Disagreement with vet-thoughts?

My boys' vet and I are having a disagreement, and I'm wondering if I could get your opinion. I send her Orion's blood sugar numbers every other week or so. She has told me in the past not to give insulin if he is below 180 right before his shot is due, and I question this. I feel some insulin is better than none, and if I'm around to monitor him I don't see the risk unless he is really low like below 50 or something. I sent her his numbers this morning, and she called me a bit upset that I wasn't following what she told me. Is she just concerned about getting sued because Orion got too low or am I the one totally off base here?

 

Most vets are taught in school that owners either don't home test, or don't understand what to do when cats go too low. Because of this, most vets consider the safe range quite a bit higher than the physiologically normal range. They consider a "good control" range. It's mostly a safety thing.

If you are diligent in testing during the cycles (not just before tests) then you can get comfortable shooting lower with that data. My cat is on levemir, and I've even shot in the 50s at times, as I knew that for him, levemir takes HOURS to kick in, and his nadir is right at the shot time so enough time to increase. I tested a lot tho. It's not for every owner and not for every cat though.

 

I agree and practice usually giving some (reduced dose) Levemir at abnormally low PS'. If I skip the dose the next PS is very high
Typically the PS of three of my insulin-dependent diabetics is below 100. I have even shoot a full dose as low as 59

 

Accumulating enough data to support your decision is definitely the key to shooting low safely.

Those who are truly following the TR Protocol with Lantus or Levemir will routinely shoot full doses on preshot numbers 50mg/dL and over every 12 hours on a meter calibrated for humans (68mg/dL and over on a meter calibrated for pets) if they're available to monitor and have accumulated the data necessary to support their decision.

I've shot Levemir on preshot numbers in the 40s, as low as 41mg/dL, because Alex was carb sensitive which resulted in a large food spike after being fed at shot time. Her Levemir dose usually didn't onset until around 4 hours after the shot was given. This combination pushed her BG numbers up high by the time the insulin started working.

It's all about "knowing thy cat"... knowing how YOUR cat responds to the combination of food fed and insulin... and monitoring closely.

Learn how YOUR kitty is responding to insulin:

• Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
• Peak/Nadir - the lowest point in the cycle
• Duration - the length of time insulin continues to lower blood glucose

Most vets simply aren't used to their clients being as proactive as many of us are...

 

Thank you everyone. I'm not sure how to handle this. I've never had such a disagreement with a vet before. I respect her knowledge but think she's being overly cautious. I don't want to lie to her about when I give insulin, but I also don't want to have a debate whenever I shoot and she disagrees. I believe we both want what is best for Orion.

 

My vet was the same way - his words: "I'm happy if you can keep him in the low 200's". Her thoughts may be based on her 'in office' procedures and curves. If she know that vet stress raises bg's, she wants them in high enough numbers there to safely care for that 'less stressed at home' lower ones. Your testing at home changes that dynamic but she's not seeing that. My vet and I finally agreed to disagree on FD treatment, I treat the FD part, he treats everything else....

 

Same here. He was happy to see Squallie with numbers between 200-250. He probably has a stroke every time he looks at my spreadsheet now, lol, I make a habit of not bringing it up at vet visits.

Angela, something I did that seemed to help was to send my vet a link to the Roomp-Rand study Management of Diabetic Cats with Long-acting Insulin and to Tight Regulation with Lantus or Levemir for Diabetic Cats. I'm not sure he ever actually read either of them, but I guess he figured he was outnumbered, lol, because we've never spoken about it since then.

 

Lol, good idea!

 

It will be our little secret

 

I've thought about lying actually but in the event that Orion ever needs to be hospitalised or has an emergency I worry about his safety if I'm not 100% honest.

 

Thank you very much for these links.

 

The ER vet at my vet office told me not to give insulin for the next cycle after he hit 43 in the morning cycle. I KNEW that wasn't going to work for my cat. I ignored his "orders". The two spreadsheets could work. If there's ever an emergency situation you can show them the SS with ALL the shots and they should be able to see that you have the data to back up your decisions. At the time of an emergency if they are more worried about the SS and not telling them about shooting under a certain number-- I'd find another vet! They should be more concerned about helping your kitty than lecturing you at that time.

 

Hope maybe it'll help if you show them to your vet and explain that this is the protocol you're following. I have no doubt my vet turns inside-out every time he sees numbers in the 50s and 60s on my ss, lol. He also can't wrap his head around me using a human meter, but he finally came to the conclusion that I know what I'm doing, so we normally don't discuss it, any more!

 

First, I wouldn't lie to the vet. It is never a good idea to lie to a doctor, whether human or animal.

She probably has few clients who are home-testing, let alone anyone wanting to do tight regulation. So when discussing it with her on the phone or in the office, tell her you understand she doesn't approve. (If you really think she is concerned about being sued she can put put this in your chart.) Remind her that you are the one who is there day to day and that diabetes is a home-managed disease. That you are doing what you think is best for Orion. Maybe even print out TR information for her to read if she is open to that.

And I would just not send her any more spread sheets. Since you are not relying on her input, what is the point?

 

My thought is that if you have to lie to your vet it is time to find a vet you can be honest with whether you both agree or disagree on different things. I quit my first vet a few months after my first kitty was diagnosed for many (good) reasons and when I interviewed my second vet she was not in favour of home testing but was not against it either. She understood that I had a good idea what I was doing and was not being reckless. Now the few times I do have to take one of my kitties in she is quite excited to see their spreadsheet and only asks me where my dosing is at and what ranges they have been in since the last visit. She thinks the spreadsheet is very informative and is very impressed with the colour charting. She has learned some things from me and I have learned some things from her over the last 2+ years.

 

I will have the same situation. My vet thinks 240 is good enough. She will poop when she finds out I am at 7 + units. If I tell her she has been in 300s she will suggest I go back to 4 units. She thinks anything over 5 or 6 units is going to cause the insulin resistance, or toxicity. We did it her way first. Now I am going to do my way. She can do it with me or I will find another vet.

 

LOL

 

My vet was very resistant to home testing so I found another vet who had a technician that was very experienced with feline diabetes. The new vet and tech were extremely surprised at the spreadsheet and pleased. I told them about FDMB so they could share with their clients. Meanwhile when I took my cats in for their annual examination to my old vet, he asked about Smokey and I explained what I had been doing, showed him the spreadsheet and told him about FDMB also. He told me that he had been researching feline diabetes and was happy I was able to home test. He said most clients are not compliant even with the simple instructions at home so he was surprised at my willingness to do the testing. The upshot of this long rambling message is that he now supports home testing and has passed my name to a client with no money and a newly Dx FD kitty.