Kat & Elsie
Member
*NOTE* This was originally posted in the Main Forum, and it was suggested I also copy & share it here. Sorry for the double post.
***
https://www.felinediabetes.com/FDMB...amps-98-3-71-5-77-6-5-81.285798/#post-3144977
Hi guys, it's been a while since I updated here. My apologies for not maintaining contact at the forum, life has been hectic. This is long, sorry.
I've not been the biggest fan of our vet for a while now, but things still seemed to be going alright enough for us not to seriously consider switching, since so many offices in our area are not accepting new patients at all, or are booked out 3-4+ months.
Elsie was diagnosed in September '23, and though I'd tried to talk to the vet about following TR and instructions from you guys here, home testing etc. I was never able to sit down and have a real proper conversation about any of it. They just kind of said, "Well this is what we want you to do" and sent me on my way. Not great communication or availability at all. They insisted they had to run all curves there at the office, and are against me using a human meter. Despite me trying to explain things to them, they seemed pretty uninterested, so I just did it anyway. My mistake I suppose, but here we are. They finally (after months of not hearing anything from them after they last upped her dose) called to check in on the cat and see how she was doing. Wanted me to come in to run another curve, at which point I then tried to explain again about how I'd been treating at home. So they said to send them the information from the home curve. I sent them this email:
"Hello Dr. [redacted]!
You'd requested an update on Elsie cat & her diabetes/insulin doses. She is currently doing well on 2 units, and her neuropathy in the back legs has resolved.
She received & continues to take a liquid methylcobalamin supplement with her breakfast, which I believe may have helped some with her back legs, along with managing to get her insulin under control.
One of the information sources you provided has www.felinediabetes.com listed as a good place for additional research. I have found it to be a very informative website, and have been learning as much as possible about how to help treat Elsie at home. The community web forum on that site has been running for many years, and is strictly dedicated to helping cat parents care for their diabetic kitties, including help with dosing regimens, diet, etc. Most of the experts there use, and all of the support information there (including the spreadsheet I've linked) is formulated with, glucose readings from a human meter, rather than a pet meter.
I have been following the instructions they suggest, and using one of their recommended meters. I've been following the "Tight Regulation Protocol" (https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/) and, with practice & help from the members of this forum, now feel comfortable adjusting Elsie's doses by 0.25 units at a time only as needed, with strict home observation during those times. I'm using syringes with half-unit markings, and using the insulin pens, essentially, as small vials from which to draw.
One of the requirements to use the help forum is to keep a running spreadsheet of glucose readings from home tests, viewable to all members/experts who are helping. Again, this spreadsheet was created with numbers from my human glucometer, so they do not match up to exactly what you have at the office. But the color coding is helpful to see what a safe glucose range should be, relatively. Here is Elsie's spreadsheet:Elsie's FD Spreadsheet - Google Sheets. It stays updated as I add information.
I last ran a curve for Elsie on April 4, 2024, which can be seen on the spreadsheet. The "normal" blood glucose range for my meter is between 50-99.
Her morning pre-shot number (AMPS) was 128
Fed breakfast & gave 2U insulin, tested every 2 hours
AMPS +2: 86
AMPS +4: 85
AMPS +6: 79
AMPS +8: 87
AMPS +10: 94
Number at +12, pre-shot before dinner (PMPS) was 104
Fed dinner & gave 2U insulin
PMPS +2: 125
I hope this is helpful, please let me know if I left out any information you were wanting. I would like to continue to monitor Elsie at home, as she is extremely nervous in the vet office and has gotten into a good routine of testing & treats here."
Yes, in the paperwork they gave me when she was first DX'ed, this website (not the forum specifically) was listed as a good source for further reading and information about FD. It's how I found this forum in the first place.
This is the response I received almost 2 weeks later:
"Hello.
Thank you for the update. As you have chosen to change her insulin dosing without any guidance from a veterinarian, and perform curves yourself, I can no longer agree to care for your cat due to liability issues. I cannot continue to provide care or medications under these conditions as per the state mandate for standard of care, as well as per my liability insurance carrier mandate.
Additionally, I do not agree with this protocol or "tight control" for animals with diabetes. Tight control is not commonly practiced in veterinary medicine. Therefore, I am not probably not the best veterinarian for you. I can tell you very much love your Elsie and want the best for her. I would recommend you consult a board certified veterinary internal medicine specialist who can further assist you in her care for diabetes. This is one of their areas of specialty and they have the most up to date and pertinent knowledge in veterinary medicine for internal medicine disease processes. I would recommend either [redacted] or [redacted].
Sincerely,
Dr [redacted]"
Which brings me to my question... What do I need to ask about before signing on to a new vet? I really don't want to have to go through this again, and I'm very nervous I won't be able to find anyone in my area who will be on board with the protocol. The two offices recommended are half an hour away at least. If they are willing to go with the program, I'll make the trip, but I'll call every office closer to home first, if I have to. I'm also hesitant to take the recommendations from my current (former) vet, being that they don't agree with the treatment plan & so may not be trustworthy to provide references to someone who would agree to it.
The other concern is that I am hoping to find someone very soon, before Elsie's insulin runs out, since I don't think I can continue to refill the existing prescription. Or can I? Is the RX still valid until expiry, even if the doctor is no longer caring for my cat?
Thank you, and sorry to be so long-winded, I'm a little overwhelmed.
*Edit to add: I know I've been bad about getting night time numbers, I plan to get back on track with that starting tonight. Part of my inconsistency with posting has been just exhaustion, and I've been crashing hard after dinner. I will set multiple alarms if I have to!
