Silver - Vet's response to my email

Status
Not open for further replies.
KittyMom777

KittyMom777

Member Since 2014
Sorry for the 911 but need quick response.

At + 12 Silver was at 9.2 (x 18 for US figures). I called vet who said to skip the dose.

Two hrs later he was at 12.7

An hour and s half later he's at 26.7!!

The next dose is due in 8 and a half hours.

What do I do? I'm about to go to bed but he'll keep rising right? And if I givf insulin he may drop suddenly as is his pattern. Help!!
 
Re: Silver - need quick answer

Hi Juliet,

I'm not really experienced enough to give you advice, but I post about your status over on the TR board in hopes that some of their more experienced members are online right now.

You can always shoot or give a reduced dose, but Lantus likes consistency. If you decide to shoot, you would need to rearrange your dosing times for the next few days to work back to your regular schedule. Typically this would mean subtracting 15 minutes each dosing time until you are back to your 6:30/6:30 schedule.
 
Re: Silver - need quick answer

Thanks for replying. I can't adjust schedule tho. I am out the house from 6:30am-6:30pm.

I don't know how much longer I can do this dance. I can't cope.
 
Re: Silver - need quick answer

You skip tonight, start fresh tomorrow at 1.5. He will only go so high and he'll come back down again when you restart him on insulin in the morning. Just get a good night's rest hon.

Mel and The Fur Gang
 
Re: Silver - need quick answer

Any advice for how I tell the vet I don't want to listen to her anymore? The jump to 2 units is bouncing him about sll over the place. But in the 6 weeks he's been on insulin he's always been bouncing. Super highs and lows in a couple hrs. From 7 then two hrs later up to 28!

The main reason I am not coping is because I am caught between the vet and the forum. How does everyone else -especially newbies -handle the vet???
 
Re: Silver - need quick answer

Juliet....since you skipped, you don't want to give a shot now since you can't adjust your schedule

We can help you with every step of this dance, but you are going to have to decide if you're going to listen to us or listen to your vet.

Usually we'd shoot a 165 but with Silver's quick drops, 2 units is just too much

We've suggested you drop back to 1 or 1.5 unit...I think that's a great idea and may help even out the numbers. It's sure worth a try!!

Nobody here will ever risk the health of your baby...we want what's best for both of you!
 
Re: Silver - need quick answer

We smile, nod our heads and go home and do what the people here have taught us Juliet!

You control the syringe and you're the only one there. Your vet isn't peeking through the windows (at least we hope not!! :lol: )
 
Re: Silver - need quick answer

But that's where I get confused. I get differing advice even on the forum. I was advised to drop back to 1.5 not 1. On 1 he was in the reds and blacks all the time. At 2 he was coming down to a more normal range but bouncing high again.

I don't know how to decide between the vet and the forum. My vet knows about diabetes too and if things all went wrong, you all say to go to the vet. How can I do that if ivd chosen to ignore her advice?
 
Re: Silver - need quick answer

KittyMom777 said:
Any advice for how I tell the vet I don't want to listen to her anymore? The jump to 2 units is bouncing him about sll over the place. But in the 6 weeks he's been on insulin he's always been bouncing. Super highs and lows in a couple hrs. From 7 then two hrs later up to 28!

The main reason I am not coping is because I am caught between the vet and the forum. How does everyone else -especially newbies -handle the vet???
Click to expand...

Hi Juliet, I'm a relative newbie as our journey here started in February but I know this much already- take a deep breath! And another! Diabetes is a very tough dance to learn but you've got this!! The great people on this forum will make sure of that! :YMHUG: :YMHUG:

As for handling your vet, remember, your vet works for you- not the other way around. It was weird at first with our vet, I had to tell him that I was following the Tight Regulation Protocol, and I showed him Tiger's SS and other handouts. He was so impressed, he went and showed all the other vets and vet techs and now some of them view the forum as well as ask questions as to what I am doing for her at the moment. Clearly, I need our vet clinic for Tiger's other medical needs- she has hypothyroid, probably CKD and occasional bouts of age related things, but we now have an understanding that I get her prescriptions for insulin but I'm not asking for dosing advice. And each of the other vets I have seen, they must have notes on our file LOL, but they all get it and are okay with it. Be firm and clear about your goals for Silver, and let them know that you plan to be proactive, and if they are not okay with it for some reason, I would find a new vet.

Hope you get a good night's sleep-you have a very long commute tomorrow!
 
