Smiffy's second episode

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manxcat419 said:
Here you go - one your vet might actually listen to since it's from the makers of Vetsulin! http://www.vetsulin.com/vet/Cats_Diagnosis.aspx (third paragraph). We usually say that vet stress can raise a cat by 100-200 points on the US scale, and 5 on the international scale is a little under 100 US so I was being conservative with my estimate! Smiffy wouldn't actually hypo at the vet because the effective reading at 6.8 was higher - even a stress increased reading still counts for protection from hypo.
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Got that written ref written down now thanks ...
 
I believe Prozinc was recently authorized in the UK (?).

And here are some Vet Interview Topics, compiled from suggestions here on FDMB, in case you decide to consider checking out some other vets.
 
Oh, and if he still won't believe you - I have a copy of blood work results for one of our non-diabetics who read over 300 as a direct result of vet stress. At home she came in at 90!!
 
Girls I gave a blow by blow account of what happened with Smiffy's feed and shoot tonight in response to One of Capoo 's posts - did you all see it ? I have just thought too @Elizabeth and Bertie and the rest of you that if Smiffy's curve at the Vet could be as much as 5 or 6 higher than a curve at home then her curve would surely indicate that she has done well on the 2 units and definitely should have earned a decrease in units so it should have been good news ...her preshot number at the vets was 21 (15) etc .........
 
When she was taken into the Vet after her first suspected hypo her reading was 14.9 so take off 5 that's 10 and I had half a hour previously given her honey and her liver would have kicked in to help her so it is possible it was a hypo no? But the Vets there (not her normal ones but two others said that they didn't think it was ...... Her usual Vet himself admitted last time we saw him that surgery readings were affected by stress so don't understand why he doesn't think 6.8 at the Vet is not cause for concern ..... Her curve suggests she needs a insulin reduction and that should be a good thing no? @manxcat419 ?@Elizabeth & Bertie
 
I just looked at her feed and shoot info again - she's really putting you through it right now! She will get there - really she will...it just takes some cats longer than others to settle with the idea that shots are going to happen whether they agree or not!! But it's tough going until they do figure that out. :bighug:

I do, genuinely think she could very well have been hypo - even when the vet ran that curve, if you take 5 points off everything, she would have been very low indeed at her lowest point. If she had been at home and relaxed that day, I think you would have seen symptoms for sure. And yes, a bounce plus carbs could absolutely take her all the way up to 10 or more especially as Caninsulin, with it's shorter duration, could actually have been starting to wear off by then too! I'm not quite sure how you can make your vet listen, but I really do think he HAS to. If she's been under 2 at her low point, then she absolutely needed the reduction you've just given her - whether the vet chooses to believe you or not, the reduction you've given her makes sense!
 
Looby & Smiify said:
what else could it be?
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Something neurological, possibly from going too low, maybe some seizure type events. That would require a specialty vet, not a generalist.

The curve may have looked OK at the vet, but given the effect stress can have on numbers, the numbers at home could be considerably lower - as much as 10 mmol/L (180 mg/dL).
 
manxcat419 said:
I just looked at her feed and shoot info again - she's really putting you through it right now! She will get there - really she will...it just takes some cats longer than others to settle with the idea that shots are going to happen whether they agree or not!! But it's tough going until they do figure that out. :bighug:

I do, genuinely think she could very well have been hypo - even when the vet ran that curve, if you take 5 points off everything, she would have been very low indeed at her lowest point. If she had been at home and relaxed that day, I think you would have seen symptoms for sure. And yes, a bounce plus carbs could absolutely take her all the way up to 10 or more especially as Caninsulin, with it's shorter duration, could actually have been starting to wear off by then too! I'm not quite sure how you can make your vet listen, but I really do think he HAS to. If she's been under 2 at her low point, then she absolutely needed the reduction you've just given her - whether the vet chooses to believe you or not, the reduction you've given her makes sense!
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We should in that case be pleased that she has earned a reduction in insulin - that's good news right? @manxcat419
 
To all you girls including @manxcat419 and @Elizabeth and Bertie :
Smiffy is fine this morning as she always is a few hours before her shot at both ends of the day so I am now thinking that she feels better when the Caninsulin has worn off ....

I have reduced her dose from 2 to 1 unit .... I managed to shoot her easily this morning in the bathroom ....

I have a good reference from one of the girls on the FDMB that is the Vetsulin website (same as Caninsulin) which says that readings at the Vet can be as much as 5.5 out so if her Nadir at the Vet was 6.8 she could well have gone into hypo if she were at home on the same dose .....

