Simmie, PMPS 315, +4, 368 HELP!

[LydetteSimmie (Iceman)]

Simmie had being doing fairly well though his number have indicated that he probably needs more insulin. I did (ok, I am crying now so bear with me) have the discussion with my vet last week and she came down hard on me saying that she did not want me to alter his insulin doses at all without consulting with her first and that she wanted me to wait awhile after our visit to do a curve (at least at that time she realized that I could do a decent curve myself). Bottom line is that Simmie is bouncing all over the map. I just know he needs more insulin but if I piss my vet off she may decide not to treat him any longer...I guess that doesn't matter the only thing is that the owner of the clinic we take Simmie to is a brilliant vet who cares for our doggie, who has some serious health issues, and I don't want to risk losing his care because of the problems I am having with Simmies vet.

I know I sound absolutely stupid. If I read this I would say "Darlin' you need to get a new vet for Simmie, not now, but yesterday!".

Immediate problem/question - Simmie has started climbing very high and he needs to get lower. I only have syringes with full 1 unit markings, no 1/2 unit markings. I was told by my pharmacy that I would need a new prescription for 1/2 unit syringes...that means I would have to deal with my Simmie vet now rather than when I would like to sometime later this month.

I don't want Simmie to live with such high BG numbers. What should I do? I would have contacted you all sooner but this past few days were very difficult for many reasons. I am feeling overwhelmed. I have Simmie's profile completed but because of some technical issues I needed to create the file in Word and I plan to upload it to Google Docs but I haven't been able to do so yet (need to find the help instructions). If you want his profile I can email it to you.

Can anyone help me? I am sad and worried about my baby. I don't understand why he was doing so well and now he seems to be out of control.

 

[Wendy&Neko]

(((Lydette))) - first thing, you need a big hug. :YMHUG: Looking after a diabetic cat is hard, having a vet that isn't so cooperative makes it even harder. You are doing a fantastic job testing and helping Simmie.

Regarding the syringes, if you vet knows you are at 2.5U on insulin, I think you should be able to ask for a prescription for .5U marked syringes. Just tell her you are having a hard time getting a consistent dose and having the half unit marked syringes will help. Claim bad eye sight - whatever, it should be an easy sell. What brand of syringes are you currently using?

Regarding the dose, you are right, it's time for Simmie to go up to 2.75U. The protocol says:

Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

You saw a glimmer of blue in there, but nadirs have been mostly less than 300. The longer you hold doses when they aren't getting great numbers, the more their liver gets used to these numbers as normal.

How to approach the vet - nod your head when the vet suggests what to do regarding dosing. Does the vet watch you when you load the syringe? No. Who works for whom? The vet works for you. Who is at your place watching what is happening with Simmie? You are. My vet originally told me what dose to give, but a locum vet told me to go to FDMB. After that I stopped asking my vet what dose to give. Most vets don't have clients who test like you do, so don't know how to handle such an involved caregiver.

 

[Tiger(GA) and Ruth]

(((Lydette))), I can't give you dosing advice, but I can give you a great big hug! Take a deep breath- and another!! There are wonderful people who do give advice here on this forum, they are the greatest! :YMHUG: :YMHUG:

As far as your syringes, do you have a WalMart nearby? You can presumably go to a Walmart and get syringes with 1/2unit markings although I have gone to 3 different Walmarts in 3 different towns and had no luck, the person at the pharmacy counter had no idea what I was asking for. You might have better luck! You could also get a caliper like this: http://www.harborfreight.com/6-inch-dig ... 47257.html . Here is a link to how to use a caliper and don't be scared, it isn't hard you just need good light! viewtopic.php?f=9&t=79851&p=874756&hilit=Dosing+with+calipers

I don't suppose the vet who treats your dog can treat Simmie? I am lucky, my vet is supportive of home testing and this forum, in fact all the clinic was impressed with this forum. Don't get too stressed out over this, Simmie will probably need to go up in dose and it may take some time to find the right dose for him, but he will find the right dose with the help of the people here! (I had the same problems)

 

[Chris & China (GA)]

Are you sure you need a prescription for insulin syringes in Ohio?

I've done some searching that says insulin syringes are OTC

Syringe laws in various states

 

[LydetteSimmie (Iceman)]

Hi all,

I just love you all. I can't stop crying because Simmie is sitting next to me, happy as a clam, licking his little bowl of ice (don't know if you have seen the postings about his love of ice) but I am feeling like I am hurting him by not doing anything in the moment. You know what I mean? He just sits next to me, licking his ice, than my hand, with his little tail bobbing up and down, not knowing that his high BG is killing him. Is there anything I can do right now? I guess not. I wish I could give him a little insulin to balance him out but I know with him on Lantus this is just a dumb idea.

I'm going to make a cup of tea, watch a dumb sitcom, and pet my baby Simmie...oh, he needs a couple more cube in his ice bucket! Then I'll read your notes again so I can digest your intelligence and wisdom for tomorrow.

Thanks for being here with me, tonight. I thought we were doing so well. We wouldn't have been even this far a long without all of you. I am thinking I need to write an article about this group for a magazine like Cat Fancy. Don't know if that makes any sense. You are all angels.

Well, Simmie wants his ice cubes and some lovin'! Thank you all for being here with us. cat_pet_icon

 

[Sandy and Black Kitty]

Hi there

How to approach the vet - nod your head when the vet suggests what to do regarding dosing. Does the vet watch you when you load the syringe? No. Who works for whom? The vet works for you. Who is at your place watching what is happening with Simmie? You are.

I could not agree more.

You can probably order syringes online - I did when we were on our journey.
The important thing is to be able to get your rx for Lantus.

My Black Kittys 3rd vet was very nice and very good however she freaked out when she saw how much insulin I was shooting (BK had a condition that required high doses). She was of the opinion that he would be better off switching to PZI (a different type of insulin) which I politely refused.
She then told me she would not renew his Lantus prescription. Luckily things turned around for BK, just in the nick of time.
She was amazed and I gained her respect. I think it was just that she had never dealt with many diabetic cats and never with a diabetic cat like BK.

Many, probably most of us have stories of vet 'push-back'. Seems to come with the territory.

Hang in there...and hang in here. It is truly the best place a for a diabetic kitty to be.

 

[Sienne and Gabby (GA)]

First, Simmie's numbers aren't awful. You're right -- he needs more insulin but his numbers aren't off the charts.

Most vets like to see numbers higher than we prefer here. That's because they are not used to having their clients home test. The vets prefer a margin of safety -- a wide margin -- and that makes sense if the only time your cat gets tested is when a curve is done at the vet's office. However, you are home testing. Is this the same vet who started Simmie on 4.0u?

As far as vet management, I tend to look innocently at a vet and ask what they think of the article I'm attaching. It's an article that was published in one of the top tier vet journals that's the research on the Tight Regulation Protocol. If the vet puts up a fuss, I'd simply ask what research he bases his recommendations on since you'd like to compare approaches. If the vet is still being a pain, why not discuss this with your dog's vet since he's the owner of the clinic? Asking what the best way to approach Simmie's vet since you are not happy with how the vet is managing your kitty's FD may be a way to get your point across after having tried to communicate with Simmie's vet.