Calmer now but could you still help me

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Harry and Katies Mum

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Ok here goes

Harry went back to the vets for blood tests last week his potassium levels are now at the high end of the normal range, his pancreas test showed 1.2 which is normal apparently and his fructosamine came back fair control.

Now this is where the questions start
The number she gave me for his "fair" control was 450 now not sure what they've measured but this seems very very high to me does anyone understand how they measure fructosamine also bearing in mind he was ill for 2 weeks of their test apparently its over 3 weeks and 1 week he was in hospital with them monitoring and injecting fast acting insulin I believe.

We've done blood glucose monitoring at home and the results are high so vet said its because we are using a human machine and it only gives an idea of the curve and isn't reliable for the numbers and we should buy a feline specific one. Now I've looked online they are expensive but if we have to we will do however I've seen your comparison numbers on here and it seems to go against what the vets says (not really surprised to be honest)

I think thats all the questions for now

I know you advised to switch foods and I agree however have had trouble convincing the other half and the vet is just you must use the food we gave. Anyway long discussion with other half last night and now the pancreas is normal we are doing a bg curve at the weekend and we have to take him back for another fructosamine test next week. I actually managed to see the vet last night when I collected Harry's caninsulin and thats when she gave me his pancreas results so I spoke to her about the numbers we were getting and thats when she mentioned this new machine. I have said to the vet that I want to have a serious discussion with them about getting his numbers down as they say they are ok at between 18 (324) and 25 (450) but the vet in Inverness that treated him when he was really unwell said they should be between 5 (90) and 10 (180). Having spoken to the other half he has said wait to do bg curve at the weekend and speak to vet next week and see what response we get but he is happy to change food to one thats been recommended for diabetic cats Borizto I think its called and I can order it online. I know I've going to have to detox and stop (cut down) insulin when we change food. I know this seems like I'm dragging my feet but I was hitting a brick wall last week with both the vet and my other half and unfortunately I can't do this on my own. He was agreeing with the vet and I felt I couldn't fight both of them but now the rest of Harry is back to normal he's understanding what I'm saying.

We aren't sure if we are going to convince the vet to change the insulin from Caninsulin but I'm sure the change of food alone will help.

Hope the above makes sense and I look forward to your responses
 
It is really hard when you get conflicting advice and your vet won't support your ideas. All we can offer is a plan that has worked for hundreds of cats - wet lo carb food (Assume you have seen this vet site: www.catinfo.org), a mild long lasting insulin (Canninsulin has worked for some cats, but it is harder to regulate with because it is not long lasting and usually the cat has a fairly fast low drop and then heads right back up) and home testing. (The argument for feline bg testers has been on the site over the years. Yes, they may be a little more accurate for animals, but they are terribly expensive. Not just for the meter but for the strips. The majority of people here use human meters with great success. You are looking for patterns and trends - if the numbers are not exactly the same as the animal meter, it is the general trend that is important. Many of our vets use human meters.)

So it boils down to whether you can work with your vet - whether she/he will listen to and respect your views and let you try some things. First, the diet. This was a stickler for my vet originally. She wanted us to feed prescription food; we wanted to feed Fancy Feast. We agreed to disagree and we stopped talking about diet - especially when Oliver's numbers dropped by 100 points and we had him into regulation in a few weeks. Your vet is not there when you feed your cat. You can feed what you want and just say your cat wouldn't eat the prescribed food and you knew how important it was for him to eat......

You can say that you just can't afford the expensive meter right now. Can you use the human one (or can you borrow the feline meter for a week?) That way you can take two readings and compare the two meters. There really shouldn't be much difference.

If you want to try to work with your vet, you should. If you think you want to change, we may have members nearby with fd friendly vets that might be easier to work with. Your choice, your cat. You have to do what is comfortable for you, and changing vets may be one step too many for you right now. Many vets have a plan that they want to follow. The question is how many diabetic cats has your vet worked with and what has the success rate been? It isn't that vets don't get it. It is usually that they see a few diabetic cats a year and they rely on what they learned during the one seminar in vet school they attended. Vets have to treat many different species and many different diseases. They just can't be an expert in everything.

