BG 98 at the vet

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Tina and Gracie (GA)

Tina and Gracie (GA)

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I'm a a little bit of a mini panic -and I need help, as my vet will be calling me back and I want to know what to say.

I took Gracie to the vet this morning. The vet asked about insulin and I was honest. I said she hasn't been getting for awhile. She asked why and I stated she is currently diet controlled . . . and you could see the look of annoyance on her face.

She asked what her numbers have been . . . and I pulled up my SS and looked at numbers in the past and she goes "she shouldn't be that low". I then said, well, that is within normal range WITHOUT insulin. It got a little awkward, as she didn't hid her annoyance well, and I didn't back down.

She goes "can I take her BG right now". I said yeah, but it won't truly be accurate, as we are at the vet and there is a level of stress involved.

Oh well, the BG was 98 and she goes "thats actually a little high". I said, yeah, we are also at the vet and she ate just before coming.

Then she said can we do a fructosamine test, and I said no, but then she said "maybe she is diet controlled". This will help us. I gave in--like a sucker.

Anyway, if its "high" she'll want me to start giving insulin again--she didn't say, but I know it'll be coming. I''ll be sure to get the number from her.

I want to be honest with my vet, but $%*& they make it difficult.

I think if her test is high I'd want to get some regular BG home readings first before deciding to jump on the insulin wagon again.

Open to suggestions though.
 
Hi. I do not see any test results on the spreadsheet since 5/30. Is that correct? If it is, I do not think a fructosamine test is a bad idea. It would at least give you some idea of how she has been doing over the last 2 to 3 weeks. If she really is fully diet controlled, the fructosamine should do nothing more than validate that for you and the vet. If she is not, the test may help you discover that so you can take appropriate action. Don't panic! Either way, it will be fine. :)
 
Yes, that is correct. I’m ashamed to admit. Lol

Vet just left a message. Her test was 320.

She wants to do 1/2 “half ” u Prozinc 2x daily then recheck in 3 weeks to say “she’s diet controlled”

Thoughts?
 
Just as a side note...Mia's result in April was 339. She was on 2.5 u twice daily of ProZinc at the time, and her PS numbers were still in the 300s most of the time.

It is hard to have an opinion with there not being any testing data for so long, but based on the fact that when you were testing there were still some pretty high numbers, and that the vet wants her back on insulin based on the fructosamine result, I think it may be a good idea for you to have insulin on hand. A very small dose for awhile may be a good idea. It could be that she still needs just a little help. If you start testing regularly again, you will be able to see what is going on and judge how to proceed.
 
I believe "normal" fructosamine is below 350, so she may still be ok, but I don't think you can really know unless you are home testing. Maybe start testing again before you decide what to do. If she's truly in remission, the daily tests should bear that out, and then I definitely wouldn't give insulin.. but if the numbers suggest she's starting to run high again, she may need a little help. I think testing for a few days before buying the insulin seems like a good idea, just to make sure you actually need it.
 
Even if a cat is in remission, it's a good idea to test occasionally, just to be sure. Cats can and do slip in and out of remission.
 
FurBabiesMama said:
Just as a side note...Mia's result in April was 339. She was on 2.5 u twice daily of ProZinc at the time, and her PS numbers were still in the 300s most of the time.

It is hard to have an opinion with there not being any testing data for so long, but based on the fact that when you were testing there were still some pretty high numbers, and that the vet wants her back on insulin based on the fructosamine result, I think it may be a good idea for you to have insulin on hand. A very small dose for awhile may be a good idea. It could be that she still needs just a little help. If you start testing regularly again, you will be able to see what is going on and judge how to proceed.
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I think I’ll try to squeeze some tests in over the next few days. I won’t be able to get any evening PS number though until Friday or Saturday. Thanks @FurBabiesMama
 
Merp! Those darn vets (I say this lovingly). :D

It's totally your call, Teenuh, but I would not give anything without testing first (I know you know this, but you know I've gotta say it!). My guess is Gracie doesn't need it. Would the vet have you give insulin on a green preshot?? I'd do your AM and PM testing routine when you can (we know life gets in the way) and I probably wouldn't give insulin until I had a few days tests in. I mean, sure if you get a yellow preshot for AM and PM and then again the next AM, I'd probably want to give a bit of insulin support. But if you're getting greens...