Eldy Ld Squeaky and April Murphy and Elizabeth Campbell this could well be a good thing that she has responded to the 2 units and her pancreas is producing a bit of insulin now to produce these lower numbers? Is that a good thing? So she has earned a lower dose of insulin?

She was purring on the bed and looking so content this morning and responding to strokes .......

I am going to update the girls on the FDMB ... still really appreciating your support in these difficult days .

I am so scared she is going to have another wobble when I am asleep or not with her ...

The Vet intermated that if she was on too low a dose of insulin then she was open to Pancreatitis and Keto acidosis ...

Oh I have just remebered something else he said ..... he asked me if I could VIDEO one of her episodes as if he didn't believe me ....

I think it is because of my mental illness and appearance that he thinks I am panicking - it can work against you and there is prejudice ..... I was too busy treating her to take a video of it!!!!!




That was this morning and now it is nearly four and Smiffy is fine today ... her estimated Nadir has been and gone and she has had a snack and come for a walk with me and repsonded to a visitor so she is much better so for on one unit rather than two ... phew ... she called to me at 1.30 and I wondered if she was calling for help like yesterday but she is fine ...

I have got the e-mail address of admin for Moor Cottage Vets - our Vets and now know that the Pracise Manager is called Sharon Tongue ....

|Smiffy is due to go in next Wednesday for a curve at 10.30 so an hour after I have given her her shot but I think it is the Vet Alex wanting to just prove to me if he can that he is right and I am wrong so I somehow want to take him off the case in favour of one of the Vets that is going to appreciate the stress factor a bit more in the curve ..... as I say I think I am being treated with a little prejudice because of my condition - just becuase I have anxiety doesn't mean to say that I panic and over react to how Smiffy is doing nor does it mean that I am less intelligent ..

However I am not sure how to procede with this delicate matter and preferably before Wednesday .... I have been filtering information about Diabetes and BGs and insulins etc through to husband Malcolm by text but he really doesn't take it all in ... I am the one that thanks to all of you understands what is going on ...

It is true that a home curve would be difficult at this stage so I would go ahead with a curve at the Vet if somebody a bit more responsible and open were looking after her ... what do you think ... write an e-mail to say I would like to discuss treatment of my cat and arrange a phone call or set out the problem as diplomatically as possible in an e-mail ... the Manager Sharon is going to be Admin though not a Vet .. the owner of the Practise who doesn't practice anymore Alwyn is probably the person to talk to I guess ...

I used to be good at this sort of thing but I am a bit torn as to what to do .... Malcolm is NOT knowledgeable enough to fight Smiffy's corner ...
 
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If you and your husband are up to it, do your own curve over the weekend - it is basically testing every 2 hours from pre-shot to pre-shot. Using our reference guide, it can be interpreted to identify how the dose is working for him.

And I think it would be fine to say you want ProZinc, as it tends to last longer than Caninsulin, and if he's not willing to prescribe it, you will be looking for another vet.
 
manxcat419 said:
It is possible, just not all that straightforward in a lot of cases. There has to be clear proof that Caninsulin isn't working before a human insulin can be prescribed. Without the vet's agreement as to whether or not the Caninsulin is working for Smiffy, it is close to impossible for an alternative to be given. Looby has asked about vet recommendations on the FB group today, so although she would need to confirm that, I would imagine that looking for a different vet is currently in the picture if that turns out to be what would help Smiffy the best.
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Is that just in the UK or USA? I have had two different cats develop diabetes, with two different vets and both times the 'first-line' treatment was Lantus - not even a discussion about anything else.. I'm in New Zealand.
 
In the UK it is a legal requirement that only veterinary medicines with EU approval may be used as a first line treatment. If the treatments don't work then the vet may at his discretion prescribe other non-approved medicines under the UK drug cascade rules. Evidence needs to be presented to demonstrate the first line treatments don't work before he can prescribe under the cascade.

Up until recently Caninsulin was the only approved insulin for veterinary use. Recently ProZinc has also been approved.


Mogs
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Critter Mom said:
In the UK it is a legal requirement that only veterinary medicines with EU approval may be used as a first line treatment. If the treatments don't work then the vet may at his discretion prescribe other non-approved medicines under the UK drug cascade rules. Evidence needs to be presented to demonstrate the first line treatments don't work before he can prescribe under the cascade.

Up until recently Caninsulin was the only approved insulin for veterinary use. Recently ProZinc has also been approved.


Mogs
.
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And it's the same in the whole Europe, it's a legal requirement.
 
BJM said:
If you and your husband are up to it, do your own curve over the weekend - it is basically testing every 2 hours from pre-shot to pre-shot. Using our reference guide, it can be interpreted to identify how the dose is working for him.

