Hi Kelli,
For information, I have had very mixed experience with the veterinary profession. I've had great vets save the lives of my companions and I've had bad vets fail my companions, leading to the premature deaths of two and very nearly costing the life of a third. Therefore, I very much endeavour to be fair when commenting on things vet-related and I sincerely hope that this comes across below.
all blood values normal except BG (398).
I weighed her again on 1/3/18......9.6 lbs.
Here's a link to the manufacturer's guidelines for starting dose calculation (NB: Caninsulin is another brand name for Vetsulin):
Caninsulin/Vetsulin Starting Dose Calculation
In fairness to your vet, according to the above guidelines he did actually calculate the starting dose correctly:
- if cat's BG >360mg/dL then start dose is 0.5IU/kg.
- Sky's weight at Dx = 9.6/2.2 = 4.36kg (rounded down to 4kg for starting dose calculation).
- Calculated starting dose of Vetsulin per manufacturer guidelines = 0.5 x 4 = 2.0 IU
Also he would have been taking into account Sky's clinical signs when making his provisional diagnosis (PU/PD; poor hair coat condition; unexplained weight loss; cat 'out of sorts').
HOWEVER ... ... ...
My vet did not do a fructosamine test. The BG was from a blood test. He didn't test her urine.
As Janet advises above a single spot check showing a significantly elevated BG level - even taking the above clinical signs into account - is not sufficient evidence upon which to base a solid diagnosis of diabetes. Travel /vet stress can temporarily elevate BG levels as can infection or other underlying problems. A urine test positive for glucose would not have been affected by temporary stressors (shows that the BG was high enough over a period of several hours to cause glucose to spill over into the urine) and, as mentioned above, a high fructosamine test would have confirmed that Sky's BG had on average been in the diabetic range over the last couple of weeks.
I think there are possibly two hiccups here:
- insufficient diagnostic testing and also not factoring in vet stress and time of week when making the decision on starting dose (a more conservative 1.0IU Vetsulin may have been wiser).
- a communication breakdown about the switch to low carb food.
Things your vet got right:
- Suspecting diabetes based on Sky's clinical signs / performing some differential diagnosis between diabetes and hyperthyroidism.
- Starting dose calculation based on manufacturer guidelines and Sky's weight & BG test result.
- Advocating home testing. (This is a
huge plus for your vet!!!
)
- Making sure that you got karo syrup in case of hypoglycaemia.
- Recognising the importance of prompt treatment commencement for a cat who needs insulin. (Some cats needing insulin don't get it quickly enough and as a result can go into diabetic ketoacidosis, a potentially life-threatening complication of diabetes which requires intensive care in a hospital setting and is very hard on the kitty.)
Things I think your vet could possibly have done better:
- Urine glucose test to reinforce provisional diabetes Dx (result won't be stress-influenced) and fructosamine test to confirm provisional Dx. (
Definitely should have done these.)
- Taking into account possible stress influence on the blood glucose test done at time of consultation and factoring that into decision on starting dose.
- Bearing in mind the weekend was ahead and also that you would not have the pet meter till next week, prescribing a more conservative starting dose as a precaution would perhaps have been wiser.
- Given that the manufacturer's maximum starting dose was prescribed, it would have been safer to have monitored Sky's response at the practice to make sure that the starting dose was not too high (as recommended in the manufacturer's treatment protocol).
- Advising you against switching to a low carb food until your meter had arrived and an action plan for managing food transition and dose adjustment had been agreed between the two of you. Bear in mind that the BG number he was working to for starting dose calculation would have been influenced by the carb load of the dry food Sky had been eating prior to Dx. [As mentioned above, I think this could perhaps have been down to a bit of a miscommunication between ye about diet. Happens.
]
I hope you will have a helpful and productive conversation with your vet tomorrow. To his absolute credit he immediately recommended that you start monitoring blood glucose at home. At FDMB we
wish that every vet would be so proactive and safety conscious. Alas, but many vets are positively hostile to the practice so your vet could still prove to be a bit of a keeper.
I hope after your consultation tomorrow that you'll both be able to develop a good action plan for Sky going forward.
One final suggestion: With Sky's blood glucose levels showing such dramatic improvement since the switch to all low carb, wet food it's possible that she may go into spontaneous remission with diet change alone. If Sky still needs some insulin support following the diet change she may now only need a very small dose to keep her in healthier BG numbers. If that's the case then, because of the way it works, Vetsulin may prove to be a bit of a sledgehammer to crack a nut. It typically drops BG levels quite hard and fast producing fairly steep drops in the early part of the cycle and then it peters out a good while before the next dose is due. The steep drops can sometimes make it very difficult to safely dose diabetics who are running in relatively good BG numbers but who only require a tiny amount of help from insulin.
There are other longer-acting insulins with gentler action profiles (Lantus or Levemir) which don't typically produce steep BG drops in the way that Vetsulin tends to, and they have better duration in cats. Assuming that Sky's insulin requirements will be lower now the carb load in her diet has been significantly reduced it may be an idea to discuss with your vet the possibility of switching to one of the 'L' insulins. They may suit Sky's needs better, making it much more straightforward to dose her safely, keeping her better regulated for more of the day, and perhaps seeing her into remission!
(NB: US prices for Lantus and Lev will give you sticker shock. Many of our members get a written Rx from their vets and buy the insulin from the highly reliable Marks Marine Pharmacy in Canada for much less $$$.
Further details here.)
My two penn'orth. Hope some of the above is helpful to you.
Once again,
great job on the testing! Give that girl of yours some scritches from me.
Mogs
.
I'm so glad to hear that she's feeling so much better. 
). You want to get a picture of BG over the course of a normal day.
I had it all in nice columns not run all together.
)