Coco Update~ back from the Internal med specialist!! I LOVED the dr!!

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Anna123

Anna123

Member Since 2016
For anyone following Coco's high dose journey & the awful previous vet experience...We are back from the internal medicine specialist. Turns out, she specializes in diabetes! She was AMAZING. Talk about thorough!! The biggest thing was, she was thrilled with my spreadsheet. THRILLED!! She encourages them & thought mine was very well organized! She loves that I home test & asked if she could film me doing the testing, to show others how to test. Wow~ what a difference! She took tons of blood tests, calcium test, urine test, and even did an ultrasound. (coco has been breathing quite heavy lately, so she wanted to check on that.) Everything turned out normal :) ..she's just waiting on the thyroid test which we'll get Thurday.If thyroid is normal, she says we are just dealing with a classic insulin resistance, with no underlying condition to speak of. She believes that it is not necessary to do the acro test, because Coco really has no symptoms of that upon examining her (but if I wanted it she could, she said) She also wants me to change her diet. She says Fancy Feast may be lower carb, but she likened it to junk food. Coco has gained 2 lbs since last vet weigh-in. She gave me a prescription for different food. She wants to see how that goes & then believes she will switch me to Levimir. She says it's much stronger, so I will start out on 1 unit~ wow!! Bottom line: I trust her. Very, very knowledgable~ she spent 2 1/2 hours on Coco!. .... (we won't talk about the bill...Ugggg)
 
So great to hear you're so much happier with this new vet!!!

As for the "prescription" food, I have to disagree.....if you look at the ingredient lists for most of those, they aren't any better than the ingredients in the Fancy Feast.....except they cost a LOT more! If Coco is gaining unwanted weight, the key is to reduce the amount she's eating and increase her activity level (if possible).....Just like humans, weight is a mix of calories consumed and calories burned.....there's no magic in the "prescription" food.....and the one most vets tend to use is W/D which is very high carb...and the reason a lot of animals will lose weight on it is because it contains "powdered cellulose".....that's a fancy word for sawdust....If you ate sawdust, you would lose weight too!!

I also have to strongly disagree about the levemir.....it's not exactly "stronger" than lantus, it just works slightly differently......We usually suggest a starting dose that's 70% of the previous dose of Lantus, so for Coco, who's been on 9U, that would be about 6.5 U

Dropping all the way back to 1U will just leave Coco in high numbers for an even longer time, with glucose toxicity setting in the whole time. You'd basically be starting completely over.
 
Hi Anna,

It's wonderful that you found a vet you like and trust so much. I'm sure that's a huge relief after your previous experience. It's great that she was so thorough in the exam and didn't find any underlying issues. I would keep the acro test in the back of your mind, just in case .

Anna123 said:
She gave me a prescription for different food
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What food does she want you to feed? You know there is nothing special about prescription food but the price, right? Most "prescription" foods are much higher in carbs than Fancy Feast and some other food that people here feed, not to mention a lot more expensive. I'm sure you want to follow all her instructions, but be aware of the carb % (you can look it up on Dr. Lisa's list - the "prescription" foods are at the back) and watch to see if it raises her BG.

Anna123 said:
The biggest thing was, she was thrilled with my spreadsheet. THRILLED!! She encourages them & thought mine was very well organized! She loves that I home test & asked if she could film me doing the testing, to show others how to test.
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That is absolutely delightful. I wish we could clone her! If you have a printer, here is a sheet of "business cards that she could give clients with diabetic cats to introduce them to the Board.

I'm sure this is a big load off of your mind.

 
I'm glad the visit went well and she's willing to work with you!

Anna123 said:
She believes that it is not necessary to do the acro test, because Coco really has no symptoms of that upon examining her (but if I wanted it she could, she said
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If it were me on 9.5u I would get bot the Acro and IAA tests done so you know what/if you're dealing with that. Most acros don't show any "symptoms" until later.

Anna123 said:
She wants to see how that goes & then believes she will switch me to Levimir. She says it's much stronger, so I will start out on 1 unit~ wow!!
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Sounds all too familiar. Levemir is not stronger than Lantus. When you switch from Lantus to Levemir we suggest the starting dose of 70% of the current Lantus dose. I switched Doodles on 4/17/16 so you can take a peak. He's IAA only. We started at 10u of Lev, have gone down a few times to around the 5u mark and we're currently climbing back up sitting at 7u. The IM vet told me I could never microdose Lev....well thus far that's nothing for me to be concerned with

Anna123 said:
She gave me a prescription for different food.
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Curious what food she prescribed. The majority of prescription foods have worse ingredients than Fancy Feast. There are other LC options that do have better ingredients if that's what you are looking for. Personally, I feed Ziwi Peak . Doodles is also confirmed IBD and hasn't been sick from food since I switched. Of course ECID.

