7/8 Figaro AMPS=456 +10=364

[Figaro's Liz]

Yesterday http://www.felinediabetes.com/FDMB/threads/7-7-figaro-amps-338-2-455-4-418-6-430-8-451.216527/
7/6 http://www.felinediabetes.com/FDMB/threads/7-6-figaro-amps-460-2-427-pmps-414-3-402.216492/
7/5 http://www.felinediabetes.com/FDMB/threads/7-5-figaro-am-10-410-somogyi.216446/
(forgot to link previous posts)

Yesterday's curve: AMPS=338, +2=455, +4=418, +6=430, +8=451.

Is it right to keep holding at 0.5? If I were following SLGS, the protocol would be to hold Figaro's dose, I think, since it has not been a week. I see it right there in text but I'm worried about these constant highs. He was on 0.5U but with almost no home tests for over a week before the vet told me to go to once a day (still kicking myself for doing that).

For those of you who don't work with a vet (or don't follow their advice), while following SLGS or TR, how do you handle prescriptions and check-ups? If I commit to SLGS (against the instruction of my vet), my concern is that I won't have access to syringes and insulin if she won't write the scripts. I'm trying to switch to a different vet, but I'm not sure the change will make it any easier. I want to have a good relationship with Fig's vet so that if we need them for an emergency, they are accessible.

I want to follow SLGS, but my vet is not working with me here. Just talked to her and she wants to put him up to 1 unit 2x/day. I said I'd like to do 1/4 unit and she just said that's not possible. I don't trust her at all, but I'm very apprehensive about not being able to call a vet with issues, especially if he needs to be seen.

Edit just to add, I know many of you are confident in the method and that gives me confidence too. Just want to have a plan going into this as much as I can, so appreciate any stories from your experience "working around" uncooperative vets.

 

[AmandaE]

Hi Liz! Welcome!! ( I must have been away when you joined )

RE your dosage: I'm not very much more experienced than you, but I do follow SLGS. Technically when you skipped the PM shot on the second and third of July that would trigger a cycle reset for dosage, but you have been on 0.5u for almost 3 weeks with very high numbers, I also would be tempted to increase. Are you absolutely sure that your monitor is properly calibrated? If so, I personally would probably increase by 0.25u for a total of 0.75u on the next shot. @Wendy&Neko @carfurby and @Bobbie And Bubba are members I really trust for advice, so I've tagged them in hopes that they will have some time to chime in today. Worst case scenario is that you hold the dose for 3 more days. Don't worry, this is a marathon not a sprint, the important thing is that you're taking action for Figaro now, he's a very lucky kitty to have such a caring cat mom

Also... it looks like you are able to test enough to follow tight regulation, have you considered it? you should have a look at the sticky and see if you think it could work for you... if you think it would, I'm pretty sure that it would be time for an increase for Figaro on TR

RE your vet: Hmm, this is the most frustrating situation when trying to reconcile advice from the board with advice from your vet. I think that the most important part of what you wrote is that you don't trust your vet. If this is true, looking for a different vet is definitely a must. Trust is very important in your relationship with your vet. In the end, Figaro is your cat so you can decide what dose to give him. Even if you do decide to go against the advice of your vet, I would be very surprised if your vet flat out refused to prescribe syringes and insulin for a diabetic cat, and I would be shocked if they refused emergency services. The best thing you can do is be open with your vet, show her your spreadsheet and the data you've begun to pull, ask her why she is opposed to quarter unit increases, send her the links for SLGS and TR. Hopefully she will be willing at least to read a bit to see where you're coming from.

RE if your vet doesn't cooperate: Did your vet prescribe a vial or pens for Lantus? If you got the pens you will have enough insulin to last you a while until you find another vet. Do you need a prescription for the 100u syringes? a lot of people from the US just get theirs at Walmart. I'm from Canada so I am fortunate enough to be able to get both the insulin and syringes over the counter.

You should ask your vet what are her boundaries in respect to how you plan to follow her advice. If she gives you the feeling that she definitely won’t support you or provide prescriptions maybe you could just tell her you’re going to follow her advice until you can find a vet that is more supportive, open, and cooperative. I think this would be my last resort, but you do have access to support and experience here that can help you along until (and after) you’re able to find a more suitable vet.

