First vet visit since diagnosis

DavidJ

DavidJ

Active Member
Charly is due her first vet visit since her diagnosis tomorrow.

She's been on a starter dose of 0.5.

bearing in mind the awful state she was in last week I think she is doing quite well. she is eating well and gaining a little weight.

but her energy levels are she is hungry most of the time. she is slow on her feet except as we get close to dose time when she is running around like a kitten in search of food.

so a couple of questions:
1. looking through the prozinc literature the vet gave me it looks likely the vet will suggest to increase by 0.5 but I have read here that smaller increases are generally preferred. if the vet suggests 0.5 should i advocate for slower increase?

2. i'm going to ask the vet for the full blood test results and if we know whether she had dka before finally being diagnosed diabetic . is there any other info i need from the vet at this stage?

3. she walks slightly strangely on one of her back legs. i m wondering if this might be neuropathy? is there a specific test for this and how is it treated?

4. anything else i need to ask the vet while we are there?

thank you so much everybody for your help:)
 
Hi there, and welcome to the ProZinc forum. I am glad you set up a spreadsheet, that’s a great start. I cannot advise on dosing at this point because there’s no Blood Glucose (BG) data on your spreadsheet — so we don’t have any idea how low the .5 dose is taking Charly (and neither will the vet by the way, as a spot check at the vet will just be a measure of what her BG is at a single point in time … it will not indicate how low (nadir) the dose is taking Charly during each 12 hour insulin cycle. It is also important to realize that most cats have higher BG at the vet due to stress… so the vet is just going to be guessing at a dose with almost no information. Right now, you are blindly shooting insulin into Charly. Do you have a glucometer and test strips at home? Have you attempted to get any tests? I am just trying to determine where you are in the process. If we don’t know Charly’s lows, then we cannot keep her safe from a potential hypoglycemic event. Did the vet do a fructosamine test to diagnose Charly? Do you know what that number was? The fructosamine test will give an average of the cat’s BG for the last couple of weeks and is a useful tool for diagnosing diabetes, but beyond that it’s not useful information because it will not tell you how low a certain dose is taking your cat (just an average of the highs and lows.)
 
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I would definitely get all bloodwork that you can.
She may have diabetic neuropathy. There isn’t a test for it, but if she is having any difficulty with her hind legs then she probably needs to start on Zobaline, which is extremely helpful for neuropathy. Zobaline is methylcobalamin (a form of B-12) and folate (another B vitamin.). Many people on this Board have their cats on it. It takes a few weeks to start seeing improvement usually.

If I can see her bloodwork, I can see if there are any other possible causes for hind leg weakness.
 
What is Charly eating. Is she on a low carb wet food diet? That’s really important. The vet prescribed foods are generally all too high in carbs for a diabetic cat and they mostly serve to empty your wallet and keep kitty’s blood glucose high and make it more difficult to control with insulin.
 
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I will check back with you this afternoon. It sounds like Charly was really ill but is now doing better since starting insulin. What a relief! It definitely would be good to know if she was in DKA at some point as that will make a difference in any dosing I would recommend. In addition, you should start testing for ketones at home. Ask the vet if they tested her for ketones (usually they will use a urine dip stick for this — a few vets may have a blood ketone meter, but not many. You can test for ketones at home either using urine strips (keto stix) or with a blood ketone meter that uses a drop of blood from the ear just like a BG test.)

Talk to you later :)
 
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Oh, and when was Charly diagnosed? We need to get your signature set up with all the usual information so I won’t keep asking you the same questions over and over.
 
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thank you so much. I think I've put all the answers into my signature now. yes i've moved off the purina diabetic food back onto the food she previously ate which is high protein and almost zero carb.

I've had a meter since last night and I am trying hard to test. I've managed to find blood a couple of times but not enough to test succesfully yet. finding difficult with her black ears, and general reluctance to co-operate and no one to help hold her still! but i will get there soon:)

i will try my very best to get some tests done before our vet visit!!
 
arggh. its really difficult getting blood from her ear. couldn't get another test today. had to stop jabbing her in the ear before she loses all faith in me! will try again tomorrow
 
DavidJ said:
arggh. its really difficult getting blood from her ear. couldn't get another test today. had to stop jabbing her in the ear before she loses all faith in me! will try again tomorrow
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Let me send you a few tips that I just sent to another member last night. I’ll go ver to her thread and copy and paste what I wrote.
 
There are lots of tips and tricks to get a blood drop. I told you before that I said I could never do it and that I cried a lot in frustration and felt like a failure.

