? Mimi AMPS 138 8/24- might have screwed myself a bit on something..

Mimis mom

Mimis mom

Member Since 2019
https://www.felinediabetes.com/FDMB...-116-3-74-5-67-7-72-9-66.267463/#post-2992409


I sent my latest “curve” which wasn’t really a curve to my vet that has been kind of “demanding” nicely I send her on. Here is the email she wrote back.
Hi Rosa,

I have reviewed the BG curve you did for Rosa on August 22. I would recommend you drop her insulin dose to 2 units of Lantus insulin every 12 hours for 2 weeks and then repeat her curve in 2 weeks. Try not to change her insulin dose at all in that period of time. You should continue to measure her BG prior to administering her insulin and make sure she eats before each insulin injection. If her BG is less than 80 before any of her insulin injections, skip the insulin injection and follow up again 12 hours later.

Also, Dr. Wilson forwarded Mimi's urinalysis result. There was no evidence of infection. She was spilling much glucose into her urine. That should stop once we get better control of her diabetes.

Looking forward to seeing if this will help!

Dr. Kinne


Darn it now she has my SS info and can check to see if I’m following:
Drop to 2 units? 80 and above shoot?
She’s saying her diabetes isn’t greatly regulated but how will it get better if we lower her so much? Should I just try this for a couple of weeks? Perhaps Mimi’s constant “bouncing” is what’s causing her diabetes to not be regulated (from what she sees from the fructosamine and now glucose in her urine)

She has gotten older now (13 vs 10 when first diagnosed)
Maybe she does need less regulation?
Not because her numbers are always in green but because she bounces too much.

I’m going to tag some people I need advice from as well as anyone else

@Sienne and Gabby (GA)

@Wendy&Neko

@tiffmaxee

@Chris & China (GA)
 
Bouncing is not what is causing her diabetes to be unregulated. I am not sure what dosing method you are following because it doesn't look like TR as written for a long term diabetic cat.

It is your choice how regulated you want her to be.
 
Wendy&Neko said:
Bouncing is not what is causing her diabetes to be unregulated. I am not sure what dosing method you are following because it doesn't look like TR as written for a long term diabetic cat.

It is your choice how regulated you want her to be.
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I am following TR to the best of my ability. Not sure this is the response I was hoping for. I mean what do I do as far as the vets concerned?
If ECID - then why can’t you tailor TR slightly based on how your cat reacts? Sometimes I hold the dose a little longer because there was a day I couldn’t get any cycle numbers, only a PS, so I adjust a little for that. I also believe there are meter variances and I think shooting over 50 might work on whatever meter they used for TR which I believe was a Freestyle lite- so whenever (and I’ve done this several times) checked the Freestyle to the Relion it was ALWAYS a good 10-15 points lower at low numbers! So a 52 on relion- and a 39 on freestyle. I’ve stressed this time and time again- I need someone to argue why we aren’t looking further into this? TR is final? No changes or adaptations? We have to apply some common sense to ALL protocols right, otherwise how can we say every cat is different then how can they all follow one protocol?
 
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I think one point that Wendy was trying to make was that in a cat that's been diagnosed over 1 year, we don't take reductions until they either drop below 50 three times (on different cycles), drop below 40 once or stay in green numbers for a full 7 days in a row.

As for the problem with the vet, that's a tough one if she's actually going to be paying attention. I don't recommend it but you could do as she suggests and drop it to 2U for a week and hopefully that will be enough proof that 2U isn't a good dose for Mimi? It's not what would be advised here, but I guess it depends on your relationship with your vet.

ETA...when was a fructosamine done and what were the results?
 
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By not following TR, I meant that long term diabetic cats earn a reduction by going under 40 once, or a week in solid green. Or if the cat doesn't hold reductions well, you wait for three drops between 40 and 49. The longer a cat is diabetic, the harder it is for the pancreas to heal, that's why it's made more difficult to earn reductions. Reminder: *earning* reductions and starting OTJ trials If you reduce before it's earned, often the reduction isn't held. Your goal is to get her to spend more in green, to get used to it and hence reduce the bouncing.

Where did you get the idea they used the Freestyle lite with the original development of TR? Original development was done in Germany and Australia. I don't know if they even have that meter there. With TR, we use the face value on the meter, not play what-if games and meter variance.

