pmps number question & vet reccomendations

Tonight for Sissy's pmps it was 408, that was quite a bit higher than she's been running, so I tested again and it was 432. Her ear was still bleeding a bit so I tested again and it was 461. So...my question is do I put the original 408 number?

We are going to do her first curve tomorrow. It's my first chance to do it since I'll be home all day. Last week I thought I gave her a fur shot, but apparently I did get some in her because her numbers went lower during that time and were normal the rest of the day. Later, after I posted on here about doing a fur shot, feeling her fur wet, I was telling my husband about it and my daughter said, oh no...It was probably from when I dripped water on her when I was emptying the dishwasher and she was under my feet. So I think that was probably what I felt that day. But yesterday morning I did do a fur shot for real...I tested her later in the day and she was higher so I knew she didn't get it. Would missing that shot cause her to run higher the last couple times? I was really surprised it was so high tonight.

 

If I understand you right, you got those 3 different numbers from the same poke/at the same test with the same meter?

That's a near 100 point drop at onset. Looks like you might have some action tonight and you may want to set an alarm and get a test later.

Are you following SLGS or TR? Could you mention that in your signature as well as the SS?
Also, it looks like Sissy is due for an increase in dose. Even with SLGS, you hold the dose only a week.

If you can continue to get some tests during the day or night (like you have been doing) you don't have to wait for a curve to increase. Doing tests at different times every day can help fill in the gaps in her SS and help you understand her response to insulin.

 

It was a couple different pokes, but within a few minutes of each other, same meter. I poked her twice then was going to a third time and saw that it was still tiny bit of blood there so I just rubbed the ear a bit to get more blood from the same spot. Why are the numbers so different? 408, 432 and 461 are big differences?

I have some reading to do tomorrow on method. My plan was to do that over the last few days, but have had to take car of my grandmother and take her to appointments so my days have been messed up. Tomorrow I'm dedicating to Sissy...curve and reading. I think probably SLGS though?

Her vet said the other day that since I moved her time back an hour (over a couple days) that she'd like me to hold this dose for a week and then do a curve and then she'll see about increasing. Said she wanted it at the new time for a week...although it was only an hour difference that I went back to over 15 min increments. I don't know how to increase or when, I haven't gotten that far and I'm trying to work with her vet, I don't really want to make her mad because I need her to help me with Sissy's other issues...and the other animals. :/ Is it normal to change a dosage without talking to the vet

I'm getting ready to do a +4 here in about 5 minutes.

 

The +4 was 209

 

The differences are meter variance which can be as much as 20% - one would think the should be more accurate, right?!

There are two methods TR and SLGS. TR is more aggressive but can help you get your kitty to a good dose sooner. Requires at least 2 spot checks in addition to the pre-shot tests. Doses are changed as often as every 3 days. SLGS is more suited to be people who cannot test often. You hold doses for a week. Here's the sticky detailing both methods - https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

I hear you when you say that you don't want to piss you vet off, but my personal experience with vets has been that they don't know a whole lot about feline diabetes. I have learnt a lot from this board and have been dosing based on protocols and advice here.

Let me tag a couple of senior members to help you out.
@Bron and Sheba (GA)
@Wendy&Neko

 

@Bandit's Mom , Right? I would think they would need to be more accurate.

I just have been reading over the methods...trying to stay awake to test again. I think we will have to go with SLGS because of our schedule. It will fit better for us right now.

Yeah, my vet is supposed to be one of the best in the area...here is her blurb from their website..." Dr J is a 1986 graduate of Purdue University. She is known as “The Cat Doctor” and is one of the few Feline Specialists in the country, board certified in Feline Practice since 1995. She has worked specifically with cats for over 30 years and understands their unique needs. She offers house calls to those feline friends that object to traveling! Dr. J loves spending time with her husband and son. In her free time she likes to read, quilt, and crochet thousands of catnip mice for many cats to enjoy, including those patients of Dr. J.

I really don't want to piss her off, but I agree that even with this as her background, I still was having to explain why I didn't want to use the pen needles and use the syringes instead...and she was pretty adamant about me waiting a week to do a curve...which I am not going to do. I'm just not sure how it would go over if I tell her I increased the dose after our conversation the other day. She was very supportive of my home testing and the foods I've chosen for low carb and to deal with her food allergies...she seemed happy with the spreadsheet I sent her...just still seemed like she wasn't sure about me and the whole situation.