I'd get what tests you can, and then decide from there. Post here if you want and we'll help you decide if she needs insulin. I know that can be a hard decision on your own.

As for the fructo...honestly I would put it out of my mind. It just doesn't mean that much and your testing at home will give you whatever information you need!
 
I think your vet needs a refresher on how to interpret a fructosamine test. 320 is still in normal non-diabetic range. At least according to IDEXX. They list this: Normal (nondiabetic) reference ranges: Feline: 191-349 μmol/L

Here is the link to look it up: https://www.idexx.com/en/veterinary/reference-laboratories/tests-and-services/

The fructosamine scale isn't the same as what you see on a glucometer.

But I agree with everyone else: you do need to be testing still ;) :bighug::bighug::bighug:
 
Djamila said:
I think your vet needs a refresher on how to interpret a fructosamine test. 320 is still in normal non-diabetic range. At least according to IDEXX. They list this: Normal (nondiabetic) reference ranges: Feline: 191-349 μmol/L

Here is the link to look it up: https://www.idexx.com/en/veterinary/reference-laboratories/tests-and-services/

The fructosamine scale isn't the same as what you see on a glucometer.

But I agree with everyone else: you do need to be testing still ;) :bighug::bighug::bighug:
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Maybe I should send her the link.

It was probably one of the more weirder conversations I've had with her. I was going to blame my mood to PMS, but now I'm glad I stood my ground.
 
Rachel said:
Merp! Those darn vets (I say this lovingly). :D

It's totally your call, Teenuh, but I would not give anything without testing first (I know you know this, but you know I've gotta say it!). My guess is Gracie doesn't need it. Would the vet have you give insulin on a green preshot?? I'd do your AM and PM testing routine when you can (we know life gets in the way) and I probably wouldn't give insulin until I had a few days tests in. I mean, sure if you get a yellow preshot for AM and PM and then again the next AM, I'd probably want to give a bit of insulin support. But if you're getting greens...

I'd get what tests you can, and then decide from there. Post here if you want and we'll help you decide if she needs insulin. I know that can be a hard decision on your own.

As for the fructo...honestly I would put it out of my mind. It just doesn't mean that much and your testing at home will give you whatever information you need!
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I forgot to ask . . . should I buy the Prozinc? Mine is bad. It froze awhile ago in my fridge. I'm guessing I should wait, but want to make sure. Moreso like a cautious thing.If it turns out I need I'd rather have on me.
 
I would hold off. It’s expensive and even if you get a higher blue or yellow, you’ll want to see more than one before you start and it’s not difficult to find. Most vets carry it, so it should take more than a day to get it.
 
The havoc of trying to find a new vet in the middle of summer school is annoying. I have an appointment for two different practices in the next 2 weeks. I'm debating if I want to tell that I home test, and adjust insulin as needed (even though currently I don't). I know they won't like it, but I also don't want to the this song and dance again of arguing with a vet.

Anyway, the numbers I'm getting are very normal. When my vet called this morning to check on Gracie I stressed that her numbers are technically normal, and the longer iI wait on the lesion--the more of a likelihood she'll come out of remission. She tried to tell me that a lesion wouldn't cause a feline to come out of remission.

Oh well, part of me wonders if she wants me to feline to come out of remission. I know that isn't fair to say, but it has crossed my mind.

I accidentally ordered a bottle of Prozinc too, and its non refundable. I didn't even think to question why my online order was higher. Oh well . . .

Happy Monday. :rolleyes:
 
If you can't use the Prozinc you may want to post it for sale on the Supply Closet forum. I sure hope you can find a vet that will help you and understand why you are advocating for Gracie. Testing is one of the best things you can do, and you know that. :cat:
 
Teenuh said:
The havoc of trying to find a new vet in the middle of summer school is annoying. I have an appointment for two different practices in the next 2 weeks. I'm debating if I want to tell that I home test, and adjust insulin as needed (even though currently I don't). I know they won't like it, but I also don't want to the this song and dance again of arguing with a vet.
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It may not hurt to try to talk to a new vet before going for a visit just to see if your going to be compatible on how to manage diabetes. I was at a point where I could tell in a brief conversation whether or not to bother with a vet. There were two I never saw because it was a definite NO after a quick phone call.

