10-14 Persians -New Vet visit- 2nd opinion.

So, according to my current vet visit I need to do the following:

1- I need to purchase an Alphatrak Glucometer, my vet said the human one is not calibrated for felines and therefore can be 40-100 off of his actual values.
2- Need to switch my kitty to the Purina DM w/S/O. Dry food is allowed if I want to do can and could afford it, I could.
3- I need to give Persian probiotic supplements, there's a connection with gut health and diabetes.
4- Give Persian Fatty Acids, once again there's a connection with the two.
5- Refrain from checking his BG until I start him on the new prescription. Once I start him on the new food check his BG for 3 days; if there's a steady trend, proceed with normal feedings and insulin dosage. If it gets lower then normal (right now) I need to skip the dose.
6-Continue my spreadsheet, and if anything to call the vet and it will be immediately directed to her since he is a VIP patient now.
7- Think about getting acupuncture for my kitty's legs since he does have diabetic neuropathy.

My interpretation is that he'll be on more of a sliding scale type of dosing with the minimum being 0.50u and the max being 2u.
She was happy that I became paranoid and did not continue the 4u of insulin when changing his food.
She said she wanted me to not shoot if he is at 300 or lower in BG after meals (30-1hr), next BG would be at the 4-8hr mark (peak for Vetsulin looking for nadir) then after dinner. So, 3 BG tests during the 3 days of fully being on the new prescription food. At the 2 week mark, I could do a 12hr curve.
I have a follow up in 4 weeks to get labs done and see how he has been in the last 30 days via bloodwork. I assume she was talking about a type of A1c test, but for fur babies.
She hopes that maybe this food will allow for Persian to not need insulin anymore and for possible recovery for his diabetic neuropathy, however it is a 50/50, she said. I'm hoping it can be reversible by just controlling his BG.

Original post:https://felinediabetes.com/FDMB/threads/new-to-this-i-need-advice.269452/

 

Previous post
https://felinediabetes.com/FDMB/threads/10-13-persians-amps-376-6-337-pmps-354.269583/#post-3008219

And intro post
https://felinediabetes.com/FDMB/threads/new-to-this-i-need-advice.269452/#post-3007499

 

Tagging Melissa for you since she's a Vetsulun and has commented on some of your previous post
Sorry to say but I don't agree with one thing this vet has told you

 

Thank you for tagging!
Ugh, can you explain, I am not sure what is right or wrong. I need help!

 

1. Little does.your vet know that the AlphaTrak itself can be 40-100 off actual values lol all meters are allowed 20% variance from lab values. Overall, the AlphaTrak does read higher, but we account for that when determining dosing.

2. I think I had mentioned the DM in prior threads, since it has the S/O if you were worried about that. No real harm, but please do not feed the dry.

3. A lot of us give probiotics anyway! Proviable is a pretty common one. S boullardii specifically helps with diarrhea if she ever has trouble with that.

4. Not sure on that one? Did she give any more specifics? Some here give fish oil but I don't know much about it.

5. Disagree on testing. I would go up to 2.25U - you can continue to increase dose while waiting for new food. Then we'll use that as a baseline for food transition safety - it should still leave some wiggle room, but we never know until we test! It often takes longer than 3 days (we say two weeks) to see the full effects - take a look at my spreadsheet 2021 tab very beginning. You can see he continued.to drop in BG and dose over the course.of 7-10 days.

We try not to skip shots but rather reduce doses accordingly. And we try to maintain consistent doses, not a sliding scale. She does not look like a sliding scale cat yet; sliding scale cats typically have very uneven AM vs PM cycles (where one dives much lower yet the other stays higher...yet is not technically a bounce).

7. Can't speak to the acupuncture, I know some here have tried it. But the real solution for neuropathy is the methyl B12 supplementation, it can take some time (@Diane Tyler's Mom has the link for that I believe, zobaline?)

I have yet to see a +8 nadir lol It is usually +4 to +6 at the very latest, but most of the time closer to +4.

If you never shoot below 300....you'll never get BGs where you want them. Again, look at my spreadsheet, beginning of 2021 tab. You can definitely learn to safely shoot under 300 (we actually say 200), that is why we test. Those type of recommendations are more common for caregivers that don't test at all...I suspect the vet isn't used to someone as involved as you are.

