Vet etiquette after hours

Status
Not open for further replies.
majandra

majandra

Member Since 2018
I have unexpectedly come across a couple days that I can monitor my cat for starting insulin. I have not discussed brand or dose with vet since last appointment, but we had planned on insulin if her numbers weren't better after her dental procedure. I have Lantus given by a friend who no longer needs insulin.

I would prefer to not bring her in for an appointment to pay $70+ only to discuss insulin and get a weight, and I don't believe I have a day that I can bring her in for at least a week, and especially not a day that I can monitor. *edit- I may have time monday morning, but I work after*

So my question, after saying all that, is would it be considered poor etiquette to call the after hours number and hope that my vet is on call, to ask if he is ok with starting low dose lantus tonight/tomorrow morning? If it isn't my vet on call, then I definitely wouldn't know what to do. This is not an emergency, just a scheduling nightmare mixed with me worrying too much about initial dosing while working.
 
You and your vet planned on insulin but did he specifically recommend Lantus? If she is definitely diabetic then you'll have to start somewhere but the dosage and especially the type of insulin is the doctors call even at an extremely low dose. Check the Lantus your friend has for an expiry date and make sure it has been stored properly.
As far as etiquette goes most doctors have to believe in you meaning you know what syringe to use, how to measure a unit (not necessarily the same with every insulin), where to inject and a bunch more things. Our vet has known us since 2002, 14 cats (2 diabetic) and 2 dogs so she gives us repeats on insulin and even BUPE without having us visit the clinic. That kind of trust is rare and she is more than our vet, she is a close personal friend so I never want to make her look like an idiot by abusing that trust. She gave us her home and cell numbers years ago.
Vets are doctors and can get into a lot of trouble by expecting you to do the right thing. If her license to practice is suspended her clinic is finished. Even allowing me past the "employees only" sign violates her insurance but I've been called back there when it took five of us to get a blood sample from Andrew. He was a known biter but he was very sick so we had to have that blood sample.
Any vet that has an after hours number should expect more than just emergency calls. If not than they're in the wrong business. All you have to do is be ready with your questions and be as brief as you can. He's a vet, not the Pope and he made an oath to help you.
We had what we thought was a great vet once, maybe it was just his staff that were nasty. Leroy was 23 years old and on a Saturday morning I made the call, Leroy's time had come and no alternate treatments or heroics would save him. Those idiots would not squeeze him in and we ended up at an emergency clinic. Poor Leroy was almost dead already by the time our name was called, I'll never forgive that.
You have nothing to lose by calling after hours.
 
Thank you,

As far as the insulin goes, exp is 2020 and stored properly.
We do not have an extensive relationship built yet, so he may not be comfortable with phone advice. Hadn't thought of that.
 
He knows I am more than the average person given that I've been home testing and shared spreadsheet with him, but that's likely not enough to prove anything!
 
I would say it depends on the relationship with your vet. I have a great one and if needed I can just email in a question or when I am doing a prescription renewal and leave a note for her on something that is happenening-- 9 times out of 10 she will call me. We have been her clients for awhile now and she has gotten us through a couple of really bad situations and have been kind at the end.
 
We've just had incredible luck finding great vets but first you have to get by the front desk. I had a vet in Edmonton that by chance graduated with a vet in my new neighborhood in Toronto. That vet knew our vet here, that was 16 years ago. She even opened up on a Sunday morning for us, we took our dog for her last walk (dementia) and there she was with my favorite tech waiting at the door for us.
Just like emergency rooms the doctors can be great but it's the nurses that take all the crap and sometimes are quite miserable themselves.
Just like our local Nurse Mildred Ratched. She makes my skin crawl.

nurse_ratched03.jpg
 
Lantus is a good long lasting insulin that has shown good results with kitties. The best approach is to get the penfills and use a regular syringe to draw up the insulin. This allows for smaller increases or decreases since the pen mechanism only measures by 1 unit changes and 1/4 unit changes work better with kitties. With Lantus the initial dose is usually 1 unit every 12 hours. You would need to have U100 syringes, preferably with the half unit markings. You would test before each shot, with no food having been eaten for at least 2 hours beforehand. Then you would want to test at +2 hours after shot, +4 hours, +6 hours and +8 hours the first day or so ( as much as is possible) to get a feel for how the insulin is working for Rhubarb.

These are the syringes I use ( I am in Canada so this is what is available at the pharmacy)

51rD15GM-WL.jpg


It would be good to read through at the stickies ( in yellow) at the top of the Lantus forum:

http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

Rhubarb's numbers are not terribly high, but she looks like she needs some insulin to get those numbers down into lower ranges. Have you changed the food to low carb wet and removed any dry food? Food changes can make a difference in glucose levels. You have started home testing and are doing a spreadsheet so you are well on your way to getting Rhubarb into healthier numbers.


