Mogee has been on insulin for a week now with no results.

[Adam Flowers]

Mogee has been on insulin since last Tuesday night, the 26th. He will see the vet this Saturday to discuss the next move, which I am sure will be increasing his dose. I have yet to see him go under 200 and he is on 2 units twice a day.

If anyone has time to look at his spreadsheet posted in my signature, I would appreciate it! Any advice helps!

PS. I am going to talk with vet about food change as well.

 

[FurBabiesMama]

Yes, I think the pretty boy needs a dose increase. If it was me, I would want to try going up just half a unit to see the impact of that rather than jumping up a whole unit right away.

If you get the vet onboard with lower carb food, that should help bring the numbers down some.

 

[JanetNJ]

Mogee has been on insulin since last Tuesday night, the 26th. He will see the vet this Saturday to discuss the next move, which I am sure will be increasing his dose. I have yet to see him go under 200 and he is on 2 units twice a day.

If anyone has time to look at his spreadsheet posted in my signature, I would appreciate it! Any advice helps!

PS. I am going to talk with vet about food change as well.

I didn't get a number under 300 until two months in. It's a marathon.

 

[JanetNJ]

If you want the numbers down just ditch the higher carb dry food. Most of us feed fancy feast classic or Friskies pate foods. You want to pick foods under 10% carb. http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

 

[FurBabiesMama]

@Adam Flowers let us know how your vet visit goes!

 

[Adam Flowers]

Will do! Thanks again for everything! Mogee had his lowest bg at +4 last night, 224. He may have gone under 200 last night but I was too tired to stay up. Vet early tomorrow morning. I am sure we will increase his dose. Going to discuss food. Have a good weekend!

 

[Adam Flowers]

Mogee had his vet appointment this morning. His bg while there was 358.

The vet had him fast and had me not administer his shot this AM prior to our visit.

He wants to increase Mogee to 4 units, twice a day.

I have increased him up to 3 units, twice a day for the time being to see how he adjust, based on what you guys have all told me.

We talked about food, he says I can go to all wet of the Glycobalance if I'd like, but recommended not changing his diet at the moment. I also showed my vet Mogee's spreadsheet and he said I am "doing too much." That I am trying to "micro manage" this and it will take time and to not stress so much. He believes Mogee is close to being regulated and believes this increase will do it.

He also advised against testing him so much as to not stress him, to which I showed him the video of me testing to show Mogee does not mind.

The only thing we did agree on is that it does not make sense to bring Mogee in every other week to get a bg in office, as he agreed my meter is working just fine and that I can call him and update on numbers and we can go from there. That will help with vet bills, so that is one positive from the meeting. He did, as mentioned, advise against testing all the time.

I am going to give it another week or so and see what Mogee's numbers do and then I will decide whether or not it is time to search for a new vet. (I already got another second opinion to which I was told my vet was doing what was protocol.)

Thanks again for all the help. I will keep you updated on Mogee's progress. He seems happy at the moment.

 

[FurBabiesMama]

Doubling the dose is a big jump. I agree with your plan to just go up 1 unit instead. The Glycobalance wet is still 14% carb, but better than the dry at least. It will probably just mean that he will require a little bit more insulin than he might if his diet was lower in carbs. You have not been testing too much. The first time he drops too low, and you catch it by testing, you will get over any conflict you are feeling from trying to listen to the vet on that. There are many examples on this site of people's vets telling them the same thing (or not to test at all) but them quickly finding out the value of the testing. Taking a pre-shot test is necessary to be safe. You just never know if his numbers might be much lower than you would have thought. Like people on here say so often, you would not blindly shoot insulin into a person, so why do it to a cat? Catching mid-cycle tests is helpful, especially when there has been a dose change, to see the impact of the insulin, but if you feel the need to skip any tests, it is better to skip those than to skip the pre-shot.

The thing about testing is, you cannot get SO caught up in the numbers that it is all you focus on. I think that may be the greatest fear of most of these vets who seem opposed to people home testing. You have to pay attention to the clinical signs. If your cat has no symptoms of diabetes but their BG runs on the higher end of what is considered normal, then it is probably fine, and you should not be stressing out and going up in dose.