***
https://www.felinediabetes.com/FDMB...amps-98-3-71-5-77-6-5-81.285798/#post-3144977
Hi guys, it's been a while since I updated here. My apologies for not maintaining contact at the forum, life has been hectic. This is long, sorry.
I've not been the biggest fan of our vet for a while now, but things still seemed to be going alright enough for us not to seriously consider switching, since so many offices in our area are not accepting new patients at all, or are booked out 3-4+ months.
Elsie was diagnosed in September '23, and though I'd tried to talk to the vet about following TR and instructions from you guys here, home testing etc. I was never able to sit down and have a real proper conversation about any of it. They just kind of said, "Well this is what we want you to do" and sent me on my way. Not great communication or availability at all. They insisted they had to run all curves there at the office, and are against me using a human meter. Despite me trying to explain things to them, they seemed pretty uninterested, so I just did it anyway. My mistake I suppose, but here we are. They finally (after months of not hearing anything from them after they last upped her dose) called to check in on the cat and see how she was doing. Wanted me to come in to run another curve, at which point I then tried to explain again about how I'd been treating at home. So they said to send them the information from the home curve. I sent them this email:
"Hello Dr. [redacted]!
You'd requested an update on Elsie cat & her diabetes/insulin doses. She is currently doing well on 2 units, and her neuropathy in the back legs has resolved.
She received & continues to take a liquid methylcobalamin supplement with her breakfast, which I believe may have helped some with her back legs, along with managing to get her insulin under control.
One of the information sources you provided has www.felinediabetes.com listed as a good place for additional research. I have found it to be a very informative website, and have been learning as much as possible about how to help treat Elsie at home. The community web forum on that site has been running for many years, and is strictly dedicated to helping cat parents care for their diabetic kitties, including help with dosing regimens, diet, etc. Most of the experts there use, and all of the support information there (including the spreadsheet I've linked) is formulated with, glucose readings from a human meter, rather than a pet meter.
I have been following the instructions they suggest, and using one of their recommended meters. I've been following the "Tight Regulation Protocol" (https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/) and, with practice & help from the members of this forum, now feel comfortable adjusting Elsie's doses by 0.25 units at a time only as needed, with strict home observation during those times. I'm using syringes with half-unit markings, and using the insulin pens, essentially, as small vials from which to draw.
One of the requirements to use the help forum is to keep a running spreadsheet of glucose readings from home tests, viewable to all members/experts who are helping. Again, this spreadsheet was created with numbers from my human glucometer, so they do not match up to exactly what you have at the office. But the color coding is helpful to see what a safe glucose range should be, relatively. Here is Elsie's spreadsheet:Elsie's FD Spreadsheet - Google Sheets. It stays updated as I add information.
I last ran a curve for Elsie on April 4, 2024, which can be seen on the spreadsheet. The "normal" blood glucose range for my meter is between 50-99.
Her morning pre-shot number (AMPS) was 128
Fed breakfast & gave 2U insulin, tested every 2 hours
AMPS +2: 86
AMPS +4: 85
AMPS +6: 79
AMPS +8: 87
AMPS +10: 94
Number at +12, pre-shot before dinner (PMPS) was 104
Fed dinner & gave 2U insulin
PMPS +2: 125
I hope this is helpful, please let me know if I left out any information you were wanting. I would like to continue to monitor Elsie at home, as she is extremely nervous in the vet office and has gotten into a good routine of testing & treats here."
Yes, in the paperwork they gave me when she was first DX'ed, this website (not the forum specifically) was listed as a good source for further reading and information about FD. It's how I found this forum in the first place.
This is the response I received almost 2 weeks later:
"Hello.
Thank you for the update. As you have chosen to change her insulin dosing without any guidance from a veterinarian, and perform curves yourself, I can no longer agree to care for your cat due to liability issues. I cannot continue to provide care or medications under these conditions as per the state mandate for standard of care, as well as per my liability insurance carrier mandate.
Additionally, I do not agree with this protocol or "tight control" for animals with diabetes. Tight control is not commonly practiced in veterinary medicine. Therefore, I am not probably not the best veterinarian for you. I can tell you very much love your Elsie and want the best for her. I would recommend you consult a board certified veterinary internal medicine specialist who can further assist you in her care for diabetes. This is one of their areas of specialty and they have the most up to date and pertinent knowledge in veterinary medicine for internal medicine disease processes. I would recommend either [redacted] or [redacted].
Sincerely,
Dr [redacted]"
Which brings me to my question... What do I need to ask about before signing on to a new vet? I really don't want to have to go through this again, and I'm very nervous I won't be able to find anyone in my area who will be on board with the protocol. The two offices recommended are half an hour away at least. If they are willing to go with the program, I'll make the trip, but I'll call every office closer to home first, if I have to. I'm also hesitant to take the recommendations from my current (former) vet, being that they don't agree with the treatment plan & so may not be trustworthy to provide references to someone who would agree to it.
The other concern is that I am hoping to find someone very soon, before Elsie's insulin runs out, since I don't think I can continue to refill the existing prescription. Or can I? Is the RX still valid until expiry, even if the doctor is no longer caring for my cat?
Thank you, and sorry to be so long-winded, I'm a little overwhelmed.
*Edit to add: I know I've been bad about getting night time numbers, I plan to get back on track with that starting tonight. Part of my inconsistency with posting has been just exhaustion, and I've been crashing hard after dinner. I will set multiple alarms if I have to!
