Critter Mom
Member Since 2014
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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pmps number question & vet reccomendations
- Thread starter Mandy S
- Start date
- Status
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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Mandy S
Member Since 2020
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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lol yikes, so how do I fix it so she can't see it. I regret sending it to her now.
jt and trouble (GA)
Member Since 2009
Eh I'm over it ...mostlyOh, I'm very sorry to hear that, Jeanne.
(Feel like a fink now for making a silly joke.
Mogs
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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.
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.
Panic
Member Since 2019
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.
Critter Mom
Member Since 2014
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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Mandy S
Member Since 2020
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 counter-regulatory 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.
Patty & Teal'c
Member Since 2019
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.
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.
Critter Mom
Member Since 2014
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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Attachments
![20200819_113840[1].jpg](/FDMB/data/attachments/52/52880-b78f119bfb17bca22f591f57dc16ebd3.jpg?hash=t48Rm_sXvK)
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Mandy S
Member Since 2020
@Critter Mom ,
I practiced with colored water. Does this look right?
I practiced with colored water. Does this look right?
Attachments
Mandy S
Member Since 2020
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
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
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Critter Mom
Member Since 2014
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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Critter Mom
Member Since 2014
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.
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Critter Mom
Member Since 2014
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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Dusty & Roe
Member Since 2020
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
Mandy S
Member Since 2020
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.
That's normal with Lantus. Some cycles are less 'active' than others.
A nice morning dip in the lagoon!
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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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.
Mandy S
Member Since 2020
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
Critter Mom
Member Since 2014
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!
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Mandy S
Member Since 2020
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!!
Chris & China (GA)
Member Since 2013
Replied on your Lantus thread
Chris & China (GA)
Member Since 2013
Replied on your Lantus thread
Chris & China (GA)
Member Since 2013
Replied on your Lantus thread
Dusty & Roe
Member Since 2020
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 ?
Mandy S
Member Since 2020
@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.
Don't feel guilty about the food...I know it's hard. We just learn as we go...and now we know.
Critter Mom
Member Since 2014
jt and trouble (GA)
Member Since 2009
wow awesome!
Dusty & Roe
Member Since 2020
Mandy sometimes I swear 13 yr olds could teach us. Lol. How are you and Sissy doing?
Mandy S
Member Since 2020
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
Mandy S
Member Since 2020
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.
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.
jt and trouble (GA)
Member Since 2009
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)
Critter Mom
Member Since 2014
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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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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jt and trouble (GA)
Member Since 2009
I LIKE this idea!
Mandy S
Member Since 2020
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).
jt and trouble (GA)
Member Since 2009
Give your old vet another try. You have solid evidence to share. It may change his whole way of thinking...Hey.. It could happen.
Mandy S
Member Since 2020
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.
Critter Mom
Member Since 2014
Check out threads from Polgeria and read about the the effects that lopsided dosing had on her cat, Mouse.
Mogs
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Mogs
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