Lantus TR "talk" with vet advice

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tomtom13

tomtom13

Member Since 2013
hello all

with the encouragement of TheBowHuntress/Gobbles and Dara/Bob (thanks guys!), I have decide to clue my vet into my dosing Lantus. or kinda sorta hint at it.....to see his reaction. :o

Background on my vet: kinda laid back .....country vet....started me off on Humulin N and prescription can/dry! .....I had to ask several times before he reluctantly gave me a prescription for Lantus. He didn't seem to know anything about it. Almost even asked me about starting dose!! anyway......he does not make me bring Tom to the office for curves and he does not charge me for phone consults....which is all I do. So he is basically free....a plus!

He had me increase Tom's insulin by 1 unit increments with one home curve many times.....of course I didn't do this. Last phone call I had a 119 value to report (so proud) and he FREAKED OUT. did not like that low of a number....even though he knows and supports my home testing. He said to hold dose for another 2 weeks. I questioned him at the time.....ie: well isn't that a good value for a cat?, I am watching Tom closely and I can stave off a really low number with food etc. nope didn't work. so given all this.....I seriously doubt the fellow is going to be in full support of me adjusting doses on my own and pushing for a low value like 49!!

Another thing: My Dh is kinda a conservative type who thinks a vet knows it all......more certainly than a forum of us cat lovers. So he is always saying: what does your vet say? does your vet say to increase? so that doesn't help!....obviously, i would like to have his full support as well....but i have to have my vets first.

i guess my fear is the vet will be so turned off that he will no longer give me the lantus prescription...and i will be stuck shopping around for a new vet who costs the earth and makes me bring poor stress tomcat into the clinic once a week!! not too mention, god forbid i have to have Tom treated for some other ailment and i have to come clean that Tom is really on a higher dose.

okay given all of that: what experience have you all had? what EXACTLY do you call the lantus tight protocol? and if he is clueless....how do i explain it?

"well, you see doc,.....remission in my goal.....and therefore, i just keep juicing up the cat until he bottoms out below 50 and then i slowly reduce...."

that isn't gonna work! ha

the vet already thinks I am a little slow and not very skilled as he doesn't believe in bounces....at all. he has frankly told me that when Tom bounces and/or stays flat pink for day (which is normal for the poor cat) it is because i am giving furshots this entire time. "there is no other explanation for why his numbers don't lower every cycle."

advice please.....and/or reassurance that it is okay to disregard an educated doctor and keep my secret and keep getting my lantus prescriptions. and when i call in numbers...just kinda skew them? :razz:

it would be so nice and such a relief to have his support.......just a calming reassurance that your vet is cheering you along with praise: your doing the right thing kelly!

~kelly
 
I think the first thing I would do, Is print out contemporary veterinary references on feline diabetes management.

This includes:
AAHA Diabetes Guidelines
and
The Merck Veterinary Manual Online section on Diabetes Mellitus

From international expert in feline diabetes, Dr Rand, the short article General information regarding Glargine use in treatment of Diabetic Cats.

The initial article which led to the development of the Lantus Tight Regulation protocol by Roomp and Rand.

Also, I'd provide them to the vet while mentioning that you know vets can be very busy and it can be difficult to stay up to date on every condition for every species without spending every single minute studying, so you thought you'd save some time for him by printing out the references. You have to say this with sincerity or you may generate some irritation.
 
Some people "agree to disagree" on the treatment of feline diabetes with their vets.

What is your vets goal for your cat TomTom? Regulation or remission? How many cats has he successfully gotten into remission with his methods? How many new diabetic cats does he see in a year?

Many vets are scared of those low numbers because of liability reasons. Few vets encourage home testing and do not realize we can keep our cats safe at these lower numbers with home monitoring and feeding to help the cats surf in those low numbers.

Those vet journal references BJM pointed you to are a good starting point.

How about this slideshow presentation? Insulin- A Review and What is New from the University of Queensland. I think this was from 2009 or 2010.

This one is very good too. Understanding Feline Diabetes mellitus: pathogenesis and management

Your vet already prescribed an outdated insulin (Humulin N) for your cat, so we know he is not current with the latest research. Tell your husband that and show him that slideshow presentation and have your husband read the AAHA guidelines to show your husband that your vet is not current. Maybe then he will see the vet does not know everything.

We will always cheer you on and be supportive.
 
I think when it comes down to it, diabetes is mainly something that is managed at home. We are the ones at home with our cat, not the vet, so we need to be the ones in charge.

tomtom13 said:
what experience have you all had? ~kelly
Click to expand...

This was my experience:

The vet clinic I had used a couple of times, for vaccines and one constipation issue, was called Exclusively Cats . . . which I assumed meant the vet would know more about cats than one that treated everything. When Papaya started showing symptoms and I got a full (very expensive) blood panel, and then a (again very expensive) fructosamine test, and thus diagnosed with diabetes, he suggested a diet change and gave me the list of low-carb canned foods to try before we started insulin. Meanwhile I found this website. So while he was right about the diet, alarm bells really went off in my head when the vet wanted to use Caninsulin (seriously, even without knowing much, canine=dog so why would this be for a cat??) and keep her for a full day curve. The alarm bells got louder when he got really offended and squirrely about me asking why he was using this insulin and trying to get ANY kind of estimate for what they would charge me for the curve.