Using a larger size lancet in the beginning and not the super/ultra fine ones can help. Hold the lancet at a 45 degree angle when you prick the ear. Warming the ear with something (pill bottle filled with warm water for example) can really help. Putting a bit of vaseline on the ear can help the blood drop to bead up better. Gently “milking” the ear after you prick it to kind of squeeze a little more blood out can help. If you have trouble holding everything and getting the tip of the test strip onto the drop of blood, you can scrape the blood drop onto the top of your thumb nail and test the drop from there.

You already have seen the photo of the area you are aiming for. I hope one of these tips can help.
 
Have you seen this photo?
 

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Always give a low carb treat like a Pure Bites freeze dried treat or boiled chicken bit or similar …. every single time you test or attempt to get a test whether you are successful or not. It’s best to set a designated place for testing with most cats and do it always in the same place.

Cat ears will start to bleed more easily over time as the capillary bed grows. It does get easier.
 
thanks yes i've seen the picture and i'm aiming for the right place i think, but i'm not getting any blood most of the time. she's not being very co-opertive either is the other problem. i suspect i would have more luck with one of the those calm cats in the how to test your cat for blood glucose videos. Charly is squirming and meowing and only interested in food food food at the moment.
 
26 or 28 gauge lancets are better for beginners. Later you can switch to the ultra fine ones. It’s less stress on the cat if you hold the lancet in your hand at a 45 degree angle (as opposed to using the lancing device.) You may need to buy some of those lighted magnifying glasses if her vein is difficult to see because her ears are black.
 
i've only been warming her ear by rubbing. i will warming it a bit more thoroughly

im getting nowhere with the lancing device so i've been doing it by hand. will try the 45 degree thing!
 
DavidJ said:
thanks yes i've seen the picture and i'm aiming for the right place i think, but i'm not getting any blood most of the time. she's not being very co-opertive either is the other problem. i suspect i would have more luck with one of the those calm cats in the how to test your cat for blood glucose videos. Charly is squirming and meowing and only interested in food food food at the moment.
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Ha ha. Yes. They always pick the really calm cats for the videos!
 
Oh my gosh. I just read your signature about the steroid injection and what happened. You can’t know if a cat has IBD without an abdominal ultrasound at minimum! An SCL diagnosis would require a biopsy to be definitive. I have had a few cats with IBD confirmed and one with SCL.
 
DavidJ said:
we've done it. first successful BG reading
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YAY! Such a big accomplishment. We are just over 30 days of a diagnosis, and I assure you it will get easier and you'll get more confident. Their poor ears while we learn though!

I'm finding it easiest and with the least amount of pricks, to do it when he's sleeping. Seems to bleed easier and he's half dazed and doesn't care as much, he just wants to get back to sleeping.

I use a lancet pen that came with the alphatrak and I shoot for the very outside edge. Sometimes it takes a second for the droplet to appear. I'm amazed at how little blood it takes.

❤️
 
Has her heart ever been checked? I am concerned because you said she collapsed after the steroid shot. Was it a Depo Medrol injection (methyl prednisolone acetate?) They should have listened carefully to her heart and lungs prior to giving the shot, but honestly, a Depo shot isn’t really the first choice for a cat with IBD anyway. Usually oral prednisolone would be given. Does it say this on your invoice (methyl prednisolone or Depo Medrol?) When was the diabetes diagnosed in relation to the shot? Before? After? At the same time? A Depo shot is long-lasting and can raise her BG for some weeks before it wears off.
 
We need to get your spreadsheet setup with the U.S. tab, which it should automatically open up to for me All I can see is the World tab so something is amiss. Anyway, I see you got a 247 today at +5. Even though that’s the only test we have on her right now, I would definitely hesitate to increase by a full half a unit. I would not increase anything at all until I could get the two preshot tests and one mid-cycle test for each cycle. We don’t have enough information and must keep her safe. I hope you can get a preshot test tomorrow morning before giving her the dose.
 
DavidJ said:
i've only been warming her ear by rubbing. i will warming it a bit more thoroughly

im getting nowhere with the lancing device so i've been doing it by hand. will try the 45 degree thing!
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A lot of cats hate the noise of the lancing device right up next to their ears. Also, you get a lot better control doing it freehand.
 
ah sorry. i hid the us tab because i was working with the UK meter. it should be visible again now.

steroid was 'rapidexon' . she wasn't diagnosed with anything at that point. she had been lethargic and off her food for a few weeks. been in and out of the vets for fluids. she had had some blood tests that showed elevated liver and pancreas numbers. she was eating intermittently enough in theory to maintain weight but was slowly losing it. diabetes diagnosis was made following the steroid experience.

how is heart checked? they have listened to her heart but no tests beyond that as far as im aware.
 
