Would like to know who is using SLGS

As a newbie, I would really appreciate at least a few people replying to this request. I have just begun getting more test data from her.

She is on Lantus.

I have learned her nadir is around +3 and the vet assumed it was +8.5. Scarey. So glad I am here to better be aware of the need to test more often (he said 1x a day at 8.5).

Anyhow, I would like to have periodic contact when wanting to adjust doses from someone doing the same protocol and hopefully some will also be on Lantus but that really may not be critical?

My ss is in the process of being uploaded by another member shortly. Thank you.

 

Hi ColdPlay and welcome to Lantus/Lev Land!

Excellent that you are getting more testing data - it's definitely a positive that your vet encourages home testing. I get the feeling that vets who encourage home testing in the first place often ask for bare minimum so that they don't overwhelm the cat parents. So many people are unwilling to "do the work" and I have a feeling some vets are too often faced with people who opt for euthanizing the cat if they are told they have to follow an intensive (or what seems like an intensive) treatment regimen, they suggest the bare minimum to start.

Not to nitpick, but SLGS is a method, not a protocol. That said, it still has some "rules" and guidance which I assume you have read.

Your first step in getting great advice here is to upload your spreadsheet, I see you are getting that done. Would you also be able to update your signature? It is extremely helpful to have some information on your cat there - a little about your cat, that you are using Lantus and following SLGS, what meter you use, and your cat's basic diet (all wet, low carb?). This keeps you from having to repeat yourself any time you post, as it is critical info for anyone offering any guidance.

There are people here with years and years of experience - the veterans here will provide you with excellent advice and guidance, even though most follow the Tight Regulation Protocol. Never fear, I have read that many cats can be successfully treated using SLGS, some even going into remission and the folks here are very well versed in both.

If you post here with a ? on dose advice in the title - let me know if you need to know how to do that - someone will respond quickly.

Welcome!

 

Hi Coldplay. We're using SLGS and joined FDMB just under 1 month ago but have been on Lanus since July. Since joining we've made more progress than we did in the first 3 months! I agree with Melanie that it doesn't matter the method you're using, the advise you get here is priceless even if the advisor is using TR.

 

BTW - about the Nadirs..once you think you have it figured out there's a good chance they change and continue to throw you for a loop! You'll begin to understand more about Coldplay's behavior which will help you know when to test. I've increased my testing significantly which gives me much more piece of mind. Hopefully you are using a human meter where the strips are affordable!

 

I agree with Sour Pea - just when you think you have the nadir time, it moves! Genghis is an angel about coming to me to "tell" me she's feeling low, so I'm lucky that way.

 

Genghis looks great! So close to an OTJ trial...

 

As your dose goes up, you may get better duration and your nadir may move. The vet assuming that late is pretty scary though.

SLGS method was actually developed by some of the board members. The only protocol tested and published in the scientific world is Tight Reg for Latus and Lev. So even though some of the long time board members don't use it, they might just be someone who helped develop the method. Most of us watch and learn from as many cats as possible.

As far as getting support from someone on the same path, that is great. But keep in mind that FDMB is a peer-reviewed support board. It is discouraged for members to give advice privately. I don't know if that's what you meant, but getting dosing advice in PMs would be frowned upon. In the forums you can take the opinions or leave them of various members that will answer you, but it keeps the opinions public so nothing inaccurate and possibly dangerous is missed.

 

Thanks @Doodles & Sour Pea - paws crossed. I've been extremely fortunate at how easy Genghis has been to regulate and, like you, cannot imagine I would ever have gotten such great results without the help of the folks here!

Doodles looks like a lion in some of the pics in his profile - sorry if this is a dumb question but is he shaved down in those? Both your cats are so beautiful!

 

Oh Thank you! Yes, he gets a bath and shaved down with his lion cut about every 3 months. He hates being dirty and we live in AZ so he gets a little warm. The last pic on the profile is his full fuzz going on My fingers are crossed for you!

 

The best thing you can do to get dose advice, is to post a condo and put dose ? in the subject line. The experienced members can help with either TR or SLGS. I have used SLGS for Furball since she was diagnosed and have received great advice from members who follow TR. Do you plan to post a daily condo?

 

Welcome

You in the right place. Feline diabetes management is very frustrating process and support of the members FDMB is very helpful. Gus was diagnosed in February and is on Lantus since and we using SLGS guidelines. Initially he had very good response and was approaching remission until he had started having lots of other health issues and we weve unable to have him regulated. Recently we finally getting more cycles with blue/green BG's. This is all thanks to the support and expert advice that I received from members here. I find it very helpful to post daily and ask lots of questions and lots........ patients. I often look at the SS of other kitties and see that most have setbacks and irregular response to the insulin. The first time when Gus went to 50mg/dL I was so stressed that my hands shook so bed that I couldn't check his BG but I posted and got lots of advice, support and cheers. Now s long I am prepared (plenty of test strips, mid and high carb foods) I know what to do.

Good luck and stay in touch.

Elizabeth and Gus

 

Just want to echo what everyone has already said. Welcome. My Polly probably wouldn't be with me today if it weren't for L&LL (Lantus & Levemir Land).