Is it okay her numbers went down 104 points from where it was? I'm trying to stay awake to get one more at +5 because I know if I go to bed I likely won't hear the alarm in an hour to get back up...but I want to make sure she will be okay if I fall asleep.

 

Well, +5 was 179. So I'm not sure if I should keep checking her or not since she's going down so much?

 

You're probably not going to like the answer, but yeah, you need to get another test in.

PJ parties are fun for the kitties....not so much for the human!

Have you fed her anything lately? Might help to give her a teaspoon or two of her regular low carb food.

 

@Chris & China (GA)

I gave her probably 1/4 cup of her Tiki Cat chicken/pumpkin aloha stuff..she ate it in between the +4 and +5 test. She ate most of it.

Nights like this I wish I liked coffee. lol

 

I hear you!! You might want to look into one of these Sonic Boom Alarm Clocks.....LOL

 

Omgosh, I'd probably have a heart attack. lol

 

Her +6 was 190. I'm going to give her some food.

 

Hi Mandy and Sissy. She is a lovely girl!
Your vet can be an experienced feline vet but not know much about feline diabetes. Its great she is supportive of home testing, the SS and the food you have chosen.
Almost all of us here choose the dose of insulin without the vets input.
When I first started looking after a diabetic cat I always found the vet wasn't open for the AMPS and was shut for the PMPS!!
Here we go up and down in 1/4 unit increments which is safer for the cat and doesn't go past the best dose whereas vets almost always go up in 1 unit increments.
Maybe you can talk to her about it.

 

Looks like she is flattening out. You can stop feeding and see how she does.

 

You know your cat best. I understand your hesitation with this Vet. She doesnt HAVE to know you ran THIS curve. She has to be on board with you changing doses because what would she say if your kitty tested at 59 and you gave a full dose? We know that lantus is a depot insulin and you are learning quickly what that means. How many instances has she had to "bring a cat back" from a hypo? Its all relative. Just let her know you are grateful to have found a vet that is willing to work WITH you, not just dictate TO you.
Flattery goes a long way!

 

I didn't see that till after I'd already given her some food and went to bed. :/

I'll try the flattery. lol

Sissy's AMPS was back up to 365. I gave her food after her +6, she usually gets a little food then because that's when my husband leaves for work. We usually leave fod out for her all night. We have a timer bowl with an ice pack under it. Sissy will floor surf and eat hair if she's out of food and wants more, so we just make sure she has food all night. During the day I keep and eye on her and when she starts to look for hair/strings whatever, then I give her more food..if I have to leave I use the timer bowl.

So is this wonkiness because of her fur shot two mornings ago? I got to read some of the stickies in the night and I read the one about Lantus being a depot insulin. So I am understanding that. Or is this just something that happens from time to time?

I was going to do her curve today, but after poking her so much in the night, this morning she is not wanting me to be near her. I walked toward the supply table and she took off. I'm wondering if I should do spot checks during the day today and do the curve tomorrow? I have the alarms set on my phone for them all today, maybe I'll just do it and hope she will forgive me later. Poor Sissy Kitty.

 

Tomorrow sounds like a better day
Lantus is like a damn when they let water out to relive stress. It takes a while to build the lake back up to its normal water line. Timing of the two are not relevant.

At least thats the way I equate it. As always *PLEASE CORRECT ME IF I AM WRONG*

 

A fur shot can indeed interrupt the depot. Next time smell the wet spot - Lantus has a distinct smell so you'll be able to tell if it was indeed a fur shot. Which can make numbers seem a little wonky for a couple cycles. You've been on this dose long enough to build the depot (5-7 days), so we know what this dose can do. We decide how to change the Lantus dose based on how low it takes the cat. If you are following SLGS, you increase if you aren't seeing numbers below 150, which you are not.

As for how to approach the vet, I found it helpful to print off the dosing method and give a copy to my vet. That way she knew how I was deciding to change the dose. The vet also got weekly copies of the spreadsheet for a while. I too was having difficultly at first getting in touch with the vet in a timely manner to get dosing advice when I needed it. She worked the afternoon shift (too late for AMPS) and always did follow up calls after my PMPS. Eventually our relationship got to the point where she just asked what Neko's current dose was.

