Pinky went to her new Doc yesterday (2nd visit). I really like this vet. Familar with lantus and home testing. Willing to listen to my concerns.
Last visit we went up to 6u and she asked me to hold it for 2 weeks. Though not TR protocol I was quite happy to do this as I always wanted to know what would happen with a longer trial at a particular dose. Unfortunately, Pinky didn't respond.
I came armed with a copy of Problem Cat article by Rand and an excellent one entitled 'Discovering the Reasons Underlying Difficult to Control Diabetes in Cats' by Cook
.
Each article had a list of tests to consider which I had written down. (Neither by the way mentioned IAA testing, but I asked about this too.)
(I never plan on giving the articles to the vet unless they would ask me for them , which I then would happily do. But I do show them and use it as a back-up of what I am asking for.)
Blood work has already been done to identify hyperthyroidism. (but see the Cook article for more on this and testing free T4). But I ddin’t catch this when reading article prior to appt so didn’t ask about it.
I asked about acromegaly IGF-1 and anti- insulin autoantibodies IAA test.
I know there is also Cushings (though rare in cats) to consider but I didn’t push for that one yesterday—that requires more than bloodwork. I had pancreatitis on my list but forgot completely to ask about it. I believe we discussed ths before but I can't remember with which vet.
She quickly said she would call an internal medicine specialist at lab to ask about the tests. And she did this while I waited which was great.
When she got back she said she actually thought they would say IGF-1 for acro was unnecessary but instead they said it was under-diagnosed and a good idea.
They did tell her that IAA was not a particular useful test for cats and not recommended.
I said I will probably do it anyway for my own peace of mind but I have done a bit more research since then and though I really don’t understand half of what I read I believe they think many cats will test positive anyway as they are on an insulin foreign to their bodies.
Not sure if I have this right or wrong. This is the test that has to be frozen and shipped overnight with ice packs. And you still dose just as you would with regular FD just more aggressively I guess.
I will probably do it but I do think the acro test which does impact treatment decisions is more important but again it might be a relief to see a high IAA number to explain dose.
What was interesting was they said they usually wait to test IGF-1 (acro) until you are at 1 unit per body weight. That would be 10u for me. Given time to think on this I believe I will do it sooner. Because if the cat really is an acro , from what I read, you want to know so you don’t push for below 100 and not be able to bring it back up. Plus there are other treatment options.
Most acro kitties are males but I heard some raspy breathing from Pinky a few times, plus she has GAINED weight, plus the new vet said on first visit she had a big head for a female cat. ???? I completely forgot about acro enlarged extremities when vet and I were laughing about this big head business. But I think her head was always like this, not sure though. Doesn’t look unusual to her parents. (DH and me).
Finally, the big recommendation I got from my vet was not to change insulins but to add another insulin to the equation. I really, really wanted to avoid this but I am coming around to it. I asked her to let me do 6.5 (& maybe even higher) and if that doesn’t work go with her suggestion. I know people on lantus do this all the time. It just seems much more complicated and the ‘gentleness’ of lantus would go out the window.
Lots more testing and more worries so I just wish the lantus would do something on its own.
Elaine and Pinky
Last visit we went up to 6u and she asked me to hold it for 2 weeks. Though not TR protocol I was quite happy to do this as I always wanted to know what would happen with a longer trial at a particular dose. Unfortunately, Pinky didn't respond.
I came armed with a copy of Problem Cat article by Rand and an excellent one entitled 'Discovering the Reasons Underlying Difficult to Control Diabetes in Cats' by Cook
.
Each article had a list of tests to consider which I had written down. (Neither by the way mentioned IAA testing, but I asked about this too.)
(I never plan on giving the articles to the vet unless they would ask me for them , which I then would happily do. But I do show them and use it as a back-up of what I am asking for.)
Blood work has already been done to identify hyperthyroidism. (but see the Cook article for more on this and testing free T4). But I ddin’t catch this when reading article prior to appt so didn’t ask about it.
I asked about acromegaly IGF-1 and anti- insulin autoantibodies IAA test.
I know there is also Cushings (though rare in cats) to consider but I didn’t push for that one yesterday—that requires more than bloodwork. I had pancreatitis on my list but forgot completely to ask about it. I believe we discussed ths before but I can't remember with which vet.
She quickly said she would call an internal medicine specialist at lab to ask about the tests. And she did this while I waited which was great.
When she got back she said she actually thought they would say IGF-1 for acro was unnecessary but instead they said it was under-diagnosed and a good idea.
They did tell her that IAA was not a particular useful test for cats and not recommended.
I said I will probably do it anyway for my own peace of mind but I have done a bit more research since then and though I really don’t understand half of what I read I believe they think many cats will test positive anyway as they are on an insulin foreign to their bodies.
Not sure if I have this right or wrong. This is the test that has to be frozen and shipped overnight with ice packs. And you still dose just as you would with regular FD just more aggressively I guess.
I will probably do it but I do think the acro test which does impact treatment decisions is more important but again it might be a relief to see a high IAA number to explain dose.
What was interesting was they said they usually wait to test IGF-1 (acro) until you are at 1 unit per body weight. That would be 10u for me. Given time to think on this I believe I will do it sooner. Because if the cat really is an acro , from what I read, you want to know so you don’t push for below 100 and not be able to bring it back up. Plus there are other treatment options.
Most acro kitties are males but I heard some raspy breathing from Pinky a few times, plus she has GAINED weight, plus the new vet said on first visit she had a big head for a female cat. ???? I completely forgot about acro enlarged extremities when vet and I were laughing about this big head business. But I think her head was always like this, not sure though. Doesn’t look unusual to her parents. (DH and me).
Finally, the big recommendation I got from my vet was not to change insulins but to add another insulin to the equation. I really, really wanted to avoid this but I am coming around to it. I asked her to let me do 6.5 (& maybe even higher) and if that doesn’t work go with her suggestion. I know people on lantus do this all the time. It just seems much more complicated and the ‘gentleness’ of lantus would go out the window.
Lots more testing and more worries so I just wish the lantus would do something on its own.
Elaine and Pinky
