My vet still doesn't want to start insulin

Hey all!
Back again with a little rant and looking for some opinions. Effy was diagnosed 10/14/17 and bg was at 470. I switched from purina dm (vet prescribed food) to ff classics once I read the purina dm wasn't that low in carbs and was constantly giving him diarrhea. Effy has never had normal solid poops the whole 4 years i've had him. I switched him to ff classics pate and he has completely normal solid perfect poops and it's amazing, only time the bad poops come back is if I give him anything with liver in it so at least that's settled now. Anyway, the past month after the new diet he's been steady between the 230-270's and has been fine. Energetic, running around and playing with his sister, just a total normal happy cat. I slipped up and left a plate of my left over sloppy joe on the coffee table and he jumped up and ate all that was left on my plate and had bad poops again, mix that with me giving him a few cans of the seafood flavored ff classics to see if he could tolerate sea food since it's more low carb than the chickens and turkeys, and it was bad poops for a week. That whole week his tummy was messed up he was testing around 330-440, so I called and made an appt to hopefully start insulin since I assumed the diet change is just not enough. It's been over a month that he's been diagnosed and my vet still does not want to start insulin. Though he estimated me for an all day glucose curve test, and checked his bg while we were there. He tested 315 at the vet today an hour ago. Vet wants me to start testing multiple times a day to get a good idea on how he fluctuates throughout the day/week but still didn't say anything about when he would like to start insulin...... Is that weird to you guys?
Have any of you waited this long to start insulin? Did everything end up okay?
Have any of you went into remission with diet alone, how long did that take for your kitty?
I know all cats are different but I'm curious to see if this has happened to and worked for anyone else on here.
Just trying to understand why my vet is so adamant on just treating this with diet alone. It kind of eases my mind on the possibility of only wanting my money by instantly giving me insulin. I know the last post I made on here I told you guys he made that nasty comment on putting him down vs starting insulin... But he's been calling me weekly to check up on us, and has been genuinely like, talking to me while i'm there but it just seems like he doesn't think this is that big of a deal... I want to get a second opinion but I'm SO awkward that I'm scared to have the second vet call up my current vet for Effy's paperwork and then leave my current vet thinking I don't trust him or his opinion. I know it's on me to do what I feel is best but I'm still so paranoid! I'm most likely calling our previous vet tomorrow to go in for a second opinion.
Part of me thinks since I'm so young my current vet is just assuming I can't afford the insulin and is trying to do me a favor by trying everything else first... But money is not an issue here.
I don't know, just wondering if anyone else has been in this situation and what you did. Did you go somewhere else and get the insulin or did you take a leap of faith and keep on going with the diet. What was the end result?
I know this is me and my cat and nothing will be the same for others but what is your opinion, do you think I should push for insulin or wait it out? I don't want him to be high for so long that he ends up going blind or something else happens. I know 300-400 isn't the HIGHEST people have seen on here but I'm so new to this I don't know what I should really do here. Thoughts?
Is there any other food that is better and lower in carbs than ff classics pate?
The absolute highest he tested during that week he wasn't feeling good was 434, is that super high, should I be worried if he won't go below the 300's after this?
Is it normal to HAVE to do a glucose curve to start insulin?
I'm just confused on how he's treating others who don't home test like I do since he never actually suggested that I start home testing, he was actually surprised when I told him that I started the same week he was diagnosed. This isn't an all animal vet, it's a straight up cat hospital with many other diabetics there... I feel like I should calm down and stop second guessing him but I don't know. In all honesty I would love to avoid insulin all together but does that ever truly work?

 

One more quick thing- ignore the spreadsheet link in my signature. I made one just incase but haven't started insulin or regularly testing so I haven't used it yet. Just an fyi!!

 

I'm not sure why he's not started insulin either but diet can play a huge role. We've had some that when taken off dry food completely, they went into remission - sometimes with just a shot or two.

Go ahead and put your test numbers in the spreadsheet - that will help all of us see what he's doing on diet alone. Just put 0 or - in the 'units' column. Those tests will show a huge story.

Others will be along to add to this - I just jumped on for a minute before feeding the doggie/kitty/human zoo....

HUGS! I'm so glad you're testing!

 

Generally, if the switch to low carb food doesn't bring them down below about 150 in a week or two, it's time to start insulin. The sooner you start, the more likely the cat is to get into remission.

Most vets think it's OK for the cat to stay higher than we do....they're more concerned with hypos (especially since most people can't or won't home test) so they'd rather let them run high and take the risk .....but as long as you're home testing, that's not a problem!!

Anything over renal threshold is too high. Renal threshold is the point at which the kidneys can't process the glucose any more and it spills out into the urine.....this varies from cat to cat, but is generally around 220-250 (but we've seen cats that had sugar in their urine as low as 150)

Doing a glucose curve when the cat isn't on insulin seems pretty useless to me. Yes, it might tell you if his pancreas is doing ANYTHING, but I think it's pretty much a waste of money, especially if all the testing you're doing at home has him running in the 200's or higher.