I'm surprised you are still listening to the vet on dosing three years after diagnosis.
 
Wendy&Neko said:
By not following TR, I meant that long term diabetic cats earn a reduction by going under 40 once, or a week in solid green. Or if the cat doesn't hold reductions well, you wait for three drops between 40 and 49. The longer a cat is diabetic, the harder it is for the pancreas to heal, that's why it's made more difficult to earn reductions. Reminder: *earning* reductions and starting OTJ trials If you reduce before it's earned, often the reduction isn't held. Your goal is to get her to spend more in green, to get used to it and hence reduce the bouncing.

Where did you get the idea they used the Freestyle lite with the original development of TR? Original development was done in Germany and Australia. I don't know if they even have that meter there. With TR, we use the face value on the meter, not play what-if games and meter variance.

I'm surprised you are still listening to the vet on dosing three years after diagnosis.
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They do have that meter there- it’s where I would buy the test strips from eBay from and it would be Australia
 
I don’t want to listen to the vet but this one seemed to understand more and I wanted her to read about TR and see all the work I’ve done with a spread sheet through the years. But she surprised me and is telling me I don’t have enough data and I need to do curves and she doesn’t believe TR is safe at all- as per stated in her email. And now she has access to my spread sheets so she’ll know if I followed her advice at all.
I never said I wanted to listen to her but now I feel like I’m obligated to otherwise go through finding a new vet again. She writes for Mimi’s lantus.
 
Mimis mom said:
I don’t want to listen to the vet but this one seemed to understand more and I wanted her to read about TR and see all the work I’ve done with a spread sheet through the years. But she surprised me and is telling me I don’t have enough data and I need to do curves and she doesn’t believe TR is safe at all- as per stated in her email. And now she has access to my spread sheets so she’ll know if I followed her advice at all.
I never said I wanted to listen to her but now I feel like I’m obligated to otherwise go through finding a new vet again. She writes for Mimi’s lantus.
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First off, remember that a vial of lantus can last a very long time for cats! My vet did the original script for it, and now I just get the refills from my pharmacy, he has not had to write a new script for it, so you could potentially be going for a few more years on the same script, depending on your arrangements.

My vet (for example) is aware that I do a specific protocol with Whiskey, and he no longer asks questions but mostly because he sees the results whenever we do a checkup, so he doesn't argue with me.

Second, the proof of the pudding is in the eating, yes your vet is a professional and she knows what she is doing, but the team here have helped you and Mimi get so far, so I would trust in their experience too. The thing all of us secretly hope for is remission, but TR is also an effective way to get her regulated and safe, and it seems to be doing a fantastic job so far!

Finally, there are some amazing studies that show that TR for cats works, so it may be worth pointing your vet in the direction of those and letting them make up their own mind about it?
 
Mimis mom said:
They do have that meter there- it’s where I would buy the test strips from eBay from and it would be Australia
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Having test strips available in Australia now does not mean that the Freestyle was used in the original studies (primarily done on the German Diabetes-Katzen forum) and published in 2009. I know there have been changes done to the Freestyle Lite because that's what I started using in 2012 and there were issues with the strips then, which have since been resolved. I'd be interested in any references you have showing that the Freestyle Lite was done in that research.
 
Mimis mom said:
And now she has access to my spread sheets so she’ll know if I followed her advice at all.
I never said I wanted to listen to her but now I feel like I’m obligated to otherwise go through finding a new vet again. She writes for Mimi’s lantus.
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If you wanted to preserve the status quo with this vet, you could also make a copy of your spreadsheet with a slightly different name, which would be at a different URL, then stop updating the one your vet has a link to and say you've been too busy. Or delete the old one altogether and if she ever brings it up, invoke a technical issue and say you'll try to figure it out... then stall forever.
 
Sugar’s Mama said:
Love this advice @Virginie - you can still provide the next curve data in a screenshot/other format without sharing allll the information.
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I have definitely learned from this thread to NOT provide the link to my vet. I will email or print out a screenshot or something and bring it with me to the appointment. I hate this part of the vet-pet owner relationship… if you are too informed they label you “difficult”.
 
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