After several instances of pancreatitis, Ming is on 6 units twice daily

Crista & Ming

Very Active Member
Hello! I just want to start by saying there's A LOT. At least, it feels like a lot to me. Not just in terms of how many units I'm giving Ming, but all the other factors and issues I'm having regarding Ming and his diabetes.

This is probably going to be a long post so I'll try to organize it in a way where it will be easy for every one to understand. Thank you SO MUCH in advance for reading and taking the time to answer all my questions and concerns!

I'll be going through all the stickys posted but I thought it wouldn't hurt to post about my cat and see what others think! If I ask any questions that are already answered on the stickys, I apologize but thank you for your incredible patience and knowledge!!

Ming's Medical Issues
March:
  • Was hospitalized for a week because of vomiting and was diagnosed with pancreatitis and diabetes
  • Did an ultrasound and saw that the pancreas was very ... inflamed? I can't remember the word my vet used to describe lots of tissue or damage around the pancreas
  • Was prescribed 1 unit twice daily Prozinc
May to August
  • Several instances of pancreatitis - CHRONIC PANCREATITIS
  • Vet did not want to prescribe steroids because of diabetes
  • We slowly went up 1 unit each time he got pancreatitis or when his fructosamine test would come back high
  • End of August, Ming is on 6 units twice daily Prozinc. Started 6 units on August 25th 2018
Home Testing
  • No home testing. I asked about it with my vet. He recommended against it - saying it caused unnecessary stress. I also didn't know anything about home testing and where to even BEGIN. The chronic pancreatitis (and other unfortunate things in life happening) did not help with giving me the time and state of mind to figure out home testing
  • TODAY: I started home testing!!!!!! I bought a OneTouch Ultra2. I poked Ming 3 times already (he received insulin at 7:45 pm according to my mother) and his readings are as follows (I’ll update as I go):
    • 2100: 14.0
    • 2200: 13.6
    • 2300: 9.3
    • 2400: 6.0
Appetite, Behaviour, and Eliminations
  • Ming eats A LOT: 2 big cans of DM PLUS snacks. Before diabetes, he also would eat about four 3 oz. cans. He is 16-17 lbs. Before diabetes, he was 18 lbs. Since having 6 units, he's been visibly gaining weight.
  • Ming gets hungry after finishing his meals and will look for food and try to eat human foods
  • He pees BIG pees. Before 6 units. he was peeing A LOT (4-5 big pees a day). Since 6 units, he pees a more normal amount (2 big pees a day)
  • He used to never drink water before diabetes. After diabetes, drank a lot. Since increasing his dose of insulin, I have not noticed him drinking too much but I know he drinks something since his big water cooler has lowering water levels.
Ming's Diet
  • Before diabetes, he ate a variety of foods: Fancy Feast classic pates (80% of his diet), Primal Freeze Dried Raw Nuggets, and Nature's Variety. Sometimes I'll throw in things like Cats in the Kitchen, Weruva, and Simply Nourish. These foods were all chosen because of budget and Ming's preferences. I would have loved to have him only on Weruva or Frozen Raw but Ming said no. Haha!
  • After diabetes, I kept the same diet but added DM because my vet wanted that and because my mother wanted that.
  • Since August, Ming is only on DM and some freeze dried raw mixed in and as snacks
Ming's Feeding Schedule
  • 7AM and 7PM Feedings
  • We leave his food out until he finishes
  • 730AM and 730PM Insulin Shots
  • However... my mom and I both feed and shoot because of my work schedule. I try to be consistent. Sometimes I'll shoot 10 mins early or feed 15 minutes early. My mom? I have no idea.
  • Ming gets SNACKS. He gets hungry around 3 pm and 11 pm. I sometimes will give him one nugget of Primal. Same with my mom.
Issues with my mom and Ming's Diet
  • I want him on RAW. I've found out that he will eat frozen raw if I mix in the freeze dried raw. Perhaps I could work him up to be exclusively on frozen raw
  • My mom is against this.
  • I buy DM food because my mom got mad at me for feeding him raw, feeding him FF, and getting pancreatitis over and over. She thinks his diet is causing his pancreatitis. I don't know if it is and I have decided it would not hurt to appease my mother and feed Ming DM until we get his pancreatitis under control
  • When I was trying to feed only freeze dried raw, my mom would feed him DM meals when I wasn't able to feed and shoot. I felt this was worse than only feeding him DM since the difference in carb content and fat content would be different and possibly affect his insulin and glucose levels. Remember, I was NOT home testing.
  • His poop on DM is HUGE and DARK. His poop before diabetes on FF & variety was always small and light brown
  • Good news: I think my mom is satisfied that Ming has been on DM for a month or so and seems to be open to me trying to feed him raw exclusively. Especially because I've been talking to her about home testing.
GOALS
  • Raw food diet
  • Understanding home testing
  • No more pancreatitis
  • Understanding if snacking is okay
  • Decrease hunger and amounts eaten
  • REMISSION!
Questions:
  • I have the OneTouch Ultra 2. Are the readings on par with whatever the vet uses/what is standard?
  • How do I know when to decrease/increase a dose of insulin?
  • What is a normal blood glucose curve? What is normal?? (I kind of googled it and got some answers but it would great to hear from the experienced on his forum!)
I am going to see another vet on Thursday. It's actually one of the vets I work for! I just started working at a vet clinic as a vet assistant. I've had NO prior training or education as a vet assistant hence my absolute lack of knowledge with anything. But since working at a clinic, I've gained confidence and more knowledge about diabetes from discussing things with my coworkers. So far, I've only had the opportunity to do a partial blood glucose curve on a dog and to be honest, things get so hectic and crazy at the clinic that it's hard to sit down with anyone, let alone the vet, and ask all the questions I have about diabetes. Plus, I've only been working there for a couple of months! (Don't worry. I don't do important things haha! I wouldn't feel so hot knowing a newbie is taking care of my beloved pet. I mostly restrain, clean, do laundry, set up for procedures, and administer medication under the instruction of the trained and educated vets and technicians.)

Anyway, again, I appreciate you SO MUCH for reading all of this and taking the time to answer my questions! THANK YOU THANK YOU!
 
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Good morning! Okay going to try to cover some stuff here, but please let me know if I leave something out.

