Is my vet's advice correct?

[Sarah & Wubby]

Hi everyone,

Wubby went into the vet today so we could talk about his hypo episode from Saturday and determine the best path forward. Let me first say that I really like my vet - she seems really knowledgeable and like she genuinely cares about my cats and me. Just want to present a summary of her recommendations to you guys and get opinions on if I should follow:

1. While she is not against home testing, she thinks testing before every shot provides "too much potentially inaccurate information." However, she did advise me to test "a few times weekly" if I was willing to, and not too shoot if he is under 150-200. For me, it seems like the only way to be safe is to test every time before, especially since Wubby's AMPS and PMPS levels have all been below 100 since I started testing Saturday.

2. She reduced the Vetsulin dose from 4U to 2U every 12 hours. Last time he was at the vet to confirm his 4U dose was working well for him was May 5th 2018, and his results at the vet were Glucose: 163 mg/dL and Fructosamine: 334 micro mol/L - from these results she kept us at 4U (these results were AMPS). Today in the office the results were Glucose: 107 mg/dL and Fructosamine: 290 micro mol/L (+4). With the reduction to 2 units today, she also told me to skip the shot if I notice something is off in his behavior. She also advised me it may be best to keep him off insulin for a few days.

3. When I asked hopefully if he is in remission, she said it was unlikely. When I asked if it was potentially due to his diet change (previously high carb dry diet, now low carb wet) she also said that it was unlikely. She concluded with she was unsure why his BG is so much lower and just said I should be watching him, and that these kind of dips occur sometimes - is that in line with everyone else's experiences?

4. I asked if cats can go hypo without receiving an insulin dose and she said yes, if there is some other underlying disease within the pancreas or the liver. Has anyone's cat ever gone hypo on a day with no insulin dose?

5. She recommended not to use neosporin on his ear pricks, just saline solution.

Outside of my vets advice, I also have a question about changes in BG throughout the day when there is no insulin given. Wubby's AMPS this morning at home was 55. I fed him after getting this value and did not give a shot. At the vet his +4 BG was 107. Is this BG rise normal?? Is it possible his BG will peak in the middle of the day in a way that warrants insulin? If so, I am assuming I would catch this at his PMPS -- is that correct?

Sorry for writing a novel -- your guys's advice is truly invaluable to me. I was gushing about you all at the vet

Thanks in advance!

Sarah and Wubby

 

[JanetNJ]

1. How is testing inaccurate? Guessing, hoping, and crossing your fingers while blindly shooting is inaccurate. I disagree with your vet.

2. Now that you are home testing I think it is good to Reduce. If you are getting numbers like 55 though I would reduce to 1 unit. If the testing shows it to be not enough, raise the dose in 0.25-0.5 increments at a time. Not whole units.
I agree with your vet to reduce until you have more data but 2 might be too much. No shoot of the number is under 200 until you get more data.

3. Lowering the carbs in the food definitly lower the numbers. A cat is not in remission until they are in normal numbers and no insulin for 2 weeks. Insulin is not a set and forget kind of thing. It's not a medication it is a hormone, and the needs fluctuate which is why testing is so vital.

4. The only time I saw this problem was someone who had a cat with cancer. Otherwise no they can't hypo without insulin.

5. A few cats have reactions to neosporin... Most have no problem. I use it occasionally.

6. The number fluctuates throughout the day. It's affected by stress, food, activity, ect.

 

[Jenna & Kitsu (GA)]

Hey there, Sarah! I'll help answer these to the best of my ability, though I am no expert myself.

1. I don't understand her logic on the "too much potentially inaccurate information". What is more accurate than checking to see if your cat is safe to give insulin to? Testing a few times weekly is more inaccurate than testing before each shot. I really cannot follow the logic on this at all and suggest you always test before each shot, and again at +4 or +6 (this means 4 or 6 hours after the shot). Once you get a curve done and can see when Wubby hits his nadir (lowest BG level after giving insulin), you can also test closer to that time period going forward with future tests.

2. If I'm not mistaken, you're saying his BG test today at the vet was 107? If so, that is a tremendously good number to have at a vet's office, considering being at the vet raises BG levels up for most kitties. As for keeping him off of insulin for a few days, I would test him before shot time and see if that advice is good to follow. With Vetsulin, I would be wary to shoot if under 200, although I have shot as low as 166 before and kept a close watch on Kitsu. If you are still seeing those low 100's at shot time, I would definitely follow your vet's advice and skip a dose until you see those numbers come up again, if they do. Fingers crossed that they don't, though!

3. He could very well be in remission, but that's why it's important for you to test him more than a few times a week. You will never really know until you see those numbers yourself. The diet change could have absolutely put him into remission, though. For some cats, they don't really need insulin as much as they need a diet change to a lower carb diet. As for why your vet does not recognize this could be a potential possibility, I am not sure.

