Found a new vet

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Kathy and Mr. B.E.

Kathy and Mr. B.E.

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When I picked up Mr. Big Eyes after they got him started on insulin at the vet, I knew I didn’t want to go back to that vet again. One of her staff gave me a printed sheet of instructions for giving insulin along with a bottle and needles that day—no demo or discussion. She said I could bring him back if I wanted them to check his BG, but never suggested he should come back for a curve. I was also disappointed the vet hadn’t told me the sores and hair loss I took him in for in March could have been caused by diabetes and suggested testing his blood then. Or noticed he’d lost too much weight recently on his diet. (I was the one who realized he had diabetes and took him back for the blood work.)

With only about six veterinary clinics in my town, I was afraid I might not find a vet who’d be sympathetic to what I’ve been doing. I was quite pleased with the vet we saw last Thursday, though. She listened to me and gave quite a bit of time for the appointment. She agreed diabetic cats should eat low carb food and said she wouldn’t have prescribed k/d . I think she would have preferred a low-carb prescription food, but was OK with what I’m feeding. She also knows that home testing will result in more accurate BG readings and wants me to do a curve in 3 weeks.

A couple things did bother me—she says a cat is considered regulated if BG is in the 200s and I thought it should be 100s during the lower part of the cycle. Also, she didn’t realize Alpha Trak is a special glucometer calibrated for dogs and cats. I tried to explain there would be a difference between my numbers done on a human glucometer, but I think she thought I was talking about the normal deviance in all glucometers. When I do the curve, I’ll try to make it clear that if she’d done the curve the numbers would have been higher.

She wants me to stay at the 2.5 U for the three weeks before the curve, then check with her about the dose. I can also email her the SS anytime I want her advice about the dose and she won’t charge anything. She also has a paperless office and emailed me the receipt and discharge notes which was nice. (I hadn’t even got copies of the visits or itemized receipts at the last vet the past few times because they were too busy.) I can understand the new vet doesn’t want me taking advise from folks online. Of course, she doesn’t realize how much experience there is on this board and how careful everyone is to err on the side of not giving too much insulin.

I appreciate all the support and advice from I've gotten so far from folks here:bighug:. I’m sure I’ll have more questions in the future!

Thanks for listening!

Kathy & Mr. Big Eyes
 
Kathy and Mr. B.E. said:
When I picked up Mr. Big Eyes after they got him started on insulin at the vet, I knew I didn’t want to go back to that vet again. One of her staff gave me a printed sheet of instructions for giving insulin along with a bottle and needles that day—no demo or discussion. She said I could bring him back if I wanted them to check his BG, but never suggested he should come back for a curve. I was also disappointed the vet hadn’t told me the sores and hair loss I took him in for in March could have been caused by diabetes and suggested testing his blood then. Or noticed he’d lost too much weight recently on his diet. (I was the one who realized he had diabetes and took him back for the blood work.)

With only about six veterinary clinics in my town, I was afraid I might not find a vet who’d be sympathetic to what I’ve been doing. I was quite pleased with the vet we saw last Thursday, though. She listened to me and gave quite a bit of time for the appointment. She agreed diabetic cats should eat low carb food and said she wouldn’t have prescribed k/d . I think she would have preferred a low-carb prescription food, but was OK with what I’m feeding. She also knows that home testing will result in more accurate BG readings and wants me to do a curve in 3 weeks.

A couple things did bother me—she says a cat is considered regulated if BG is in the 200s and I thought it should be 100s during the lower part of the cycle. Also, she didn’t realize Alpha Trak is a special glucometer calibrated for dogs and cats. I tried to explain there would be a difference between my numbers done on a human glucometer, but I think she thought I was talking about the normal deviance in all glucometers. When I do the curve, I’ll try to make it clear that if she’d done the curve the numbers would have been higher.

She wants me to stay at the 2.5 U for the three weeks before the curve, then check with her about the dose. I can also email her the SS anytime I want her advice about the dose and she won’t charge anything. She also has a paperless office and emailed me the receipt and discharge notes which was nice. (I hadn’t even got copies of the visits or itemized receipts at the last vet the past few times because they were too busy.) I can understand the new vet doesn’t want me taking advise from folks online. Of course, she doesn’t realize how much experience there is on this board and how careful everyone is to err on the side of not giving too much insulin.

I appreciate all the support and advice from I've gotten so far from folks here:bighug:. I’m sure I’ll have more questions in the future!

Thanks for listening!

Kathy & Mr. Big Eyes
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Glad you found a vet more willing to work with you!

Regulated is when the cat is consistently in the 200's-300 with a nadir of around 100.

Whenever possible, try to get mid cycle readings... Esp around +5 and 6.
 