Your questions:
1. This is fine to use. The vet usually uses a pet meter which will read higher, but we can read both of them on the forum. Pet meters are way more expensive for strips, so most of us use human meters.
2. This is a tough one. I can't give you number guidelines exactly, but it's basically if your preshot is yellows or above and your mid cycle numbers don't get into greens (this is referring to the colors on the SS...listed across the top). However, ECID (every cat is different) so sometimes we increase based on different numbers. It depends on your cat and the patterns you learn over a bit of time. Decreasing happens when the cat gets into low numbers (like lime greens) usually...but can also happen if the dose is suspected to be too high based on some data.
3. Normal curve is a smile curve. I love seeing low 200s at preshot and dark greens (like higher than 50 but lower than 100) at nadir (which is the exact midpoint of your curve...usually between 5 to 7 hours after shot).

Okay, as for food. Raw is GREAT. I feed raw exclusively. I don't have a diabetic anymore, but I wish I had fed her raw when I had her! It's actually even better for you since Ming has pancreatitis. I don't have a pancreatitis kitty, but @Djamila does and she can tell you more about it. She feeds raw too. DM is definitely too high in carbs and might even bet causing some of the pancreatitis flares. HOWEVER...please DO NOT change food until you are consistently home testing. We've seen a new food drop the BG over 100 points overnight. It can be dangerous to change before you feel good about home testing. It's okay if you need a few days to get you and Ming used to it. We all did. :) While waiting on that, check out catinfo.org for some good info on feeding. Maybe if you can provide your Mom some good info like that, she will be more for it. We want you to both feel good!

Snacking is FINE. Just try to take up all food 2 hours before the shot so you can shoot on a true number that isn't food influenced. Most of us provide snacks or free feed throughout the day other than that window.

The hunger and amount of food will decrease as Ming becomes regulated. He can't use the food as easily to satisfy himself right now because of the diabetes. Most cats decrease that as they get better regulated and feel better.

Please ask more questions about home testing that you have! It's kind of iffy because it really depends on the cat and the patterns that cat has, but we CAN help you figure this out.

As for pancreatitis...it's good to have a goal of no more, but understand that it may be a chronic condition. That just happens...it sucks and it's no fun, but you learn to deal with it the best you can. I have 2 cats with their own chronic diseases and I know how awful it can be. As I learned to accept it and treat as best I can, it got better. Djamila can give you more info on treating pancreatitis better than I can so I'll leave that to her.

Feeding/shooting 10 or 15 min off is okay. You have a bit of leeway with Prozinc. You just want to be as close to 12 hours as possible.

Okay, as for dose. 6 units is a LOT. I'm very worried about that amount, though your numbers really look good. Increasing due to bouts of pancreatitis isn't great because you might need to decrease afterwards since the panc can cause the numbers to go higher with pain..and go lower when it's over! We also usually only increase by 0.25 OR 0.5 at most. Cats don't need such big increases...they are such small beings! Is your Mom okay with testing? Will you be able to test before each shot? That would really help. And get as many tests during the day as you can...we can help figure out a good dose for Ming.

Quick question. What time zone are you in?

PLEASE ask any questions you have! This was a ton of info I just gave you and there's a ton more in the stickies (and others will chime in as the day goes along...I'm the early bird). Please do read the stickies on top of this forum and ask ANYTHING...we've all been new and we remember it. We are here to help and we're glad you've found us!
 
Good morning! Okay going to try to cover some stuff here, but please let me know if I leave something out.

Your questions:
1. This is fine to use. The vet usually uses a pet meter which will read higher, but we can read both of them on the forum. Pet meters are way more expensive for strips, so most of us use human meters.
2. This is a tough one. I can't give you number guidelines exactly, but it's basically if your preshot is yellows or above and your mid cycle numbers don't get into greens (this is referring to the colors on the SS...listed across the top). However, ECID (every cat is different) so sometimes we increase based on different numbers. It depends on your cat and the patterns you learn over a bit of time. Decreasing happens when the cat gets into low numbers (like lime greens) usually...but can also happen if the dose is suspected to be too high based on some data.
3. Normal curve is a smile curve. I love seeing low 200s at preshot and dark greens (like higher than 50 but lower than 100) at nadir (which is the exact midpoint of your curve...usually between 5 to 7 hours after shot).

Okay, as for food. Raw is GREAT. I feed raw exclusively. I don't have a diabetic anymore, but I wish I had fed her raw when I had her! It's actually even better for you since Ming has pancreatitis. I don't have a pancreatitis kitty, but @Djamila does and she can tell you more about it. She feeds raw too. DM is definitely too high in carbs and might even bet causing some of the pancreatitis flares. HOWEVER...please DO NOT change food until you are consistently home testing. We've seen a new food drop the BG over 100 points overnight. It can be dangerous to change before you feel good about home testing. It's okay if you need a few days to get you and Ming used to it. We all did. :) While waiting on that, check out catinfo.org for some good info on feeding. Maybe if you can provide your Mom some good info like that, she will be more for it. We want you to both feel good!

Snacking is FINE. Just try to take up all food 2 hours before the shot so you can shoot on a true number that isn't food influenced. Most of us provide snacks or free feed throughout the day other than that window.

The hunger and amount of food will decrease as Ming becomes regulated. He can't use the food as easily to satisfy himself right now because of the diabetes. Most cats decrease that as they get better regulated and feel better.

Please ask more questions about home testing that you have! It's kind of iffy because it really depends on the cat and the patterns that cat has, but we CAN help you figure this out.

As for pancreatitis...it's good to have a goal of no more, but understand that it may be a chronic condition. That just happens...it sucks and it's no fun, but you learn to deal with it the best you can. I have 2 cats with their own chronic diseases and I know how awful it can be. As I learned to accept it and treat as best I can, it got better. Djamila can give you more info on treating pancreatitis better than I can so I'll leave that to her.

Feeding/shooting 10 or 15 min off is okay. You have a bit of leeway with Prozinc. You just want to be as close to 12 hours as possible.

Okay, as for dose. 6 units is a LOT. I'm very worried about that amount, though your numbers really look good. Increasing due to bouts of pancreatitis isn't great because you might need to decrease afterwards since the panc can cause the numbers to go higher with pain..and go lower when it's over! We also usually only increase by 0.25 OR 0.5 at most. Cats don't need such big increases...they are such small beings! Is your Mom okay with testing? Will you be able to test before each shot? That would really help. And get as many tests during the day as you can...we can help figure out a good dose for Ming.