4. A cat is unlikely to go hypo on a day with no insulin unless, like you said, there is some other underlying medical condition happening that you aren't aware of. This doesn't seem like a strong possibility, so I wouldn't worry too much about this, especially if you are doing BG tests to check on his levels.

5. I use Neosporin on Kitsu's ears when I test her. I don't know why the vet would steer you away from it. It helps the blood bead up and helps their ears heal. I'm no expert, but I feel like a saline solution would only cleanse the wound, not necessarily help with healing. And there's no huge need to clean the wound unless you are re-using lancets or not washing your hands before testing. A fresh lancet and clean hands make it a lot harder for the wound to get infected.

As for why his BG went up at the vet, this is totally normal. BG levels spike under pressure and stress, which is what most cats feel at the vet. I know some cats may be comfortable at the vet, but others are not, and their BG levels reflect this. For instance, Kitsu is rarely above 280 at my house, but at the vet, she is usually 400-500. It also may depend on the glucometer they use. If you home test with a human meter and the vet is using a pet meter, the numbers will be very different. My vet uses an AlphaTrak meter, which usually reports back ~100 points higher than my ReliOn Prime meter that's made for humans, so it's important to remember that there will be a variance between the two devices.

Hope this helps and feel free to reach out if you have more questions!

 

[Sarah & Wubby]

1. How is testing inaccurate? Guessing, hoping, and crossing your fingers while blindly shooting is inaccurate. I disagree with your vet.

2. Now that you are home testing I think it is good to Reduce. If you are getting numbers like 55 though I would reduce to 1 unit. If the testing shows it to be not enough, raise the dose in 0.25-0.5 increments at a time. Not whole units.
I agree with your vet to reduce until you have more data but 2 might be too much. No shoot of the number is under 200 until you get more data.

3. Lowering the carbs in the food definitly lower the numbers. A cat is not in remission until they are in normal numbers and no insulin for 2 weeks. Insulin is not a set and forget kind of thing. It's not a medication it is a hormone, and the needs fluctuate which is why testing is so vital.

4. The only time I saw this problem was someone who had a cat with cancer. Otherwise no they can't hypo without insulin.

5. A few cats have reactions to neosporin... Most have no problem. I use it occasionally.

6. The number fluctuates throughout the day. It's affected by stress, food, activity, ect.

Thank you Janet! I completely agree about the testing - it just doesn't make any sense to blindly shoot, especially since he has been getting such low numbers! Also, I feel much better about your advice of dropping to 1 unit and increasing by .25 - I don't ever want to see my baby hypo again.

Thank you so much for your help!

 

[Sarah & Wubby]

Hey there, Sarah! I'll help answer these to the best of my ability, though I am no expert myself.

1. I don't understand her logic on the "too much potentially inaccurate information". What is more accurate than checking to see if your cat is safe to give insulin to? Testing a few times weekly is more inaccurate than testing before each shot. I really cannot follow the logic on this at all and suggest you always test before each shot, and again at +4 or +6 (this means 4 or 6 hours after the shot). Once you get a curve done and can see when Wubby hits his nadir (lowest BG level after giving insulin), you can also test closer to that time period going forward with future tests.

2. If I'm not mistaken, you're saying his BG test today at the vet was 107? If so, that is a tremendously good number to have at a vet's office, considering being at the vet raises BG levels up for most kitties. As for keeping him off of insulin for a few days, I would test him before shot time and see if that advice is good to follow. With Vetsulin, I would be wary to shoot if under 200, although I have shot as low as 166 before and kept a close watch on Kitsu. If you are still seeing those low 100's at shot time, I would definitely follow your vet's advice and skip a dose until you see those numbers come up again, if they do. Fingers crossed that they don't, though!

3. He could very well be in remission, but that's why it's important for you to test him more than a few times a week. You will never really know until you see those numbers yourself. The diet change could have absolutely put him into remission, though. For some cats, they don't really need insulin as much as they need a diet change to a lower carb diet. As for why your vet does not recognize this could be a potential possibility, I am not sure.

4. A cat is unlikely to go hypo on a day with no insulin unless, like you said, there is some other underlying medical condition happening that you aren't aware of. This doesn't seem like a strong possibility, so I wouldn't worry too much about this, especially if you are doing BG tests to check on his levels.

5. I use Neosporin on Kitsu's ears when I test her. I don't know why the vet would steer you away from it. It helps the blood bead up and helps their ears heal. I'm no expert, but I feel like a saline solution would only cleanse the wound, not necessarily help with healing. And there's no huge need to clean the wound unless you are re-using lancets or not washing your hands before testing. A fresh lancet and clean hands make it a lot harder for the wound to get infected.

