? Snickers - Internist suggests stopping the home BG readings

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Eric Minor

Eric Minor

Member Since 2017
Snickers was introduced to diabetes via a DKA emergency on May 3, 2017. When she came home from the ER vet on 5/10, I had purchased an AlphaTrak 2 and was ready to go with monitoring her closely. For the next 12 days, I did take many BG readings and recorded them both in my own spreadsheet and the spreadsheet used on this site.

We finally went to see an internist on May 22 and he advised to largely stop taking the home BG readings, perhaps doing it once every 3 days at nadir. He seemed to suggest that doing it too often only prompted owners to make too many micro-adjustments to the insulin dose. He wants the BG readings (that he will use) coming from my regular vets office, not from home readings.

Any thoughts? You can see the spreadsheet in my signature line.
 
I would continue doing the home testing. I cringe at the thought of not home testing Rex. I was told to do 3 units and bring him back in for a curve. I started home testing as soon as I started Lantus. I started slowly and as soon as Rex hit 3 units, he raced back down the ladder and now about done with his OTJ trial. If I hadn't done that and just did what the vet said, he would probably have gone into hypoglycemic shock and died. Just follow one of the protocols on here to adjust your dose - Tight Regulation or Start Low, Go Slow. Good luck!! You have a great start so far!
 
I hate to think what would have happened if I had injected my cat on my vet's suggestion that morning without testing. He had a low reading at nadir of 65 at the vets and was told to skip the evening shot but to resume the next morning. Thank God I tested him first that morning because his reading was 85! I would have sent him even lower than the day before.
 
I would keep doing what you are doing. It is too dangerous just to give insulin without knowing the impact. Humans do not just keep to a dose and just inject without testing each day. And if it was a human baby, as a parent I would not be injecting with knowing what it was doing. Why would we follow something different for our kitties?

It seems that some vets like to treat insulin like a drug - you give X dose to get Y outcome. Insulin is a hormone, which is means you don't get a Y outcome. You get A, B, C... K, L, M, N, O, P. And each day, cat, hour can be and is different!

Once you pick your protocol, I would print it out and give it to your IM and say this is this the process I am following. They can either accept that or not. At that point you may need to decide whether to keep to this IM or switch. It is your cat, so you hold the testing supplies and syringe.

And a final note - both my vet and IM have left me do my thing with Jones - why? It worked, the SLGS system worked for him. Look at his spreadsheet - you can see the results when the testing really started and I followed the advice here vs. my vet. Just one caveat - Jones is unique has he has continued on steroids for his IBD so he will probably always be on insulin to ensure his diabetes stays in control vs. going OTJ.

Second Caveat - as @Noah & me pointed out - this is not medical advice. As stated it is your cat.
 
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Tracey&Jones said:
And a final note - both my vet and IM have left me do my thing with Jones - why? It worked.
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@Eric Minor This is NOT medical advice. Tracey and I share the same story. Our first diabetic cat Nigel was going straight downhill; numbers out of control, weight loss. Our vet said "Clearly this is not working" and we broke all the "rules" about feeding and a bunch of other stuff. Everything changed for the better. Don't get bullied by someone with a lab-coat and a clipboard! Like I said, you're only testing. That's a cheerleading thing and not medical advice.
 
Please keep testing. You don't even have to tell your vet you are doing it, but it is a vital tool to help keep Snickers safe.

I see from your spreadsheet that you just did a dose increase, but I don't see any tests since then, even though the last shot before the increase had his lowest yet pre-shot. Once a cat hits the "right" dose, things can move very fast (see Rex's spreadsheet above for a great example of this!), so please do keep up with at least the pre-shot tests so you can keep an eye on how he's doing on the new dose. Any spot-checks you can get in between shots will also be very helpful. Even if you prefer to stick with the vet's advice for dose changes, doing those tests are what is going to help you keep Snickers safe once he does hit the right dose-- you'll know if he's high enough to shoot, and if you see him going too low, you will know to feed him some high-carb food to bring him up. Without the test, you'd never know...
 
Yes, I haven't taken any readings since the vet asked me not to 2 days ago. I will think on the guidance given here and decide how to proceed. I appreciate the input from everyone.
 
