Lizzie's Vet wants to raise dose by 2 units - Eek

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Jacquie & Lizzie

Jacquie & Lizzie

Member Since 2012
I emailed Liz's spreadsheet to our vet this morning. I asked what she thought of raising her dose to 2.5 units. She emailed me back wanting to raise it to 4 units twice a day. That thought scares me!!! I'm not sure that 2.5 units is enough, but I'm super afraid to raise it to 4 units. You all know how dangerous that can be.
Her morning preshot was 572 and +4 was 329

Thoughts????

I'll email her back after getting a few opinions but I'm not raising it that much right away. I guess if she doesn't agree, then I'll explore my options.
 
I'd be scared, too. IMHO, that's way too big of a jump and raising Lizzie's dose to 2.5u makes much more sense. Do you know how familiar with Lantus your vet is? Not all insulin is created equal. I'm attaching a copy of the veterinary journal article that the Lantus dosing protocol is based on. Maybe this is something to discuss with your vet.
 

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First of all, take some deep breaths. There is no pressure to decide what to do right away. Also remember Lizzie is your cat and your responsibility. You decide on her care.

That dose is scary. And unwise, in my opinion. You won't find any vet in the universe with more experience and expertise in treating feline diabetes than what is available here. I'm sure your vet has the best of intentions but just may not have the background to make the best dosing recommendations. You might want to email her this article from a top vet journal. This is the research basis of the protocol followed here.

I'm sure others will weigh in too. Hopefully, your vet will realize that Lizzie's care is a team effort.
Liz
 

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I am pretty new to this, but 2u seems like large amount to increase all at once especially with only a few days data. My vet and the folks here strongly emphasize that giving too much insulin is worse than giving too little, best to make small changes and monitor what happens to avoid going too far. Someone posted that diabetes kills cats slowly, too much insulin kills cats very quickly. Vet guidance can be great but not all vets are feline diabetes experts and the vet can only advise. As Sienne and Anne already said, Lizzie is your cat and its your syringe so the dose is ultimately your decision. A decent vet will not abandon you because made your decision by weighing all the info available to you.
Leslie
 
I do agree with Sienne on 2 unit jump. It's too much at once, and could have some negative affects like diving too low too quickly. With the protocol, it's usually increased by 0.25u, or by fattening and skinnying up the doses, and sometimes by 0.50u increases. More often than not, though, 0.25u is sufficient, unless 0.50u is needed in certain cases. Please let the experts on here advise you on the correct dosage for your kitty. They'll help you get your kitty on track.
 
One of the problems with such a huge increase is that you could miss Lizzies perfect dose. Her best dose might be 3u but you would bypass it and not know until eventually when all else fails you work your way backwards who knows how long later! I definitely think Sienna's suggestion of .50u was the one to go with. Most of us do not deal with our vets when it comes to handling the doses and day to day care of the diabetes but only when they are sick or need something that we cannot handle. We keep the vets updated but follow the protocol. If our vets cannot handle that, we get different vets. My vet is not thrilled with it but has come to accept it and knows that Racci is doing great this way so no longer interferes except to want to do her own fructosamin for her records every once in a while.

Melanie & Racci
 
Hi Jacquie,

Remember yesterday when several people told you that you needed more data before you could figure out if 2u was too much or too little? (Nice job getting the mid-cycle test last night, by the way!). Because Lantus is a depot type insulin, it takes a few days for a dose to build up the "shed", so you are just now getting to a point where you can figure out if 2u is right, right? I don't use Lantus, so I really can't advise on dosage.
But, some of the people here have been using it for years, and they've seen hundreds of kitty cases over the time they have been here, so the collective experience here is probably greater than any other single place in the world. To my untrained eye, it looks like Lizzie will need a higher dose. How much higher? Like many people say here.... we don't have crystal balls, so nobody knows for sure. The only safe and logical way to find out what that dose will be is to take baby steps (.25u at a time, .5u at the most).

You may decide to follow the Tight Regulation protocol, or the "Start Low Go Slow" protocol, both are good approaches to treating FD. I guess my point it that the way things are done here has been proven time after time, and kitty after kitty, that they work, and work well. The primary concern on the board is to do things that are the safest possible way to do things for the cats.

I just can't see how, given that the people here have advised that you need more data in order to be able to figure this out, that a vet can tell you "okay, it's time to double the dose and see what happens". That isn't based on any logical or scientific approach to treating feline diabetes. This isn't a race to see how fast Lizzie can go into remission, or become regulated. It seems like your vet thinks it is. "It's a marathon, not a race". Do a board search on that phrase and you'll probably get hundreds of hits. :smile:

I'm glad you found this place when you did. I think what worries me more is that they might hand out that sort of advise to another "bean" at some other time, and put that kitty's life in danger.

Please share all the links you've been given with your vet, for you, for Lizzie, and for any other kitty that gets brought through their clinic's doors.

Carl
 
Whoa! Let me give you an example. Every cat is different, and there is no way to say your cat will do what mine did, but my cat was having Blacks and Reds, Blacks and Reds at 2.0 units. Then, (after lowering the dose just in case it was too high) I raised the dose slowly to 2.75. He's now in the Greens almost all day. That was all it took -- 0.25 unit raises twice and a long time of waiting for his body to get used to having low numbers. If I had raised his dose to 4 units, he would have hypo'ed, I would not have been ready for that, and he may have been in the emergency room (or worse). In my opinion, raising the dose slowly 0.25 units at time is best and safest.
 
I really appreciate everyone's responses.

Lizzie isn't my first sugar cat so I'm definitely not following our vet's order's blindly :-D I'm most definitely going with small dose increases with time to settle in between. I'm moniotring her blood sugar, ketones, appetite, urine output, eating, drinking, etc...

I emailed Christa and told her I wasn't comfortable with a 2 unit increase & gave many reasons including my experience with O'Malley. She hasn't gotten back to me yet but I will start Lizzie on a skinny 2.5 unit dose tonight & get a before bed reading.

I worry also how she is treating other cats in her clinic. There are quite a few people who follow doctor's orders blindly & don't do any research or bother to manage their pet's health closely. We'll see how she responds & I'll share the links with her. Christa is a very good vet & great with people & animals so I have hope that she's open-minded enough to work with us.
 
Yeah it was PZI... which I'm finding is much different than Lantus. I'm reading as much as I can about though. Gotta stay informed & educated!
 
Jacquie,
I used PZI with Bob too. When I started reading about Lantus, it might has well have been a foreign language. Even now after months of lurking and posting here, I still have to be reminded to "forget the PZI-think"! because they do work so differently. My vet was all about increasing Bob's dose by one unit at a time, from 1u to 4 in a matter of 5 weeks or so. I've come to think of that as using a sledge hammer when a tack hammer will do the job. When you said Christa wanted to double the dose all at once, I had a flashback. :lol:

Carl
 
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