Follow-Up with the Vet (Update Post)

Hi, everyone! So I was previously told by my new vet to test Mus everyday (twice a day) before meals (Glucose Meter Opinions + Update). So far he's been on a diet of Friskies (Pates and Prime Fillets some with liver), his water intake is down to almost nothing, his weight has been maintained at 15 (vet says he looks healthy too), and the ketone sticks come up in the clear. Today was his follow up appointment.

Upon seeing the chart I made and testing in the office, it's my vet's opinion that we shouldn't put him on insulin yet. Levels have gone down a bit, managed by the diet, and he doesn't want Mus to drop too low on insulin. He says I should continue to test Mus the same way for a month (with maybe extra tests 1-2 hours after meals) until our next appointment to see how we should proceed (and said it would be okay to use a human meter so long as I test alongside the pet meter for at least a few days so we can get an idea of what the numbers look like and how they compare). This morning I tested Mus's glucose an hour later than usual and he tested 175 mg/dL and at the vet's office (2-3 hours later and after his food) he tested 173 mg/dL.

I'll attach the chart I made using the pet meter below. One time he was in the 500s and I tested again using a second meter, which is why you'll see two results in one of the evening time slots.

Sorry for the long post, but please let me know what you guys think.

 

**please disregard the 2022! It’s meant to be 2023!**

 

FWIW, I think your cat needs insulin. It would have made a great deal of sense if your vet ran a fructosamine test back in January. At this point, it's pretty much irrelevant. Mus is in diabetic numbers. Even at the lowest, they are still over what is considered normal range (50 - 120) and those numbers are not staying in a close to normal range.

The longer Mus' numbers stay above renal threshold (roughly around 250), the more you are risking kidney damage or other end organ problems. Diabetes is a nasty disease that has systemic effects. In addition, the longer your cat is diabetic, the harder it is likely to be to get him into remission.

The only way that Mus is likely to drop too low is if the vet prescribes a whopping dose of insulin or prescribes a shorter acting insulin that's really not appropriate for cats. You would want to start Mus on either glargine or Prozinc. You can also start the dose as low as 0.25u. (Your vet is likely to tell you that you can't measure that small of a dose. You can.)

 

What he told me is to look out for symptoms and that that's when we should be worried. But that judging from his current numbers, it would be more of a concern to put him on insulin and have him drop too low.
He's not available now, but I was told I could send an email and they'd inform him of it.

Would it make sense to skip dosages, like the morning one, if his numbers at that time are consistently low?

 

Small update: I sent an email about my concerns and expressing my interest in glargine. Hopefully I'll get a response from him soon. I also got my hands on the ReliOn Premier Classic and some test strips.
Does anyone know if I need control solution for this meter? (I didn't see any in the aisle)

 

I don't think people here use the control solution. There should be somewhere on the package telling you how to contact someone to get some sent to you.

 

How off are the numbers between ReliOn and a pet meter usually? And what should I be looking for? Yesterday the numbers between the two were a little more than 100 off, but today they were about 30 off from one another. I know that there’s no conversion and the meters will always be some numbers off from each other, but still seems like a big leap.

 

Hi and welcome. I totally agree with Sienne that Mus needs insulin and with everything else she said.
He is still a young kitry at 7 years of age so you want to give him the best chance for a good life.
If you set up a spreadsheet that we have, we can help you with dosing.
The ReliOn meter is a human meter and reads a bit lower than the alphatrak meter which is a pet meter. The lower the BG, the closer the numbers. The higher the BG the further apart the numbers are. Don’t try and use both meters. Choose one meter and stick to it. I’d go with the ReliOn.
Ill send you a link to the spreadsheet.

 

HELP US HELP YOU
Click on the blue type to get information about the SS, hypo kit and other things.

 

Thank you! At this time I’m waiting to hear back from my vet to see when I can possibly get Mus started on insulin (asked about glargine). According to the AlphaTrak, Mus’s morning numbers for the past few days haven’t been looking too bad (including this morning), but his evening numbers always go up.
I’d like to stick with one meter, but my vet requested that I at least test Mus with both the human meter and the pet meter for three days.

 

Well it won’t hurt to do that for 3 days, but don’t try and compare the two meters. It will drive you crazy. You just take notice of the ReliOn meter BGs. If you have any trouble with the SS let me know and I will get someone to help you with it.

 

I'll link the spreadsheet to my signature when I can!

 

I agree with Bron -- using 2 meters will make you nuts! One of the moderators, Marje, tried comparing meters. It's a pain. Animal meters are calibrated a bit differently than human meters. For example, a 50 on a human meter is a 68 on a pet meter. And that's where the comparison stops. As the numbers get larger, so does the difference between how the meters read. All of our dosing guidelines are based on using a human meter.

 

I just realized that my chart and spreadsheets have been marked 2022 and not 2023, I’ll have to go back and make that correction. Sorry for any confusion!

 

Definitly needs insulin. It's double normal. Maybe go for a second opinion

 

This vet is my second opinion. He's been more understanding than the previous one who diagnosed him. And my usual vet refused to see my cat unless I followed the other vet's (the one who diagnosed Mus) treatment (my previous post about this). I'm just glad that I've become a little more informed since joining this forum.

 

The one thing I would strongly suggest is testing for ketones. It's a bit of prevention/early warning especially since you're not giving insulin. Ketones/diabetic ketoacidosis (DKA) can be deadly. You can get urine test strips at any pharmacy. You have to stalk Mus to the litter box and put the strip in the urine stream and then compare the strip to the color code on the container. If you see more than trace ketones, you need to talk to the vet about insulin immediately. (When my cat was diagnosed with FD, she had DKA. She nearly died. It was a several days at the kitty ICU and thousands of dollars for her care. Testing for ketones can save you and your kitty in very tangible ways.)

 

I got some strips a little while back! Unfortunately, it's a little hard to catch him in the act. When I have caught him, the strips have come up in the clear. (I'm so sorry to hear about your experience with DKA. Thank you for helping to keep us informed!)

 

Would a 12 hour curve be helpful even though he's not currently on insulin?

 

It would not hurt. Let us know how it goes.
I would continue to monitor the BGs and continue testing for ketones

 

Will do!

 

If you could note in the remarks column it in the SS when you give the snacks that will help us as well. This is because if the pancreas is working at all, the food given will stimulate the pancreas to produce insulin and the BGs should reduce a couple of hours after food.

 

I haven't been giving snacks because I'm not always home within the cycles. I think the closest he got to a 'snack' was today about two hours before dinner, but it really wasn't very much.

 

Have you thought about getting an automatic timed feeder? A lot of us use them here and they are so good for when people are at work.
Cats do better with several smaller meals instead of 2 big meals.
We recommend a good meal before the dose of insulin and then 2 or three snacks during each cycle.
I know you are not giving insulin at the moment. I feed my non diabetic cats 4 times a day.

 

I did see a few people mention autofeeders, but I think they're a little on the pricey side for me right now. Also, knowing what he's like, Mus would probably either find a way to get into it or avoid it altogether.

 

He would soon get used to it.
IM not sure of the cost in the US but i think the regular ones are not too bad. the ones with a microchip are expensive.