Marilyn and Polly

 

What is a daily condo? assume this means the readings? Are people posting every day? And if so why?

 

This post is called a condo. It's where you cat lives. Most people post every day to keep everyone updated on how their cat is doing and ask any questions they may have. You don't have to post every day, but most people do. They put the date, cat's name and any BG readings in the subject line.

 

What is the difference in SLGS and Tight reg in a nutshell. I am sure I can to read about it where I printed about the slgs but I felt comfort with that method so I just thought work that way.

 

Human meter Micro Relion. Someone working to get my signature updated as well but right now waiting on tech support with my log in issue. I was glad to learn someone said the Nadir's can come as early as 3 hours but they do shift.

 

Hi - Hyde was diagnosed in May on ProZinc, switched to Lantus in July and are switching to Levemir as soon as it gets here from Canada next week. We have to follow SLGS because one of our civilians (non diabetic kitty) will not give up his dry food (he attacks the other cats when the bowl is low). If you feed ANY dry food, you cannot follow the Tight Regulation Protocol (TRP or just TR). The other significant differences are how long you stay at a dose before increasing, the low number for taking a reduction etc.

 

Looking at other cats spreadsheets has been very helpful for me. Basically it tells me to expect the unexpected and don't freak out lol

 

Agree. That is why I would like to know who uses the same method or protocol (whatever lingo). Not that any predictions can be made but it helps increase my understanding and knowledge of variances that "could" occur. More knowledge is good and I prefer to have a few people that I can just look at how their sugar baby is doing. Is there an advantage to the Tight Regulation for faster control over the go slow one?

 

She does not get any dry food. Are adjustments over a longer period of time and smaller in amount of adjustment on tight regulation? I apologize. I can go and read it I am sure, just so much information. My Mocha is actually doing great and I would love to get feedback once I can get the spreadsheet uploaded. Fairly new to home testing with results but it is so critical and thankful vet at least approved home testing with HUMAN meter w/o an argument and he admitted he could not help me test her ear because he is not good at it. He may gain admiration for me when I send him the first batch of test results and CANCEL my apt for Monday and indicate what I would like to do for insulin adjustments with the protocol sent.

 

In a nutshell, TR requires a bit more testing and dose decisions can be made quicker, 3-6 days. It requires a low carb wet food diet.
SLGS can be less midcycle testing (though I see many testing as much as the TR folk). Dose decisions are made after a curve is run at the end of a week on a dose.
When doing TR, you immediately drop the dose on a number under 50, in SLGS you drop the dose on a 90. Your no shoot number will be higher too for SLGS.
A nutshell, there is more that differs, but I am in the car so that's my short version

 

Do visit the stickies and read all the info on both TR protocol and SLGS, the more you read it, the more it makes sense.

 

I prefer to be "safe" so hence that must be why I went the SLGS route. At least I have some great company!

 

Can someone post the link how to upload the spreadsheet? I have it updated but I was waiting on a tech support person to help me and that has not happened in a few days. I would like to just do it myself if someone could help with the instructions again.

 

Here you go...just go slow and you'll get it done. It looks hard but it's not.

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

 

I have been though 5 cats on TR and never felt it wasn't safe. Not trying to influence your decision, just don't want people to think TR is reckless or unsafe. It is a published protocol and as long as someone is following, not trying to speed things up more, and testing, any problems are usually caught quickly.
My personal opinion is that SLGS would be less safe because less testing means less of a chance to catch a low number. Being data ready makes either easier, probably why I see many who say they are doing SLGS following more of a TR pattern.

 

I have to follow the SLGS because of Doodles kibble but do lean on the edge of TR as often as possible. Thanks to the support here I'm comfortable shooting much lower than the 150 in SLGS now and after a failed reduction Doodles has to earn it a little more than 1 little under 90

 

shouldn't have used the word "safe." I agree with you that more testing gives more information. But, until I get a consistent testing pattern I personally feel it is best for me to lean more toward not shooting with a higher number. I think more information would of course be best. I did not mean to say otherwise.

 

This is a test to see if the spreadsheet uploads. I think she is doing very well for only 2 months at a slow increase with just recent testing. Yes? We need encouragement.

 

You are doing good. Great you started testing before each pre-shot. We call the morning AMPS and the evening PMPS for your reference. You'll want to start getting tests in at night...at least 1 before bedtime as most kitties go lower at night time. Anytime you have a question ask here....they will be happy to help. Great job getting the spreadsheet up!

 

I do want to get nighttime numbers as it seems she does drop about +3 so that is her last feeding and "my bedtime." I am just happy that she is getting in range with the insulin after 2 months. And, if I was not here, I fear to think what happens with shooting with no data as some vets advocate. Even mine did not say to test prior to the insulin shot or what number to skip. This is a life saver! Literally.

 

I went May & June without home testing or this site an July-Oct testing occasionally. Had no idea what we were doing and my vet said...."no need to poke your cat"...just come here every 10 days UGH. Needless to say he hypo'd and almost died. Lesson learned!!