Glad you are feeling calmer and more in control. The testing at home usually really helps with the control thing - at least now you know how the insulin is working and that your kitty isn't headed for a hypo event. Sorry that the vet issue is causing concern. We will help you regardless. We have worked with people who have had vets whose methods are contrary to ours. Our interest is only in helping you and Harry.
 
Thank you so much for your reply to be honest it wasn't so much the vet as how would she know what I feed if I don't tell her it was the other half that was the real problem but I think I hit break through last night - god theres been some rows in our house over the last week :lol: I wouldn't have been surprised if Harry and I were told to move out.

I'm going to do his curve at the weekend take him for his fructosamine test depending on the results of the curve I will or won't try to get a change of insulin. I will ask her about a change of food but if she doesn't agree as everything else is fine I'm going to change it regardless of what she says. I also want to try and get him off his Kaminox which is his potassium supplement as the major part of it is fructose which can't be good for his bg. If all I manage next week is a change of food at least its something. If I still can't get his curve to stabilise I will try again for an insulin change.

I am so pleased I found this website I don't know what I'd have done the last few weeks otherwise.

Sorry forgot to put that changing vet is difficult the next one is 1.5 hours away and the next after that is 3 hours away so could do with trying to work with the vet we have but we'll have to see to be honest
 
I imagine you have already heard this, but if you change from dry to wet lo carb (not sure what you are feeding now), be ready to stay on top of his numbers. We switched Oliver from dry to wet and saw a 100 point drop overnight and had to reduce the insulin immediately. ECID - some show a drastic change, some not as much.
 
Yeah I need to get my head round the detox/insulin issue. He's actually on a wet food now but its 26% carbs on a dry matter basis so fairly high I can't remember what the new one is about 6% I think so its a big drop so I know it could be an issue just need to read the bits on here to find out how to do it right. I've already warned the other half it will mean alot of testing until we find out what happens to his bg.
 
It sounds like you're in good hands, but hope you won't mind my chiming in... :)

My vet was also adamant about sticking with the dry food that she prescribed to me. I listened to her for 2 months, but just this past Saturday switched Neo over to wet lo-carb and I noticed a difference the same day - he was drinking and peeing WAY less water, and he has been looking more perky too. I started home testing at the same time and his BGL hasn't dropped dramatically (he's on Caninsulin), but they do seem to be more stably lower than they were on the dry.

Does your vet's office have several vets? I'm just asking because I called the vet this morning (they have 30 minutes where I can call for free every day) and got someone I don't normally get in the office, and he sounded really pleased with me for taking Neo off the dry food and going with low-carb. :? So regarding food at least, I wouldn't worry too much about what the vet is trying to push on you. I'm glad you got your other half to see the light! :)
 
Of course I don't mind.

I am hoping that we too will see a nice drop in Harry's numbers from the change in food. We have been seeing a different vet from the one that Harry normally sees but we've got an appointment now for his fructosamine test next week and I've booked it with his normal vet so hopefully she will be a little easier to deal with over the food issue. If not I think we will be doing it anyway.
 
Larry and Kitties said:
Fructosamine and BG are measured on a different scale. See:
http://www.sugarcats.com/articles/Fruct ... on-charts/
Click to expand...

Ohhh thank you so perhaps Harry hasn't been as high as I thought from the numbers the vet gave me but even so he was in hospital for a week of that and I'm sure they were giving him a different fast acting insulin not his normal caninsulin certainly at the start because he was so ill and his numbers so high.
 
Not sure what you mean about insulin detox if you change food? You don't have to change the dose you just have to be vigilant about monitoring.

So you are running into a situation common when the vet says one thing and we and even another vet says another. Its not uncommon but it is very difficult. Lets try to break it down

1. the human glucometer is valid for pets. We can dig up articles that support using human glucometers for hometesting. Even the Canadian Veterinary Association supports it. So stick to your guns.

2. the food. ask the vet what is magical about the food. if it is dry that is supposedly low in carbs, ask why not canned/pouches that are lower in carbs, higher in protein and moisture. Print out food from Dr Lisa's page www.catinfo.org if you need a vet's opinion. show the ingredient labels for the foods and look at the crap that is in the vet food. And then say that while you respect the vet's opinion and knowledge, on this issue and perhaps others, you wish to do things differently.

