Spreadsheet advice appreciated impending vet visit.

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Sam-cat

Sam-cat

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I have a vet appointment with Sam on Saturday and I am pretty much dreading it I think I will probably changing vets. Mostly due to having moved further away from current vet, but also if I had followed their advice about FD I don't think Sam would be here. I doubt I will find a local vet who will have much specialist knowledge but I can at least spare him the long car journey which he hates.

Anyway taking him to current vet for his routine shots. After asking advice on here I am not wanting to do the fructosamine test that they wanted to do as we have done so much BG testing and don't think it will give any more info.

But I do know that they are going to say I should be increasing the dose as they want him in single numbers all the time. I'm not sure if that is necessarily worth pushing at the moment when I have to leave him through the day when I'm at work.

I think that his BG is slowly getting better and if is is heading in the right direction and just needs more time I am happy to do that - and it feels the right way. I suppose I am asking if that is the right approach or if I should be more immediately concerned with getting his BG down to the level they want.

They are also going to say he has put on weight. Which he has - and needed to - but I know that he now is right for him. He is a big cat half Maine Coon with bug chunky legs. Our vet uses 'normal' car weight guides and he always cones out as underweight. Having been very ill last summer he lost a whack of weight looked awful and felt bony and they still wanted him to lose more weight. They also only want him to have two meals a day when he gets his insulin. Which I have never done, he has had four meal times with - apart from the preshot times - extras if he has wanted. I have reduced the amount in his meals and he doesn't now get food on demand but the vets will still want him to be more restricted.

I am quite 'happy' to stand my ground with the vets. Sam will probably move vets anyway. But i have a pony and they are good with him so he will still be with them. So I want to leave amicably.

More than that I have less faith in vets and would like some advice on whether what I am doing is likely to be the best things for Sam.

Thanks for any help in advance.
Tess and sam
 
Having just posted this I thinking might have been better on the main board but not technical enough to move it. Apologies it isn't very ProZinc specific.
 
Ah vet visits! They are always so stressful, aren't they? :bighug:

It doesn't sound like you need anything in particular from the vet right now, so I would think you could just politely decline the fructosamine since you have regular data at home, and say you can't afford it if they push too much. And then smile and nod while they lecture you about the rest of it. It doesn't seem like there's any need to argue or convince him of anything. Then you can leave and go about your merry way, dosing and monitoring as you see best.

As far as dosing, with a bit more monitoring on non-work days, I do think you could get him into better numbers. I'm not a fan of sliding-scale dosing with Prozinc, so if that is your preference, I'll defer to someone else for suggestions. Good luck with the vetty visit!
 
Oh those vet visits! I'm with Djamila. I'd just politely say no thanks for the fructo...bring your SS and let them look at it maybe? And just nod and smile with their other suggestions, then come home and do what you're going to do!
 
Thanks that is my thinking. Be nice but kind of believe that what I am doing is right for Sam.

Djamalia - I think he has always been best on a consistent dose. I think I am struggling to find that consistent dose and he seems to get random high or low numbers and then i do change the dose. Which isnt ideal and maybe I should not be doing that for a random high number but not sure what to donwhen it is low as then he can't have the usual dose.

Thanks for the reassurance about vets!
 
Djamila said:
Ah vet visits! They are always so stressful, aren't they? :bighug:

It doesn't sound like you need anything in particular from the vet right now, so I would think you could just politely decline the fructosamine since you have regular data at home, and say you can't afford it if they push too much. And then smile and nod while they lecture you about the rest of it. It doesn't seem like there's any need to argue or convince him of anything. Then you can leave and go about your merry way, dosing and monitoring as you see best.

As far as dosing, with a bit more monitoring on non-work days, I do think you could get him into better numbers. I'm not a fan of sliding-scale dosing with Prozinc, so if that is your preference, I'll defer to someone else for suggestions. Good luck with the vetty visit!
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I've already said no to the fructosamine test but think will have to have that conversation again tomorrow.

Think I just find it hard to feel apprehensive when I do all that I can for sam. I may not get it right but their advice was dangerous.

Any advice about dosing would be very much appreciated. I really want the best for him - i just have a very overactive imagination and worry about hypo while i am at work. It feels like I aim to give him a consistent dose but we am not quite managing to do that. Plus I think I over react to high or low BGs? Is a variation of dose between for example 1.4 and 1.6 ok or should am and pm doses be exactly the same?
 
Sometimes the random numbers are caused by the dose change from the cycle before. And sometimes they are just because cats can be pretty random!

Forgive my poor memory...but you work during the week? A couple of things that might help you feel more comfortable might be to try to get more data on days when you aren't working - so several mid-cycles instead of just one if you can. If you can hold the dose consistently for a few cycles, and figure out when Sam hits nadir, the nadir numbers are what really help you know that he's safe. Then you can hold that dose during the week when you're at work and can't monitor as much.

The second thing might seem silly, but I had to get security cameras a few months back, and while I don't think they actually help with security, they are super fun for checking on my kitties during the day when I'm at work! You can get a single camera off of Amazon for not too much and just put it in whichever room Sam hangs out in the most.