 

Glad kitty is ok. I get so concerned about hypo when I read about the symptoms and members losing their fur baby. There should be an outrage in the vet community to educate their clients about getting reads to protect the life of these sweet creatures. With my not being able to work, I appreciate not relying on an inflated glucose number for a life treatment decision, COSTLY $30 for only 10 second poke and a vet visit that is "in" and "out" to the next appointment with just a word "come back in 10 days." They sure have that down don't they? Would they settle for this with their pet? Makes no sense.

 

Good job on getting the spreadsheet up. I was concerned that you were going up pretty fast - only a few shots/days at each dose, then I looked at the date column and realized that they were not consecutive days !

Always nice to get out of those blacks & reds and down into the blues!

 

Yes! Spreadsheet is working!!

I know you're new to home testing so don't have a lot of data yet, but the first thing that screams out at me is you may have already been increasing too fast (a common occurrence when listening to a vet and only getting vet tests done!)

We hardly ever see cats that need 4 Units around here that have found the FDMB early in the sugardance. The problem (as you're learning) with getting just the vet tests is that 1. cats react to stress by having higher numbers at the vet so the only numbers the vets see's are those higher numbers so 2...they keep increasing the dose

On SLGS, we start them at .5 to 1U and then hold each dose for 7 days and try to get at least 4 tests a day in....ALWAYS before testing and then a mid-cycle on the AM dose and a "before bed" test on the PM dose......then once a week you do a curve where you get tests every 2 hours for 12 hours or every 3 for 18 hours

At that point, we decide whether to go up or not...and then it's only in .25 unit increments (occasionally .5 unit increments) but never whole units. Each time you change the dose, it takes time for the depot to stabilize so you'll truly see what that dose is doing. Using Lantus is like steering a barge...each time you increase it's like turning the steering wheel, but it takes time for the barge to complete the turn and be heading in the right direction. There are other insulins that work more like speedboats....you turn the wheel and the boat responds immediately.

I think if you can get at least 3 tests per day in (the Pre-shots and the "before bed" test) and can do a curve once a week, I'd strongly consider dropping back on her dose

Too much insulin can look like too little because without knowing how low the dose is taking them, they could be going too low and then the liver responds by releasing stored sugar and hormones to bring the blood glucose back up fast....so the cat is consistently in a state of "bounce"

I'll tag some others and let's see what kind of opinions we get on the idea of re-starting Mocha and seeing if we can get better control with her! @julie & punkin (ga) @Wendy&Neko @Marje and Gracie @Sienne and Gabby

 

Mocha's spreadsheet looks great Kari. Is she a dilute orange tabby? I have a soft-orange boy Picasso I got as a rescue - they look a lot alike. If he didn't already know his name, I would have called him Orange Creamsicle!

Loved Chris' description of Lantus - definitely like steering the Queen Mary! Was the on 91 reading on 11/05 the reason you figure Mocha's nadir is at +3? Just my 2 cents but there could be other reasons for that being the "lowest" reading of the day. I know it's a lot of info to digest but looks like you are doing great. Everything will begin to fall into place and make more sense once you can get some consistent pre-shot numbers and a little more data.

So glad you could be here for Mocha - you're in great hands.

 

Nadirs can definitely move around. And if a cat is bouncing, that overrides the regular cycle entirely.

There is nothing about Tight Reg that is unsafe, as long as you follow the guidelines. I want to strongly agree with Melanie on that. For some reason people are assuming SLGS is safer. It IS safer if you aren't testing much - and in fact, here is the quote from the SLGS sticky on testing:

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.
​

It doesn't say test preshot, or mid-cycle - it says once a week and it's helpful to do spot checks. For a person doing minimal testing like that, it is definitely safer to follow SLGS.

Tight Regulation is the only dosing protocol which has been published in a professional veterinary journal for using Lantus/Levemir in diabetic cats.

It's your choice, but there is nothing safer about one that the other, IF the prerequisites and guidelines for each are followed. If a cat eats any dry food on a regular basis, SLGS is the only possibility because Tight Reg requires only canned low carb for the regular food. Tight Reg also states:

• It will be necessary to test kitty's blood glucose levels multiple times per day.

It's always good to go straight to the source (the yellow stickies) for your information. Each of us recalls different parts - much like the fable of the 7 blind men and the elephant. We each are struck by some part of our own experience with our diabetic cat, and that's what we focus on. It's perfectly normal human response, but you really do want to read through the stickies, Kari. Spend the time and compare, then ask questions if you don't understand.

You should choose SLGS or Tight Reg based upon what works for you and your life. Know that Tight Reg allows you to increase the dose more frequently because you have more data (your tests) to guide you. SLGS has the dose held for one week at a time.

As far as dosing, in general, I'm a fan of holding the dose and gathering more data before making a decision. At the moment, today, Mocha's blood sugar control looks pretty good. Today it looks like she may be clearing a bounce . . . but it's definitely possible that she's having lower numbers at night and that's the reason for the very high morning numbers.

I'd suggest continuing to test today and this evening and see if you can catch how low she goes when she gets to the bottom of this current cycle. What i mean is that her blood sugar is dropping today, and I'd want to know how low it goes before it begins to climb again.

