9/9 Baby PMPS 378 :( Discouraged and confused

So Baby's been on 5.5u for 5 days now and her pmps was 378...the worst it has been since I've been home checking. I don't understand? Also not sure how to proceed. I spoke to my vet yesterday and she said to keep her at 5.5u for at least 10 days? Also, told me NOT to feed her more than twice a day - just a few PureBites as a mid cycle snack. I was so encouraged when her morning amps was 220 (her lowest number ever) - I thought we were finally getting somewhere. (Last night and today I gave her a break from the constant testing because she was starting to get mad at me ) Words of wisdom??? Thanks!

 

It seems like vets have universally agreed on insisting on 2x a day meals. I encourage you to strongly consider calculating how many calories your kitty needs a day and dividing his food into several small feedings.

My cat vomited every cycle on 2 meals a day. When I broke it into meals or snacks every 4 hours, he felt much better right away.

 

My vet said, "better for her to only spike twice in a day than 3 or 4 times"...I didn't want to contradict her. Baby is not vomiting, but she is just soooo hungry all the time! She gets about 200-220 calories per day.

 

My vet said similar things. She was very wrong. What I learned here is that an unregulated cat needs more food in the beginning of their treatment because their body is not processing it well when their glucose is not regulated. They are starving. I also learned that insulin releases over time, not just at the time of the shot so it will be on board to help control "spikes." With small amounts of food throughout the day, instead of two spikes, you should see more moderation.

Don't be afraid to challenge your vet. Or don't verbally disagree, but make adjustments yourself at home. My favorite vet (not the one who diagnosed him) asks me what I'm doing as far as dose amount and food. Her last Facebook message to me was, "who knew you could manage pancreatic cancer?"

I had two vets advise me to euthanize my cat in June. He and I are very glad I didn't listen.

 

It takes a while for many kitties to get settled into a good dose and start getting better numbers. I agree with @Beck and Grandpa : most diabetic cats do better on several smaller meals over the course of the day. I don't understand your vet's assertion about "spiking" (I assume that he considers that feeding in the morning at amps and the evening at pmps = "twice" a day). That seems like a long time between meals. No wonder Baby is hungry all the time! The smaller meals don't have to be the same size. You could feed a larger meal at AMPS and divide up the rest of the food for that cycle into a smaller meal at lunch time, and a snack at about +9. If you can't be home to put out food during the day or at night, you could get an automatic feeder (many people here do that).

Keep in mind several things: it is often said that feline diabetes is a marathon, not a sprint. It is unrealistic to expect wonderful results at the beginning of this journey. ECID (Every Cat Is Different): what works for some cats doesn't always work for others. But we can learn from each other's experience and fortunately the protocols set forth here in the FDMB have had good success. Finally, patience is required!!!

Hang in there. Follow the protocols. Don't deprive your cat of food simply because you might see lower numbers.

We've all been where you are.

 

Hi Ella, yes - vet says to feed one can of FF pate at amps and pmps - 12 hours apart, with a few no or low-carb snacks throughout the day. I guess it's just hard for me to completely disregard my vet and tell her that I know better (although I totally agree with everyone here that maybe feeding Baby 3/4 can at amps and the other 1/4 can at +5 would be better). Do I just fib to the vet that I'm doing it "her way"? Baby's been on Lantus since May 22 - it's been 3 1/2 months now, with no improvement in numbers. Since her numbers seem worse at today's pmps, but her morning amps was the lowest it's ever been (although 220 is not exactly a good number...) is it advisable to increase again? I am thinking to increase to 6u tomorrow morning, but not sure if I have waited long enough at the 5.5.

 

It looks to me that this evening's pmps is a bounce from the 220 at amps and whatever numbers she may have had later in the AM cycle. But you don't have any other tests today, so you don't know how low Baby may have gone. Generally the lowest point in the cycle (the nadir) is the number that dosing changes are based upon. You've had several days that look like they have been pretty flat in the 300s. Then this morning's 220. It seems to me that Baby may have gone lower than the 220 and is bouncing from the unaccustomed lower numbers. This is very common. My suggestion would be to hold the dose at 5.5 units and see where it takes Baby. But be aware that it can take up to 72 hours to clear a bounce.

Is there a reason why you are increasing your dose by 1/2 units? Normally we do increases and decreases in 1/4 units. The reason for this is that if you increase by too much, you could bypass what was a good dose. Sometimes too much insulin gives results that "look" like you are not giving enough insulin.

With regard to your vet. Many people here have found that it is often the best course tacitly to "agree" with what the vet says, but follow the principles that you have learned on this board. Vets have to learn about all types of health issues. They typically spend no more than a day or so on feline diabetes in vet school. We love our vets and we need them, but when it comes to diabetes, you will find terrific collective knowledge here, where we deal with feline diabetes 24 hours a day, every day. There is no reason why you have to share your spreadsheet with your vet all the time. Just give her a "report" once in a while.

