Help, I think this vet was a giant d*ck!

Status
Not open for further replies.
Clemptor

Clemptor

Member Since 2013
I'm new here, my cat went in last week with 400 level, there was zero discussion of diet or home testing and they want me to crate my poor buddy once a week at 30$ a pop to test him! I want to get my own glucometer and test him myself but I need parameters and every vet I e-mail seems only interested in selling me a "pet specific" glucometer which I know from perusing in here is totally unnecessary. I paid 300$ for my initial visit and I feel hosed. I just want to take care of this on my own.
 
Well, we might cut him a little slack. The ugly truth is that vets get a short workshop in Feline Diabetes and a nutrition class sponsored by Purina. And they do have to treat everything from geckos to labradors. We are okay with vets who may not be up to date, but are willing to learn and willing to accept that you are the customer and your cat's best advocate.

Lots of members do the FD on their own with the help of the forums for their specific insulin on this site. They use the vet for vaccinations and emergencies. You can tell him you are planning to use a human glucometer as you cannot afford the vet specific one or its strips. You can also say you will be testing at home and are happy to send him faxes of your spreadsheet but you cannot afford weekly visits for bg levels. If he balks, then we may be able to find a member near you who has a FD vet they can suggest.

Here is a shopping list for home testing:

A human glucometer. Any one that sips and takes a tiny sample is fine. Some members stay away from any meter with True in the name and the Freestyle meters. Some people think they are unreliable and read lower than other meters. The meters are often free at drug stores; it’s the strips that are expensive. You can, however, buy them on ebay at less than half the price of stores. Lots of people here also like the ReliOn from Walmart. It is an inexpensive meter and its strips are the cheapest around. Try the meter out on yourself or someone else before you try it on your cat. You want to be familiar with it before you poke the cat.

Lancets and a lancet device. Usually, until the ears “learn” to bleed, a 26-28 gauge is good. Any brand will work as long as the lancets match your device.

Ketone strips. (Ketostix) Just like human diabetics use. You will sometimes need to test urine if the numbers are high.

Rice sack. Make this out of thinnish sock, filled with raw rice or oatmeal and then knotted. You heat this in the microwave until very warm but not hot. Then heat the ears before poking. You can also use a prescription bottle filled with very warm water. It provides a good surface to poke against.

Also nice to have. Flashlight: so you can look at the ears and find the little capillaries that come off the vein running down the ear. Vaseline: Put a tiny smear where you want to poke. It will help the blood bead up.

And some lo carb treats to give your kitty, successful test or not Lo carb treats

How to get the cat ready for home testing

While you wait, you can get your kitty ready for testing.
First pick a place where you want to test. Some people use the kitchen counter, a blanket on the floor, between your legs while sitting – whatever works for you. Take the kitty there and give him/her lots of praise while you play with his/her ears. Give a treat and release. Next time, add the rice sack (thin sock filled with raw rice, heated in the microwave until very warm but not hot) or a prescription pill bottle filled with very warm water. Lots of praise, treat and release. Finally add the lancet so he/she will get used to the noise. The hope is that when you finally poke, they will be used to the process and know a treat is coming!

Since the test at the vet was just one done at the office and could have been influenced by stress, you might start testing and change the diet to wet low carb. In a few days, you should get a clearer picture of whether your kitty is a borderline diabetic or full blown.

Have you seen the info on wet low carb food: http://www.catinfo.org
Has your vet said what insulin he wants to prescribe? We advocate Lantus, Levemir or ProZinc. If he suggests Humulin or Canninsulin, he is old school and it is another reason to start looking for a new vet.
 
He's been on ProZinc for a week now, and I've been feeding him fancy feast chicken twice a day, there's Iams naturals dry food that's out 24/7, I had to ask the vet myself if I needed to remove it and he told me no, and from what I see online messing with their diet without closely monitoring them can be dangerous. I assume with a 400 level he is going to be totally insulin dependent. He's a good cat, more dog like than any cat I've ever seen, and luckily for me my Mother is an RN, so I see zero problem with monitoring him at home, but I can't get any vet via email or on the phone that doesn't want to take me for every cent they can. I need to know BS parameters and how to adjust accordingly.
 