But . . . Punkin was a high dose cat - he had acromegaly and got up to 15.5u per shot - 31u per day. We know now that it occurs in 1 in 4 diabetic cat - the acromegaly is the cause of the diabetes. This shapes the bias that I have because this is the part of the elephant that I know best - cats need as much insulin as they need. So I am not a fan of immediately dropping the dose because in fact, one in 4 cats do need a larger dose than usual. Dropping the dose if they need that much insulin can leave them in high numbers unnecessarily.

Is it possible that Mocha is overdosed? absolutely. It is possible she needs this much insulin? absolutely. But only one of these can be true for Mocha,

So . . . I wouldn't want to advise you one way or the other at this point. I would get more tests in - especially in the night cycle. Personally, I would always get at least one test in the pm cycle too, and then make a decision after I had more information. I like to see at least 3 days of at least 4 tests per day (2 preshots and one mid-cycle in each the day and pm cycle) before making decisions about increasing a dose, just so there are no hidden lows in the mix. I wouldn't want to try to give advice without enough information.

My concern about the tests that your vet did that caused him to increase her dose is twofold - one is that some cats can have their blood sugar soar at the vet's from the stress of being there. The second concern is that once a cat's body has become used to their high numbers (before they started insulin) the cat's body responds to it by bouncing. Bounces can last up to 3 days. What if the vet's tests happened on bounces?

The reason you'll hear almost every person here suggest a test in the pm cycle is because we see over and over again that many cats will have their lowest numbers in the pm cycle. Every cat and person experiences Dawn Phenomenon, which is probably the reason that day cycles tend to be higher. As inconvenient as it is to have to test in the pm cycle, it provides invaluable information that simply isn't available during the day.

So that's my 2 cents worth - for free. I am not a vet, but just know from my own experiences. Let's see what others suggest as well.

Ask questions about anything that is confusing, Kari.

 

I think other people may be confused the same way that I was in thinking that your spreadsheet was back-to-back days. Maybe if you put a blank row in the spreadsheet to represent the gap between the days the vet tested it will be more obvious when you started home testing daily.

 

Before suggesting you essentially start over with dose, I have a question. How was Mocha's health at the time she was diagnoses? Was there any problem with diabetic ketoacidosis or were ketones present? Ketones are always a consideration if a dose is going to be lowered. Were there any other medical issues?

Generally, I don't think I've ever seen a situation where someone started over with dosing that did much other than cause the caregiver to lose time with regard to getting their kitty in a better number range. Because the dosing approach suggests that you start at a particular dose, once you've been at a particular dose, I don't believe there's a cogent rationale for dropping the dose way back.

Thanks for adding info to your subject line. I'm a recent transplant from Chicago. If you're not thrilled with your vet, there are a couple of very good vets at Cat Hospital of Chicago.

 

Just to be clear...I'm not suggesting she start completely over....just without more testing, especially at night and with as fast as she's gone up in dose, it's possible Mocha is in a constant state of bounce.

Of course now that she's testing more, it should become clear soon one way or the other

 

I absolutely agree that tests during the PM cycle are essential.

 

Thanks for input! I feel she is too high as well. Curious what others think and I will get more testing in the evening is the goal still.

 

I would say she is a buff color. Her sister, Latte, known as Trouble! is a true orange. The contrast is good so I don't mistake the insulin as others.

 

I agree completely. Been trying to get night data and I am hoping tonight it happens. Her ear is a little poka dotted but it makes it easier to know where I could get a drop. Despite the Neosporin there are still little dots. I think I should hold and get more data and I agree the vets data was basically useless. But, it was all I had despite attempts to get blood earlier on.

 

Great idea. Yes can see that it may have appeared the dose was increased rapidly but really it was held for a period of time. Changed it.

 

I know that she is close to regulation, or believe it. Hunger is incredibly better. The screams were tiring for all of us, even the other kitty. The litter box is proof she is also much better. Not at the water bowl like she was. The food is diluted with 1/2 c water to each 3oz to make it last and she is content with that apparently now. The other factor is the play, bouncing, running factor. I cannot keep up with her running around, up and down the stairs when she knows food will come. I believe she is stabilizing and I am eager to get proof of that in more tests and I think holding and perhaps a slow taper back will be coming.

I am actually nw burbs and I tried another vet and it was far worse than my vet of 21 years. So, back I went. He at least will work with home testing. The other would not permit human meters and discouraged inaccuracies. Too noisy, chaotic. So, I got the dental done and returned to my peaceful vet. But thanks. I have heard of this clinic.

 

I have now spaced out the gaps in time. Do you still think they pushed her high fast? Anyhow. Will get night data. Tried last night but it failed and I test while she eats and I did not want her to have a substantial extra amount of food. Feeling more confident will get it tonight.

 

I AGREE. Will get there.

 

No ketones tested. I just read about this recently. I don't have the supplies. At the time of diagnosis coming off a fatty liver syndrome from a dental plaque issue bugging the gums. She was unable to chew dry food and the wet food began in May pre diagnosis. Otherwise no signs of diabetes but water consumption @ time of diagnosis. But the litter issue came w/I starting the insulin. Vet said "every cat is different." I thought that was weird to have the urine change after!

