2/25 - Xander | AMPS 369 - Just wondering what your thoughts might be on vet's advice

[Brianna & Xander]

2/24/25

Morning everyone,

Looks like we're set to have a repeat of yesterday's morning cycle with the same AMPS. Dying to break out of this and see some good numbers again. As always, things were just starting to get going when we had to reduce/skip.

The new vet wants me to send her the pdfs from LibreView (so just the constant curve) a couple of times a week, so she's definitely planning to watch closely. My problem is that the guidelines she sent me for "our plan" are so vastly different from everything I've learned here and have been doing. I don't want to switch to something that seems like it will be a lot less effective than I've seen TR be, but if she's going to be watching that closely I don't know what I can do.

This is what she sent me. Emphasis is mine, just to point out specific things that directly contradict everything else I've read.

NOTE: (rounded down to the nearest unit, and ≤ 2 U per cat q 12 hr regardless of weight).
Base dose adjustments on pre-insulin blood glucose value rather than nadir.
• If pre-insulin blood glucose concentration >290 mg/dL, increase glargine by 1 IU per cat.
• Do not change dose if pre-insulin blood glucose concentration is 220–290 mg/dL.
• Decrease dose by 0.5–1 IU per cat if pre-insulin glucose is 80–180 mg/dL.
• Decrease by 1 IU per cat if glucose <80 mg/dL. If clinical hypoglycemia occurs the dose should be
decreased by 50%.

This seems like a weird mixture of SLGS with something unnamed (increases of 0.5-1 rather than 0.25) while staying extremely conservative (decreasing by 1 if <80). Also the "base dose adjustments on PSBG rather than nadir." There'll be no consistency with adjusting that way and that was my whole problem to begin with and gaining consistency is why I've switched to TR.

She also thinks that he could still be adjusting to switching entirely to wet food in mid-January, but I really think that's resolved by now, especially since he was having like 98% wet before that, it's just when I stopped leaving out any dry food for him overnight (which he almost never touched anyway). And to keep the 1.5 for another full week "at least." I know he's all wonky from the blue and then the reduce>skip>PFS but if he doesn't start responding to the 1.5 in the next couple of cycles I was going to be increasing to 1.75.

I know no one's going to necessarily tell me "ignore your vet," but am I crazy or does this seem like not the best route? I want to continue what I'm doing and see if I can get TR to work, but as an autistic person who struggles with things like self-advocacy and confrontation, I'm honestly a little afraid to not do what she says. Just hoping for some thoughts/suggestions!

 

[Tim & Pookey]

It’s your cat at the end of the day, and you should do what you feel most comfortable with.

I don’t think you’ll get a lot of support for that protocol, it’s just against a lot of what is practiced here as you know. That being said, it’s healthy to keep an open mind and have all the options. I’m sure there are cats who have achieved remission that haven’t followed TR or SLGS. Has this vet had good success with this?

My guess would be you’ll be adjusting the dose so frequently based on pre-shots that things will be all over the place.

 

[Brianna & Xander]

It’s your cat at the end of the day, and you should do what you feel most comfortable with.

I don’t think you’ll get a lot of support for that protocol, it’s just against a lot of what is practiced here as you know. That being said, it’s healthy to keep an open mind and have all the options. I’m sure there are cats who have achieved remission that haven’t followed TR or SLGS. Has this vet had good success with this?

My guess would be you’ll be adjusting the dose so frequently based on pre-shots that things will be all over the place.

Yeah, it doesn't seem even close to anything that's here. If it were at least similar to something here I'd already learned about I'd be more open to trying it. But she also pointed out a bunch of yellows as "looking good," so I'm feeling like her idea of good numbers is much higher than ours.

I have no idea what history she has with treating cats with feline diabetes aside from the fact that she at least seems more knowledgeable than the person she filled in for. Based on my visit I would think more than the usual "vet level" familiarity but maybe still not as much as the veterans here (who I understand are not veterinarians, but you know.)

My thought is the same, that adjusting that way will just make it impossible to see any patterns and that's exactly what I was trying to get away from by switching to TR.

 

[Wendy&Neko]

Our saying here is "you hold the syringe". You have to evaluate what makes you comfortable and what your goals are for Xander. We will support you no matter what you chose, but won't be able to help with dosing if you follow what the vet suggests.

His adjustment in food has already happened, that takes days, not weeks. Now he just needs more insulin. The longer you wait to increase, the more glucose toxicity sets in.

The numbers you see may be actually higher with a BG meter, especially in the lower numbers. Did you ask the vet if the numbers in the "method" above are with a pet meter or a human meter?

I've seen my cat give preshots ranging from over 400 to the 70's on the same dose. Not sure I'd want to dose based on preshots. Much less increase by an entire unit based on that >290. Or decrease by a full unit on a dose getting numbers over 400.