Quick question. What time zone are you in?

PLEASE ask any questions you have! This was a ton of info I just gave you and there's a ton more in the stickies (and others will chime in as the day goes along...I'm the early bird). Please do read the stickies on top of this forum and ask ANYTHING...we've all been new and we remember it. We are here to help and we're glad you've found us!

Hi Rachel! THANK YOU for your reply. It was so nice to read and thank you for being so encouraging about asking more questions! And I think it's so nice there's people here ready to go and to answer questions. It's so cool that there's a morning crew :cat:

Phew! Glad that snacking is okay! Would there ever be such a thing as too much snacking? Or if a snack becomes a meal and becomes a problem?

As for the situation where ECID... how can you tell if your cat falls under those situations? Would it be more of a trial and error where if you change the dose of insulin, you notice something in the cat's glucose readings and/or behaviour?

Yes, I'm glad I didn't go head strong and decide to do all raw (again). I did do that earlier in August/late July before another pancreatitis flare up. Perhaps the diet change had something to do with it? Before that, Ming was still on his regular diet of FF with some DM mixed in. Then I decided I'd do freeze dried raw and DM. Then the flare up happened. So I just stuck with DM after my mom got mad/insisted on DM.

But let's say, we begin to feed raw and we're home testing consistently, how would we remedy problems like you mentioned where BG goes all the way to 100? And what are things to watch out for? Also, would a gradual change in diet be better (mixing increasing amounts of raw with DM)?

I'll have to teach my mom to the tests and I'm sure she'll be okay with it (she used to be a nurse). I'll also be teaching others in my family but they won't be too willing or present to test so it'll be more of a back up thing in case both my mom and I are not there to feed and shoot.

Which may be a problem at the end of the month since my mom is leaving for a trip for 2 weeks. I work 10 hour days, 4 times a week and am not always able to feed Ming in the morning. That meal would have to be fed by another family member but I'm not sure if they'll be okay with testing. If I tested Ming 2 hours before his usual feeding time, would that reading be able to predict/help with figuring things out before his insulin shot?

The good thing is if the inconsistent testing is a problem, I could bring Ming to work. But that's also putting him in a stressful situation but he's generally a very chill cat. Maybe I'm overthinking it. What do you think?

But anyway, I think perhaps after doing this curve, going to the new vet, and reading up on everything, I can give you all a better idea of what's going on. And also be able to speak to my mom and get her on board with everything. She's very wary about what I have to say in regards to Ming and his diabetes. I don't blame her. I'm not a vet. But it's very frustrating to me. Ming is my cat (I pay for everything and bought him etc.) but I'm also asking my mom for a lot of help and I'm really grateful for her. I know everything she does is purely for Ming's well being but it's frustrating when I give her information about things but she doesn't believe it or read it. I've sent her many snippets from catinfo.org and even sent her that chart of diabetic-safe foods and showed her on the DM can the amount of carbs. But my vet said one thing about fats and now she's fixated on that!

Sorry for all the personal issues/ramblings but I really feel like it's an important part of Ming's journey with diabetes. You know, I can do my best but when the other member of my team thinks differently and isn't 100% on board... sigh.

I'm on PST time! So it's almost 4 AM while I write this post.

Today, I'm testing every hour and only the last hour did I finally figure out a way to poke Ming without causing him pain :nailbiting: It also might be because he's super sleepy and so has decided he couldn't care less that I'm making him bleed for the 6th time lol!
 
Well, that was a lovely curve! Maybe those 6u are about right. Time will tell, but for a first peek, Ming is looking pretty good!

Rachel has given you some great advice, so I won't repeat what she's already said.

I will add that given the curve you have, I would definitely make the food change gradual and keep an eye on the numbers. Since you'll be moving from a higher carb food to a lower carb food, you will likely see the numbers trend lower. How much lower we'll just have to wait and see.

Long work days: You may be able to adjust the shot time while your mom is gone so you give Ming his injection right before you leave for work, and then my guess is that 12 hours later would be roughly right as you get home? That way you can test/feed/shoot both the AM and PM cycle. We can help talk you through how to move the shot time if you think you can be home around 12 hours.

Unfortunately Rachel is right about chronic pancreatitis. As much as I wish there was a permanent cure, there isn't. And there is not nearly enough research on it in cats. What we do think we know at this point is that it is not caused by food. It used to be believed that higher fat foods were a trigger, but that doesn't seem to be the case. Cats with all kinds of different diets get it or don't get it without there being a clear food connection. Some vets say steroids. Others say antibiotics. Again, no clear proof that either of these work. Sometimes they seem to work, but it could also just be that the kitty was going to get better anyway, since with no medication at all, it will resolve in time. The best course is to manage it at home: anti-nausea meds, appetite stimulant if the kitty doesn't want to eat, sub-Q fluids help many cats, and probably the most important: pain meds. It is quite painful for cats, and vets often don't prescribe the pain meds unless the owner requests them, but I would argue pain management is probably the most important aspect of treatment. Since you can't make it go away, helping your kitty not suffer with it is essential. Managing the pain also helps keep the BG in check (at least somewhat), and helps with appetite since no one wants to eat when they are in pain.

The only ongoing treatment that I've seen that does really seem to help is CBD. I'm guessing you are in Canada, and I think it's becoming legal for you soon, is that right? It's made a huge difference for many of our pancreatitis kitties.

Rachel was also right that raising the dose with pancreatitis works during the flare, but can result in the cat being overdosed once the flare clears up. Now that you'll be home testing, we can help guide you through moving the dose up and down to be responsive.

As for your questions about dosing, the answers are not so easy and clear-cut. There are so many patterns and variations of patterns, that the best thing to do is to post often and ask questions. As you share data and we all look at the spreadsheet and try things, you will start to learn Ming's patterns and responses and can figure out when to raise and lower and by how much. Dosing with Lantus is more of a science. Dosing with Prozinc is a science with a good sprinkling of art thrown in. You asked how to know if Ming fits into the ECID idea. EVERY cat fits into it. While there are certainly patterns that we see repeated over and over, there is always an element of uniqueness to each cat and their treatment. That's why we rely so heavily on the data here - there just aren't simple rules that you can put in place and then always do the same thing with the same numbers. It's a bit of trial and error, but know that you are not alone, and we are here to help. In no time at all you'll start to get a feel for all of this.
 
