Need UK vet recommendations/stories/info

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Lori&Scout

Lori&Scout

Member Since 2012
Several requests for my fellow Brits...

1) I need a new vet, one who might possibly give me something besides Caninsulin. I'm in Leicester but willing to travel a few hours if I have to.

2) If you got your UK vet to give you something other than Caninsulin, please give me specifics about what you did - how long were you on Caninsulin, what tests did your vet run before switching you, did you show them your spreadsheet? Maybe if I can convince my current vet she's not going to prison for giving me a long lasting insulin, she'll be more receptive? If you could PM me your vet's name and name of practice, that would be much appreciated as well.

3) Is the an equivalent in UK for the American diabetes treatment protocol here: http://www.felinediabetes.com/AAHADiabe ... elines.pdf ?

Thank you so much for any help you can provide. I'm at an impasse with my current vet, long story short Nipper will be subjected to fructosamine tests every two weeks for several months before they will consider switching insulins. Long story in this thread: viewtopic.php?f=28&t=130117

Thanks :)
Lori
 
Are you working with the RVC? Amanda (Betty), one of our acro cats was treated there, but they have an FD remission clinic... and I believe they use Lantus. Betty was in a drug trial for acromegaly. There are also a couple other acro-moms that are in the UK - not sure if they're here or just on Facebook.
 
Update: My situation is a little different than a few weeks ago because Nipper appears to be insulin resistant (see spreadsheet). I'm now less concerned about Caninsulin giving her a hypo and more concerned about why it hasn't!

I took the girls to a new vet today and she was GREAT. She spent 45 minutes taking a history, examining them, studying my spreadsheet, asking questions, listening to answers, and DISCUSSING treatment options with me. These sound like simple things, but given my previous vet's attitude, I'm SO RELIEVED.

She recommended the following order of treatment, while holding current dose:
1) 24-hour glucose curve (taken every hour) to rule out rebound hyperglycemia from too high a dose. (She said either they could do it or I could do it, of course I will do it to save Nipper a hospital visit... who needs sleep anyway?) :rolleyes:
2) (after curve is done) Course of antibiotics to rule out gum infection or other infection as cause of insulin resistance. She got a good look at Nipper's teeth and said her gums are definitely infected. (I suspected this in December but previous vet dismissed my concerns.)
3) If BG still high, ultrasound and X-ray to rule out cancer/tumors/pancreas issue. Her belly is distended (it has been for some time) but the vet didn't feel anything abnormal.

If she's still high with no unknown cause, we'll then look at changing insulin. I got the feeling this vet is not a huge fan of Caninsulin.

Also, Scout, my OTJ diabetic, got a clean bill of health! :cat::cat::cat: Her coat is better than it's ever been, she's lost an amazing 4.5 lbs since her diagnosis and diet change 3 years ago, her muscle tone and heart are good, teeth are good, etc. etc. I have this board to thank for that miracle. :kiss:

Lu: Thanks for your note. I did speak to Ruth at RVC and she offered to see Nipper to give her a second opinion. I decided to try another primary vet before making the road trip, but that option is in my back pocket. If Nipper gets an acro diagnosis, I'll certainly need your advice on dosing and testing as I'm out of my depth there.

I welcome any other feedback and confirmation that we might be on the right track.

Lori
 
Sounds like you've got a great new vet. Teeth issues can definitely be a source of resistance - my cat's in at the dental vet today. :nailbiting: For dental issues - it's good to get an X-ray. Cats are prone to FORL - feline odontoclastic resorption lesion, which may only be detectable by X-ray. There's been many a cat here whose blood glucose has improved when the bad teeth are removed. Regarding doing a curve, every hour seems a bit excessive. You could probably do every 2 hours or maybe every 3 if in higher numbers, but perhaps every hour if he's below 8.0 (144) or so.

Good luck getting on Lantus - or Levemir. Neko was on Caninsulin first, so I feel your pain on trying to get switched. We have a number of acro kitties here in the Lantus/Levemir forum here should it come to that. You are lucky to have the RVC relatively close to you. They are doing great work with their diabetes remission clinic and also the acromegaly clinic. If you do rule out other reasons for high dose, and you get up to 6 U of Lantus or Levemir, then we suggest the blood test for acromegaly.
 