And I think it would be fine to say you want ProZinc, as it tends to last longer than Caninsulin, and if he's not willing to prescribe it, you will be looking for another vet.
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We have already decided to change Vet from Alex to Roberta who specializes in elderly cats and their illnesses and is cat mad and has an elderly cat of her own and goes on courses about cat care .... she also looked after Smiffy last weekend so she knows her now and has some attachment to her ........ my husband is too busy to take part in a curve and is too squeamish .... I have yet to get blood from her ear yet after the first successful attempt ..... is there a video that I can watch that is really good? I watched one from the International Cat Organisation and they put the needle right into the vein and there was loads of blood and they had to have cotton wool on hand to mop it up .. that's not what we learn here is it? We learn here to get the needle in between the vein and the edge of the ear - the sweet spot ..... help?
 
scoobydoox said:
Crittermom uses lantus and she is in the uk so it must be possible. Why not get vet referrals from the other uk members if the current vet is refusing?
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Got other referrals now for other surgeries but to start with (as per post above) there is another Vet at the Surgery : We have already decided to change Vet from Alex to Roberta who specializes in elderly cats and their illnesses and is cat mad and has an elderly cat of her own and goes on courses about cat care .... she also looked after Smiffy last weekend so she knows her now and has some attachment to her ........
 
Critter Mom said:
In the UK it is a legal requirement that only veterinary medicines with EU approval may be used as a first line treatment. If the treatments don't work then the vet may at his discretion prescribe other non-approved medicines under the UK drug cascade rules. Evidence needs to be presented to demonstrate the first line treatments don't work before he can prescribe under the cascade.

Up until recently Caninsulin was the only approved insulin for veterinary use. Recently ProZinc has also been approved.


Mogs
.
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I am going to put a strong case to then that the Caninsulin may not agree with Smiffy ..... difficult to prove but the new Vet we have decided to go with in the same surgery sounds as if she would be willing to try something new: We have already decided to change Vet from Alex to Roberta who specializes in elderly cats and their illnesses and is cat mad and has an elderly cat of her own and goes on courses about cat care .... she also looked after Smiffy last weekend so she knows her now and has some attachment to her .......
 
Girls I need a link to a good video about getting the right spot on the ear so I can refresh my visual memory .... I have failed to get blood since the first attempt ... just watched a video from the International Cat Organisation that is a site recommended by the Vets (they even have cards to hand out to people) and they injected the vein and not between the vein and the edge of the ear so there was loads of blood but that is now what we learn here is it? Is there a specific video that you girls would recommend? Also I don't think I have the guauge high enough so the prick is not penetrating enough even though I took advice for the setting from another member on the Facebook site - have to try again whilst she is resting .. perhaps Smiffy has thick ears?!!!!
 
I have just tried again with the needle a bit longer and got some blood but put the tab into the blood too quicly before the meter was ready ... progress though (:
 
Elizabeth and Bertie said:
Have a look on this page, Looby. Some helpful stuff here:
Hometesting Links and Tips
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Just did a successful home test with no problem ... had the lancet at longer needle setting (still in the pen) and put my finger behind where I was poking as you suggested @Elizabeth and Bertie and Bertie and didn't put the strip in the meter until I had got some blood and then put the strip in and waited for the blood sign to appear on the meter and then soaked up the blood .... her reading was 13.8 which is 7.5 hours after her morning shot at 9.30 am ..... I am sooooo pleased ... this is a not bad reading so pleased with the progress and convinced now that she is better on one unit of Caninsulin (for the time being) wanted to share with @Critter Mom as you have been so caring about Smiffy ..... she seems better today
 
Capoo said:
Congratulations!!!!!!! :bighug::bighug::bighug:

Next step: fill in the spreadsheet...
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Do you think that 13.8 is a reasonable figure for her for this time in her cycle (7.5 hours after shot? I was expecting it to be higher ..... one unit of insulin better than two - now episodes either ...
 
Looby & Smiify said:
Do you think that 13.8 is a reasonable figure for her for this time in her cycle (7.5 hours after shot? I was expecting it to be higher ..... one unit of insulin better than two - now episodes either ...
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Difficult to say when having only one number, and without knowing what was the pre-shot number...

The spreadsheet is really easy to use, and whit it, you share your numbers with everybody on the board, and thus they will be able to help you with the dosing of insulin. The SS (spreadsheet) is stored in the cloud of Google, so no worry to loose it.

Everything is explained here :

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/
 
Well done, Looby!

cartoondance.gif
 
And then she refused to eat this evening and hid under the chair upstairs and so I couldn't shoot her never mind take her BG ........... swings and roundabouts again !!!
 
