Pretty sure my vet thinks I'm crackers

Status
Not open for further replies.
Alexis & Nikki (GA)

Alexis & Nikki (GA)

Member Since 2013
After a fructosamine test run on Saturday, he called tonight and wants me to increase from 1 unit to 2 units. I'm pretty sure he could hear me rolling my eyes over the phone...Since Nikki has to remain on a high carb food due to her gastro issues, a hypo probably isn't likely, but I still can't believe a vet would take a fructosamine test and weight and just up the dose by a whole unit in these days. :roll: I asked him about maybe going up a half unit at a time and I could tell he was rolling his eyes. :?

Since we are on a high carb food, I'm going to up to 1.5 units tomorrow night and get a +5 in just to make sure she doesn't drop too fast. I can't test more often than every 3 hours since I have to use her food while I test, which in turn bumps up her blood sugar. It's a vicious cycle. It's super frustrating that I can't change what she eats, but since she almost died before changing to this food, I can't start messing around with it. :evil:

At this point with her food issues I'd settle for regulation. I'd love remission, but don't see it happening because of the food....
 
Have you considered a slow transition to making your own food to see if that helps the digestive issues, although I don't know what those issues are..

Test a bit more and you can skip the fructosamine tests and save yourself some cash. Also I might do a curve for the next few days before increasing, just in the off chance that there is a low and some bouncing going on.

Definately wouldn't increase by a whole unit. We like 1/4unit changes.

Wendy
 
We tend to take the info from the vet as more of a 'suggestion' then an 'edict from god'.

You are not the first person that wants to go against their vets advice and be more conservative on the dose changes. We would advise you to do the same.

On the food, it's only the AM and PM pre-shot tests where we want food taken away for 2 hours before if possible. All other blood tests are expected to be food influenced. That means you can take a test 30 minutes after feeding if that happens to be a +2 or a +6 that you wanted to get a test for.

Re: remission vs regulation. Not all cats can achieve remission, even on a low carb food. Cats fall out of remission for unknown causes also.

You do the best you can to make your cat feel better. You are already doing that and providing plenty of love and attention. Keep it up and yo have a happy cat. That is what matters most.
 
Wendy&Tiggy said:
Have you considered a slow transition to making your own food to see if that helps the digestive issues, although I don't know what those issues are..

Test a bit more and you can skip the fructosamine tests and save yourself some cash. Also I might do a curve for the next few days before increasing, just in the off chance that there is a low and some bouncing going on.

Definately wouldn't increase by a whole unit. We like 1/4unit changes.

Wendy
Click to expand...

Unfortunately, an ultrasound done last fall along with various blood tests were inconclusive. We think it's either a food allergy, IBD, or cancer. Prior to being put on pred, Nikki started getting dehydrated because along with diarrhea, water would come out. It was a pretty close call but once we had her on pred, she was having fairly normal stools (which leads me to think it is cancer, but it's hard to tell when every test has been inconclusive). I had her down to a half dose once a week but the pred (we think) is what induced the diabetes so we stopped it when she went on the juice. I'd be open to trying a raw/home cooked diet but I'm afraid to start the downward spiral again. The z/d works so as much as I hate to, I'll stick with it for now. Meanwhile, I have my civvie on low carb, wet food as I would prefer to never have this happen again! ;-)
 
Deb & Wink said:
We tend to take the info from the vet as more of a 'suggestion' then an 'edict from god'.

You are not the first person that wants to go against their vets advice and be more conservative on the dose changes. We would advise you to do the same.

On the food, it's only the AM and PM pre-shot tests where we want food taken away for 2 hours before if possible. All other blood tests are expected to be food influenced. That means you can take a test 30 minutes after feeding if that happens to be a +2 or a +6 that you wanted to get a test for.

Re: remission vs regulation. Not all cats can achieve remission, even on a low carb food. Cats fall out of remission for unknown causes also.

You do the best you can to make your cat feel better. You are already doing that and providing plenty of love and attention. Keep it up and yo have a happy cat. That is what matters most.
Click to expand...

Since the food influence is much higher with the high carb content of her food, wouldn't that lead to a higher BG reading than I might get mid-day without testing?

And thanks, you are always so good at making us feel better! :-D
 
I should add to this that I think my vet is pretty great, he's worked really hard to keep Nikki comfortable. I just get nervous over full dose increases when I'm out of the house 11 hours a day. :? I've changed our shot schedule so I can get a PM +5 or +6 most nights while I increase her dose. :-D
 
The food will in general keep the BG numbers higher overall. Not just at mid-day, but all the time.

To counter the need for that high carb food and the higher BG numbers as a result, you will need to give more insulin to overcome the food and any steroid use.

