Hi! Newbie with an out-of-date vet

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Wow! Bummer! That vet is a bit disappointing. Maybe he was having a bad day. It can be difficult for vets to keep up with all the latest info on all the diseases and issues they see with the various animals they treat. They can have liability concerns too, with a medication like Lantus if they have never used it before and are not sure how to manage diabetes with this new to them drug. It can be a learning experience for the vet too, if they are willing to take on the challenge.

Still, you live in an area where you should be able to find another vet so those phone calls should turn something up. Hope you find another vet that is more responsive to your needs. Remember to get a copy of all the records from your current vet. You paid for all those tests, you are entitled to copies of all the results.

You know that all of us here will be supportive of whatever you want to do. We're engaged, interested and motivated to get your cat feeling the best he can. Our goal is remission if possible. You never know, so let's reach for that brass ring for your cat Cheshire.
 
Chris & Cheshire said:
I've just finished my mini-research-brief and proposed treatment plan, which I'll be delivering to the vet tomorrow. My goal is to be switching to Lantus this weekend (when I'll have time to do the initial close monitoring).

If anyone wants to see the brief (and/or make any recommendations): https://docs.google.com/file/d/0By1ctcDEMTONaFh5WFoxU0JFX3c/edit?usp=sharing
Click to expand...

This is fantastic work! Would you mind if I share it with others in the future as a "case study" type thing to help others to get their vets to switch? Your (current) vet might not be interested, but other vets might! :-D
 
Sure thing, KPassa, though let's see if it works first, lol. :)

Deb & Wink said:
It can be a learning experience for the vet too, if they are willing to take on the challenge.
Click to expand...

Yep, it's a challenge for all parties involved, and if this vet won't step up and do his job, I'll be glad to give my money to someone else. He works for me, and I just don't think he realizes that.

And thanks for the interview tips, BJM! I need to just start checking your sig first every time I have an issue/question. :)

I spent some time on the Reporting tab of my spreadsheet tonight to set up a graph of the overall and monthly BG curve. Kind of please with how it's turned out (though the limitations in Google Spreadsheets can chafe a bit). I'd handle the data collect a bit more automatically in Excel, but, c'est la vie. Maybe it'll be useful to someone. Or maybe someone's already done it better! :)
 
Monthly average is kinda cool. What's the 1,2,3, Etc.. Is that hourly average? Not sure how useful that is if so since nadirs vary as do bounces.

I have an offline line chart that shows all readings over time which is interesting for trends...
 
Wendy&Tiggy said:
Monthly average is kinda cool. What's the 1,2,3, Etc.. Is that hourly average? Not sure how useful that is if so since nadirs vary as do bounces.

I have an offline line chart that shows all readings over time which is interesting for trends...
Click to expand...

The 1, 2, 3 is hours after shot - so you can see how it averages out and get a sense of what the curve looks like. The chart shows what the average reading at +1 was overall, then in July, Aug, etc. Next row is average reading at +2 overall, July, Aug, etc. And so on. Then the graph visualizes those hourly averages. It might hide some of the variance in nadirs/bounces, but mainly I wanted to confirm my sense of when the insulin wears off.
 
So the vet came through and prescribed the Lantus... which I just paid an arm and a leg for. The card sign-up site wouldn't let me registered and I haven't had time to call... so I just paid for it. I figure it'll last 6-9 months, so I'll fight the coupon again then. I want to be able to monitor closely when I switch to Lantus, so I'm waiting for Saturday morning... new chapter beginning! Thanks a ton to you guys for encouraging me to push for this.

The brief went over well, too, once he sat down and read it. I put the spreadsheet on top, and he'd just never seen a client do anything like that before. Hopefully it'll spur him to educate himself a bit.
 
Congratulations on getting your vet to prescribe the Lantus. After the presentation you did, building your case as to why you wanted to use that insulin and the research you included, I don't see how he could have said no.

Have you been over to the Insulin Support Group for Lantus TR and read the documents at the beginning of the topics section labeled Sticky.......? Lots of good information there.

We'll be waiting to see how Cheshire does on the Lantus. Wishing for all the best for him.
 
Yay for the vet! It's not necessarily a bad thing if they're out-of-date; it's only bad if they're not willing to work with you. ;-)

I noticed on your spreadsheet that Dinah vomited from the Friskies Poultry Platter perhaps? It does contain fish, which many cats are allergic to. Keep track of what you feed her when she vomits and see if there's any correlation in the ingredients. Other common allergens are beef (which Mikey is allergic to) and even poultry.
 
Deb, thanks for the pointers about the stickies - will definitely read before starting on Saturday.

KPassa - fish in the "poultry platter"?! That's terrible, deceptive marketing. Dinah and Cheshire have different tastes, so I've got to start doing a better job of monitoring her, too. Thanks for the heads-up... that's really bizarre.
 
Hey Wendy - dose is exactly what I'm thinking about. I'm a little eager to update my sig to say "Lantus", too. :)

The TR Protocol would suggest 1.3U based on weight. We've been doing 1U of Humulin, and depending on which food he's on, getting into the mid-low 100s at nadir. So I'm hesitant to start any higher than 1U, and there's part of me that thinks I should start at 0.5U just to be on the safe side.

There are practical factors that play into this, too:

I'll be able to monitor him extensively over the weekend, so I'll get two cycles of frequent readings. But Mon-Wed, I'll be at work all day, so testing will be limited.

What's worse is that on Thursday, I fly to California for 8 days, during which time he'll be boarded. He hasn't been diagnosed long and I don't have a good vet (and I'm not boarding him with my crappy vet, anyway). So I feel like I need to be quite conservative with this initial period. He's going to stay at a vet hospital (they want him to stay in the hospital ward, but I don't love that idea - I'd rather he be in one of the "cat condos" with a outside view), so I know they can handle a hypo situation, but I'd rather not risk it.

So, how do you feel about a 0.5U starting dose for the first two weeks? I know this isn't an ideal way to start, but my only other option is to leave him on 1U of Humulin for the next two weeks, and I'm just as worried or more about it.

All ideas/advice appreciated.
 
Yes, it's one of the requests I'm making. Though it won't be as frequent as what I would do. I have to negotiate that, but I'm planning to ask for a AMPS, +6 and PMPS, and telling them not to shoot if the PS is less than 200. That sound right?
 
Hahaha!

So, the plan was to give the first injection of Lantus this morning so I could monitor the first cycle closely all the way through. Cheshire has other plans. His BG was 126 this morning, which I understand to mean no shot (below 200 = no shot, right?).

Since I'm brand new to Lantus - should I inject him at 126 anyway? Should I test again in an hour (after he's eaten) and then if he's higher, start the cycle then?
 
Actually, think I found my own answer: Lantus dose changes are based more on the nadir than the PS tests (though they're a factor).

So, I should give the 0.5U starting dose, and start monitoring. And start a thread in the Lantus forum. I'm going to miss this one. :)
 
First as a newbie to lantus I wouldn't shoot under 200 since we don't have data to know what he will do. But if you did, please get a test at +2 for sure to see what Cheshire plans are for the day and if is lower, get more tests in..

Lantus is a depot insulin and so takes a few days to build up in the cats system however chesh might still have some old insulin in there that will impact things.

The depot means it takes a few days to see any impact of a dose change too which is why we hold the dose a few days before making changes. And hold it a week when starting out (unless BG drops below 50 which earns a decrease immediately )

Don't worry about moving forums, many of us are over there too and u can always ask questions here too..
 
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