? Scared, Overwhelmed, Worried- Need dosing advice for Bijan

Hi friends, I have been grateful for this community and your support the last few weeks as I try to help my big boy Bijan and his diagnosis. I have posted a few times in the Lantus forum, most recently here. But I wanted to reach out directly for more help... I can't sleep at night and wake up constantly to check his BG and just feel like I am not doing the right things for my boy I have had him for 12 years and he just turned 13 this February. His older age was also constantly on my mind but the diagnosis makes me fear losing him every day I had suspicions in October that he had something wrong with him but we didn't get diagnosed and started on insulin until December due to my work travel.

I felt we were headed in the right direction with switching over to TR but it has been a bit difficult for me to understand what to do here and if I am dosing correctly. With the forum's advice, we landed on currently 1.25U of Lantis but the idea was to bump him up to 1.5U this weekend when I have time to hang out with him and watch him closely.

I spoke to our Miami vet yesterday and she basically made me feel like I am doing everything wrong. I got the impression when she first diagnosed him she had little to no experience with Feline diabetes as she mentioned needing to consult the lab diagnostic team that ran his testing multiple times... she had me start him on 2 units of Lantis, and wanted me to bump him to 3 quickly because she wasn't seeing the progress she wanted but rather than doing that I turned to the forum. She recommended the RC special diet which even I thought sounded ridiculous as it was dry food. Yesterday when she talked I showed her the spreadsheet and she told me she had "never seen a cats numbers like this", that he was "all over the place" and that "he should have been doing much better by now" that I was messing with his "dose too frequently" and essentially I was doing more harm than good... I asked her if she had other diabetic kitty patients and she told me yes but they were stable for years. She told me to stick with 1.25U until at least the end of the month and then bring him in for labwork to check how he is doing. I am feeling no hope for him going into remission with her.

This all goes to say I don't know what to do. I am thinking of getting a second opinion but I don't know if we can afford time-wise to start all over. I think I gave Bij a fur shot on 2.8 AM cycle and he is bouncing a bit now? is this correct? I smelled the insulin on my fingers.

She couldn't really give me an idea of what to expect when we started this process.. how long to be patient, what an ideal normal curve is... when to increase and when to decrease. Everyone here has been much more responsive and helpful but I feel like I am still not getting this right and my baby is suffering. I am ordering a freestyle lite kit right now to double-check his continuous meter.

He seems fine, he plays with me when I get his toys out.. but sleeps a lot but I can't tell if that's not normal for a 13-year-old cat. He doesn't pee that much anymore but still drinks a good amount of water with his meals. I wish he could talk to me.

Sorry for the long message.. I feel like there isn't really anyone who I can talk to except for you all that understands why I am so worried

 

First of all here is a big hug
I am really sorry your vet spoke to you like that. I don’t think she knows much about FD at all. Her advice on dosing and diet is bad advice.
If she had ever monitored a diabetic cats BG she would know that your SS is typical of a newly diagnosed cat. I can see that Bijan is a bouncy cat and we can see that by the black and red numbers he gets after he goes into blue and green BGs.
Have we given you information about bouncing? I’m on my iPhone atm but will post information after I post this.
And I can see he is responding really well to the Lantus because the doses are bringing him down into blues and greens.
In my opinion you don’t need another vet opinion. And I would definitely not follow your vets advice to stay with 1.25 U until the end of the month. A lot can happen in a month. By home testing you are in control and by following TR you have a proven dosing method that works.
Please don’t let your vet undermine your confidence. You are doing a great job with Bijan. My advice would be to continue doing exactly as you are doing and keep posting on the Lantus forum. I am going to tag as couple of others to give their opinion.
@tiffmaxee
@Bandit's Mom

Bron

 

Here is the information about bouncing from The Basics on the Lantus page

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

 