 

someone thought it might be confusing and to separate. glad it makes more sense now. yep, loving the blue and green

 

Hello Coldplay, I certainly can not give dose advice. I'm using Lantus and trying to do SLGS but Smokey doesn't cooperate well. TR is not for Smokey. He does steal civvies dry kibble on occasion(when husband leaves it out). He also takes 4-5 days to adjust to a dose, then gives wonky numbers for a day, then settles for a few days then..........I test enough so I don't run curves every 7 days as per SLGS. We have been getting much better readings since 10/31. He is spending longer cycles in the good zone so I'm optimistic we will become consistent soon.

I inherited Smokey (in 2014) who was diabetic. I was told how much to give and come back in 6 weeks for a test. No one made sure I knew how to give insulin (lucky I was a nurse and knew). Had no idea about food or testing. When he hit 5u in July my vet said they couldn't go up anymore????? Started looking for other options. Found FDMB.

Just wanted to say hi and your in the right place for help.

 

It sounds like you have learned a ton and are on the right track now with Mocha.

Do you mean she was actually screaming when her blood sugar was high? I saw that comment in her spreadsheet and meant to ask about it. Can you describe more?

 

2 suggestions re testing. A warm ear will give more blood than a cold one. We use some uncooked rice in a sock and put that in the microwave for 15 seconds then hold that against her ear while loving on her. Also, she gets a freeze dried treat after the test. Actually, everybody has started showing up for test time to get a treat!

I think the spreadsheet is visually less confusing with the gaps - thanks for adding them.

 

I would agree on holding the dose for now until you see what kind of numbers she’s getting at night. Her daytime numbers look fine at this dose.

 

Would you believe her head bumped me and released the insulin onto the other hand? I figure these things always happen for a reason. But as you see, her afternoon number was climbing. Will check her in a few hours and I expect will be higher than afternoon with food, though barely any carb. Then I will know she missed it entirely. I am sure she got nothing. I had just got a slight puncture when she bounced my hand. Hopefully a missed shot won't spike her more in the am. Fooey

 

Smokey is clearly in loving hands. Thanks for the friendly greeting.

 

Her hunger pangs result in a high pitch squeal for food. But, she is much more subdued the last 4 days. I have seen the behavior pattern where she consistently improves after the 4th day at a new dose and hold the pattern. I have seen her bathe more after eating, with contentment. Quite some time ago, it was so painful to see her pacing and wanting to eat round the clock.

 

Would you make a note in the spreadsheet dosing column (maybe FS for fur shot) where you think you gave a furshot? We count cycles for both TR and SLGS and a furshot starts the cycle count over. You want consecutive cycles at a dose to determine if you need to increase or not, so fur shots are very important.

 

Thanks Julie. Did not know what to do but did not want to put the 4.0 when I knew she clearly did not get all. Interestingly, her glucose did go down a few hours after so this will be interesting to see when I know she gets a full dose does she drop substantially more as in the amps. Great idea! And, I did not know how it impacted the dosing cycle. Had not read that anywhere. Thx.

 

This happens to everyone at some point. It doesn't usually take too long to get them back on track so try not to worry.

 

To all, I asked this elsewhere and I did not get a reply. What do you do in regard to visits to the vet for the diabetes?

I intend to cancel my Monday vet blood draw and present him with perhaps a fax in another week, once she restabilizes after the one fur shot last night. But, should I give him a copy of the method and say this is what I want to use for dosing based on the testing at home and hope he is good to let me manage?

What did you do in regard to keeping a respect for the vet and yet controlling the insulin regiment?

Thanks.

 

This is exactly what I did. I emailed my vet the link to Ivana's spreadsheet as I'd done a scheduled curve, then attached the article with the protocol and said something like this is the method we'd like to use to manage Ivana's diabetes, what are your thoughts? She replied back that she knew of that protocol and had heard lots of success using it, and was more than happy that we were being proactive in the DM management.

 

That's a toughy. On one of my visits (was every 6 weeks). They used the meter. I asked if that was something I could do at home. They said yes. Told me what kind is was. Kept the next appointment and brought mine in to compare the readings. They were exact. But didn't get any instructions on how often to test. So I didn't do it often at all. Didn't know about FDMB. When he hit 5u the vet said we needed to find other ways. He didn't mention changing insulin (I figured out he didn't know others except Vetsulin and Prozinc). Started boiled chicken in place of dry food. Wasn't told to check BS. Well he crashed by just removing the dry but still on 5u. Then I started becoming more involved. Tested more but still not enough. Started googling. Found FDMB. He crashed again that night. Became addicted to this site. Smokey has quarterly visits for labs, general exams etc. His next visit I asked to change insulin. Gave him info on PZI. Thought that would be better. He suggested Lantus. I ran with it. Ordered some. Took it on next visit. I had to show him how to draw it out. He was only familiar with vials. I showed him my ss. He was impressed. I send it to him weekly. He will call me if he thinks a change is needed. But for the most part he has said "I trust your judgement, you know what your doing" OMG if he only knew I don't know. His office is open 7 days/week. If I need them. He suggested the DM food because the insulin kept needing increases. I agreed to try. He gave me the print outs of analysis and free cans. It did make a difference. You have to keep communication open and not alienate them.