Well, that was a lovely curve! Maybe those 6u are about right. Time will tell, but for a first peek, Ming is looking pretty good!

Rachel has given you some great advice, so I won't repeat what she's already said.

I will add that given the curve you have, I would definitely make the food change gradual and keep an eye on the numbers. Since you'll be moving from a higher carb food to a lower carb food, you will likely see the numbers trend lower. How much lower we'll just have to wait and see.

Thank you for replying and all the great info!!

I'm happy to hear that last night's results look good. Although, this morning seems interesting if you don't mind taking a look. Would activity have anything to do with BG levels? I let him play outside and he was chasing bugs and birds.

And okay! I think everyone, especially my mom, would feel better about a gradual food change.

Long work days: You may be able to adjust the shot time while your mom is gone so you give Ming his injection right before you leave for work, and then my guess is that 12 hours later would be roughly right as you get home? That way you can test/feed/shoot both the AM and PM cycle. We can help talk you through how to move the shot time if you think you can be home around 12 hours.

I'm just thinking about it and seems like some days, I'll have to be late to feed/shoot Ming at night or not be able to feed at all. I have work at different times but the usual shifts are: 700 AM - 600 PM, 730 AM - 630 PM, and 900 AM to 800 PM. And it takes me anywhere from 30 minutes to 40 minutes to commute.

For now, I think the best thing I can do is work it out with everyone at home to see how we can deal with the upcoming 2 weeks. Worst case scenario is I bring Ming to work.

After today's curve, I plan to sit down with my mom and other family members and perhaps show them this thread as well to discuss how we can do things from here.

What we do think we know at this point is that it is not caused by food. It used to be believed that higher fat foods were a trigger, but that doesn't seem to be the case. Cats with all kinds of different diets get it or don't get it without there being a clear food connection. Some vets say steroids. Others say antibiotics. Again, no clear proof that either of these work.

That was also always my belief and my vet also believed that. Until one time we did a blood test and Ming's blood was super fatty. He said it might just be from his pancreas not working again but, just in case, take him off FF which was when my mom got mad at me :banghead: I'm quite envious of those who feed FF since I have so much FF and am hoarding them in case one day, Ming decides he will eat NOTHING - no DM, no raw. That's when I'll break out the FF, I guess?

The only ongoing treatment that I've seen that does really seem to help is CBD. I'm guessing you are in Canada, and I think it's becoming legal for you soon, is that right? It's made a huge difference for many of our pancreatitis kitties.

Actually, two of my coworkers mentioned they give their dogs CBD! So that's really great to hear that it helps with pancreatitis! I actually asked them what CBD did and they listed some things but none of them fit with diabetes or pancreatitis. Perhaps I was thinking of the symptoms of the diseases when it's happening rather than thinking about it in a preventative way. I'll be doing some research on CBD now and also ask my vet about that.

And I know I asked you this in a private message (thank you for replying by the way!) but if my new vet recommends a bit of steroids, what would be your opinion on starting them? I'm starting to lean towards not doing them unless Ming has another pancreatitis flare up. But what if the steroids "reverse" some of the damage done to the pancreas? Is that even possible?

It is quite painful for cats, and vets often don't prescribe the pain meds unless the owner requests them, but I would argue pain management is probably the most important aspect of treatment

Yes! I actually asked my vet if I could have some extra bup at home and he gave me some. Except now I've used it all up. Thanks for the reminder. I should probably get some more. There was only one time I used it that didn't result in Ming having to be hospitalized again. Every time he does a vomit, I've just shot him up with that and hoped for the best.

but know that you are not alone, and we are here to help.

Thank you thank you thank you! :bighug:
 
Woah! Those line greens are low! Where are you at now? Has he come up?

As for schedule we can help you figure out what to do if your family can’t help out. We’ve had people with odd schedules on here and we always figure something out.

I actually use CBD also (my cat has cystitis). It’s supposed to have some pain relief and also possibly stimulate appetite which is good for pancreatitis. As for steroids I think they just help with inflammation...which CBD does as well. Steroids can actually cause diabetes in cats. That doesn’t mean never use it...but know that. We have had kitties who had to be on them and we dosed around them. I don’t know about using them for pancreatitis.

I keep bupe in the house! My vet has a prescription on file for me so we can have pain relief. I’m big on that since cats can’t understand why they hurt and I can’t stand to see it!
 
Woah! Those line greens are low! Where are you at now? Has he come up?

As for schedule we can help you figure out what to do if your family can’t help out. We’ve had people with odd schedules on here and we always figure something out.

I actually use CBD also (my cat has cystitis). It’s supposed to have some pain relief and also possibly stimulate appetite which is good for pancreatitis. As for steroids I think they just help with inflammation...which CBD does as well. Steroids can actually cause diabetes in cats. That doesn’t mean never use it...but know that. We have had kitties who had to be on them and we dosed around them. I don’t know about using them for pancreatitis.

I keep bupe in the house! My vet has a prescription on file for me so we can have pain relief. I’m big on that since cats can’t understand why they hurt and I can’t stand to see it!

I just fed him some FF and meowmix that a fellow diabetic cat owner and coworker gifted me after browsing quickly for Hypo information. and here I was just saying I wish he could eat some FF...

What should I do from here? I have some honey? He’s sleeping right now and not exhibiting any symptoms. I’ll be testing again in 10 minutes.
 
I’d give him some gravy from high carb food or a bit of honey. He’s pretty low and not going up.
 
I’m at +5 after the AMPS. I’m still not familiar with what nadir is or how to know if it is.

Okay! I’ve already given him some FF but it’s not the gravy kind but I’ll give him some honey.

It dropped so suddenly this morning and it was so different from last night’s cycle. Is there any reason for this?
 
Okay give a bit of honey (run on gums if he won’t eat it) and test again in 10-15 min. Posting now and will answer questions in next post.
 
Nadir is the low point of the cycle. It’s different for every cat. Djamila’s Sam Nadia around +3 or 4. Some cats nadir at +8. Usually it’s between +5 and +7. We don’t know Ming’s yet since it takes time of gathering data and it can change. My guess is you are near nadir which is good.

