Disco Update 11/29, Vet is Learning on this journey, too!

Status
Not open for further replies.
Teri & Disco NoFurNo (GA)

Teri & Disco NoFurNo (GA)

Member Since 2019
Just used the last of the AlphTRAK2 test strips in the current vial, so from here on out, I will simplify and just be using the ReliON Prime monitor. I'll keep the unopened vial for his supply kit.

I sent his vet the latest SS on yesterday (Nov 8) and have yet to hear back from her, probably won't be til Monday now, but maybe she'll have me increase his dose of Vetsulin again? but feel the switch to Lantus will be happening before long as his numbers aren't changing much, and then I'll be learning all about Lantus here, been reading in advance of course.

So for those who are following Disco and his SS, I'm going to a few PM tests when I 'get up to use the facilities' as recommended and at my age, that’s something I do at least twice a night anyway (HaHaMeow!)
 
Last edited:
Teri -

Can you extend the turquoise coloration across the spreadsheet? (You can also highlight and merge the cells to remove the lines. The merge icon is a couple to the right of the paint can.) I typically work on a laptop and if I scroll to the right, I'll miss the info about your switching meters. Coloring the line all the way across will make sure people see the break.
 
Sienne and Gabby (GA) said:
Teri -

Can you extend the turquoise coloration across the spreadsheet? (You can also highlight and merge the cells to remove the lines. The merge icon is a couple to the right of the paint can.) I typically work on a laptop and if I scroll to the right, I'll miss the info about your switching meters. Coloring the line all the way across will make sure people see the break.
Click to expand...
I knew there was a way to do that because I see it on other people’s SS, but I didn’t know how. Thanks for the info! I'm not sure I did it in the right way, but think at least jumps out at the viewer now, HaHaMewMew
 
Last edited:
The other thing you can do is center the text about the meter switch. Next to the merge icon is another icon with a drop down -- I think it's called horizontal align. Highlight the text then click on the item in the drop down that centers the text.
 
Oh yes, life is less complicated using just one meter! A big Thank You to @MargieandGracie for making a new spreadsheet (and one for 2020, too! and for figuring out how to change my user name).

I did get a phone call from Disco's vet on Saturday and also a follow up email on Monday with details and a link to the AAHA Diabetes Management Guidelines, which I let her know that I found on the group here and printed out. I was able to do a number of evening tests over the weekend, too. His SS is current.

Here is what the vet said:

Hope you are well. As we discussed on Saturday, I would continue Disco on Vetsulin 1.5 units BID x 1-2 more weeks and monitor response. Also, I mentioned sending you an email with summary notes and tips on how to help regulate and monitor Disco's Diabetes. Please let me know if you have any questions. Thank you!

Summary Notes - Provided by VIN (Veterinary Information Network) & 2018 AAHA Diabetes Management Guidelines:

Blood glucose curves can be very useful in the assessment of diabetes, although they also have limitations and there is considerable day-to-day variation in results. Therefore, it must always be interpreted with caution in light of other clinical information.

The primary aims of therapy in diabetic cats are to achieve resolution of clinical signs, avoid insulin-induced hypoglycemia, and to optimize the chance of diabetic remission.

As you previously put so well, this is a marathon, not a sprint... Unfortunately, that is the truth for most medical cases.

Glucose homeostasis in cats is a dynamic process that can change rapidly. Cats with diabetes have dysfunctional glucose homeostasis and so there is even more pronounced variability of blood glucose concentrations, especially in response to stress or illness. A common error when managing feline diabetes is to assume that the condition can be "stabilized" and that measurements taken on one day are representative of diabetic control on other days. A more appropriate approach is to establish an ongoing monitoring regimen that will detect the changing trends in the cat's response to treatment. Improved activity, resolution of increased water intake and urinations, and weight management are all indicators of improved glycemic control. When this occurs, the cat's insulin requirement will usually decrease substantially and remission might occur. Diabetic remission is most likely when the blood glucose concentration is kept below the renal threshold (250-300mg/dL).

The principal reason for performing a glucose curve is to find the lowest blood glucose concentration (nadir) resulting from the current insulin therapy. This is usually tracked over a 12 - to - 24 hour period after insulin administration. This is most ideally performed in a home environment. Significant day-to-day variation in blood glucose concentrations has been shown to occur in patients with no variation in insulin dosing or food intake. Stress, in particular in feline patients, can substantially increase glucose concentrations, especially if the cat struggles before or during blood sampling or has concurrent illness.