It depends on your vet. Some are okay and some are not. You will have to feel them out. Maybe take one step at a time. First home testing. Then show the data you collect. Then ask if he can make suggestions or recommendations. Doesn't mean you have to do what they say once your home.

 

Kudos!

 

Let us know how you go with your vet! I'm sure he will have no issues with you taking such a managed approach.

 

Got it. Just as I thought. Thanks for the chuckle about the last sentence. I do sense a little "rub" between he and I. He took a backseat for too long with her gum inflammation when se did not respond to antiobiotics and then spun into the fatty liver and I nicely said I need to take her for a consult and I did not understand why the glucose was not mentioned as a concern when it was from normal to mid 400's. He said well stress can do that but when the other vet got the same reads he said yes it is diabetes. I don't think he likes my questioning him not long ago but at least I did come back to him for her ongoing care. I do sense it is not the same and I have to be careful not to rock the boat even with my frustration. Don't have the energy to shop a vet again. The consult vet was a terrible experience except her cleaning was phenomenal but we both were stressed with the noise and confusion and no vet at the appts only vet techs.

 

The downside of printing out SLGS and using it to inform your vet of what you're doing is that if the vet objects, you have no science to back up your decision. With Tight Regulation, we can provide you with the journal article from the Journal of Feline Medicine & Surgery where the protocol was published. Some vets won't be happy but they can't tell you your listening to a bunch of crazy cat ladies on the internet when you walk in with published research from a top tier veterinary journal.

SLGS has a good track record on this board but it is not based on research.

 

We're on vet #4 ....mostly because the vets around here are "mixed" practices and see more cows than cats but I was also lucky to find the FDMB the same day I got the diabetes diagnosis so knew what I was looking for (and what to listen to and not listen to)

Vet 1 told me to feed dry W/D and that "insulin was a hassle and if I can keep her in the 300's, he'll be happy" (Well I wouldn't be happy!!) Vet #2 said "no, I didn't need to feed W/D, but he did have some other great (again DRY) food he'd sell me.....on to vet #3!

Vet 3 didn't know you could use Lantus in cats but was willing to let me do it! (SCORE!!!) He didn't know the first thing about how to use it, but was willing to give me the script and after that, I trusted the people here to guide me

Vet 4 that we're using now is a "feline practitioner" and was the only one within 60 miles that could do a proper dental with x-rays so that's why we're with them. By the time we started there, China was pretty nicely controlled and I just sent them the link to her spreadsheet if they wanted to follow along. I don't ask questions about the diabetes and they don't push me on how I'm doing (probably since they can see I seem to know what I'm doing). They have called in my scripts (and were shocked to see how little I was paying for Lantus from Canada and are now telling their other clients about it)

When I had China in for her URI not long ago, the vet looked at the spreadsheet and said "I might want to consider dropping her dose back to 1U so she doesn't drop below 80".....I told her the numbers on the spreadsheet were from a human meter that reads a little lower than the AlphaTrak so the numbers she thinks are too low are really close to her "chosen" 80....she seemed good with my explanation.

I've trusted the people here 100% with China's diabetes because they have so much real life experience in dealing with sugarcats....and we're doing great!

 

So, is it better to not indicate the method and just periodically check in and say I am "thinking of doing 'x'?" Trying to make this as painless as possible for all involved. How to maneuver?

 

Sounds like #4 is learning from you and working alongside you. That would be great if it happens.

 

I'm not sure what your experience is with MDs, but dealing with vets is no different. When Gabby was diagnosed, I was living in Chicago. The vet at the intensive care specialty hospital started her on Humulin N. Once I overcame the shock of Gabby being diagnosed, being very sick, and surviving coupled with learning how to test and shoot, I was back with my vet. I started doing research and came in with the TR protocol in hand and asked if she would be open to switching Gabby to Lantus and my following TR. She was fine with the switch but had not seen the protocol. Not only did she embrace what I was doing, she trained the other vets in the practice on the protocol.

And then there are those vets who take the, "My way or the highway." stance.

Initially, my vet wasn't entirely comfortable with my making dose adjustments on my own. I reminded her that she wasn't available 24/7 and I had a resource in FDMB. I gave her the link to my SS. Once she saw I wasn't killing my cat, it was never a discussion. She trusted my decision making.

I relocated to Ohio about 1.5 yrs ago. The first thing I did was interview vets. The vet I use is familiar with the TR Protocol, saw Gabby's SS, and basically said keep doing what you're doing and I should let her know when I need an Rx for insulin. She's smart, she stays on top of the literature, and her way of working with me is that we work together to keep Gabby and Gizmo healthy. I listen and ask questions. It also doesn't hurt that I have access to library resources that most people don't have (e.g., medical and veterinary libraries).

From my perspective, I need a vet who will work with me and who will explain her thinking and not get impatient. If I ask for the research, I want someone who can provide me with the journal article. That's what makes me comfortable. You need to figure out what you want in a vet and have that discussion so you don't end up at odds with the vet. The bottom line is that even if your vet gives you the nod to handle the bulk of the FD decisions on your own, you will likely need the vet for other things so the relationship is important.

