Deborah & Muffy(GA) & Wendall
Member Since 2010
From the Journal of Feline Medicine and Surgery (2015)
http://jfm.sagepub.com/content/17/3/235.full.pdf+html
http://jfm.sagepub.com/content/17/3/235.full.pdf+html
Recent Article re Management of Diabetic Cats
- Thread starter Deborah & Muffy(GA) & Wendall
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Olive & Paula
Member Since 2015
I've read this. Very interesting. It's nice to see some updated info. They advocate home testing. They make some good points overall.
Shoeskitty-GA
Member Since 2016
I saved this too. It seems to advocate not being so aggressive as well!
Olive & Paula
Member Since 2015
Yes, they don't agree with TR protocol. But they don't mention SLGS either. It states a 2 hr early or late window for shots. I don't necessarily agree with that, but it's nice to know there is some leeway. It's nice to see some ranges for low, regulation, high.
Shoeskitty-GA
Member Since 2016
It's almost like they are advocating a new protocol. I'm like you in not agreeing with a two hour leeway window on the injections. Knowing my cat, that would not be a good idea to be off by that much. And yes, I was happy to see the ranges there!
DustBunnyMomma
Member Since 2016
Im going to email this to my mom to be printed so I can give it to my vet...
Melanie and Smokey
Member Since 2010
SLGS is not a recognized protocol, it is something developed on the board as an alternative to the aggressiveness of TR.
The article repeated states that us, as owners, are either not willing or not able to do TR and that is why they don't support it.
There are some good parts on bringing down the ranges many vets use now and recommending (again) the better insulin for cats to be used. I find the article a bit insulting on its insistence in pet owners lack of ability and caring to treat our cats to the best of their needs. They should recommend the BEST care, and then offer adjustments if the caregiver cannot or will not do it, not state that they don't think we can/will so they will recommend less.
Julia & Bandit (GA)
Member Since 2009
I completely agree-this is the HUGE problem I have with this article! I was just talking to Bandit's vet about this article last week, and he said something very, very similar to what you just said--that it's wrong to make assumptions about what owners are willing to do and not do, so you should start with the best recommended treatment, and adjust your treatment plan from there depending on their ability or willingness to follow it.
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Shoeskitty-GA
Member Since 2016
I don't know how the research is derived that goes into making these or any recommendations by the group, but I honestly think that the people here and in other cat groups are in the minority as far as willingness to do whatever is necessary to help their diabetic pets, whether it's a dog, cat, or horse, etc. I do know that I am definitely in the minority in my vet's office and in the community where I live because I take care my fur kids like they are family. I know that when Shoes was first diagnosed and put on Novolin N then later put on Langus, my vet told me that because most owners are not like me because they are not willing to do the testing and provide the care nor the money needed to help a diabetic cat and that's what he encounters in his practice and the other vets in the area have the same situation. This is probably not the norm in a large urban area but it is in the more rural areas. So if input from veterinarians impacts these guidelines, one should not be offended. Vets are sometimes caught between the proverbial rock and hard place in these kinds of situations, i.e. they feel the need to tell the owners what the recommended treatment should be and then watch the owner do nothing for the reasons I mentioned and let the animal die slowly or say put it down or advise a less costly and less commitment by the owner to a different treatment that is more dangerous because that is something that the owner will comply with. It really depends on a lot of things. Vets aren't perfect and in my opinion, have a tougher time than medical doctors because their patients can't talk and must depend on the beans to speak for them.
Melanie and Smokey
Member Since 2010
Yes I should. I should absolutely be offended that a veterinary panel is releasing recommendations where one of their assumptions to reach their conclusion is lesser commitment to care. It results in ALL cats getting the lower level of care because vets are going to refer to their recommendations and argue with those of us who are willing to meet the higher standards of TR. Their only argument against not recommending TR that I find in the article is that caregivers aren't willing/able to do it. I have no problem with people who want to take a less rigid approach. Many days hubby and I are exhausted fro My issue is with them making it the recommendation based on the assumption that we aren't willing/able to do it. If you have a false assumption in your process, then your conclusion is wrong. (Maybe I had too many proof and theorem classes in college
). I see no reason that they cannot recommend multiple paths based on willingness, financial ability, etc. Veterinary care should be a dialog, not a directive.They don't run human medical care that way. I haven't seen them lessen the guidelines telling people that we should eat healthier and get more exercise just because they know we aren't going to eat healthier enough or get enough exercise.
