Seeing better numbers; vet ripped into me for adjusting dose

[Tucker's Mama CS]

Hi all!

Just an update on Tucker: we have been seeing better numbers lately, which is why I haven't posted as much. I think he might finally be done with his bouncing (hopefully).

I am a little peeved at his Internal Medicine specialist. Tucker saw him last Friday 4/19 because he has been having some stool inconsistencies and I was concerned the lymphoma was returning. I wanted to have another ultrasound done, but his specialist stated that he's gained weight since his hospitalizations last year and that he is eating okay and also because of his conditions, he is "not a good candidate for treatment" so basically there's no point and he refused to do one.

I showed the vet Tucker's spreadsheet and he first scolded me for "checking his sugar too much," stating that I was stressing Tucker and myself out unnecessarily. I explained to him that I wanted to collect the data to make sure Tucker is safe. He said that I should only be checking it or doing a curve if Tucker is symptomatic. Given his history with DKA, I think waiting until he is symptomatic is extremely dangerous!!

Then he ripped into me for adjusting the dose to 2.25 units for that 1 week earlier this month. He said I should not be making ANY adjustments without his consent....to which I reminded him that I had texted him Tucker's curve results on 4/1 and he never replied to me. Then he told me he wants me to stop checking Tucker's BG's altogether. I informed him that I am a nurse and I would NEVER give a patient insulin without knowing what their BG is and that I cannot and will not go without checking it entirely. He basically said "Okay, do what you feel is necessary" but I could tell he was unhappy with me and I just feel like he was really rude to me for no reason. Very upsetting because I am just trying to do right by my sweet Tucker and make sure he is healthy and happy and it felt like his specialist was really unsupportive.

Anyways, thanks for reading. I'm going to get some mid-cycle tests this weekend. Hope everyone and their kitties are doing well.

 

[Bron and Sheba (GA)]

Good on you for stating your case. You are Tuckers advocate and have every right to do what you did. What you said is 100% correct.
My suggestion would be to change IM vets. You need to be working with a vet in a partnership to help Tucker, not a dictatorship. He is showing you no respect.
And I know from reading here that cats with FD do get treated for lymphoma. @Wendy&Neko

 

[Wendy&Neko]

Here’s what I think of your IM vet. I was dealing with a lot of the same conditions you are. I am so glad I only had minor complaints about my IM vet in comparison. Not sure what the IM vet means about not being a good candidate for treatment. Got any other IM vets in town?

Glad you will be getting some more mid cycle tests soon, on that I agree with you.

 

[tiffmaxee]

Ditto what Wendy and Bron said. I’m sorry you have to deal with a ignorant and pompous vet.

 

[JeffJ]

Your vet is full of Cxxp. I would change vets. Your vet does not have a modern understanding of feline diabetes. Frankly the experienced people here - do understand it.

Leoberry would be DEAD if I didn't test on a frequent basis. Look at his chart, and how many times I have saved him through a hypo.

It really bugs me when I hear of a vet like yours. On the contrary - my vet in north Austin has a very good understanding of feline diabetes and is very supportive of frequent testing and dose changes. Plus I have educated her on the Acromegaly treatments we have experienced on FDMB.

Tucker's chart looks great. You are doing a great job. Since you are not home during the week, you may want to set a "don't dose under this BG value" limit.

 

[JoyBee&Ravan]

My vet was very sceptical about home testing. After a few months I brought him Ravan's SpreadSheet. He was "very" impressed. He said he now shows it to his Clients with diabetic cats!
I agree with everyone else here. Find another Vet!

 

[Sienne and Gabby (GA)]

Finding a new vet isn't always easy. If it's a consideration, let people know roughly where you live and there may be people either here or on Health who have vets they really like and who don't have "my way" temper tantrums. Good for you for standing up to this vet!! I couldn't agree more about shooting blind. I sincerely doubt that he'd practice what he's preaching if he had a diabetic child (and if he said DM management is different in a human than a cat, I'd run for the hills).

If there is a cats only vet in your area, you may want to consider a feline practitioner vs an IM vet. I've used cat only practices all of Gabby's life and now that I'm in Columbus, where there is one of the top vet schools in the country, I'm still using a cats only vet (vs. the vet school). My vet here saw Gabby's SS and pretty much said to let her know if she could offer any help since I clearly knew what I was doing. She knew about TR and had no issue with giving me prescriptions. She has also been phenomenal with Gizmo's IBD. There is a website where you can search if there's a cat friendly practice in your area. FWIW, I interviewed my vet here when I moved. We talked for some time and she gave me a tour of the practice at no charge. I had a vet lined up for Gabby before I had an MD for me!!

