Jasmine continued

Jasmines original thread (long!): http://www.felinediabetes.com/FDMB/threads/jasmine.209831/

Continuing in a new thread now, as advised, as that got so long.

So I’ve been away over the weekend and then working all day Monday so figuring out where we are at again.

Hubby cared for Jazz over the weekend and I was rather upset coming home to find out he didn’t test her at all!?! Even though I said how important it was and showed him how and got him to practise before going!! Argh. He did her insulin still, but he reckons maybe one of them he missed. At least he didn’t try again, but I’m still really upset about it all.

Anyway, can’t change that now. Moving on!

My vet called on Friday as I was leaving so I didn’t get her message until I got home again. She was really happy with the numbers on the 5th, which I do agree they went down nicely but they also bounced up so high!?

Anyway, the vet wants to see us tomorrow and she wants to do a curve on Jazz herself and check against my glucometer. I don’t think they use a glucometer at all and only do full vein draws for their curves. I’m so wary of leaving her there for that but also I need my vet onside with me and she wants to be 100% happy with the readings my glucometer give before trusting my numbers.

I really just want her switched over to lantus cos the remission rate is so much better, but I also have to work with my vet who wants to keep going with caninsulin! I will chat to her more tomorrow anyway but I needed to just dump this info down so that after tomorrow’s appointment (and curve I guess) I can come back with more info.

 

If you have the vet do a curve, the numbers will probably be higher than you normally see due to vet stress. Personally if it was my cat, I would refuse to do it, especially since you are testing. Instead I would do a curve at home and then provide the readings to my vet. But I have also had 4 diabetic cats and a long relationship with my vet. If you decide to do the curve at the vet, I suggest that you do not increase the dose based off of their readings if they are higher than what you normally see. You do not want to risk hypoglycemia with too high of a dose.

 

I agree totally with @Lisa and Witn (GA)
There is no guarantee that Jazz will have a nice low curve like she did for you the other day. She could be having a bounce....you would not know as there are no numbers for the last several days. And the vet stress for Jazz will influence the numbers. I can guarantee you, you will get more accurate numbers with a home curve....and a lot cheaper. And as Lisa said, we suggest you do not increase the dose off their curve
My vet, once I was testing, never asked to do a curve at the practice, but totally trusted my numbers......he was more experienced than most with FD.
Please push for going onto Lantus because these constant high numbers are not good for Jazz, especially after the DKA.
Have you tested for ketones again?

 

I haven’t tested for ketones again as I’ve just not really been home until today.

I THINK the idea of the curve done by them is to ALSO do tests with my glucometer at the same time and compare the readings. Not to do a curve for adjusting dosing levels. She is only to stay for a few hours so it won’t even be a full curve. I’m not sure, it was a receptionist I talked to today not my vet so maybe I’ve got it wrong.

My vet is just obviously unsure about the readings of the human meter and wants to see how it actually compares before truely believing the readings I’m getting.

 

The readings will be a bit different. I know I took my glucometer into the vets and we did a comparison with the same drop of blood and mine was a few points lower if I remember correctly. They checked on their glucometer and they put it in a machine as well. So three different answers. But there is up to a 20% variance in all glucometers so that has to be expected.
It would be a good idea to test again for ketones as Jazz is constantly in high numbers.
Are you testing in between the cycles and feeding the curve? I know you have been away but try and do it most days to try and break the constant cycle of bouncing she is doing.

 

Another thing to note and tell the vet is both our protocols, the Tight Regulation and the Start Low Go Slow, are both based on human meter numbers.

 

I haven’t been feeding the curve, no. I have been away and unable to do that for like four days.
I’m home today though and have been testing her every two hours and she hasn’t dropped more than a 3 points per hour (6 in two hours) so I haven’t fed the curve at all and she appears to be going up again already.

I will lock her up and get a urine sample from her this afternoon hopefully.

 

With no interventions to try and slow down the drop during the last 4 days, Jazz is probably bouncing again today.......
The only way to tell where she is as far as bouncing or staying high is concerned is to test during the cycle, every cycle.....even a +3 before you go to bed is very helpful. Without the inbetween tests it is like trying to do a jigsaw puzzle without all the centre pieces.
Does that make sense.?

 

I feel for you with this. Small town New Zealand means winning over the vet and practice. It isn't like more populated areas where there may be several vets and practices to choose from . Also , the practices here talk to each other. One doesn't want to be pegged as difficult. I got lucky in that Ty was put straight onto lanctus however it did take some work for the vet practice to understand that my home monitoring with a human meter was perfectly fine.

The vet will do a full vein draw for each test - and which is painful to know and watch - but will use a glucometer. They way they do it is laborious & un-necessary. I think they will use an Alphatrak & they may then claim that your meter is no good for home testing. I do hope not though.

As you know a few hours is not a curve and it will not be indicative of her BG numbers. I shall hope that your vet is open to listening to you with this. I had a heck of a job over diet, testing and other issues. The approach does seem to be one size fits all diabetic cats which makes it all the harder to deal with . I am not sure how many diabetic cats some vet practices come across. I know that for the practice I used they had just 2 diabetic cats and 1 dog . That was it. My vet ended up researching and contacting overseas specialists to help me and Ty. He was that good in the end once he knew I was intent on being totally pro-active no matter what.

Fingers crossed you get the lanctus. Regardless of what the vet readings state, you just keep on home testing and asking here.

 

I am testing all day long today to get a picture from mid cycle again... Have you seen all of today’s tests? It totally makes sense that we need the mid cycle tests, I just haven’t been able to when I’m not home!! Lol.

I didn’t get around to locking her inside, but I just stalked her and encouraged her over to her usual garden she pees in, and managed to catch a sample direct from her again! And again it’s negative for ketones, so that’s good anyway.