Jill & Alex (GA)
Member Since 2009
Hey everyone! I posted the International Society of Feline Medicine (ISFM) Consensus Guidelines on the Practical Management of Diabetes Mellitus in Cats in the Health Links / FAQs about Feline Diabetes Forum over a year ago.
If the article is new to you, you might want to mosey on over to that forum to see what other interesting articles/posts/information you may have missed.
I whole-hardheartedly agree with Melanie... especially the part where she says, "They should recommend the BEST care, and then offer adjustments if the caregiver cannot or will not do it, not state that they don't think we can/will so they will recommend less.", but do want to clarify the first sentence in her remarks.
The Start Low, Go Slow Method (SLGS) for use with all insulins was created by laypersons who are members of the FDMB and used here prior to the time any tight regulation protocols were used with any insulin (PZI, Lantus, Levemir). Practicing TR with Lantus or Levemir was not widely accepted on the FDMB until around the end of 2006 - beginning of 2007.
In recent years, it was necessary to adapt the original SLGS Method to fit the the action of the newer insulins (Lantus & Levemir): Start Low, Go Slow Method (SLGS) with Lantus or Levemir for Diabetic Cats. Once again laypersons (members of the FDMB) developed the adaptation.
Tight Regulation with Lantus or Levemir for Diabetic Cats, known as the TR Protocol on the FDMB, was developed by laypersons who are members of the German Diabetes-Katzen Forum. This method (TR w/Lantus or Levemir for Diabetic Cats), developed by laypersons, was then published in the Journal of Feline Medicine and Surgery some years later.
Note the re-occurring theme: Laypersons! Chances are these laypersons are not the caregivers talked about in the article linked. I bet these caregivers might have a few choice words about this article!
Julia, I love your vet!
Not everyone can or is willing to do as much as others when it comes to pets. It's just reality. I don't agree, but I do think that's where this consensus of opinion is coming from in the original article linked.
Melanie and Smokey
Member Since 2010
I did say on FDMB, not by FDMB
I do not remember the terminology like SLGS being used when I joined so I did not believe an actual structured "protocol" existed other than TR when I came in 2010. It was TR or people called themselves "relaxed", which didn't seem to have any stated guidelines at the time. Maybe it just wasn't called SLGS until it was adapted in recent years? Maybe I am just old and have bad memory.
Jill & Alex (GA)
Member Since 2009
I'm not surprised. You probably weren't aware of any of this because by the time 2010 rolled around, Lantus and Lev users were basically broken down into two groups... those following the German TR Protocol and those who weren't. The ones who weren't were doing a variety of different things... mostly bits and pieces of SLGS combined with trial and error, but that doesn't mean SLGS didn't exist prior to and at that time.
The original SLGS Approach has been around since the 1990s and has never disappeared from the FDMB. I couldn't tell you the specific year it was created. It was what Rebecca linked in the "Relaxed Forum" on the old board. In Nov. 2014, BJM started a TT thread "Proposed Adjustment to the Start Low, Go Slow protocol" because she recognized a need for adjustments to the protocol for Lantus and Levemir users. The outcome is what we now know as the SLGS protocol for Lantus and Levemir.
Julia & Bandit (GA)
Member Since 2009
@Jill & Alex (GA) Me too! And I find it very encouraging to speak with the vet students in each of Bandit's frequent appointments for his myelofibrosis...some walk in completely confused that he's healthy, and has been diabetic for 7 years.
It's been a bit humbling this past year to go from diseases in my cats that I understand and feel confident in treating to one that I still can't seem to wrap my head around after a year of reading. I'm very lucky to be in the place I am...I have no doubt that Bandit would not have survived, let alone made the amazing recovery he did had it not been for Cornell. I avoided them for years because of the percieved cost, but they aren't really more expensive than anyplace else I terms of treatment-- I think that the amount of testing they want to do is where that reputation comes from, but it really is needed for a lot of conditions.
If only there was a way to home test for RBC and PCV...Bandit would be so much happier to not have to go in every 3 weeks.