Re: Silver - need quick answer

Silver has been bouncing all over the place because your dose has been inconsistent and going up way too fast for a depot insulin. Silver's body can't catch up and is reacting to it. These blue numbers aren't worrisome numbers, they are good numbers and ones you want to start seeing, but not with all the peaks and steep drops. You need to let the new doses settle and let Lantus do its job of flattening out the curve once its had that chance.

You tell your vet that you are tired. Things are going too fast and you are SCARED to keep giving Silver that much insulin so you are reducing the dose and working your way back up slowly if you need to, but for now you need to get things settled down. Maybe her aggressive methods work with a non-depot insulin, or someone who isn't out of the house for 12 hours at a time, but its not working for you and Silver.

Your vet is aggressive. More aggressive than anyone I have ever seen with dose increases. You say you are taking the start low-go slow approach, but started high and going faster than any protocol here. That scares us. Safety needs to come first even if it feels like it might be slowing down progress. You can't do this if you are always in red alert and never getting any sleep. Your vet needs to understand that. Both you and Silver need things to settle down and not be so full speed ahead.
 
Re: Silver - need quick answer

Ok. I've sent this to my vet:

Now I really need the forums help as I havd cut off help from my vet.

Hi,
Silver's numbers have been going haywire since we put him up to 2u twice a day - if you click on the spreadsheet again you will see. It's scaring me silly as he's at 9 one minute then three hours later at 23. I called to day and was told not to give him his evening dose as he was still at 9 twelve hours after his am dose. But three hours later he has skyrocketed up to 23. I really can't handle this. My nerves are shot.

So I want to back down and try the SLGS Protocol that I'm attaching here. I'm out 12 hrs a day and cannot monitor him if he drops too low and can't leave food out.

viewtopic.php?f=32&t=61794

http://www.felinediabetes.com/start-low-go-slow.htm

Let me try it this way for a couple weeks and then we can look again.
My spreadsheet is available to you any time. Just click the link as it updates automatically.

Silver's SS.

Thanks

Juliet

Sent from my iPhone
 
Re: Silver - need quick answer

Figuring out the relationship with your vet is always tricky. I'm not quite sure why, but those who prescribe Lantus (instead of Humulin or a similar insulin) right away tend to adhere to the belief that 2 units is the appropriate starting dose. My vet is very nice, he is always super impressed with Maddy's spreadsheet, but he always recommends 2 units of insulin. He's never held it against me when I don't take his advice, and I never rub it in when he is wrong. I also understand that there are a lot of suggestions on the forum that seem to be contradictory.

I think one of the main things that concerns everyone looking at Silver's chart are the huge drops in BG after insulin is administered. With depot insulins, you expect to see flatter curves. Lowering the dose and holding it for awhile will give us all a chance to see if Silver can flatten out a bit on Lantus. If he were mine, I'd take Mel and Chris's advice and shoot at 1.5 tomorrow.
 
Re: Silver - need quick answer

Yes that's the plan. I tried it the vets way and it's been a crazy four days. Can't take the stress anymore. I'm a basket case :-(
 
Re: Silver - need quick answer

It is perfectly reasonable what you are asking your vet and she should be on board with helping you in this, it shouldn't be a pushing away. Stress that you want her help, but you need it to be slower. You don't have to make her feel like you are choosing between her advice or someone else's.

Along our FD path I've run across a lot of vets because the fosters just get whatever vet the shelter took them to. I've worked with 1 vet that was very hand's on and involved (my vet with Smokey), one vet that was on board, but hands off, one vet I've never talked to or involved in the treatment at all, and one vet who was so obstinate and set in her ways that the cat was taken to a different vet and was off of insulin in a matter of a week or two. Hopefully you will have a vet that will put her client's best interests first and work with you on treatment.
 
Re: Silver - need quick answer

Juliet,

Caring for a diabetic cat doesn't have to be stressful, in fact if they are brought down properly it can actually be kind of fun. You start developing a routine, and a partnership grows between you. You start seeing your bubby back again and probably acting younger than you remember him acting in awhile. Because cats are stoic creatures, he has hidden from you the fact that he was becoming diabetic for a long time before you noticed he was even sick. So he didn't become diabetic overnight and he isn't going to be cured overnight either.

We call this a dance for a reason. Just like learning any new dance, you are going to feel clumsy, you are going to trip and fall down, you are going to forget steps or get the steps in the wrong order. And above all you don't try to learn the dance start to finish all in a day or even in a couple days. You break it down into baby steps. It's the same with the Sugar Dance. You two don't need to go from zero to warp speed. Let his body get use to the ever slowly lowering numbers first, let the pinks become yellows, then the yellows become blues and finally blues become greens. But not all in the same day, over days and weeks. First of all it feels better to him not to have those steep peaks and valleys, and second of all, as you get use to him being in those different levels you will gain confidence in giving his dose and leaving him, because you'll know how he works that dose in those numbers.

