BG still erratic - part 2

It's been ages since I posted an update about HRH, mainly because there wasn't much to update you on...

He's been stuck in high numbers for some time and for quite few weeks I didn't increase his dose as I was quite poorly with a bad sinusitis and couldn't do any extra testing so I didn't want to risk anything. But HRH enjoyed having me at home for 2 weeks, we enjoyed many snuggles on the sofa with a blanket, tea and Netflix (this crazy cat watches TV sometimes).

I've raised his dose to 3.75 for a couple of weeks now and we're seeing better numbers, only in the evening though - maybe it's the Somogyi effect (although I know some argue it's existence in cats entirely). Now I'm thinking to increase to 4 units, which is kind of scary (3.75 is the highest dose I've ever given him).

As always, I'm open to any ideas and suggestions if anyone has any for Perlutz

 

HRH enjoying Madagascar some years ago when he was a lot chubbier (to put it nicely)

 

Is it in mmol the bg numbers?

If so, IMHO, with that Blue on 3.75 units I would give the 3.75 some more time before increasing.

 

Crikey yes he did used to be chubbier didn't he!

My Saff likes tv but she's very selective - only cartoons and wildlife programmes, everything else leaves her cold

I'm not a dosing person as you know but I would say that diabetic cats just need as much insulin as they need, whether it's a tiny fraction of a unit or ten units or more. But I know it's a very hard call when you do see the occasional blue...

See what others have to say on the ISG, maybe?

 

Haha, yes, he was a chubster (wish I did my homework on nutrition earlier )

Perlutz also only likes some animations and wildlife programs - he's a big David Attenborough fan

I don't know why I find the insulin units scary, I know he's been in more than safe numbers and even the blues were in the higher range. I'll see what he has in store for me tonight

 

Yes, they are in mmol. There's a second tab on the spreadsheet in the US mg/dl

 

HEY Georgiana, Toby likes tennis hahah..love HRH watching his cartoon.

Just going to put it out there, we know HRH likes his trampoline, Toby was the same, are you ready to consider a change of insulin to Lantus or Levemir? Toby is SO much better since switching. No pressure and I'm not an expert, just thought it might be worth some thinking about xxx

 

Hey Kate, I was literally just looking at Toby's SS!

I've had the insulin change chat 3 times, 1st a more generic chat and the other 2 more of a demand, with 2 different vets (same practice) but both refused We will be going back soon, for routine check up and blood tests and I will try my luck again!

 

Maybe after all this time the vet will be more open to discussing a different insulin - it's worth being as pushy as you dare, I think. Insulins are different and work in different ways, so even if two insulins haven't got you where you want to be, a third just might.

 

Let me know if you need some help, I did quite a bit of research and went armed with lots of data and a list of reasons why I wanted to switch, and then I had to convince them to prescribe Levermir not Lantus. In the end it was the specialist vet that trusted me and wrote the prescription. When my regular vet saw what the insulin was they said "never heard of it, and never known a cat go on human insulin", I rest my case. The Romp and Rand paper was really helpful and my vet liked it. And the Royal Veterinary College are also now in favour of Lev/lantus (albeit not as a first choice) and so this is a huge step forward.
Toby like Perlutz was a serial bouncer, and whilst we are still tweaking dose, he is generally staying in better numbers (apart from last week when he had a bout of pancreatitis), he us even putting on weight

 

Yep agree Diana, Levermir is our third insulin and Toby was only diagnosed in July 2019!

 

Hi Georgina, Nice to see you and Perlutz again.

I think you held the 3.5u and 3.75u doses too long and Perlutz is kind of stuck and has some glucose toxicity. The only way past that is to raise the dose until you get a breakthrough and start seeing better numbers. Dose can be increased by 0.25u every 3 or 4 days as long as pre-shots are shootable. You can shoot full dose for any reading over 5 or 6 mmol as long as you can monitor. Perlutz needs to spend more time in good numbers to get used to them and that is the only way the bouncing is going to lessen.

