language barriers and international members (was: overdosed kitty looking for new dose)

[Steph & Quintus & L & O]

Hi everyone, this is not about Quintus (who is still saying "no thank you" to the juice) abut about a francophone cat who unfortunately doesn't speak any English. I am wondering what experience we have here of how to deal with a cat that seems to have been chronically overdosed.

The cat was put on Lantus 2ui, then upped to 4ui by the vet, then 6, then 8ui. Because the curves done at the vet were too high. Shooting blind. When it was suggested 8ui was still too high, the CG balked, because clinical signs had definitely improved since beginning December (start of 8ui): cat drinking less, gaining back a large chunk of the weight it had lost. So CG decided to get into hometesting and seek exterior advice.

Here's the spreadsheet: https://docs.google.com/spreadsheets/d/1mTmzFEsN8zPhND-_OLowtN-hBGZsFBvg1dgY541aUuw/edit?usp=sharing

You'll see the data is very spotty compared to what we are used to, but we're working on that. The general agreement on the francophone forum was that this cat was overdosed and CG should "start over" with a much lower dose, by skipping a dose (spotty understanding of how Lantus works, too).

I came in on 14.01, when after a curve in the reds on the second 2ui cycle, CG wanted to up the dose. IMHO we weren't absolutely certain the cat was really overdosed on 8ui, given the lack of data (could in theory be high-dose?), and she chose to go with 6ui, a dose she was comfortable with. After two 6ui cycles the numbers dropped into the yellows and I suggested this was telling us (already) that 6ui was two high. She dropped the dose to 4ui.

Then the mess starts, because anxious CG, itchy syringe, and misunderstanding that you don't dose Lantus on a sliding scale like caninsulin. Hence the dose hopping the next days. She got back on the 4ui train and we're now approaching cycle 6 on it. But the cat is clearly showing clinical signs (drinking more, super hungry, lost 100g) that it is not happy in those high numbers, and it is freaking out CG.

The cat is eating HC kibble (RC diabetic) and CG has understood she needs to change and is currently looking at LC food to order (but it will remain dry).

Questions:

• I know the SS is a mess, but what do you make of the situation?
• what's the best strategy to "adjust" the dose of a cat that seems to have been overdosed?
• does it look like this cat was overdosed on 8ui, based on what little data we have?
• if the next 4ui cycle is still a high flat purple, does that warrant upping the dose (and by how much?), or sticking it through for a few more cycles given the dose-hopping?

Thanks for sharing your wisdom!

 

[Wendy&Neko]

Not necessarily over dosed to me. Not enough data even at 8 units to say that dose was too high. Plan should be to stick with the same dose at least 6 cycles to evaluate and gather good test data. With dry food in the picture, you can't be as aggressive so may have to hold longer. If the person could follow TR, which they can't due to dry food, they would do a 0,5 units increase, under SLGS, a 0.25 unit increase. I would also get on changing to LC as soon as possible. As you know, that can make a huge difference.

 

[Steph & Quintus & L & O]

Thanks @Wendy&Neko! She's definitely going to switch to LC as soon as possible. Thanks for the info on holding longer because of dry food, that's useful to know. Agreed that we don't have enough data to be sure 8ui is overdosed, it would have been good (if we could go back) to test a few cycles on 8ui before deciding what to do.

The thing that does keep nagging at me is the blue/yellow cycle on the 15th, with a partly emptied depot and lower than 8ui...

Now, if she is going to start transitioning to LC within the next days (as soon as her order arrives), should she stick with the 4ui or go for an SLGS increase? That's what I'm wondering about now.

 

[Steph & Quintus & L & O]

Bump -- anybody else have ideas? Kitty seems to have had another reasonably flat pink cycle. As per SLGS I take it we'd have to hold for a week, but given the (however minimal) prior data I'm wondering if an earlier increase couldn't be justified here. Or if on the contrary it would risk ruining the stabilisation.