As it turns out, my vet started us on Caninsulin cause "that's what they did". They didn't do home testing and the vet couldn't even show me how. I did like the vet for other things. She scheduled me with a locum vet who could show me how to home test. He got me started on Lantus and told me to go to FDMB and follow it for dosing. (turns out I was already lurking). I stayed with my vet. I did try to get help from her on dosing, but her hours didn't make it easy. Our relationship turned to one of me dropping off weekly copies of the spreadsheet for a couple months, and the vet just asking me what the current insulin dose was.

 

[Brianna & Xander]

Our saying here is "you hold the syringe". You have to evaluate what makes you comfortable and what your goals are for Xander. We will support you no matter what you chose, but won't be able to help with dosing if you follow what the vet suggests

Understood! And I've come to rely on this forum a lot, so frankly I'd rather not adopt it for that reason too.

His adjustment in food has already happened, that takes days, not weeks. Now he just needs more insulin.

This is what I thought too, even though she said differently. I don't feel like there's a chance that he's still adjusting to something he's had for as long as he has.

The numbers you see may be actually higher with a BG meter, especially in the lower numbers. Did you ask the vet if the numbers in the "method" above are with a pet meter or a human meter?

She knows we use the Libre because we can't ear prick, so I assume she meant on the Libre as opposed to a manual reader (whether for humans or pets).

I've seen my cat give preshots ranging from over 400 to the 70's on the same dose. Not sure I'd want to dose based on preshots. Much less increase by an entire unit based on that >290. Or decrease by a full unit on a dose getting numbers over 400.

Exactly! Preshots can vary so much that it just seems like it will cause even more chaos to dose that way.

Our relationship turned to one of me dropping off weekly copies of the spreadsheet for a couple months, and the vet just asking me what the current insulin dose was.

I'm kind of hoping to be able to get away with doing this. Just send the charts and continue dosing as I have been, and explain if she asks what I'm doing but otherwise just kind of float on by.

I know I'm not a vet, of course, I just feel like based on the endless reading I've done and even my own limited experience, following that advice wouldn't be helpful for Xander at all.

Thank you for stopping by and giving your thoughts! I appreciate it.

 

[cecile & bella]

I think I would just tell them "I think I've got it, I'll call or email you if I have an issue, thank you very much for your help". And keep doing what you're doing.
That's basically what I was doing with Bella, my vet always asked how she was doing, I told her the dose and the range of glycemias she had, and she always commented on how well regulated she was and how much lower I kept her than most of her patients.

 

[tiffmaxee]

I agree with the others. I sent my vet my ss every so often. Once in awhile he’d comment he hadn’t seen one in awhile. It’s hard with the Libre ss but honestly I’m goad it was around Max.

 

[bluesunshine]

Early on I struggled with a similar thing with my vet. What she prescribed for Bell was far far different than the methods used here. My vet has a portal where I can write requests and message them, and for areas I disagreed with her approach, I wrote my explanations and tried to cite scientific papers to back why. I am lucky that my vet didn’t knee-jerk reject my (FDMB’s) suggestions and did follow up with her own research. I’m sure I was annoying .

I didn’t have a strong relationship with my vet going into this, and since she didn’t know me well, I think she was cautious to make sure I wasn’t doing anything harmful to Bell. Over time she realized my priority was keeping Bell safe. When I pushed for Bell’s acro and IAA tests, which came back positive for IAA, she told me if it had to be anyone with an IAA cat, she was glad it was me. She had never even tested for it before. Wendy shared a similar story about getting vet “cred” by pushing for Neko’s (positive) acromegaly test.

I do know that this place has saved Bell from a lot of suffering and even potentially saved her life (my vet wanted to start Bexacat and didn’t check ketones). Your vet seems to be engaged (which is good!) so maybe you’d be able to get her to buy-in to the methods used here. There are papers to back TR up. As someone who also struggles with confrontation, I found that writing out my thoughts was a way better approach than trying to rush through a poor explanation of what I am doing with Bell at a vet appointment. You know your vet the best, though, so my approach might not be best for your situation

 

[Briana + Binx]

Mirroring everyone else's comments here. Unfortunately, I think a lot of us have struggled with this dilemma at some point in the feline diabetes journey. Whatever you decide is the right decision for you and Xander, we'll support you as we can. You're his biggest advocate and know him best, I would trust your gut.

I found myself posting here because I felt like I wasn't getting the right direction from my vet and I was at my end. She wanted me to hold my dose without any testing for 7-10 days and then do a curve and adjust based on that one day of testing (amongst other bad advice). I don't think they had the best knowledge on feline diabetes, because after 6+ months they didn't understand why Binx wasn't stable and all they could recommend was an internal medicine specialist. When I mentioned I wanted to try TR they were very hesitant and said they didn't recommend it, but if I wanted to try it and monitor closely, they gave me their "blessing". For the first month or so, I was doing bi-weekly curves with both a human meter (my main testing method) and then a pet meter to give them numbers they could understand. Eventually, I stopped sending numbers and only sent them written progress on how he's doing. Now that they hear he's improving, they are glad and don't ask for more information. It's worked for us, but ECID and it's whatever you're comfortable with.