Here's an excerpt to add on to Janet's post: From this article - http://www.felinediabetes.com/fdmb-faq.htm#regulation
Q6.1. What is regulation?

A6.1. There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum":
  • Not treated [blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs]
  • Treated but not regulated [often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs]
  • Regulated [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia]
  • Well regulated [generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia]
  • Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin]
  • Normalized [60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin]
Glad you found a better Vet, she might even learn a few things from you ;). I don't think you should hold his 2.5U dose for another three weeks though and he's ready for 2.75U. His preshots are getting better with more yellows. But remember this is just my opinion :smuggrin:
 
Yong said:
Here's an excerpt to add on to Janet's post: From this article - http://www.felinediabetes.com/fdmb-faq.htm#regulation
Q6.1. What is regulation?

A6.1. There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum":
  • Not treated [blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs]
  • Treated but not regulated [often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs]
  • Regulated [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia]
  • Well regulated [generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia]
  • Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin]
  • Normalized [60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin]
Glad you found a better Vet, she might even learn a few things from you ;). I don't think you should hold his 2.5U dose for another three weeks though and he's ready for 2.75U. His preshots are getting better with more yellows. But remember this is just my opinion :smuggrin:
Click to expand...
I'm on my 2nd vet and neither of them had heard of this forum or seemed inclined to do so. But you seem to have gotten things under control- good on ya! I live in a medium-sized city (Tucson) and there are plenty of vets and I've gone through just about all of them in the past 12 years and not just for Chloe). I'm having the same problem finding my own doctor. The one I had no longer accepts my insurance. I've spent hours on Yelp, Healthgrades, and other sites. All the doctors that got good ratings are booked into Sept/Oct! Thank you for that regulation chart, Yong. I hadn't seen it before.
 
srk3cats said:
How do you know my name? I don't know how to find people's names. I'm never sure if their user names are theirs or their cats.
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Psst... (I Know very few names and I've been here a year! I only know Screen names.). Lol
 
JanetNJ said:
Glad you found a vet more willing to work with you!
Regulated is when the cat is consistently in the 200's-300 with a nadir of around 100.
Whenever possible, try to get mid cycle readings... Esp around +5 and 6.
Click to expand...
Thanks! I'm usually at work M-F and away from the house on Saturday around the +5 and 6. Fortunately I usually take off some afternoons in May and early June for gardening, so I did catch a few more as I was getting started with the testing. I haven't tested enough to even know when his nadir occurs (if it is even a regular thing.) I did take off a little early today and caught the 7.5 and was pleased to see 177:).
 
Yong said:
Here's an excerpt to add on to Janet's post: From this article - http://www.felinediabetes.com/fdmb-faq.htm#regulation
Q6.1. What is regulation?

A6.1. There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum":
  • Not treated [blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs]
  • Treated but not regulated [often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs]
  • Regulated [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia]
  • Well regulated [generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia]
  • Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin]
  • Normalized [60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin]
Glad you found a better Vet, she might even learn a few things from you ;). I don't think you should hold his 2.5U dose for another three weeks though and he's ready for 2.75U. His preshots are getting better with more yellows. But remember this is just my opinion :smuggrin:
Click to expand...
Thanks for this list! I will save it to share with my vet when I do the curve.

I agree that he needs more than 2.5U, but the vet seems to have a "thing" about 3 weeks at a dose. She said she normally has a cat just started on insulin stay at the same dose for 3 weeks, then come in for a curve. So I will stay at that dose for another two weeks since I agreed to that. When I share the curve; the "regulation continuum;" and the fact that the numbers she usually sees with the Alpha Trak would be higher than mine, I hope she will want me to increase the dose. If not, I may carefully do what I think best:smuggrin: to achieve better regulation.

I'm glad, though, that he is doing better at the current dose, especially in the last week or so. He is moving around the house a little more and must be getting into the box better. I'd cut down a big plastic box for him with 3" height, but I think he didn't get into the box well and would leave pee on a puppy pad in front of the box and track poop across the floor since he probably didn't have good balance and stepped in it. But I haven't seen this happening for over a week:joyful:.
 
srk3cats said:
I'm on my 2nd vet and neither of them had heard of this forum or seemed inclined to do so. But you seem to have gotten things under control- good on ya! I live in a medium-sized city (Tucson) and there are plenty of vets and I've gone through just about all of them in the past 12 years and not just for Chloe). I'm having the same problem finding my own doctor. The one I had no longer accepts my insurance. I've spent hours on Yelp, Healthgrades, and other sites. All the doctors that got good ratings are booked into Sept/Oct! Thank you for that regulation chart, Yong. I hadn't seen it before.
Click to expand...
Good luck to you in finding a vet you like and a doctor! It's too bad you've lost your doctor due to insurance. It controls so much of what we do about our health.:(
 
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