The sooner a cat is started on insulin, the better their chances of remission because it allows the pancreas to rest....and hopefully it can heal enough to go back to producing enough of it's own insulin to go OTJ (Off The Juice)

 

Thanks so much! I just have a feeling we should be on it by now but whenever I ask for it he just keeps insisting we keep doing what we're doing, sigh. I don't know how I would go about even refusing the glucose curve, he made it seem like he has to do one to be able to find out what dosage of insulin to give him. He was at 230-235 for a good two weeks, then slowly went up to 270's then slowly to the lower 300's and the night before I called to schedule the appt he tested 434. So I freaked out and made the appt solely to start on insulin and then he didn't even talk about insulin the whole time I was there telling him I wanted insulin. I'm kicking myself for not switching vets sooner.

 

thanks for the hugs!!! very much needed! I shall start filling out the ss!!

 

This is bizarre. I would want insulin. It also seems odd to do a curve before starting insulin. Normally, you would start with a low dose then do a curve after they have been on it awhile to determine if a dose change is needed. It almost sounds like the vet is 'scared'. Has he personally treated other diabetic cats who were on insulin?

 

I would only assume he's treated other cats on insulin, he acted like he had a procedure on how he goes about prescribing insulin. Theres also another gal who always seems to be there when I'm there with her diabetic cat whenever I have an appt, lol. I mean it's the only "cat hospital" in my city and I don't live in a necessarily small city.... but who knows!!

 

This is so true!! Goes for BOTH of the vets that we've been seeing (multi vet practice, but i only see these 2).

It's a scary high number, one I've seen alot. Don't let it worry you too much, but I really don't see why Effy hasn't been started on insulin... I'd probably switch vets. They longer he stays in these numbers, the harder it's going to be to bring him down. Not to mention the irreversable damage it's doing to his oragans.

Don' feel too bad about this. Spicoli has IBD and ANY seafood except Weruva Pretty in Pink will give him the runs. It seems like a food change helped this. Maybe a food allergy? If it does return maybe think about starting him on some human grade probitiocs. Here are a few good websites http://www.foodfurlife.com/my-cat-has-diarrhea---what-do-i-do.html http://www.ibdkitties.net/

We started insulin the day he was diagnosed.

Don't be scared. Not many vets are well rounded in FD. Get that second opinion! It's your money, it's your cat, and you want the best for him and his health. There's nothing wrong with that.

Once a diabetic, always a diabetic. Even if remission is achieved. Like Chris said, some cats can have a diet change and need insulin for a very short period of time. But the sooner his little pancreas gets some help, the sooner it can start healing and *hopefully* start doing its job.

Sorry for so many quotes. You obviously care deeply for your sugar cat, and want the best for him. My personal advice would be to go ahead and get that second opinion and preferably start insulin. The longer he stays in those higher numbers the more damage is done - which means the longer it'll take to him him where he needs to be. I hope things start to work themselves out Head bumps

 

call your vet's office and tell them you're starting a file on Effy and want copies of all his test results so you have them at home (this is a good idea anyway just in case you ever end up at an ER vet in the middle of the night)

then you'll have the tests to show a new vet and you can make your decision from there whether you want to leave your current vet or not for Effy's treatment

You can call and do a "pre-interview" on vets you might want to try too. Call and ask that the vet call you back (this will usually be after hours).

Ask questions like:

How do you usually treat your diabetic cats?
What kind of food do you recommend?
What is your "go to" insulin? Are you willing to use something else if that one doesn't seem to be a good fit for my cat after giving it a reasonable chance?
How many diabetic cats have you seen?
Do you support home testing?
If I bring in bloodwork that's been done within XX days, will that be OK or will you insist on repeating it?

A helpful question at this time is also "do you have dental x-ray equipment"? but it's not as important....until you need to have a dental done!

We're on vet #5 because my 1st vet said "insulin is a hassle....feed her this prescription dry food and she may live another 4 months, but she'll probably go blind soon" ( I left that day and have never been back)
#2 said "I only want my diabetic cats eating either Hills or Royal Canin diabetic food" (too high in carbs and they have lousy ingredients)
#3 agreed to give me a script for Lantus, but told me she'd need to start at 4U twice a day and would probably need more than that. She weighed less than 8lbs at the time.. (I took the script and ran)
#4 was pretty much a repeat of #2

We found our last vet when China needed her first dental. She called me and explained the whole procedure and spent quite a bit of time with me on the phone. She answered my questions without making me feel like she was rushed....and they did have the equipment to do dental x-rays (which is very important if you want the job done right)

They're over an hour drive away, but when it comes to China's health, that's what we do. She occasionally tries to give me some advice on managing her diabetes, but I just nod my head and smile and say "I'll have to think about that" and come right back here.

China's actually never been back to a vet since her original diagnosis except for vet #3 (who looked at her labs from vet #1). She's had several dentals and a nasty URI that required a vet visit, but when it comes to her diabetes, I listen to the people here who live and breathe it 24/7/365