ETA When I first started with FD (4 years ago) I went for the orientation session to be shown how to give insulin (Lantus at that time) It was a waste of time and money and I learned FAR more reading the information and asking questions on this forum. The clinic I went to ( and left after a month) sold me repackaged Lantus and gave a lot of wrong information on giving insulin. I was told NOT to home test and bring my kitty back in 2 weeks for a curve. I did this ONCE and for two FD kitties I have never done a curve at the vet since.
 
Last edited:
@Tuxedo Mom
She is on low carb wet, no dry since beginning of Oct. Her urine glucose on keto diastix measures just below 28 mmol, and meter reads on the low side of the 15% variance. I really hope that just a short course of insulin gets her back on track since her numbers are still lower than many that use same meter.

For the rest of the reply, thank you. Been reading stickies till my eyes cross, and it's nice to have the cliff notes version here :)

For vets, I'm guessing that we will have a great relationship based on experience so far, but I haven't had need of it before. It's too bad my equine vet doesn't do cats- we have an amazing relationship, developed quickly due to horses being horses (lol/facepalm).
 
majandra said:
@Tuxedo Mom
She is on low carb wet, no dry since beginning of Oct. Her urine glucose on keto diastix measures just below 28 mmol, and meter reads on the low side of the 15% variance. I really hope that just a short course of insulin gets her back on track since her numbers are still lower than many that use same meter.

For the rest of the reply, thank you. Been reading stickies till my eyes cross, and it's nice to have the cliff notes version here :)

For vets, I'm guessing that we will have a great relationship based on experience so far, but I haven't had need of it before. It's too bad my equine vet doesn't do cats- we have an amazing relationship, developed quickly due to horses being horses (lol/facepalm).
Click to expand...


I use the AT2 pet meter with the FS Lite as a back up. You are doing a great job with proper food, monitoring and having the dental done first. Some kitties do well just with a food change...others need some "help" with insulin shots to get the numbers back into better ranges. Looking at Rhubarb's number so far she seems to be holding in a fairly tight range, but just a bit too high. Using insulin at this point would help her to bring the numbers down and give more time for the pancreas to 'heal'. Kitties have the ability to regenerate their pancreatic cells that produce insulin normally. Keeping the numbers down helps the pancreas to 'heal' and hopefully start producing more insulin on their own.

I am in Winnipeg and my first vet was not very helpful...most of the communications were done through the vet tech ( not very knowledgeable about FD). After a month I 'interviewed' a different vet without my kitty and chose to go with her. Although I don't see her much she respects my insights and is always open to my concerns. Finding a vet that will work with you is priceless!!


BTW I buy my test strips ( which are the most expensive part) at Shopper's on Thursdays ( in Manitoba anyway) They give 20% off for seniors (age 55 +) which saves me about $20/100 on the FS Lite strips. If you qualify or know someone who is 55+ it is a good deal without having to order online. PLUS the Optimum points add up....I save an extra $200/yr with the points. :)
 
With Rhubarb not being very high, you might want to consider starting at .5 unit but you'll need syringes with half unit markings.

It's a lot safer to start low and work your way up if needed!!

My own cat hasn't been back to the vet for her diabetes since she was first diagnosed over 5 years ago. The vets around here don't know anything about FD so I chose to listen to the people here who live and breathe it 24/7/365

We can help you with dose adjustments and then maybe when you do see your vet, they'll be impressed with how much you already know and what you're already doing!
 
Would it hurt to pick up the syringes now, regardless of the type of insulin she ends up on? From the reading I did, it almost seems like using conversion chart for u40 to u100 is easier for fine dosing.
 
If you’re sharing your spreadsheet with your vet, does that mean you have an email? If so, email and ask your question. If your vet says make an appointment, wait and take her in as requested. One week shouldn’t make much difference because she isn’t too high.
 
Maggies Mom Debby said:
If you’re sharing your spreadsheet with your vet, does that mean you have an email? If so, email and ask your question. If your vet says make an appointment, wait and take her in as requested. One week shouldn’t make much difference because she isn’t too high.
Click to expand...

I have the main office email, so I emailed friday afternoon asking if my vet could call me after reviewing spreadsheet if he had a chance on monday.
On a side note, is there any way to make the spreadsheet link a little less .... bloated?
 
majandra said:
Would it hurt to pick up the syringes now, regardless of the type of insulin she ends up on? From the reading I did, it almost seems like using conversion chart for u40 to u100 is easier for fine dosing.
Click to expand...