What's been scaring the bejeepers out of all of us is how much he's dropping and how fast, that isn't typical of how Lantus works, and because it is a depot insulin each shot is building on the next and dropping him farther and farther and faster and faster. With Lantus you want a flat curve, no more than a 100 pts or 5.5 drop from preshot to nadir, and that is still a pretty big drop once you've fine tuned the dose.

Mel and The Fur Gang
 
Re: Silver - need quick answer

hi Juliet
like Mel says Silver was diabetic for a long time before you even knew he had it and it may take a long time to get him regulated and that is ok. it will happen but it is safer to have it happen slowly. my boy was diagnosed in july of this year and is just now starting to make the journey down to lower numbers. if you drop the dose, slow down and just know that slower will be safer for your baby and then you can finally breathe & relax and not worry about him being in danger of hypo. don't worry Juliet, everyone here can help you. oh and your letter to the vet was great !!!!
 
Re: Silver - need quick answer

Hi Juliet, I think you've gotten good advice tonight and I really don't have much to add. My only thought about the dose is things need to be different for each situation. Because of your schedule I think Silver needs to run a little bit higher. It's not the perfect solution, but it's realistic. If there were a way to leave food, that adds some protection for him, but you can't do that.

Just wanting you to have a little support. It is hardest when you're starting out. It gets easier. I think you wrote a good email to your vet. I imagine she'll work with you.

Julie
 
Re: Silver - need quick answer

Hi

I too think you wrote a good email to your vet. What you have to remember is that you are living and breathing this and have to cope with the highs and lows and so in the end it is your call. My vet is absolutely fantastic but besides agreeing with the initial dose I haven't consulted him once about changing the dose. I send him the link to the website just for info and ofcourse listen to any advice but he knows that I am getting great help here. If this is going to be a long term issue than we have to take ownership of it.
 
Re: Silver - need quick answer

julie & punkin (ga) said:
Hi Juliet, I think you've gotten good advice tonight and I really don't have much to add. My only thought about the dose is things need to be different for each situation. Because of your schedule I think Silver needs to run a little bit higher. It's not the perfect solution, but it's realistic. If there were a way to leave food, that adds some protection for him, but you can't do that.

Just wanting you to have a little support. It is hardest when you're starting out. It gets easier. I think you wrote a good email to your vet. I imagine she'll work with you.

Julie
Click to expand...


Is it safe to run on the high side?
 
Re: Silver - need quick answer

MommaOfMuse said:
Its much safer than on the too low side of things.

Mel and The Fur Gang
Click to expand...

Ok I brought him down to 1.5 this morning. His AMPS wasnf much higher than his +15 last night thank goodness. Back to square one with Silver. I never was a very patient person :-(
 
Re: Silver - need quick answer

KittyMom777 said:
Ok I brought him down to 1.5 this morning. His AMPS wasnf much higher than his +15 last night thank goodness. Back to square one with Silver. I never was a very patient person :-(
Click to expand...

Being patient is one thing you will learn with this crazy FD dance. I love my vet but since my cats have gotten illnesses in their old age and I got a computer, my admiration only goes so far. When my Tiffany had to start epogen, I listened to dosing by the person I trusted on line that had much experience with dosing. My vet told me all cats develop antibodies. He clearly was doing something wrong with dosing as that just isn't true and my cat didn't have that happen. He never knew I didn't follow his dosing. When I started here I couldn't imagine following this advice over my vet's. I wish I had because we didn't get remission. At some point over the last month or two I stopped emailing the ss. I even have two. One just for my vet. My vet is a diplomat in internal medicine but I guarantee he hasn't seen as many diabetic cats as the dosing experts here. They will make sure your cat stays safe. As already suggested take some deep breaths and get ready for the ride.
 
Re: Silver - need quick answer

tiffmaxee said:
KittyMom777 said:
Ok I brought him down to 1.5 this morning. His AMPS wasnf much higher than his +15 last night thank goodness. Back to square one with Silver. I never was a very patient person :-(
Click to expand...