That is why glucose curves in isolation are of limited use, but their clinical value can be greatly improved when combined with a detailed history.

Monitoring/History:

Urine Glucose - No importance can be attributed to the amount of glucose recorded on the dipstick - that is, there is no important difference between 1+ and 4+ results; it is simply a question of positive or negative glucose. Persistent negative glucosuria identifies periods when the exogenous insulin dose should be decreased.

Daily recording of urine glucose provides a useful "early warning system" for the risk of clinical hypoglycemia for most cats. Decreasing the insulin dose within 2 weeks of the onset of negative glucosuria will thus ensure that hypoglycemia is avoided in the majority.

Water intake - Monitoring daily water intake provides a useful guide to the current level of glycemic control. (i.e. Decreasing)

Body weight - Gaining/Maintaining weight vs. weight loss.

Appetite, general demeanor and behavior.

Diet - lowest carbohydrate foods are the best. Most canned or wet cat foods have a low carbohydrate content. Dry foods formulated specifically for diabetic cats, such as Hill's w/d, or Royal Canin Glycobalance are most ideal.

Fructosamine - An additional way of assessing glucose control in diabetic dogs and cats. It provides an approximate measure of average blood glucose concentration over 2-4 weeks and thus is an indicator of longer-term diabetic control. Best used once clinical signs have improved and patient is on a maintenance dose of insulin.

Key Points:

Due to the potential considerable day-to-day variability in blood glucose measurements for Disco, we need to also be adamant about monitoring Disco's overall clinical improvement prior to making adjustments in insulin dosing. (i.e. resolution of PU/PD, stable appetite, improved energy level, and maintaining body wt.)

At this time, we will continue Vetsulin 1.5 units BID. Monitor the listed items above and see how Disco is overall feeling.

Diabetic remission is most likely when the blood glucose concentration is kept below the renal threshold (250-300mg/dL). This is our target, with a nadir in the 100-150range.

Micromanagement of feline diabetes with frequent insulin dose adjustment should be avoided. In general, insulin dosage adjustments should not be made any more frequently than once every 1-2 weeks.

Feline diabetes that is complicated by concurrent disease and/or medications that are causing insulin resistance (i.e. steroids) will typically present with very unpredictable blood glucose results that vary from 1.5mmol/dL to 30mmol/dL despite consistent insulin dosing.

If Vetsulin does not work, we will initiate insulin therapy with glargine (Lantus) or protamine zinc insulin (PZI; Prozinc) at a starting dose of 1-2 units (U) per cat q 12 hr.
 
I haven't a clue where your vet is getting some of her information. If she is citing the AAHA 2018 guidelines then she should know that Vetsulin is NOT recommended. Either Lantus or Prozinc are the two insulins recommended for cats. Vetsulin does not have the duration necessary for feline metabolism. It was formulated for use in dogs. The sooner Disco is on an insulin that is recommended for cats, the greater your chance of remission.

Diet - lowest carbohydrate foods are the best. Most canned or wet cat foods have a low carbohydrate content. Dry foods formulated specifically for diabetic cats, such as Hill's w/d, or Royal Canin Glycobalance are mostideal.
Click to expand...

This is an incredibly contradictory statement. Hill's W/D is approximately 36.9% and the Royal Canin Glycobalance is approximately 29% carbohydrate. These are very high carb foods. Saying that most canned/wet foods are low in carbs is simply wrong. You can refer your vet to Lisa Pierson, DVM's website on feline nutrition. The site also contains a food chart with carbohydrate values for a huge number of canned cat foods. Your vet may find this enlightening. We consider low carb as below 10%. We suggest that you keep some high carb food on hand to manage numbers if they get too low. High carb is above 15% so the dry food your vet is suggesting as regular food will keep your cat diabetic unless you are dosing a huge amount of insulin. You vet has been drinking the Kool Aid provided by the prescription cat food manufacturers and not doing her own research. There are any number of problems with dry food, including it's not a species appropriate diet as cats are obligate carnivores. Dr. Lisa's site provides excellent detail about a cat's nutritional needs.