Eric Minor said:
he advised to largely stop taking the home BG readings, perhaps doing it once every 3 days at nadir. He seemed to suggest that doing it too often only prompted owners to make too many micro-adjustments to the insulin dose.
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two things jumps to mind here 1) the internist won't have to witness seizures and convulsions that Hypo brings in cats, why care? 2) he's been protecting the interests of the vet's guild - the income must be steadily going in to one direction only. If ALL CG tests at home - who'd pay for an in office done curve?!

Well renowned vet Dr. Lisa Pierson once compared giving insulin without prior testing to driving a car with a paper bag over ones head.

Eric Minor said:
top taking the home BG readings, perhaps doing it once every 3 days at nadir
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How do you suppose to know when her nadir is if you are not testing? :confused:If the vet's textbook says it is 6 hours after the injection it does not mean Snickers will comply. Every cat is different. We see here nadirs anywhere from +4 to 12.
 
I very gently asked my favorite long time tech about the diabetic lack of knowledge fiasco (and that's what it is) and she rolled her eyes, looked down at her shoes. Yes it's true, it's just not as dramatic as kitty cancer or kitty whatever so here's a pamphlet, what credit card are you using, there's the door. A friend of mine still has her diabetic dog pee on a piece of paper because she worships her vet.
 
You don't need your vets permission to test. It's your cat.

In general, diabetes in both cats and humans is a home managed disease with input from vets and doctors. If it was me, I would still do regular testing before shots, and at nadir. If your vet questions you, just say you prefer to test. I usually don't like keeping the vet out of the loop, but if he really makes a fuss, don't send the numbers to him unless there is a problem.

If this was your child, would you give insulin without knowing his/her blood glucose reading? Testing lets you know it's safe to give insulin. If you think your cat is going too low, testing gives you the information you need to properly treat your cat. Example: Maggie was fine at shot time, but I noticed she was acting a bit odd a couple of hours later. Testing showed she had dropped way too low, and needed to be treated. How would I have known if I wasn't testing?

I like my vet vet, but there were times I just said "I'm not comfortable doing that. Can I do 'xyz' instead?" She probably thought I was crazy, but she would try to understand my objections and worked with me.
 
It was my first exposure to this internist (recommended by my regular vet) and I did surmise that there was a certain element of me infringing on the veterinary domain where I shouldn't be. I couldn't imagine why there would be any problem with me taking home readings beyond A) My cat being irritated that her ears are being poked and B) me not wanting to put in the effort, both of which I can decide for myself. He suggested that cats are more resilient to hypoglycemia, IE their natural defense mechanisms will kick in and keep them away from it more so than say humans, and that was one reason in his mind that the home readings were not as necessary. With that said, his instructions included guidance to call them if Snickers showed signs of low blood sugar, including seizures. We'd obviously like to avoid that eventuality before it occurs.

Either way, I've taken readings again at shot time last night and this morning as well as presumed nadir last night.

We had also decided on a new dry food "Young Again" that my girlfriend found online that asserts to be very low carb and 100% grain free. Their materials assert a pretty high success ratio for helping get cats into remission (and a good number of favorable user reviews as well). We had switched Snickers over to it about 10 days back and she is eating it well, so I'm not really inclined to switch her away from it. The internist stated we wasn't familiar with it and recommended switching to more well-known diabetic fare like Prescription Diet m/d. I compared ingredients and the Young Again seemed to be superior. The 2nd ingredient on the Prescription Diet was corn and a few more grains made it into the top 5 if I recall.

Thanks for all the good feedback.
 
I agree with what the others have said and just wanted to add, you're not testing Snickers to constantly make micro adjustments. Would the internist only periodically check a human infant/toddler on insulin?;)

Lantus protocols don't allow for the assumed micro adjustments but you are doing it to know he is safe. Most Vets are not familiar with anything outside their prescription diets which are too high in carbs for diabetic kitties. Many members, including myself, use Young Again Zero. Make sure you ordered ZERO :cat:. I would at least keep doing AMPS and PMPS to make sure Snickers is safe to receive insulin. We know we are not Vet's here but we live and breathe FD 24/7 and offer suggestions and advice based on our own experiences. The choice is still yours.

Good luck :)
 
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