As for why his BG went up at the vet, this is totally normal. BG levels spike under pressure and stress, which is what most cats feel at the vet. I know some cats may be comfortable at the vet, but others are not, and their BG levels reflect this. For instance, Kitsu is rarely above 280 at my house, but at the vet, she is usually 400-500. It also may depend on the glucometer they use. If you home test with a human meter and the vet is using a pet meter, the numbers will be very different. My vet uses an AlphaTrak meter, which usually reports back ~100 points higher than my ReliOn Prime meter that's made for humans, so it's important to remember that there will be a variance between the two devices.

Hope this helps and feel free to reach out if you have more questions!

Thanks Jenna! Yeah I think she just doesn't want me to trust the meter too much because its not as accurate as the in lab blood tests they do (I'm not sure what the test is - they take blood from his leg and 'spin' it for 20-30 min). However, I told her I am going to be testing before each shot anyway because I would rather have a ballpark of how he is doing rather than going in blind!

Yes his BG at the vet was 107. This was after he had eaten and after I tested him in the morning (no food for 2 hours before AMPS) and got 55. He handles the vet and traveling very well as long as he gets cheek scritches and is being held by his mommy. When he was originally diagnosed, his BG at the vet was in the 400s, and has dropped down every visit since.

Just to clarify, are you saying you apply Neosporin before the ear prick, not after?

Thanks for your advice!

 

[Jenna & Kitsu (GA)]

Thanks Jenna! Yeah I think she just doesn't want me to trust the meter too much because its not as accurate as the in lab blood tests they do (I'm not sure what the test is - they take blood from his leg and 'spin' it for 20-30 min). However, I told her I am going to be testing before each shot anyway because I would rather have a ballpark of how he is doing rather than going in blind!

Yes his BG at the vet was 107. This was after he had eaten and after I tested him in the morning (no food for 2 hours before AMPS) and got 55. He handles the vet and traveling very well as long as he gets cheek scritches and is being held by his mommy. When he was originally diagnosed, his BG at the vet was in the 400s, and has dropped down every visit since.

Just to clarify, are you saying you apply Neosporin before the ear prick, not after?

Thanks for your advice!

Oh they did the actual blood test, not just a BG test with a glucometer, I see. I don't have much experience with those, as Kitsu has only had 3 done and I haven't been able to compare them with my meter. I agree with the vet that the blood tests done in a lab are more accurate than a glucometer, but she shouldn't shy you away from using your own meter to check his levels before shot time. That is just inviting hypo to happen if you continue giving insulin without testing. My previous vet gave me the same advice, telling me to only test a few times a week. It just doesn't make any sense to me.

That's good that he is mostly content being at the vet - it definitely helps with seeing how accurate the BG levels are if they aren't changing much between home and the lab results! Good to hear that those numbers get better with each visit, too.

Yeah, I apply the Neosporin before the ear prick, so the blood will bead up on it and not just fuse with her hair and make it harder for the glucometer to pick up. Basically my testing technique is to rub her ear for about 15-30 seconds, pressing on the edge of her ear lightly a few times. Then I apply a tiny bit of Neosporin to the ear, poke it a couple of times, wait for blood to bead. If no blood, I poke again a few times in a similar area, which will usually produce some blood. Then I push the testing strip into my meter and suck the blood up with it, wait on the result, then take a couple sheets of toilet paper and fold them into a square. Then I wrap the square around both sides of her ear where I poked her and hold it there, gently squeezing/rubbing for 10-15 seconds to prevent bruising. This takes most of the Neosporin off the ear, but it also helps rub the remainder into the hole(s), so she still benefits from it without having too much to clean off from herself later.

 

[JanetNJ]

Quo

Thanks Jenna! Yeah I think she just doesn't want me to trust the meter too much because its not as accurate as the in lab blood tests they do (I'm not sure what the test is - they take blood from his leg and 'spin' it for 20-30 min). However, I told her I am going to be testing before each shot anyway because I would rather have a ballpark of how he is doing rather than going in blind!

Yes his BG at the vet was 107. This was after he had eaten and after I tested him in the morning (no food for 2 hours before AMPS) and got 55. He handles the vet and traveling very well as long as he gets cheek scritches and is being held by his mommy. When he was originally diagnosed, his BG at the vet was in the 400s, and has dropped down every visit since.

Just to clarify, are you saying you apply Neosporin before the ear prick, not after?

Thanks for your advice!

You don't need to put neosporin on every time. I only use it every so often if I had been testing a lot that day or if I caught the vein.

 

[jayla-n-Drevon]

I use animal scents ointment from young living essential oils... it is like a wax base and Dre seems to prefer it. I only test pre shot now but back in the early days I tested like crazy and how ears were perfect with no irritation it is a little thicker than Neosporin .