Intro & Some Questions

[Michele & Fosse]

Hi there
I'm Michele and my 11 year old Fosse was recently diagnosed as diabetic.
But I have some big problems...

Now I don't normally take her (or her sister Guinness) to the vet. They're indoor only and I just don't bother traumatizing them with unnecessary car rides. The last time we went was when Guinness got spayed in 2008. Fosse was acting a little odd - not really eating (and yes I dry fed her) and would show amazing interest in human food. She's always liked people food and generally shares chicken and tortilla chips with me, but this was getting weird. A little analysis and I suspected she had an infected tooth. Without a vet I really liked or trusted, I turned to Yelp. First one I tried couldn't get us in for 2 weeks so I went to a different one. The place was okay. Clean and I'm sure they are okay with regular pet maintenance. But I just don't trust them for treating diabetes.

First experience there was Thursday 4/26. Doctor #1 seems nice enough and does a quick exam and verifies the necessity to extract 3-4 teeth. He does a blood draw to ensure she's okay for surgery, then makes me an appointment for Friday 4/27 for a drop off.
I bring her in on Friday morning on my way to work. Doctor #1 is there, looks at her blood work and announces her sugar is high and she can't have the surgery. This annoys me for 2 reasons - one, this is something he clearly could have called me about anytime yesterday evening or this morning. It's pretty obvious he didn't even look at the results till now. Second, I have now FASTED a cat for 12 hours unnecessarily & tortured her with another car ride.
He keeps her for the day to wait until she has enough urine to do a pee test for glucose.

Saturday 4/28 I get a voicemail that yes the urine test came back high for glucose & we'll need to start her on insulin injections. OK. But he instructs me to use the Purina Glucotest http://www.amazon.com/Purina-Glucot...ction/dp/B0000VJ55U?tag=felinediabetesfdmb-20 on Sunday & then on Monday Vet #2 will call with a prescription.
I sprinkled the flakes on Sunday 4/29 and they have yet to turn any color.

Monday 4/30 Vet #2 calls me & says there is a prescription waiting for me to pick up. It's like pulling teeth getting her to give me any information. I'm seriously annoyed by this. She is essentially doing the job of a receptionist so I'm not sure why if all she wanted to do was tell me to come by and pick up a piece of paper that she had to call me herself. So I'm trying to get info out of her as to dietary changes (I did some googling over the weekend and found a lot of confusing information), types of insulin, etc. She didn't appear concerned at all. Anyway I go in and pick up the prescription (Lantus), take it to the pharmacy and experience quite a bit of sticker shock. I'm really annoyed that she didn't even mention anything to me about pricing, how long the bottle lasts, etc. I'm glad the pharmacy tech was very nice.

Anyway. Thank you for reading how much I dislike and distrust this veterinary office. I need to find a better one for Fosse but I don't know where to start since I have no friends with cats and I'm not sure that a vet that's good with dogs is going to be amazing with feline diabetes. I wish there was a specialist! I'm in San Diego, CA if anyone has a recommendation.

So now we haven't started her on the Lantus yet because well, no one has bothered to even tell me where on the cat to give her an injection. All the literature online indicates her neck, but I haven't been trained. Is there a wrong way? Or a good educational video?
I already switched her food.
This vet did not go over doing any home testing either, or dealing with any warning signs of low blood sugar. NOTHING. I feel like I received zero support from this office.

I got a copy of her blood and urine tests when I picked up the prescription so I can share them with our eventual new vet. But we definitely need to find one soon.

Some online literature also says that blood sugar can be temporarily elevated due to stress and infection. So I'm worried they may be overzealous in their diagnosis/prescription because she has at least 1 infected tooth & was stressed by that and the vet visit.

Also, for the healthy Guinness, I had bought some of the Fancy Feasts that do have grains in them when I figured it was just a tooth issue with Fosse and that she'd appreciate soft food. For a non-diabetic cat, she can eat those, right?

Thank you. I appreciate all the advice and help that anyone can offer.

 

[Sue and Oliver (GA)]

We have people in your area who might have a good vet suggestion. How about going back to the original post and adding San Diego to the subject line.