If there is any way to push your vet to prescribe a better insulin, I would encourage you to do so. I don't know how she can cite the AAHA and then prescribe Vetsulin. I would not follow her recommendations about diet.
 
Sienne and Gabby (GA) said:
I haven't a clue where your vet is getting some of her information. If she is citing the AAHA 2018 guidelines then she should know that Vetsulin is NOT recommended. Either Lantus or Prozinc are the two insulins recommended for cats. Vetsulin does not have the duration necessary for feline metabolism. It was formulated for use in dogs. The sooner Disco is on an insulin that is recommended for cats, the greater your chance of remission.

This is an incredibly contradictory statement. Hill's W/D is approximately 36.9% and the Royal Canin Glycobalance is approximately 29% carbohydrate. These are very high carb foods. Saying that most canned/wet foods are low in carbs is simply wrong. You can refer your vet to Lisa Pierson, DVM's website on feline nutrition. The site also contains a food chart with carbohydrate values for a huge number of canned cat foods. Your vet may find this enlightening. We consider low carb as below 10%. We suggest that you keep some high carb food on hand to manage numbers if they get too low. High carb is above 15% so the dry food your vet is suggesting as regular food will keep your cat diabetic unless you are dosing a huge amount of insulin. You vet has been drinking the Kool Aid provided by the prescription cat food manufacturers and not doing her own research. There are any number of problems with dry food, including it's not a species appropriate diet as cats are obligate carnivores. Dr. Lisa's site provides excellent detail about a cat's nutritional needs.

If there is any way to push your vet to prescribe a better insulin, I would encourage you to do so. I don't know how she can cite the AAHA and then prescribe Vetsulin. I would not follow her recommendations about diet.
Click to expand...

No fears, I’m not changing his diet! I have followed Dr Lisa long before I joined this group and I will send the vet the link to the carb chart, too, when I update her at the end of the week.

And i just feel he is not going to respond to Vetsulin and let her know in the beginning that based on the info i learned at the cat clinic I worked at before moving here that I was wanting to go to Lantus or ProZinc if he didn’t respond to the Vetsulin and I have learned so much more since joining this group.

I also have an appt on Tuesday with a new vet AAHA and AAFP Gold Feline Friendly with Disco and Brighton for their Purevax Rabies 1 yr and to review Disco’s records and SS and will let everyone know how that visit goes. This is only the 2nd time in over 47 years that I have been a “client” rather than staff member at a vet clinic with my cats (except for specialist visits) and am finding it both unnerving and disappointing on various levels.

Last edited: 9 minutes ago
 
Last edited:
I'm sorry!! I have been very fortunate in that in both Chicago and Columbus I use cat only practices and the vets were/are wonderful. I know how frustrating it can be to do your homework and have to argue with a provider -- even if it's a plumber or mechanic, let alone a medical professional.
 
I agree with Sienne that a lot of the info your vet gave was incorrect. Lantus, Levemir, or PZ are better insulins with the two former being gold standard.

If you decide to switch, let us know and we will help you determine the dose of the new insulin. If the new vet just says “1u”, we would probably disagree with that :)
 
Updated SS, had a number of 'in the blue' readings this week at +3 and +4 tests. His appetite has lessened from ravenous this week and he has enough after meals to graze a while. His weight is stable at 11# 11oz and I think he is drinking and peeing less, but hard to tell with 2 other cats on the water consumption. I forgot to make a note if I gave him his budesonide on Monday but know I forgot on Wednesday (he gets it M-W-F, 3 x a week) but gave it this morning. I wonder if that is why his readings were better? Guess we'll see if they change again this coming week. Any thoughts? (Other than get on PZ or Lantus soon-hope to make that change before too much longer but he's only been on the Vetsulin 3 weeks now--sure seems like longer!

Also, I was having trouble computing the carb % in w/d and glycobalance and wanted to give his vet those numbers. No, I'm not changing to Rx diets, but when she cited the AAHA 12% ME numbers. I usually use the Hilary Watson calorie calculator (http://www.hilarywatson.com/tools.htm) as it's user friendly (but my previous vets used some other way to calculate it) and I wanted to be accurate when saying that Glycobalance dry says ME 355kcal per 100g (about 1/2 cup), but that's not a percentage. Math was never my strong suit.
 