 

I think it's more along the lines of I don't give them much choice...they ask me what her BG has been running and I tell the truth..usually between 50-150...if they do suggest anything, I just nod my head and smile....and go home and continue doing what's been working for us so far ....Listening to the people here who have the most real experience with this disease

When I was calling around looking for a vet that could do a proper dental, I said I had a diabetic cat and needed a practice that could do a dental with x-rays and they said they could. They saw her once to give her a good "look over" and ran pre-surgical bloodwork before the actual dental. I think that since I talk to them like I know what I'm doing and she looks as good as she does, they don't try to change how I'm managing her (much) and if they do suggest something I don't agree with, I do the "nod and smile" .....and if it's something I wonder about, I ask the people here what they're opinions are

It's not that they're bad vets....it's just the facts are that vets don't have the time to keep up to date on the latest treatments for every disease in every type of animal they see. The people here do nothing but deal with diabetes and the diseases that tend to come with it

 

Agree totally. I wish I could say I had no experience with MD's. Got rearended @ 70mph, when sitting still and it bent the frame of my CRV. I lost my job from it and have been to literally dozens of doctors. Sadly 99% of the providers I saw resulted in a horrible experience. I saw an article once by a physician explaining that MD's are not comfortable with chronic pain patients, it hurts their ego. That made sense to me because I was not improving despite their effort or mine. That said...it makes me now wonder if the same is not true of a vet, who also wants to have improvement with our furry friends, as we do, but when it does not happen with some chronic issues.....frustration develops with everyone...furry one included. It sounds like I may need to change to TR if he uses that method. I just preferred the SLGS. I did not know it was equally recognized by the vets. Don't want an argument. Have to think thru this week. Thanks.

 

I really like this idea. Sounds like you never showed the spreadsheet? It does make me ponder if it will create more interference. It seems your approach could be a good fit for starters. I don't see my vet calling me to see what I am doing. But, every single time I call for her health issue, he always takes the call in a minute or so. He even has saved me emergency trips when I had a cat that needed iv's on Sunday at the same fee and he is CLOSED. So, I don't want to ruffle any feathers. My guess is he will be in the backseat as long as I don't "ask him" to give advice. Maybe I just cancel the appointment. What I don't know is if I should ask her to note in the file having successful home testing or that will likely result in a phone call to ask how she is? Then I can use your range suggestion. Argh. I agree that I would be so lost w/o this forum. I so need the encouragement and information.

 

What was the appointment for, the one you're considering cancelling? If it was for glucose tests, I did the same thing - Ivana was booked in to spend the day at the vets for a curve, but in the meantime I learnt how to home test. So I called the vet the week before her appointment and asked them (but kind of really just told them) if I could do the curve at home and send them the results. They said it was actually a really good idea, as it will be less stressful for her and therefore more accurate. I sent them the link to the spreadsheet which had the curve data and all the previous numbers and said they could look at it at any time, though I only know of once that they looked at it (unless they're just not worried enough about her to call me, which is fine).

 

It is for the glucose blood draw. But, the more I think about....I believe he may be very receptive to not having to be the one determining her care. He has repeatedly said that the vet draw spikes the numbers so I doubt he feels they are accurate. He supported daily home testing once daily.

But, I am reminded of the visit 2x ago when she really spiked and he came in perplexed and sat on the counter (never does) and had this blank look....he was asking questions what could be different? And, then he paused a long time and said bring her back on a Saturday and hold the dose. I asked if I should at least bump it .5 and he agreed that was fine. I get the impression he feels like a fish out of water. Walking a fine line to let him feel respected but manage her. They don't have technology given such as emails but I could offer it or fax it was my initial thought if wanted.

 

Can you post the link for how to use TR? I cannot find it anywhere to compare and sound knowledgeable if the vet asks me how it compares. I doubt he would but I should understand.

 

Here it is: http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol.1581/

On that sticky, just a couple of paragraphs down from the top you'll see the links to the actual protocol:

Links to protocol guidelines (same protocol presented in two different formats):
Tight Regulation with Lantus or Levemir for Diabetic Cats
Management of Diabetic Cats with Long-acting Insulin - A summary published in 2013 includes the TR Protocol in chart form (Table 3).
​

 

It's always in the "Sticky's" at the top of the forum but here's the whole thing (including the link to the published paper)

Tight Regulation Protocol

 

Hi Kari, sorry I wasn't around but looks like you already have the info.

I also love this article from the Journal of Feline Medicine and Surgery. I know I saw it cited here first and it's an excellent all round resource. Edited to add: Here is the link where Jill posted the article on FDMB

It cites TR as the "Intensive Management of Feline Diabetes" on p. 242 - not precisely the protocol itself but a summary of it. The only reservation the Panel had with the TR protocol is they felt that most pet parents wouldn't be prepared to be so involved. Ha! They clearly haven't met the "crazy cat ladies" here a FDMB!

It sounds like you might need to help guide your vet to working with you in managing Mocha's diabetes. I don't see how any sensible vet could argue with this article.

 

Got a 109 amps with no food since 10:30 pm. Never seen it that low since testing! That should definitely help me with my vet call huh? So proud of my Mocha!

I looked in the stickies but was not able to find it. Appreciate the patience to help me find my way.

