New vet's recommendations - your thoughts?

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FurBabiesMama

Member Since 2017
Hi. I did not feel that the vet who diagnosed Mia's diabetes was knowledgeable enough. For one thing, she recommended against home testing and wanted me to come in every couple of weeks for a fructosamine test - enough said. So, I decided to find a new one. I found a mobile vet service, and emailed a couple of questions. I could tell by the responses that this vet had more knowledge - for example, she feels at-home testing and periodic curves are the best way to monitor/decide dosing - so I decided to give her a try.

The first visit was yesterday. First, let me say that mobile vet service is AWESOME. It was so much better having her come to us than having to take Mia to an office. She asked about what I am feeding her and had me show her the Young Again bag. She asked where I was getting my info on which wet foods to use, and when I told her catinfo.org, she was actually familiar with it. I told her I try to stick with 5% carbs or less which she said is great, and that I would like to eventually have them on wet only though that is not going so well. She agreed with that goals. She wants me to continue to monitor symptoms - drinking/urination/appetite - and weigh daily or every other day.

So, here are the things she recommends/says that are a little different than what I have read here, and I would like your thoughts on this, please:
1) I have read that ketone checks should be done regularly. She said that with a diabetic cat, I need to be alert to any symptoms of sickness and treat them as urgent, but if none are present, there is no reason for blood work, urinalysis or even ketone checks any more than maybe every 6 months.
2) I have read that if a pre-shot test is lower than 225/250 (AlphaTRAK), I should not give a shot but should stall and test again and so on. She said if pre-shot test results are not below 100, to give the shot as normal, and if they are slightly below 100, she still wants me to give the normal shot but first make SURE Mia has eaten some.
3) She does not want me adjusting dosing without her okaying it. She said that changing the dosing around too much can slow down the process of getting them regulated.
4) It had been suggested to me that Mia may have done some bouncing, and what I read on it made me agree, but she said she does not think so. She said Mia did not go low enough for the somogyi effect. She said her body is just having to adjust to lower levels (and the correct response is to hold firm on the dosing and let it work itself out).
5) She said our goal range should be 90-270. I have read many different things about ranges. so I really do not know on this one. Throwing it in here for feedback.

Sorry this is SUPER long, but I wanted to get it all in. Feedback on any or all points is appreciated. Thank you.
 
This is just my experience/take.

) I have read that ketone checks should be done regularly. She said that with a diabetic cat, I need to be alert to any symptoms of sickness and treat them as urgent, but if none are present, there is no reason for blood work, urinalysis or even ketone checks any more than maybe every 6 months.
My vet didn't really cover keytone testing. He has never been positive for keytones - not saying it wouldn't happen. I test now and again when: 1) numbers are running higher than normal 2) he is off his fuds and 3) he seems like he wants to hide. Just to rule out one possibility.

2) I have read that if a pre-shot test is lower than 225/250 (AlphaTRAK), I should not give a shot but should stall and test again and so on. She said if pre-shot test results are not below 100, to give the shot as normal, and if they are slightly below 100, she still wants me to give the normal shot but first make SURE Mia has eaten some.


I don't know about you but I wanted lower numbers and then was scared to shoot them. The theme here is keep kitty safe. So unless you know what you are doing and how kitty is going to react at shooting lower numbers - it is easier to have the help of the peeps here. Karen and Wendy did a lot of hand holding during the first greens, shooting the first blues and yes shooting the first greens. You will probably get used to shooting lower numbers....maybe just not now.

3) She does not want me adjusting dosing without her okaying it. She said that changing the dosing around too much can slow down the process of getting them regulated.

Ok, um, if I did that I would still be on 3 units BID of Lantus. I am now micro dosing. Both my regular vet and Jones IM vet - don't comment anymore. The proof is in the pudding - his numbers and his FD are in control/remission status. You are holding the syringe - it is up to you. I think the OTJ success rate of this site is also a good indicator that the methods work. And my personal feeling is I am on the front lines every day - the vet is not.

4) It had been suggested to me that Mia may have done some bouncing, and what I read on it made me agree, but she said she does not think so. She said Mia did not go low enough for the somogyi effect. She said her body is just having to adjust to lower levels (and the correct response is to hold firm on the dosing and let it work itself out).

It is Mia's body perceived low that is causing the bouncing, which the vet is technically correct, not necessarily the low numbers themselves. Bouncing and somogyi are not the same thing in my mind. Jones would bounce at first from going from a red to yellow. Those are not low hypoglycemic numbers but to his body they were: hence a bounce. Maybe someone will come along with the technical terminology for the difference.

5) She said our goal range should be 90-270. I have read many different things about ranges. so I really do not know on this one. Throwing it in here for feedback.


I think this depends on many factors but for me...I like greens and blues - I take anything in that range. With the prednisolone factor for Jones - I like that.
 
I have to say that I totally agree with Tracey. The bouncing bit is very difficult to comprehend and I'm afraid that even vets don't understand it and can give you wrong information. My understanding is that you ignore bouncing due to kitty going in lower numbers like from red to yellow (you stall or slowly increase the dose) but you react with the dose decrease if kitty goes into very low numbers in hypo area. And yes, I have seen many ranges for healthy BG but to me the most important thing is to get kitty into physiological BG of 4.4 (79) to 6.6 (118). And shooting low numbers - first of all you need some experience, secondly it is sensible to keep testing if you get a low PS to see if BG is rising, you don't want to shoot low number if BG is still going down as it can happen (sometimes insulin last longer than expected).
Good luck.
 
Bouncing is different for every cat. The cats body decides when to bounce. I can only say what Smokey was like. Going by the colors, he was use to high numbers (he was long term diabetic) in reds and some pinks. So if hit a yellow, his body wasn't use to it and perceived it as to low so the stored up glycogen gets released to get him back where it thinks it is safe in the red zone. Over time he would get more yellows and it would bounce him into the pinks. Then when he was mostly yellows and get a blue, that blue would bounce him back to yellow. Any number can bounce a kitty back up, it takes time for their body/pancreas to learn the lower number is okay.
 
Bouncing is different for every cat. The cats body decides when to bounce. I can only say what Smokey was like. Going by the colors, he was use to high numbers (he was long term diabetic) in reds and some pinks. So if hit a yellow, his body wasn't use to it and perceived it as to low so the stored up glycogen gets released to get him back where it thinks it is safe in the red zone. Over time he would get more yellows and it would bounce him into the pinks. Then when he was mostly yellows and get a blue, that blue would bounce him back to yellow. Any number can bounce a kitty back up, it takes time for their body/pancreas to learn the lower number is okay.
This makes sense to me and what you described happening over time is pretty much what I was/am expecting.
 
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