Whatever your decision, you have support

 

[Brianna & Xander]

I think I would just tell them "I think I've got it, I'll call or email you if I have an issue, thank you very much for your help". And keep doing what you're doing.
That's basically what I was doing with Bella, my vet always asked how she was doing, I told her the dose and the range of glycemias she had, and she always commented on how well regulated she was and how much lower I kept her than most of her patients.

Thank you so much for chiming in! I feel like that's pretty much what I plan to do. If nothing else, seeing good numbers (which hopefully come back soon, fingers crossed) should show that regardless of if I'm following her exact recommendations, he's doing well and is getting better.

 

[Brianna & Xander]

I agree with the others. I sent my vet my ss every so often. Once in awhile he’d comment he hadn’t seen one in awhile. It’s hard with the Libre ss but honestly I’m goad it was around Max.

Thank you as always Elise! At the very least I think the Libre will be okay because she even uses one for her own cat (who is apparently borderline diabetic, but she keeps an eye on it). So at the very least she's familiar with the Libre and isn't bothered by it not being a pet meter.

 

[Brianna & Xander]

Early on I struggled with a similar thing with my vet. What she prescribed for Bell was far far different than the methods used here. My vet has a portal where I can write requests and message them, and for areas I disagreed with her approach, I wrote my explanations and tried to cite scientific papers to back why. I am lucky that my vet didn’t knee-jerk reject my (FDMB’s) suggestions and did follow up with her own research. I’m sure I was annoying .

I didn’t have a strong relationship with my vet going into this, and since she didn’t know me well, I think she was cautious to make sure I wasn’t doing anything harmful to Bell. Over time she realized my priority was keeping Bell safe. When I pushed for Bell’s acro and IAA tests, which came back positive for IAA, she told me if it had to be anyone with an IAA cat, she was glad it was me. She had never even tested for it before. Wendy shared a similar story about getting vet “cred” by pushing for Neko’s (positive) acromegaly test.

I do know that this place has saved Bell from a lot of suffering and even potentially saved her life (my vet wanted to start Bexacat and didn’t check ketones). Your vet seems to be engaged (which is good!) so maybe you’d be able to get her to buy-in to the methods used here. There are papers to back TR up. As someone who also struggles with confrontation, I found that writing out my thoughts was a way better approach than trying to rush through a poor explanation of what I am doing with Bell at a vet appointment. You know your vet the best, though, so my approach might not be best for your situation

Thank you for the thoughtful reponse, Seth! I'm sorry that you can relate to the struggle with confrontation so well, but I'm glad someone understands! I also definitely write things out (and proofread them and maybe have a beta reader too lol) and it's helpful. We'll probably mostly be communicating by email anyway, so that's always my preference.

I think that you're right and that hopefully by being given evidence of the efficacy of TR (both in research and in Xander's numbers improving) that she'll feel less need to hold the reins and just let me update her as I go.

 

[Brianna & Xander]

Mirroring everyone else's comments here. Unfortunately, I think a lot of us have struggled with this dilemma at some point in the feline diabetes journey. Whatever you decide is the right decision for you and Xander, we'll support you as we can. You're his biggest advocate and know him best, I would trust your gut.

I found myself posting here because I felt like I wasn't getting the right direction from my vet and I was at my end. She wanted me to hold my dose without any testing for 7-10 days and then do a curve and adjust based on that one day of testing (amongst other bad advice). I don't think they had the best knowledge on feline diabetes, because after 6+ months they didn't understand why Binx wasn't stable and all they could recommend was an internal medicine specialist. When I mentioned I wanted to try TR they were very hesitant and said they didn't recommend it, but if I wanted to try it and monitor closely, they gave me their "blessing". For the first month or so, I was doing bi-weekly curves with both a human meter (my main testing method) and then a pet meter to give them numbers they could understand. Eventually, I stopped sending numbers and only sent them written progress on how he's doing. Now that they hear he's improving, they are glad and don't ask for more information. It's worked for us, but ECID and it's whatever you're comfortable with.

Whatever your decision, you have support

Thank you so much Briana! I appreciate everyone here's support more than I can say.

It sounds like your vet was a lot like the vet this one is filling in for (this one is a little better, but her advice is still a bit weird). She also seemed concerned by the low numbers and said "I'd be scared to let him get that low, but if you're around to watch him..." Hoping that maybe I have the same result and can keep her happy with updates that show progress, even if it's not gained the way she wanted it to be.