It may be that Perlutz would do better on another longer lasting insulin like Lantus or Levemir but in the meantime, I'd raise the dose to 4.0u and only hold that dose for 3 days and re-evaluate at that time.

 

One other thing I omitted above .....if BG drops below 5 (90) mid cycle, then I'd reduce the dose again by 0.25u.

 

Hi Linda, I'm glad you haven't forgotten us after all this time!

I was going to increase to 4.0u yesterday evening but I ended up sticking to 3.75u as he vomited a little bit yesterday sometimes in the afternoon and then again just after dinner and one more time during the night As he was in high numbers and he did keep some food in, I'm sure he would've been fine even with 4.0u, but the first thoughts were to be cautious and that was that... I've just seen him at lunch time and he was still in 20's so he will most likely get 4.0u tonight, unless he decides to pull one of his tricks and give me a very low PMPS.

 

Hi Kate,

I too went there with my homework done, print outs to support my request for Lantus/Levemir...but the 1st vet, the usual one we see, said he wouldn't have time to read the files during the appointment and when I suggested leaving them with him in case he would have a minute sometimes, he said he will look into it but find the resources himself and kinda threw me the papers back When I brought it up again, he said he doesn't believe Perlutz would benefit from Lantus or Levemir. I booked another routine check up with a different vet in the same practice as she's been recommended as more open minded. How wrong that was! She dismissed everything in 10 seconds "no, human insulins don't give better results" "no, human insulins are not safe for cats" "no,there are no reliable studies" "no,the RVC only did a study on few cats" She couldn't have sounded more incompetent, ignorant and stupid if she tried!

We also saw a specialist back in June but despite diabetes being our main concern, she wasn't willing to try and tackle it until ruling out every single thing you could think of and that involved various tests and surgeries/procedures that we (myself, bf, regular vet, locum vet, our old vet before we moved to UK, some people on the forum, friends etc) thought wouldn't be necessary and might do more harm than good. On top of how stressful and invasive these would have been for Perlutz, we spent around 3K for few tests which left us with more questions than answers and if we would've done just 2 more of the procedures she wanted to do immediately, it would've cost another 5-6K (and we're not insured so we pay every single thing ourselves). At one point she told me I'm not giving Perlutz the good care he deserves, partly because I wasn't rushing to do those procedures and partly because she didn't agree with what and how I am feeding Perlutz (she was pushing dry prescription foods and I said he will never eat those again, and she didn't agree with him being fed more than twice a day). So that's how we stopped seeing the specialist... @Diana&Tom in particular might remember my frustrations with the specialist...

So it's either something I'm doing to these people, or we've just had a bit of bad luck in finding a decent vet

 

I certainly do remember your frustrations with vets, Georgiana... it drives me crazy how uncaring and/or ignorant and/or incompetent some of them are. I don't consider vet-bashing as a hobby - there are good and bad vets just as there are good and bad everything else - but it does seem that an awful lot of them don't get the education or experience they need to treat a relatively common condition such as FD. I was either told, or read here, that vets get an average of half a day's training in FD which doesn't seem anything like enough if you consider all the related issues that can and do play an important part in treatment. Sigh...

I know you've searched for a good vet in your area without luck, but there must be one not far away that's better than what you've got now. Maybe you can join some local online groups for the sole purpose of asking for recommendations? There's a Facebook page called "What's on in ..... " (town) for example - I find my local page a brilliant source of information about and recommendations for all kinds of things. Failing that - move near Kate, her vet always sounds wonderful. Or actually, maybe @Kate & Toby could ask her vet if they know anyone good in your area? Anything's worth a try... I'm so sorry you haven't had the support you need and deserve up to now. You have done and are still doing phenomenally well, but having a decent vet when you need one would give you a lot more peace of mind, I'm sure...

 

I know the RVC did a study (saw video presentation not the actual research papers) and came to the conclusion that remission rates were about the same for a cat on ProZinc as a cat on Lantus but there didn't seem to be any bias one way or the other short of the fact that UK rules are such that a veterinary insulin has to be tried before a human insulin will be considered. The vets are of course free to come to their own "conclusions" from those studies and it seems the vets you've tried have either misinterpreted that Lantus is not necessary or the paper itself may have suggested that conclusion or left it open to interpretation.

