Question for JoJo or whoever else might have advice...

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linda and guinness

linda and guinness

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Tomorrow I will be taking Guinness to a new vet (who I have been to in the past, but has not seen Guinness for his diabetes). While talking to her on the phone, she mentioned she would probably start him out at 2u Lantus 2x per day. It's the same amount that my other vet started him out at and he experienced huge bounce back numbers. That's when I found this board and was told "low and slow" is the way to go. So on my own (with help here), I reduced his dose to 1u and started there. It worked to get him green faster and evened out his BGs.

Here's my question. Tomorrow I will be faced with telling my vet that I won't start him at 2u and will want to start him at 1u. Can anyone help me with the best way to explain this reasoning to my vet? I don't necessarily want to hand her an article, because she won't have time to read it while I'm standing there, so I want a good, easy to explain story for her. I plan to take my spreadsheet from 2 years back and show her how things progressed, but I'm still a little nervous about getting my reasoning down.

I'm really hoping that this time around, with this vet, I won't have to go behind her back and do opposite of what she suggests. I would really like a collaborative relationship instead of a "bad patient" one.

Thank you so much for any thoughts or advice you can bestow.
 
I just read through your last post, sorry your kitty has gone out of remission.

351 isn't a very high number, so 2 units would be quite high to start at. My only suggestion is to be open and honest with your vet and hopefully she will be willing to work with you. I've been fortunate enough to have vets that are very easy to work with. They weren't the most well-informed when it came to diabetes (no one mentioned home testing for the first several years), but have been supportive with my proactive approach.

You should be honest about what dosage you feel comfortable starting with. And if she tries to scold you, be sure to let her know that you are doing BG testing as well as checking for ketones. It sounds like you have all the knowledge you need to get his diabetes under control, so all you really need is that prescription. But hopefully the visit tomorrow will go well, good luck!
 
I would explain exactly what you said in your post. You started at 2u BID last time, and he went into rebound, so you sre too nervous to start at more than 1u this time. Very reasonable - and if the new is also reasonable, there shouldn't be a problem. Promise that you will be watching the BGs and checking for ketones, and her mind should be set at ease.
 
I agree. If you approach her with the idea that you are nervous, you are worried about starting at a higher dose, it doesn't undermine her advice. It allows her to do something that will put the "customer's" mind at ease.

Educating her at start low, go slow can come later.

If all else fails, insist on waiting until he gets home to start and then start at the dose you want. Don't forget- she works for you and it's your kitty.
 
I have no experience with Lantus, but I agree with everyone else -- trust your gut instinct. I made the mistake of not trusting my gut once and it could have turned out very badly.

Motska stayed on Vetsulin longer than most other cats here, because it worked pretty well for her -- she was on .1u BID (or sometimes .2u if she had a higher PS number). But once our reserves started to run low, I decided that it would be a good time to start with a new vet who knew more about FD, at the same time we switch to ProZinc. She had a check-up and a dental done by the new vet, and then a week after the dental, I broke our last vial of Vetsulin. So I spoke to the Vet, she told me that I could come pick up the ProZinc that day, and that she wanted to start Motska at 1u BID. I asked her why it would be 1u, when Motksa had been on only .1u of Vetsulin -- and they are both the same "concentration" of insulin. Motska would be getting 5-10 times the amount of insulin that she had previously been receiving! She told me that we would want to "start over" like you would with a newly diagnosed cat. I got the impression that I wasn't going to be able to change her mind, so I just said, "Thank you" and went home knowing that I had no intention of giving 1 full unit of ProZinc.

Instead, I gave Motska .5u that night -- I thought that would be a safe compromise. And by +5, her BG was in the low 50's and dropping. I stayed up with her and gave her Karo and dry food, and she was fine (after several hours). But I was really mad at myself for not listening to my instinct to start her at .1 or .2 units.

Trust your instincts -- you know Guinness better than anybody else. And if the new vet insists that you start out at a higher number, just say, "Ok, thank you" and when you get home, give her the amount that you feel comfortable with. You can always increase her insulin down the road, if you'd like. Hopefully, your vet will be a good listener and all will go well -- instead of you having to work around her! Good luck!
 
I love my vet. But when she suggested something I didn't feel right doing I'd just say that I was not comfortable with it and would like to be more conservative. For instance, Maggie wasn't eating, but my vet said I should still give her full insulin dose. I told her I wasn't comfortable with that, what did she think of giving half the dose. She said the full dose would be fine, but to go ahead and give half.

In your case, you can say you want to start low and go slow. You can honestly say that your experience with how YOUR cat reacts to insulin leads you to want to start at 1 unit. Say you can always increase the dose if it doesn't work. You can't take the insulin out of the cat once it's in them.
 
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