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no luck this morning. jabbed her several times but just no blood. feeling a bit despondant about it at the moment. but we will try again later. she is calmer and happier usually for a few hours from +2 so we will practice again then.
 
ok. i got a reading about 15 minutes after isulin and food. not ideal i know but we are still learning! warm rice sock, 45 degree angle, calmer cat all seemed to help
 
DavidJ said:
ah sorry. i hid the us tab because i was working with the UK meter. it should be visible again now.

steroid was 'rapidexon' . she wasn't diagnosed with anything at that point. she had been lethargic and off her food for a few weeks. been in and out of the vets for fluids. she had had some blood tests that showed elevated liver and pancreas numbers. she was eating intermittently enough in theory to maintain weight but was slowly losing it. diabetes diagnosis was made following the steroid experience.

how is heart checked? they have listened to her heart but no tests beyond that as far as im aware.
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Oh, okay. That is a Dexamethasone injection that I believe does not last more than about 48 hours in cats. I suppose they gave her something to reverse it. That injection would be contraindicated in a cat with diabetes. You would think that they would have done full bloodwork, which would have included a glucose value at minimum or a fructosamine value if not. It sounds very scary. A steroid injection can cause congestive heart failure very quickly in a cat with heart disease. That’s why I asked about her heart. She would need a cardiac ultrasound to diagnose heart disease. Hopefully she doesn’t have any heart problems and it was perhaps just the diabetes. I know you will be very cautious about any of the vet’s suggestions at this point and you will advocate for Charly.
 
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DavidJ said:
ok. i got a reading about 15 minutes after isulin and food. not ideal i know but we are still learning! warm rice sock, 45 degree angle, calmer cat all seemed to help
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You are doing so well! It’s quite high, but that’s to be expected. Keep up the good work! How long until you have to take her to the vet?
 
Suzanne & Darcy said:
Oh, okay. That is a Dexamethasone injection that I believe does not last more than about 48 hours in cats. I suppose they gave her something to reverse it. That injection would be contraindicated in a cat with diabetes. You would think that they would have done full bloodwork, which would have included a glucose value at minimum or a fructosamine value if not. It sounds very scary. A steroid injection can cause congestive heart failure very quickly in a cat with heart disease. That’s why I asked about her heart. She would need a cardiac ultrasound to diagnose heart disease. Hopefully she doesn’t have any heart problems and it was perhaps just the diabetes. I know you will be very cautious about any of the vet’s suggestions at this point and you will advocate for Charly. .
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we are seeing a different vet now at the same practice. and yes i will certainly be quizzing the new vet thoroughly!
 
Now let’s talk about feeding. ProZinc onsets (starts to lower BG) at about +2. Diabetic cat do much better with small amounts of food spread throughout the early portion of the cycle (before nadir, so before about +6). I recommend feeding small meals/snacks at about +2, +4 and, if the cat is quite hungry and/or needs more food and calories +6. Usually the snacks are going to be the same regular low carb food that you usually feed her and they’re going to be one or two teaspoons. In situations where you are trying to steer her numbers, you can use differing amounts of carbs. Feeding smaller amounts during the early portion of the cycle really helps to prevent steep/rapid drops in BG. Rapid drops can set up what we call a bounce, where you will see sustained high numbers after either a steep drop or after any lower BG numbers that the cat is no longer used to.

I just thought I would mention the feeding schedule now because many vets will tell clients to feed only twice a day, which is not best for diabetics and also is not kind for a diabetic cat who is unregulated and cannot make proper use of their calories (and as a result are generally ravenous.)
 
i'm in UK we are on GMT right now.

Yes the initial advice was to feed twice a day but they have since said that further food is ok if she is ravenous - which she is!

in the absence of a glucose reading i've been feeding at jab time and then giving dose when i was sure she was eating as vet suggested this was the safe procedure. and then further food at +2 and +4 . I fed her at +6 too on one occassion but that seemed to cause us problems as she looking unhappy and discinclined to eat at next dose time.

you mention +2 and +4, is this in addition to zero or do you not feed with the jab? I've noticed she seems often to be uncomfortable for the first hour or two after dose and food so this would make sense. but as i say until i can get a pre dose test feeding with test seems to be my only safety net.
 
You definitely want to feed at both shot times. The usual procedure is to test, feed and shoot the insulin all within a few minutes. The cats do need some food on board with the insulin, but if she’s not inclined to eat a large meal at that time it’s okay because she will be eating more later on. The +2 snack can be really important.
 