 

[Sienne and Gabby (GA)]

My biggest concern is that with transitioning the cat to LC, the caregiver is going to need to monitor carefully. The 4 or more units may be offsetting the HC food. You might coach her to transition gradually so that numbers don't drop abruptly. Until the cat is on a LC diet, there's no way to know what an effective dose will be.

 

[Steph & Quintus & L & O]

My biggest concern is that with transitioning the cat to LC, the caregiver is going to need to monitor carefully. The 4 or more units may be offsetting the HC food. You might coach her to transition gradually so that numbers don't drop abruptly. Until the cat is on a LC diet, there's no way to know what an effective dose will be.

Yeah I've been telling her (and I think she understood!) repeatedly that she needs to do a gradual transition because BG will drop. There are other people in our little francophone peer group who have experienced it so I think she is aware of the danger. I think this morning the cat was clinically less "less well". My gut would be to hold the 4ui just a bit more even though the numbers are high so she can start the food transition, rather than upping the dose now and starting the food transition 24h later.

At least the curve is flattish, that's already a good improvement and the CG is really happy about that.

Thanks!

 

[Stacy & Asia]

Bump -- anybody else have ideas? Kitty seems to have had another reasonably flat pink cycle. As per SLGS I take it we'd have to hold for a week, but given the (however minimal) prior data I'm wondering if an earlier increase couldn't be justified here. Or if on the contrary it would risk ruining the stabilisation.

Do they have a particular method or protocol they follow on the French board? I think it may be difficult to get much done without a baseline. There are so many different ways to handle diabetes, some (a lot) better than others, but shooting from the hip certainly isn’t one of them. Also, as I’m sure you’ve read on here and are aware, mixing and matching overrides the safety measures that are built in.

If there aren’t any particular methods that people follow, I wonder if you might suggest/implement them? I found it hard to understand, at first, why we had to pick something, why can’t you just treat your cat as directed by your vet with some modifications (like testing at home) and get help and advice from people here. As it turns out, that’s a bit like asking “help me find my keys, they are lost somewhere in the state of New York” While there are some things that are pretty universally dealt with, like low numbers, everything else isn’t really and most of the wisdom and help we get here comes from having vast experience applying TR or SLGS to treating diabetes.

Good luck to your friends cat and I hope something can be figured out to sort the kitty out.

 

[Stacy & Asia]

I think this morning the cat was clinically less "less well"

Also keep in mind many cats feel like crap when they get to better numbers because they are not used to it. Additionally, it can’t feel good to shift doses around, skip shots and have numbers all over the place. It looks like a mess on a SS, I visualize that as them being a mess on the inside. No hard science to back that up, but my gut says that just can’t possibly feel nice.

 

[Steph & Quintus & L & O]

Do they have a particular method or protocol they follow on the French board?

Shoot from the hip and sliding scale dosing of Lantus depending on PS values...

If there aren’t any particular methods that people follow, I wonder if you might suggest/implement them?

Yep, I did, and got banned from the group for talking about TR and SLGS, getting people on spreadsheets, sharing translations to our forum stickies (too "advanced")...

So I'm now working with a small group of people who are actively invested in learning how to use Lantus "correctly" (SLGS mainly). The challenge is most of them are (well, like so many of us, including me) trying to get on the train with an existing dose that is probably too high, or not.

Which makes me think that maybe we are missing a method or protocol for transitioning from "shoot from the hip" to SLGS/TR.

I found it hard to understand, at first, why we had to pick something, why can’t you just treat your cat as directed by your vet with some modifications (like testing at home) and get help and advice from people here.

Agreed, me too. And (continuing from above) feeling I didn't have a clear roadmap for getting to TR or SLGS from the mess I was in and the values I was initially shooting, I think, didn't help. There was too big a gap in between where I was at and where I was supposed to be, and I had trouble seeing how to bridge it (and once I started figuring that out, Quintus decided to go all "meh I think I'll start producing insulin" on me, and it was downhill from there).

Also keep in mind many cats feel like crap when they get to better numbers because they are not used to it.

