Advice My Vet Gave Me

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Cat Ma

Cat Ma

Member Since 2015
This is not meant to put down vets or techs; many are very good. Some are so-so. Others are simply....(insert your own words here).

One area many of us share frustrations with is our vet's lack of knowledge about treating Feline Diabetes properly. Some vets are awesome in this area but they are rare to find. Many are simply not aware there are several insulins available, they don't understand the impact diet has on BG #'s and they have no clue that home testing exits and is necessary.


What advice has your vet given you?

Mine:

1. You don't need to test BG #'s at home. Bring your cat in every few weeks and we'll check it then.
2. Come back in two months or so for a BG curve.
3. We've had a high success rate with Novolin. In over 40 years of practice, 4 of our cats have gone into remission.
4. Don't change the diet for a few months. We need to see how your cat is doing on insulin first.
5. Your cat's BG # dropped too low? Continue the insulin and bring her in for a BG re-check.
6. We'll discuss putting your cat back on insulin when BG #'s go over 300.
7. I am so sorry your cat has diabetes. Stop the steroids. Bring on the lymphoma! (last sentence is mine)
8. Since your cat has had diabetes, we can't give her a dental under anesthesia. But not to worry. We'll be able to do a full dental without anesthesia. It will be an all day procedure.
9. Your human glucometer is very nice but we have an even better one just for pets! It even comes with a video!
10. Your cat is normal now. There is no need to keep testing her at home anymore.
 
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I was told
1. insulin is a hassle
2. just feed her this dry W/D
3. if we can keep her in the 300's, I'll be happy with that
4. keeping her in the 300's will slow down the damage being done to her kidneys and eyes but not stop it...she will go blind and die from kidney failure
5. bring her back in 2 weeks

(We have never returned to this vet, nor have we ever gotten even a phone call asking how China was doing)
 
I, too, was told by a vet giving insulin was a hassle. I said I'd do whatever it took.
 
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Off the top of my head:

1) wet / low-carb food is for obese animals not diabetics
2) this lovely W/D kibble is fine (although she did go OTJ on W/D)
3) her BG was so high during her curve that we increased the dose by a whole unit
4) bring her back in a week or so to see how she's doing on the higher dose
5) what do you mean that the increase was too much and now she's lethargic, vomiting and not eating? Well you can bring her in for a BG test but we're out of strips so we'll have to send the blood out to get a BG reading. We'll get back to you tomorrow. Oh and whatever you do, don't stop giving her insulin.

I knew she was hypo so I went out and got a new vet immediately.
 