I used to shoot the insulin dose many times while my cat was eating. He never even noticed. He did like his food, and if he stopped eating, I knew something was wrong.
 
i've been giving her about half her food for the cycle with the dose and half at +2 then a small extra snack at +4 if she is looking perky and hungry.
 
How's Charly doing? is good you are in the ProZinc Forum you will get amazing assistance from Suzanne & Darcy on every concern of yours, especially dosing. I trust her blindly when it comes to Corky, She was able to help my Corky get where he is right now, Good Work on your spreadsheet, and it is important you fill in the BG when you test, it would be the correct way to give you dosing advise. Hope you are getting a bit more relax on testing Charly, and don't worry out furr babies know we do all this because we love them.:bighug::bighug::cat::cat:
 
CORKY said:
How's Charly doing? is good you are in the ProZinc Forum you will get amazing assistance from Suzanne & Darcy on every concern of yours, especially dosing. I trust her blindly when it comes to Corky, She was able to help my Corky get where he is right now, Good Work on your spreadsheet, and it is important you fill in the BG when you test, it would be the correct way to give you dosing advise. Hope you are getting a bit more relax on testing Charly, and don't worry out furr babies know we do all this because we love them.:bighug::bighug::cat::cat:
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she seems quite good just now. still in the first half of the morning cycle and has eaten well and is on the prowl looking for more food.

we are getting better at testing but we've not quite cracked it yet. i'm more relaxed about it and less clumsy and causing charly less distress. finding blood regularly now though not quite enough to test succesfully on last attempt.
 
DavidJ said:
she seems quite good just now. still in the first half of the morning cycle and has eaten well and is on the prowl looking for more food.

we are getting better at testing but we've not quite cracked it yet. i'm more relaxed about it and less clumsy and causing Charly less distress. finding blood regularly now though not quite enough to test succesfully on last attempt.
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Awesome, and so you feel better at first it took 3-4. Strips 2-3 pinches before It got it right once I got right for a day that was it, like a walk in the park. I’m glad Charly is better it really helps for cat parents when we start seeing that what we are doing is working the stress starts to wear off, and we begin not to doubt ourself thinking, What am I doing wrong.. good job Charley, Good job DavidJ!!!:bighug::bighug::bighug::cat::cat:
 
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Suzanne & Darcy said:
I used to shoot the insulin dose many times while my cat was eating. He never even noticed. He did like his food, and if he stopped eating, I knew something was wrong.
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Exactly, once 1/2 food is eaten, I just go behind Corky, pick up the scruff and VOALA! he got his dose, he doesn't even stop eating
 
DavidJ said:
she seems quite good just now. still in the first half of the morning cycle and has eaten well and is on the prowl looking for more food.

we are getting better at testing but we've not quite cracked it yet. i'm more relaxed about it and less clumsy and causing charly less distress. finding blood regularly now though not quite enough to test succesfully on last attempt.
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when you feel stressed, I was told to take a step back, breath in and breath out, cats are very sensitive to our feelings and that can stress Charly and give a wrong reading when testing:bighug::bighug::cat::cat:
 
And we're back

Vet suggests no change to dose for now.

Apparently charly was tested for ketones during her recent crisis and there were none.

There was no fructosamine test.

They will send me all the recent test results. I will update when I get them.
 
DavidJ said:
And we're back

Vet suggests no change to dose for now.

Apparently charly was tested for ketones during her recent crisis and there were none.

There was no fructosamine test.

They will send me all the recent test results. I will update when I get them.
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David I am really happy for you and Charly, however, this is my opinion and mine only, give this Forum a chance to regulate Charley’s BG with help with dosing, with you home testing especially before each shot, and inputting the data on the spreadsheet, and of course the proper diet, with this Forum is an every day event and check up, in case you can’t see your vet or contact him for dosing, put your trust here as well, if I would've Not trusted, I would have lost Corky, many of these member are more up to date then a vet, many time Vets tread FD like they treat a dog. Any for small concern you may have for the hour or day we are here to guide you to get Charley where she should be!! You are doing awesome, Charley knows it:bighug::bighug::bighug::cat::cat:
 
got a first pmps reading. seems high. should i be worried? stressed by the vet visit perhaps?
 
DavidJ said:
got a first pmps reading. seems high. should i be worried? stressed by the vet visit perhaps?
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She might need an increase but do not quote me , it is very high, please post in the ProZinc forum while I tag several members that can help you with dosing, not to worry it will be ok, is she drinking water excessively? Has she gotten in some high carb food maybe?
@Suzanne & Darcy
 
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