Definitely. In this case the clinical signs were drinking much more and being very hungry, which he had stopped doing when on 8ui. This morning, however, he did not yell for food and seemed more like himself. Agreed it's tricky to see if it's a good or bad sign.

BTW: made her check for ketones. None.

It looks like a mess on a SS, I visualize that as them being a mess on the inside. No hard science to back that up, but my gut says that just can’t possibly feel nice.

Yeah. That's why I'm leaning towards sticking with that 4ui dose even though it's probably not right, if only for the stability, even if it's too high.

Thanks for your comments!

 

[Amy&TrixieCat]

I would encourage these folks to actually come and join FDMB, since they seem to be interested in being more proactive with FD treatment.

 

[Jill & Alex (GA)]

I would encourage these folks to actually come and join FDMB, since they seem to be interested in being more proactive with FD treatment.

I think this is awesome advice!
It's so much easier to help people one-on-one than to go through a third party. It's been my standard suggestion when a situation like this is brought to our attention. Somehow or another we manage to get through any language barriers...

 

[Jill & Alex (GA)]

I think this is awesome advice!
It's so much easier to help people one-on-one than to go through a third party. It's been my standard suggestion when a situation like this is brought to our attention. Somehow or another we manage to get through any language barriers...

I should have added...
since this is a peer reviewed board, all suggestions and advice should really be offered on the board itself. Otherwise it could easily fall into "off-board dosing advice"... which isn't keeping with the true spirit of the FDMB.

 

[Steph & Quintus & L & O]

I would encourage these folks to actually come and join FDMB, since they seem to be interested in being more proactive with FD treatment.

It's so much easier to help people one-on-one than to go through a third party. It's been my standard suggestion when a situation like this is brought to our attention. Somehow or another we manage to get through any language barriers...

That would definitely be ideal, but I think you're underestimating the language barrier. I've spent a lot of my nearly 20 years online bridging that language barrier for francophones, because I realised that for "normal" people who really don't speak English (and that is the people that you, as English-speakers, never get to interact with -- unless you're fluent in another language), it really IS impossible to participate across the language barrier. And they won't even consider going there.

There is Google translate, but that ads a technical barrier, and another linguistic one. For some people, trying to wrap their brains around FD when clearly explained in their mother tongue is already hard enough. Add to that the broken translations of Google translate, having to use the translation tool, dealing with the quirks of automatically translated language... That can work if you're highly literate, and reasonably comfortable with technology, but if your written expression in your mother tongue is already clumsy, it's just too many challenges added on top of one another.

It's easy to forget that in communities like this one, members are self-selecting, and not representative of "everybody out there".

 

[Jill & Alex (GA)]

It's easy to forget that in communities like this one, members are self-selecting, and not representative of "everybody out there".

I understand, but something you may not be aware of is we have members from many countries speaking various languages. While difficult, somehow or another we've managed to make it work.

 

[Amy&TrixieCat]

In addition to the information that Jill provided (that we have members here who are multilingual, as well as members from all over the world), you yourself could serve as their translator here on FDMB, since you know the language and since you're already doing so off the board. Having as many eyes, ears, and brains directly involved as possible is always the best and safest route, and since everyone here is very generous with their time, experience, and knowledge, members always go to great lengths to help anyone and everyone, no matter what type of barrier may exist.

 

[Steph & Quintus & L & O]

So, how would that work in practice? It seems indeed that "serving as translator" is already what I'm doing. I've talked with her, I've told her I would explain her situation here on the board, I've told her what was said here.

Seriously, I would love to get all the francophones I'm in touch with on the board. But my past experience (maybe because I've been working over these language issues forever and I'm discouraged) is that getting people to use a tool their not familiar with in a language they don't understand is already a major hurdle.

 

[Steph & Quintus & L & O]

I understand, but something you may not be aware of is we have members from many countries speaking various languages. While difficult, somehow or another we've managed to make it work.

Not to minimize this, but I do want to draw attention to the fact that the "international" board members are a self-selecting crowd. It reminds me of my American friends who are astonished when I tell them people here don't speak English, because they've visited Switzerland and "oh, but everybody in Switzerland spoke English when I was there!" -- yeah, everybody you interacted with, obviously...

