Talked to Vet -- Feedback please?

This is Charlie's 1st week of testing, 3rd week of injecting. I haven't talked to his vet since his initial diagnosis 3-1/2 wks ago. I sent her 2 days of data on Tuesday evening and just heard from her (mix-up with email address).

Here is a summary of the conversation:

1. While she thinks it's great that I'm so committed as to be testing regularly, it isn't necessary.
2. Testing felines isn't the same as testing humans (test before inject).
3. I should do a curve once a week, but more testing than that is not necessary.
4. She wants me to increase dosing from .75 u back to 1.0 u for 2 weeks. See Charlie's spreadsheet for a 64 BG reading on 8/16 which precipitated the .25 u reduction, per the wise people here.
   
5. She agreed on changeover from Vetsulin to Lantus. [Aside: how are shipments working out from Marks Marine now? On time, in spite of the USPS debacle?].
   
6. Lantus dosing would be the same as Vetsulin dosing.

Would sure appreciate hearing thoughts from the FDMB sages. Thanks a million!

 

Going to bite my tongue on this. Your vet doesn't sound too bright on diabetes in general. What kind of doctor doesn't want extra data.
Don't let her degree convince you you don't know what you're doing. You caught that 64 and your vet is poo-poo'ing it. She's not educated on FD.
What was her reasoning for putting the dose back to 1u? Is she hoping for a hypo?

You can always direct her to this lovely article that was done on the priorities and treatment of FD from owners' POV. It basically says most caregivers were disappointed in their vets for not mentioning/discouraging home testing ...

Glad she approved the Lantus but she sounds like she's not going to be much help otherwise.

@Chris & China (GA) might know Marks' current situation on shipping.

 

Haha! The context was regarding testing (humans) vs. nontesting (felines), but now that you mention it...what does it mean?

 

Okay but ... what does she think glucose curves are? That's testing.
Diabetes is diabetes!

 

Great article, thanks! I hadn't run across it here yet.

 

I chuckled when I read about your tongue. She had mentioned previously that she has only one other patient for whom the owner sends in curve data (canine). I remember now that, at the time, she said the other owner sends it to her once a week....just what she suggested I should do. I sense that you're right about her FD education/experience.

I'm mad at myself that I didn't ask her about increasing back to 1 u. That's not like me to not question.

I shared his spreadsheet with her (she'd only seen his 1st 2 days' numbers), and she's going to get back to me Monday after reviewing it. It'll be interesting to see what else she has to contribute.

 

If it were a child, would she give insulin blindly? No.
Creatures may different metabolisms and have different insulin requirements but the rest of it is pretty much the same.

 

The difference between diabetic cats and dogs, is that diabetic cats can and do have the possibility of going into remission, should you be able to get the cat regulated and have it spend time in healing numbers. Meaning, the dose needs can change. So yes, you do need to test.

I actually do agree with your vet on dose. 0.75 units isn't doing much. Reading back on your post when you got the 64, you gave low carb and tested 30 minutes later and got a 221. Makes me wonder if that 64 was a wonky test. If you do get a test that seems a really surprising numbers, it's worth retesting right away. Normally low carb wouldn't bring a cat up 150 points in 1/2 hour.

 

I had to bite my tongue, as well.

The first clue to your vet's familiarity with FD is that she recommended Vetsulin -- an insulin that is far more appropriate to treating dogs than cats. Since you're planning the switch to Lantus, how about helping to educate your vet? This article that I attached is the research that the Tight Regulation Protocol is based on. You could even suggest that your vet visit us here. We've had vets who were not familiar with a particular insulin (e.g., Lantus) join FDMB in order to learn how to manage their FD cat. (It will also help for her to realize that we're not a bunch of crazy cat ladies -- we are but "crazy" in a good way.)

If all of the above fails, simply agree to disagree.

 

I as WELL smh (shaking my head)

Sounds to me like your Vet may be "over taxed" and doesnt have time but once a week to study clients "curves" .

Sorry but...my hubby is diabetic he would NEVER shoot insulin into his body without a test first. and I would NEVER shoot insulin into my cat without knowing if it was safe to do so.

 

Are veterinary medicine students required to complete a compulsory "it isn't necessary" course module before they can be awarded their degree? I have heard vets say this so many times in relation to management of feline diabetics - both personally and in reports from other FDMB members - but I have yet to hear a valid argument* against daily home monitoring of a diabetic cat's blood glucose levels.

Taking your vet's logic to its natural conclusion, then technically it wouldn't be necessary to test any diabetic daily. Technically, there's nothing to stop a human diabetic pulling a dosing figure out of their fundament, administering the injection, then sitting back and crossing their fingers that it doesn't kill them. While it may not be necessary to test, it is certainly unwise not to.

Vets aren't infallible. Sometimes they prescribe doses that are too high (with a frequency that is quite alarming based on the cases we see here). How else can a caregiver protect their cat from such potentially lethal errors than by daily home testing? It's easy for a vet to give testing advice of this nature but they aren't the one holding the syringe day in, day out. If a poorly-monitored cat were to have a fatal hypo, it wouldn't be the vet who had to live with the devastating emotional fallout that would inevitably accompany losing a much-loved member of the family in such circumstances. Such avoidable circumstances.