Don't bother with the fructosamine. It just indicates average BG over the last 2-ish weeks...so if you're already testing, you already know where shes at and jt doesnt really tell you anything.

 

Ok! This was SOOOOOO helpful! I am so grateful for this response. And so glad I numbered haha!

1- yes, I remember reading something on the forum about alphatrak vs human glucometer. She said the only one she could recommend is the Libre freestyle one that stays attached and I can quickly scan And I was not too excited about having one on my kitty. Just because I know how much he will try rip it off, but it sounds like such an easy way to check on his BG.
2- Oh, the Purina Pro Plan Veterinary Diet. I will try to do wet cans, a majority of the time since it's expensive. I need to do more research on this one then. She said the dry food was safe for him. She also said to stay away from fancy feast due to Ashe and Phosphorus, it's not recommended for cats with a history of cystitis and urinary issues.
3-Yes, she wanted proviable but this office had fortiflora one. However, the check people gave me the canine supplement. Not sure if this was done by mistake.
4- Yes, she explained that the Fatty acid can help with BG control and slow the progression. Probably due to his neuropathy.
5- yes! I believe I'll be testing maybe the whole time. I am way too paranoid to not test. She told me to transition him, test him during it. Then once he's fully on it test him for 3 days see his baseline fully on the DM diet, and then I can give him a break and at 2 weeks to do a curve. She also mentioned to purchase a litter that can detect glucose in the urine or ketones. And this is how I can know if his BG is increasing or not. If I see it going up, then I can whip out the glucometer double check and see where his numbers are and go from there.

I mean the way she explained it, seemed like a sliding scale type of dosing but only when transitioning him to the new food. Since it might be low since he won't be consuming so many carbs. We will see though. She put it more as, if he's around 250 you dont want to give 2u since he could drop lower than what wed want. Since we're not sure on his nadir on the new food or during the transition period with insulin.
I personally would sleep better at night testing still and giving him his insulin as normal with slight 0.25 increases until his new food comes in.
I'll DEFINITELY reference your spreadsheet. I just want to do it the safest way possible! I really appreciate this reference!!
Oh yes the B12 is coming soon! She said she'll reference her acupuncturist and see if it's possible if not then hopefully BG control will help it. I'll definitely take the b12 if it means increasing the chance of helping him jump on my bed again. my vet did not mention b12 though. So thats very strange!
Yes! I agree, I believe my boys nadirs have been +4 to +6!! Not sure on this +8 I think it's already metabolized by then
Ok this! I whipped out my tiny spreadsheet and she was so surprised at how organized I was with his BG. She did tell me to not test so much if he lowers and stays on the same food. Not sure on this though i am too scared to just let it be. She said he can possibly not need insulin anymore depending on how he reacts to the food. Sometimes probiotics help, the Fatty acid helps. So all these factors might help it go down + the prescription food. We shall see.
Yeah, I'm not too keen on this, if I'm already monitoring his BG. I guess it's bc she told me to stop testing after a few days and assumes I will stop.

 

Is this the one you ordered
Methyl B-12 for neuropathy it's tasteless ,just sprinkle it on the wet food and add water to it. Give one per day
https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6
14.49 for 100 capsules
Once you start to get Persian's BG regulated and starting the Methyl B-12 you should start seeing an improvement
Tyler had neuropathy and he's back to walking and jumping
Took about less than 2 months, but every couple of weeks I saw improvement

 

Ok I see what you mean by sliding scale, we just use the term a little differently. Yes, as you start to see changes from diet changes you'll have to do some dose adjustments on the fly, so to speak.

The dry is still too high in carbs.

I'm not sure I agree about the probiotics and fatty acids helping diabetes specifically, but if they aren't going to hurt anything then worth a try!

Yes the methyl B12 has helped soooo many cats recover from neuropathy! It may take some time but most make a very good recovery.

As for the litter - renal threshold is the point at which glucose spills over into the urine. For most cats, it's somewhere between 200-300, some lower. So if BG is in that range for some time (even just a few hours), you'd get spillover. So I don't really see much point in the litter - we don't care as much if they're higher (aside from DKA risk), we care much more when they go low.