Urine tests in the office are not a good indicator of diabetes. A fructosamine test is the definitive test. Stress raises blood glucose levels and most cats are very stressed there. Once they get home, their levels may be much lower. Infections, like teeth problems can also raise bg levels.

If he were mine, while I was figuring out a better vet, I would get them both on wet low carb diets(fancy Feast Classics are a good starting point). I would get a human glucometer (lots of people here like the ReliOn from Walmart and it is the cheapest overall) and test his numbers at home. That will give you a better idea of what his blood glucose numbers really are. Once you have the info you need, and see what difference the diet made, then you are ready to talk to a FD vet who will be able to tell you if he needs insulin and prescribe a good insulin.

 

[Carl & Polly & Bob (GA)]

Michele,
Yes, there are youtube videos that show you where and how to inject insulin and also how to home test. Just go to youtube and search for "feline diabetes insulin" or "feline diabetes home testing". You'll get a couple hundred hits...
You can feed the non-diabetic the FF with grains, but you will probably find it more convenient to feed them both the same thing, so you won't have to worry about Fosse getting into Guinness's food. As long as the food is low carb, it's great for both of them.
Carl

 

[Blue]

That's a lousy vet office, so I'd get copies of all the test results they have done, and there is no real need to ever go back there. If you had a blood draw, then you would have had the glucose number amongst all the other values, so I am not sure why time was wasted to get a urine sample. If anything, as was mentioned, the vet should have done a fructosamine test from the blood draw as this test gives a value to indicate what the cat's glucose has been over the last 2 weeks.
You have the most important thing: the rx for Lantus. Most vets know very little about feline diabetes, and quite often give very dangerous info, like an insulin starting dose that way too high. You will be just fine on this site where the members know more than many vets.

The first thing would be change the diet before starting insulin. Many cats are actually DIET CONTROLLED .... once they are off the dry food, and onto decent wet low car food, their blood glucose numbers go way down to a non-diabetic range. Going back to dry food will not be possible as you most probably would see the high glucose numbers return and you'd need to give insulin. If you have already started the insulin and have not completely changed the diet, be sure to start testing as soon as you can because the diet change will cause a big drop in the BG numbers.

Pick up a meter at the pharmacy, I like Bayer contours but Relion is a good one with very economical test strips. The OneTouch and AccuChek meters are also good, but just stay away from the FreeStyle meters as their strips give incorrect readings for cats. Also pick up some KETOSTIX so that you can test Fosse's urine for ketones.

Once you have the cats on the wet food and all dry's been tossed out the window, you will have a good idea if you will need to give insulin or not.

There's one more thing to mention and that's the teeth. If you have some dental issues, they can cause high glucose numbers. Once you have the pearly whites all shined up and the bad ones extracted, you may have a happy Fosse with non-diabetic numbers and no need for insulin.

There are plenty of youtubes and instructions available for you to show all about loading syringes and giving insulin shots and also how to test on Fosse's ear to get his BG numbers.

When you go looking for a real vet, have a list of questions that are important to you. You may not find a vet who knows everything, but you DO want a vet who will work with you and even learn alongside you. You also want to have the rest of the office along the same vein. My first vet was amazing... she did not know alot, but she knew the important stuff like giving a good and safe dental and was great with researching and working with me. She was good with the real doctor stuff like mending bones and doing Xrays and ultrasounds, diagnosing illnesses and giving the right meds for them. That's the stuff you need from a vet, not really the diabetic stuff. Sadly, she was the only thing good about that office; the other vets were idiots, so I left that office, and found a very good vet office with 3 vets, all excellent in all areas. They even had a good handle on feline diabetes!

You've got your insulin, so that's about all you would need from a vet right away. The next need would be for the dental, so you may want to make a list of info on dentals from fdmb and then shop around for a vet.
Start home testing and feeding the wet low carb diet. After a week, you should have an idea which way Fosse is heading and what you need to do.