As for why he did this? No idea. It could be he didn’t eat as much or he was stressed last night or something else. Most likely the dose is just too high and he just couldn’t deal today. He might have been dropping low sometimes without you knowing...as you see he’s got no symptoms! The important thing is you caught it today. :)

I’m at work on my phone but I’ll be here until he comes back up. It’s an easy day here but wanted you to know it may take a second to get back to you since I’m typing on a tiny keyboard!
 
Yay! 2.6! Thank you for the prompt replies and instructions, Rachel!

That was so interesting, honestly. I kind of expected him to be more like this last night so I was pleasantly surprised to see him relatively stable and so then I was hopeful he’d react similarity during the day. I hope it wasn’t stressed induced since I’m about to stress him out more and more with more ear pokes and a visit to the vet.
 
Scary low numbers. I'd reduce to 4 u tonight for sure. If you need to increase it's best to do it in 0.25 u increments, 0.5 u max at the level of dose you're at.
 
Scary low numbers. I'd reduce to 4 u tonight for sure. If you need to increase it's best to do it in 0.25 u increments, 0.5 u max at the level of dose you're at.

You think so? Even though it’s my first time doing a curve? I’m assuming it’s less risky to give less insulin than to give too much.
 
Yep it’s fine! Sounds like he’s coming up nicely. Phew! I’d grab one more test to make sure he’s in good numbers.
 
Nice! Yes I definitely agree with Kris. 6 was too much and Ming might be a little insulin sensitive after that low.
 
Okay! After giving him 4 u, would it be reasonable to test Ming's BG during this cycle's nadir time around +4 and +5 or should I continue to do hourly tests? I would like to stop doing hourly tests after 9PM PST (when his curve is completed) because I don't want to stress him out and plus I need to sleep haha! But i'll do it if needed :)
 
Wooooo progress. I spoke to my mom briefly, showing her what happened this afternoon. She came to the conclusion herself that Ming got too much insulin. I asked tentatively how she felt if I reduced to 4 u. She was like yeah makes sense.

And then I started explaining how testing works and she completely peaced out saying she needs to go eat because she has low blood sugar herself LOL She did just come from a full day of volunteering. Sigh... Are there other users out there that have struggled with family dynamics when it came to their diabetic cat?
 
No you don't need to do hourly tests tonight. Get maybe a +3 if you can? That should show you where he's going and maybe you can go to bed? Or if you are planning to stay up until +4 or +5 that's fine too. Generally you just want to get a test to see if he's diving like he did today and then you can kind of infer what's going to happen.

Sounds like your mom is coming on board! It takes some time to convince people. It's a tough thing to trust a bunch of crazy cat ladies on the internet instead of a vet...we all know! Maybe once you start testing Ming yourself you can show her how you do it and she can see it's really not tough? Most kitties get used to the tests really fast (that bribe of a special treat after each test helps with it ;) ). So maybe if Ming accepts testing fairly easily you can show her and she'll see he doesn't mind and be more okay with it.
 
Oh WOW! i missed all the fun today! :nailbiting: So much for thinking that curve last night was looking good! I definitely agree with Rachel and Kris about lowering the dose, and 4u sounds like a good place to start. It's just going to take some experimenting for a little while here to figure out how much insulin Ming really needs. But the one thing we do know is that 6u is too much right now!

You are most likely to see a very high PMPS number. Dont' be alarmed if you do, it's a normal response when a cat has gone low. Still give the reduced dose.

Pancreatitis: I definitely would not start steroids if Ming is not in an active flare. If he gets to a point where he's not eating from the pancreatitis and is in a bad way, then at some point you just try anything, regardless of the connection to diabetes. So far, I've been lucky enough to be able to avoid them just by treating with the other things I mentioned. I'll be honest though, if Sam got sick enough or the flares were too frequent, I would try them. The way I look at, he's already diabetic, so maybe the steroids would increase his need for insulin, but they wouldn't cause something he doesn't already have. Also, Sam is well beyond the window of likely remission, so he is most likely a life-time diabetic. If I thought he still had a chance at remission I would be even less likely to try the steroids.
 
I’m glad you replied, Djamila! I was just about to ask about the high number I just got: 21.1 haha! I have 2 more hours until his shot but I’ll keep the 4 u like everyone has suggested :) I’m so glad and grateful for all the help today!!!

I’d feel more comfortable with not starting steroids for no reason too. Something I realized I forgot to mention but Ming was on Baytril for 20 days at the end of August just as a preventative thing if that means anything in regards to his pancreatitis.
 
Hmmm...I'm not really familiar with Baytril, but I just googled it and a lot of the side effects sound like pancreatitis. How was the pancreatitis diagnosed? If I remember correctly, Ming had an ultrasound. Is that correct? Just wondering if there is a chance that it wasn't really pancreatitis, but if he had an u/s, then it's probably a good diagnosis.
 
Hmmm...I'm not really familiar with Baytril, but I just googled it and a lot of the side effects sound like pancreatitis. How was the pancreatitis diagnosed? If I remember correctly, Ming had an ultrasound. Is that correct? Just wondering if there is a chance that it wasn't really pancreatitis, but if he had an u/s, then it's probably a good diagnosis.

I’m under the idea it was a anti inflammatory. But he’s been off of it for a week now. The last time he went to the vet for suspected pancreatitis, he bounced back within the day and the numbers didn’t add up to it. But he gave us Baytril just in case.

The first time he was diagnosed, they did blood work and suspected it to be severe pancreatitis. Then did an ultrasound and saw that it was. Ming has actually had two ultrasounds and both times there was a lot of damage around the pancreas but it wasn’t spread to other organs.

His flare ups happen the same every time: he’ll vomit more than 5 or even 10 times an hour until it becomes bile. And sit in front of his water bowl in a loaf position and not eat. I don’t wait any longer than a few hours now and just call the vet right away and bring him in. They usually hook him up to fluids, give bupe, cerenia and maybe an appetite stimulant. And then 2 or 3 days later, he’s good again and comes back with an increased dose of insulin.

This happens almost monthly. I feel like if we can get through September without an episode, it would be a record!
 
Oh poor Ming! It does sound like your vet is doing a good job of treating the pancreatitis though. If it's helpful to your finances, you can do those same treatments at home. Sub Q fluids can be a little scary at first, but most kitties handle them just fine at home. And particularly if you and your mom can work together, I'm sure you could manage it. It might be worth talking with your vet about taking over that care. Assuming Ming is going to be a chronic patient, it may be easier on his stress level too. I keep all of the meds on hand, and then stay in touch with my vet to pick up more whenever I run low. He's worked with me enough now that he doesn't feel the need to see Sam each time and agrees that the stress of a vet visit isn't good for him when he's so sick.