Good luck.

 

My vet didn't have experience with Lantus, but rather with Vetsulin (called Caninsulin elsewhere). For those fast acting type of insulins, feeding most of the food up front is recommended. For vets who don't have experience with the longer lasting depot style insulins, the two meals feeding seems to be a common suggestion. But I never talked to my vet about how often I fed my cat. And as long as you are feeding most of the food before nadir, it's not going to make much difference in Baby's numbers.

Some cats need more insulin than others. Mine was one of them. When we get to a total dose of 5 units or above, we do increases by 0.5 units at a time. It does look like Baby could use more insulin. I wouldn't stress about the "highest number" so far. Meters can vary by 20%, so that PMPS tonight could well be close to other numbers you've seen. It could also be that Baby is seeing some lower numbers than she's used to, in those cycles when you can't get any mid cycle tests. That can cause bouncing. Cats will bounce when they see numbers they aren't used to, it could even be low yellows that are setting off bounces. Over time, as Baby sees better numbers, she won't bounce as high.

One suggestion is to read our two dosing methods TR (Tight Regulation) or SLGS (Start Low Go Slow) and decide which one best fits your life style. After that, put TR or SLGS in your signature so we know which one you are following and can help you appropriately. Following a dosing method methodically will eventually get Baby to a dose where she'll see better numbers. There IS a dose out there that will do that. Over the years, I've seen it work for cats with all different dose requirements.

 

I'd be curious. How many times does your vet eat in a 12 hour period? Most humans eat 3 meals plus snacks over the course of approximately 12 hours. Keep in mind that a cat's metabolism is faster than a human's. And further, what you're vet is saying about only having food spikes twice a day makes some sense if you're dumping a lot of food in the bowl x2/day. If you talk to a nutritionist, small meals spread out over the course of the day keeps the metabolism ramped up -- in other words, it will help to prevent the big swings in BG levels. Chances are your vet had about 10 minutes on diet and nutrition over the course of vet school. It's not a topic that is typically spent much time discussing. In other words, do what works for your cat!

Depending on whether Baby is losing weight, your kitty may need more food. When BG levels aren't regulated, glucose isn't getting into the cells. That's why Baby is hungry.

Like Wendy, I also think it looks like Baby needs more insulin. If numbers aren't where you want them, then more insulin is indicated. When you increase depends on which dosing method you choose to use.

 

I don't know what kind of relationship you have with your vet - except paying the bill at the end you don't owe her any explanations for taking care of your Baby and doing what you know is best. If I'd listened to my vet I would have gone along with his recommendation to put her down! Really? Those were his exact words 'If it were my cat, I'd put her down' .... That was almost a year ago - and thank GOD for this group. I did NOT listen to my vet. I DID listen to this group - and still have my precious girl here with me to prove it. She's not in remission and she may never be, but she's healthy and happy and gives me the business every day...

I'm not saying your vet doesn't know what she's talking about - but unless your vet is an expert in feline diabetes or an endocrinologist - then you really should listen to the experts in this group and not to your vet - you don't have to tell her anything else...if she insists on seeing numbers, etc. show her your spreadsheets...usually that's enough proof to them to see that you've got a handle on this...and you're doing what's best for your cat.

 

Many have perfected what we call the "smile and nod". Smile, nod, and then do what's best for you and Baby. As improvements are seen, share Baby's spreadsheet and how well she's doing with your vet. It won't happen overnight, but it will happen.

Hang in there!

 

My second vet - I couldn't bring myself to go back to see the first one, except to get a prescription for insulin (which was the wrong one)...and info on which needles, etc. He was very skeptical and told me all about how some young couple had basically killed their at (yes, I thought to myself afterwards, due to your advice of giving 2 u, no testing...go about your business...they came home to find their cat dead)...well no wonder...bad advice...what can I say, I'm a little bitter??? If he's telling everyone that... oh well..enu of that!

The second vet asked me to send him an update of Luci's progress - told me I was doing a great job - asked me why I reduced her dose (after she went below 40! He didn't understand about modifying the dosage in response to dropping numbers)...I would just say 'she's doing fine'...she had a good day today...you know... a little vague. For REAL help and advice, I'd post to this group. It was apparent (IMHO) that my vet knew little about FD...and was not going to be a reliable expert for me to go to when she was doing crazy things with her numbers. Luci is a bouncy kitty...no one understands like this group... Thankfully, they're here to help and support!!! No billing at the end...

 

Oh don't get me wrong. A real sense of pride and accomplishment is felt if or when you're open to and able to build an equal partnership with your vet... a relationship based on mutual respect. A relationship where you're eager to learn together. I know it can be done from first hand experience and I must say it's a very rewarding experience for both parties. After all, there are no "experts" in everything about your cat or any cat... not here nor in your vets office. However, until one can get to that point... the old "smile and nod" routine works out pretty well.