***Disclaimer: I am very tired and its been a long day for me, but I don't want to let this pass by without clarifying...

You mean that you would be buying U-100 syringes now -- Then if you use Lantus you are fine as is, but if you end up with a U-40 insulin, only then would you make the conversion? If he answer us YES, then you are good.

I just wanted to be sure: A) you knew Lantus was U-100 and not U-40 (it's happened), B) you didn't buy U-40s now and then end up trying to convert the wrong direction if using a U-100 insulin like Lantus (if this doesn't make sense, then ignore me because it probably means that you're ok).

We've seen people make all kinds of mistakes, unfortunately sometimes based on their vets instructions (or at least *their understanding* of their vets instructions...which could be a totally different thing) -- like someone giving 10 units instead of 1 unit on their very first shot. So I try not to assume anything without clarifying it.

Personally, I would vote for going in for that first visit if you can just to make sure you are solid on what to do. How to draw up the shot, how to inject, etc. We've certainly taught people here via descriptions and videos, but an in person visit might be worthwhile.

My sleepy two cents worth,
Sandi.
 
I'm thinking it may be a good idea to stop in for that visit too, if even to have a tech show me.
And yep, I know Lantus is u100, and I would only be doing a conversion if I had u40 insulin like prozinc.
Thank you for helping clarify dosing there- I appreciate it, especially after reading how easy it is to make a mistake! Pretty sure I will be posting a photo of drawn syringe before first shot to be extra sure.
 
majandra said:
@Tuxedo Mom
Where do you buy the syringes? Nowhere seems to have them here!
Click to expand...


I am in Winnipeg so they are available at Shopper's Drug Mart, Walmart, Safeway or Superstore. I didn't check PharamPlus, but they may have them too. You have to ask at the pharmacy for them, Having a photo would be good, since when I first started buying them, they didn't even realize that they carried the syringes with 1/2 unit markings

51rD15GM-WL.jpg


This type comes in 6mm and 8mm needle lengths, although all I can find here is 6mm
 
The only place I didn't check was walmart- Independent here said they would have to order them, and the lady wasnt sure why they were any different. Rexall has theirs out on regular shelf and had none. Most stock wad 29ga too
 
My Walmart usually carries the syringes Tuxedo Mom provided pic of, but sometimes they were out and then they would order them for me.
 
majandra said:
Would it hurt to pick up the syringes now, regardless of the type of insulin she ends up on? From the reading I did, it almost seems like using conversion chart for u40 to u100 is easier for fine dosing.
Click to expand...

Depends... Where I used to live, if I bought syringes with a prescription, there was no sales tax, but there was if I bought with no prescription. 11 plus percent difference nothing to sneeze at.
 
majandra said:
He knows I am more than the average person given that I've been home testing and shared spreadsheet with him, but that's likely not enough to prove anything!
Click to expand...

My vet insisted on office visit so vet nurse and tech could train me before providing prescriptions.

I think an email would be best, but probably plan on an office visit for training before getting prescriptions
 
Last edited:
I ended up booking an appointment for monday. My vet has been out on farm calls all week, so if he got my email, he has had no chance to call.
I'm more comfortable learning to give needles under guidance anyway, and hubby can learn at same time too.
 
Are you using two vets? An equine vet and a "city" vet? Most people who have never owned a horse or lived on a farm don't know the crazy hours a rural vet keeps or the insane amounts of money it can cost to keep just one horse healthy. Our city is on the edge with rural Ontario and we have a store/feed lot that sells stuff like electric fencing and 50 pound bags of "barn cat" cat food for $20. It's a totally different world out there where livestock comes first and a 22 is euthanasia for a sick cat.
I'm assuming from what you've said that you own a horse and none of this is news to you but there are vets somewhere on Earth that can't make sense of why anyone would care for a diabetic cat. Just make sure you and your vet are on the same page.
Gag. There's no way to say that without sounding condescending, sorry. Once you're comfortable with all of this and excluding any other medical problems you'll seldom need to see a vet. Many of us haven't had our cats in a vet's office in years, neither Nigel or Noah had vet visits for strictly diabetic issues.
This will all get a lot easier. Do I sound like a jackass now? I hope not. Really! :oops:
 
Thankfully no vets here have those values. Some farmers do though (but then some city folk are like that too).

My horse's vet used to work in a clinic, but decided to specialize with horses, and so is based off her own property and travels lots.
Both vets are great at what they do.
 
Status
Not open for further replies.
Back
Top