pmps number question & vet reccomendations

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Mandy S

Mandy S

Member Since 2020
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.
 
Bandit's Mom said:
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.
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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 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.
 
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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.
 
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! ;):coffee:
 
Bandit's Mom said:
Looks like she is flattening out. You can stop feeding and see how she does.
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I didn't see that till after I'd already given her some food and went to bed. :/

jt and trouble (GA) said:
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! ;):coffee:
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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.
 
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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.
 
Mandy S said:
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.
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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.
 
Mandy S said:
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.
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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).


Mandy S said:
[Our vet] did say that she reads stuff on the internet from different places and some of it's just not right, but some is...
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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
.
 

Attachments

Critter Mom said:
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
.
Click to expand...

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...
 
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.
 
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".
Mandy S said:
he 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.
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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.
 
Wendy&Neko said:
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.
Click to expand...


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.
 
Mandy S said:
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.
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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.
 
Wendy&Neko said:
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.
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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.
 
I mean no disrespect to your vet, but it is not just people on the internet who get things wrong.
Mandy S said:
She isn't budging on moving her up to 2 units in the morning and staying at 1 at night.
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^ 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
.
 
Critter Mom said:
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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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.
 
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?
 
Mandy S said:
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?
Click to expand...

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

There are easier workarounds should the need arise. :)


Mogs
.
 
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