Teenuh said:
I accidentally ordered a bottle of Prozinc too, and its non refundable.
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The expiration date (if unopened) may be a few years out. The bottles I got usually were. So, if you wanted, you could hold on to it for awhile just in case. If you get to within a year or 9 months or something of the expiration, you could try to sell it.
 
@FurBabiesMama
I hate to ask such a silly question, but when you talked to the vet over the phone what exactly did you tell the reciptionist? You wanted a phone interview? Haha. I just want to make sure I ask the right thing.
I actually like that idea. If I don’t like the vet, or we don’t mingle well then why would I waste my money... when I can use for her dental.
 
Idjit's mom said:
If you can't use the Prozinc you may want to post it for sale on the Supply Closet forum. I sure hope you can find a vet that will help you and understand why you are advocating for Gracie. Testing is one of the best things you can do, and you know that. :cat:
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Me too. And I will. It just may take a little more time & patience.
My vet has diabetic felines of her own. I know she tests...why oh why can’t they advocate for the caregivers to test.

My pet sitters vet also claims “felines don’t go hypo”.
 
Teenuh said:
I hate to ask such a silly question, but when you talked to the vet over the phone what exactly did you tell the reciptionist? You wanted a phone interview? Haha. I just want to make sure I ask the right thing.
I actually like that idea. If I don’t like the vet, or we don’t mingle well then why would I waste my money... when I can use for her dental.
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I told them that Mia is diabetic, and I have found that doctors have different 'philosophies' about how to manage it, and that I wanted an opportunity to speak briefly with the doctor to make sure it was going to be a good fit. Be forewarned that not all vets will speak with someone who they have not already seen previously. I had one like that. I ended up having the conversation with his staff member who he had call me. I knew for sure I was not going to take Mia to him after that call!

What are your goals regarding the new vet? If Gracie's numbers keep being 'in the green', you are not going to need to give insulin. Are you just looking for someone who does not have a problem with you testing and who will not try to charge you to do unnecessary tests and push insulin on you when the numbers are good? You mentioned dental... are you wanting a vet who will take care of the dental at a better price? I just want to understand your current objectives (articulating them may help you organize your own thoughts/goals which will make any vet conversations you have easier).
 
Yeah, that was my assumption is that vets will not speak with a "potential" client and rather suggest you come in and have a face to face meeting. My only concern with that is . . . why waste anyones time and money if it won't be a good fit.

My goals are:
-Open communication feline diabetes (likes home testing, is OK without doing curves at the vets office, [but I'm more than willing to do at home], does not push insulin when numbers are good).
-Dental=> Gracie has a lesion on a tooth, and it concerns me that the vet isn't able to get her in for 3 months. Yes, I'm on a cancelation list, but so are about many others. The cost seems high to me. around $1700. Sadly, I don't know what the going rate is. One of the places that I'm interested in going is about half that cost.
Then I hear its actually painful for felines. I just don't get it. If its painful why can't they squeeze her in? The vet who will be doing the procedure tried to assure me she is getting people in as fast as she can.
I know I can't compare human dentists to pet dentists, but when I call my dentist and say I'm having pain she'll squeeze me in, or just tell me to come in and she'll get me in when she gets a chance.
 
About the dental cost: It can sometimes be difficult to compare costs between vets on a dental. Make sure that both are including pre-surgery blood work (if needed), x-rays (much a feline dental problems are below the gums and can't be seen without an x-ray), procedure including extraction(s), IV - makes a big difference in their recovery time, and post-procedure pain meds and antibiotics if recommended. I may be forgetting something here, so someone else might be able to chime in. Regardless, just make sure that the quotes are including the same level of care so you're getting a fair comparison.
 
Teasel's sister's recent dental involved blood work beforehand, cleaning, X-rays, extraction of two teeth (partially resorbed), post procedure pain meds but no antibiotics. The total cost was close to $1700 CAD.
 