Why isn't 'test before you inject' the same for cats as for humans?

Why don't cats merit the same attention to their safety as humans?**

What are the pros and cons of daily testing vs. no daily testing?

(Answers came there none.)

Cats are living creatures. Their bodies are not static systems. Their insulin needs can and do fluctuate day to day, as is seen here all the time in our cats' spreadsheet records. We see a far greater quantity of cat BG data here than a typical general practice vet will ever see. Indeed, there are occasions when more newly-diagnosed cats arrive at FDMB in a couple of days than some vets see in a lifetime of practice.

Cats can't go to the cupboard to get themselves some biscuits when they're running low. Neither can human babies. Cats can't talk, so they can't tell someone how their insulin is affecting them. Neither can human babies. Would your vet advocate no daily testing for the latter?

Feline diabetics who are artificially carbed up to reduce the risk of hypos might be able to get away most of the time with weekly curves, but the price for that is a reduced chance of remission, and the very much increased risk of the cat spending a significant part of each day in diabetic numbers, perhaps causing avoidable damage to its internal organs and possibly reducing its life expectancy.

A sub-optimally regulated cat: now that is something truly "not necessary".


Mogs

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[*] I've only been in one situation where a vet made - from where they were standing - a legitimate claim that daily home testing was a bad idea and could interfere with the caregiver-cat relationship because "it would stress the cat out"; legitimate because the testing 'technique' [*cough*] they used in the clinic was appallingly poor: 3 vet nurses needed to subdue my cat, struggling to get samples because they were pricking the cartilaginous part of her ear, ear in complete tatters by the end of the curve they were running. If all home testing experiences were like that, then they might have a case to argue. But they're not.

[**] Some human diabetics could probably improve their overall regulation if, instead of relying solely on preshot testing, they incorporated more frequent nadir checks into their testing routines.
.

 

I suspect you're absolutely right. And, I know that's what I've read here, too.

Vet is saying, though, that FD and HD are different. I took that to mean certainly as far as testing is concerned, since she is recommending none (except weekly curve).

Thanks for dropping in; I appreciate your perspective and your time.

 

Such great perspective, as always Mogs. I told her that Charlie was giving me no trouble with testing or injections (not ABSOLUTELY true, as he is a bit wiggly and winces occasionally). That's also when I should have told her that I'd prefer to keep testing, as there is no downside. When we next speak (Monday), I'll be making that point, and others. Thank you!

 

^ This. ^

This should be fine in the grand scheme of things, Karen, as long as she doesn't try to actively impede your efforts to care for Charlie. With a little time, Charlie's spreadsheet data will do all the talking for you.

I second Sienne's suggestion that you use the Roomp-Rand journal article as a solid foundation for discussions on dose adjustments when Charlie switches to Lantus. I did so with my vet and both of us found it valuable. (I was the first feline diabetic caregiver at the practice to choose to follow the Roomp-Rand protocol.) For info, my vet had a diabetic cat himself and was highly supportive of daily home testing.


Mogs
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Look at the differences humans are larger and STRONGER Cats are small and well not as strong. Not as big with complicated immune systems. To me your vet is endangering the lives of her clients. Besides you dont need her permission to test.
ok off soap box.

 

I, also, was married to a diabetic...I will always test before injecting, no matter her advice. Thanks, Jeanne!

 

I love a good soapbox...I've been on quite a few in my years!!

 

Hi Wendy,
Remission is absolutely my dream...right now Charlie isn't in optimal health, and I feel like I have a second job. Fortunately, I work from home or I don't know what I'd do!

I dropped his dose on advice from, and with numerous concurs from, the kind people here. I hope you won't take offense if I also ask for feedback on your advice to increase back to 1 u? Do meters occasionally do wonky tests? Boy, that's not anything I'd like to think happens very often--one more thing to worry about!

As you advise, if I ever do get a test that feels way out of "normal" I definitely will test again right away, just in case. Thank you!!!

 

To be fair, she offered Vetsulin and Prozin; I chose Vetsulin for budget. Now I know.

Thank for the study! I think I'll email to vet, as well as study it myself. I'll also need to be reading the stickies on the Lantus board to familiarize myself with the differences in Lantus vs Vetsulin. I'll be changing from SLGS to TR...this is an education, isn't it! Some days I feel like my old brain can't absorb one more factoid.

Thanks for your advice!

 

Thanks, Mogs...good solid plan!

 

Thanks everyone for your great insights, perspective and advice.

INCREASED DOSE
I went ahead and increased to 1u and then tested 2X at +.5 -- tests were within minutes of each other--as long as it took me to grab another lancet and test strip: 439 and 416. What would you infer from those numbers? Will test again at +1.

Thanks!!

P.S. his AMPS was 393!

 

Food rise.

.

 

Ahhh...

 

I had to google that. LOL!!

 

I blame the fact that I was convent-educated.


Mogs
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At the time, with you being so new and just learning the testing ropes, a reduction was absolutely the right thing to do. Many things are much clearer in hindsight, and with data gathered since then. You've been doing an awesome job gathering data so far. As for wonky test numbers, they can occasionally happen if you get too little blood on the strips. Not super common as you gain more experience. My girl benefited from an unnecessary feast of high carb food the first time it happened to me. If in doubt, retest.