Attachments

  • IMG_0268.jpg
    IMG_0268.jpg
    125.2 KB · Views: 124
Last edited:
Red & Rover (GA) said:
I cannot use the above link as I do not have Flash installed on my Mac. Using two other simple calculators, Glucobalance dry comes in at 29%.
For an accurate accuracy, I'm tagging
@Marje and Gracie
for you. She has written up the math here but I do not know if it applies to dry food. (I'm not great at math either.)
Click to expand...
I couldn't get that link to work, but did find her math page and really feel math challenged now! http://www.felinediabetes.com/FDMB/threads/calculating-calories-from-carbohydrates.204051/
 
Last edited:
Well, it's Wednesday and I haven't had a reply from Disco's vet to the email update I sent her last Friday. I also sent along info on the nutrition calculations/calculator link for her edification. Disco's had more 'blue' readings at +3, +4, +5, but still some readings in the 400's pre-shot numbers. but no 'blacks' and less 'reds'. Both the group and I feel that Vetsulin isn't the right insulin for him as his numbers show that true to form, it doesn't stay with him long.

I had my 'Meet & Greet appt with the new AAHA & Feline Friendly vet yesterday (just for Purevax 1 yr Rabies--the other vet didn't carry this vaccine and it's the one I prefer to use on my cats) and that is how I found the new vet, by calling them to see what vaccine lines they used. It is a dog and cat mixed practice, but the fact that they went to the effort of being a gold level AAFP Feline Friendly practice means a lot. The vet I saw only has 2 current diabetic patients and the other vet has a few more, but she spent a lot of time with me but the staff had only printed off a few pages of Disco's records (understandable as I sent EVERYTHING for the past 15 years including xrays, specialist reports and all labs) and she appreciated my condensed 1 page history listing I brought with me (being in the profession, I know how that helps both tech and doctors when seeing a patient for the first time). She recently attended a conference and said she learned a lot of new things about diabetes (all things you have recommended, too LOL) and asked me if I was ready to change to ProZinc of Lantus immediately. I let her know that I hoped to hear from his prior vet this week and would keep her updated if we changed or would make an appt to consult with her and make the change with her clinic. She said that was good as it would give her time to review all of Disco's records thoroughly.

I have 4 of the U-40 syringes left and then planned on using the U-100 ones I use for giving their B12 and Adequan but they are U-100 3/10cc 31g syringe/needle and I printed off the U40 Insulin in a U100 Syringe guide this forum provides (so happy to have these resources here!) and just want to clarify that as Disco is currently getting 1.5U of Vetsulin, that in the U-100 syringe I would give 3.75 so the U-100 syringes I have won't be big enough, sigh. I've got 3 boxes of them and I could estimate what the 0.75 would be even though the markings don't go that far, there is room to fill past the last marking. Advice appreciated.
 

Attachments

  • DiscoThanksgiving1.jpg
    DiscoThanksgiving1.jpg
    104.7 KB · Views: 110
You can also compare the two syringes.
Draw up 1.5 units on a used (since you do not have many left) U-40 syringe. Squirt it onto the counter.
Draw up 3.75 units on a U-100 syringe. Squirt it onto the counter.
Compare the two.

Sorry to be brusque. Focussed on keeping my son's plane up in the air (as one does).
 
Red & Rover (GA) said:
You can also compare the two syringes.
Draw up 1.5 units on a used (since you do not have many left) U-40 syringe. Squirt it onto the counter.
Draw up 3.75 units on a U-100 syringe. Squirt it onto the counter.
Compare the two.

Sorry to be brusque. Focussed on keeping my son's plane up in the air (as one does).
Click to expand...
OK, I did what you suggested and the amount was way different so I’m not computing something right? I am attaching two photos, with the two syringes side-by-side, the 1st photo is the 40U syringe filled with water to the 1.5 and then on the 100U syringe with the same amount of water (which I squirted into the cap of the syringe that covers the plunger part and sucked it up into the 100Usyringe it comes to 5 on the 100U syringe. Help Appurrciated!
 

Attachments

  • C5DAD858-9D07-4102-9ECD-FE92F0849BA7.jpeg
    C5DAD858-9D07-4102-9ECD-FE92F0849BA7.jpeg
    16.5 KB · Views: 147
  • 83770C06-52CB-4B7F-95F5-DFE875877FE5.jpeg
    83770C06-52CB-4B7F-95F5-DFE875877FE5.jpeg
    22 KB · Views: 125
Do your U40 syringes have half unit markings or are you eye balling the half unit?

