Garth's New Vet, BG high today

[StefO]

I wanted to change Garth's vet shortly after he was diagnosed but the new vet recommended that we come after his first curve with old vet. I scheduled an appointment for his next curve with new vet, but there must have been some confusion and it was just an exam.

He was open mouth panting and breathing rapidly in the exam room. This has happened a few times at home but not since the appt. I assumed the panting was from heat/humidity/stress but the vet suggested a chest x-ray to see if there was any fluid or check if his sternum was close to the heart. No fluid, but she suggested there was something abnormal with his abdomen and they only way to find out what could possibly be wrong would to run diagnostics for $600. Not sure I want to sedate him, so when I asked if I could give new vet my decision in a few weeks, she said there may not be enough time.

I was having so many complications testing him at home (too squirmy for a poke, not enough blood, use a different test strip) but the day before his appointment from his 10amBG was 360, then 2pm 363. The new vet suggested that if it stayed high like that to up his Lantus from 3U to 4U. She also implied that she wouldn't have given him Lantus. I just checked his BG and it was at 506. He doesn't get his shot for another 1.5 hours.

I am feeding him 1 full can of FF at 8am/8pm and a half can at 2pm/2am (I work nights). He normally starts his incessant crying around 5:30am and I try to give him some freeze dried salmon, but this AM I was desperate and gave him a handful of Purina DM Dry. Now I feel really terrible that I did that ! Also today, I started him on sublingual methyl b-12 to aid his neuropathy. (Thank you so much JanetNJ!!)

This week has got me feeling disheartened and frustrated. ;/ Not sure I will stick with the new vet and am considering just going back to the old one since they know him so well.

Is there anything I can be doing differently? Any and all suggestions appreciated! Thank you so much!

 

[Yong & Maury GA]

Sorry you're going through this, Stef . Did Vet give any hints to what abnormal was in his abdomen? I would not increase his dose by a whole unit. 3.0U is kind of high for a newer diabetic kitty. Did she say why she would not have given Lantus? It's one of the better insulins if dosed properly for the kitty . There is a chance he is on too high of a dose right now. Are you testing for ketones?

Remember, the BEST thing to help his neuropathy is getting his BG under better control, that doesn't mean regulated (think I've said this before).

Not being judgemental but the best thing, I think, you can do is try to get down home testing. There are others who deal / dealt with squirmy (even semi-feral) kitties, don't be afraid to ask for tips. Have you posted on the Lantus thread at all? Lots of really experienced members over there

 

[Olive & Paula]

I'm concerned about open mouth breathing and panting. Has it only happened at the vet office? Isn't the office air conditioned? Did vet say if xray showed enlarged heart?

 

[Squalliesmom]

I am concerned about the panting, etc, too. Has he only done this when he was under stress or exposed to heat? It is definitely not normal behavior. What does the vet think is abnormal about his abdomen, and what diagnostics is suggesting?

ETA: I don't know why she thinks Lantus is not a good insulin, it's one of the best, arguably! I'm with Yong, though, I think his dose may be too high and that's why his numbers aren't coming down.

 

[Chris & China (GA)]

Panting due to stress is quite common

If he's not in any distress at home, I don't see any real reason to have an expensive x-ray (and subject him to sedation too)

If there's something in the abdomen, they should be able to do an ultrasound ....x-rays aren't the best diagnostic tool for masses

 

[StefO]

The vet gave no hints to what might be the problem in his abdomen, just that she thinks something is going on in there. I am wondering if it his pancreas. I keep feeling his belly and can't really determine if it feels abnormal or if it's just cat belly. The x-ray didn't show an enlarged heart, but she also mentioned that he wasn't being very accommodating to the x-ray taking. She mentioned that she would have given him NPH? and another insulin over Lantus.

I've only noticed the panting in relation to the heat. We don't have central air in our house and he hangs out in the hallway more than his room with a fan. It was a hot 15 minute car ride to the vet but the AC was blasting. I was going to say that I haven't seen him do the panting since our appointment earlier this week but he is doing it at this moment. We were downstairs in the hot kitchen and I picked him up and he had his mouth open while I was carrying him. It only lasted about 2 minutes.