 

[Julia & Bandit (GA)]

Some vets opt to confirm a diabetes diagnosis with a urine test instead of doing a fructosamine (which is far more expensive than a urine test), and this is a legitimate way to confirm diabetes. The urine test for glucose is an average of what the level of glucose has been over a period of about 5-8 hours (the time period from last urination). This can confirm diagnosis because while a high blood glucose number can be stress induced, a high urine glucose number cannot be unless the cat has been stressed for an extended period of time. Glucose does not spill into the urine from the kidneys unless a cat is consistently above the renal threshold, which is around 240. However, this will not work if the cat has been at the vet for more than 4-5 hrs, which was the case here. You can either confirm the diagnosis at home by getting a home glucose meter and testing at home in conjunction with urine testing (less costly but it will take a few days), or by taking her to get a fructosamine.

Urine testing is not good as the main way of monitoring your cat at home for the exact same reason. Because you're not detecting any glucose levels below 240, there is no way to detect hypoglycemia, and this is dangerous for your cat. Lantus is a every good insulin for cats, so your vet did get that part right. With Lantus, we recommend blood testing at home at least three times daily--once before each shot to make sure it's safe to give insulin, and one test in the middle of one of the cycles to see how the insulin is working to lower blood glucose. Dose adjustments are made off of that third, daily mid-cycle number. With this treatment and a low carb, canned diet, your cat stands an exceptionally high chance (84+%) of going into remission.

If Fosse needs teeth extracted, it's better to have that done sooner than later. Some vets will say that you should wait until the blood sugar levels get under control to do the extractions--the problem is that usually the bad teeth are contributing to high blood sugar levels, so you'll be waiting forever. This happened to Bandit and I. If you look at Bandit's spreadsheet (linked below), you'll see the vast improvement in his numbers came after I ended up switching vets and getting the dental done.

What sort of starting dose did the vet tell you? The average starting dose for a cat is 1u, twice daily. However, you may want to wait a few days while you're testing and changing the diet before you start insulin. Diet changes can cause some cats to go into immediate remission. You'll know within 3-5 days if your cat is one of these lucky ones.

Here is some information on handling and care your Lantus: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=151. Lantus is only guaranteed for 28 days, but with proper handling it can last up to 6 months. My first vial only lasted a month because I didn't know I wasn't supposed to inject the excess insulin back into the vial. After that I got the pens, which work as smaller, more cost effective vials. You use the syringes with them just like you would a vial, and there's far less wasted insulin.

 

[linda and guinness]

Hi Michele and Fosse (and Guinness),

I live in San Diego and can recommend my vet. I went round and round with a few vets when my cat was first diagnosised and even had to divorce a few. The vet I have now is good in that she trusts me and my judgement as to how to treat my Guinness (I have one too, but he's a boy). Your best bet is to learn all you can here on the boards and then tell your vet what you want to do, home test, etc. You are going to need the vet, so you have to find one you can work with and can trust. I listen to my vet's advice and then research and decided whether to go along with what she suggests or not. I travel from East San Diego to Point Loma to see her, so you know she's good for us. I can tell you that it's been eye-opening for me to realize how little some vets know in regards to feline diabetes. I understand, they just don't have the time to research every little thing and kind of just do what they've always done. My vet has that problem too, but like I said, I find she differs to me with my cat's care most of the time. Here's my vets information:

Dr. Barbara Darnell
Shelter Island Animal Hospital
3625 Midway Drive, Suite T
San Diego, California 92110 United States
http://www.shelterislandvet.com/site/view/90101_Home.pml
Phone : (619)222-0597

Feel free to tell her you know me or were referred by us.

P.S. I have to run out now, but if you would like you can private message me and I can answer more questions later.

 

[Ann & Maggie11 (GA)]

Hi Michele,
I live in SD and can recommend my Veterinary Clinic, and they treat both dogs and cats and also do recommend home testing for diabetic kitties. Here's the link. I've been going to Dr. Craig Marvil for over two years now with my diabetic kitty, Maggie. Dr. Emily Cross is also excellent as is the other Vet, Dr. Shaprut. They are located in Kearny Mesa part of town, more inland central San Diego. The Staff is also great.

Here is the link with all the info:

http://kmvet.com/about-us/doctors

Let me know if I can be of further help.

Ann & Maggie