vet won't prescribe insulin now...

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beccalecca

beccalecca

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We went to the vet today to get an insulin demo, armed with the information the blood glucose monitoring system gave us last night and this morning (202 and 199 respectively). We finally got a copy of her test results from last week (459). Our only change from before was the diet change to low-carb. Now the vet won't prescribe insulin at all. He says she is maintaining her weight, and the fact that we told him she is drinking water more normally and not urinating as much combined with these two measurements makes him not want to prescribe anything at all. Just keep watching her, he says.

I got him to give me a copy of her test results, so I think we could go elsewhere. He wasn't keen on the home monitoring thing anyway. When we talked on the phone, he said they've "done that in the past..." but in the office today he said insulin would mean that he would need us to bring her in once a week to get tested anyway. Even if we're monitoring.

Maybe it's time for a second opinion? Or do we wait a bit and see, like he says?
 
Find a new vet. That is ridiculous! No cat needs to go to the vet every week for diabetes. That would make the cost prohibitive for someone like me, at probably a $100+ per visit. The new numbers are really looking good, get someone who will work with you, and she might only need insulin for a short time. I have heard that vets that don't encourage home monitoring think that under 200 is fine, it may be, but for how long?
 
Time to go Vet shopping! That is asinine, there is no way any diabetic needs to go to the vet once a week for monitoring. She is still in diabetic numbers even with the diet change, while she might go into remission with a short course of insulin, she will stand a better chance of it happening if treatment is start sooner rather than later.

Maybe someone here could suggest a new vet, if you want to post a general location asking for recommendations.

Mel, Maxwell and The Fur Gang
 
Diet alone rarely works for diabetic cats. The sooner your cat starts on a good insulin, the greater the chances of remission.

I also agree on finding a new vet. I've already sent you a PM with the name of a good vet, if commute isn't too far for you.
 
Becca,

A little bit of Lantus would probably make all the difference for your cat. With those numbers, now is the time to move him/her toward remission with a very low dose of a gently insulin like Lantus. It would allow the pancreas to heal combined with low carb wet food.

If you have a relationship with this vet and want to keep him/her, there are ways to work with them. If you just met the vet and this is their practice culture, then I agree find another vet.

Diabetes is better handled at home. I'm a 30 + year insulin dependent diabetic, and I don't go to the doctor more than 3 or 4 times a year. I monitor 7 diabetic cats at home - 5 on insulin and 2 in remission.

If the vet can be convinced that you will care for the cat's diabetes at home with good monitoring, then he will have a patient for a long time. He will make up his money with dentals, yearly blood panels, well visits and the occasional office visits that we all have for our pets. If he makes treating diabetes prohibitively expensive, he risks losing a patient. Don't know why they can't see that:(

Good luck,

Claudia
 
Until you can get to a vet, the best you can do is go lo carb, test glucose, test urine for ketones, and (possibly), after doing some reading, pick up some NPH insulin to use in the interim, to keep from ketoacidosis from excessively high glucose.

If you do pick up some NPH insulin, please read the Humulin N Primer

Sometimes, it is possible to find some spare Lantus or Lev here, in the Supply Closet section.

edited 2011_06_10 @ 4:34 PM to eliminate reference to R
 
Hmm. Yes, I suspected the vet was overly optimistic on those counts. He said all we can do with diabetes is maintain weight and keep her under 200. So yeah. Time for some homework. Starting with squeem's suggestion. (We were new to this vet, so no attachments.)
 
Make sure to bring copies of your cat's medical records, especially the diabetes related stuff, to the new vet. Or fax them over a few days ahead of the appointment so the new vet has a chance to review them.

Hope the new vet works out :-D
 
Sad to hear a vet's response to this....just pitiful. He's a DOCTOR for god's sake!
 
BJM said:
Until you can get to a vet, the best you can do is go lo carb, test glucose, test urine for ketones, and (possibly) pick up some R or NPH insulin to use in the interim, to keep from ketoacidosis from excessively high glucose.

If you do pick up one of these insulins, please read the Humulin N Primer

Sometimes, it is possible to find some spare Lantus or Lev here, in the Supply Closet section.
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just a quick note as i totally missed this the first time i read it, and it is probably just a typo, but do NOT get R insulin. it's a very dangerous insulin in inexperienced hands and should only be used by professionals or a layperson with alot of experience with this disease & it's treatment.
 