Syringes (at least the U100 and I assume the U40's too) are notorious for having markings that are not exactly consistent/off just a bit. Unfortunately, you don't know if your U40 syringe lines are set a bit too short or high and it could be that you have been dosing a bit less or more than you think. The important thing is consistency. The small difference in the lines doesn't mean much to a human taking much larger doses of insulin but can make a difference in our kitties particularly when they get down to very tiny doses.

The only way around the problem is to use calipers to measure doses instead of the syringe lines. It's a bit finicky but it does make measuring more accurate. If you'd like to consider that option there is a ton of info HERE. Note the information was done for U100 syringes but the same principles would apply to theU40 syringes.
 
MrWorfMen's Mom said:
Do your U40 syringes have half unit markings or are you eye balling the half unit?

Syringes (at least the U100 and I assume the U40's too) are notorious for having markings that are not exactly consistent/off just a bit. Unfortunately, you don't know if your U40 syringe lines are set a bit too short or high and it could be that you have been dosing a bit less or more than you think. The important thing is consistency. The small difference in the lines doesn't mean much to a human taking much larger doses of insulin but can make a difference in our kitties particularly when they get down to very tiny doses.

The only way around the problem is to use calipers to measure doses instead of the syringe lines. It's a bit finicky but it does make measuring more accurate. If you'd like to consider that option there is a ton of info HERE. Note the information was done for U100 syringes but the same principles would apply to theU40 syringes.
Click to expand...
I have just been eyeballing it as there are no 1/2 unit markings and I so understand how iffy that it. I have read a bit about the calipers as someone else posted about using them recently. Can you look at the photos again and let me know if on the 3/10ml 100U syringe where the markings go to 30units, would the fill line be down below the 5 on the syringe? I am thinking that is right, not past the 30U as I previiously thought and that is why I thought the syringe wouldn't hold his dose...
Sincere appurrciation,
Math challenged human dependent on smarter nurses!
 
2.0 units in the U40 syringe would be the same as 5u in the U100 syringe assuming the syringes are accurately marked. The black stopper on the plunger should be lined up exactly on the 5u line. You appear to be a smidge below it in the photo. Since you are eyeballing the 1.5u unit dose on the U40 syringes, it's possible you've been giving a little more or less insulin to Disco.

It looks to me like Disco could use a little dose increase so if you want to use the U100 syringes, how about increasing Disco's dose to 1.8u and drawing up insulin in the U100 syringe to the 4.5u mark? That could potentially be a small decrease or increase of insulin but the numbers will tell the story soon enough and you can then adjust accordingly.

If you decide to do this, make sure you do so when you can test and please get a test at night even if it's only a before bed test. So many kitties go lower at night it's important to know what they do at night to be able to dose properly and safely.
 
MrWorfMen's Mom said:
2.0 units in the U40 syringe would be the same as 5u in the U100 syringe assuming the syringes are accurately marked. The black stopper on the plunger should be lined up exactly on the 5u line. You appear to be a smidge below it in the photo. Since you are eyeballing the 1.5u unit dose on the U40 syringes, it's possible you've been giving a little more or less insulin to Disco.

It looks to me like Disco could use a little dose increase so if you want to use the U100 syringes, how about increasing Disco's dose to 1.8u and drawing up insulin in the U100 syringe to the 4.5u mark? That could potentially be a small decrease or increase of insulin but the numbers will tell the story soon enough and you can then adjust accordingly.

If you decide to do this, make sure you do so when you can test and please get a test at night even if it's only a before bed test. So many kitties go lower at night it's important to know what they do at night to be able to dose properly and safely.
Click to expand...
Pawsome recommendation I feel completely comfortable with. I am retired and 67 so tend to get up at least twice during the night to pee, and Disco is so affable that he is easy to test (though I am still using his paws as he is so headshy and sometimes need to prick him 2-3 times...he loves his Vital Essentials Chicken Hearts and Minnows). Just gave him the 1.8u (4.5u on the 100u syringe) and it's 7:30p so can test him in +2 and +3 and +4 if needed. Smooches to you and the Men!
 

