The Vet vs What We Know

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babyg

babyg

Member Since 2019
Hi, everyone,

Can I express some feelings and doubts I have been having lately without hopefully not offending anyone? I think we all struggle with knowing what's the best thing to do and with "going against the grain" and not listening to the vet on everything. We've heard the horror stories. But I'm definitely really struggling. Everything I've learned about diabetes, I've learned here. The importance of home testing, how to home test, how the insulin works, etc. Vets never really educate people on these very important things. I wonder how much they truly know about it. This site has been of incredible value and comfort over the years. But now I am in a place with the diabetes where I'm struggling with and feeling ostracized due to my dosing decision. I'm trying to hold the dose for the recommended amount of time before upping to the next level, but almost every shot time I feel like caving in and just doing what the vet said. I worry if something bad will happen because I'm being too cautious. Is there any way to balance things out or feel better about going it on our own? Anyone care to share their own stories or experiences?
 
It’s true many vets do not know much about FD and most do not educate their clients.
It took me quite a while to get over the guilt of dosing myself and not what the vet said. But in the end the vet was quite happy with what I was doing and would just ask me what dose I was giving now. He knew quite a bit about FD but he was always open to learning more. So he was a keeper!

If you are following one of our dosing methods you will do well. You need to print it off and hilite the important points and follow it properly. Not just the parts that suit you.
I can see you are following SLGS but at the moment you are not following the method but are chopping and changing the dose. Remember the dose is based on the nadir not the pre shot.
 
babyg said:
Hi, everyone,

Can I express some feelings and doubts I have been having lately without hopefully not offending anyone? I think we all struggle with knowing what's the best thing to do and with "going against the grain" and not listening to the vet on everything. We've heard the horror stories. But I'm definitely really struggling. Everything I've learned about diabetes, I've learned here. The importance of home testing, how to home test, how the insulin works, etc. Vets never really educate people on these very important things. I wonder how much they truly know about it. This site has been of incredible value and comfort over the years. But now I am in a place with the diabetes where I'm struggling with and feeling ostracized due to my dosing decision. I'm trying to hold the dose for the recommended amount of time before upping to the next level, but almost every shot time I feel like caving in and just doing what the vet said. I worry if something bad will happen because I'm being too cautious. Is there any way to balance things out or feel better about going it on our own? Anyone care to share their own stories or experiences?
Click to expand...

I think vets are trained to handle diabetes like this because the vast majority of people won't put the time to to daily curves or dose adjustments (humans do this for themselves, you never shoot before a test). Yet, they will gladly tell you to shoot a dose and come back in a month for a curve - I think they know it's not optimal, but the average owner will not rearrange their life to treat their cat.

I know I've basically changed everything I do, I essentially only go to work and come home and do 24 hour curves when I can. It's hard but, who else is going to do it?

When my guy was diagnosed my vet started talking me out of euthanasia before I had even replied.... she must get that response for a lot of people. Instead I just asked for a Lantus script.
 
In addition to what others have said - I know we worry about the high numbers. But you're actually shooting yourself in the foot a bit with the chip-chop dosing. Lantus is a depot insulin, and it is especially important to maintain consistent doses whenever possible - because if you don't, you're now affecting the depot in some unknown way and adding another variable to mix. The concern in high numbers is neuropathy (treatable with B12), ketones, and kidney damage over time.

I'm sure others have mentioned - but the fastest way to get where you want to go (regulation) is the TR method. You have the Libre which makes it ideal from a monitoring perspective - the problem will be the dry food, that has to go in order to do TR (as it's yet another unpredictable variable with how long the carb effects stick around).

I would also argue that what the vet is doing apparently isn't working - he's been diabetic for 3 years and still not regulated. The average here is 3-6 months; very few cats struggle beyond that, and those that do usually have other underlying conditions that make it difficult (IAA, acromegaly, IBD/SCL, CKD, etc)

Have you browsed the Lantus board at all? It's worth reading through some of the threads and looking at spreadsheets so you can be reassured that what we do works.

I see a lot of ketone test notes - you really only need to test 2-3 times a week if his last DKA was 2019 and he's not showing any ketones recently.
 