Missy could also be bouncing from that nice string of blues last night - she's not used to closer to normal numbers yet. If you haven't heard of bouncing yet, here is the definition:
Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

 

Hey guys, I'm posting here because we had talked about not wanting to piss off the vet....She called awhile ago, she had looked over Sissy's curve numbers from Sunday. She has a link to the spreadsheet so she can see it all the time. I also sent her the information on the different methods, telling her I'm interested in the SLGS method with Sissy. She said she didn't see that in the file, but she will look for the email and read it. Their staff just print the email and put it for her to find and call on...but they must not have printed all that I had sent. ANYWAY....she wants me to give 2U in the morning and 1 at night. I asked her to look over the SLGS method and get back in touch with me. How do I handle this going forward. She did say that she reads stuff on the internet from different places and some of it's just not right, but some is...but I got the feeling she doesn't want me to take advice from a message board. I posted her "about" info above, so you will see why it might be hard to talk about going against her plan.

 

Sadly this is nothing new. smh. Honestly I would flat out ask her that very question "Do you think I am wrong in taking advice from people that, live, eat, breathe, feline diabetes?" You could just tell her a whole unit is too much at once and you would feel more comfortable climbing up to that second unit. I am no way a dosing adviser, so please wait for more replies ok? But It sounds like you have a vet that believes shes right no matter what you present her in the way of facts.

 

Attached below is a study published in a professional veterinary journal. It contains the dosing protocol used for "tight regulation" (TR) here at FDMB.

The published Roomp-Rand protocol is quite an intensive method for regulating cats when using Lantus and other long-acting insulins, suitable for people whose cats can eat a low carb, wet food diet and who can work adequate testing into their schedules to make sure their kitties are safe.

The 'Start Low, Go Slow' protocol (SLGS) is a less intensive method of treatment which is better suited to the needs of caregivers who can't get as many tests in, whose cats are on a dry diet, or simply for caregivers who just aren't comfortable with the intensity of TR. The size of dose adjustments is the same as for TR. The key differences between TR and SLGS are:

* Doses are held for longer in SLGS before review and adjustment if needed (unless a dose reduction is earned before the scheduled review date).

* Dose reductions are earned at a higher BG level in SLGS than TR.

Maybe you could schedule an appointment with your vet to review the SLGS protocol alongside the dosing protocol in the above study to help promote better mutual understanding?

At our veterinary practice I think I was very much the exception, not the rule, in wanting to tightly regulate my cat, and I needed their buy-in. I brought a copy of the 'Management of Diabetic Cats' study in to our vet to discuss it with him when Saoirse was being switched to Lantus. He reviewed it and was happy for me to follow the protocol therein. He had access to Saoirse's spreadsheet and we touched base regularly on the telephone to review her BG regulation and discuss her progress. In this way, I earned his trust and respect because he could see I was keeping Saoirse safe (and I got her into remission - their external FD consultant had earlier said she had no hope of achieving it).

Your vet is perfectly correct in saying this.

It is also true that a published, peer-reviewed study is not just "something on the internet".

It is not unreasonable for you to ask your vet to review the protocol you would like to follow and discuss it with you, not just dismiss it out of hand because *some* FD information on the web is utter tosh. If she objects to the contents of the SLGS protocol she should be able to make a solid, evidence-based argument on why she doesn't support your use of it. She should also be able to provide you with details of the protocol she wishes you to follow instead, plus its source and the evidence base for it. (Play nice! You need your vet onside. )

Vets do have legal obligations WRT the animals under their care so they are right to exercise caution. Providing evidence-based information to them is a good foundation for successful negotiations on treatment approach.

My two penn'orth.


Mogs
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Well, she just called me back, having looked over all I sent her and said she thought it was amusing they were still referring to a study that they don't consider valid...something about they threw out the cats that weren't working and were left with the 50...or something. She isn't budging on moving her up to 2 units in the morning and staying at 1 at night.
I don't think making an appointment with her to discuss is going to make any difference.