As far as dosing, I often had a different dose AM and PM just because Sam runs lower at night (as do lots of kitties). The trick is to just try to hold whatever dose for at least a few cycles. Sometimes you just can't and you have to adjust sooner, but one thing I found with my Sam was that on a higher number, he would drop farther, and on a lower number, he would stay flatter. But either way, his nadir was usually right around the same range. So I actually didn't need to shoot more insulin on a higher PS. Every cat is different though, so you can only figure out your Sam's patterns with time and data.
 
Thanks Djamila

I think I do overact to a random reading and that maybe just throws things out more. It feels that 1.4 ish is probably the right dose so i need to try and be more consistent at that dose.

That is really fascinating about the Nadir. I.always assumed that the Nadir dropped from where the preshot BG was so a higher preshot would mean a higher Nadir. So I wasn't really sure how I could be consistent but that makes much more sense. I am scared of him going too low but equally want him to be as well regulated as possible.

I work full time so through the week and have pony who is a 45 minute drive away so i am often away for the full 12 hours between his doses. I try and get as much nadirs on days off. Things have been kind of crazy and my partner has had 4 hospital admissions over the summer so it has been a case of trying to fit everything in and not massively much time for anyone.

Camera sounds fun. If probably be needing to come home at lunch time and check he is still breathing - think he spends most of his day sound asleep. I saw one where you can speak to your cat via an app on your phone. Might make me less productive at work ha ha

Anyway soon him leave for vet - joy.

Thanks for your help.
 
Wow! you have a lot going on! Yes, each of us just does our best. Testing is important, but taking care of your partner and your pony and yourself are also all important.

One other thing about nadir - it isn't always at +6. For most cats it's somewhere around +5-+7, but some cats hit nadir much earlier or later than that. And it can move around a bit too.

With my camera, it has two way communication, so I can talk to them, but the speaker is terrible and it makes voices sound a little scary. I only did it once, but it terrified them, so never again! :)
 
Djamila said:
With my camera, it has two way communication, so I can talk to them, but the speaker is terrible and it makes voices sound a little scary. I only did it once, but it terrified them, so never again! :)
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I imagine them being like AHHHH...ROBO MOM!!!!!

Yes, testing is important, but your life is also important...and you have plenty going on for sure! Just do what you can...get tests in when you can. All data is good data and can help us understand what is going on. :)

Let us know how the vvet visit goes!
 
Thanks - life has been a bit crazy but through it all Sam is lots healthier than he has been. Poor Mark has been visited in hospital for very short amounts of time so that I can get home for Sam's shot. He knows where he is in the pecking order;)

Vet actually was really positive - never what to expect really. Realise how nervous I was about the appointment. Saw a vet I really like and she is lovely with all our animals. She was cuddling him and we were chatting about ponies. She obviously then looked up at the computer and said aww this is the diabetic cat. She did his boosters and weighed him. Then practice partner vet came through - Id had a bit of a fall out on the phone to him so was dreading that. But he was really positive, said how well we had done. Vet LOVES the spreadsheet, colours are amazing and the way you can see everything so clearly. He said he thinks I not always 'bold' enough with dosing - possibly true - and not consistent enough - fair point.

Best of all both vets agreed Sam looks amazing. He has put on weight and I know he can't put more on but they said that was fine. That clinically he must be in a much better place even though we are still working to find the right dose. And they both said that he looks so healthy and you would never know that he was an older cat or had a health condition. And he purred throughout :cat:

Seemed to cope so well but BG high tonight and he is very tired so obviously has been hard day for him.

Thanks for much needed reassurance. Vets were way more supportive than I expected. Don't think they can advice about diabetes TBH but do feel that they genuinely are caring if that makes any sense. Think that the chance of me finding a knowledgeable diabetes vet in this area is remote so may be better to stick with the devil I know?? Long journey for Sam but hopefully we won't be there too much??
 
And feel I now need a two way communication camera with him:). I can imagine his pained reaction to being remotely spoken to. Mark has found one where Sam can call me by pressing on a paw pad and I can dispense a treat via an app on my phone.
 
Djamila said:
Wow! you have a lot going on! Yes, each of us just does our best. Testing is important, but taking care of your partner and your pony and yourself are also all important.

One other thing about nadir - it isn't always at +6. For most cats it's somewhere around +5-+7, but some cats hit nadir much earlier or later than that. And it can move around a bit too.

With my camera, it has two way communication, so I can talk to them, but the speaker is terrible and it makes voices sound a little scary. I only did it once, but it terrified them, so never again! :)
Click to expand...

Sam's Nadir seems to be around the 6 hour mark through the day. Harder to tell overnight as it seems a lot flatter and then his BG is higher in the morning. I suppose with time and trying to be more consistent with the dose it will become clearer.
For now I think it is probably enough to know that he is in a much better place to 4 months ago and dosing is still work in progress?
 
I'm so glad to hear the vet visit went well! I agree - as long as the vet is caring and can take care of everything else, no need to worry about the lack of FD expertise. There is plenty around here!

If you get the treat-dispensing camera, you have to post a video. I bet it's adorable!!!
 
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