As with deafness, when sounds we don't hear just cease to exist, those it didn't work out with probably also just disappear into the ether.

Again: more than willing to give this a go, but I have a lot of doubts that it's realistic.

 

[Amy&TrixieCat]

So, how would that work in practice? It seems indeed that "serving as translator" is already what I'm doing. I've talked with her, I've told her I would explain her situation here on the board, I've told her what was said here.

Seriously, I would love to get all the francophones I'm in touch with on the board. But my past experience (maybe because I've been working over these language issues forever and I'm discouraged) is that getting people to use a tool their not familiar with in a language they don't understand is already a major hurdle.

Well, just as one feasible idea, they could post using translation software, and if you see an gaps or holes in the information they post, you could add that info within the same thread; this way everyone has eyes on the same thing.

I know I personally am not comfortable offering advice that I'm not seeing publicly displayed here on the board; if I inadvertently give out incorrect information here on the board, I have the confidence that fellow FDMB members will catch and correct it. Posting publicly on the board is an important safety net.

 

[Steph & Quintus & L & O]

they could post using translation software, and if you see an gaps or holes in the information they post

Thing is, if they post the translated version, I don't have access to the original. When I read my own words sent through google translate sometimes I don't even know what I meant originally.

The best, it seems to me, would be for non-anglophones to post both their native original text AND the English automatic translation underneath. That could work.

Then they can Google translate (or use Chrome automatic translation) to understand the responses. Or we can work the same way and Google translate responses to French and stick them underneath the English -- and there again, I can step in if things are too wonky.

Remains the hurdle of signing up on the board and learning to use the software, and that is definitely handholding I can do. (I'm already doing it for the spreadsheets and access to translated documentation.)

Posting publicly on the board is an important safety net.

Oh, believe me, I understand that part very well. I would MUCH prefer the situation to be different. But what do you do -- shut up and leave them on their own, when you would actually have the information to help?

 

[Gill & George]

Stephanie,
on your short time on the board you may not have come across many.
But we do have French/Italian and Spanish members, who may not be posting at the moment. Additionally there are members who are from the US and have lived and worked all over Europe, we are a very mixed bunch.

I myself am bilingual Spanish and English, I also speak french (a little rusty, that mostly affects my spoken french) and I get by in Italian.

We have a Japanese member, who we have been helping, it can be a struggle at times, sure but with the help of some members who speak japanese and google translate we have been able to help and slowly the CG is understanding how it all works.

My experience with language, is that as long as there is a willingness from both parties, the language barrier can be overcome.

I can understand that it may be daunting for someone who is not a native English speaker, please try and reassure her that there are many here who will take the time to help and overcome the language barrier.

The best, it seems to me, would be for non-anglophones to post both their native original text AND the English automatic translation underneath. That could work.

I think that is a good idea.

 

[Steph & Quintus & L & O]

My experience with language, is that as long as there is a willingness from both parties, the language barrier can be overcome.

I do agree -- but upto a certain point. If communication requires jumping through too many hoops, you need a huge amount of willingness... of the available willingness expires.

I think that is a good idea.

Thanks. The more I think about it, the more I think this is the solution. Would also allow French (or whatever the non-English language is) speakers to reply in their language (nothing lost in translation for the non-English member) and either rewrite in English underneath or provide Google translation for people who don't speak the other language.

If we're open to doing things like that, then the only (!) hurdle left is getting them from facebook to the board ;-)

I have always loved multilingual spaces. I think FDMB is a hugely precious ressource and community. I would love to help make it available to French speakers.

 

[Steph & Quintus & L & O]

Woohoo, well, I just suggested this to Caramel's CG, and she's game!

 

[Gill & George]

you need a huge amount of willingness... of the available willingness expires.

Where it concerns our cats, there is usually a huge amount of willingness.