Being patient is one thing you will learn with this crazy FD dance. I love my vet but since my cats have gotten illnesses in their old age and I got a computer, my admiration only goes so far. When my Tiffany had to start epogen, I listened to dosing by the person I trusted on line that had much experience with dosing. My vet told me all cats develop antibodies. He clearly was doing something wrong with dosing as that just isn't true and my cat didn't have that happen. He never knew I didn't follow his dosing. When I started here I couldn't imagine following this advice over my vet's. I wish I had because we didn't get remission. At some point over the last month or two I stopped emailing the ss. I even have two. One just for my vet. My vet is a diplomat in internal medicine but I guarantee he hasn't seen as many diabetic cats as the dosing experts here. They will make sure your cat stays safe. As already suggested take some deep breaths and get ready for the ride.
Click to expand...

Yes, I struggled with this decision most of last night and came to the conclusion that I am following the advice here NOT the vet. It scares me as I am not the type to think that the trained professionals don't know more, but I have seen that the people on here eat, sleep, dream feline diabetes while my vet does not. So it makes sense who probably knows more. Now that I have made the decision, a lot of the stress will likely be relieved. The vet did not recommend me using methylcobalmin but I ignored her and used it anyways, I hope I am not imagining it, but I think I see a slight improvement. He has only been on it a week though.

Juliet and Silver.
 
Re: Silver - need quick answer

Well the vet just called me at work and I ignored the call.....cant handle it right now. So, I hope I am not alienating my vet! :-Q

Struggling at work today - I don't think I have slept a full night since Silver got diagnosed. My eyes are closing and its only 4pm. Cant wait to get home to my baby. cat_pet_icon
 
Re: Silver - need quick answer

If you do you do, she isn't the only vet office in the world. Heck I'm in a tiny little town and we have only 3 clinics to choose from and I went through all 3 before finding one I liked and could work with. Still love the one before the last one and she is still my go to for everyday routine stuff for the non-diabetics. There isn't a more skilled surgeon around and she is a definite in my book for spays and neuters or anything that would require them going under the knife, but for my sugar babies she is completely clueless, well meaning just clueless.

Its sort of like finding a personal doctor for yourself, you start with the ones closest and the ones friends recommend but that doesn't always mean that is the one that finally wins your business. You need one that has both knowledge and a decent bedside manner and respects how involved you want to be in making heath care decisions. There is no one size fits all.

Mel and The Fur Gang
 
Re: Silver - need quick answer

Yeah Mel but if I find another vet, it will mean going through another exam and blood tests etc for their files and I cannot afford any more vet bills right now.

I just had a horrible call from a friend - a really good friend actually - who is seeing how stressed and tired I am over this and is pushing me to euthanize my cat!! Seriously! I told her that I would not euthanize a human who was diabetic so why would I consider that for a cat. Honestly some people have no tact and are so insensitive. They do not understand "cat people" at all. I was very upset by the call.

Juliet
 
Re: Silver - need quick answer

There is no need for new blood work just ask for a copy " for your records" then hand that to the new vet. I have a binder for each animal here that has a copy of every test ever run on them including xrays. I paid for the tests so I get copies of the results.

Mel and The Fur Gang
 
Vet emailed me this. Do you think I have alienated her? She has obviously been on the forum and read some of my posts.

Hi Juliet,
I just called your work and LMonM, as I do not have a cell phone number.
If you are more comforatble and wish to stay with 1.5U twice daily, then do so. Nothing wrong with start low and go slow.
I looked at the spreadsheet today, all in american units so, a bit difficult for me to get an overview. As much as the values are down at 124, 113, 104, 106, they are not critical to me, they are within the normal limit and they never stay down there for more than 2-3 hours. Not a big deal.
It would be delightful if all cats would read the textbook and respond to the Lantus injections as outlined by Mel and The Fur Gang. Sadly they don't and they do as they wish. I will reiterate, this is not a micromanagable disease in cats.
I will check spreadsheet periodically and look forward to the SLGS 10 day results.
Dr S. Graf

I think I have bought myself and Silver a little time.
 
MommaOfMuse said:
Nope it sounds like she is on board with you slowing things down to me.

Mel and The Fur Gang
Click to expand...

Good :-)

After last night I am so done in I'm going home to test feed shoot then go to bed. Unless of course his numbers are low and in the blues then I'll be back on here and panicking. We have ten days. He's down to 1.5. I'll post his AMPS and PMPS and if you can keep a wee eye on us Mel?

Thx
Juliet and Silver
 
I'm always watching over my babies here just not always posting if someone else has it handled :-D

Mel and The Fur Gang
 
KittyMom777 said:
I looked at the spreadsheet today, all in american units so, a bit difficult for me to get an overview.
Click to expand...

That's easy to sort. If you go to your spreadsheet, right click on the the World mmol sheet tab. You'll see an option to "Move Left". Select that option and the mmol/L values will be the first sheet to display when the spreadsheet loads/refreshes so it will be easier for your vet. US forum members can click on the US mg/dL tab to see the numbers they are more familiar with.
 
