Does Bubba need a new doc?

[Debbie Do]

Bubba was diagnosed as diabetic in March. I'm just not sure the vet I'm taking him to is the right choice for him. Here's what's been going on:

• Took him in because he'd lost a lot of weight. Tests showed BS was over 500. Doc put him on 3 units of Prozinc twice daily and scheduled a glucose curve in one week, then two weeks. She sent me home with a bag of Science Diet dry food.
• Glucose curves showed him staying in the 200 range with a big afternoon dip, so Doc upped the Prozinc to 5 units twice daily and scheduled another glucose curve in a month.
• The next glucose curve started in the low 100's and dipped into the 50's (!) in the afternoon. Doc reduced his insulin to 3 units. That was Friday (6/24). She said bring him back in 3 months. Three.

Because Bubba's BS was so low, I skipped his dose Friday evening and resumed @ 3 units Saturday morning. His appetite started decreasing to the point of refusing any food - even junk food - as of yesterday. I stopped dosing him last night. This evening I started force feeding him. He goes back to the vet tomorrow.

I'm about half an inch from taking him somewhere else. It seems everything this woman is doing - and she portrays herself as a cat specialist - goes against what I've read here and at other sites.

1. She sent us home with dry food that contains starches and gluten. She lectured me on "grain free" mass market foods that aren't really "grain free," because they contain rice and other starches - the same ingredients in SD.
2. She told me to shake the insulin. I read elsewhere to never shake it. She told me to never draw the insulin into the syringe and leave it, because it would react with the plastic syringe. I read other places that it's ok to do this with Prozinc, particularly if you have a substitute care giver come in.
3. She told me that most human glucometers wouldn't work for cats. She said she would check mine (I am diabetic) and let me know. She later said mine wouldn't work because it was 60 points off. End of that conversation. No other options suggested.
4. I have read here that insulin should start in small doses, increase in small doses, and decrease in small doses. She's making big changes without instructions on stepping up or stepping down.
5. Friday's visit didn't even rate a consultation with her. The vet tech came out and told me to reduce Bubba's insulin. I had to ask about his numbers, I had to ask about his weight, and the tech was snotty about it.

There's more, but this rant is getting too long. Please offer comments and suggestions. Bubba would appreciate it, and so would I.

 

[Debbie Do]

I failed to mention that I returned the SD dry and put him on Fancy Feast.

 

[Sharon14]

Wow Debbie I'm glad you found us! 3 units is way too large a starting dose and jumping from 3units to 5 is insane! We all know a human meter reads lower than a pet meter and the protocols take that into account. Have you checked out the ProZinc protocol? http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.109077/
Have you been testing his BG? If so what kind of numbers are you seeing?
Also, have you been testing him for ketones?

 

[Carol & Murphy (GA)]

Oh Dear, I think you have gotten some bad advice - from the Science Diet dry, to starting with 3 units of Prozinc then upping to 5
Debbie - are you testing Bubba- since you are diabetic, you can use your meter - human meters give results lower than the pet meter (the 60 points difference sounds about right) - it is worrisome that Bubba isn't eating well - how is he doing on fancy feast?. If I were you, I would definitely change vets - right away - and begin home testing immediately. You need to be very careful when changing to a low carb wet diet while on insulin because the low carb wet can drastically lower his blood sugar. Do you know any other vets in your area - you can check this site from the American Association of Feline Practitioners to find a member vet near you. Or ask around.

 

[Misterbeesmom]

Please find another vet, yes. You are 100% right on that.

Vets can be disappointing with regards to diabetic management, but she sounds really lacking. As soon as you mentioned she gave you dry food, i groaned. Nevermind all the rest, which is awful.

 

[Misterbeesmom]

Actually in re-reading your post i dont think i'd ever go back to that vet. It sounds like she has made your cat very sick. I'm glad you stopped dosing him! I think that was a very good idea.

 

[Chris & China (GA)]

She told me to shake the insulin. I read elsewhere to never shake it

ProZinc should be "rolled", not shaken....just lay it flat on the palm of your hand and use your other hand to roll it back and forth a few times until it's well mixed.

The human insulins, like Lantus and Levemir don't require rolling at all.

 

[Ruby&Baco]

Actually in re-reading your post i dont think i'd ever go back to that vet. It sounds like she has made your cat very sick. I'm glad you stopped dosing him! I think that was a very good idea.

I think so too! this sounds like a vet that isn't good for your Bubba! She has given you bad advice from what i've read. And i'm so glad you found this forum and already read things about what to do with Bubba.