Did you by any chance show them the AAHA or ISFM guidelines for the treatment of feline diabetes or Roomp and Rands papers from the U of Queensland. It sounds like the vets you've run across are pretty closed minded but perhaps one of them might be willing to at least consider research from sources other than the RVC.

My personal opinion is that a vet should work with you as a partner rather than a dictator and it sounds like the vets you have had the misfortune to deal with are not willing to do that. I'd keep vet shopping if I were you, if there are other options out there you can access.

 

I didn't actually have a chance to show anything, they weren't willing to look at the papers I've had printed, none of them The AAHA guidelines were among my print outs, along with some guidelines and studies from RVC (I thought RVC would be my best shot to convince them since it's not only renowned but also from UK).

The usual vet we see is not always so close minded, I don't really understand why he is so adamant about changing insulin. Just an example, he considered the acromegaly test useless for example, and so did the specialist but I really wanted it so he did the test without much persuading if any...

 

The vet may have tried to dissuade you from doing the acro test because it's normally not a consideration until kitty's dose gets over 6u twice daily however there are acro cats who do not need larger doses of insulin but I take it they probably aren't diagnosed with acro until other health issues crop up. My girl had IAA and my vet told me it was so rare there was no point in doing the test. I told her to humour me and she was gobsmacked when my "gut feeling" was right. She admitted to never dealing with IAA and had no clue what to do. I went to her with suggestions and she was open to trying pretty much whatever I wanted. I wish everyone were lucky enough to have a vet like mine.

 

Oh wow Georgiana, it sure has been a bad run of luck for you with vets.
I do sympathise.

I think Diana has some great ideas, try local groups on Facebook and ask for recommendations, I will absolutely ask my specialst vet if she has any people, what county are you in? We are Hampshire, near Winchester/Southampton, is that too far?
There has to be a way for HRH to get the insulin he needs, and you to find a vet who is up to date and open to new ideas. I'm going to have a think, I have three friends from school who are vets now, perhaps I can ask them what they think.
How has the new dose gone? I think you were increasing tonight, are you testing tonight? Xxx

 

Georgiana - I take it your kitty's acro test results were negative?

I often wonder why acro isn't mentioned here more often, when up to 1/3 of diabetic cats may have the condition. When Rocket's dose hit 4U with no regulation I knew something else was going on, as diabetes didn't make a whole lot of sense. So I had our second vet do the test, and sadly it was positive. Both our vets said that no, he couldn't have acro, he has no physical signs, etc. But one agreed to have it done "just to rule it out." Sigh.

 

I've given him 4.0u! I've just tested him now at +3.5 and it didn't drop much so I've set his feeder overnight as per usual and I'll be going to bed soon, won't annoy him with more testing.

Unfortunately you're too far away Kate I'm in Berkshire. I've joined some Facebook groups (thanks to Diana's suggestion) and asked for vets recommendations but unfortunately there wasn't anyone close to me. Closest good vet that I've heard of/been recommended is the vet Diana is taking Saff for her dental, minimum 40 min away

I do have to book an appointment for a check up and blood tests (no specific concerns, just want to see what's what) so I will refresh my Lantus speech and try again!

 

Hi Karen,

Yes, his results came back negative

 

Great to hear
I agree too that an insulin change may help. I've heard Lantus can sting at higher doses, so Levemir may work better for you.

 

Another suggestion Georgiana - you could look at Mumsnet as a possible source of info for vets... I know it's supposed to be for parents discussing family issues, but actually you are a parent and our pets are family.
The site used to be very popular, it may have lost a bit of momentum or been superseded by other sites, I don't know, but definitely worth a look I'd say. I've "consulted" it in the past about one or two domestic issues and there are always plenty of people ready to chime in!

 

Oh the infamous Mumsnet! I must admit I never thought I'd ever sign up to it but why not, I'll give anything a try!