So I packed Papaya up and took her to a different vet, based on the fact that I asked the new vet's receptionist "what insulin do you use for cats" and she said Lantus. The new vet just showed me how to give a shot and sent me home with the Lantus to start that night. He initially wanted me to come in weekly so he could test Papaya's blood sugar, but once I started bringing in spreadsheets with lots of home testing, he realized that wasn't terribly necessary, so we moved to a quick visit every few months just so she can stay in touch with a vet. Honestly, I don't think he believes in bounces at all either, and pretty much has just looked at her spreadsheet with furrowed brow trying to figure out why she's so up and down. He has seemed reasonably interested in taking a copy of the Roomp and Rand protocol to read so he knows what I'm doing. He hasn't really had any useful suggestions but hasn't objected to anything I'm doing either, and after a while would just look at it and agree with what I was doing, so it seemed to be a balance I could live with.

Really, I talk to people on this board more about dosing than the vet. At this point I'm going in every three months and they just bill me a small fee for a glucose test (cheaper than a regular visit, and it gives me time to talk to them about whatever I need to) but from my standpoint it's more so that the vet knows Papaya well in case something more serious develops in future than to actually help with anything diabetes-related.

I think in most cases it's too much to hope for to find a vet that is actually up-to-date with how to treat feline diabetes. They have to know how to treat a lot of things in a lot of animals. So as long as you can keep getting the Lantus, you can probably find all the information you need on this board and do things as you choose. Ideally your vet would be more supportive of what you're doing . . . maybe see how it goes after you share some of the information linked in BJM's post. And do convince the vet you're "sharing" this great information you found because you know he'll love it too - rather than telling him what to do ;-) If he's willing to work with you to some degree, you probably don't need to switch since in the end it's you doing the day-to-day work. If you do end up having to switch, just remember that the vet works for you not the other way around, so they can't "make" you come in weekly. You can always just print out your spreadsheet and assure them that you are totally on top of testing so thank you but it won't be necessary for you to come in so frequently.
 
BJM and Deb and Amy:

great! perfect idea! i will print them out...and just give to the front office girls. That way when i talk to the vet, he will already be informed and i won't have to be the "teacher" stumbling all over myself. i always am sincerely humble when i talk with him.....i truly do respect his knowledge and his time he offers me. Perhaps, if he "sees the light", i and you all will be able to indirectly help his future diabetic clients.

Thank you all for taking the time and letting me know: hey, he isn't the only one! i would never tell him what to do! rather, i will softly ask: hey, what do you think? i am more than capable of following this protocol. and my goal is remission.

****he told me at diagnosis that he sees a cat go into remission 1-2 times a year. He told me his goal is: "just to make Tomcat feel better."


thanks again for taking your time for me

kelly
 
Well, our goal for Tomcat is remission! He may not make it, but along the way, he will be feeling better.

How is Tomcat doing with the 5 P's and his appetite? The WCR or whole cat report? That will tell you bunches about how Tomcat is feeling and doing. Our goals are happy kitties here, support for their caregivers, best practices with the latest research, and remission when possible. ;-)

Wink is a foster cat from my local shelter. I was disagreeing with 2 shelter staff, 3 different vets and doing things on my own basically. I tried to educate them. Not sure how much good it did but they finally put one of their other cats with allergy issues and diabetes on a raw diet and she went into remission. This was just after Wink went OTJ. I'm hoping I had a tiny bit to do with helping that other cat. :-D
 
Wink is a foster cat from my local shelter. I was disagreeing with 2 shelter staff, 3 different vets and doing things on my own basically. I tried to educate them. Not sure how much good it did but they finally put one of their other cats with allergy issues and diabetes on a raw diet and she went into remission. This was just after Wink went OTJ. I'm hoping I had a tiny bit to do with helping that other cat
Click to expand...

of course you had A LOT to do with it......! that has to make you feel good. that must be one of the reasons why you give so selflessly to all of us .......just helping that one cat...that one "scared to death" overwhelmed newbie ......makes it worth it to you....and that is very telling of your character.
very telling of a lot of helping folks on this board!

okay...well, since I have an experienced owner of an OTJ cat called Wink helping me out.....and anyone else that cares to offer their advice: can you please overview my post this am.

viewtopic.php?f=9&t=99991

here is my ONE QUESTION for your overworked eyes/fingers/mind

can I, given that Tom is SKYHIGH, give his PM SHOT earlier than I should give it? I am basing this on what Sienne said:

You can shift your time back either by shooting 15 min early at each shot time or 30 min. once a day unless you see a bounce into pinks
Click to expand...

this isn't for my convenience, I don't care when I shoot, I just feel so badly for RED tomcat (been a while since the poor dude has been red). obviously if by some miracle the insulin kicks in....I will shoot when I am supposed to.

not a fur-shot by the way

thanks

~kelly
 
Re: Lantus TR "talk" with vet/question re: shot time

Answered in your Lantus post.
 
Re: Lantus TR "talk" with vet/question re: shot time

I think what you've got there is a goldmine (in combination with this group and the tight regulation protocol)....how wonderful that you have a vet who is not up on the latest...but willing to give it a try...and extremely cautious (erring on the side of safety for your cat)....and NOT CHARGING YOU! Holy smokes! I really miss my old country vet I used to use here (he has retired). Not in it for the money, just trying to give animals good care and quality of life without destroying the bank accounts of their families.
Hope all goes well with your discussion with your vet. And I hope your kitty goes into remission quickly :-D
My kitty Molly only took a few months...by changing her diet from dry to canned first (Fancy feast "classic varieties only) and then starting the lantus shots after
a week of new diet. You're welcome to print up her spreadsheet to show the vet if that's helpful. It's linked below. I use a Relion meter and once I got testing down...away we went! Molly's still tubby, but boy does she feel better!
Best of luck to you.
 
Re: Lantus TR "talk" with vet/question re: shot time

something else you can do is print out the spreadsheets for other cats on lantus that dropped below 50 and went into remission. He may find that information helpful in demonstrating that we know what we are doing ...at least most of the time... ;)

Maui is one example and otj for over 4 years, Wink another and there are 200 more to choose from.
 
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