Fwiw I've found that Google translate works best when you keep the sentence structure simple. My DH uses it often, and he's found that it has improved over the years, it's translations getting more accurate the more people use it.

 

[Gill & George]

Woohoo, well, I just suggested this to Caramel's CG, and she's game!

Excellent, I look forward to meeting Caramel and her bean. It will have to wait till morning. Late here.

Just wanted to ask, is there any data for December? When caramel was on 8u?? I'm not seeing it, perhaps it's just me and my tired eyes

Would be good to see some data, however space on the 8,u.

 

[Steph & Quintus & L & O]

Just wanted to ask, is there any data for December? When caramel was on 8u?

No data, sadly. Maybe she can get the curve data from the vet. But that is all there would be.

 

[Steph & Quintus & L & O]

Fwiw I've found that Google translate works best when you keep the sentence structure simple. My DH uses it often, and he's found that it has improved over the years, it's translations getting more accurate the more people use it.

Yes, GT has made huge progress. But it still doesn't really do well with spelling mistakes and wonky grammar. I'm not sure people on this board realise what a highly literate bunch we are. You can go through condos and condos without spotting a spelling mistake (well, nearly, but see what I mean? not everybody is as comfortable with expressing oneself in writing as most participants in this board)

 

[Stacy & Asia]

Woohoo, well, I just suggested this to Caramel's CG, and she's game!

That's awesome, tell her we can't wait to meet her and that we understand how intimidating it is, but will try to make it as painless as possible so her kitty can get sorted!

 

[Marje and Gracie]

We would love to have them but if any of them speak German fluently, they might prefer the German Katzen board. Many of the native continental Europeans I know well speak a few different languages.

I spoke French and German fluently but am a little rusty as I have little occasion to speak it regularly, living back in the US.

 

[Steph & Quintus & L & O]

We would love to have them but if any of them speak German fluently, they might prefer the German Katzen board. Many of the native continental Europeans I know well speak a few different languages.

I spoke French and German fluently but am a little rusty as I have little occasion to speak it regularly, living back in the US.

These francophones are French, so they tend to speak... French. Even the Swiss francophones don't have much German to speak of (their English is better). I know a ton of French speakers who pretty much speak only French...

You might get some French practice soon! It was tricky but Caramel's CG is now on the board. It's 2am and we're wiped out so she'll post tomorrow. Look out for her! I might be in my car heading off to my holiday.

 

[Jill & Alex (GA)]

I've read through this thread and have to smile...
using a Translator and requesting posts are written in the OP's native language as well as English... sounds like business as usual to me. It's what we've been doing as far back as I can remember and my guess is before that.

Happy to hear Caramel's caregiver has joined us on the FDMB. This is a much better arrangement for a multitude of reasons. Thank you for making it happen. Hope to see her posting often!

 

[Steph & Quintus & L & O]

Glad it's business as usual. Maybe it would be an idea to have a sticky detailing how to get non-English speakers on board? Just an idea. (Or does it already exist and have I missed it?)

 

[Steph & Quintus & L & O]

Caramel is on board, with an « itchy syringe » incident this morning:

http://www.felinediabetes.com/FDMB/threads/1-21-caramel-ss-amps-15-178-1-161-1-1-2-163.189943/

I’m commuting so ignore anybody is around it would be great! Mel knows she needs to watch this cycle closely and that if he drops too much she has to prop him up, but she has never dealt with this.

 

[Steph & Quintus & L & O]

So, an update. So far four francophone members have joined FDMB. You might have seen them posting, here and in the main forum (three are on Lantus, one on caninsulin): @Mel & Caramel, @Kailee § Dallas, @Martine et Gomette, @Marie Dagobah&Nikita (yup she has two diabetics).

Thanks in advance for your support in welcoming them and dropping in on their condos. Google translate works surprisingly well but it still makes it a little cumbersome to communicate here, and they're struggling a bit with "forum culture" which is quite different from Facebook. If there are any "understanding" issues, do tag me immediately and I'll drop in to interpret if needed.

I'm looking forward to introducing more francophone members to the forum over the next weeks!