I really, really, really . . . dislike my vet now. They are refusing to give the records to me. The potential "new" vet has tried too and they just aren't responding. I went in today and asked to speak to my vet about pain meds and records, as I felt what she was given Saturday worked. I want her comfortable until her next appointment. Now, they are saying I have to go through the office manager. Well, she hasn't returned my phone call or email, or follow up calls. I get the sense she is trying to avoid me. I've been trying since Monday.

I really have tried to be nice. I even slightly adjusted my not so nice Yelp review, but now I'm thinking it needs updating again.

:banghead::banghead:
 
Djamila said:
About the dental cost: It can sometimes be difficult to compare costs between vets on a dental. Make sure that both are including pre-surgery blood work (if needed), x-rays (much a feline dental problems are below the gums and can't be seen without an x-ray), procedure including extraction(s), IV - makes a big difference in their recovery time, and post-procedure pain meds and antibiotics if recommended. I may be forgetting something here, so someone else might be able to chime in. Regardless, just make sure that the quotes are including the same level of care so you're getting a fair comparison.
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I actually just glanced over the estimate and that did NOT include post op meds or blood work. Thanks @Djamila for point out what was missing and what I should look for. :-)
 
Teenuh said:
Are the antibiotics only to prevent potential infection?
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Possibly. The vet can also sometimes see evidence of infection while doing the dental in which case you'd definitely get antibiotics. My vet said there was no sign in Teasel's sister so I crossed my fingers and hoped for the best. It's best not to overuse antibiotics and she's like a slippery fish when I try to hold her for anything meds related.
 
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Yes, and like Kris, my vet doesn't give them either unless there is concern. Blood work is sometimes omitted if the cat has had a recent blood panel and there hasn't been a change in their health.
 
Wow...that's awful! I don't know enough about this to be sure, but I think your vet is required to send records to a new vet if requested. You might try to contact the veterinary licensing board where you are and ask what your rights are...I don't think they can just refuse to give you records for the things you paid for.
 
I think I would set up camp in their office until they gave me my cat's records. That is ridiculous!

If there is any bacteria in the mouth (which there very often is if there are dental issues) there is a risk of that bacteria entering their system resulting in infection. So, antibiotics are often started a few days before a dental procedure and continued for a few days after. The dental specialist who I took Mia and Willow to gave both of them antibiotics for their procedures. I personally like this safeguard, especially if anything like extractions ends up being done.
 
Well, @FurBabiesMama I took your advice. I literally showed up and just waited. The receptionist told me they would send them over. I called the other vet and nothing. I said I was going to wait until they received them and I have a paper copy. She tried telling me a veterinarian has to authorize it. So, I waited and waited, but they kept telling me "you don't have to stay". I said I have the time it's okay.

Well, while I was there I asked about the pain meds for my feline, as they indicated if the Bupe worked they's send some lotion like codeine to a compounding pharmacy. This was on Saturday. Now, the vet came out and tried telling me that lesions aren't always painful and she'd rather I not use it unless she needs it. It's like they think I was drugging my cat for the fun of it.

Needless to say she gave me the script and my records. I went home and typed up a letter and on my way to school I dropped it off and basically fired them.

I couldn't be more relieved at this point.
 
You go, girl! :) I am glad you got the records. I saw your other post about the prescription they gave you.. sorry about that. I hope the new vet works out so much better.
 
Teenuh said:
Not sure if it will come up, but when I mention I home test-if asked should I say I use a human meter?
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If you have any hope to be able to work with your vet, which would at some points probably involve sharing your testing results, you will probably need to disclose that.
 
FurBabiesMama said:
If you have any hope to be able to work with your vet, which would at some points probably involve sharing your testing results, you will probably need to disclose that.
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Just got off the phone with her. She said she was fine with me using a human meter.

The only thing she said that she is not okay with is caregivers who adjust the insulin on their own.

I guess we’ll cross that bridge when/if we get there.

However she did disclose that in the end I would do what I felt was best for my cat.

She said I could always send SS in & get a dose reduction suggestion.

They charge $35 to go over SS though. Is this a thing?

You guys are free and IMO more experienced.
 
So let me get this straight. She says to reduce dose, you have to send her your SS EACH TIME...and she'll charge you $35 a pop?? That's nuts. Some vets will review it for free. And quite frankly, you don't NEED her to tell you to reduce dose. We can help you decide that and you can do it for yourself! I remember I brought my SS to my vet and she looked at it and told me I was doing everything she would have done. And she pretty much let me handle it from then on out!