Yes, I would definitely get confident with testing before removing the dry. We switched Oliver over from dry to wet and overnight his blood sugar levels came down 100 points. If we hadn't been testing and had given the normal amount, he would have hypoed.

The general perimeters are for new diabetics not to shoot if the preshot is 200 or less, but to wait, without feeding, for 20 minutes and retest. You want to make sure the number is rising and that it is over 200 before shooting. (Food raises bg levels so we want you to wait until after the second test to feed.) We consider a cat regulated if their preshot numbers are in the 200 range and they go down into double digits at nadir, but above 40. (Anytime you get a test 40 or below, you need to start monitoring every 20 minutes and have some higher carb food available to bring the numbers up if needed.) I copied off the Hypo thread at the top of this page and had it available if needed. We consider a cat in remission if they range from 40-120, off insulin, for 2 weeks with the majority of the time in double digits.

ProZinc does not have a sliding scale (i.e., if you get this, shoot this) We have a member who is good at developing them, but only after you have several weeks of data to base it on. This huge document on PZI has great info and links: http://felinediabetes.com/FDMB/viewtopic.php?f=24&t=32799 We have a forum of ProZinc users where you can post and get input on his numbers: http://felinediabetes.com/FDMB/viewforum.php?f=24

And we would like you to set up a spreadsheet. Not only is it a great tool for you, but if you get a low number and want input, we can immediately see his history of doses and numbers. Here are the directions: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 It's a little tricky; if you need help, just ask.
 
Hi guys and welcome to the board! Glad to hear you are interested in taking matters into your own hands .. If you are nearby to a wal mart, run over there and grab a 9.00 meter (we use the relion micro) .. should come in a kit with the meter, the lancing pen and a few lancets .. They are the cheapest meter/strips by far .. and you can always find a wal mart!

If you post your city/state you might find a member nearby who will come over and show you how to test ..
 
Wow, thanks a lot guys, I've been on the verge of tears ever since this happened, and not because of the situation itself, but due to the fact that every clinic I turn to just wants to bilk me out of every dollar I have. No one wants to educate me to help myself and as a small business owner who loves to educate my clientele I find this really distasteful and infuriating. Luckily my Mother will be coming over this afternoon, (6 hours after his last injection), to test him for me.
 
Just saw you are in Colorado. We have a long time member in Aurora who might be able to suggest a vet. I'll send her a message and see if she has any ideas for Parker. I am in Colorado Springs and will be moving to Westminister this summer, so I'll be looking for a vet also.
 
You have already gotten great advice from the others on the treating FD side of things so let me first just welcome you to the family.

And secondly address the statement you made with levels over 400 that he will be insulin dependent for life...while this maybe true, it also may not be true..I adopted both of my diabetics as diabetics and my Maxwell when he was first dxed was 485 two weeks later after ditching the dry food, and switching all 14 cats over to a low carb high protein diet and just a little insulin therapy this last November 1st he celebrated his 2 year anniversary insulin free and diet controlled. My second girl who was left untreated altogether for over 10 months before I adopted her is now well regulated on a mere .5u of insulin twice a day and I have every hope that one day I will get to help her celebrate throwing the insulin away too...but if it doesn't happen oh well, she is still my happy healthy purry girl that just happens to take two tiny shots a day.

Mel, Maxwell, Autumn & The Fur Gang
 
MommaOfMuse said:
You have already gotten great advice from the others on the treating FD side of things so let me first just welcome you to the family.

And secondly address the statement you made with levels over 400 that he will be insulin dependent for life...while this maybe true, it also may not be true..I adopted both of my diabetics as diabetics and my Maxwell when he was first dxed was 485 two weeks later after ditching the dry food, and switching all 14 cats over to a low carb high protein diet and just a little insulin therapy this last November 1st he celebrated his 2 year anniversary insulin free and diet controlled. My second girl who was left untreated altogether for over 10 months before I adopted her is now well regulated on a mere .5u of insulin twice a day and I have every hope that one day I will get to help her celebrate throwing the insulin away too...but if it doesn't happen oh well, she is still my happy healthy purry girl that just happens to take two tiny shots a day.