3. Numbers. Your other vet was right, numbers between 90 and 180 would be MUCH healthier for your cat.

4. Husbands. THey are notorious for not wanting to go against a vet's advice. Notorious. Why? White coat symdrome perhaps? Women are by nature more instinctive caregivers I think (not slamming men at all) and we want to research and don't always blindly listen to authority when it comes to caring for our pets or our children or ourselves. Husbands care too but they do not want to go against authority. So he has to be educated in feline diabetes as well so that he can understand why you want to go against your vet's advice.

Does this help?

Jen

4.
 
A few quick comments:

It's really a no-brainer for diabetics - a diet lower in carbs should result in lower BGs. If you can't switch totally to wet, then at least feed some and some, and then if you get lower numbers that will prove your case.

The fructosamine test is not like a one-off BG reading, it's a blood test that gives an average BG for that cat over a period of weeks (not sure exactly how long, it may be 2-3 weeks) but measured in a different way. The figure you got sounds high but the vet should be able to give you the range, so you can see immediately whether your reading is within range or at high/low end etc. At the moment you are just working in the dark. Vets are very fond of fructo tests but as you are testing at home there is really no need to do it at all - it's a waste of money!

I wouldn't be put off by the comments about using a different machine, the one you've got is fine. Everyone here will say the same, and also be glad of "human" machines because they have saved many a cat's life here.

The discrepancy in comment from the two vets about Harry's numbers is amazing. 18-25 is NOT okay. 5-10 is fine for a diabetic.

I don't know how you're going to get round the insulin (change of) issue, if at all, but the key to it all really is finding a vet who speaks the same language as you and understands that you are serious about this.

Good luck

Diana
 
Hi Jen

That definately does help thank you. The vet prescription food is for his pancreatitis as its low fat but as his latest results came back normal I have a strong case to argue. I did manage to get them to switch him from the dry version to the wet as Harry actually doesn't like dry food and they couldn't understand why he was just picking at his food but even the wet version is 26% carbs calculated on dry matter so its still really bad. I've got some pages that are on here I think with comparisons of pet v human machines that I found last night through petdiabetes wikia I think so I'm hoping they do the trick but either way I don't intend buying the pet version if the human one is good enough and everything I've found says it is.

Its strange because when I started explaining things I read here to the other half he agreed with me and saw sense but just won't stand up against the vet with me. He seems to think the vets will refuse to treat Harry and we also have another cat and dog at home. I have a little folder at home with all the stuff I've printed off the internet and asked him to read it before we go to the vet next week, hopefully it will convince him once and for all but I've definatley won the food battle with him so phase one complete I just need to order it which I will probably do later.

Sorry I also didn't mean insulin detox I meant his body has got to detox the extra carbs and so we would need to watch how much insulin he has by testing his bg more often.
 
Sounds like you are getting a handle on things. Yes, some people have found fats to be an issue for pancreatitis but there seems to be little actual evidence. I think that if you avoid really high fat foods but just go moderate, he will be fine.

As for hubby, keep working it :)

oh, and about the insulin...it definitely isn't the best but it is better than nothing right now and while you get your head wrapped around all the many details, its good at least that he is on it.

Jen
 
Thanks again Jen that was what information I found about pancreatitis too so I definately think this new food will do its not as low as the one he's on now but I just can't get my head round feeding him all the carbs I'm doing at the moment so I think to me that is definately more important unless they can give me a very good reason not to.

Hehehe I'll keep working on him hopefully he'll read all the info I've left him.

I just wish they hadn't done away with his original insulin he only got pancreatitis because we changed his insulin and his bg went all wrong and made him really really sick. I'm amazed he managed to fight back so I've got to take on the fight for him now and make sure it doesn't happen again.
 
Has anyone given you the article I've attached yet? I would print it out and bring it to your vet. I already had Bandit on the treatment plan suggested in the article when I switched vets (low carb canned diet, a slow acting insulin like Lantus (glargine), and tight regulation via daily home testing), and they changed their treatment recommendations after I showed them the research. Some vets are just not aware of the changes in feline diabetes treatment recommendations in recent years because it is very hard to stay current in every disease for every animal, and once they are presented with the research they will get on board. And if they don't, well, you find a vet that will.