I am glad to hear the vet at least is not insisting that you come in every other week for a BG test. That would be not only expensive but completely unnecessary.

You look fancy!

 

[Bron and Sheba (GA)]

Hi Adam,

I don't think your current vet knows very much about feline diabetes at all.
It is great you are home testing and asking lots of questions trying to find out what is best for Mogee.

Food is key in getting a cat regulated. You need to change to a low carb wet food early on in the process, not waiting until later.
When you do change over to a low carb wet diet, you need to be testing regularly as the blood glucose will come down and you need to be able to keep your kitty safe.

You are not micro managing or stressing your cat by testing the number of times you are doing it each day.
Your vet wants you to blindly increase the dose without seeing what it does to the blood glucose. That is risking a hypo.
If I were you I would continue testing as you do. I would always get a preshot to ensure it is safe to shoot. And at least another one around the nadir to see how effective the insulin is.

Wanting to increase the dose of insulin from 2 to 4 units is DOUBLING THE DOSE!!
We recommend increasing by only 0.25 units at a time and waiting at least 3 days ...6 cycles....to see how the dose works. Insulin is a hormone and does not work like an antibiotic for example. It takes time for it to adjust the glucose in the body. If you race through the doses you are not doing what is best for Mogee.
Please do not go up to 4 units tomorrow as you have written in the SS.

Do you have honey and high carb food at home in case of a hypo? Here is a link to hypos. I would print it off and put on your frig in case it is ever needed. That is what a lot of us do.
http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

Personally I would be looking for a new vet.

Mogee is beautiful.Keep asking lots of questions, we love to help

 

[Bron and Sheba (GA)]

Hi again Adam,
I just noticed in your SS that in the second day of giving insulin you gave a fur shot then you gave another shot.
We always advise that if you ever give a fur shot....and we have all done it.......that you do not give another shot but just leave it until the next due shot. The reason for this is because some of the insulin could have been injected and we can not tell how much. So it is safer to just and leave it until next due.

 

[Adam Flowers]

Hi again Adam,
I just noticed in your SS that in the second day of giving insulin you gave a fur shot then you gave another shot.
We always advise that if you ever give a fur shot....and we have all done it.......that you do not give another shot but just leave it until the next due shot. The reason for this is because some of the insulin could have been injected and we can not tell how much. So it is safer to just and leave it until next due.

Thank you for the advice and the concern about the fur shot. I had explained in a previous post that it was my second attempt at a shot and Mogee moved at the last second, I hesitated, and pressed down. As I did so, I saw the entire dose shoot across his back. If I felt he had received any of the dose, I would not have re shot. As it was all new to me, I let my nerves get the best of me and I missed entirely. I have become.mote comfortable now. The injections went from my most dreaded thing about Mogee's diagnosis, to one of the most easiest things.

Once again, I appreciate the advice for future injections or fur shots.

 

[Adam Flowers]

Hi Adam,

I don't think your current vet knows very much about feline diabetes at all.
It is great you are home testing and asking lots of questions trying to find out what is best for Mogee.

Food is key in getting a cat regulated. You need to change to a low carb wet food early on in the process, not waiting until later.
When you do change over to a low carb wet diet, you need to be testing regularly as the blood glucose will come down and you need to be able to keep your kitty safe.

You are not micro managing or stressing your cat by testing the number of times you are doing it each day.
Your vet wants you to blindly increase the dose without seeing what it does to the blood glucose. That is risking a hypo.
If I were you I would continue testing as you do. I would always get a preshot to ensure it is safe to shoot. And at least another one around the nadir to see how effective the insulin is.

Wanting to increase the dose of insulin from 2 to 4 units is DOUBLING THE DOSE!!
We recommend increasing by only 0.25 units at a time and waiting at least 3 days ...6 cycles....to see how the dose works. Insulin is a hormone and does not work like an antibiotic for example. It takes time for it to adjust the glucose in the body. If you race through the doses you are not doing what is best for Mogee.
Please do not go up to 4 units tomorrow as you have written in the SS.