  1. There is nothing seriously wrong with your cat. She is an old lady. Everything you're worried about is normal for older cats. She has had a good innings. (Consult in May '14 where vet refused to carry out diagnostic tests and missed diabetes.)
  2. It might be diabetes but we think there's a build up of fluid in her abdomen. If it is a fluid build up, it's due to nothing good. She may have a few months left; maybe a year.
  3. Oh ... it is diabetes. (After I insisted on diagnostic tests.)
  4. Hill's w/d Dry is the only suitable food. You can never give your cat anything different for the rest of her life. And no treats either.
  5. There is no point in monitoring BG at home. Keep an eye on how much she's drinking. If you must, test her urine.
  6. I'm not going to give you a recommendation for a suitable glucometer. There is no point in home testing. Buying a meter would be a waste of money.
  7. Home testing stresses out the cat. (Erm ... the way you guys test stresses the cat out. If I was as cack-handed at ear sampling as their veterinary nurses were, they'd be right.)
  8. Saoirse "is a true diabetic" with "little or no chance of achieving remission." (Quote from a feline diabetes specialist at one of the most reputable university veterinary hospitals in the UK upon seeing Saoirse's w/d / 3IU Caninsulin curves. Saoirse obviously didn't get the memo because she went into remission four months later.)
  9. No need to reduce the dose. (During dry to wet food transition - ignored my gut & followed advice. Saoirse had a symptomatic hypo ABOVE the hypo threshold that night. Caught it with home testing.)
  10. Still no need to reduce the (now reduced) dose. (Reduced dose anyway, and Saoirse still went very low.)
  11. She doesn't need insulin any more (when Caninsulin too risky to give any more. Numbers started rising after a week and strain triggered a bad pancreatitis flare.)
  12. If she were my cat ... (Erm ... she's not.)
  13. Insulin cannot be administered safely to a cat whose fasting blood glucose levels are below the renal threshold. (Quote from a feline diabetes specialist at aforementioned university hospital. Uses Lantus as an exception.)
  14. You can't blame prescription foods for what happened to your cats. (I could go on at length about this one ... for four of my furry children.)
  15. There's no point in testing frequently. (Really? Vets never get doses wrong? Cats never hypo?)
  16. It's not too high a dose of buprenorphine. It's based on her weight. (Feline diabetes specialist again after I advised her Saoirse was hugely med-sensitive and even an average dose of bupe SID was too strong for her. Rx for larger dose (TID!) triggered a bad pancreatitis flare after only 2 doses.)
  17. Your cat is no longer diabetic. (Wrong. She will always be diabetic. She may not always be an insulin-dependent diabetic.)
  18. She has had things her own way for long enough. She'll just have to get used to it. (This response was given when I rang to request advice on staggering Saoirse's feeds after she started insulin. The diagnosing vet's insistence on Saoirse only being fed twice a day at injection time resulted in Saoirse having very painful and distressing bouts of vomiting. I subsequently ignored their instructions. I wasn't going to see my cat in pain for anyone. I was shocked by the attitude.)
  19. A dry diet is the best diet for a cat. It's just as nutritious as wet food and it's much better for their teeth. (Grrrrrrrrrrrrrrrrrrr...)

But all of those pale into insignificance compared to the reaction from our current main vet when he saw Saoirse after the diet change and a month or so on Lantus:

"I can't get over the transformation in [Saoirse]. If I hadn't seen her notes I would have thought she was a much younger cat."

To our main vet's credit, he also commented that most vets aren't used to having such dedicated caregivers as we have here at FDMB as clients, and that they therefore tend not to give as much credence as they ought to the input of competent and committed pet parents.
 
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OMG, I'm at a loss for words... and that doesn't happen very often. Y'all ditched these vets, right? I'm starting to feel pretty blessed with Hannie's vet.

Critter Mom said:
To our main vet's credit, he also commented that most vets aren't used to having such dedicated caregivers as we have here at FDMB as clients, and that they therefore tend not to give as much credence as they ought to the input of competent and committed pet parents.
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I've gotten this compliment from our vet, as well as from his vet techs. Right on!!!
 
@Critter Mom

#1 Yep, ma'am, diabetes is just an old lady's disease
#2 Or it might just be we don't know what we are doing....
#4 Hill's paid us to say that
#5 Because there's just no point in monitoring....
#6. See #5
#7 Who hasn't been told this?
#9 Let's just keep watching those numbers drop, shall we?
#10 Let's see how low Saoirse can go :facepalm:
#14 The prescription companies paid us to say that
#15 Of course not. That's what vets are for!
 
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I feel blessed.
My vet's first comment when he saw Shiloh's BG was "Well, it's not just a possibility anymore, she is diabetic."
He didn't recommend home testing, but when I asked about it, he said you can if you feel up to it. He wanted me to bring her in a week later for a test, but said if I was testing her at home, I didn't need to bring her in.
I started home testing that day, and started sending him the spreadsheet numbers within a week. He had me adjust up, then told me that I could adjust on my own, based on her numbers.
A month ago, he said she was in remission, and to stop the insulin, but I listened to my gut, as she was still giving me some out of range numbers. He was happy if she was below 250. Me, not so much.
I got her records today and there was a note that said, "Shiloh is well treated and monitored. Mom has sent charts several times."

