Forgive me! NOT 911.

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shylock13

Member Since 2013
I have been a member of this group for a while but have not posted on this page, nor visited much. :( We've had a hectic year and my cat Shylock's diabetes, so I thought, had been well-managed. I will try to make this as short as possible... I'm in the process of switching my animals (2 cats and 2 dogs) to a holistic vet (who also is very well schooled in traditional medicine) and had a consult with my Shylock (who is 13 yo) with her yesterday. Shylock was diagnosed with diabetes 1.5 years ago (prednisone induced, he's on pred for a brain tumor) and after the initial testing and curves, has been on 4 units of lantus BID since dx. The first thing that the vet wanted to do yesterday was bloodwork. I got a call today and the voicemail from the vet stated that overall organ function was well, but Shylock's fructosamine levels were "beyond poor" and incredibly high. He is at 730, very poorly regulated. I haven't connected with her yet, will talk her tomorrow. But, ultimately, her recommendations (per voice mail) was to do another curve test for the lantus, or switch him on to another type of insulin. I have to admit my knowledge is INCREDIBLY limited with diabetes and recommended treatments. We've lost a couple of very special animals in the recent past and my grief has affected what I can learn (or sought out) about Shylock's illness and necessary tx (shame on me). But, now I'm back in the saddle and looking for your expert advice! I'm SO happy that I finally made the decision to leave my vet of 16 years and find a more proactive, compassionate advocate for my animals. It sure was tough, but I think a well made decision! I know there are so many variables to this, but are there any talking points that any of you could recommend for me to discuss with my new vet (who I am absolutely CRAZY about!) tomorrow? THANKS in advance! I look forward to being more active on this board!

Thanks so much!

Stacy & Shylock
 
Re: Newbie Here! Questions O'Plenty!

Welcome!!! (your post looks great!!!)

While you wait for people to weigh in, you might want to peruse the Stickies at the top of the list. They hold an abundance of info that is really helpful. It's overwhelming at first, but it's always good to know where to come to find things you will want to know at some point. The people on here are really good at talking you down from the ledge of panic attacks FD makes you feel like you are having. Everyone is always so helpful and super supportive!
 
Re: Newbie Here! Questions O'Plenty!

Hi, Stacy, welcome (back) to LantusLand. Good for you for finding a vet that is better suited for your critters!

The first thing that comes to mind is home testing. It's a little traumatic at first but you and Shylock will soon figure it out. It's the only way to keep your kitty safe. You can use a human meter, it's much, much cheaper than an animal meter and the strips are much cheaper too. Having the vet do a curve is a waste of time and money because the cats BG will likely be higher due to stress.

The second issue is food. Cats should be eating about 4-5% carbs and that means wet food. Dry food is unacceptable. Most vets like to sell you high-priced prescription food which is actually lower quality than a lot of commercial food. You can look at catinfo.org for a chart of foods and their composition.

I am wondering what other insulin your vet would recommend. It seems that Lantus or Levemir is the best available insulin for cats.

Another issue is what protocol she recommends for setting the dose. We change doses fairly often around here, based on recent tests. Vets usually can't give you that kind of advice.

Good luck with the visit tomorrow. I know Shylock will appreciate it too. Ok, maybe not. :lol: :lol:
Liz
ETA: Could you not use the 911 icon? We use that for life threatening acute situations. It tends to raise blood pressure... Better to use the ? icon. Thank you.
 
Re: Newbie Here! Questions O'Plenty!

Hi and welcome to LantusLand! It will help if you can give a little more information.
  • Are you home testing? If so how are your records recorded? We use a spreadsheet here that is posted in Google docs. If you haven't set one up someone here can help you get started.
    What type of food are you feeding? Canned, raw or dry? Have you seen the food list on Dr Lisa Pierson's site? It lists the carbs in practically every cat food out there.
    Are you shooting on a regular 12 hour schedule?
    How often do you adjust the dose?
    When you said you thought Shylock's FD was well managed what were you observing in him?

I'm not sure what instructions your old vet gave you about Lantus, but many vets have heard it is "the new thing" and haven't really learned how different it is from older fast acting insulins.

Please give us a little more info , there are so many here who have sooooo much knowledge of FD and are willing to help.
 
Re: Newbie Here! Questions O'Plenty!

Welcome to Lantus Land.

In addition to the questions others have asked, what was Shylock's starting dose and how were doses changed (i.e., by how much and how often)?
 
Re: Newbie Here! Questions O'Plenty!

First off, sorry about the 911 use! I didn't know it was for dire emergencies. I just wanted some advice before I spoke to my vet tomorrow.