I would also give the article for your other half to read! Then maybe you can finally say the argument is done!
 

Attachments

I agree with Jen and Diana (hello Diana, it's been a long time!) whole heartly.

A low carb food is essential as a first step to help lower your kitty's blood glucose number. If you can't change insulin then at least please put Harry on low carb WET food. I listened to my first vet and put Major on vet recommended prescription diet for diabetic cats. He became so sick (diarrhea for days) and dehydrated and yet the vet said it was normal to have diarrhea after a quick change of food and told me not to bother to bring him in. Then he told me to give him dry food to FIRM up his stools! I almost lost my Major. I have since learned not to listen to everything my vet tells me. I do my own research, I check with other caregivers and I use my own commom sense.

Personally, I think the frutosamine test is a complete waste of time and money if you are doing home testing. Of course, the vet wants you to bring your cat in for a fructosamine test because it's another way for them to make money. I will not take notice of your vet's comment about glucose meters for human not being accurate when using it for cats.

If you are concerned that a glucose meter for human is not accurate, if using it on cats then please read the article (see the link below) which I sent you last week. Did you have a chance to read it? This is an article published by University of Queensland. Although the entire content of the article is not relevent to you, the last paragraph on the first page of the article explains how you can calibrate the meter reading.

http://www.uq.edu.au/ccah/docs/diabetesinfo/link2.pdf
The paragraph says:
'The blood glucose values were based on using a portable glucose meter calibrated for human use which measure glucose concentration in whole blood. Blood glucose concentrations measured using a whole blood glucose meter calibrated for human blood may measure 30-40% lower at the LOW end of the range than glucose concentrations measure using a serum chemistry analyser or a plasma-equivalent meters calibrated for feline use (AlphaTRAK Abbott). When using these latter methods for measuring blood glucose concentrations, target glucose concentrations at the lower limit of the range should be adjusted accordingly by adding approximately 30mg/dL (1.7mmol/L) to the value listed in the protocol below (there is a table attached to the article).'

If you are concerned that the glucose meter for humans may not give you an accurate reading if using it for cats, then you can do the calibration yourself. I honestly do not know if any of us on this board is doing the calibration.

Just another comment, if you are doing the home testing, you can treat Harry's diabetes WITHOUT a vet, especially a vet who tells you that blood glucose of 18-25 mmol/dL is okay. At this level for a period of time, there could be potential organ damage. 18 - 25 mmol/dL is really NOT OK. Please take look at the following link on blood glucose guidelines for cats.

http://petdiabetes.wikia.com/wiki/Blood ... guidelines
 
Also, highlight the last paragraph in the chart on p. 671 (4 of 15) for your vet. It states: "NB: For human-use meters which provide plasma-equivalent values, readings are approximately 11% higher than glucose measurements for whole blood in human patients. For veterinary-use meters calibrated to give plasma-equivalent values for feline blood, add approximately 1.7 mmol/l (30 mg/dl) to target glucose
concentrations, for example, aim for 4.4e7.2 mmol/l (80e130 mg/dl), instead of 2.8e5.5 mmol/l (50e100 mg/dl)."

As long as you understand the small difference between readings on a human meter and one calibrated for felines, you do not need a feline meter. The protocol for Lantus which is listed here: http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf, makes adjustments for both human meters and meters calibrated for cats.
 
KSAkitties said:
The article says:
'The blood glucose values were based on using a portable glucose meter calibrated for human use which measure glucose concentration in whole blood. Blood glucose concentrations measured using a whole blood glucose meter calibrated for human blood may measure 30-40% lower at the LOW end of the range than glucose concentrations measure using a serum chemistry analyser or a plasma-equivalent meters calibrated for feline use (AlphaTRAK Abbott). When using these latter methods for measuring blood glucose concentrations, target glucose concentrations at the lower limit of the range should be adjusted accordingly by adding approximately 30mg/dL (1.7mmol/L) to the value listed in the protocol below (there is a table attached to the article).'
Click to expand...