And not just to be contrary, looking at Tucker's SS, I'd encourage you to try to get more tests so you know that you're not missing any dose reductions.

 

[Tucker's Mama CS]

Good on you for stating your case. You are Tuckers advocate and have every right to do what you did. What you said is 100% correct.
My suggestion would be to change IM vets. You need to be working with a vet in a partnership to help Tucker, not a dictatorship. He is showing you no respect.
And I know from reading here that cats with FD do get treated for lymphoma. @Wendy&Neko

Thank you Bron. He is the only IM vet in my county that specializes in oncology, but I am looking outside my county now.

 

[Tucker's Mama CS]

Here’s what I think of your IM vet. I was dealing with a lot of the same conditions you are. I am so glad I only had minor complaints about my IM vet in comparison. Not sure what the IM vet means about not being a good candidate for treatment. Got any other IM vets in town?

Glad you will be getting some more mid cycle tests soon, on that I agree with you.

None in town, but I am looking outside my county now. The reason I've stuck with this guy for so long is because he knows Tucker's history and he is the vet that took care of him during his hospitalization for DKA/pancreatitis back in December. But I'm going to start looking for a new IM specialist outside of my county. Thank you.

 

[Tucker's Mama CS]

Your vet is full of Cxxp. I would change vets. Your vet does not have a modern understanding of feline diabetes. Frankly the experienced people here - do understand it.

Leoberry would be DEAD if I didn't test on a frequent basis. Look at his chart, and how many times I have saved him through a hypo.

It really bugs me when I hear of a vet like yours. On the contrary - my vet in north Austin has a very good understanding of feline diabetes and is very supportive of frequent testing and dose changes. Plus I have educated her on the Acromegaly treatments we have experienced on FDMB.

Tucker's chart looks great. You are doing a great job. Since you are not home during the week, you may want to set a "don't dose under this BG value" limit.

Thank you, Jeff. Yes, and this past week was even worse because I had final exams in addition to my full time job. I am going to start testing more in the evenings again to make sure he's not going hypo on me. What do you think would be a good "Don't dose" value? That one morning I had a pre-shot of 115 I was pretty nervous but I gave him half his dose.

 

[Tucker's Mama CS]

Finding a new vet isn't always easy. If it's a consideration, let people know roughly where you live and there may be people either here or on Health who have vets they really like and who don't have "my way" temper tantrums. Good for you for standing up to this vet!! I couldn't agree more about shooting blind. I sincerely doubt that he'd practice what he's preaching if he had a diabetic child (and if he said DM management is different in a human than a cat, I'd run for the hills).

If there is a cats only vet in your area, you may want to consider a feline practitioner vs an IM vet. I've used cat only practices all of Gabby's life and now that I'm in Columbus, where there is one of the top vet schools in the country, I'm still using a cats only vet (vs. the vet school). My vet here saw Gabby's SS and pretty much said to let her know if she could offer any help since I clearly knew what I was doing. She knew about TR and had no issue with giving me prescriptions. She has also been phenomenal with Gizmo's IBD. There is a website where you can search if there's a cat friendly practice in your area. FWIW, I interviewed my vet here when I moved. We talked for some time and she gave me a tour of the practice at no charge. I had a vet lined up for Gabby before I had an MD for me!!

And not just to be contrary, looking at Tucker's SS, I'd encourage you to try to get more tests so you know that you're not missing any dose reductions.

Thank you Sienne. That's wonderful you had such great support with Gabby and now with Gizmo!

I just checked that website link you posted, and neither Tucker's primary vet nor his specialist were on there, lol. I love his primary vet, though, because he is very supportive and usually lets me do what I want because we've known each other for 20 years...but he is not the most knowledgeable or the best at giving advice.

Last week was a really bad week for me with final exams in addition to working full time, but I am back on the ball now and checking Tucker's sugar more frequently again. I know with the SLGS protocol we are looking at the nadir for dose reductions, but is there a specific protocol if the pre-shots are lower than usual? That one morning we had a 115 so I gave him 1 unit because I was quite nervous about shooting his full dose.

 

[Tucker's Mama CS]

I don't know if I added that picture correctly, but Tucker thanks you all for your sweet thoughts, encouragement, and help!

