Frustrated With Vet...Should I change?

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Simonsmama

Member Since 2013
Hi everyone,
Thanks for all the info here. My 9 year old kitty Simon was recently diagnosed but after reading everything here, not sure I should stick with my present vet. Please let me know if I am just stressed or if I have a sincere beef.

1) She told me I could check Simon's blood sugar "if I wanted to".
2) She had me buy the dry DM
3) She told me to put insulin in his scruff.

All which I read here is wrong.

SOOOOOO, I started testing him with my glucometer (I'm diabetic too). Switched to the classic Fancy Feast and started putting the insulin where it needs to be.
THOUGHTS?
 
Wait...giving the insulin through the scruff is wrong? Uh oh...

I've always given Casey her shot just below the shoulder blades, lined up with the spine (got that from a YouTube video on how to give your cat an insulin shot). I've been messing up her shot for over a year?! Well, that might explain why her doses are so high...where SHOULD they be going?
 
Hi, and welcome to FDMB!

Some vets support hometesting, some actively discourage it. If your vet says to do it 'if you want to' I think that's pretty good, actually! It could be a lot worse. We've had folks on this forum NOT test because their vets were opposed to hometesting, and that is not good at all... My own vet was not keen at all on my hometesting when I first started, but now, well, he is very supportive!

Regarding the dry food, many vets are keen on that too... But as long as the vet is happy to prescribe insulin for your cat despite your decision to feed wet/canned, I wouldn't see that as a particular problem either...

And as for injecting in the scruff, a lot of us here do just that. But some folks say they have insulin absorption problems injecting in the scruff and inject into loose skin elsewhere on the body (ie, along the flank). I've injected in the scruff on my own cat for 6 years now, and never have any problems with absorption (so far....).

As to whether you should stick with your vet, well, if you have a good general relationship then I don't really see any reason to change... But it's your choice of course. You need to feel comfortable. (I did change vets after my cat was first diagnosed, but then the vet who diagnosed my cat wanted me to have him put to sleep!)
 
Your vet sounds not too bad.

I like the "if I wanted to" because it means she takes direction and leaves things to your decision. Means you wont be fighting with her like some people are here with their vets. What kind of insulin did she recommend?

Scruff is fine but its a great idea to rotate sites in order to prevent development of a lipoma or scar tissue. Here are typical injection sites.
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Good decision for you to change his food and start home testing. What meter are you using?

Wendy
 
I guess my concern is that we had never seen this vet before because we just recently moved and it was actually our first visit with this practice.

I had read here that the scruff wasn't the best since the blood supply isn't as good. But I do move the sites where I give it.

I am using the accucheck mini (i think that's the name)

He is on 1u of lantus twice a day. BS have come down from 450 at time of diagnosis to 300 as of yesterday but wondering if I need to see about upping the dose? He has only been on the insulin for a week.
 
You are doing great! What time do you normally test in relation to giving him the shot ? Lantus works on a 12 hour curve and we making dosing recommendations based on his lowest levels during the day i.e.

Example of a typical Lantus curve: (in hours)
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.


So you should always test at the preshot to make sure he isnt too low, and then around +6. Dont feed for two hours before the shot so the number isnt influenced by food. We track our results on a spreadsheet - see here for how. If you do this we will be better able to advise.

Wendy
 
one week is not long for being on insulin. what insulin are you using? have you gone to the insulin forum for the one you are using and read the stickies information that is listed there. For example, in lantus it discusses the start low go slow approach and how many cycles to keep with the same dose before making adjustments - and of course home testing is important.

regarding your vet- many vets do not understand nutrition and how carbs, dry food, etc affect cats. so they typically push/recommend using prescription only.

my suggestion for that - is to just say no thank you and manage the food on your own.

the vet saying you can test if you want - is better than being told you are not allowed to test and if you do I will not treat the cat - that is what my former vet said to me. finding a vet that supports home testing, will discuss and even teach you is great.

regarding location to inject insulin - most vets inject vaccines and anything else in the scruff, hence they believe that you need to inject insulin there as well. It does not mean that is the only place to test. what i did notice when taking care of another diabetic cat - when I shot in the flank, his bg would drop really quickly and when I shot in the scruff, it dropped slower.

experiment and test to see what location works best for your cat - and you will only know with home testing - you may find that rotating locations, shooting flank, shooting scruff works best for your cat.

overall, i don't think is a bad vet.
 
Thanks so much guys. So mama here will take a big breath, relax and not be so crazy :oops:
Today when I got home from work, his BS was 338, he ate and I gave him his meds. 3 hrs later, 254. Seems like we are doing better.
 
Not sure what you mean about next week.. is that when you are going to do the spreadsheet or..?

Please take a reading before every shot, plus if you can do a check 5-7 hours after the shot it would be good to check how low he is going.. and remember dont feed for 2 hours before the shot so his preshot test number isnt inflated by food.

Also if the preshot is under 200, dont shoot, dont feed and let us know. Until you have enough data to know how he behaves you need to be careful when shooting low. Maybe read this http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

Let me know about the spreadsheet!
thanks
Wendy
 
Sorry Wendy,
I meant I just started doing the log so I really don't have much to show you. But I do want some clarification...Simon's bs was 284 this morning and now is 168, 6 hrs after his 1u of insulin and eating. My understanding from your table...this is the peak of the insulin. Just a little nervous that we might go hypo.
 
Simonsmama said:
...[BG] 168, 6 hrs after his 1u of insulin and eating. My understanding from your table...this is the peak of the insulin. Just a little nervous that we might go hypo.
Click to expand...

168 is a safe number at peak, and a nice number to see at this stage of the game.

Edited to add:
Here is the link to hypo numbers and symptoms, and info on how to treat. It's a good idea to print this out if you can and have it to hand in an emergency. Your cat may never have a hypo - many don't - but it is as well to be aware.
http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887
 
Here is some info from the 'FAQ's' about 'regulation that might explain some of the numbers:

--------------------------------------------------------------------------------

6. 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]"
 
So far so good. Keep testing and we will see how he does!.

You could even do a "curve" and test through the day from AMPS ( morning preshot) to PMPS(evening preshot) every 3-4 hours to see how the lantus is trending. Although many cats peak is at 5-7 hours (+5 -to +7) from the shot, my Bailey tends to be at +3.
 
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