Critter Mom said:
KittyMom777 said:
I looked at the spreadsheet today, all in american units so, a bit difficult for me to get an overview.
Click to expand...

That's easy to sort. If you go to your spreadsheet, right click on the the World mmol sheet. You'll see an option to "Move Left". Select that option and the mmol/L values will be the first sheet to display when the spreadsheet loads/refreshes so it will be easier for your vet. US forum members can click on the US mg/dL tab to see the numbers they are more familiar with.
Click to expand...

Thanks Aine. I told her how to look at the mmol/L but that will make it simpler for her.
 
I agree with Mel. It looks like your vet is willing to work with you. Hopefully bringing Silver down to 1.5 will ease some of your stress and allow him to settle into the dose.
 
I hope so. Really I hope to shos her really good stable results in ten days so she will agree to leave me be when it comes to dosing.
 
She can't force you into anything anymore than we can. All she or us can do is give suggestions. Now if Silver had a broken leg and you refused to allow her to set it, then maybe she could call it animal cruelty and have him taken from you. But you are treating his diabetes, you are testing him at home just like a human diabetic and you are doing your best to protect him from an overdose that could kill him very easily...so not much she can do about it if you you choose to ignore her advice besides being a pain in the butt. And she definitely isn't going to be in your house twice a day everyday to see what you are drawing up in the syringe.

Autumn's vet doesn't even have a link to her spreadsheet online. If I want her to see it, I print it off and take it to her, or will pull it up on my phone. Now she does know my user name here and I know hers so its not like she can't come on the board and find my post and just follow the link in my signature anytime she wants. But when she does see Autumn in the clinic what she sees is a happy, healthy, old cat. She moves a little stiff because she's ancient, but she isn't malnourished, she isn't covered in parasites, she's clean and well groomed. Nor does she cower when reached for or strike out in fear at people, in fact she is very social and out going. Now if she drew blood she would also find that she is a well regulated (at least most days until mom get stupid) diabetic cat. Same with Cassanova and Maxwell if you came into my house and didn't know which of the 16 were diabetic you probably couldn't pick them out. Because they aren't sickly cats, they are just cats.

Mel and The Fur Gang
 
Makes sense. Am feeling a tonne better today now that I've made the decision to listen to forum over vet. It was a struggle knowing what to do for the best. Everyone keeps saying it's my decision but out of me, forum and vet - I am the one who knows the least! But I do know my cat and not at any dose have I seen him miserable, lethargic or sick. That's my priority. That he is not in pain.
 
I too like the vet's response. By the way, I have my vet email or fax copies of all tests for my records. I've caught several things that were important to me but not apparently to my vets over the years. If I see something I don't understand that is low or high, I ask about it. My vet doesn't mind at all.

Now you can breath and continue without fear of having to search for a new vet. :smile:
 
your vet's response sounds just fine to me. She's respecting your wishes, and that's the important thing.

As to your question about if it's safe to let a cat run higher - in everything FD we are weighing risks. The risk of going too low and getting into hypoglycemic numbers outweighs every other risk. It's better if Silver isn't high, of course. Ideally, you can try to keep him below renal threshold (the point where his kidneys can't process the glucose and it spills out into his urine) as much as possible. That # varies depending on cat, but is generally accepted to be around 200-250. It can be pretty hard to get a cat to flatten out except for in green numbers, but it's a great goal.

All you can do is what you can do. You love Silver, you have to work, you just do the best you can. That's all anyone can do.

hugs, julie
 
Thanks all.

I hope by the time he's in green numbers I'll be more confident. I could do adjustments at the weekends to get him to flatten in green but I think we're s ways off that yet. Feel like I sm starting all over.
 
Ok that has made my night. Silver thinks he's a kitten tonight and is chasing a piece of rolled up paper round the living room. When I say chasing, he falls over but he's having fun. Picture a drunk trying to run, that's what he looks like. But he's having fun and that makes my night.
 
You might find it helpful to share my signature link Glucometer Notes with your vet. It discusses meters, reference ranges, and the FDA allowed variance in measurement that is allowed.
 
BJM said:
You might find it helpful to share my signature link Glucometer Notes with your vet. It discusses meters, reference ranges, and the FDA allowed variance in measurement that is allowed.
Click to expand...

Well I'm in Canada so we have nothing to do with the FDA. I showed her how to get the mmol/L tab on my SS. She's find now. She didn't like the American numbers.
 
Status
Not open for further replies.
Back
Top