Attachments

  • IMG_0362.jpg
    IMG_0362.jpg
    61.8 KB · Views: 134
Last edited:
Disco has had 2 doses of Vetsulin at the 1.8u dose and last night his 4+ reading was 146. This morning's AMPS was 454 and his 4+ was 65. @MrWorfMen's Mom advised me the last time I got nervous about a 110 reading some time back where I got anxious and fed him that a rescue reading was less than 90 if the BG does a quick drop of 100 points in the span of an hour or 2. And this time it took 3 hours for a drop from 454 to 65, so I probably didn't need to feed him, but I did feed a 'portion' of Sheba's Purrfect Cuts Tuna and 30 min later got 294. I am still figuring out 'bouncing' but assume he will bounce. I will do a +6 and +8 today, too.

Oh, and I did hear from his vet: Reviewing his spreadsheet, the values are improving and we are targeting a range with values highest at around 300-350, with a nadir of approx. 150. Unfortunately, there will still be a large day- to-day variation and certainly giving his steroids can affect those values. At this point, since his symptoms are improving and values appear to be improving, I would continue his current dose of Vetsulin and we can check a Fructosamine in 2-3 weeks.

I did email her back today and let her know I upped his dose a bit, and gave her the SS link as I usually do. I know I keep saying the change to Lantus or ProZinc will happen, and everyone here hopes it will be soon, not sure why I'm reluctant to be pro-active and forceful with this new vet, it's so different than working in a practice where I didn't feel like I was treading on toes if I took a different direction with my cats care, such as using Adequan or feeding raw. What is everyone's experience with Fructosamine testing (I think I recall that it's usual to do one about 4-6 weeks into treatment and Disco started Vetsulin on 10-25-19.
 
Last edited:
You did the right thing feeding Disco today when you got that 65 reading. You don't want Disco much below 90 on Vetsulin due to the huge drops in BG it can cause as you've seen today. Any time he drops below 90, feed him a snack to keep BG from dropping more and retest BG to make sure he stays around 90 or higher.

That 1.8u dose seems to be a bit too much insulin given that lower BG today. I'd reduce to 1.6U which would mean drawing right to the 4.0u line on the U100 syringes.

I don't agree with your vet about aiming for BG 150 to 300/350. That is far higher than ideal and it's quite possible to safely keep kitty's BG somewhat lower with home testing. I think vets often keep numbers high because they often don't recommend home testing and are just leaving a huge safety margin for that reason.

That drop from 400+ down to 65 today will no doubt cause a bounce in Disco's numbers but they will come back down so I'd definitely reduce the dose and keep monitoring.

On the fructosamine front, I personally think they are a useless waste of money if you are home testing daily. They give you an average of BG over a 2 to 3 week period based not on glucose but another blood component. If BG is going from very high to low constantly, it can effect the results. I had one done on my girl that came back telling me she was well regulated when I could see on my spreadsheet that she wasn't even close to being well regulated. Fructosamine can also be affected by other blood values. If you weren't home testing, then a fructosamine is really the only tool the vet has to see how kitty might be doing but otherwise, I wouldn't waste your time, money or put Disco through another vet visit.

I do think Disco is burning through the Vetsulin quickly and not getting enough duration. ProZinc or Lantus would be much gentler and last longer and that should smooth out those huge drops which would no doubt make Disco feel even better.
 
MrWorfMen's Mom said:
You did the right thing feeding Disco today when you got that 65 reading.

That 1.8u dose seems to be a bit too much insulin given that lower BG today. I'd reduce to 1.6U which would mean drawing right to the 4.0u line on the U100 syringes. I don't agree with your vet about aiming for BG 150 to 300/350. That is far higher than ideal and it's quite possible to safely keep kitty's BG somewhat lower with home testing. I think vets often keep numbers high because they often don't recommend home testing and are just leaving a huge safety margin for that reason. That drop from 400+ down to 65 today will no doubt cause a bounce in Disco's numbers but they will come back down so I'd definitely reduce the dose and keep monitoring. On the fructosamine front, I personally think they are a useless waste of money if you are home testing daily.
I do think Disco is burning through the Vetsulin quickly and not getting enough duration. ProZinc or Lantus would be much gentler and last longer and that should smooth out those huge drops which would no doubt make Disco feel even better.
Click to expand...