The first time we made it a whole month without a flare, I wanted to throw a party! You can tell when Sam is sick by the yellows on the spreadsheet. When he's feeling good he stays mostly in blues and greens. When he's having a flare he hits a bunch of yellows. :oops: There is way too much yellow on his spreadsheet. :stop:

I may say this too much, but I really am a huge fan of the CBD. Sam still has too many flares, but the CBD seems to get him feeling better much faster than just the cerenia/bupe/fluids. Plus, he hates bupe and doesn't mind the CBD at all. Both CBD and THC are legal in my state, so Sam actually gets a version that has a small amount of THC in it. That is toxic for dogs, but seems to be fine for cats. I say "seems to be" because there isn't any solid research either way. THC is a better pain med than CBD in humans. CBD is a good anti-inflammatory though. He takes one that is a ratio of 250/5 CBD:THC, so just a tiny bit. If you want to be careful though, I would recommend Charlotte's Web brand which is just CBD and from reading in the pancreatitis groups, has a very good reputation.

Fingers crossed Ming stays healthy for you!
 
Oh poor Ming! It does sound like your vet is doing a good job of treating the pancreatitis though. If it's helpful to your finances, you can do those same treatments at home. Sub Q fluids can be a little scary at first, but most kitties handle them just fine at home. And particularly if you and your mom can work together, I'm sure you could manage it. It might be worth talking with your vet about taking over that care. Assuming Ming is going to be a chronic patient, it may be easier on his stress level too. I keep all of the meds on hand, and then stay in touch with my vet to pick up more whenever I run low. He's worked with me enough now that he doesn't feel the need to see Sam each time and agrees that the stress of a vet visit isn't good for him when he's so sick.

The first time we made it a whole month without a flare, I wanted to throw a party! You can tell when Sam is sick by the yellows on the spreadsheet. When he's feeling good he stays mostly in blues and greens. When he's having a flare he hits a bunch of yellows. :oops: There is way too much yellow on his spreadsheet. :stop:

I may say this too much, but I really am a huge fan of the CBD. Sam still has too many flares, but the CBD seems to get him feeling better much faster than just the cerenia/bupe/fluids. Plus, he hates bupe and doesn't mind the CBD at all. Both CBD and THC are legal in my state, so Sam actually gets a version that has a small amount of THC in it. That is toxic for dogs, but seems to be fine for cats. I say "seems to be" because there isn't any solid research either way. THC is a better pain med than CBD in humans. CBD is a good anti-inflammatory though. He takes one that is a ratio of 250/5 CBD:THC, so just a tiny bit. If you want to be careful though, I would recommend Charlotte's Web brand which is just CBD and from reading in the pancreatitis groups, has a very good reputation.

Fingers crossed Ming stays healthy for you!


I definitely would rather do sub q fluids at home than have him at the hospital. Both for my pocket’s sake and Ming’s stress level. And I’ve learned a few weeks ago how to administer sub q so the next time that happens, I’ll be ready to offer that option to my vet! :) and it sounds like a good idea to talk to my vet more about home care vs. Hospitalization. I’ll be adding that to my big list of things to ask.

A little rambling: I really like my current vet but he doesn’t agree with home testing but that’s about it with my complaints. I feel bad about going to see the vet at the clinic I work at but I also think she’s great too from what I observed. I’m almost tempted to take Ming back to my original vet after some time with the new vet lol!!!!! Just to keep up relations. After all, my current vet is just 5 minutes away from my home and so accommodating.

I was wondering actually, how are you able to figure out how much to reduce when it comes to dosing by looking at the data? Why 2 units?

And thank you for the info on CBD! Time to do some more research
 
No I would stay at 4 units this morning. He was almost surely going to be high due to those lower numbers, and he still had a pretty good drop. Most likely, he is bouncing some. The best explanation of bouncing I've ever read comes from Kris:
Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high:
  1. BG goes low OR lower than usual OR drops too quickly.
  2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
  3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
  4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
  5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
  6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
As for how much to reduce by well....we kind of guess. ;) Okay really in general, if you've been slowly raising the dose by small increments, we will usually suggest backing off 0.25 or 0.5 depending on how early the low happened in the cycle and on the cat's normal patterns. But with Ming, this 6 units was arrived at by 1 unit jumps that were based on numbers that were elevated from vet stress and pancreatitis. Most likely, Ming hasn't needed 6 units all this time. So since the 6 units was reached in a way we don't normally dose (btw, NOT your fault...it's hard to know what to do!), we suggested 2 units decrease in hopes that would be low enough. We didn't want to lower TOO much so that he was really high, but we also didn't want to go too little and have him dive again. As you get more data, we'll all be able to do better at figuring out increases/decreases.

And yes, I'm still the early morning crew. I only take a break on the weekends. ;)
 
I'm glad you have Rachel and Djamila here to help. I think 4 u is the way to go for now while you gather a bit more data. I apologize for my short response - only doing a quick "fly by" on the forum right now because I'm busy with other stuff.

To echo what Rachel said, deciding how much to reduce can be tricky. I looked at your data and drew upon my own experiences to come up with 4 u. I *think* it'll give you some leeway dose wise to increase by 0.25 u increments if need be.
 
Thanks everyone!

This morning he was really high. My meter said higher than 33.3. But also, I know he ate a little bit of food half an hour before I checked his levels because I forgot to take away his food last night. I gave him 4 u like suggested. Anything else I should do?
 
Yikes. That is high. If you can get a test in sometime in the middle of the cycle today between +4-+6, that would be great to see how much of an impact the 4u is having. He did have a good insulin response last night, and it can take a few cycles to settle down after hitting a lime green like he did. Are you starting the transition off of the DM?

Do you know about testing for ketones? It's a good idea to start that habit. There is a sticky about it at the top of the Prozinc forum.

Let's see what he does during the day today (if you're able to get a test, and what his PMPS is, then we can figure out if we want to head back up in dose or not.
 
Okay. My sister will be posting on my account on my behalf since I’ll be out of the house the rest of the day.