I agree with Bron 100%. You should never start cat on 2 units or increase by full units. Your instinct about your vet not being experienced with feline diabetes is right. I’m sorry you’re feeling discouraged and feeling guilty is not uncommon. I felt like that too but only felt better like I was doing the right thing for Minnie once I came here. Feline diabetes is a marathon not a sprint so just keep doing what you’re doing. You’re doing great and most diabetic cats live a full healthy life and will die of something completely unrelated, like my Minnie who died of intestinal cancer.

hugs from me too

 

I too agree with Bron. It’s dangerous to increase in whole units plus you could miss a good dose. T much insulin can appear as not enough giving lots of high bg. Bron already explained that when she explained bouncing. One thing I quickly learned here is that many vets don’t know how to use lantus or manage fd. We are here to help you. Keep posting and asking for help. Ask as many questions as you have as no question is a bad one except for the one you don’t ask. Feline diabetes is complicated but luckily this great resource called the FDMB exists. Deep breaths and hang in there. This all will make sense eventually.

 

your in great hands here.....I had a very bouncy boy and this forum surely saved him and he lived a good long life.

 

I'm a big fan of dealing with vets and MDs by hitting them over the head with published research. First, what is your vet basing her recommendations on? If it's her "experience," that's fly by the seat of your pants treatment. In humans, "Guideline Driven Medical Therapy" (GDMT) is state-of-the-art since it is based on clinical research. TR is based on research that was published in a leading veterinary journal. I seriously doubt she's read the research since we use TR and follow those guidelines. I included the pdf for the journal article on TR. Given when the original research was published, she should have read the article -- especially if she's prescribing Lantus/glargine.

All of that said, you want to find a way to not embarrass your vet with what you have read. Perhaps letting her know that you came across this article (bring her a copy) and you're curious about what she thinks since it seems like the authors have published extensively on Lantus and have good results. Doesn't she think this would be a good approach for Bijan?

My vet was one who was a proponent of diabetic prescription food. After being a member here, I brought all of the food I'd purchased back to the vet's office and asked for a refund. When she asked why, I pointed out what the carb count was and that it made no sense to be feeding a diabetic cat high carb food when I could buy Fancy Feast that was much lower in carbs and much less expensive. I honestly don't think she was aware of how high in carbs the prescription food was. (My vet also had a very hard time arguing with me since I have more access to veterinary journals than she had and I brought her the TR protocol to read.)

If you need a copy of the American Animal Hospital Assn guidelines for diabetes treatment let us know. There's a link to their materials in the Health Links.

 

I’m suffering same way as you . I’m not here to give you any advice because I know nothing and seeking advice all the time from this forum. My vet and nurse are lack of experience like yours , they made me to increase the dose 2 , 4 , 6 , 8 …… and nurse is telling my girl is a experiment for her…… but my vet and nurse are really kind heart people and I really appreciate they save my girl when another young vet decides to sleep my girl on first vet consultation after checking her blood . ( she had pancreatitis/ diabetes few other issues on that day) but I have no other vet place to go . You are in good hand with this forum…. I have hopes now with this kind heart people…. I hope you will feel same way …..

Giving you a big hug and wishing and praying for your Big boy to recover as soon as he can ......

 

Thank you so much @Bron and Sheba (GA) @Ale & Minnie (GA) @tiffmaxee @jayla-n-Drevon @Sienne and Gabby (GA) @Din i appreciate your kind words and motivation so much, I cried a few happy tears finally :')

 

this is great advice I think I will try to find a way not to challenge or undermine her but maybe help her see that I am just trying to be as resourceful as possible

 

Did you ever get your kitty angel into a good cadence?

 

he would have times he would go a while in the blues and greens but it was rare ... he was a scuba diver for a while

 

dont let the bouncing discourage you, the wonderful people here will help you and EACH cat is different......it is difficult when you are working I would rec. the slow protocol from my experience. Vets dont seem to understand the bouncing and often give too high of a dose that will encourage the bounce