 

[JeffJ]

Great pic of Tucker - he is a sweet boy.

That one morning I had a pre-shot of 115 I was pretty nervous

That is a strategy that I have used in the past as well. And it worked for me. As long as the kitteh is eating fairly well, I think this is a safe strategy. And it is probably healthier for Tucker since he will not be BG=500 at the next 12 hour mark.

I sympathize with those who can't do mid-day testing. It can be quite nerve wracking. Theresa and I were talking the other day, and none of these home test tools were easily available before 1990. I suspect many kittehs died from lack of decent BG info.

Good luck on your exams. I have 3 college degrees. My last one was a PhD in Computer Science.

 

[Giomax]

What a rude man! I'm glad you stood up for yourself. If Tucker tolerates BG checks and is responding well to your dosing, why shouldn't you do it?!

 

[Sienne and Gabby (GA)]

The only approaches that base the dose on the pre-shot numbers are for the short acting insulins (e.g., Novolin). With SLGS, if the pre-shot number is lower than what you're comfortable with, you have 3 options:

• Skip the shot
• Stall -- don't feed and re-test in 15 - 20 min to see if numbers are on the rise. You can repeat for as long as 2 hrs if that will work for your schedule. If it's longer than 2 hrs and numbers aren't moving, I'd probably skip.
• Shoot a reduced dose. There's no recommended amount to reduce the dose by -- it's a judgement call.

The downside of any of these alternatives is that it messes with the depot. But, it's important that you aren't spending hours worrying and that Tucker is safe.

I'm more concerned about your getting PM tests. For example, Tucker started out in the 400s at PMPS yesterday and this morning he was at 266. It is possible his numbers were lower than his AMPS. Gabby was capable of starting a cycle in the 400s, dropping into the 40s and zooming back into the 400 by her next pre-shot. If I hadn't caught the numbers in the 40s, I would have raised her dose. Instead, she earned a dose reduction.

 

[Tucker's Mama CS]

Great pic of Tucker - he is a sweet boy.


That is a strategy that I have used in the past as well. And it worked for me. As long as the kitteh is eating fairly well, I think this is a safe strategy. And it is probably healthier for Tucker since he will not be BG=500 at the next 12 hour mark.

I sympathize with those who can't do mid-day testing. It can be quite nerve wracking. Theresa and I were talking the other day, and none of these home test tools were easily available before 1990. I suspect many kittehs died from lack of decent BG info.

Good luck on your exams. I have 3 college degrees. My last one was a PhD in Computer Science.

Thank you, Jeff! Yes, he is a very sweet boy and I just love to kiss that cute face!

The half-dose idea seemed to work okay this time, but I need to keep collecting data to make sure he hasn't been dipping too low, especially at night.

This is my 3rd college degree as well, and definitely my last! I've been in college for about 15 years now and I'm ready to quit. Bless you for having the energy to get your PhD

 

[Tucker's Mama CS]

The only approaches that base the dose on the pre-shot numbers are for the short acting insulins (e.g., Novolin). With SLGS, if the pre-shot number is lower than what you're comfortable with, you have 3 options:

• Skip the shot
• Stall -- don't feed and re-test in 15 - 20 min to see if numbers are on the rise. You can repeat for as long as 2 hrs if that will work for your schedule. If it's longer than 2 hrs and numbers aren't moving, I'd probably skip.
• Shoot a reduced dose. There's no recommended amount to reduce the dose by -- it's a judgement call.

The downside of any of these alternatives is that it messes with the depot. But, it's important that you aren't spending hours worrying and that Tucker is safe.

I'm more concerned about your getting PM tests. For example, Tucker started out in the 400s at PMPS yesterday and this morning he was at 266. It is possible his numbers were lower than his AMPS. Gabby was capable of starting a cycle in the 400s, dropping into the 40s and zooming back into the 400 by her next pre-shot. If I hadn't caught the numbers in the 40s, I would have raised her dose. Instead, she earned a dose reduction.

Thank you Sienne. Yes, that morning I felt like his pre-shot was quite a bit lower than it had been the previous couple of days, so half dosing felt comfortable, but you're right..I hate to worry about him while I'm at work with no one to check on him!

I am going to start getting some more PM numbers now that I'm on break from school for a week or so. Not sure if perhaps giving him his Mirtazapine early yesterday had an effect on his appetite and therefore the higher PMPS number. This is why collecting data is important, which apparently the vet doesn't understand.