Personally once I decided to follow SLGS I fully committed and basically just use my vet for other problems. I trust the experience here more than the experience of my vet based on my personal experiences with vets since Mowgli was diagnosed as well as based on various papers i’ve read. If you’ve done your research and feel confident to follow a method here, I say go for it.

 

[Sue and Luci]

I won't have access to syringes

If you're in New York, you can walk into any Walmart - go to the pharmacy counter and ask for syringes - it's good if you have a favorite already and show them the package, etc. No prescription needed to obtain syringes. I've never had trouble getting all the syringes I need from Walmart - if another store - just ask - typically no Rx. required for syringes.

As for the insulin - if you already have a prescription you can use it at Mark's Marine - mail order pharmacy in Canada - or if you're close enough to the border, perhaps go over there yourself and pick it up - I understand there is no prescription required in Canada for insulin (but I'm not Canadian, so check with one of the Canadian's on the group to be sure)...there is also a list here (For Sale/Free) where you can obtain insulin from other members - typically at a reduced cost. Rest assured there are ways around your vet to get what you need for your cat.

Yes, it's nice to have a vet for other things - but you don't have to have a confrontational relationship with a vet who doesn't understand feline diabetes - just say, yes, uhm...thank you, uhm...etc. Go along with what they say about other things and don't get into a big conversation about the diabetes...there's plenty of literature here on the forum that you could print and give to your vet - if you think she's interested and wants to learn...

 

[AmandaE]

If you're in New York, you can walk into any Walmart - go to the pharmacy counter and ask for syringes - it's good if you have a favorite already and show them the package, etc. No prescription needed to obtain syringes. I've never had trouble getting all the syringes I need from Walmart - if another store - just ask - typically no Rx. required for syringes.

As for the insulin - if you already have a prescription you can use it at Mark's Marine - mail order pharmacy in Canada - or if you're close enough to the border, perhaps go over there yourself and pick it up - I understand there is no prescription required in Canada for insulin (but I'm not Canadian, so check with one of the Canadian's on the group to be sure)...there is also a list here (For Sale/Free) where you can obtain insulin from other members - typically at a reduced cost. Rest assured there are ways around your vet to get what you need for your cat.

Yes, it's nice to have a vet for other things - but you don't have to have a confrontational relationship with a vet who doesn't understand feline diabetes - just say, yes, uhm...thank you, uhm...etc. Go along with what they say about other things and don't get into a big conversation about the diabetes...there's plenty of literature here on the forum that you could print and give to your vet - if you think she's interested and wants to learn...

I can confirm there is no prescription needed for Lantus insulin in Canada, but I think if you’re ordering it online from Canada (Marks Marine Pharmacy) you have to have one.

If you are within Canada’s borders you can walk into any pharmacy and pick up insulin and syringes without a script. There have been a lot of news stories here in Canada about Americans making the journey to Canada to get more affordable Insulin as the US prices are so expensive.

I agree with Sue, there are always ways to get what you need without your vet, but it’s too bad that she can’t at least try to be supportive of you.

 

[Bobbie And Bubba]

Hi there! Figaro needs more insulin. This dose isn’t cutting it. We usually raise and decrease in increments of .25 units. It would be nice if there was some data when he was on 1 unit. Why did you decrease? And how much does he weigh?


ETA: just trying to figure out what the dose should be.i see in signature he is 13 pounds.

 

[Bobbie And Bubba]

@Marje and Gracie , I see you are online. Can you weigh in for a dose amount for Figaro?

 

[Figaro's Liz]

Hi there! Figaro needs more insulin. This dose isn’t cutting it. We usually raise and decrease in increments of .25 units. It would be nice if there was some data when he was on 1 unit. Why did you decrease? And how much does he weigh?


ETA: just trying to figure out what the dose should be.i see in signature he is 13 pounds.

Thanks so much for weighing in. The 1 unit dose was what the vet put him on at first. That was very early on, and I may have been overly cautious but I suspected hypoglycemia from his behavior (had no idea about home testing at the time). That, combined with the fact that his BGs were borderline high prior to diagnosis, led to the vet reducing to 0.5 units. At the time, he was also on an AB for UTI. Shoot... I just realized that should be in his SS.

 

[Bobbie And Bubba]

It looks like Marje signed off. With you suspecting that 1 unit was too much , how about going up to .75 and let’s see how that dose does with testing. Then we will see systematically what each dose is doing. Sound like good plan?