Do you have honey and high carb food at home in case of a hypo? Here is a link to hypos. I would print it off and put on your frig in case it is ever needed. That is what a lot of us do.
http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

Personally I would be looking for a new vet.

Mogee is beautiful.Keep asking lots of questions, we love to help

The first thing I was worried about during today's visit was when he wanted me to increase him to 4 units, twice daily. I knew, from my readings on here, that was too much. I also understand from my readings on here that the Glycobalance is too high in carbs.

The problem I am running into is finding a vet in Lincoln, Nebraska that knows what they are doing. I have gotten a second opinion, to which I was told the only change they would make is put Mogee on Vetsulin instead of Prozinc, and said they would use Hill's DM, instead of Glycobalance. They said they would use Glycobalance if they still went through Royal Canin though.

I have called a few other vets in town and have gotten similar answers.

My current vet insists the Glycobalance is good and that it is specifically made for cats with diabetes. He said he has had numerous cats go into remission just with the diet change alone without insulin. I have also read as many reviews about Glycobalance helping cats go into remission and that it helped stabilize their cat, as I have heard about how horrible it is and how kibble is the devil.

Obviously I am not trying to discredit anything I have learned here from anyone or I would not continue seeking advice. I want what is best for Mogee. And each one of you has helped me tremendously along the way.

I guess the next step is to keep Mogee at 3 units, twice a day, watch his numbers, and continue my search for someone in Lincoln, Nebraska who knows what they are talking about. All the vets I've spoken to keep telling me to not listen to the internet and "Dr. Google."

If anyone knows anyone in my area, please let me know. I guess at this time, I am just walking on egg shells with my vet as I can't find another as of yet, and I NEED someone that will prescribe insulin.

Thanks for taking the time out of your day to help me in the right direction .

 

[Adam Flowers]

Doubling the dose is a big jump. I agree with your plan to just go up 1 unit instead. The Glycobalance wet is still 14% carb, but better than the dry at least. It will probably just mean that he will require a little bit more insulin than he might if his diet was lower in carbs. You have not been testing too much. The first time he drops too low, and you catch it by testing, you will get over any conflict you are feeling from trying to listen to the vet on that. There are many examples on this site of people's vets telling them the same thing (or not to test at all) but them quickly finding out the value of the testing. Taking a pre-shot test is necessary to be safe. You just never know if his numbers might be much lower than you would have thought. Like people on here say so often, you would not blindly shoot insulin into a person, so why do it to a cat? Catching mid-cycle tests is helpful, especially when there has been a dose change, to see the impact of the insulin, but if you feel the need to skip any tests, it is better to skip those than to skip the pre-shot.

The thing about testing is, you cannot get SO caught up in the numbers that it is all you focus on. I think that may be the greatest fear of most of these vets who seem opposed to people home testing. You have to pay attention to the clinical signs. If your cat has no symptoms of diabetes but their BG runs on the higher end of what is considered normal, then it is probably fine, and you should not be stressing out and going up in dose.

I am glad to hear the vet at least is not insisting that you come in every other week for a BG test. That would be not only expensive but completely unnecessary.

You look fancy!

I totally agree that I have not been testing too much! I want to know what is going on with Mogee at all times. Especially working 10 hour days. I want to know what he normally does as I hate injecting him and then worrying about him as I have to leave for the day.

Testing is something that I am comfortable with and is something Mogee doesn't seem to mind.

I am really hoping I see some results and drop in his bg at 3 units, so that I can relax a little. I will stay up and get a +6 tonight.

Once again, you are the best. Thanks for all you're help.

https://drive.google.com/file/d/0BxzsZK6pw2BATGxxV3F4TE53WE0/view?usp=drivesdk

 

[JanetNJ]

I wonder why in the world he would want you to NOT give insulin this,morning? That makes no sense. I do think you are due for an increase but I would only go up 0.5 units, stay at 2.5 for about 5 days, then try 3 units. Hoping straight to 4 is dangerous

 

[Adam Flowers]

I wonder why in the world he would want you to NOT give insulin this,morning? That makes no sense. I do think you are due for an increase but I would only go up 0.5 units, stay at 2.5 for about 5 days, then try 3 units. Hoping straight to 4 is dangerous

I am new to all of this. Your guess is as good as mine. I was just as confused as to why he would not want me to give him his injection. I would think not staying on schedule would hurt his numbers. Just one more thing to add to the list of things I don't understand thus far.