Mel, Maxwell, Autumn & The Fur Gang
Click to expand...

Wow, awesome! You've all given me some hope. Finally! Thank you!
 
Clemptor said:
Wow, awesome! You've all given me some hope. Finally! Thank you!
Click to expand...

Hey man.... (I'm assuming you are)...I jumped on her just over a week ago and these folks have helped me every step of the way... I am extremely confident that you will find that your experience is similar. Since I am new, I will refrain from making any recommendations on dosing, but what I will say is that testing is the hard part, but be patient and get a nice fluffy old towel to wrap your boy up in, because he will not like the ear pokes at first. I learned this the hard way and got shredded. I am glad to see another man on the board... makes me feel less like a wuss :razz: Anyways... you are in the right place and in very good hands. My frankie was in the 400s to start and most here think she will go into remission... anything is possible. Oh and BTW... be ready to type emasculating comments about your kitty... it's okay we know you love him cause you are here ;-)
 
Dan and Frankie said:
Clemptor said:
Wow, awesome! You've all given me some hope. Finally! Thank you!
Click to expand...

Hey man.... (I'm assuming you are)...I jumped on her just over a week ago and these folks have helped me every step of the way... I am extremely confident that you will find that your experience is similar. Since I am new, I will refrain from making any recommendations on dosing, but what I will say is that testing is the hard part, but be patient and get a nice fluffy old towel to wrap your boy up in, because he will not like the ear pokes at first. I learned this the hard way and got shredded. I am glad to see another man on the board... makes me feel less like a wuss :razz: Anyways... you are in the right place and in very good hands. My frankie was in the 400s to start and most here think she will go into remission... anything is possible. Oh and BTW... be ready to type emasculating comments about your kitty... it's okay we know you love him cause you are here ;-)
Click to expand...


I hate to burst your bubble but I am a woman. :lol:
 
I am glad to see another man on the board... makes me feel less like a wuss
Click to expand...
Over the years I've been on FDMB there have been quite a few men even though us women outnumber them. There have/are married men that are the caregivers, not their wives, and the men have always been awesome in learning and doing everything needed for their kitty. They also have not been ashamed to make known their feelings when their cat passes away. Never feel like a wuss for loving and caring for a cat. Whether a man is single, married, divorced, young, old, gay.........we don't care. We care because he is doing everything he can to help his cat and that is all that matters cat_pet_icon Welcome to FDMB and glad you found us.
 
So, he's at 257, down from a bit over 400 as of a week ago today. I left a voicemail for the vet asking what the next step should be, let's see if he wants to call back or not...
 
They were nothing but dry until 4 years ago when I added fancy feast chicken wet food, now they have dry food out 24/7 and wet food twice a day, the vet told me not to change anything initially, but now that he's down I'd like to know what the next step is.
 
So we consider that around his nadir - or the point in the cycle when the number is the lowest. It is not that low for a nadir. If you can monitor at shot time and sometime around that 5-7 hour mark, I think I would get rid of the dry. Be sure you watch his numbers because they are likely to drop, but if you are testing, you can stay on top of things.

If that makes you nervous, consider waiting till you are going to be home during the day and can monitor when you stop the dry.
 
I figured I'd pull the dry here pretty soon, I can watch him, I'm self employed thankfully. Should I pull it now?
 
I would get rid of it. Just watch him and keep on top of his numbers. There are many things about this sugar dance that fall into the category " every cat is different". Some react to an all wet diet in a day with lower numbers; some gradually go down for a week. For some, it is a huge difference, for others not as much.

Remember if you get a 200 preshot or lower or numbers 40 or below any time, come on for advice.
 