5 more days!!!
 
I was "blessed" to see two vets after Neko's Dx. Her regular vet, who I talked to on the phone about the initial b/w results, then the locum who was filling in for her while she was away, and showed us how to shoot insulin. I got very mixed messages.
1. Caninsulin is good for cats - it's what we use here. But they only had a couple of cats gone OTJ, those who had been on steroids.
2. You might want to consider testing at home - and it's OK to reuse syringes up to three times.
3. Watch the cat very carefully for about 20-30 minutes after the injection. Nothing mentioned about when nadir might be and that it was a more important time to be vigilant.
4. Have you thought about getting an AlphaTrak for home testing - from the vet who uses a OneTouch in the office. Umm, no?!
5. I wouldn't trust any advice you get on the internet. From the older vet in the practice.
6. You don't need to test any cats for high dose conditions until they get over 10 units. (Neko has 2 high dose conditions and maxed out under 9 units). Oh by the way, it was the internet that suggested I should get her tested.
7. Lantus can be dosed differently in the AM and PM cycles.

And when I saw a second locum vet who showed me how to home test:
1. Lantus is a better insulin for cats. Here's the prescription.
2. Go to FDMB for your dosing.
 
Another one ...

#20: Your cat needs a three-day stay in hospital to get curves run so we can determine the right dose. (Saw me coming for miles ... :oops::rolleyes:)

Also ...

#21: "___________________________" (The advice I received about DKA, diabetic nephropathy/neuropathy, etc.)

.
 
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Some of these posts make me want to go bake cookies for my vet. He prescribed the right insulin, then when I decided to home test with a human meter and use a spreadsheet, he supported that. He was honest about not knowing the conversion be tween the readings of the two meter types. After a few months of gathering data and following the protocol, I brought Mikey in for a check up. Of course, I brought my spreadsheet with me. At the end of the appointment, he said to me, you know what your doing. Just do it. I love my vet!
 
Critter Mom said:
Another one ...

#20: Your cat needs a three-day stay in hospital to get curves run so we can determine the right dose. (Saw me coming for miles ... :oops::rolleyes:)

Also ...

#21: "___________________________" (The advice I received about DKA, diabetic nephropathy/neuropathy, etc.)

.
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Three day stay? :nailbiting:
 
Marycatmom said:
Some of these posts make me want to go bake cookies for my vet. He prescribed the right insulin, then when I decided to home test with a human meter and use a spreadsheet, he supported that. He was honest about not knowing the conversion be tween the readings of the two meter types. After a few months of gathering data and following the protocol, I brought Mikey in for a check up. Of course, I brought my spreadsheet with me. At the end of the appointment, he said to me, you know what your doing. Just do it. I love my vet!
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We need to adopt your vet :)
 
Wendy&Neko said:
1. Caninsulin is good for cats - it's what we use here. But they only had a couple of cats gone OTJ, those who had been on steroid
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And I thought advice from my vet was bad.

Glad you received sound advice from your second vet.
 
Cat Ma said:
Glad you received sound advice from your second vet.
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Actually, I stuck with the first vet. She is willing to learn and work with me, didn't push their food and was open to home testing. I think she was told later by the office manager that they were missing a revenue opportunity on the meters. And got bad advice from a local IM vet on the high dose testing. The first locum gave wonky advice, the second one was great and is now a vet full time there so he's now Neko's back up vet.
 
Cat Ma said:
This is not meant to put down vets or techs; many are very good. Some are so-so. Others are simply....(insert your own words here).
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Oho...here's mine - many of you already remember this from another thread:

1. You don't need to change her food.
2. Inject twice a day (nothing was EVER mentioned about home testing)
3. You didn't follow my directions (spoken in a condescending tone) after I "ruined" Abby's fructosamine test because I "altered her dosage".
4. "This is nice, but it's meaningless" - when referring to the bg chart I'd made.