 

Wow, that is great Kari. I had a peek at your spreadsheet - did you shoot last night? I saw you had a 170 last night but no notation of a shot.

Would you be able to get a +2 reading from Mocha? It would be nice to see where she is heading today. Lantus does a better job of keeping lower numbers low so she could stay nice and "blue" today, but some cats have been known to dive so for safety, get a +2 reading. If it is lower than her AMPS number, I would suggest posting for help.

I'd also make a brand new thread for her and put this in the title: 11/09 Mocha AMPS= 109, +2 = "her reading"

If you post every day or have questions, someone more experienced will usually take a peek.

 

I realized I missed entering the dose last night awhile ago and fixed it. Thanks.

I tried to go back to another area for injection because scruff is bugging her. In so doing, I thought all was good but it was mostly if not all fur shot. Then in looking at the amps numbers, I am relieved! I think for HER it could have been a grave danger with the insulin dropping her far in the am in excess of 181 points.....she did not have 181 points to go. Whew! I was just thinking if 90 or more keep the insulin. This is scarey and thankfully it was a fur. But, I am going to watch her closely today and check more often. I really think I need to reduce her and ask for help. Cancelled vet draw today since in the blues mostly. Have a dentist @ 11, so hope she is good before I need to go or will have to reschedule. I will post her numbers more often as I begin to understand what to put in the title. Thanks! I think I dogged a dive.

 

Hi Kari and Mocha!
So glad you've joined. It looks like you are already getting some great help from some of the same people who have helped us.

Rascal and I are doing SLGS as well, but if you look at our spreadsheet you will see we do a lot of testing because my work is very flexible and allows me to pop in and out a lot or work at home. I have been able to pick up her patterns that way and try to figure out how to manage her wonkiness. Definitely still a work in progress and I don't know what I would do without this group. We are still struggling to get her regulated.

If you look at the spreadsheet you will she she's been kind of all over the place. She tends to be a fast diver, meaning sometimes within just a couple hours her sugar drops dramatically, so she has early nadirs sometimes. Other times it's a slow steady decline through a 12 hour cycle. Then other times, nothing. It's like there was no insulin given at all. She's a real bouncer. When she drops a lot or very quickly she is very prone to having a period of 1-3 days of high numbers where her body has gone into emergency mode and pumped out hormones to pull out extra glucose and that keeps her high for a while. It's very annoying. That's why you see waves of blues and yellows followed by waves of yellows and pinks.

This is her second round on insulin after a brief remission in the summer. I just assumed TR would be the way to go, but in Rascal's case we were quickly advised here to go with SLGS because her case is rather complicated. She actually has real symptoms of hypoglycemia at 60 mg/dl which means the goal numbers and shooting very low numbers like in TR would not be for her. Then there is her tendency to dive and bounce. Too scary for TR at the moment. I'm not comfortable making dose changes as quickly as one does with TR in Rascal's case because it takes her longer to settle into a dose. For example, it might seem like she needs more insulin because her numbers have been really high for a few days, but with her it's because she is bouncing, rebounding from a good low number. So I feel better with not changing doses more than once a week.

Rascal is 17, is on a medication for inflammatory bowel disease that can raise BG and is unfortunately for now on a canned diet for her IBD that is too high in carbs. This probably also contributes to her BGs being all over the place. Some of that just has to do with when she ate and her higher carb food spiking her BG for a little while. Yet more reasons to go with the more conservative SLGS method for us.

You and Mocha will find your way and what works for you. There is definitely a learning curve with all this, but it looks like you are off to a great start just being on here, getting your spreadsheet started, home testing, taking responsibility for things yourself. It's more than many people would do to take care of these kitties. Keep reading, keep testing, keep up with your spreadsheet, keep asking questions here. You will soon understand more and more about how Mocha responds to the insulin and what doses to use. Hopefully soon you will have the nice flat low numbers we are all dreaming of!

 

Thanks for the reply. Looks like for the small amount of insulin you are getting close to the goal.....happy to read of a brief remission. I would love for Mocha to go on a reduction soon. She is so much more subdued. I am home all day and the stares and cries are hard......even with small meals. So happy to see more contentment and less litterbox urine streams. Go Rascal! I too feel the SLGS is a comfort with Mocha's vast drops from insulin.

 

I'm uploading the actual journal article for the TR protocol.

Re. MDs managing pain. There's actually been research suggesting that MDs, especially surgeons, are better at managing acute, post-surgical pain than chronic pain. Couple this with the FDA tightening of the regulation of prescriptions for narcotics, it makes it harder for even the very good MDs to do their jobs competently. At least in Ohio, this has led to the development of pain management programs who treat everyone like a drug addict.

 

I want to digest the info on this great journal .

Love this: 84% for cats started on the protocol within 6 months of diagnosis went into remission,
and only 35% for cats that began more than 6 months after diagnosis (P < 0.001).

Mocha was caught w/I a couple months. I hope she can go into remission. Never saw a percentage this high.

Yes the doctors that want to help relieve pain are really w/o an oar anymore. The only md who would prescribe a narcotic, I can no longer access with my plan dropping. A primary would not want to do so. Chronic pain does not mean you are addict like the government thinks.