I have been looking at my syringes..they are so hard to see even with my higher magnification reading glasses. I see the .5 and 1 unit markings fine...but the space for the .25 is barely discernible to me...

 

HINT READING GLASSES made all the difference for me

 

I mentioned that I still can't see it very well even with my higher magnification reading glasses on. I had to get them just to see Sissy's ears better. I guess I could go higher, but if I glance up with these on the room is so blurry I feel sick.

 

My apologies I must have missed it. But yeah Mine to that too me too. Kind of like tummy flipping. yuck

 

One small comment - Missy is your cat. You have to feel comfortable with what you are doing. Our saying here is "you hold the syringe".

It would be interesting to see where she read that - it's not in the paper Mogs attached.

For finer doses, magnifying head lamps, or craft lamps with magnifiers also help. I found that a white background, good overhead light, and a magnifier helped. Which syringes are you using? Some brands have fatter barrels, meaning the lines are closer together. Ones with thinner barrels, lines further apart, can help.

 

Yeah, it's rough. I'll pick up some even stronger ones to see if helps.

 

What she read was all the information I copied from the Lantus board on the two dosing methods. It was like 7 pages worth of stuff.

 

TAKE THE SYRINGE WITH YOU! lol Thats what I do

 

Have I told you lately how CUTE Sissy is as your Avatar?

 

There is nothing there about "throwing out" cats from a study. Maybe she followed up on some of the links or references? There have been some studies, specifically on rates of remission, that removed cats with certain secondary conditions from the study. That makes sense. For example, my girl had two secondary endocrine conditions, acromegaly and insulin auto antibodies, that made it extremely unlikely she would go into remission without addition treatment of those conditions. Putting her in the study wouldn't have been a good test of remission rates.

 

Aw..Thanks. I think she's pretty darn cute too.

 

She must have, she gave me specifics of it and mentioned something about remission regarding it. I can't remember at this point exactly what she said. But I do remember the tone...and after she talked about that she started talking about all the cats that have done well following the way she does it...I'm going to have to do things on my own. Do I start looking for a new vet? ugh.

 

Ummm I would. smh

 

This may be dumb...but do I just call around and ask how they handle feline diabetes? I have no idea where to start.
Do we have a state by state database of vets? lol That would be nice.

 

Thats exactly what I would do. I also would add that you fully intend to be engaged with your cats treatment of diabetes.

 

I mean no disrespect to your vet, but it is not just people on the internet who get things wrong.

^ This is wrong. ^

Lantus is a depot insulin, not an in-and-out insulin. It requires consistent dosing for both safety and efficacy. Each time you give a dose of Lantus, some of it tops up the depot. The aim is to start low and adjust the dose in small increments until the Lantus injections topping up the depot balance the Lantus being drained from the depot while keeping your cat in safe numbers.

Lopsided dosing knocks that on the head.

Your vet has dismissed the Roomp-Rand study. Has she provided you with any peer-reviewed evidence base to support the dosing recommendations she is making?

Would she possibly be amenable to a negotiated compromise: agree between yourselves that you will follow the SLGS protocol for a set number of weeks and if that does not produce improvements then do it her way?

Ultimately, Sissy is your cat - and you hold the syringe. You have to decide what you feel comfortable about.


Mogs
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If theres a database for Vets I am not aware of it. sorry

heck keep checking back theres bound to be someone who has!

 

I used a cheap 'n' cheerful jeweller's loupe (plus the reading glasses ).


Mogs
.

 

Geez Ive use loupes for for years I use to retouch photos and negatives. It never occurred to me DUHHH jeanne!

 

See, I felt like it was wrong because of it being a depot insulin. It didn't make sense after just the little bit of reading I've done. I don't feel comfortable bumping her up that much, it makes me nervous. I really don't think her numbers are THAT bad during the day...I mean not ideal obviously, but how do I know how she'll react to it...sometimes she drops quick on just one unit at night.

Idk. This is so frustrating, and it's not helping my anxiety much either.

 

Cool...off to ebay. lol

 

I had sent the vet a link to her spreadsheet. If I change the access to only people added instead of people with the link can open...will it not show up for her then?

 

Excellent idea!


Mogs
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Never had to use a loupe for that. God gave me PhotoShop.