It's definitely up to you of course. Did she give you any guidelines? Does she expect you to send her the SS and pay $35 if you get a 100 at preshot one night or something?? Whatever you feel most comfortable with is fine, but I probably wouldn't worry about it if it was me. HOWEVER, some vets can get awfully testy if you don't follow their advice and that can be a problem too. I might be more willing to work with the vet if the $35 thing wasn't there (clearly that part bugs me :) ).
 
In light of how awful some vets are about all of this, she does not sound that bad to me. She did not give you grief about home testing or using a human meter, and she acknowledged that you will ultimately do what is best for your cat. You are not even having to give insulin right now, correct? I would not worry about what she said about dose changes. Like you said, cross that bridge if/when you get there. You will be able to decide what to share with her and what not to share. You still have the option of getting advice here then determining what you want to do. And, you know that if you do want her to review your data and 'bless' your plan of action at some point, she will do it. The $35 part stinks, but yes, that is 'a thing'. Did you get a chance to watch that video I gave you a link to in the other conversation? Here it is again. I found it interesting hearing vets discuss this topic. http://veterinarymedicine.dvm360.com/home-diabetic-monitoring-how-much-should-you-charge

So, what did you think of the vet? Did you 'like' her based on the call?
 
@Rachel- that is what it sounds like. I plan to clarify at my appointment Thursday. I don't want to sound picky, but I want to point out that it did take her almost 4 days to return my initial phone "interview". I'm certainly not going to wait 3 days for a dose reduction if my FD crew (you guys) feel it is deserved. Now, I could also argue that I'm not "yet" her patient so perhaps the priority wasn't as high, or maybe there were emergencies she was dealing with at work, or other personal stuff going on. I want to try to give her the benefit of the doubt.
She didn't call until after 8pm last night. At least she called.
I'm documenting all of this on my SS so I can reference back in the future if needed.

She hasn't given me any guidelines yet. I'm guessing she will at our appointment, or if not I will ask.

I'm definitely going to set my limits and be be vocal this round. I want to start on the right foot and have an honest (mostly) relationship. Even if that means me telling her . . . I don' t feel comfortable doing XYZ here is what I want to do instead and this is why.

Are there any other questions you think I should ask? You guys are better at this than me.

Side note: She said they do not carry Bupe at that office, but it sounds like she would be more than willing to send to a pharmacy for me. and She "usually" uses Gabapentin for cats. I did some research, and it doesn't appear to be as strong as say Bupe, or the Morphine I'm using on her right now.
 
@FurBabiesMama I like her so far. I just really hope this isn't a front on her end. Several people in my local FB cat group have all said good things about her. Only time will tell though.

I don't think I saw that video on our other convo, and if you sent it then I read over it by error. I just watched it though. I get it is a thing, as it does take time out of their day, but hell if I'm coming in regularly and getting routine labs then I kind of feel like you owe it to me. I might think differently if you send them a whole email with a list of questions, and photos. Then I could see why they might consider charging.

I think medical professionals are trained on this stuff in school. It's how they make money.

Also, this got me thinking. The health group I am apart of offers the connivance of emailing your doctor and sending photos for medical advice. Some providers opt out this and still require you to come in for an office visit and others are fine with a email appointment and send something over. I'm all about simplifying life.

I would rather someone else go to the doctor who really needs it. Something that can be handled over email or the phone should be.
 
This is just painful to read.
My sisters and BIL's are all so arrogant and condescending. The kind of people who know they're the smartest people in the room, have never been wrong about anything and may mumble "I'm sorry" every five years but then deny it. After all, they went to university! My dream is for someone on a plane to ask "Is there a doctor on board?" so I can throw my sister into the aisle.
My vet and my alternate vet use their first names, my primary vet will sometimes ask my opinion of recent hires. The alternate vet boarded Noah last month and was very eager to learn about bouncing. Our primary has not even seen Noah in 2+ years, I just phone in when I need his BUPE. Sadly her staff still don't know what a unit of insulin really means. Its a...you know...the lines on the syringe... a unit!
I'm glad you stuck up for yourself. Why some people cannot conceive of another person being as able as themselves really burns my bum. Are they taught that in med school or is that the kind of people med schools attract?
If I want a new family doctor here we have to do a meet & greet first. So someone is going to look at my list of neurological nightmares and think I'm the ideal patient?
Did I mention sister #2 kept her boy in diapers until he was 4? Apparently his IQ is off the scale but he enjoys that warm, squooshy feeling. Oh that's good.:oops:
This is where two of our cats came from. Someone had locked Lewis out on the 7th floor balcony to teach him a lesson. He's asleep on the chair next to me now.
Sorry for venting everyone.
 
