge water/urine activity to pretty much normal after switching her to a wet (only) low carb diet.

When we asked our vet this morning about whether we would be using the SLGS or TR regulation...she didn't know what either of those acronyms were. Are they specific to these forums, or are they known as something different in the vet world? It may be moot since she said that "we are not looking for tight regulation in cats; we are looking for more clinical signs such as urination, water - that sort of thing." But that's my point...we have noticed these `clinical signs' here, at home. They point to a marginal improvement since Mouse consumes substantially less water (over the last 12-14 days) without having any insulin yet.

The vet is now insisting that we bring Mouse in for a day so that they can do the Glucose Curve IN HOUSE, to watch for hypoglycemia. She suggests starting with 2 units and then increasing as needed, but...we wonder why starting with a smaller dose (1/2-1 unit) and then adjusting up, if needed, is not an option.

Hypoglycemia is certainly very critical, but if starting with a low(er) dose minimizes the chances of that, could we not do this at home and spare Mouse from the extra stress from being in the canine heavy/friendly clinic all day?

Thank you.

 

Most vets discourage home testing because they're concerned that caregivers don't really know what they are doing. They say it's for the safety of the cat to keep them from hypoglycemia, but if you follow closely the advice of the highly experienced people here, your cat will stay safe. Diabetes is a very very small portion of what vets have to learn in school, whereas the accumulated years of experience of the moderators and senior members of this group make it be most knowledgeable place in the world for feline diabetes. Bringing the cat in for glucose curves would only stress the cat, artificially elevating blood glucose levels.

My vet also discouraged tight regulation because of fear of hypoglycemia, preferred for my cat to stay in the 200 range of BG levels. Once I joined this forum, I basically stopped asking my vet for advice. I still took her in for bloodwork and nodded and smiled whenever the vet gave me advice on dosage. As my Ruby started getting more regulated because of the amazing help I got from people here, I sent the vet my spreadsheet and he said, "Ok, whatever it is you're doing, keep doing it!" He was happy to allow me to manage Ruby's diabetes as he understood that I knew more about what I was dealing with than he did. Since then she's developed other health issues, but her diabetes is well under control.

Hopefully a more senior member of the board will be by to help you with your dosing question. What kind of insulin is Mouse getting and how much does he weigh? (Sorry if you've answered this in other posts.)

 

Follow your gut.
Does it seem safe, to inject a powerful hormone into a body, without knowing if the blood glucose is high enough? No, not really.
No need to do curves at the vet, the vet won't get a clear result anyway.
Your gut is right, on the units to begin with.

I'm impressed by your own research and critical thinking! You'll do absolutely great, I'm sure
Trust your gut and these amazing people here. We won't make you rob a bank to keep your furbaby safe

 

I agree with what PerfumedCatMom and Sashav have said.
Sorry but your vet does not seem to know that much about diabetes
If it wasn't for the members here and their advice Tyler would have never gone into
remission

 

Please would you set up your spreadsheet and enter your cats numbers
I assume you did it at home
The members have to see it on the spreadsheet in order to give you any advice about dosing
2 units seems like a high dose to start with,
I'm going to ask @Bandit's Mom or
@Chris & China (GA)
to set up your spreadsheet for you

 

Hi,

We haven't setup a spreadsheet yet because Mouse has not yet started insulin therapy and we've only run one Glucose Curve. I have attached the curve to this post.

 

Mouse's numbers don't look too bad. Have you switched him to a low carb canned food diet yet to see if that brings the values lower? Many cats will go into remission with a food change alone.

The only reason I could see starting with 2 units is if your cat is very large and there's a grave concern over glucose toxicity, i.e. if your kitty has had DKA.

 

Hey Katherine, she has posted many different posts , one was about syringes with half unit markings
She's from Canada and I have no idea where to tell her to get them from
The only one I could think of is Lyla
Think I should tag her, I know she's busy with Butters not feeling well
@PerfumedCatMom




https://www.felinediabetes.com/FDMB...-giving-insulin-to-mouse.245831/#post-2774440
Here is her post about the syringes, I think she thinks pens come with half unit markings

 

@PerfumedCatMom
Thank you. Yes, we switched [her] Mouse to the low carb diet after receiving her Fructosamine numbers last month. It seems to have helped at least in terms of less water/urine and more `normal' like behavior in terms of not sleeping as much. She's quite petite in terms of her weight.

@Diane Tyler's Mom
Yes, I have found that there are at least 4 companies producing pens with 1/2 unit dosage: HumaPen Luxura HD, Junior Star, NovoPen Echo and NovaPen Junior. No idea if they're available in Canada or even a real option for us yet.

We would prefer to use pens, but not if it compromises our treating Mouse safely.

 

I'm sorry I know nothing about those, we all use syringes with half unit markings

 

I'm starting to think that I should stop trying to reinvent the wheel here and just use syringes with 1/2 dose markings!
Thank you.

 

The syringes have half unit marks, but we dose in .25 both ways. So a pen dosing half units is still too much.

I know the feeling! But what if one day, reinventing the wheel is what's making a difference? But go with the flow on this one

 

We have a bit more info:

Since we relocated to our new home ~ 5 months ago, and thus needed to find a net vet, we found it difficult for two reasons; we moved to a much smaller town, and most veterinarians anywhere near us are not accepting new patients, likely due to Covid-19. While we are still grateful to have found a vet here, we're concerned about the treatment plan that is being proposed for Mouse's newly diagnosed FD.

Then it occurred to us that we, technically, still have our old vet even though we are no longer local to that area! We called and scheduled a tele-medicine consult to get a second opinion via phone or Zoom. Yay! Since we will only be sharing data and information with our old vet (practising cat care exclusively), there's no need for her to actually examine Mouse. Problem solved.

Thanks again for all of the feedback.