Mogs
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lol photoshop ended my career. that and digital

 

You'd have to add the entire membership of FDMB to the list of people with permission to view!

There are easier workarounds should the need arise.


Mogs
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Oh, I'm very sorry to hear that, Jeanne.

(Feel like a fink now for making a silly joke. )


Mogs
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PS: I actually didn't use Photoshop. I preferred Corel PhotoPaint.

.

 

That doesn't surprise me to hear, Mandy. Have a hug.



Getting to grips with testing and insulin treatment is more than enough to have on one's plate. One could well do without vet issues on top of that.


Mogs
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lol yikes, so how do I fix it so she can't see it. I regret sending it to her now.

 

Eh I'm over it ...mostly
really no biggie

 

I didn't agree with all my vet said about dosing, but we agreed to disagree. I had a long standing relationship and she was great at other conditions. Of course, Neko was a bit more complicated than she was familiar with, but we learned together.

Worst case with the spreadsheet, make a copy of the existing one as your new spreadsheet. Put the link to that copy in your signature and update it going forward.

 

It would be very helpful if we had a thread where members could post vets they recommend and form a list! How handy would that be!

There is a list found here which helps to offer ways of finding a new vet that will work with you. Another way to narrow it down might be to consider AAHA accredited clinics? There aren't very many, something like only 15% of clinics, but they would at minimum be following the AAHA Diabetes Management Guidelines.

 

You're a quick study, Mandy.

A hoped-for Lantus response will see the run of the cat's numbers in each cycle form wide, shallow, 'smile' shaped curves.

Assuming the cat is not yet in well-regulated numbers, the idea then is to use tiny dose adjustments to g-r-a-d-u-a-l-l-y nudge the 'smile' curve down into better and healthier numbers. This takes a little time, but this is advantageous because:

1. It gives the kitty's body time to relearn how to respond properly to insulin again, and to become accustomed to running in a lower, healthier BG range.

2. Making larger dose adjustments (e.g. 1 unit at a time) increases the probability of jumping over the 'goldilocks' dose that the cat needs. Too high an insulin dose can, counterintuitively, drive numbers higher, since the cat's bodily defences will jump in to drive up - and keep up - BG levels in order to protect the cat from constant threat of hypoglycaemia. This means that BG levels for too much insulin can look very much like those for too little insulin. Instead of gentle smile curves, overdosed cats tend to have high and flat BG numbers, or even 'inverted smile' curves, where numbers mid-cycle run higher than at preshot times. (Occasionally this leads to some cats being prescribed higher and higher doses of insulin with no improvement seen - and greater hypo risk).

3. Gradual adjustments reduce the risk of hypoglycaemic episodes.

I have had a look at Sissy's spreadsheet. Based on the available data, Sissy seems to be having a beautiful response to her Lantus. With the exception of occasional outliers (which are normal, and to be expected) she is getting lovely gentle smile curves on both AM and PM cycles.

Most cats run lower at night. So does Sissy. Nothing abnormal about AM cycle numbers being higher than PM cycle numbers.

Sissy's morning AMPS values are higher than the PMPS values. This again is very, very common (dawn phenomenon). Often the AMPS value is the very last value to come down into the normal BG reference range when a cat is going into remission. Also, if a cat runs lower to a safe but 'unfamiliarly low' BG level during the night that can cause a little bit of a bounce which may also feed into the higher AMPS.

As you correctly observe, Sissy has shown she can drop quite a bit in the PM cycle when she is only receiving 1 unit of Lantus on the AM cycle. If she were to receive 2 units on the AM cycle it could potentially push her early PM cycle numbers down further. That, in turn, could perhaps cause a counterregulatory reaction leading to an even higher spike in the AMPS, or perhaps set off bounces of greater amplitude and duration - which can make regulation trickier.

Another possible consequence of lopsided dosing is that, with a 2-unit dose given in the daytime, the PMPS may become too low to safely allow a dose of insulin to be given at all for the evening cycle. (Note: For cats on doses where the PMPS is regularly too low to permit giving insulin, the usual solution is to reduce the dose for both cycles so that there will be a 'shootable' preshot BG both morning and evening.)