Shylock was started off on 2.5 units of lantus BID after his initial diagnosis. After several curves, he was adjusted to 4.5 units. We have had him at 4 units for approximately 10 months. He is a big boy, weighing in at 15-16 lbs consistently for the last 10ish years. 4 years ago, he presented with an acute ataxic/staggering episode. After a battery of test were run, and a visit to the neurology techs at a local university, we discovered he has a progressive tumor of unknown origin on the right side of his head. He was started on a regular dose of prednisolone at that time, which he has remained on. This condition is still an unknown at this point in time, though the pred seems to keep his ataxia/vertigo in balance. His development of diabetes seems to be pred induced. He eats wet food (weruva canned and stella & chewy's raw) twice a day and has orijen kibble available if he wants it (our other cat hasn't warmed to wet food and insists on his cereal. I do believe Orijen to be a good kibble, if he must!). I don't notice Shylock nibbling much on the orijen, and he seems to enjoy his wet food daily!
 
Re: Newbie Here! Questions O'Plenty!

Most of us here follow either the Tight Regulation Protocol or an approach referred to as Start Low Go Slow. Regardless of the method of dosing, the dose is raised in small increments (usually 0.25u) in a systematic manner. The dose adjustments are based on what home testing results tell you. Most of us have found that basing a dose change on a curve run at the vets usually results in too large of an increase since kitties are stressed at the vet and the stress inflates BG values. In addition, a small, systematic increase in dose reduces the risk of missing what could be an effective dose. It is rare for any cat here to be on the same dose of insulin for 10 mos. Holding on to a dose, especially one that isn't putting BG numbers into a good range, makes it harder to get numbers down. (This is called "glucose toxicity.") In other words, Shylock's body regards high numbers as "normal."

At this point, I'd encourage you to get on the home testing bandwagon. I don't think you'll be able to fairly assess whether Lantus is working unless you can see what Shylock's numbers look like in response to dose changes. (FWIW, most of us adjust our kitties' insulin without consulting with our vets. However, this is your decision.)

The pred, while obviously necessary, is going to raise Shylock's BG numbers. It's not a problem to adjust insulin around the pred.

If your vet isn't familiar with the Tight Regulation Protocol, I'm attaching the article from a leading feline vet journal that describes the research and the protocol. You may want to share this with your vet.
 

Attachments

Re: Newbie Here! Questions O'Plenty!

You have to edit the very first post to change the icon and subject line that is visible in the forum.
Liz
 
Re: Newbie Here! Questions O'Plenty!

You have to go back to your first post in this thread, click on edit, click on the none button above the subject line, and then click on submit in order to remove the 911. Thanks! :-D
 
Re: Newbie Here! Questions O'Plenty!

I got it ;-)
 
Re: Newbie Here! Questions O'Plenty!

Hi Stacey and Welcome to Lantus Land.

My cat Jupiter was diagnosed on 3/14/13 - so I dont really have any advice... but... I am here to support you and cheer you on. There are a lot of really experienced members here though who are so kind and knowledgeable and Im sure they will give you the advice you need. I know it must be a little stressful changing vets, but I understand - and think you making this decision to help your kitty is really great.

Only advice from me - Ask any and all questions you have! There is always someone here to help and answer your questions. It is the best way to learn how to help Shylock!

Goodluck with your new vet :smile:




and... hehe you called your cat a big boy...My cat Jupiter weighs 17.4 lbs!
 
Thank you, Sienne, for your MOST helpful post!! You've given me a lot to think about and things to discuss with the vet tomorrow!! Thanks SO much!! Have a great night!
 
Stacey

Sorry...I should have welcomed you first but I saw the 911 and we all react quickly to a 911. Glad everything is ok :-D

When you get a chance, it would be great if you could get a Spreadsheet set up so you can start recording the data you get. Also, we also ask if you can do a Profile as soon as you can so we have lots of interesting info about your baby.

Please let me know if you have any trouble with either...just send me a PM. :-D
 
Thank you all, for the responses. I think at this point, I am overwhelmed. I am crying as I type this, as I only wanted some guidance for questions to ask my new vet tomorrow and have been met with such a barrage of questions ( and advice), and how not to post at 911 alert. I am not comfortable posting any more in this group. Thanks.
 
Everyone feels overwhelmed with FD and your cat has a tumor too. That's even more to deal with.

I wish you would come back. There are many of us here who want to help but we have to ask questions so we can give the correct advise. And often
you will get quite a few of us at a time. I started to post and saw Ann and Anne had already asked the same things I was going to ask so I held back
and waited.

You already had one vet who has mismanaged Shylock and the community here can help you get him back on track.
We can give you many suggestions. We all live this 24/7 and there is so much more experience here than you will get from most vets, even the best ones.

You took the first step and posted for help. Feline diabetes is very stressful and we have all been where you are so we Do Understand.
 
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