I can't help you with the dosing because my girl is on Levemir, but I can tell you that Sue who is posting with you at the moment KNOWS her Prozinc, inside, outside and backwards. :-D I will admit I know absolutely nothing about the PZI insulin, but if I ever adopted a diabetic that is using it...it would be Sue and Oliver that I would be asking how to dose it. :-D Way before I would be asking my vets, and I have wonderful vets that I absolutely love, they work with me and have learned a lot about treating FD because of what I learned here and them been willing to listen and research for me. I just know that Sue has a lot more in the trenchs with its use on several diabetic kitties. You couldn't be in better hands to learn how best to help your boy. :-D :-D

Mel, Maxwell, Autumn & The Fur Gang
 
Ooh, Mel made Sue blush :lol:

I agree with Sue - ditch the dry as soon as you can. When I did, all the raccoons in my yard loved me for a couple days. :-D

When you do so, be prepared for lower numbers overall too. It's like magic! You may need to increase the amount of canned to replace the calories at first, but as the numbers come down, so will the increased appetite.

Human meters are certainly good enough to monitor the BG levels. They will read lower than the super-duper vet meters, but we all know that, so we think in terms of "human meter numbers" since 95% or more of us use them. We only have to adjust our thinking when people tell us they are using a "pet specific meter". Your vet(s) might insist you need to get an Alpha Track meter in order to manage feline diabetes. But thousands of cats that have gone into remission after being home-tested with human meters would probably beg to differ.

Welcome to the family!

Carl
 
Just saw you are in Colorado. We have a long time member in Aurora who might be able to suggest a vet. I'll send her a message and see if she has any ideas for Parker.
Click to expand...
Hi and welcome to the board! I received Sue's message - I'm located in Aurora. I take Klinger to Alameda East Veterinary Hospital because they have the 24 hour emergency department. They are located at Alameda and Havana in Denver, but that might be a hike for you. I don't know of any vets in the Parker area, but I will ask around the office tomorrow.

Hang in there.
 
Okay, so this is interesting. I received a call back from the vet I took him to initially, followed by a call from Belcaro, a place I was referred to. Vet #1 says up his insulin, don't ever touch his food, reasoning being you can't be sure when he's eating, also tells me ideally he should be 100 or lower. Vet #2 said to take a day and test every 2 hours to get a curve, call her and go from there as far as pulling his dry food, and that 100 or lower would be dangerous, 150-300 is more ideal to avoid seizures etc, she was actually pleased I was taking steps at home to take care of my guy. I think vet #2 wins. What say you guys?

Oh, and thanks for all of the welcomes! I feel better than I have all week.
 
Okay what is choice number 3? Vet number 1 got the levels right...on a human meter normal for a cat is between 40-120 that is where you want them most of the time in order for their pancreas to heal if it is going to. But was a complete miss on the food. Vet #2 got the curve right and wanting to see his numbers over all before chosing a dose, again a miss on the food and way off on the range you want to keep him in.

But my personal vote for a vet would be...pick one you like for the everyday kitty stuff, and go hang out with Sue and Carl and the other Prozinc users and let them guide you on all thing feline diabetes wise and prozinc dosing wise and let the vet do the vetty stuff like shots, emergencies and dentals, but share your spreadsheet with them once you have some good data to share...but that is just my 2 cents worth. :-D

BTW the only time my two have seen their vet is just for the everyday kitty stuff, I do as most of us do, base our dosing decisions off the information here and we have lots of kitties in remission and off insulin to back our protocol up. :-D

Mel, Maxwell, Autumn & The Fur Gang
 
I generally like vet #2 better although under 100 is not dangerous. We consider 40 and under dangerous. Maybe he/she is being cautious which is okay.

I don't think he will go down a whole lot without dumping the dry, unless you continue to up his dose. (which is sort of like a human diabetic eating donuts while increasing his insulin to compensate. Better to improve the diet)

It is hard to get advice from cat people on the Internet. But everyone here has a regulated cat or in remission, using our protocol of wet low carb, insulin and home testing.
 
It all depends on where the 100 fits into the 12 hour insulin cycle.
Normal BG for a cat, on a human meter, is between 40-120.(70-150 on a vet meter).

If the 100 is read at shot time, then you would not give any insulin.
If the 100 happens around 6 hours after the shot, that's terrific, perfectly safe, and you'd just smile a lot.

The vet who says 300 is okay? At first, and if that's what you read at shot time, sure it's okay. But it's too high to consider everything being "good", and indicates some insulin is needed.