At the moment, Sissy looks like she might be a dream of a cat to regulate using steady, gradual dose adjustments. Cats don't become diabetic overnight. It's not possible to pile drive glucose levels down into better ranges by throwing more insulin at one part of the day. The body's homeostatic and circadian mechanisms don't work that way. It takes time - and a little patience - to get their sugars under good control.

That's just my interpretation of Sissy's available data. Other members may offer a different take.


Mogs
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Thank you so much for that thoughtful reply. You explained that in "Mandy" language so I could follow easily. lol
I plan on not going with the vet plan. My biggest concern is being able to read the syringe. I'm just getting over the panic when I give her the 1 unit. Even tonight after I gave her the shot I had a moment of panic of what if I gave her the wrong dose...my heart raced, test tightened up, hands shook...just that feeling of OMG. Unless you've lived with that kind of anxiety/panic it's hard to explain, but I know we've talked about that before. I've looked at that syringe 100 times today with lights on it, my strong readers and I still can't figure out where to put the barrel. I looked at that picture in the lantus board all day and I still don't think I can figure out the 1.25 dose and do it the right amount. And with my issues it makes it even harder to feel good about it. I feel ridiculous saying some of this stuff out loud. I know it sounds bonkers to some. It's an extreme form of the nerves "normal" people get.

I'll probably make a copy and replace the one in my signature. I'm so irritated now I don't want her watching me. After our conversation today I feel like she will. I don't think we will agree to disagree. She's a cat expert and I'm not. I want to take advice from the internet and not listen to a specialist. At least that's the take I got. I somewhat regret telling her about this board, if she did come here this thread has a lot of stuff in it I wouldn't want her to see...like her bio above. I guess I can remove that part.

 

Ahh, but you are a Mandy expert.

My vet and the clinic owner were not keen on me taking advice from the internet (at first). Then a locum vet got us switched to Lantus and pointed me to FDMB. What could they say - they hired him to be a locum, and later on as a part time vet there. Later on, all I learned from acromegaly was from here and studying research papers. The clinic owner finally admitted I knew more than he did on the topic. At one point I was shopping around for a new vet - we were started on Caninsulin , but the one vet I found who seemed to know what she was doing - had a diabetic cat on Lantus, admitted it probably hypoed and died at home alone.

 

I had a vet very different from yours. In my case he was not the least bit interested in Teal'c's treatment for diabetes. Gave me the syringes, insulin and left me to figure it out on my own. No follow ups. No vet curves no fructosamine test, nothing. This at the time didn't seem any better to me, but after reading yours and others horror stories about vets unwilling to admit they may not know it all when it comes to FD I now feel mine was a better situation then what I thought.

With the help of people on this board Teal'c has made some big strides in controlling his diabetes. He now spends most of his days in greens. I owe this to the people on this board, not my vet.

 

When I was measuring a 1.25 unit dose, I would use my magnifiers to check if there was a crack of light between the edge of the 1.0 unit dose mark and the edge of the syringe plunger. Similarly when measuring a 1.75 unit dose, I'd look to see a crack of light between the edge of the 1.5 unit dose mark and the edge of the plunger. I used to draw myself little 'enlargement' diagrams of how I was measuring the doses so that I could refer to them each time I was drawing up a dose.



Excuse the quality of the artwork: I'm no Banksy.

That's what wrecks my head. I know that so much of my thinking and behaviour is irrational, but that knowledge is no help whatsoever; it just makes me more hacked off about the bonkersness of it all. It doesn't curb the fear.

(((Mandy)))


Mogs
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@Critter Mom ,
I practiced with colored water. Does this look right?

 

Okay, so I went ahead and did the 1.25 dose this morning. She's been running for AMPS in the 300 and 400 range for 4 days, and why the vet wanted me to do 2 units in the mornings. Today her AMPS was 265. Her +2 is 188. That's the lowest she's ever been in the daytime. I'm really glad I didn't give her 2 units this morning. Especially if I was someone who had to leave for work after shooting and being gone all day. Or not testing. Who knows how low she would have went. (or will go) I'm going to test her off and on today just to see what she does.

Last night her PMPS and her +2 and +4 numbers were around the same, then her AMPS this morning was right around the same as last night. She usually drops lower in the night. So that was different.