IMHO...if you are low on finances, and just a change in food has made a significant difference in the glucose numbers already, I'd agree with your vet on this part to wait on prescribing insulin at a cost of about $160 (lantus) and continue on for another 2 weeks of trying diet change only. I'd suggest continuing hometesting to see what the trend is with his glucose. If you notice it going up in the higher 200 numbers, then you should start insulin. There are some people here who advise not shooting under 200 and 199 and 202 would fall in that range.

I adopted a cat from a shelter and waited a month to get him. They fed him canned only during that time with no insulin given. When he came he was in perfect non-diabetic numbers.

Obviously I don't agree with the vet of taking your cat in weekly. Testing at home will give you the info you need. So for today and with the numbers you got on your meter, I'd advise continuing on a couple more weeks with diet change and hometesting, and careful watching litterbox and water habits.

JMHO,
Dale
 
We got 178 on our most recent test. We'll keep checking and looking for a new vet in the meantime. We have family visiting, so it will take us a bit to get to a new vet either way.
 
Cindy + Mousie said:
just a quick note as i totally missed this the first time i read it, and it is probably just a typo, but do NOT get R insulin. it's a very dangerous insulin in inexperienced hands and should only be used by professionals or a layperson with alot of experience with this disease & it's treatment.
Click to expand...

And if her cat were still getting readings up in the 400s or higher and she didn't have any insulin whatsoever?

She isn't, which is fortunate, however I really think we should have an emergency protocol for that kind of situation.
 
Not for R. I see absolutely no case for telling a newbie to use R. N, yes. R, not. Factor in the 200 and lower and I see a recipe for disaster.

Do no harm....
 
agree with Jen. not R. absolutely no way someone that has no understanding of the disease or insulin or food and the way it all works together should have R in their possession. not unless they have a direct line to a good vet. N is readily available and while not the best insulin, it's better than nothing. R is too dangerous, in inexperienced hands, no matter the BG level.
 
Cindy + Mousie said:
absolutely no way someone that has no understanding of the disease or insulin or food and the way it all works together should have R in their possession...R is too dangerous, in inexperienced hands, no matter the BG level.
Click to expand...

I couldn't agree more! Sad to say but not even vets with DVM after their name really know how dangerous this stuff can be. My only experience with R was with an internal medicine vet who gave Harley 1u R on a 449 preshot while he was at the ER hospital for a plasma transfusion & ultrasound. They tested his BG 5 hours later (no monitoring in between) and it was 160 - that was a rising number. I was livid when I picked him up and saw his medical records. cat(2)_steam
 
For this vet, it is probably the correct move in not prescribing insulin. He seems to be too inexperienced and doesn't know enough to be giving insulin dosing advice on a cat under 200. Isn't the boards' guide typically to tell people who don't have enough experience to not shoot under 200? At least this vet know his limits and isn't trying to dispense medication in a haphazard way like some vets do.

For the good of your cat, finding a different vet that CAN treat a cat with diabetes and not just get into the safer zone and quit is the best obtion. Hopefully the food change has done a lot of good and it may be possible that a new vet will decide the numbers have come down enough to continue on a food trial, but you are right in feeling that leaving your cat at 200s is not quite right.
 
I agree....No R, to dangerous for a newbie. Just a question here....is your kitty on any other medications that my increase his glucose levels? My Ralph is on pred and he tests higher than he did when he wasn't on it.
 
Dear beccalecca, and, of course, you too, precious sweet furry girl,

I'm a completely unintentional renegade. It took me one month and 28 days to finally home test Giz, yet, we wondrously danced for four more years. I home tested Nikki within probably 7 hours after she decided to grace my life; and, we're only a little over three years into our dance.

I love two vets. Both of whom I've humbly and stumbly taught the value of home testing.

I never set out to be a renegade. I just loved Giz from kittenhood, and she taught me how to be brave and dance. And Giz, being Giz, sent me Nikki, who's quirkiness I will probably never fully understand, yet love so dearly.

I just want to welcome you to the place you never wanted to be; but, will be blessed for having found.

Love and encouraging hugs,
Deb and Nikki -- and, Giz, forever dancing in my heart...
 
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