Can't give you any specific number of units dosing advice. You aren't testing enough to make anyone here willing to give that dosing advice, at least not in terms of "increase by 0.5u" or "decrease by 0.25U.

I can tell you a few things by looking at your spreadsheet
1.You have held that 1U dose for way too long - a month. You should not stay at the same dose for more than a week if your BG numbers are not changing.
2. you need to test for ketones daily. High numbers, not eating enough food plus infection = likely DKA.
3. You really should be testing every pre-shot and more tests at mid-cycle. Fill in the blanks on your spreadsheet.
4. You diminish your chances at remission the longer Nikki goes unregulated.
5. Unregulated numbers over the renal threshold (250-280) are continuing to damage Nikki's organs. You need to make insulin dosing changes quicker to stem this continuing damage.
 
I wasn't asking for advice at this point. My vet asked me to hold the dose until we got a fructosamine. I appreciate the knowledge that everyone has here, but because of our unique circumstances with her food, I'm doing what I can and don't expect anyone to feel comfortable with advice. Nikki has no infections and is eating the recommended amount of food for her weight. Now that I've gotten her used to testing I am planning on getting pre-shot tests every day. Unfortunately, I'm out of the house 11 - 12 hours 5 days a week so mid-day testing can only happen on weekends. That's the reality of having an hour long commute each way and being single. *shrugs* At this point, I'm doing what I can for her.
 
Nikki's Mom said:
I wasn't asking for advice at this point. My vet asked me to hold the dose until we got a fructosamine. I appreciate the knowledge that everyone has here, but because of our unique circumstances with her food, I'm doing what I can and don't expect anyone to feel comfortable with advice. Nikki has no infections and is eating the recommended amount of food for her weight. Now that I've gotten her used to testing I am planning on getting pre-shot tests every day. Unfortunately, I'm out of the house 11 - 12 hours 5 days a week so mid-day testing can only happen on weekends. That's the reality of having an hour long commute each way and being single. *shrugs* At this point, I'm doing what I can for her.
Click to expand...

I am unable to test Katie the way I want to also. We can only do what we can do, you know? And I think you are doing great! Don't let anyone make you feel otherwise. cat_pet_icon
 
You're doing great.

My cats are grazers and I don't pick up the food before testing / shot time. I also work full time +, so I understand.

If the pred really helps a lot, you don't have to stop giving it. Yes, it _might_ cause blood sugar to increase, but it might not.

Quality of Life is important.

My first diabetic cat, Norton, had a brain tumor and Pred really helped him feel better. So I gave him the Pred and gave him the insulin that he needed to be a comfortable, happy cat.
 
Thanks ladies (and/or gents). This is all such a big lifestyle change. It's so hard not to be home all day! I really do appreciate having a place to vent. Fingers crossed our dosecrease goes ok!

Also, I should check my sig I think. Nikki hasn't been on pred in over a month, since she got her diabetes Dx. Right now she's managing to keep things solid-ish, which is good enough for me! :lol:
 
I wasn't asking for advice at this point. My vet asked me to hold the dose until we got a fructosamine
Click to expand...
Got you. Now I see why you held the dose so long.

Although, I thought the fructosamine only did an average BG over the last couple of weeks, usually 2 weeks?

Maybe BJM will chime in on how long a time period the fructosamine test 'looks back'.
 
If you can't get tests during the day, some folks have actually set alarms in the middle of the night to get up and test (ugh, right?). Since many cats will go lower at night, evenings/before bed/middle of night can be a good times to check, when possible.

My signature link Secondary Monitoring Tools has some more indirect measures for assessing your cat. Some of these are used in a very slow protocol, such as follows (see bottom of the table):

If blood glucose measurements are not available:
If water intake is < 20m ls/kg on wet food or < 60 mls/kg on dry food, Same dose
If water intake is > 20 mls/kg on wet food or > 60 mls/kg on dry food, Increase dose by 0.5-1U
If urine glucose is > 3+ (scale 0 - 4+), Increase dose by 0.5-1U
If urine glucose is negative, Decrease dose until 0.5-1 U SID and then check for diabetic remission
 
If you have a few weeks of test data, it may be a waste of your money.

Fructosamine is an average measure; blood glucose tests are point in time measures. If you have widely swinging glucose tests, the fructosamine may average that into a value which looks good, but does not reflect what is going on in the cat.
 
Deb & Wink said:
Got you. Now I see why you held the dose so long.

Although, I thought the fructosamine only did an average BG over the last couple of weeks, usually 2 weeks?

Maybe BJM will chime in on how long a time period the fructosamine test 'looks back'.
Click to expand...