I made a new spreadsheet and deleted the old one so now only you wonderful people have access. lol

 

It's in the ballpark alright, Mandy. Given that you're comfortable with that as the way you measure the 1.25IU dose, now you can stick to that and use your photo to compare each dose you draw up.

LMAO!


Mogs
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That's normal with Lantus. Some cycles are less 'active' than others.

A nice morning dip in the lagoon!

It's important to note that it takes two to do the sugar dance: kitty and caregiver. The treatment plan needs to be manageable for BOTH.

Just as a heads-up, it can take a few cycles for a new dose to 'settle' while the depot adjusts, and sometimes you may see some oddities - a phenomenon referred to in this neck of the interwebz as New Dose Wonkiness.


Mogs
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Again, I wonder about your vet's understanding of how Lantus works.

Dosing decisions for depot insulins are based on the nadir BG level, not the preshot - some reasons for which I went into earlier in this thread.

Last night's less active cycle possibly influenced this morning's lower AMPS (less likely to trigger a counterregulatory response).


Mogs
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Mandy my Cat was short hair and even with that what made my life a little easier was my Vet shaved 2 spots on either sides where to shoot now she just used clippers not shaved down to the skin . You can just use a scissors . It made it so much easier to avoid fur shots I could see the spot so much better . The hair grows back . Sissy is a Cutie

 

I hope I can get it the same. I've been wondering how they can level off with doses you have to eye ball. Doesn't seem you could get it the same each time. I kept the syringe with the colored water in it so I can compare the next one.

She's been in and out of the lagoon today. I have a question about this evening. If her PMPS is still down there, I don't give her a full dose? I know people on fb say not to shoot below 200, but don't they need something? I have a feeling I'm going to be up all night again.

That's what I thought about the nadir. And that was 240 on her curve a few days ago. I didn't think of it when I was on the phone with her yesterday...I wish I had so I could have at least asked her about it to find out her reply.

 

I've thought about doing that. I still might. I feel bad thinking about shaving any hair off. We tried so much to get it to grow back in! lol She had licked every area she could reach completely bald over part of last year and beginning of this. Finally started to grow back when we put her on rx food and now it's all back in. I still feel like that food is what made her diabetic. Her blood work was normal at the beginning of May...and last year it was normal....she's always been perfectly healthy until a few months into that food. I had reservations about putting her on it, I should have listened to my gut. IDK

 

The 200 No-shoot limit is set there as a safety threshold for new caregivers arriving to the board. As members start testing they will eventually gather sufficient data to identify the cat's pattern of response, then it becomes possible to give injections at preshot numbers below 200.

If you are in a position to test, it would be good. If I hadn't taken my sleep meds, I might have offered to keep you company, but as it is, I can barely see the keyboard right now. (No hyperbole.)

Time to get horizontal. Day, day!


Mogs
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I'm only 20 days into this, so I probably don't know enough to shoot below 200, I assume? Or should I say hope? lol I feel like I still have no idea what I'm doing half the time...but that's better than all of the time.

I haven't slept all week...got that appointment tomorrow that I overslept and missed Monday. :/ At least it's in the afternoon so I shouldn't miss this one.

Thank you so much for all your help. I hope you sleep well!!

 

Replied on your Lantus thread

 

Replied on your Lantus thread

 

Replied on your Lantus thread

 

Hi Mandy I felt the same way about the food my Cat was on dry food all her life I didn’t know better and thought it was good for her teeth . I still blame myself . Lol Mandy just clip a little little spot . How is Sissy doing ?

 

@Dusty & Roe She's doing pretty good. This morning was her 3rd dose since we adjusted. I have to leave for an appointment so I'm a little nervous because I don't know for sure how her sugars will be...but I just taught my 13 (going on 30) year old to do the ear test. She did it twice today and is doing great, so I think if I'm longer than I hope to be, I can have her do it and see where she's at. I've left everything she might need on the counter...karo, higher carb foods, etc...but I think she'll be fine. Just precautionary measures.

Don't feel guilty about the food...I know it's hard. We just learn as we go...and now we know.

 

Kudos!


Mogs
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wow awesome!