We get so emotional about our sugar cats, but your words, comfort and knowledge brought a lump to my throat and tear to my eyes. You mean the world to me and I feel more confident in talking this out with my current vet and changing vets. I need to compose an email to my new vet with my concerns and your recommendations and see what response I get.

Thank you so much again for being there!
 
Teri (Disco NoFurNo) said:
We get so emotional about our sugar cats, but your words, comfort and knowledge brought a lump to my throat and tear to my eyes. You mean the world to me and I feel more confident in talking this out with my current vet and changing vets. I need to compose an email to my new vet with my concerns and your recommendations and see what response I get.

Thank you so much again for being there!
Click to expand...

I know it feels so counterintuitive to go against your vet or to recommend things to them instead of the other way around, but at the end of the day they work for you. I was the same way with Sophie’s vets at first but I eventually got tired of the run around and spending SO much money, that I just started insisting on things. For example, I wanted them to run a test for pancreatitis. One of the vets insisted that she did not have pancreatitis because her pancreas was normal on an ultrasound, but I insisted that he run the test anyway since I was the one paying. So he did. And I was right, she had pancreatitis. He also wanted me to run a fructosamine but after already spending upwards of $300 on fructosamine tests alone, I said no. He said okay. And that was the end of it.

If you would like your cat to be on another type of insulin, then I would push for it or find another vet who will prescribe it for you. There are many published guidelines (AAHA and ISFM are two examples) that recommend both Prozinc and Lantus for cats, and do not recommend Vetsulin. If you like this vet for other things but not how they treat diabetes, then simply see another one for the diabetes if you want to. Sophie had two vets and I liked them for different things. It took me a while to learn to be “pushy” but it worked out for the better for my cat. I know how stressful it is, but you are doing a great job! :cat:
 
Teri (Disco NoFurNo) said:
Updated SS, had a number of 'in the blue' readings this week at +3 and +4 tests. His appetite has lessened from ravenous this week and he has enough after meals to graze a while. His weight is stable at 11# 11oz and I think he is drinking and peeing less, but hard to tell with 2 other cats on the water consumption. I forgot to make a note if I gave him his budesonide on Monday but know I forgot on Wednesday (he gets it M-W-F, 3 x a week) but gave it this morning. I wonder if that is why his readings were better? Guess we'll see if they change again this coming week. Any thoughts? (Other than get on PZ or Lantus soon-hope to make that change before too much longer but he's only been on the Vetsulin 3 weeks now--sure seems like longer!

Also, I was having trouble computing the carb % in w/d and glycobalance and wanted to give his vet those numbers. No, I'm not changing to Rx diets, but when she cited the AAHA 12% ME numbers. I usually use the Hilary Watson calorie calculator (http://www.hilarywatson.com/tools.htm) as it's user friendly (but my previous vets used some other way to calculate it) and I wanted to be accurate when saying that Glycobalance dry says ME 355kcal per 100g (about 1/2 cup), but that's not a percentage. Math was never my strong suit.
Click to expand...
How adorable are they, what is your other cats name that's laying next to Disco. All the pics are so cute
 
Last edited:
Teri (Disco NoFurNo) said:
Aww. Thx! FurryDance Brighton is the other 'bodyguard' to Coco, the Couture Cat (@cococouturecat on IG). Brighton is a cream and white Cornish Rex, 13 yrs old w/IBD and Coco is a brown patched tabby Cornish Rex, 14 yrs old w/IBD. Here's a group photo of them from way back in 2013
Click to expand...
Oh my god just look at how they cuddle
 
Teri (Disco NoFurNo) said:
just want to clarify that as Disco is currently getting 1.5U of Vetsulin, that in the U-100 syringe I would give 3.75 so the U-100 syringes
Click to expand...
No, give 1.5 units of Lantus in u-100 syringes. I disagree with a few other things from the vet, but the correct dose is most important.
 
Red & Rover (GA) said:
I cannot use the above link as I do not have Flash installed on my Mac. Using two other simple calculators, Glucobalance dry comes in at 29%.
For an accurate accuracy, I'm tagging
@Marje and Gracie
for you. She has written up the math here but I do not know if it applies to dry food. (I'm not great at math either.)
Click to expand...
@Teri (Disco NoFurNo)

Sorry to just get to this...I’ve been out of town. Dry Matter Basis applies whether it is dry or wet food so the calculations on my post using DMB can easily be used for dry food. Hope that helps!
 