I gave him half a can of DM this morning instead of one thinking: 1) he ate some this morning already. I was going to the washroom and saw him eating and took the food away. He usually finishes all his food before midnight but since he ate that FF can yesterday afternoon, I guess he wasn’t as hungry last night and 2) I could add the freeze dried raw food later if he’s still hungry. Kind of like we usually do for snacks but it’ll just be more of it. Does that make sense?

Tonight I’ll let my sister know to replace a portion of the DM with freeze dried.
 
In terms of testing urine, I won’t be able to get the supplies today and I doubt anyone else will be willing to do it or is able to today at least.

Ming is going to the vet tomorrow and I won’t be opposed to doing a urinalysis.

I’m a little concerned now since I was planning to bring Ming into work for the day tomorrow and place him in a kennel. I’ll be working and his appointment is at 4 pm (it was the only time my vet is available when I was available and I booked the appointment early last week too). I wanted to see if my mom would be willing to drive down and bring him instead of me having to keep him at the clinic all day but there was some minor schuduling conflicts. I’ll see if I can speak to her again about that or figure something else out. But at least if something happens, he’ll be in the presence of 3 vets? And I’ll be there to test his BG periodically?

ETA: I’ve figured out a way to get Ming to his appointment without needing to stay at the clinic with me for a whole day! Yay! Less stress :)
 
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He’s at 9.9 at +4!!! My sister just reported back to me. She’ll be doing another test at +5 and +6. Looks like 4 u is working! I’m so glad. I was so nervous the whole morning having to leave him but he was just being his normal self, pawing at the window and playing with his fish toy.
 
That's so great to see those blues! It takes a couple of days for his numbers to stabilize. Once we see him settle, then we either raise of lower the dose from there. It seems like you have such a great team of people around you to help out!
 
OK. The black is a high rebound from the very low numbers yesterday. The blues today tell me that 4 u is looking pretty good as a dose for now.

That’s great! Thank you for taking the time to explain how you got to the suggestion of 4 u and all your help :)

That's so great to see those blues! It takes a couple of days for his numbers to stabilize. Once we see him settle, then we either raise of lower the dose from there. It seems like you have such a great team of people around you to help out!

Got it! His PMPS was 26.9 so like you said, should I see that number decrease overtime if 4 u is indeed the correct dose?
 
should I see that number decrease overtime if 4 u is indeed the correct dose?

Yes, you should see the PS numbers decrease over time, but one thing to clarify about the "correct dose" is that the dose is always changing. So you're looking for the correct dose for right now. Feline diabetes is a dynamic disease and the kitty's needs will shift. The hope is to be regulated enough that the changes are small and somewhat predictable. Right now you're in the guess-and-collect-data phase. So 4u is a good dose for today, but it's likely that in a couple of days you'll need to make another change. And on and on. I promise it gets easier though. And as we guide you through a few of these, you'll start to get the hang of it and soon you'll be able to help other people figure out what to do. :)
 
Yes, you should see the PS numbers decrease over time, but one thing to clarify about the "correct dose" is that the dose is always changing. So you're looking for the correct dose for right now. Feline diabetes is a dynamic disease and the kitty's needs will shift. The hope is to be regulated enough that the changes are small and somewhat predictable. Right now you're in the guess-and-collect-data phase. So 4u is a good dose for today, but it's likely that in a couple of days you'll need to make another change. And on and on. I promise it gets easier though. And as we guide you through a few of these, you'll start to get the hang of it and soon you'll be able to help other people figure out what to do. :)

I’m happy to hear it gets easier and more predictable. I’ve been feeling a bit overwhelmed especially thinking about my schedule and how to convince my mother about home testing (we didn’t have a very good conversation last night about it. She thinks I’m going ahead of the vet and putting Ming through unnecessary pain with the ear pokes. I’m even thinking as far as needing to get a pet sitter for days I’m not able to feed just because my mom’s response to all of this has been both frustrating and surprising. She was a nurse so I thought she would understand but she’s not very open about this. But like you and others have said, you have worked through odd schedules before so I’m definitely curious and willing to figure it out! And so very thankful all of you who are helping and the responses I’ve received make me so happy and put me at ease all the time.

Sorry about the family ~~ drama ~~ but thank you for listening :facepalm:

I also have some more questions :rolleyes:
  • Because of scheduling, if I only do PS tests, what would be a red flag that something is going on? For example, this morning he was more than 33.3 which was a huge red flag. But what if I was unable to test in the middle of the cycle? Would the next PS test be indicative of anything?
  • Should I update this thread with future “odd” BG readings or even readings in general like “Today’s PS reading was this” in case what I think is normal isn’t normal. I don’t want to spam the forum, of course!
  • What DO people who have long or odd work schedules do?
  • Right now I’m using 23 G needles from work to draw blood and sometimes... I accidentally poke right through Ming’s ear :nailbiting: any tips? Also, does anyone reuse their poking needles? It’s such a waste... but I understand that sterility is important.
Again, thank you thank you. I can’t say it enough. I’m so grateful and amazed and happy that such kind people exist and give up their time to help others. THANK YOU!!!

ETA: we are at 17.7 at +5 after PMPS. Maybe he dropped earlier? I’ll do another at +6. Plus, my mom just told me she fed him the other half of DM at 4 pm... and fed him primal freeze dried only at the PM feeding. I told my sister to feed tonight but ........ i don’t know what happened. Good thing she didn’t shoot 6 u, I guess? Do you think what happened with the food today would affect the BGs significantly?
 
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Morning! It really does get easier. You start to learn your cat and what is likely to happen.

Family makes it tough sometimes. Has she seen you giving the tests? How does Ming take the tests? Maybe if she sees that he isn't in pain, that will help. You could show her some of the videos online too to show that those cats just sit there.