I did give him 4U at 8pm. I think I will go back to 3U or maybe even 2U in the morning. I just tested him and his BG was 364. I tried testing him alone and the strip wouldn't read 4x in a row! I finally got my husband's assistance and we got the reading on the 3rd try. He is oh so difficult, but we are trying! I just cry a little inside when I have to use a new strip. I haven't tested for ketones but I am going to order the strips right now ! I have not yet posted on the Lantus board but am trying to navigate my way through it.

Thank you all as always for your advice and suggestions!

 

[Olive & Paula]

Maybe the vet is not familiar enough with lantus and only comfortable with the other. I know my vet wasn't, but 2 other insulin clearly didn't work (first he was on 2 yrs and 2nd, 1 yr) so he was willing to try. You might try gentle persuasion to keep the Lantus. You haven't been on it long.

As far as the heat, take some empty soda bottles, fill with water and freeze. When frozen wrap one in a dish towel and put in the spot kitty likes to lay down. He can stay cool a little laying against it.

 

[Chris & China (GA)]

I have not yet posted on the Lantus board but am trying to navigate my way through it.

The Lantus board isn't really any different....You basically just post daily with the subject line being Date/Cats name, AMPS ###......as the day goes on, if you get other tests in, you edit your subject line to add them. In the body of the post, you just tell everyone what's going on....like you do here!

It will really help if you'll start using our spreadsheet though.....the people on the Lantus forum have lots of experience using it (much more than your vet does) and by looking for patterns in your spreadsheet, they will be able to help you make good dosing decisions.

If you need some help setting up the spreadsheet, I'd be happy to help you. Just send me a private message by clicking on my name and choosing "start conversation"

 

[JanetNJ]

Perhaps your cat is dehydrated with all the heat. Add extra extra water bowls around and water to his wet food.


If he's squirming for an war test, flick the blood drop to the back of your nail and test from there.

 

[Yong & Maury GA]

I did give him 4U at 8pm. I think I will go back to 3U or maybe even 2U in the morning. I just tested him and his BG was 364.

I'm pretty sure Lantus does not do very well when adjusting doses between AM and PM cycle as it effects the depot. Your Vet increased his dose each time by a whole unit, correct? If you did switch to NPH, home testing would be even more crucial as it is a less gentle insulin. I hope you decide to stick with Lantus. You could ask the members over there about possibly resetting him and doing slow increases. I've only been using it a week so still learning

Another trick for squirmy kitty, if getting blood drop on the back of your nail doesn't work, cut a straw in half to make little scoops. I got like 12 scoops from 1 straw . Or an acrylic nail. If you can't even get that far, there is the Caturrito option. (burrito the kitty ). Just keep asking, we'll help however we can

 

[StefO]

I think we will stick with the Lantus! My father in law actually acquired a supply for us, so unless we may not change.

I think getting the blood in another item is a great idea, not sure why I didn't think of that ! Thank you!!!

 

[Julia & Bandit (GA)]

I have to agree with what the others have said--it's proven that Lantus works better in cats than NPH or Vetsulin, and I would give it a fair shake with the recommended dosing protocol for it before switching insulins. Dose adjustments are supposed to be made in .25-.5u increments, not whole units, and doses need to be held for 3-5 days before adjusting the dose, based off a minimum of three daily tests--once before each shot to make sure it's safe to give insulin, and once in the middle of one of the cycles. Some vets just aren't aware of the new recommendations for cats. I'd print out the AAHA Diabetes Guidelines, and the article I've attached here, and bring them to your vet if she's resistant to your current treatment choices. I changed vets a few months after Bandit was diagnosed, and his new vet was not familiar at all with home testing, Lantus, or low carb, non-prescription diets for feline diabetes treatment. But once I gave her the research and articles available at the time, she was on board with it, and eventually changed their recommended treatment and diet for all of their diabetic cats.

If you can get your tests into your spreadsheet, that will help the people here and in the Lantus forum advise you as to what to do with the current dose! I agree that 3u is probably too high--and that will become apparent when you collect those daily tests. Patience is required for any insulin, but especially Lantus--typically you don't see the effects of a dose change for 24 hours because it is a depot insulin. Getting a cat regulated is a marathon, not a sprint, and it can take weeks or months.