MrWorfMen's Mom said:
Happy Thanksgiving to you and yours Teri! I see the fur kids are going to have a nice dinner! Hope you get one too! :joyful:
Click to expand...
Oh yes, they got Weruva Paw Lickin' Chicken and Weruva Nine Liver--1 large can of each! I usually get them the Merrick Thanksgiving Day Dinner canned food but couldn't find it in the 2 stores I went in here and I know Weruva is a nice low carb food anyway that they love. The photo I shared was from last year...

Here's what my mom and I had to feast on: Cornish Game Hens with Orange Whiskey Glaze, Carrot Parsnip Mash, Roasted Green Beans with Garlic and Lemon, and Pecan Apple Pie and Vanilla Gelato for dessert!

Hope you and your kitties feast was just as delicious!
 

Attachments

  • 77030477_10221440984637058_3608372380952428544_n.jpg
    77030477_10221440984637058_3608372380952428544_n.jpg
    68.6 KB · Views: 96
Last edited:
I was going to wait to start a new thread until we changed insulins, but think I'll start a new thread on Dec 1st as this one's getting a bit long and Disco's regular advisors and followers have gotten to know him now. Disco's vet got back to me after my last update on 11/25 where I shared the recommendations of this group which mirrored what my previous vet in VA said, too, so I just said it was my previous vets recommendations as she more than likely isn't familiar with the world-wide expertise of this valuable group! I was pleased, as you my mentors should be, and thought I'd share it here:

The information from your previous veterinarian is excellent. I greatly appreciate their input. To be honest, the amount of felines and feline diabetic they see is likely much higher than we see here. I found good reasoning in what was suggested. It is hard to break old habits and I'm not used to having such a diligent and responsible owner!

They are correct, if you wish to continue performing BG checks at home, we can withhold on the Fructosamine, as this only give us an average over 2-3 weeks. After further review, I do see that this is an unnecessary test, due to the daily BG checks at home. We typically perform Fructosamines with our other diabetics, but since you are an excellent DM Mom, I find it reasonable to withhold the test and not waste your time/money! :). Honestly, you are my 1st at home BG monitoring client! If your other vet has found success in allowing lower BGs vs. 150 to 300/350, without risk of Hypoglycemia, we can target their goal of the 200 range.

Hopefully 1.6 units is his sweet spot on Vetsulin. After monitoring for another 7-10 days on this dosing, if he continues to burn through the Vetsulin, lets switch to either the Prozinc or Lantus. We can order either one of these insulins through another pharmacy.

I will continue to monitor his spreadsheet and values through the week. Just FYI I will be gone from Thursday - Monday, but please let me know if you have any further questions or concerns. Again, I find it very helpful and wonderful that your previous vet is willing to help with Disco's case. As you probably already know, medicine is a constant learning process and the more information the better for all involved. Please thank your other doctors for their assistance, it is appreciated on my end as well.

Disco's SS is up-to-date and he's been in the 'yellow' the past few days which is nice and I will do another 'curve' on Sunday when I will be home all day and can do a +3 and +4 today before I head over to my new house to unpack some more. I hope to be moved in by Christmas, leaving the cats to be moved in until last so as to minimize their stress. They have acclimated well to living at my mom's house since Sept 1st, and will miss the sunny bedroom that we have there. I am not sure where the sun comes in in my new place, but it's got a 6'x18' back deck where I can put their large walk-in catio cage (4'W x4L 'x6'H) until I can afford to screen in the deck and make a catio!

 

Attachments

  • IMG_0451.jpg
    IMG_0451.jpg
    38.8 KB · Views: 115
I also like your new vet. If he prescribes Lantus ask fo the prescription for the pens instead of a vial. You use the pens like miniature vials, drawing the insulin with a syringe. The reason we recommend the pens is that you will be able to use almost every drop before it becomes ineffective. With the vials the insulin starts to become ineffective around two and a half months. Unfortunately you will end up throwing away a lot of insulin. Because the pens contain smaller amounts of insulin you will be able to use almost every drop before you have to switch to a new pen. Depending on the dose a box of pens (5) could last nine months or more.
 
Status
Not open for further replies.
Back
Top