Polly's vet appt. tomorrow. Any advice?

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Marilyn and Sheldon

Marilyn and Sheldon

Member Since 2014
Polly has been on insulin (Lantus) since April 28. Starting at .5 U and moving to 4.25 U with steady but ever-so-tiny incremental improvements in numbers. She's practicing the "slow progress" method of regulation!

I'm trying to find out why she's so resistant to her insulin. So, vet visit to

1. blood work: Superchem, CBC, Spec fPL (?)..the pancreas thingy. Vet also wants a fructosamine test. OK with me; I have a credit card!
2. mouth exam: she has no teeth but has had infection in root sockets of lower canines treated "successfully" with clavamox. Worth a check.
3. urinalysis looking for any UTI

Is there anything else I should have done, checked, examined?

Additionally, Spec fPL requires 12 hours of fasting. Vet called the lab. They ok'ed 2 spoons of food and Polly's regular insulin dose tomorrow morning at 5:15 a.m. with her blood draw scheduled for 1:45 p.m. that afternoon. (I will be at work from AM+2 until I rush home to pick her up for the appt. at +8. Any comments?

Thanks for any advice, comments...encouragement!

Marilyn and Polly
 
I would not get the fructosamine test. Just show the vet your spreadsheet, instead.
I would not fast her (almost) for 9 hours like that and give her regular dose. Can't you get an 8:00am appointment instead?
My vet allows me to bring J.D. in for a quick blood draw (by a technician in the back room) early in the morning, before they even start having appointments. Maybe your vet would allow something like that, then you can bring Polly home, feed her, and go to work until it's time for the doctor's appointment.
 
I agree with Dyana about giving Polly her insulin without food. I think that's asking for a very chaotic morning where you could end up feeding Polly to get her numbers up.

I'm curious as to why you want to get a pancreatitis test (Spec fPL). Is Polly having any symptoms of pancreatitis?

To be honest, Polly's SS doesn't look like she's insulin resistant -- at least not yet. Generally, we don't start thinking about a formal diagnosis of insulin resistance (the presence of insulin auto-antibodies - IAA) or other high dose condition like acromegaly until a cat is getting close to 6.0u of insulin. Infection or inflammation can contribute to a higher dose so it can be good to get that ruled out.
 
i had mentioned to Marilyn that pancreatitis and hyperthyroid were the 2 most common causes of a cat being difficult to regulate, according to the most recent study in the PDF on the TR Protocol page. That's why she's talking about the Spec fPL. I'd check for hyperthyroid. If you're undecided on doing the pancreatitis test, you could reread Marje's post about pancreatitis (on the New to the Group sticky, very bottom of page) and see if you think she shows any signs of it. Same with hyper-t - we don't have a sticky on only that, but there is some info on the PDF and you can look online to see if you think she should be tested for it.

If she has to fast for the test and you want to get it done (which is up to you), i'd reduce the dose or skip it in the morning. If you were going to be home, that's one thing, but since you have to leave her and go to work, I wouldn't give the full dose.

I'd be interested in a recheck on her mouth. Does she show any signs of trouble in her mouth, ie, eating on one side, drooling, pawing her mouth?

And it could be that she's just not at the "right" dose yet.

Can you print out her spreadsheet for the vet? I'd also print out the PDF on the TR Protocol yellow starred sticky (same as above) that's called "Management of Diabetic Cats Using Long-Lasting Insulin" and give that to the vet. You shouldn't need a fructosamine with the spreadsheet. You have way more data than needed. When they do the general bloodwork it will come back with a glucose result. You could take along your testing equipment and test her just before they take her for a blood sample. That could be compared to the bloodwork test results and ought to be sufficient for your vet to accept as accurate.

Hope it goes well - good luck! Let us know what you find out.
 
I'd make sure the bloodwork includes total T4 test for thyroid conditions. Hyperthyroidism is another cause of a difficult to regulate cat. Good luck with the appointment tomorrow.
 
I'd skip the fructosamine too. As well as the SS, take along you meter. Most have a function that shows 14 day (which is what the fructosamine shows), 30 day and even 90 day averages.
 
Thank you everyone. I appreciate and value your advice.

I'm basically looking for anything "simple" that might be interfering with Miss P's response to insulin. Infections, inflammations. Will do the Superchem, which includes T-4, CBC and urinalysis. I'd like to do the Spec fPL simply because on occasion Polly retches small amounts of a translucent yellow liquid, usually in the dark hours of early morning before most of the feet in this house hit the floor. Three days or so in a row. Then not for a week or more. And she sometimes seems uncomfortable and lethargic after eating, especially her evening feed. But her appy is excellent. No apparent tenderness. No apparent dehydration.

I will not, however, shoot and fast. That doesn't make sense to me. And I'm not messing with her dose; not now when she's still moving down, albeit slowly. Will talk with vet about solutions.

Won't do fructosamine. Vet has been getting spreadsheet updates throughout this journey. And I do have a 14 day average.

I use a ReliOn Confirm meter.

Thanks for all your help. Miss P would thank you, too, but she's too busy dancing over the prospect of breffis #1 and breffis #2 tomorrow morning!

Marilyn and Polly
 
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