A curve as suggested would be a good idea, both before and after getting rid of the dry food. But if you're still using dry when you run the curve, and the numbers lead the vet to advise a higher dose is needed, then the correct answer to that vet would be "rather than increase the insulin, I think I'll remove the dry food to see how much that helps before considering a dose increase". Because it is likely that once the dry food goes away, a dose decrease would be the right way to go.

Carl


Carl
 
Clemptor said:
... I assume with a 400 level he is going to be totally insulin dependent...
Click to expand...
The fact that the blood glucose may be high at this stage is no indicator of whether your cat will go into remission or not. Recently a cat with a BG close to 600 went into remission quite quickly.

Some cats go into remission, some don't. But cats that don't go into remission can still have an excellent quality of life.
 
Starting with the preshot number, then every 2 hours for the cycle. This isn't set in stone - 1.5 hours or 3 hours. The important thing is that the cycle gives us a picture of how the insulin is working - when it starts the numbers down, when they reach the lowest point, when they start moving back up, how fast they move. All of that is great data.

Usually (but every cat is different) the number rises after the food and then the insulin kicks in around 2-3 hours after the shot. On the comments section of the spreadsheet, you can keep track of when you fed. We can just factor that in when we look at the numbers.

Good luck! Remember to give treats after every poke and heat the ear well. Just in case you need it, you can always get the drop of blood on your fingernail and test there - if he is starting to move away.
 
order is test, feed then shoot...you want that first test to be without food as food will spike them but when it wears off they will drop again, so you want to base if it is safe to shoot without food influencing the number.

Mel, Maxwell, Autumn & The Fur Gang
 
Okay, but he has dry food he grazes on, I should probably wait to pull it until after I get his curve?
 
If he is eating the canned fine, I would pull the dry food and get the curve off those numbers. Because dry is going to keep him in higher numbers than the canned will and if this curve is being used to base his dose on, it will likely start you on a dose that is too high once all the dry is out of his diet. But that is just my two cents worth.

Mel, Maxwell, Autumn & The Fur Gang
 
Clemptor said:
He's barely eating his portions of wet food, and they are small portions.
Click to expand...

I'm a bit behind in saying WELCOME to you and your extra sweet kitty so WELCOME! Suggestion - if you have a blender, make a bit of 'powder' from the dry and sprinkle a bit on the wet food. I'm trying to wean the last one of my HARD HEADED civies off dry food - someone suggested this to me, so far it's working fairly well. We're down to less than 1/4th cup a day of dry! None of the other 9 kitties get hard food anymore.

BIG HUG! You're doing GREAT!
 
Okay, now I'm confused as to how to test him. Yank the dry food altogether? When do I pull it if I'm going to do his curve tomorrow morning? Or should I replace the current dry food with low carb? I don't want to make him sick. I am getting frustrated again.....
 
You indicate he is not eating much, so I have some questions.

Checking my signature link for Secondary Monitoring Tools, how are the 5 Ps?

Does his breath smell like nail polish remover? If yes, go to the ver now; it could be diabetic ketoacidosis, a complication of unmanaged diabetes.

If you gently pull up the scruff of his neck and let go, does the fur snap back down or stay tented? If it stays tented, that is a sign of moderate dehydration.
 
I also do not know what the 5 P's are, I'm already overwhelmed, I just need to know exactly what to do, and I am getting 10 different answers for every one question.
 
If your curve is tomorrow, I would see if you can get him to eat more wet low carb today and if so, pull the dry tomorrow when you will be there to monitor.

Ways to get him to get the wet food: put a little warm water in it and make it more like a gravy, put parmesan cheese or tuna juice on top, sprinkle it with a shredded up treat he likes. This website by a vet also has great ideas for transitioning from dry to wet: http:// http://www.catinfo.org

If he is not eating enough and you are uncomfortable pulling the dry, then I would wait on the curve and concentrate on getting him to eat the wet only. As Mel said, a curve with the dry in place will need more insulin than a curve with wet only.

A suggestion: It is hard to keep up with all the replies and if you skip a few, you may lose information that is referred to in a later post. Each time you come to your thread, choose Unread Posts on the right and it will take you to the first post you have not read on that thread.