For your questions:
  • We can't all get mid cycles every day. As long as you get them when you can, we can help infer from there. And remember, mid cycles don't have to be exactly at nadir. Getting any numbers is helpful...even if you get a +2 that can help tell us what a cycle is likely to look like. Do what you can, and don't worry too much if that means some days you can't get a ton of data. As you get more and more data over time, the need for as much becomes less because you learn your cat's patterns. The preshot tests are still helpful since they tell us if the cat is high enough to shoot. If both are high, it's hard to know what happened (did the cat go low and bounce back up, did he stay high, etc) but say one was high and one was much lower...that tells you that the insulin lasted awhile longer than normal.
  • Whatever works for you! We don't have any specific rules for threads. If you want to start a new one every day or keep this one going for awhile, it's fine. We generally would prefer threads don't go beyond 2 pages because it can get confusing, but beyond that, however it is easiest for you is fine for us. Trust me, you can't spam us (well...I say that but we've actually had spam attacks recently!). But we want you to post as much as you want/need. We like to keep up with the cats on our forum, and we love to hear from them daily..we get worried if we don't!
  • Long or odd schedules have to change depending on what the schedule is. Though it isn't ideal, we have had people who shoot 11/13 or 13/11 instead of 12/12 due to schedule. We've just adjusted the dose slightly to work around that. We've also had people who simply had to adjust shot time around crazy schedules and we had to just adjust the dose on some days so they could shoot early/late. I know you mentioned your schedule before, but can you remind me again what it is? We can take a look and see if we can find a general idea of what you might do.
  • Have you tried putting something behind Ming's ear to help brace against? That might help you poke better. And maybe try a smaller gauge? 26 or 28? Do you use the lancing device or free hand? The lancing device might cause that. I always free handed so that made it easier to control the depth of the poke. I wouldn't reuse needles though..even using them once can cause the tip to blunt and make it harder on you and Ming.
We're happy to be here for you and Ming! We had people who guided us through the beginning stages and we love to pay it forward for that. Sue (who is no longer on the forum) was here for me every single day, morning and night, to help me through my freakouts, tears, fears, and triumphs. I'm grateful to be able to do what she did for you and anyone else who comes on!
 
Hang in there at 4 u for today at least to see how he settles. There's a lot of art/nuance in dosing that is based on a spreadsheet of data to look at, knowledge of your kitty's responses and your own gut feeling once you've been at this a while. That's how we're able to look at a spreadsheet, see the data trends over time, rely on our experience and come up with dosing suggestions for new members and for our own kitties. We still make mistakes (but hopefully they're not too big) and cats make it their life's work to trip us up!

The L insulins have a more black and white set of guidelines to follow and many people like that. However, I can tell you that they don't work for all kitties and mine is one. ProZinc has general guidelines if you read over the yellow info stickies but there's quite a bit of judgment required of the pet owner. I've used ProZinc, Lantus AND Levemir in my very tricky, unpredictable cat so I have a pretty good feel for how they all work. You'll get there. ;):)
 
Will reply to the great comments after work tonight! Ming is coming to the vet and in a car right now. Nervous but excited to see what the vet says.

He was also 8.7 at +5
 
Oh dear...it looks like something has happened to disconnect the World/US pages of your spreadsheet.
Today's numbers don't show up on the US side. :confused:

Regardless, a drop from 23.2 to 8.7 is quite good. While eventually you want Ming to get some safe dark green numbers, it's important to also consider the change from PS to nadir. At this point, you don't need to him to drop harder than that. Looking forward to hearing the news from the vet :)
 
Hi all! I'm quite tired so I'll just do an update about the vet: it was great!

But before we start, here's some more data:
I did the PMPS reading at the vet (I was still working) and was not surprised to see it was 32.2 (580) since he was so stressed. I made the decision to only feed him freeze dried raw so as to not raise his BG anymore (even though my vet JUST said to keep his diet the same lol but his environment is not!). At +4 he is down to 8.8 (158). I'll do one more reading at +5 just because I'm paranoid. Edit: 7.9 at +5. Wish I could do a +6 but I have to sleep. But I can definitely do a +6 tomorrow night since I'm not working the day after!

Most of everything she said, I didn't prompt so it was all coming from her:
  • She knows most vets say to feed only when giving insulin but she knows cats are grazers and thinks it's better to allow food throughout the day
  • Knows DM is high carb but she doesn't want to change so much at once and suggested to continue feeding as normal but just 10% less to reduce weight and then slowly transition to freeze dried/raw.
  • Looked at my curve and agreed with 4 units
  • Wants me to do another curve in 2 weeks
  • Said I don't have to test blood so often and poke Ming so much and just do the curve
  • Mentioned IBD. I can't remember exactly what she said but she mentioned allergies and IBD linked to diabetes and/or pancreatitis. I'll have to ask her about that next time I see her. Anyone know what she might be talking about?
  • I mentioned that Ming "coughs". I've brought him to my initial vet that I stopped seeing a year ago (not my last vet) and we did x-rays and didn't see anything. She talked about asthma and also allergies that might cause it but he doesn't cough enough for it to be asthma. My last vet also said that. He probably does that cough thing (no hairball produced and low to the ground) about once a week and sometimes not even once a week
  • She knows she said we'd give steroids to him but she doesn't think it's necessary right now since his physical was good
  • Said Ming looks great! His teeth look great, she said, and mentioned that bad teeth is usually associated with diabetes. I didn't know that?
  • She was telling all my coworkers that we're gonna beat Ming's "beetus" :joyful:
  • Got some cerenia and bupe to take home just in case!
  • I asked her if she wanted to do blood or urine testing and she said nope! *shrug*

What do you guys think?

I think I'll still do BG readings because why the heck not, right? I also got some 25G needles so that should hurt less. And since I started feeding Ming half a can of DM and half freeze dried, I'll continue with that for now as well unless something happens.

Some funny moments at the vet:
  • Ming hated all the cats as I expected. We also had so many cats come in today. Usually we have no cats or one cat. But there were 3 other cats at one time! One was boarding and healthy and beautiful and who was very interested in Ming. They were kennel neighbours and the white cat was trying to get a whiff of Ming and stuck out his paw through the bars like some sort of peace offering. But Ming just hissed and hissed. Ming is more of a people person. ETA: After I saw that, I covered Ming's kennel door with a blanket so he could feel safe. I definitely don't think it's good to stress kitty out even more at the vet with unwanted encounters.
  • There's a dog boarding with us who we sometimes let walk around the clinic when it's empty. He had a surgery and needed better medical attention. He wouldn't get that where he lived since he is a working dog but is about to retire and will be adopted out. A lot of us working there joke about adopting him. When he saw Ming in his carrier, he shrunk away and I joked that I can't adopt him since my cat scares him :rolleyes:
Anyway, I'm happy my vet agrees with us/most of what we think!!! I'm also interested in what you guys think too.
 
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