I had called him after I started getting some BG numbers, and he was hesitant to raise the dose right away. He didn't want to rush things. Then he turns around and bumps us up by 1 unit. :? Plus my initial meter broke. I'm back up and running and have a system for getting tests that causes the least stress/getting bitten for me, so I think I'll be able to get better records going forward.
 
S you think you will be able to get amps, PMPS and a PMPS +5? Maybe a curve at weekends? That will give you lots of info. And us too!

She is biting you after tests? You are remembering the post test treat right?

Wendy
 
List of low carb treats to reward you cat with: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=9172

Real Food Toppers
Halo Liv-A-Littles
WildSide Salmon
Whole Life
Catswell

OnlyNaturalPet.com All Meat Bites
OnlyNaturalPet.com Freeze Dried Turkey Liver
OnlyNaturalPet.com Poultry Crispies

Bravo Pet dry roasted and freeze dried treats
Beefeaters freeze dried treats
Pure Bites
Cat-Man-Doo bonito flakes - Other brands are available in pet stores. Tip: If your cat loves bonito flakes, buy a large bag of it at an Asian supermarket. Asians use the bonito (tuna) flakes to make soup, particularily Japanese miso soup. A huge bag will only cost a few dollars and will last a long time. Be sure to check the ingredient label on the bag to make sure that only bonito flakes are listed with no other ingredient such as a preservative or salt.
Drs. Foster and Smith Liver Bites
Drs. Foster and Smith Chicken Bites
Drs. Foster and Smith Seafood Treats

Grain free freeze dried raw food such as Nature's Variety and Stella and Chewy's (new cat line coming in May. The dog ones can be fed to cats as treats)

Other low carb treats:
http://www.felinediabetes.com/low-carb-cat-treats.htm
http://www.felinediabetes.com/homemade-treats.htm
viewtopic.php?f=3&t=445

Anything that is 100% meat with nothing else is best. There are many brands you can feed. Check the dog treat aisle for meat treats. Some freeze dried RAW patties are great for treats, just make sure there is no source of grain or sugar. Catnip and cat grass are great, too.
Click to expand...
 
Wendy&Tiggy said:
S you think you will be able to get amps, PMPS and a PMPS +5? Maybe a curve at weekends? That will give you lots of info. And us too!

She is biting you after tests? You are remembering the post test treat right?

Wendy
Click to expand...

Yeah, Mikey also totally bites the hand that feeds him. :lol:

When I was first testing, I would create a trail of treats from wherever he was at to my lap and just sit patiently and wait for him to wander into my trap lap. Then I'd give him another little pile of treats to (sometimes unsuccessfully) distract him while I grabbed his test. And finally, I always throw him his after-test treat. I really thought I could teach him to take food out of my hand, but now I'm not sure that's really possible with some cats. :lol: Henry seems to be the same way!
 
As I mentioned earlier, I can't treat. Nikki can't have anything but z/d or her diarrhea gets exponentionally worse. Right now I make a soup of her food with water and give her about a tbs which distracts her enough that I can test. Unfortunately, more testing = more food which makes her need for insulin higher because the z/d is high carb. I think it's safe to say she's a special case. :?

I do appreciate the advice though.
 
Wendy&Tiggy said:
S you think you will be able to get amps, PMPS and a PMPS +5? Maybe a curve at weekends? That will give you lots of info. And us too!

She is biting you after tests? You are remembering the post test treat right?

Wendy
Click to expand...

I passed out and missed +5 tonight but she wasn't having an active cycle. Gonna try for a +5 tonight.

I can't treat, so I give her about a tbs of her wet food mixed with water to make it nice and soupy. Now that I generally get blood on the 1st try, she usually lets me do my thing while she drinks her food. :smile: Unfortunately, her z/d is high carb, which is keeping her tests high. I've set a tiny bit of timed food out while I'm at work just in case, but I wonder if my curves are misleading because she wouldn't get that much food during the day on a weekday. It's a difficult balance....
 
Is there a non-food thing she likes - for example, being brushed, playing with a certain toy, scritches behind the ears, on the chin? Use something she likes as a her "treat" instead of food.

For Maui, she wasn't food motivated, but she does love getting brushed. So, that was her testing treat. If I would forget to brush her, she would just sit in the testing spot and refuse to move until I came back and gave her a few brushes.
 
She does like being brushed...she does not like having her ears messed with. However, now that I've gotten her ears bleeding better, maybe I can sneak some tests in while brushing her. It's worth a try....
 
Wendy&Tiggy said:
passed out again did you? You want me to call you at 4am? lol.
Click to expand...

Yeah, after working all day it's hard! My plans for tonight just got cancelled so I'm passing out after PM shot and getting up around her +6... :-D
 
Status
Not open for further replies.
Back
Top