? Contradictory advice from our vet.

Our vet, who is lovely and is generally very encouraging with this process gave me some advice today that I found to be somewhat odd... I sent her my SS so we could see how Ninj is doing and discuss next plan of action. She felt that Ninja was doing better on 1.25 units than 1.50 and wants us to go back to that. She also wants me to feed significantly less food to promote weight loss, so she’s concerned that at 200 calories (4.5 portions of the Sheeba perfection portions pates, he’s currently getting about 7-8 portions) his BG will come down significantly with just less food. All of this in addition to him sitting firmly in the 300s for two days now. I’m really confused... I’d love to hear your thoughts - about vet’s advice and about his recent steady purples.

 

It's my experience that vets like our kitties to stay at higher numbers (it's "safer" that way). I've heard a lot of stories about vets moaning and worrying about numbers under 100, even though the person they were worrying to was home testing. I feel like they think as long as the kitty is under 300 or so, the vet is happy. While I can understand wanting a diabetic to lose weight (ours said the same thing, despite the fact that Lou is generally a big cat), starving an unregulated diabetic is not going to magically cure them. Will they have lower numbers? Sure, they likely will in the short term, but it's not a long-term solution. I know there is a way to try to help a kitty lose weight while regulating them, but I don't know the details. I fed my buddy Lou as much as he seemed to need (within reason), for almost the first year (and I still wondered if I was feeding him enough). It's only been since switching to Basaglar in the last couple-few months that I've been thinking more about the amount of calories he gets. He still likely doesn't eat enough (he's a grazer), but he's not starving, so we go with it.

I personally think Ninja needs the 1.5u right now. The 1.25u was getting him into blues, which is great, but there's room to maneuver, especially considering you want him out of those pinks, reds, and blacks. I would keep him at 1.5u and hope that breaks through these high numbers to bring his BGs down.

 

I really liked my vet too. But I was the first client to home test, first with a spreadsheet for her to look at, first regular user of Lantus or any depot insulin, and as it turns out, first cat with acromegaly and insulin auto antibodies. I listened to her for a couple weeks, then started listening here. My vet wasn't always available when I needed dose advice, and wasn't giving me explanations for what I was seeing. Having said that, she was willing to learn with me, and knew a lot about other conditions so I stayed with her, but I did the diabetes management.

OK, what are you seeing. You've just started on 1.5 units. We have a phenomenon we often see in the first couple of cycles after an increase that we call New Dose Wonkiness, as the depot builds to the new dose. In summary, you can see a couple cycles of higher numbers right after an increase. It might take until the 5-6th cycles before you start seeing what the 1.5 unit dose can do. Nadirs on 1.25 units were not below 150, the increase was warranted. Stay the course, see what happens.

As for food, how much does Ninja weigh? I used to weight Neko every couple of weeks and use that as my guide as to whether I was feeding her the right amount of food. For what it's worth, she was around 13.5-14.5 lbs (Maine Coon cross) and maintained her weight at around 200 calories per day. Her vet didn't want her below 13 lbs.

 

Agree with the Wendy. I had a lighter version of that from my vet. We have also had many vets tell people that they shouldn't test at home. My point? Vets are not always right. Your vet may be way too cautious. In this case to the kitteh's detriment.

Your kitteh is not even close to being regulated. You don't have to go for "under 100" to make Ninja healthy. But some 120-150 nadirs would be a lot healthier than the current values. Over 200 is taxing to the cat's whole body. In summary, those steady values over 200 are unhealthy.

 

Hi i am new here. i just have a question, that 1.25u are you giving that same does every 12 hours?

 

Hi and welcome........not sure if you are posting that question for "Viktoria" or yourself, but with Lantus the dose should be given every 12 hrs

 

I completely agree. His numbers were not coming down much on 1.25, however as of this evening, he seems to be higher than he’s been in a while. I would think he would have broken through the bounce/wonky increase dose behavior by now, right? I’m wondering if I should go ahead and lowered it - these reds and blacks are really worrying me. Not sure what the right answer is here.

 

As far as insulin goes: his numbers are steadily increasing, so now I’m really getting concerned as to what’s going on. It’s been 5 cycles and it’s looking worse than it did in the beginning. What are your thoughts, @Wendy&Neko?

Food: He currently weighs 16 lbs, the vet wants him at 13 lbs. He’s currently getting about 270 calories, but that’s also partially because he went from 17.6 lbs, to 15.5 in quick order and was starving all the time.

 

That’s a very good point. Now I’m seeing even higher numbers on 1.5 after 5 cycles. I really feel like I’m failing him. But as you said, and I completely agree, he wasn’t regulated at all on 1.25, so... not sure what else to do

 

Yep, I give the same dose every 12 hours.

 

You are not failing him. You are just getting started. You have done well with the spreadsheet, testing, and safe-dosing.

If you have spreadsheet comments, like Aug 10, I recommend putting them in the right column so the spreadsheet stays compact.

I would stay the course. Before you know it, Ninja will be swimming in a sea of blue.

 

Hold the dose. You are increasing in safe amounts, and at a safe pace. Regulation does not happen overnight and you haven't even been at this a month. The saying is that Lantus teaches you patience. I had a hard time with that too at the beginning.

Insulin is a hormone, not a drug. It's not like you add a little bit more and then you see numbers improve that little bit more. You keep increasing, following the dosing guidelines, then you will get to a dose where you start seeing the numbers you want.

Sounds like you might be feeding a good amount. You don't want them to lose weight too quickly.