I am a diabetic myself; I would never, EVER presume to dose myself if I didn't even know how high or low I was.
 
I asked my vet about home testing when Bubba was diagnosed and he said, "I'll teach you how once we get him regulated" Well, it's 2.5 months later and he is not regulated. I just made an appointment with the tech and she showed me how because I was not comfortable shooting blindly.
 
My vet was pretty good while we were treating her. They didn't have us change food (science diet light!) or home test, when we asked why after we had done it on our own they said food changes upset cats' tummies so much that they didn't force that and most clients didn't want to home test :rolleyes:

But this is a conversation I will never forget with one of the other vets in the same office that we have went to for 18yrs. I took Sly in because he was power puking. She had decided he had IBD (bloodwork and xray all clear. just picked that). We were arguing about food.
Me: he should be off of insulin in a few weeks. I don't want to jeopardize remission for a food change if we can find something that works for both issues.
Her: (rolls eyes at me) cats don't really go into remission. If they do it doesn't even last 6 months
Me: (open mouth, stunned look, shaking my head)
Her: Well we've never seen it here
Me: (still to stunned to close my mouth I mutter). But I have had 3
Her: I know you like to keep cats under 100, but that's not necessary. Cats are perfectly fine in the 200s. Most are in the 300s and do just fine.
At that point she stomped out of the room saying she'd call the shelter manager and talk to her about what Sly would eat. Figuring the shelter manager would make me feed him what the vet wanted I am sure. I later got a call from the tech asking me what I looked for in protein and carb numbers so she could look for one that would work for me. Sly is no dummy and just buried every prescription food I put in front of him.

Now this is the appointment I had with Sly's original vet (a ways across town, the reason I took him to my vet's office for the puking). She was also Cecil's original vet for diagnosis.
Tech: I need to get bloodwork to check his diabetes
Me: Here is his spreadsheet, I just checked him before we left home
Tech: (doubtful look on her face) Oookkkk, let me see if this is ok. We probably still need to check it ourselves.
Vet walks in: OH GOOD ITS YOU!!!!
tech: (hands her the spreadsheet) Do you want me to take him back to do bloodwork?
Vet: No we don't have to do anything else with his diabetes. She can handle all of that.
 
Bobbie And Bubba said:
I asked my vet about home testing when Bubba was diagnosed and he said, "I'll teach you how once we get him regulated" Well, it's 2.5 months later and he is not regulated. I just made an appointment with the tech and she showed me how because I was not comfortable shooting blindly.
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"I'll teach you how once we get him regulated"

File this under Bad Advice Given
 
Melanie and Smokey said:
Me: he should be off of insulin in a few weeks. I don't want to jeopardize remission for a food change if we can find something that works for both issues.
Her: (rolls eyes at me) cats don't really go into remission. If they do it doesn't even last 6 months
Me: (open mouth, stunned look, shaking my head)
Her: Well we've never seen it here
Me: (still to stunned to close my mouth I mutter). But I have had 3
Her: I know you like to keep cats under 100, but that's not necessary. Cats are perfectly fine in the 200s. Most are in the 300s and do just fine.
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"Cats don't really go into remission"
Hmmm....where do they go, then?

What a story! Glad it had a happy ending!
 
Critter Mom said:
...most vets aren't used to having such dedicated caregivers as we have here at FDMB as clients, and that they therefore tend not to give as much credence as they ought to the input of competent and committed pet parents.
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Poor Saoirse - I'm just shaking with irritation at all the SCREWED UP comments from vets!
 
When CJ was diagnosed, a staff member at her vet said I'd be getting "diabetes education" including handouts. I went in and was simply shown how to give insulin. No handouts and nothing else was given except a bill for "diabetes education". I asked for handouts several times; none were ever given. Fortunately, by the time I was ready to scream, I found FDMB. The vet later apologized for the lack of "training" I was given.
 