FortiFlora isn't a great probiotic, but it does do a good job of enticing them to eat whatever you put it on. If it were me I'd return it, but doesn't hurt to keep around in case of eating troubles.

 

Yes this!

 

Yes, adjusting will occur. I will reference your spreadsheet. Since I'm not sure by how much I should drop by or not drop by.

Yes, I will try out the wet DM more than anything. I just need to make sure it won't cost almost $3 a can!

Yeah I was a bit weirded out by the Fatty acid and probiotics but I know probiotics are good and fatty acids will help him if anything with his joints. Supplements I'm okay with since it won't harm him.

Yes I purchased it and plan on using ASAP to help my little guy.

Oh okay! I assumed she meant maybe if he his BG is rising and I'm not checking his BG. I would see it in his litter box. And it might indicate he will need insulin again. IF he doesn't need it anymore. Which I'm hoping for but I'm not sure if it will happen.

Ooh man. It's whichever they had at the vet at the moment. She was telling me she preferred the proviable they just did not have it in stock in that office.

 

I think you can just order the Proviable online? Not sure if you need a script or not.

I wouldn't follow my dosing exactly, I would post here for advice. My point point was more than it takes more than the 3 days your vet is saying. Each cat responds differently to a diet change, some more than others.

 

Yes! I understand. I want to reference it on how often and how long I should be checking. And what would be a trend to follow if it's going down. Like reducing dose by a 0.25 or by 0.50 or by a good amount depending on the number.
I forgot to mention, she said that after meals if he's over 300 Def shoot. But below 300 after a meal then skip a dose or I can reduce and give 0.50 if need be just never give too much because she wants me to be very careful with dropping him too low. For example, when I dropped him from 4u to 2u because he was at 334.

 

You want to test before you give a shot. However, with Vetsulin, you need to feed your cat 20 - 30 min before you give insulin. Vetsulin is fast acting and can drop numbers hard and fast so you need to have food on board before shooting. In other words: (1) test , (2) feed (3) wait 20 – 30 minutes (4) shoot. If you've not already see this information, this is a link to our beginner's guide.

 

I buy Proviable DC from Amazon no prescription required. It comes in capsules & it does have a taste. I give my sugar boy & my other boy 1 every morning after there AMPS feeding by opening the capsule in a bowl for each one of them & I split a jar of beef +beef broth beechnut baby food mixed in with the powder of the capsule.

 

Oh my goodness this is amazing! I will look for it on Amazon! Thank you! I just called my vet office about the Fortiflora SA (Canine supplement) . They said they'll call me back when they get in contact with the vet.

 

I just saw this. I never got an alert! Yes I've been making sure he eats. However now she suggests more of a feed test and then shoot depending on numbers. It's so confusing now.

 

I have seen some research on a connection between the gut biome and diabetes, and other conditions. Probiotics are OK to give to cats. I wouldn't give Fortiflora unless you need to stimulate his interest in food. It's only a single strain probiotic.

My Neko got acupuncture, but it was for her arthritis pain, not neuropathy - which she never had. The methyl B12 and getting your cat regulated will help with neuropathy.

I see you are still giving the Urinary SO food. Here is some good reading on urinary issues and diet for it. https://catinfo.org/feline-urinary-tract-diseases/

 

Replying on the fortiflora & if it's for dogs I would return it & by some from Amazon or chewy for cats. I always have it on hand for my boys because they are brats & sometimes that's what it takes to get one or the other or both to eat. I also keep other meds on hand because Panzer has pancreatitis flare ups. Hopefully your kitty gets to steer clear of that though.

 

Yeah, this is what my vet said that it has a relationship with it. The fortiflora she said to get was the FortiFlora SA, not sure if it makes a difference. She also mentioned Fatty acids as well. So I'm doing that for sure since I purchased it at the office.
Yeah I'm not sure I'd do acupuncture. She said she does it for her old man's arthritis and now he jumps on the bed better. She doesn't think it will help for diabetes neuropathy.
This reading is great! I haven't finished yet but I will once I have time!

 

Yes I called an they said to come back and return it. It's not the right one they have a feline one.
Ugh, yes.. I've heard about the issues kitty's have with pancreatitis I'm praying he does not get this!