FurBabiesMama said:
You crack me up!
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Every mommy thinks their kids are special but having it mushed in your face gives me a rash.
I don't recall having a gluten-free fair-trade ancient-grain childhood and look how I turned out. :rolleyes:
boohoo_08.jpg
Hey, look how big that kid's head is! ;)
 
@Noah & me (GA) you are funny.

Every parent thinks their kid can do no wrong either.

Many of that sh*t are fads, at least that is my opinion. I can't stand it when people brag about the keto diet. My co-worker is on it and she literally ate bacon for lunch. All she was concerned about was the carbs. She was like "at least there are no carbs". Yeah, but now you are going to have high cholesterol instead of diabetes.
 
Sister kept blabbering about her kids being 'Star Children' and did I know what that meant yappy-a-dee-yap. If you set the bar too high someone will appear to fail.
Sometimes when something sets me off I need a reminder I've chosen to surround myself with normal people like everyone here. I'd go a little bonkers without the release I get from posting here.
As for fads I like to ask for an ashtray, extra gluten and Styrofoam when we go to our favorite greasy spoon. :oops: o_O
 
@Rachel @FurBabiesMama @Kris & Teasel @Noah & me (GA)

Here is the scoop on the new vet. She did confirm that there is a charge to review SS, but didn't say I had to send it all the time.

She also indicated that she isn't going to be real concerned about BG numbers until I get several in the in the upper 200's and the stay that way for a week or so. Then she asked I contact her.

She indicated she doesn't like it when the caregivers adjust the insulin based on BG number. But she stated that if I chose to do that she can't "approve" it, as her license at at stake. But she also hinted at . . .in the end you'll do what you want to do, as she is my cat and I know her best.
So, maybe the adjusting insulin will be a don't ask don't tell clause.

She likes home BG testing and home curves.

Prozinc is not her first choice to go-to insulins, but stated she is fine if I wanted to continu to use that. She likes Vetsulin, or Lantus, but indicated many patients shy away from Lantus due to the cost.

She got my cat in for a dental next Thursday. Woohoo.
She actually thinks there are two teeth that may need to be pulled. The high cost for this place is also $800 less.

I found out my old vets office was a "dental specialist". She wanted to be very clear and tell me that RVT do the work and she or another vet oversee the procedure.
She said I could opt to see a "dental specialist", but indicated there were only 2 in the greater Sacramento area. Which is ridiculous if you ask me. One of them being my prior office and the other being UCDavis. Both of which are booked out for months.

What do you guys think about RVT doing the actual work?
 
The new vet sounds very promising! (Hopefully, you will never need to use insulin again, but if you do.. I would not consider Vetsulin. Stick with ProZinc - don't you have a brand new vial anyway?! - or go to an even longer-lasting one like Lantus, or Levemir.)

As far as the dental... that is completely up to you and whether you are comfortable with a vet tech doing the work. It sounds like the only other option would be to wait months, so that has to factor in to your decision. I am fortunate to have access to a wonderful dental specialist, so I choose to take my girls to him. But, your situation is different, so you have to weigh your options and decide what feels right for you. Years ago, I did have dental work done in my regular vets office, and it went fine. A lot of people, I would say probably MOST people, have it done in a regular office. The vet techs probably do it more often than anyone realizes.. at least your vet was very up front about that.
 
Teenuh said:
as her license at at stake
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Why is everyone so worried about covering their butt? Someone has been watching too much Law&Order/Special Veterinarian.
The anesthesia is the biggest concern during dental work, NOT the dental work itself. Everytime I've been operated on the first person I was sent to was the anesthesiologist, a tech does the EKG.
 
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