Vet who diagnosed Bertie's diabetes:
1. Feline diabetes is very difficult to manage. Our veterinary nurse (tech) has a diabetic cat and it's not close to being regulated even after 6 months. :(
2. If you decide to treat the diabetes you'll never have any freedom. It'll be like having a 2 year old child around the house the whole time. :(
3. If you decide to treat him you will have to feed this special prescription food twice a day and nothing else. :(
4. You may want to consider having him put to sleep. :(:(:(

Next (and current) vet:
1. Feline diabetes is treatable. :)
2. It would be best if you could feed a prescription diet, but I know you've got a multi-cat household, so I'll understand if you want to feed him the same food to keep life simple. :)
3. [In response to my asking about this] Cats often live a couple of years after diagnosis. :nailbiting:
4. [In response to my asking about this] No, you really shouldn't need to test his blood glucose at home. That shouldn't be necessary. :stop:

In fact, the vet did come to change his mind about my home-testing when he realised how well Bert was doing, and he stopped asking for him to go to the clinic for curves or fructosamine tests. (I am still the only one of his clients who home-tests though....)
The vet is always pleased to see Bertie. For some reason Bertie always makes him smile; maybe because he's the longest surviving diabetic cat that the vet has ever known (touch wood/anti-jinx!). :smuggrin:
.
 
I feel pretty lucky now...its a big clinic and certainly not the cheapest. But I showed up for my last appointment and the vet had printed out Napa's spreadsheet and already knew that morning's result. But I've seen lots of vets over the years and many of the stories above ring familiar. "But with all due respect Dr. XXX, that med doesn't cross the blood-brain barrier!" "Oh, let me get back to you."

So nice having the www, right? Communities of experience, access to vet journal abstracts (and whole journals for me working at a university), and so much other info. I remember the frustration of trying to manage canine ?IBD many years ago without such knowledge.

On the other hand, I sometimes worry that I miss important things so I try to hear the vets out as much as possible without pushing them away or causing them to not tell me things since I seem to know so much.
 
Im currently thinking about switching vets. Mine immediately suggested putting my cat down and then backed up and said it was hard to regulate them. He also refuses to view the walking problem as neuropathy insisting on a blood clot. Though the office has called several times and asked how she's doing on that nice prescription food I'm going to completely stop giving all together. And their hours suck. 9-5.
 
@AliciaG, sorry to say it does sound like it's time for a new vet. Or at least get a second opinion. B12 might really help his walking, I can't believe they haven't at least tried it to see if it would help. And if his BG levels stay up after you switch food, I'd want to start insulin. Just my two cents.
 
I want to start insulin, worried about costs which is another reason I'm looking for another vet. What little we had saved was used up for initial diagnosis (blood work xrays, fee for vet), hubbies in between jobs and won't see a paycheck until october and we're stretched sooo thin and it seems that the emergencies keep pilling up this month.:( Lots of vets want payment for services right away. Looking for someone who'll work with a payment plan. but I'm giving her zobaline every day:)
 
"You don't need to give Luna insulin, in fact that's very dangerous. Just buy my patented brand of raw cat food and it will cure her diabetes right up."

That seriously happened. Last time I went to that vet.

"Should I home test? No, just bring Luna in twice a day, I'll take $5 off each test for you"... Well let me see, at 2x a day, and $5 off each test, that's $280 a week, great idea doc!

Worst maybe was we were told she went into remission off of a spot check... this was before I had a clue, and we believed them, and went months without checking :(

My new vet is nice. He told my home checking was probably not possible, but I went ahead and started doing it and next time I came in I brought the spreadsheet and he was amazed, said in 20+ years he's never seen anyone do it. He asked what I needed him to do and went with it, he's very supportive now.
 