 

Mandy sometimes I swear 13 yr olds could teach us. Lol. How are you and Sissy doing?

 

Lol, that's the truth.

Sissy seems to be doing pretty well. her numbers have been weird at night, but we've been at the 1.25 dose now for about a week so we'll be doing a curve in a couple days. I think she'll bump to the 1.5. I hope so because I hate dosing that 1.25 dose. I try my best for it be consistent, but sometimes I wonder if that's why her numbers do weird things. I stack my readers and that helps and I enlarge the picture I take of the needle and it seems to be around the same, but I know it can't be as accurate as dosing off a line. The perfectionist in me has a hard time with not being exact. lol

 

I'm sorry to revive an old thread, but my question pertains to what we discussed here regarding my vet. I haven't heard a thing from her for two weeks since she told me to give her 2 units in the morning and 1 unit at night. This was AFTER the discussion about the information I sent her from here, her saying it was amusing we're using an old study, that I can find anything on the internet, etc...and talking to her about wanting to start low, go slow and then after telling me she's okay with that, to go ahead and give her the 2 units in the morning. I had deleted the spreadsheet she had access to and started another. Today I have an email requesting access to her spreadsheet from my vet. The last time she saw it was Aug 18th.
I'm really not good at confrontation AT ALL. So just seeing her request kind of makes my stomach hurt.
How would you handle it, would you give consent and then just wait for the fall out? Or just ignore it? I intend to find a new vet, so I'm leaning towards ignoring, but what if I have a problem before I find someone else? There's always the Er, but I'd hate to do that.

 

Your numbers are noticeably better than what they were under her direction. I'd show her the spreadsheet and if she asks tell her how you got to this point. If she goes off on you THEN ignore. (thats what I would do)

 

Hi Mandy,

Perhaps say you would be happy to bring in a (printed!) copy and review it together at your next consultation? I know how you're considering firing her. How would you feel if your vet decided to throw a hissy fit and fire you as a client? Relieved or disappointed? Also, are there other vets nearby who you could move to quickly if she did? (Just brainstorming here, BTW, not implying this might happen. )

Looking at Sissy's spreadsheet, your girl might eventually need a 2IU BID dose of Lantus (depending on what your next dose increase does). The vet might turn around and say "Nyah, nyah, told you so! " but that's the only arrow in her quiver. You've done a marvellous job with Sissy. She's running really evenly as her little body gradually relearns how to run in lower, healthier numbers. Wading in with a 2IU dose on day 1 could possibly have produced a much different picture (e.g. bouncing all over the place because it was bringing Sissy's BG numbers down without giving her body time to get used to the lower numbers).

At this stage, YOU know more about using Lantus than your 'lopsided dosing' vet. Are you happy with her for things non-FD? If not, then regardless of whether she might throw a strop or not it may be time to go shopping for a new vetty bean anyhow.

I must admit I wouldn't like to give her uncontrolled access to my cat's spreadsheet.


Mogs
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I LIKE this idea!

 

I really have no desire to go back to her, honestly. I think I'm going to call our old vet and ask them to schedule an appointment for her with him...and just take the spreadsheet and the info from the board and just go from there. I want to talk to him about that supposed fatty tumor in her belly anyway. We'll be moving back close to him soon anyway.

 

I dropped off copies of spreadsheets at the vet's office every week the first couple months. Made Neko's file very thick. Old ones were on top with lots of red, I felt embarrassed every time the file was opened. You can tell her you are uncomfortable giving the vet electronic access - we recently had a member who found some stranger editing her spreadsheet! (it's the truth by the way).

 

Give your old vet another try. You have solid evidence to share. It may change his whole way of thinking...Hey.. It could happen.

 

I might. But if I do, I will follow advice here to print the sheet off and drop it off. Can you tell from looking at her spreadsheet that if I had given her the 2 units in the mornings that it would have been too much? She wanted me to start the 2 units on the 19th. Go from 1 to 2 units but only in the morning.
I feel like it would have been too much and I might have had a problem. Especially if I hadn't been testing...but idk.

 

Check out threads from Polgeria and read about the the effects that lopsided dosing had on her cat, Mouse.


Mogs
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Thanks, Mogs. I found them and read. I'm glad I didn't listen and decided to dose evenly.