Seeing a new vet today - Update

Since my old vet wants to treat Mal's diabetes with Glipizide pills, I decided to look for a new vet for her. While I have always thought of my old vet as being good for the animals, he is very condescending and on Mal's recent visit to him last week, he wouldn't discuss anything with me. When I brought up several things that I have learned in my research of FD, he pretty much just blew me off.

Last week I spoke with a nurse at the new vet I am going to see today. I asked him about how they treat diabetic cats and what insulin they use. Currently they use NPH and PZI to treat cats. They were also using Vetsulin, but because of the recent problems they stopped using it. I mentioned Lantus to him and while he was not familiar with it, he did say he would do some research on it.

The nurse told me the new vet also uses prescription food but since I feed four cats at the same time, I won't go that route. Besides, from what I've learned here, prescription food isn't necessary and isn't even good for the cats. My cats eat Fancy Feast and only the low carb varieties from Janet & Binkys list. As of 12/31/09 they have been on canned food only.

Mal had a fructosamine test on 1/7/10 with my old vet. He said her numbers averaged at 560, but at the time of the test, she had only been on canned food for one week. Based on that test he told me to continue with the Glipizide. He didn't even know that I had never picked up the pills and that I had not started her on the Glipizide.

I home test Mal randomly and I know that once she's put on insulin, I'll have to test a lot more. Yesterday I tested her before she ate dinner and she was at 261. I'm going to test her today before we go to see the new vet.

Hopefully the new vet is willing to work with me and won't treat me like an imbecile like my old vet did.

Sorry if this post is long and rambling, but it's good to get my thoughts out there in front of those of you who have more experience with treating FD. If any of you have any suggestions before my vet appointment today, please let me know. Her appointment is at 3:40 PM EST.

Thanks!

 

Re: Seeing a new vet today

This sounds like a good plan, Chris. Be sure to bring any records from the old vet. Like the fruitosamine test. It would be nice if they didn't want to repeat it ($$). There really is no need since you are hometesting. (It would just tell them the bg levels average over the last few weeks.)

One warning. The NPH insulins are cheaper but for most cats, more difficult to regulate on. Hope they will agree to the Lantus or PZI.

You might want to take your meter to the vet and take a bg level at the same time. Usually the meters are within an acceptable range of difference.

I love my vet but we never agreed on diet. And it was hard to argue with success, when Oliver went off insulin. So we just don't discuss that. If it came up, you could just say your kitty won't eat the RX food. (Lots of cats tire of it.)

Good luck! Keep us posted.

 

Re: Seeing a new vet today

Hi and sorry that your old vet treated you that way.

When going in to the new vet. Be polite but firm about what you need and how you would like to treat your cat. Ask the vet if he/she is willing to work with you and partner with you on this process.

If you want lantus, tell vet that this is the insulin you want to start with and ask for the script. Also, you may need a script for the syringes so ask for those too.

Tell vet you need U100 syringes, with 1/2 unit markings, short needle.

A good vet will listen to you, answer your questions, show you how to inject and test and such and even let you practice injecting - typically using saline solution.

Oh I also found, telling new vet that I had difficulties with former vet and giving brief outline, helps solidify relationship with new vet, because I stated here were the problems, here is what happened and this is what I need from a vet.

Good luck and post here to let us know how it goes.

Oh and you may want to print the "starred" information from the Lantus ISG and give to vet for vet to read and understand.

 

Re: Seeing a new vet today

Thanks for the input!!!

When I made the appointment for the new vet, they said they would contact my old vet and get Mal's records faxed to them. They didn't expect any problems so I'm sure they got the records.

I do plan to take my meter with me. When I took Mal to my old vet on 1/7/10, I expected her to be put on insulin and I had my meter in my purse to compare with the vet's meter. But, he didn't test her so I wasn't able to do a comparison.

I have some printed information about Lantus that I had taken to my old vet (which I never even showed him) and I plan to bring it with me today to the new vet.

 

Re: Seeing a new vet today

Hi there... glad you are starting fresh. Like others have said... the NPH is not really a good starting insulin. It's fast acting and short lasting. Talk to your vet about Lantus or Levemir... Take the information and tell him you are comfortable with what you know so far (if you are - always be honest) and that you'd like him to support you and he can look at it as a learning experience and that you'll keep him updated with her records through the week by email if he likes.

Also, don't count on the other vet forwarding the records. My current vet asked for the records and never got them until I phone from the new vet office to make a stick and I told them that they would be charged for the extended visit if they didn't arrive in 2 minutes via fax. They arrived... money talks.

Also, remember... no more than 1 unit to start with... With the BG you got today that should have an impact. It's just any vet who still uses NPH may be a bit behind the times with dosing too. Just know that you have a lot of good information behind you and a lot of support. We love an opportunity to work with new vets and share the latest and greatest of the treatment of FD.... so spread the word and good luck.

 

I took Mal to the new vet today and it was a great success! The practice is a husband and wife team and the vet I saw today helps out one day a week and Tuesday is his regular day. I'm so glad I went on a Tuesday!

The vet and the tech we both very, very nice. I told the vet that the reason I left my old vet was because I didn't agree with him about his treatment plan for Mal. I explained that my old vet wanted to put her on Glipizide and that I had learned it could cause problems. He said yes, that's true, in the long run in can cause problems. He then told me he likes to treat newly diagnosed cats with Lantus. He feels they have a better chance of remission using the Lantus insulin. I had gone into the office with print outs of information about Lantus thinking I might have to ask them to consider it, but it turns out this vet was well versed on it.