Capoo said:
Difficult to say when having only one number, and without knowing what was the pre-shot number...

The spreadsheet is really easy to use, and whit it, you share your numbers with everybody on the board, and thus they will be able to help you with the dosing of insulin. The SS (spreadsheet) is stored in the cloud of Google, so no worry to loose it.

Everything is explained here :

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/
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I get something about downloading a google drive when I click on spreadsheet outside the U.S.?
 
Looby & Smiify said:
I get something about downloading a google drive when I click on spreadsheet outside the U.S.?
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Yes, that's normal. You should download Google Drive if you're using a tablet, and then you will be asked to download Google Spreadsheet (in the link that I gave you yesterday, it's written in bold at the beginning of the sticky note).
 
I would be doing the spreadsheet on my applemac laptop .... had a look at the link on my iPad where it said to download Google but I don't use the iPad very much - only late at night ... so I would be using the laptop ..... when you say spreadsheet do you mean a curve?
 
Looby & Smiify said:
I would be doing the spreadsheet on my applemac laptop .... had a look at the link on my iPad where it said to download Google but I don't use the iPad very much - only late at night ... so I would be using the laptop ..... when you say spreadsheet do you mean a curve?
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A curve is a collection of BG values, taken the same day at different times.
A spreadsheet is a table in which all the curves (and other spot values) are stored. Thus, you have the history of all your measurements, and you can share it with other.
 
Capoo said:
A curve is a collection of BG values, taken the same day at different times.
A spreadsheet is a table in which all the curves (and other spot values) are stored. Thus, you have the history of all your measurements, and you can share it with other.
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Ok got it now ... have to ask husband about downloading the goolgle thing as he hates it when I download stuff that I am not sure about ...... saves a bit of grief ..... he is right to be cautious as I was hacked into big time nowt so long ago ... he is back tomorrrow ....
 
If you do your spreadsheet with a laptop, you don't need to download anything. You just need to download some Apps if you do it with an iPad.
All you need with a laptop is a Google account (it's like creating an email count).
 
Capoo said:
If you do your spreadsheet with a laptop, you don't need to download anything. You just need to download some Apps if you do it with an iPad.
All you need with a laptop is a Google account (it's like creating an email count).
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Had a look at the spread sheet and understand it all now .... Will try to download tomorrow ...... Then work out how you get to access it?!!!
 
Access from your laptop is by logging in to Google.
Access via the iPad is by connecting via the apps that you download.

Sharing a view of the spreadsheet with us is by copying the web link it provides you in a pop up dialog box when you select sharing options,
 
BJM said:
Access from your laptop is by logging in to Google.
Access via the iPad is by connecting via the apps that you download.

Sharing a view of the spreadsheet with us is by copying the web link it provides you in a pop up dialog box when you select sharing options,[/QUOTE @BJM @Capoo @Elizabeth and Bertie I am going to have to start a new thread entitled how to do and post a spreadsheet on the FDMB and start again with all this information
..... I can't see 'sharing options' on here at all !!!!!
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The sharing options are on the Spreadsheet.
Using your laptop, in the upper right corner of the spreadsheet is a button which says Share.
Click on that.
A dialog box pops up and you select "Anyone with the link can view.
upload_2016-5-28_12-21-54.png

Copy that link and come over to FDMB.
In the upper right corner of the screen, hover your mouse over your user ID.
Select signature.
Edit your signature by typing "Smiffiy's Spreadsheet", selecting/highlighting that text and clicking on the chain link icon,
Paste the link in the box and click Insert.
Towards the bottom is a button that says Save Changes and another which says Preview.
If you want to look at it first, select Preview.
If you're happy with it, select Save Changes.
 
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BJM said:
The sharing options are on the Spreadsheet.
Using your laptop, in the upper right corner of the spreadsheet is a button which says Share.
Click on that.
A dialog box pops up and you select "Anyone with the link can view.
View attachment 20873

Copy that link and come over to FDMB.
In the upper right corner of the screen, hover your mouse over your user ID.
Select signature.
Edit your signature by typing "Smifiiy's Spreadsheet", selecting/highlighting that text and clicking on the chain link icon,
Paste the link in the box and click Insert.
Towards the bottom is a button that says Save Changes and another which says Preview.
If you want to look at it first, select Preview.
If you're happy with it, select Save Changes.
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I think the best thing for me to do is to save these instructions to a file and then get my husband to print them out so that I have them in front of me as I try this out ... can you copy your instructions to my new thread "Smiffy's spreadsheet" so I know where to find the information that you have given me so far please?
 
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