I think a lot of vets underestimate what pet owners are willing to do on their own to care for their pets. When my first cat was diagnosed my vet gave me the option of testing at home or bringing in my cat for testing. She showed me how to test and even gave me my first meter (which was a human meter :D). Once she had me test a few times in her office I decided to test at home. I found FDMB and learned a lot here. I gave my vet the link to the site and after she visited it, started also referring her owners to it. When I adopted Bandit and Charlie, I was using a different vet practice. When each vet first saw them we discussed what insulin I wanted and the dose I wanted to start at. Both vets know this site and support all of the info here. They both felt what I requested were right for each cat. They also know that I am willing to take responsibility for as much care that I can at home. This includes testing, insulin, subq fluids, etc. I think vets need to encourage their clients to be more hands on in caring for their pets and don't underestimate what they are capable of doing.
 
babyg said:
feeling ostracized due to my dosing decision
Click to expand...
It's a sad fact that once your cat goes behind those doors it's just another number, another cell slide and what's basically a textbook decision. This is a place of trust and friendship where your decision is what counts. Quality of life is never a simple decision.
We've been lucky enough to never have our final choices questioned and have twice made them on the spot. It's never easy but the last people who will question you are your friends here. It's never easy, it wasn't made to be.
From your friends here who understand.
"you are not alone, you never were", those words mean something. :bighug:
 
EVID or every vet is different. They are people with differing personalities. Neko's primary vet was stuck on Caninsulin, cause that's what she knew. She was awesome on a lot of other conditions, I'd gone to her for years. She didn't know how to BG test (though they used a human meter in the clinic too) and she got me set up with a locum vet to show me how to test. He showed me how to test, got me set up with Lantus, and pointed me to FDMB for dosing. He later became a permanent vet at that clinic, and I used to go to Dr. Joe as my backup when my main vet wasn't available. Turned out he'd treated a cat with acromegaly previously too. But my main vet was willing to learn, so I stuck with her. She also volunteered some with the local animal shelter where I volunteered/worked part time. Bottom line, a vet doesn't have to know everything, there is a huge amount to know. But having one who is willing to learn and let you do what you do, as long as they think it's safe, then they are a keeper. I passed on the dosing protocol document and spreadsheets regularly for about a month. After that our conversations about dosing amounted to her asking "so, what's her current dose?" and that was it. We also swapped stories of cheapest places to get test strips. It became a partnership.
 
As others noted, the recent frequent dose changes isn't a great strategy with Lantus. However, holding that 2.0u dose for months isn't a great strategy either especially given the limited amount of testing. Holding a dose that isn't bringing your cat into good numbers allows glucose toxicity to develop. What this means is your cat treats the higher numbers as the new "normal" making it more of a challenge to get numbers into a better range.

How can we help?
 
Well said. There is no 'one perfect sized dose'; the cat gets older every day, whether we know it or not something in the food may change, metabolisms change etc. If it wasn't this way we could toss out our meters or at least never do a curve again.
 
Just clarifying how long she has been on the 2 units twice a day...since she got regulated back in 2019 (at least, all the vets that saw her considered her regulated, not based on her numbers but on her clinical signs). Hopefully there's no glucose toxicity from that. :( Tomorrow (Sunday) will make 1 full week of her being on the 2.5 units twice a day. I updated her spreadsheet so as to make it easier to compare the sensor's numbers with the ear poke/meter numbers because sometimes they are pretty different. Sheet 1 is with the ear pokes, and Copy of Sheet 1 is with the sensor. Tonight I am doing a side-by-side, every-two-hours comparison between the sensor and my meter.
As far as her clinical signs, she is eating good, drinking a little less since she's eating wet food, and her poops are pasty I believe from the diet change, but now I'm starting to see a little blood in the poop again so not sure if that's from the pancreatitis. Sometimes she has moments she looks fine and then moments where she looks like something's bothering her. Even though she's eating good, I'm wondering if she could benefit from a pain medicine? The vet never mentioned pain meds, but I've read that pancreatitis can be painful.
 
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