He mentioned the prescription diet for Mal but when I told him about having all four cats on Fancy Feast, he didn't pursue the prescription diet. He even told me there was a site on the internet that gives information about low carb cats foods. I then showed him Janet & Binkys list.

He was very enthused about having me home test. As I have often read here, he said the cats' numbers are always up when they go to the vet and he believes the best numbers are found at home. Yeah!

The vet put Mal on 1 unit of Lantus once a day. I asked about .5 unit twice a day, but he wants me to do the 1 unit once a day for only one week and then give him my numbers from home testing. Then he'll adjust her to twice a day. Since she's only going to get one shot a day for now, I'll do it earlier in the day so I can monitor her and do some BG tests throughout the day.

Mal also has ear problems which I had asked my old vet to look at during the last few appointments with him. He looked in her ears and said there was a problem but never did anything about it. The new vet gave me Mometamax drops to put in her ears once a day. He said because the drops have steroids in them, I might see slightly elevated numbers when I do the home tests.

I'm very happy thus far with my new vet. He's younger than my old vet and not only was he extremely nice to me, but he was very good with Mal. And the tech stayed in the room the entire time to help with the exam and she constantly stroked Mal and talked softly to her.

When the tech was getting my bill ready she said that she and the doctor were very pleased with what I knew about FD and were very comfortable about me home testing and not being nervous about treating Mal.

I picked up the Lantus, syringes and sharps container at Walmart. I have to say though, those needles are skinny!

Thanks to everyone here for all the information you provide to us newbies and for being willing to help us every step of the way. If I hadn't found Dr. Lisa's site and then this forum, I would know as much as I do today. I still have lots to learn, but it's nice to know I have a great place to come and great people to talk with!!!!

Chris

 

I'm so glad you had such a great first visit with your new vet! What a difference from your old vet, huh? It sounds like Mal is in great hands between your knowledge and the vet's willingness to listen to and work with you. Hope the goodness continues!

 

Sounds terrific! I'm glad you found somebody who has a clue about FD and is willing to work with you. As you know Lantus does work better when dosed 2x a day at 12 hour intervals. I'm not sure why the vet wants to start at 1x per day especially since he obviously intends to do 2x after a week :?: There have been some studies with attempting SID dosing the results showed clearly that BID was better.

Since I know others will tell thiis as well, I would suggest to avoid disagreements with the new vet that you do this: give your Lantus as prescribed and do your hometesting. I would always measure before each shot and then every 3 hours or so until you see Mel is back to the about the same as he had Preshot. This will give you the information that the Lantus does not last the full 24 hours (probably between 10-16 hours) after a few days (maybe before the weekend) give the vet a call or ask if you can e-mail him your hometesting results for him to review and go ahead and begin giving the Lantus BID (either at the 1U or spliteach .5U BID) depending on how he responds.

Wish you lots of luck and hope to see you posting in the Lantus group here!

 

Chris, it sure sounds like your efforts to find a new vet produced a winner. Good for you, and great for Mal!! You're on a great path now.

 

Please read the links below thoroughly. The insulin depot in Lantus is an important part of the way it works and you will be delaying regulation by not giving two shots a day. The Lantus does not last 24 hours and therefore will wear off before the next shot. The success with regulation and remission with Lantus is due to the overlap when giving 2 shots a day. Really, there is no point in holding off from splitting the dose into two shots a day. Please read these links and forward them to your vet for consideration. When forwarding them, don't just copy and paste the information, send the link addresses so that the vet can read the links contained in the posts. I'm not sure if one has to be a member to read those links... if so, you can quote the posts and past that into an email to your vet. Really... it's very important that you understand how and why Lantus works so well. Your vet is on the right track, but is just step behind with his dosing instructions.



LANTUS & LEVEMIR: TIGHT REGULATION PROTOCOL

LANTUS & LEVEMIR: INSULIN DEPOT - AKA - STORAGE SHED

 

The new vet is aware of how Lantus works because when he explained it to me, he explained it exactly how everyone here explains it. He also talked about the numbers and curves with me. I cannot say for sure why he only wanted her dosed once a day for the first week, however, I do know that he plans to change it to two doses a day once he looks at her numbers on Monday. I know this is not in line with how Lantus works, but I know the vet is aware of this as well.

Honestly, I don't want to get into a disagreement with this new vet. After calling around to several vets in the area, he is the only one who knows about Lantus and uses it. On Monday I have to give him all my home testing numbers and he will then change her dosage. I know for certain that he plans to change the does to BID so for these first few days, I'm going to do as he asked and give him the information he requested.

 

You don't have to get into an argument with him, but you also do not have to follow instructions that are contrary to what you know is the right protocol.

It makes no sense to start on 1 unit once a day with the intent to increase it to twice a day. It's better to start with .5u twice a day and then increase to 1 unit twice a day if needed. Seriously... you don't need his permission to do what is right. Mal is your cat and your responsibility.

And really, you are not hurting Mal by following the vet's instructions... you are just delaying the full treatment. Mal will be without insulin for several hours in the day when she doesn't need to be. It seems counter-productive to leave a cat without insulin for several hours in the day when treating with an insulin that can cover all hours in the day if given twice a day.

Just consider it... Talk to the folks in Lantus ISG if you like.

 

After today I've decided to go .5 BID.