 

[stacia]

Oh, Debbie... I had a similar situation when my Tasha was diagnosed. The initial dose wasn't quite as high, maybe because her starting BG was around 350, and the other factors weren't as extreme, and still I went and found another vet. In my case, I had to wait a few days to start insulin and found this forum in the meantime so I immediately switched her to Fancy esFeast (the vet advised not switching her diet - then Blue Buffalo dry I think?) at all. When I mentioned that, she didn't want to account for it at all in the starting dose. If we hadn't been monitoring BG at home from the start (with the human meter the vet HATED - in fact, home monitoring was a complete waste in her eyes), we would've killed our cat.

So follow your instinct. Find a new vet. I would suggest posting to the main forum with your general location if you're comfortable doing so and asking for a recommendation. And while I'm not saying this is correct, if it were my Tasha, I'd stop dosing temporarily, change the diet, test (make a spreadsheet), then start your dose much lower based on the new food-improved number. Someone else will have better advice about an actual dose - between 0.5u and 1.0u seems to be the norm.

Best of luck to you and your Bubba. You're on the right track and looking out for him so he's in the best hands - yours!

 

[Misterbeesmom]

Please let us know how Bubba is doing

 

[MrWorfMen's Mom]

human meters give results lower than the pet meter (the 60 points difference sounds about right)

Just to clarify, the difference in readings between the pet meter and human meters increase as the BG readings get higher so that 60 point difference does NOT apply to any reading other than THAT one comparison. There is no linear or % difference that will allow a direct conversion from one meter reading to the other. Add to that the 20% +/- variance all meters, pet and human meters, allowed under FDA rules and even if there were a formula to convert, the variance allowance would skew the numbers.

 

[Debbie Do]

Thank you for the information and support!

There are two vets in this particular office, and Bubba saw the other one today. She seems head & shoulders above the other doc. I felt more comfortable having her care for Bubba. I will never ever ever go back to the other one.

She kept him for about six hours during which he refused to eat (not surprising since that's not his favorite place to be). She didn't find anything disturbing during the exam, but she did a full blood panel which was "supportive of but not definitive" for a diagnosis of pancreatitis. His lymphocytes are low, platelets are low, and Na/K ratio is low (32-41, sodium 145, potassium 5).

Everything else looks normal. He's not dehydrated.

She tested his BG, and I pulled out my meter, to which she replied, "Oh, good, you have one." Winner! His BG was 311 on mine and 350 on hers, 349 on labs. Understanding that it's not going to be a static 40 difference at every level, I can at least get a general idea. Hooray!

Since he was not eating and shows signs of pancreatitis, she said to only give him 1 unit of Prozinc twice daily. She didn't want him to get too low. I'm comfortable with that. She also said that he didn't show signs of pain, but that pancreatitis can be painful, so I agreed to giving him a pain injection that she said would last about 3 days.

She gave him a syringe of recovery food, and gave me 4 cans (for a small fee) to see if that gets him over this hump.

As for the pancreatitis, she said nothing really can be done other than to make sure he stays nourished... she had a term for the care plan, but I don't recall what she said. She didn't seem to think he was in any danger at this point. Not sure if I should be concerned about the lymphocytes, etc.

This evening he is up wandering around, nosing at the dry kibbles that are down for his kitty-siblings, and is not meatloafing like he was last night. He's having a bath in the middle of the living room floor as I type.

Tomorrow he will spend the day with me in my home office area where I can watch water intake and litter box activity. I don't have any ketone strips, but I'm getting some asap.

Things look rosy right now. Cross your fingers.

I'm off to read about pancreatitis.

 

[Sharon14]

Great news about the new vet! For some pancreatitis info, check this out
http://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.79693/
Also when you get that spreadsheet set up, come and post on the ProZinc Forum.

 

[Misterbeesmom]

Wow that sounds so much better!

My boy has pancreatitis too. So far no signs of discomfort, no anorexia. Its been 8 months since that diagnosis. My understanding is to treat the diabetes, and hope the pancreas gets better with good regulation.

Glad bubba sounds like he's feeling a little better, and getting better veterinary care.

 

[Debbie Do]

Thank you for the link, Sharon! I looked at Colin's spreadsheet. I'll certainly try to set something up this weekend.

Jen, that's good to hear. I wasn't sure if pancreatitis meant we needed to start saying our goodbyes. Bubba still wasn't interested in food this evening - even opened two flavors of a new food. Sniffed and walked away! He got a little dinner anyway (we're both wearing some of it!).