Hi Lori,

Has Nipper been tested for pancreatitis? I've just read her spreadsheet remarks and a lot of them reminded me of Saoirse's symptoms. Saoirse's tum gets distended, too, when her pancreas is acting up. When Saoirse was examined, the vet at the time didn't find anything abnormal other than fluid. They ran an ultrasound because they thought it could potentially be something more serious than the diabetes. As things turned out, the worst of the abdominal distension was due to the polydipsia (Saoirse was drinking nearly a litre of water a day - nearly 20% of her total body weight at the time! The pancreatic inflammation only showed up on the ultrasound, and they did the Spec fPL afterwards to confirm the diagnosis. I'm sure the blood test could be administered without the need for an ultrasound in Nipper's case, should one even be necessary. If you take a 'bird's eye' gander at Nipper's body condition, try to see if there's slightly more swelling on the right hand side of her abdomen.

I'm delighted to hear that you've got a much more receptive vet - it makes such a difference! The collaborative approach is infinitely preferable - better for both cat and caregiver! I had similar issues when Saoirse was first diagnosed, but our new vets are like your new one. It's like night and day.


FWIW, at one stage a feline diabetes expert reviewed Saoirse's data and advised that she thought that Saoirse was probably insulin resistant, but that was when my poor little munchkin was still on the Hills w/d Dry / Caninsulin BID protocol. Saoirse's numbers fell dramatically as soon as she switched to Purina DM canned low(ish) carb food, even on the Caninsulin. I still wanted to change her insulin because the Caninsulin was too harsh, both on her BG values and her entire system (it poleaxed her and left her withdrawn and depressed most of the day). I contacted Ruth at the RVC to ask about the trials. Saoirse wasn't a candidate because of the pancreatitis, but Ruth and I had a good chat about Saoirse's BG data. Subsequently, Ruth and our main treating vet at our current practice had a discussion together about Saoirse. Our vets also have access to Saoirse's spreadsheet. Between our vet's consult with Ruth and the documented problems Saoirse was experiencing on Caninsulin (not in regulated numbers long enough during each cycle, increasing risk of hypo, poor quality of life, etc.) it was enough to build the case to get the Lantus Rx for her.

Hope some of the above helps. I look forward to hearing how you get on. Great news about Scout! :)
 
Thanks you guys :)

Well I did the 24 hour curve as requested by new vet. My partner took over for 5 hours so I could get some sleep. Nipper has been a trooper and hasn't fussed about the pokes. She was lying on her side on the floor most of the day. I guess that just shows me how crummy she is feeling. :(

Her numbers looked good in the morning but for the rest of the day they pretty much sucked. I do like seeing the full pattern rather than extrapolating. This might help me interpret other days' numbers.

I'm heading out of town on Monday. I might bump her dose up to 6U before I go. She'll only be spot checked when I'm gone, once or twice a day, and will be alone most of the day, but I don't think theres any chance of hypo at this point.

When I get back, we'll look at what else might be wrong with her. Fingers crossed it's something treatable! I don't think she's been checked for pancreatitis yet, good idea. Her polyuria seems more pronounced than Scout's ever was, and she hasn't perked up much behavior-wise even as her numbers have come down.

Lori
 
Lori&Scout said:
She was lying on her side on the floor most of the day. I guess that just shows me how crummy she is feeling. :(
Click to expand...

That sounds like the way Saoirse was on Caninsulin, even when her numbers were lower. Does Nipper by any chance brighten up any bit at all when the Caninsulin's wearing off (+9 onwards)? Or does she seem a bit brighter in the hour or so after injection and before onset?
 
Hey guys, so sorry I missed your replies!! Nipper's appetite is really good recently, better than it has ever been. She had lost 1.5 kilos but it has been steady the past month. Between Nip and Scout they eat 3 200g tins of food per day, sometimes 4. Before her diagnosis they were only eating 2 tins some days. Nipper currently eats more than Scout. I've asked the vet to test for pancreatitis anyway, since she has the other symptoms. Maybe the diabetes (and the fact that she's starving) is overcoming the inappetance caused by pancreatitis.

As you can see from the 24 hour curve, her numbers are on a huge roller coaster. I know from experience how sh*tty it feels to have your BG change that quickly, so I put a lot of her grumpiness down to that. Not sure when she's brightest... through the day she tends to sleep and through the night I tend to sleep so the main time we interact is when she's about due for a dose or just had one.

She's no better, no worse than 3 weeks ago when I last posted. She is pretty much refusing to pee in her boxes at all now which is annoying but I'm not going to stress about it until I get her numbers under control. I haven't been testing much since she's always high.

Lori
 
OK, signature should be in there now. I just spent a solid hour cleaning up after Nipper. She is destroying the kitchen and living room floors, meanwhile Scout is destroying the carpet on the stairs with her claws (no, she won't use a scratching post, only carpet), can't wait to see the bill when I move out of here. :(

Lori
 
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