Wow, we both just thought of the exact same line from the same article at the exact same time. :-D
 
Julia & Bandit said:
KSAkitties said:
The article says:
'The blood glucose values were based on using a portable glucose meter calibrated for human use which measure glucose concentration in whole blood. Blood glucose concentrations measured using a whole blood glucose meter calibrated for human blood may measure 30-40% lower at the LOW end of the range than glucose concentrations measure using a serum chemistry analyser or a plasma-equivalent meters calibrated for feline use (AlphaTRAK Abbott). When using these latter methods for measuring blood glucose concentrations, target glucose concentrations at the lower limit of the range should be adjusted accordingly by adding approximately 30mg/dL (1.7mmol/L) to the value listed in the protocol below (there is a table attached to the article).'
Click to expand...


Wow, we both just thought of the exact same line from the same article at the exact same time. :-D
Click to expand...

Great minds think alike!
 
Julia & Bandit said:
Has anyone given you the article I've attached yet? I would print it out and bring it to your vet. I already had Bandit on the treatment plan suggested in the article when I switched vets (low carb canned diet, a slow acting insulin like Lantus (glargine), and tight regulation via daily home testing), and they changed their treatment recommendations after I showed them the research. Some vets are just not aware of the changes in feline diabetes treatment recommendations in recent years because it is very hard to stay current in every disease for every animal, and once they are presented with the research they will get on board. And if they don't, well, you find a vet that will.

I would also give the article for your other half to read! Then maybe you can finally say the argument is done!
Click to expand...

Janet,

Not many vets in the UK are up to date with the latest treatment for feline diabetes. I experienced what you are experiencing right now with my Major three years ago when I was living in the UK. I know what you are facing. I ended up having two vets. One I consulted for non-diabetes related issues. One for diabetes related issue - primarily to get the PZI insulin. I know I can get good guidance from this board even if my vet and I are not on the same page.

Please take a look at the article Julia attached in her post. I also gave you the link for the same document last week. I know you don't want to upset your vet but perhaps you can tell her that you want to share with her an interesting article on the latest treatment for feline diabetes, and you'd be interested in her view on this article.
 
Welcome to FDMB! Glad you are getting so much help.

4. Husbands. THey are notorious for not wanting to go against a vet's advice. Notorious. Why? White coat symdrome perhaps? Women are by nature more instinctive caregivers I think (not slamming men at all) and we want to research and don't always blindly listen to authority when it comes to caring for our pets or our children or ourselves. Husbands care too but they do not want to go against authority. So he has to be educated in feline diabetes as well so that he can understand why you want to go against your vet's advice.
Click to expand...

This makes me love my hubby even more! He is the one who stood in the vet's lobby when they handed Smokey back after they tested her at 83 and told us to hold the dose at 3 units and come back in a month and said "Nope, I am not comfortable with that all. There's no way we are going to keep giving that much insulin and not check things out for a month." We were really quick clueless at that point, but knew the number was well into the good range and we had been dropping. Hubby refused to go that long without another appt and I found this board that night and we started home testing within a week. A week later we were skipping shots because of low numbers, by that *1 month later* we were going from .5 to .25 units and off of insulin completely in about a month and a half. All using a human meter and feeding low carb wet food. And we actually had a pretty good diabetic vet, but I think she learned a little about tight regulation with Smokey. They tested her once more after we started testing, compared the meter results, and then I just dropped of a spreadsheet each week and she'd call and talk about dose reductions.
 
Oh about the meter, I forgot to mention that I used to bring my own meter to the vet and check my meter reading with the reading from my vet's meter (he uses that special Alpha TRAK meter). The readings were very, very close. The difference was really neglecble. I never had to calibrate the meter. At that time, I was using Accu Check Compact Plus meter by Roche.

You can also bring your own meter to your vet's clinic and compare the blood glucouse results with the reading from your vet's meter.
 
Regarding the comment about things being different in the UK....they used to be even more different...there used to be a secret network of hometesters, as hometesting was actually (correct me if I'm wrong) ILLEGAL! So yes, it is very important to be cognisant of the differences.

Regarding husbands...mine started out reluctant to go against our (wellmeaning) vet...now he is thoroughly on board and even knows to refuse dry food when a vet we used in an emergency tried to sell it to him :) He told him that he'd not be allowed to bring it home with him and that his wife (me) would be pleased to tell him (vet) why :)
 
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