 

[Debbie Do]

Just to clarify, the difference in readings between the pet meter and human meters increase as the BG readings get higher so that 60 point difference does NOT apply to any reading other than THAT one comparison. There is no linear or % difference that will allow a direct conversion from one meter reading to the other. Add to that the 20% +/- variance all meters, pet and human meters, allowed under FDA rules and even if there were a formula to convert, the variance allowance would skew the numbers.

Got it. In reading some other posts, I thought that might be the case. The 60 was when he was higher - more around 400-500, and the spread is closer with today's lower BG. Initially, I wasn't sure whether mine was higher or lower, and now I know. While it may not be extremely accurate, I will at least have an idea of how Bubba is doing, not just blindly shooting him and hoping for the best. For that, I'm happy.

 

[Debbie Do]

Oh, Debbie... I had a similar situation when my Tasha was diagnosed. The initial dose wasn't quite as high, maybe because her starting BG was around 350, and the other factors weren't as extreme, and still I went and found another vet. In my case, I had to wait a few days to start insulin and found this forum in the meantime so I immediately switched her to Fancy esFeast (the vet advised not switching her diet - then Blue Buffalo dry I think?) at all. When I mentioned that, she didn't want to account for it at all in the starting dose. If we hadn't been monitoring BG at home from the start (with the human meter the vet HATED - in fact, home monitoring was a complete waste in her eyes), we would've killed our cat.

So follow your instinct. Find a new vet. I would suggest posting to the main forum with your general location if you're comfortable doing so and asking for a recommendation. And while I'm not saying this is correct, if it were my Tasha, I'd stop dosing temporarily, change the diet, test (make a spreadsheet), then start your dose much lower based on the new food-improved number. Someone else will have better advice about an actual dose - between 0.5u and 1.0u seems to be the norm.

Best of luck to you and your Bubba. You're on the right track and looking out for him so he's in the best hands - yours!

Thank you. I had been keeping an eye on Bubba's behavior, and he had started sleeping a lot in the afternoons, about the time he hit the low spot on his curve last week, then would perk up after he ate supper. I had wondered what was going on overnight, if all was well with him. While I'm happy the other vet at the clinic seemed more... thorough, I guess... but they aren't out of the woods yet.

 

[Debbie Do]

ProZinc should be "rolled", not shaken....just lay it flat on the palm of your hand and use your other hand to roll it back and forth a few times until it's well mixed.

The human insulins, like Lantus and Levemir don't require rolling at all.

I don't shake any more. The first doc suggested a human insulin - I don't remember which - and when I checked on cost, it was prohibitive.

 

[Chris & China (GA)]

I don't remember which - and when I checked on cost, it was prohibitive.

Sounds like Lantus and yes, it's very pricey!! Here in the states a 5 pack of pens runs around $500

That's why most of us are now buying it from Canada....in case you should decide to switch, all the information on where we're all buying our Lantus is in this "Insulin from Canadian Pharmacies" post. It's 1/3rd the cost here in the states and a 5 pack of pens is enough to last most cats up to 2 years, so it ends up costing $8-$15 a month when you break it down and that's pretty cheap!!

ProZinc might be cheaper per vial, but it's a U40 insulin, so a 10ml vial only holds 400 units....with Lantus/Levemir, they're U100 insulins, so a 10ml vial holds 1000 units (and a 5 pack of pens holds 1500 total)

They usually end up being comparable in price due to the difference in concentrations (if not actually cheaper to use Lantus from Canada)

 

[Debbie Do]

Sounds like Lantus and yes, it's very pricey!! Here in the states a 5 pack of pens runs around $500

That's why most of us are now buying it from Canada....in case you should decide to switch, all the information on where we're all buying our Lantus is in this "Insulin from Canadian Pharmacies" post. It's 1/3rd the cost here in the states and a 5 pack of pens is enough to last most cats up to 2 years, so it ends up costing $8-$15 a month when you break it down and that's pretty cheap!!

ProZinc might be cheaper per vial, but it's a U40 insulin, so a 10ml vial only holds 400 units....with Lantus/Levemir, they're U100 insulins, so a 10ml vial holds 1000 units (and a 5 pack of pens holds 1500 total)

They usually end up being comparable in price due to the difference in concentrations (if not actually cheaper to use Lantus from Canada)

Oh, my! That's worth investigating. Thanks for the tip!