 

Hi Sue, thank you. I really do like my vet so much, she's very sweet, but as I had mentioned in a different thread a while ago, she admitted she was "at the extent of her knowledge" on Baby's situation and referred me to a specialist. We all know how expensive that is. After I found this wonderful group, I decided to figure this out on my own, and this group is amazing! But she is quickly running out of insulin, and how do I get another prescription for new vials from my vet if she thinks I'm still doing it "her way" (not increasing the doses on my own)? Do you need a prescription for insulin from Canada (that "Mark's Marine" place)? Kind of a sticky situation...I can smile and nod at her, but I still need more insulin. haha

 

Hi, lol - I can certainly do the "smile and nod", but how does one go about getting prescriptions for the insulin if your vet doesn't think you should be anywhere NEAR empty haha?

 

You could always take a look at the supply closet forum.

Or you could fib and say you've left the insulin out and need to order more.

Or you could say that you'd like an Rx with a certain number of refills because you don't want to wait till the last minute since you'll be ordering it online.

 

Yes, I can see where that would be a tough one, but I'm not familiar with your story. It appears you've based dose adjustments on only one test per every week or two up until recently and you've increased by half units since then.

However, bottom line... one can't dispute the frequent testing you've been doing clearly shows the need for a dose increase/more insulin. Why not just come clean? Say this is what I've been doing in an attempt to bring her BG numbers down. Print out whichever protocol you want to follow and and let her know this is what you will be doing going forward. Explain both/either one of those dosing methods are tried and true and have offered great results for at least 14 years that I know of. Let her know that you'll keep her informed of Baby's progress. Have confidence in yourself and your abilities and your vet will too.

 

Honestly, I'd show her the spreadsheet. You can show her the Roomp & Rand published protocol as well (print it out and give it to her) as the TR protocol is fairly closely aligned. Unless she's published an article in a veterinary journal on diabetic management in cats, she should respect a published research-based protocol. If she can't deal with it, find another vet, but I doubt she'll fight you with a published protocol in hand.

That being said, I got my DX and prescription from a vet clinic. I went back once to get shooting advice, to double-check against the Internet. After that, I haven't been back. They're too busy to follow up, and I'm sure they won't care one wit when I ask for a refill.

Good luck finding your breakthrough dose. And... if/when you decide to move to 6U, keep very careful monitoring. When we hit our breakthrough dose (5.5U), we just shot it once, and then BG numbers started rapidly going down. We even had to skip a shot to get ahead of the rapid BG decrease and prevent a crash... ECID, but it's good to keep a very close eye on dosecreases.

 

Now why didn't I think of that? lol, thank you for the suggestions!

 

I agree with sharing the spreadsheet. I have one vet that I adore. We are true partners in caring for my pets. She was originally on the strict 12 hr feedings with only prescription food bandwagon. She swore dry was just fine.

Now she studies the spreadsheets with me and asks what dose and food he's getting. She was fine with switching from Vetsulin to Lantus even though that clinic doesn't stock or normally prescribe Lantus.

You and your vet bring value to the table. She will hopefully respect your value as you do hers.

 

Of course, you can always tell your vet you want to have a "back-up" prescription in case you drop the vial, the insulin goes bad, etc. I believe that once you have a prescription on file with Mark's, you can simply renew as you need to.

I woked with the 2 vets (I moved - one was in Chicago and one in Columbus, OH) while Gabby was alive. The first vet switched Gabby to Lantus but wasn't familiar with the TR Protocol. I gave her the Roomp & Rand research article and that was pretty much it. She let me handle dosing on my own and I learned via this board. OTOH, she passed along the article to the other vets in the practice and it's what they all started using. When I moved to Columbus, my new vet took one look at Gabby's SS and pretty much said, "Keep doing what you're doing." When I interviewed her, it was clear she knew about TR and was invested in being a partner in Gabby's care. She's been exactly the same with my civvie. I've been very lucky.

 

@Catacular Hi - I'm so sorry for being a PITA, but could you possibly provide me the link to the Roomp & Rand published protocol? I see so many articles and I want to be sure I've got the right one...from 2008 is it? (The one I'm finding in the attached photo says "unpublished data" - I'm thinking this is not the correct article) . Thanks!

 

The link is in the FDMB "sticky" on the TR Protocol: http://www.felinediabetes.com/FDMB/threads/tight-regulation-protocol-tr.1581/

It's at the very end of the "sticky": a link to the first PDF file

 

Thank you!

 

Sorry didn't see until now... Also linked in my signature.

 

I'm attaching the journal article. The article may be useful for your vet. The version that we use here is a bit easier to follow since it eliminates the scientific jargon.