Just my 2 cents but again, super glad you like her...that's 1/2 the battle.
 
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This was the food prescribed:
 

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The Purina DM is 10% carbs. The Royal Canin isn't on the food chart, but someone else posted it's around 12% I think someone else here was feeding it, so maybe they know what the % is.
 
So happy to hear the new vet is not berating you for wanting to keep your kitty safe.
She sounds like someone that will work with you. She does however have a few more things to learn about high dose conditions as well as Lev IMHO.

Anna123 said:
The biggest thing was, she was thrilled with my spreadsheet. THRILLED!! She encourages them & thought mine was very well organized! She loves that I home test & asked if she could film me doing the testing, to show others how to test. Wow~ what a difference!
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How cool is that? You and Coco will be stars!! :p;)

Anna123 said:
If thyroid is normal, she says we are just dealing with a classic insulin resistance, with no underlying condition to speak of. She believes that it is not necessary to do the acro test, because Coco really has no symptoms of that upon examining her (but if I wanted it she could, she said)
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classic insulin resistance resistance?? I'm not aware of such a thing. BKs IAA was 84%, which is considered extreme. I recommend you get the testing done for both IAA and Acro.


Anna123 said:
She gave me a prescription for different food. She wants to see how that goes & then believes she will switch me to Levimir.
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save your $$$, so many of us use FF classic pates. there is nothing magic about those prescription foods.

 
Glad that you like the new vet and that she's willing to work with you. However much she may think she knows about diabetes, she is lacking in several areas regarding high dose cats. As others have said, the vet food is no better. Take a look at the ingredients - no really any different than Fancy Feast, except the cost and the profit goes to the vet. I'm personally not a fan of Fancy Feast myself, partly because it's high in phosphorus. Many acrocats eventually get kidney issues so getting them used to a lower phosphorus food is a good idea. There are many off the shelf options that are much better than vet foods. Personally I put Neko on a raw food diet and she did well for years on it.
Anna123 said:
If thyroid is normal, she says we are just dealing with a classic insulin resistance, with no underlying condition to speak of. She believes that it is not necessary to do the acro test, because Coco really has no symptoms of that upon examining her (but if I wanted it she could, she said)
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Wrong!! Only 35% of acrocats show clinical symptoms on diagnosis and Coco already has two symptoms in addition to the higher dose. One - she's gained weight without being regulated (that's the excess growth hormone) and second, the heavy breathing. I'm not sure where the vet did the ultrasound, but the breathing is probably from soft tissue grwoth in the throat. Neko's IM vet could detect the thickening of her pharyx by looking and she just had a tiny whisp of airy breathing. Every cat that's gone over 6 units here and has been tested has had a high dose condition. So yes, get the vet to humour you and send the tests out for IGF-1 and IAA.

Fortunately she sounds like a vet who is willing to learn. Did you ask her how many cats with acromegaly she's treated? Keep in mind that one in four diabetic cats has it, so there's a good chance she's seen a few of them, whether or not she knew it. And I'm not really surprised by your IM vet saying what she did - we so often see vets dismiss the idea of testing, just to be proven wrong. I think it's the legacy of all but recent grads being taught it's a rare disease. The true test of a vet is how they respond to the client being right.

Contrary to what Chris said about weight, I would look at body shape and see if she seems to be getting fatter instead of strictly going by the scale and deciding if she needs to lose weight. If Coco has acromegaly and the growth hormone is causing her body to grow, she may actually need more food. Think teenage boy appetite. Growing bodies may need more.

The others have addressed the vet's misconceptions on Levemir dose. Some cats need less, some more than Lantus. We start people at 70% of the Lantus dose, because some cats show an initial strong reaction to the new insulin. Starting back at 1 unit would be a huge step backward. The upside of Levemir is that often cats have flatter cycles and Lantus can sting at higher doses so Lev is kinder that way. Neko liked it much better.

Other kitties that have switched recently to Lev from Lantus are Bronx (has acromegaly) and Small Kitty (switched Feb 2017, not a high dose cat but now on the same dose as he was of Lantus).
 
Anna123 said:
This was the food prescribed:
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There IS another Purina 'DM' food that's only 3% carbs. The one pictured is 'Selects' which has gravy - note the word Select in black below DM. If the can looks the same but does NOT have that black box, it's the lower carb pate one. Learned that the hard way, still feeding contraband food to my other cats.... :) Not saying it's any better, just that it's the low carb version.

I'm SO happy that you like this specialist...that makes a world of difference.
 
Squeaky and KT (GA) said:
There IS another Purina 'DM' food that's only 3% carbs. The one pictured is 'Selects' which has gravy - note the word Select in black below DM. If the can looks the same but does NOT have that black box, it's the lower carb pate one. Learned that the hard way, still feeding contraband food to my other cats.... :) Not saying it's any better, just that it's the low carb version.