It's been a bit humbling this past year to go from diseases in my cats that I understand and feel confident in treating to one that I still can't seem to wrap my head around after a year of reading. I'm very lucky to be in the place I am...I have no doubt that Bandit would not have survived, let alone made the amazing recovery he did had it not been for Cornell. I avoided them for years because of the percieved cost, but they aren't really more expensive than anyplace else I terms of treatment-- I think that the amount of testing they want to do is where that reputation comes from, but it really is needed for a lot of conditions.
If only there was a way to home test for RBC and PCV...Bandit would be so much happier to not have to go in every 3 weeks.
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Marlena
Member Since 2015
I agree with what you've written here guys but have something else to add to it.
I think that apart from the reasons you mentioned of the vets unwillingness to recommend the best treatment for our pets there is one more: it would take much more time for the vet to present all the information to the pet owner and show all the techniques of injecting insulin and taking BG measurements and discuss appropriate diets that it is not financially beneficial to the veterinarian. It is so much more profitable to tell people they have to bring their cats for curves, push for use of Purina dry food (total crap of course) and it must be prescription diet (much more expensive) which has a huge mark up and selling of it is extremely profitable for the vet and on top of that I can see that vets truly believe that that is the best diet for a cat. I can't believe that seemingly educated and intelligent people like vets let themselves be manipulated by a very clever marketing strategy! And I would say the same about doctors - they truly believe in their toxic medication. So vets and doctors work for an organisation which is a business and profit is their first priority. Here in the UK they have 10 minutes for the patient so think how much they can cover in that given time!
My vet whom I regard as a good vet (in comparison with other vets) was trying the same tactic with me although she made an impression that she had some experience with FD. After initial diagnosis of my cat (I requested that because he was overweight and always hungry) I went well prepared and absolutely refused Purina (she even gave me printed out information how beneficial it is for FD) and insisted on other testing like kidney function, pancreatitis and IGF-1 and insisted on home testing of BG.
Well, I'm the only one customer in this large surgery who home tests and feeds animals species-appropriate diet home made.
I said my vet is a good one because she listens to me, takes on board my ideas, reads information I print out for her, takes her time when consulting and does not push me to spend more money. She is happy to speak with me on the phone often without charging for consultation. But I had to be very assertive to have thing done my way. And we are coming to another issue: some people can not be assertive, some absolutely trust that the vet knows it all and is an expert and some are very gullible and believe adverts (allelujah for marketing again)!
Marlena
I think that apart from the reasons you mentioned of the vets unwillingness to recommend the best treatment for our pets there is one more: it would take much more time for the vet to present all the information to the pet owner and show all the techniques of injecting insulin and taking BG measurements and discuss appropriate diets that it is not financially beneficial to the veterinarian. It is so much more profitable to tell people they have to bring their cats for curves, push for use of Purina dry food (total crap of course) and it must be prescription diet (much more expensive) which has a huge mark up and selling of it is extremely profitable for the vet and on top of that I can see that vets truly believe that that is the best diet for a cat. I can't believe that seemingly educated and intelligent people like vets let themselves be manipulated by a very clever marketing strategy! And I would say the same about doctors - they truly believe in their toxic medication. So vets and doctors work for an organisation which is a business and profit is their first priority. Here in the UK they have 10 minutes for the patient so think how much they can cover in that given time!
My vet whom I regard as a good vet (in comparison with other vets) was trying the same tactic with me although she made an impression that she had some experience with FD. After initial diagnosis of my cat (I requested that because he was overweight and always hungry) I went well prepared and absolutely refused Purina (she even gave me printed out information how beneficial it is for FD) and insisted on other testing like kidney function, pancreatitis and IGF-1 and insisted on home testing of BG.
Well, I'm the only one customer in this large surgery who home tests and feeds animals species-appropriate diet home made.
I said my vet is a good one because she listens to me, takes on board my ideas, reads information I print out for her, takes her time when consulting and does not push me to spend more money. She is happy to speak with me on the phone often without charging for consultation. But I had to be very assertive to have thing done my way. And we are coming to another issue: some people can not be assertive, some absolutely trust that the vet knows it all and is an expert and some are very gullible and believe adverts (allelujah for marketing again)!
Marlena
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