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AliciaG said:
Im currently thinking about switching vets. Mine immediately suggested putting my cat down and then backed up and said it was hard to regulate them. He also refuses to view the walking problem as neuropathy insisting on a blood clot. Though the office has called several times and asked how she's doing on that nice prescription food I'm going to completely stop giving all together. And their hours suck. 9-5.
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AliciaG said:
I want to start insulin, worried about costs which is another reason I'm looking for another vet. What little we had saved was used up for initial diagnosis (blood work xrays, fee for vet), hubbies in between jobs and won't see a paycheck until october and we're stretched sooo thin and it seems that the emergencies keep pilling up this month.:( Lots of vets want payment for services right away. Looking for someone who'll work with a payment plan. but I'm giving her zobaline every day:)
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Wise you are giving your cat Zobaline. That will help with the neuropathy. Glad you're giving up on the expensive prescription food. I gave you a link to a food chart in another thread. We need to file what your vet said under VERY BAD ADVICE MY VET GAVE ME.
 
I was really lucky with my vet. While ultimately I went rogue and changed her insulin from Caninsulin to Lantus, he:

1. Explained that diabetes management was a balance of time, effort, funds.
2. Showed me how to inject
3. Understood the importance of diet, to some degree and wasn't upset that I chose my own food
4. Encouraged me to home test
5. Was very pleased with the data I provided and not at all put off that I did my own curves
6. Told me that cats are capable of achieving remission
7. Told me he wished all his pet parents would put this much effort into their cats' wellness

Taking #1 and #7 into consideration, I can't imagine how many vets worry that folks might elect to have their cat put to sleep if it's perceived as too much effort.

That said, OMG what a pile of absolutely infuriating rubbish some people here have been handed!! I'm ... beyond words.

As a side note, and equally scary and infuriating, what follows is an email I sent to the makers of Caninsulin on June 20 this year, which they did email me back in July and say they agreed it was an error but they STILL haven't fixed it (note to self to email them AGAIN).


My cat was recently diagnosed with diabetes so of course I was doing some research. She is currently on Caninsulin.

I have researched at the CVMA website, and the Feline Diabetes site (felinediabetes.com), and have consistently found that diet also plays a role in diabetes management for cats, which includes a high protein, low carbohydrate wet food.

Your website on this page: http://www.caninsulin.ca/nutrition.asp?context=management_cats states:


Ideally the diet for a diabetic pet diet should supply more than 40% of the calories from carbohydrates and less than 25% of the calories from fat (emphasis mine, screenshot below)

From everything I have researched, I'm guessing that it should read more than 40% of the calories from protein. Ideally, the diet should consist of under 10% of calories from carbohydrates.


Screen Shot 2015-08-19 at 7.31.53 PM.png







From the CVMA website: http://www.canadianveterinarians.net/documents/diabetes-mellitus-in-cats

New advances in feline nutrition have led to a new approach to dietary management of diabetic cats. In the past, fibre in the diet was used to help slow sugar absorption into the bloodstream from the gut. Now we know that provision of a diet with high protein, low carbohydrate and lower fibre will provide optimal nutrition.

I'm hoping this error on your website will be corrected promptly!

​
 
Brashworks said:
I was really lucky with my vet.

Ideally the diet for a diabetic pet diet should supply more than 40% of the calories from carbohydrates and less than 25% of the calories from fat (emphasis mine, screenshot below)

From everything I have researched, I'm guessing that it should read more than 40% of the calories from protein. Ideally, the diet should consist of under 10% of calories from carbohydrates.

New advances in feline nutrition have led to a new approach to dietary management of diabetic cats. In the past, fibre in the diet was used to help slow sugar absorption into the bloodstream from the gut. Now we know that provision of a diet with high protein, low carbohydrate and lower fibre will provide optimal nutrition.

I'm hoping this error on your website will be corrected promptly!​
Click to expand...
​

Caninsulin should hire you to be their proofreader! And I am tempted to move CJ, Bonnie and my family to Ontario and adopt your vet!
 
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