I'm SO happy that you like this specialist...that makes a world of difference.
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why not saying it's any better? Isn't that better?! lol 3% is good, right?!!
 
Wendy&Neko said:
Glad that you like the new vet and that she's willing to work with you. However much she may think she knows about diabetes, she is lacking in several areas regarding high dose cats. As others have said, the vet food is no better. Take a look at the ingredients - no really any different than Fancy Feast, except the cost and the profit goes to the vet. I'm personally not a fan of Fancy Feast myself, partly because it's high in phosphorus. Many acrocats eventually get kidney issues so getting them used to a lower phosphorus food is a good idea. There are many off the shelf options that are much better than vet foods. Personally I put Neko on a raw food diet and she did well for years on it.

Wrong!! Only 35% of acrocats show clinical symptoms on diagnosis and Coco already has two symptoms in addition to the higher dose. One - she's gained weight without being regulated (that's the excess growth hormone) and second, the heavy breathing. I'm not sure where the vet did the ultrasound, but the breathing is probably from soft tissue grwoth in the throat. Neko's IM vet could detect the thickening of her pharyx by looking and she just had a tiny whisp of airy breathing. Every cat that's gone over 6 units here and has been tested has had a high dose condition. So yes, get the vet to humour you and send the tests out for IGF-1 and IAA.

Fortunately she sounds like a vet who is willing to learn. Did you ask her how many cats with acromegaly she's treated? Keep in mind that one in four diabetic cats has it, so there's a good chance she's seen a few of them, whether or not she knew it. And I'm not really surprised by your IM vet saying what she did - we so often see vets dismiss the idea of testing, just to be proven wrong. I think it's the legacy of all but recent grads being taught it's a rare disease. The true test of a vet is how they respond to the client being right.

Contrary to what Chris said about weight, I would look at body shape and see if she seems to be getting fatter instead of strictly going by the scale and deciding if she needs to lose weight. If Coco has acromegaly and the growth hormone is causing her body to grow, she may actually need more food. Think teenage boy appetite. Growing bodies may need more.

The others have addressed the vet's misconceptions on Levemir dose. Some cats need less, some more than Lantus. We start people at 70% of the Lantus dose, because some cats show an initial strong reaction to the new insulin. Starting back at 1 unit would be a huge step backward. The upside of Levemir is that often cats have flatter cycles and Lantus can sting at higher doses so Lev is kinder that way. Neko liked it much better.

Other kitties that have switched recently to Lev from Lantus are Bronx (has acromegaly) and Small Kitty (switched Feb 2017, not a high dose cat but now on the same dose as he was of Lantus).
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Chris & China said:
Yes! 3% is great, but a lot of cats get sick of eating the same thing every day and the only flavor it comes in is liver I think
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Chris & China said:
Yes! 3% is great, but a lot of cats get sick of eating the same thing every day and the only flavor it comes in is liver I think
Click to expand...
Chris & China said:
Yes! 3% is great, but a lot of cats get sick of eating the same thing every day and the only flavor it comes in is liver I think
Click to expand...
Chris & China said:
Yes! 3% is great, but a lot of cats get sick of eating the same thing every day and the only flavor it comes in is liver I think
Click to expand...
 
Anna123 said:
why not saying it's any better? Isn't that better?! lol 3% is good, right?!!
Click to expand...

Yes 3% is good. Dakota likes it but it gets expensive in a hurry and he gets tired of it fairly quickly. The regular DM is sort of a chicken/liver type pate. We feed Friskies pates most of the time.
 
I was wondering about that. WHY would they only have one flavor? seems weird to me..if I order it from Chewy, the Dr. still gets $ from it??
 
Squeaky and KT (GA) said:
Yes 3% is good. Dakota likes it but it gets expensive in a hurry and he gets tired of it fairly quickly. The regular DM is sort of a chicken/liver type pate. We feed Friskies pates most of the time.
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mayb I can combine the 2 kinds? Friskies pate & that 3% Dm??....any particular friskies pate ?
 
Anna123 said:
mayb I can combine the 2 kinds? Friskies pate & that 3% Dm??....any particular friskies pate ?
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I feed my guy a mixture of DM pate and either Friskies or Fancy Feast pates in a variety of flavours. The DM is the low carb base and the Friskies and Fancy Feast give some variety in taste.
 
It's labeled "pate"

But as long as you're feeding a low carb diet, you can save a lot of money by just sticking with the Friskies or Fancy Feasts.....and as Wendy said, if you're looking for better ingredients, there are lots of other choices in the same price range as the "prescription" diets

They really are just a waste of money for what you're getting....there's absolutely nothing special except the price and the "branding".....by calling it "glucobalance" or "diabetic food", they're just making it sound like it's somehow better.

There's even a class action suit against the makers of the "prescription" foods for (basically) false advertising
 
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