ETA. : we also have to consider a UTI in the picture earlier and be conservative with our increase .

 

[Figaro's Liz]

It looks like Marje signed off. With you suspecting that 1 unit was too much , how about going up to .75 and let’s see how that dose does with testing. Then we will see systematically what each dose is doing. Sound like good plan?

ETA. : we also have to consider a UTI in the picture earlier and be conservative with our increase .

My instinct was .75 too, so your corroboration sounds good to me. His PMPS is 410 (just now), so here we go with .75!

 

[Wendy&Neko]

Good luck with the new dose.

I started out listening to my vet when we were giving Caninsulin, and at the beginning part of giving Lantus. Then I discovered people here knew more than her about Lantus dosing. Plus I was the first client to home test. I printed off the dosing methodology I was going to follow, thankfully TR is published in vet journals, and brought her weekly copies of Neko's spreadsheet for a while. We had a long term relationship, so she was OK with me following the protocol. I still brought Neko in regularly for other things, so we could discuss how the treatment was going.

 

[AmandaE]

Good luck with the new dose Liz!

 

[Figaro's Liz]

Hi Liz! Welcome!! ( I must have been away when you joined )

RE your dosage: I'm not very much more experienced than you, but I do follow SLGS. Technically when you skipped the PM shot on the second and third of July that would trigger a cycle reset for dosage, but you have been on 0.5u for almost 3 weeks with very high numbers, I also would be tempted to increase. Are you absolutely sure that your monitor is properly calibrated? If so, I personally would probably increase by 0.25u for a total of 0.75u on the next shot. @Wendy&Neko @carfurby and @Bobbie And Bubba are members I really trust for advice, so I've tagged them in hopes that they will have some time to chime in today. Worst case scenario is that you hold the dose for 3 more days. Don't worry, this is a marathon not a sprint, the important thing is that you're taking action for Figaro now, he's a very lucky kitty to have such a caring cat mom

Also... it looks like you are able to test enough to follow tight regulation, have you considered it? you should have a look at the sticky and see if you think it could work for you... if you think it would, I'm pretty sure that it would be time for an increase for Figaro on TR

RE your vet: Hmm, this is the most frustrating situation when trying to reconcile advice from the board with advice from your vet. I think that the most important part of what you wrote is that you don't trust your vet. If this is true, looking for a different vet is definitely a must. Trust is very important in your relationship with your vet. In the end, Figaro is your cat so you can decide what dose to give him. Even if you do decide to go against the advice of your vet, I would be very surprised if your vet flat out refused to prescribe syringes and insulin for a diabetic cat, and I would be shocked if they refused emergency services. The best thing you can do is be open with your vet, show her your spreadsheet and the data you've begun to pull, ask her why she is opposed to quarter unit increases, send her the links for SLGS and TR. Hopefully she will be willing at least to read a bit to see where you're coming from.

RE if your vet doesn't cooperate: Did your vet prescribe a vial or pens for Lantus? If you got the pens you will have enough insulin to last you a while until you find another vet. Do you need a prescription for the 100u syringes? a lot of people from the US just get theirs at Walmart. I'm from Canada so I am fortunate enough to be able to get both the insulin and syringes over the counter.

You should ask your vet what are her boundaries in respect to how you plan to follow her advice. If she gives you the feeling that she definitely won’t support you or provide prescriptions maybe you could just tell her you’re going to follow her advice until you can find a vet that is more supportive, open, and cooperative. I think this would be my last resort, but you do have access to support and experience here that can help you along until (and after) you’re able to find a more suitable vet.

Personally once I decided to follow SLGS I fully committed and basically just use my vet for other problems. I trust the experience here more than the experience of my vet based on my personal experiences with vets since Mowgli was diagnosed as well as based on various papers i’ve read. If you’ve done your research and feel confident to follow a method here, I say go for it.

Amanda, thank you for the welcome and such a thorough response, and your kind encouragement I really appreciate the tags and your advice re: vets.
One of the main issues with the vet situation is that I have two--the local vet and then the vet at the hospital where I took Fig to a late-night ER for the UTI that got this whole ball rolling. The vet at the hospital is the one who has been giving poor dosing advice. Had I realized earlier, I would have transferred care back to my local vet sooner, but the hospital vet wanted to manage for the first several weeks. Anyway, in the process of transferring back to the local vet now, and I'm so glad I asked this question today so that I can go in to that relationship strong, and stick to what I think is best for Figaro based on research.