 

[Bron and Sheba (GA)]

Love the photo. Mogee is certainly a very handsome boy!

In the beginning of our FD journey, almost all of us have had differences of opinion with our vets.
Almost all vets like to go up in I unit increments or sometimes more.
And a lot of them like the prescription diets.

Mogee is your cat and you ultimately have the final say in his care, not your vet. You pay him for his opinion but you don't have to take it. Don't get me wrong. I think most vets are great people, but they have a lot of different animals and different diseases within the animal to look after and they can't be experts in them all. Treating cats with FD is not like treating dogs with diabetes and that is how a lot of them do it.
We aren't vets, we are just people who look or have looked after a cat with FD 24/7 and we like to pass on our experiences. We have found that going up 0.25 units at a time is the safest way and that using ordinary low carb food is best for kitty.

That is good your vet is happy for you to test and just ring him with results. You don't have to ring that often and he doesn't have to know how often you test. Most of us manage the dosing ourselves with the help of the forum until we learn to do it ourselves, and just go to the vet for other issues and for more insulin. You can just nod your head and agree with him and then do what you think is best.....

 

[FurBabiesMama]

The problem I am running into is finding a vet in Lincoln, Nebraska that knows what they are doing. I have gotten a second opinion, to which I was told the only change they would make is put Mogee on Vetsulin instead of Prozinc, and said they would use Hill's DM, instead of Glycobalance. They said they would use Glycobalance if they still went through Royal Canin though.

It is pretty hard to find a vet anywhere that actually has accurate knowledge about feline diabetes or even feline nutrition. Vetsulin? Uh, no. Don't pick that vet. Their repertoire of foods tend to be the 'prescription' ones under whichever brand they have chosen of the few that cater to vets.

All the vets I've spoken to keep telling me to not listen to the internet and "Dr. Google."

I totally get what they are saying here. It is true that you have to be careful of what information sources you use on the internet. That is why I try to find 'reputable' sources for things, especially for mentioning to vets. You have probably seen me refer to the AAHA guidelines, for example. Sometimes, even the insulin product documentation has information that is helpful. Also, catinfo.org is the work of Dr. Lisa Pierson, DVM. Even one of the vets I had to move on from knew about her work.

As far as him telling you to skip the shot before your visit, that was because he was planning to do a BG test and did not want to get an insulin-impacted number. I had to do the same thing for the vet that diagnosed Mia (the first vet I moved on from). At least mine was also doing a fructosamine test and not just basing her dosing instructions on one random point-in-time BG test result. It is insane to me that a vet would have you come in every week or two for them to do an in-clinic BG test then make dosing changes based on that. And, it looks like Mogee was given a shot at +3? I hope I read that wrong, because that does not make sense, unless you were changing your schedule.

If you have a specialist clinic in your area, you might want to try an internal medicine doctor there, especially if they have a focus on endocrinology. That is where we landed. When I met with this vet the first time, I felt such relief. It had been very frustrating and stressful for me up to that point. I was learning so much, and the vets I was dealing with were telling me things that were so off from what I was learning. With this guy, everything made sense. We had such an intelligent conversation about the whole thing. Nothing he said was contradictory to what I had learned. I wanted to hug him! What I had wanted all along was a 'partner'. I wanted someone with some knowledge and experience with feline diabetes but who was also okay with me educating myself and having a very active role. He gave me an insulin prescription that can be refilled three times and told me to see him every three months unless there are issues in the meantime. He said there is no need for in-clinic BG tests or fructosamine tests since I am home testing. We came to an agreement on the 'no-shot' number and the handling of dosing changes, and he left it in my hands.

I hope you find a vet that you are comfortable with, or at least that you become comfortable with following your vet on some things but making your own call on other things. You seem level-headed. You'll figure it out.