I know this is overwhelming but we are all just trying to help. If you start with your post this am about the curve and read through the replies, we are all saying the same thing, although in slightly different ways. BJM got nervous because she thought he wasn't eating at all, but that doesn't seem to be the case.
 
Clemptor said:
I also do not know what the 5 P's are, I'm already overwhelmed, I just need to know exactly what to do, and I am getting 10 different answers for every one question.
Click to expand...

Sorry, we can appear to overwhelm new members, mostly because everyone wants to try to help. And you won't get any "set" answers to your questions most of the time. That is due to the "peer review" concept of the board and that's because we've all gone through different experiences with our cats, and because every cat is different. What worked for Bob will not necessarily work for your kitty. There are a few things that are pretty universal when it comes to our advice.

1- home testing is a "must" in order to manage this.
2- low-carb canned food is the best thing to feed a diabetic cat.
3- in no case is dry food appropriate for a diabetic cat (or for any cat for that matter).
4- our top priority is the safety of your cat, and our advice will err on the side of caution. We are also a lot more conservative than most vets, or at least that is my impression in the nearly two years I've been here. Especially when it comes to dosing amounts.

About the dry vs. wet food, and when to remove the dry and how that all ties in to running a curve:

You can run a curve whether you are feeding dry food or not. Test every two hours, and record the numbers.

The results of that curve will be interpreted based on what sort of food he eats during the cycle.

If you feed him dry during the cycle, try to keep track of when, and how much he eats. Also keep track of when and how much canned food he eats.

IF the goal is to take away the dry food, but the curve is run while he's still eating dry food, then the results of the curve will NOT be used to determine if a certain dose makes sense or not.

That is because the dry food will inflate the numbers, and basing a dose on those numbers will mean that the dose is going to be too high once you get rid of the dry food.

The "useful thing" about a curve run when he's eating dry food will be to show you how much of an improvement takes place just from getting the dry food out of the picture. If you run a curve that includes dry food, and then you run another curve a few days later when he's eating only canned low-carb food, you'll see the difference that the diet change makes.

Running a curve while feeding only low-carb canned food will give you an idea of what his numbers "really look like", and then you'll be able to figure out how much insulin he might need from this point forward.

Carl
 
Oh, the "5 Ps"....

That's a term we give for some outwardly visible signs that indicate how your kitty is feeling:

Purring
Preening
Peeing
Pooping
Playing

If he's grooming himself and his coat is looking improved, if he's playing "like he used to", if he's purring and seems content, if he's pooping regularly and normally, and if he's peeing less often or in lesser amounts..... all of those are outward signs that can tell you more about how he's doing than the numbers on a meter can. We also call this the "whole cat report". Tell us what you see, and if things seem to be getting better when you notice them.

Carl
 
So, for his curve I was going to remove his dry food in the a.m., test him, feed him wet and give him his insulin, (prozinc). Now, he's on 2 units twice a day, will removing the dry food and keeping him on 2 units be too much? Should I take him down to one unit and continue to offer wet food through out the day?
 
Because it takes a little longer for dry food to digest than it does for canned food, I think I'd yank the dry tonight. Hopefully by the morning, the dry food "carb boost" will have cleared his system.

The dose is tricky, but I think reducing in the AM would be prudent. And one unit is a good place to "restart", in my opinion. The whole point of the curve is to "let's see what happens". And like I said earlier, we'll err on the side of caution in just about every case. If the one unit doesn't look like it does the trick after a couple of days on that dose, then an increase would make sense. But my thinking is that it'd be better to see not enough action from one unit than to see too much action from two units. It's always easier to "increase" than to decrease, because once the shot is given, you can't get the insulin back out.

Does that help?

Carl
 
I'm with Carl on the dose. I like starting low and increasing as necessary. My only reservation on dumping the dry tonight is that he is not real keen on the wet. I wouldn't want him to not eat tonight and then not eat tomorrow. I'd say keep an eye on him and if he is not eating at all, be prepared to offer a little dry.
 
Status
Not open for further replies.
Back
Top