I hadn't actually considered TR yet. It's funny to think that two weeks ago I couldn't even test Figaro, when now he already hops up on the table for his tests, and I am so much more capable. I'm going to re-study the sticky and think seriously about it. Thank you.

I have a Lantus vial but I will definitely ask for pens next time. You do need a script for syringes here in NYS--I'm quite sure that has to do with legal attempts to control substance abuse--but I think, as you are recommending, asking the vet (my local) about her boundaries is a great idea and would help me get over the anxiety, and on to business.

 

[carfurby (GA)]

I think the increase to 0.75 units was a good choice. Good luck with the new dose.

 

[Figaro's Liz]

If you're in New York, you can walk into any Walmart - go to the pharmacy counter and ask for syringes - it's good if you have a favorite already and show them the package, etc. No prescription needed to obtain syringes. I've never had trouble getting all the syringes I need from Walmart - if another store - just ask - typically no Rx. required for syringes.

As for the insulin - if you already have a prescription you can use it at Mark's Marine - mail order pharmacy in Canada - or if you're close enough to the border, perhaps go over there yourself and pick it up - I understand there is no prescription required in Canada for insulin (but I'm not Canadian, so check with one of the Canadian's on the group to be sure)...there is also a list here (For Sale/Free) where you can obtain insulin from other members - typically at a reduced cost. Rest assured there are ways around your vet to get what you need for your cat.

Yes, it's nice to have a vet for other things - but you don't have to have a confrontational relationship with a vet who doesn't understand feline diabetes - just say, yes, uhm...thank you, uhm...etc. Go along with what they say about other things and don't get into a big conversation about the diabetes...there's plenty of literature here on the forum that you could print and give to your vet - if you think she's interested and wants to learn...

At least in this part of NY, a prescription is necessary. However I really appreciate the reminder--there is always a way to get things! Indeed, I could relatively easily drive over the border on a day trip if necessary. Very good recommendation about side-stepping the diabetes, too (I lol'd at "yes, uhm... thank you" ). Thank you for the great suggestions.

 

[AmandaE]

Amanda, thank you for the welcome and such a thorough response, and your kind encouragement I really appreciate the tags and your advice re: vets.
One of the main issues with the vet situation is that I have two--the local vet and then the vet at the hospital where I took Fig to a late-night ER for the UTI that got this whole ball rolling. The vet at the hospital is the one who has been giving poor dosing advice. Had I realized earlier, I would have transferred care back to my local vet sooner, but the hospital vet wanted to manage for the first several weeks. Anyway, in the process of transferring back to the local vet now, and I'm so glad I asked this question today so that I can go in to that relationship strong, and stick to what I think is best for Figaro based on research.

My pleasure on the welcome and response, soon you’ll be doing the same for others

This news about your local vet is great! What a relief you already have a relationship with another vet! I hope this one is more open towards different methods. The good news is you can just switch from the ER vet back to your regular vet without any hurt feelings

I hadn't actually considered TR yet. It's funny to think that two weeks ago I couldn't even test Figaro, when now he already hops up on the table for his tests, and I am so much more capable. I'm going to re-study the sticky and think seriously about it. Thank you.

It is absolutely crazy how quickly you catch on to such a large amount of information when the health of a pet you really care for is in jeopardy

If my schedule allowed it I would definitely follow TR, it allows you to use a more aggressive dosing method which allows more frequent dose changes, thus ensuring Figaro spends more time in healthy numbers.

I have a Lantus vial but I will definitely ask for pens next time.

Yes the pens are much better, we use them like mini vials with the same syringes as you would use with a vial. pens are a favourite around here because they aren’t breakable, they last longer, and you don’t risk contamination of the whole purchased amount of insulin when you withdraw from one pen. I’m thankful I followed the advice to use pens... I feel like even though the initial cost is more for pens, you end up saving in the long run.

You do need a script for syringes here in NYS--I'm quite sure that has to do with legal attempts to control substance abuse--but I think, as you are recommending, asking the vet (my local) about her boundaries is a great idea and would help me get over the anxiety, and on to business.

Bummer about needing a script for syringes, but I would definitely get a good understanding of where you stand with your vet so you can decide if you want to follow Sue’s strategy of “yes, hum... thank-you” haha nice to have that one in tour back pocket