I’m not actually sure that the vet does want to do a curve or not as it was the receptionist who said Jazz would be staying in until 3, but perhaps that’s just her assuming because I mentioned it was a visit for diabetes. The vet may not care about that at all, and be happy to do a single test sample between our glucometers and see!? I dunno, I’ll see when we go in tomorrow.

I am giving myself pep talks today to try and be strong about insisting on lantus. She’s my cat and I am paying the bills. Give me lantus! This bouncing is silly!

 

Thanks M. It sounds like you had a great vet! I hope mine turns out to be good too, she shows some potential! Lol.

 

Yes I can see the curve you have done today. She might drop lower tonight so if you could get a couple of early tests that might be helpful for tomorrow at the vet. If she does start to drop feed her some higher carb food to slow the drop.

Great news no ketones. She is a tough little cookie.

Keep up the pep talk until you arrive at the vets. Remember we will be right beside you in spirit.
You are Jazz's advocate and the only one who can speak up for her.
There is absolutely no reason for the vet to keep her on the Vetinsulin.....it just doesn't suit her and keeping her in those high numbers is very risky with her history of DKA. And dropping and bouncing continually is not good for her either. I have been trying to find a very good article which came out recently from the RCV in the U.K. about cats and diabetes. They did a trial and found that the best insulins for cats to achieve remission were Lantus and Prozinc (which is another longeracting insulin) but I doubt it is available in NZ because I don't think it is here in Australia.
Just say you feel it has been a long enough trial and want to swap to Lantus today please. Be firm but pleasant and just don't let them talk you into a longer trial of Vetinsulin..just say 'no thanks'. As you say....you are paying the bill and Jazz is your cat.

 

Thank you Bron, I really appreciate it!

I just did her PMPS and it’s the lowest pre-shot she’s ever had, except those ones where I had to skip. It’s lower than she was over the past four hours!? So confusing.

I did find this report is that the one you meant? I will be pulling that out to show my vet if need be too.

I will monitor her over the next few hours before bed and see how she goes. Starting at a lower level will be interesting to watch.

 

No that wasn’t the report I meant. That one is older but good.
Yes that is a lower Preshot. I’m glad you are going to test in case she is coming off the bounce.

 

She’s only dropped 2 in two hours so it doesn’t seem she’s bouncing so bad now?? I haven’t given any different food because she hasn’t seemed to be dropping hard and fast today, so I’ve just continued with the pate. It’s confusing when things change so much!

 

Here is the link I was looking for http://www.felinediabetes.com/FDMB/...the-uk-about-their-remission-research.206096/

 

I just watched that video, thanks! It’s actually older than the report I linked (nov 2017, vs Jun 2018) but it was interesting and helpful!

We are off to the vets in a bit over an hour.

 

Wonderful post @Bron and Sheba .
Bron was here for me re. Ty's diet as he had other issues beside diabetes.

Best of luck with the vet visit. Will be silently urging your vet to easily agree to the insulin change.

Be good Jazzy. Tiz only a vet. Give her The Look if needs be, otherwise win her over with your feline charms.

 

No change. Didn’t even come up. I feel useless at not bringing it up.

I have only dealt with this new vet for about a week now and she is being fairly proactive right now so I’m currently rolling with it.

I tested Jazz with my glucometer right there, then they used theirs. There was a 4 point difference (14.2 on mine and 18 on theirs) as expected really, and they also took blood for their in-house machine thing that takes a while to bring back the info. She’s going to ring me with that result.

She talked about “if they are comparable” and doing curves in the clinic or using my readings for them but I think she is ok with my numbers and just being aware of them being lower than reality when she’s reading them. All of this we already know of course!

She talked about food (high protein, low carb) keeping it the same as much as possible and not changing it about so we can get an accurate reading of how the insulin is affecting her and not the food, and I think she was referencing me feeding the curve there.

So currently I feel like we will get there with this vet, but that it might take a bit more convincing. First step here was getting her to accept my BG readings, which she is mostly on board with but waiting on those other results too. Hopefully once she is accepting of those, we can then consider a more stabilising insulin for her.

 

I hope your vet is happy for you to continue testing at home and doesn't have problems with it. Testing and doing curves at the vet would be a very big backwards step and not in Jazz's best interests, or your pocket's interest! If she is testing with a pet meter we know that the readings are higher. Our protocols, are based on human meter readings not pet meter readings. Pet meters have only been available more recently....before this, vets used to use human meters.....many vets still use human meters for cats.........

I disagree with your vet and I think it shows just how much she doesn't know about FD. With Jazz's history of DKA the priority should be to get her onto an insulin that is keeping her in normal or much better numbers ......and using an insulin that is more suited to cats.....not continuing with an insulin which clearly isn't suited to Jazz and has her in high numbers a lot of the time.
At the moment, Jazz is stuck in a cycle of dropping low from the Vetinsulin then bouncing high. This is not good for her body at all.
If you continue to let her do this without intervening with food to help her get down lower and hopefully stay lower ie 'feeding the curve'..............she will just keep doing it, and I can't see any purpose in that.
But you need to feed the curve each cycle to get results....not just once in a while.
I think with the Lantus these huge fast drops and bounces will reduce greatly and at least be more easily managed because of the nature of Lantus.
Those black numbers at +11 early in the mornings lately indicate to me she could be dropping low at night then bouncing up high at shot time. Are you able to get a mid cycle test for a couple of nights to see if that is happening.. ? It would help greatly to see if that is the case. Cats often drop lower at night..
Can you get a curve today so we can see how low she gets.......that is if you haven't given any higher carb food? ....so we can see how low she's dropping?

 

Sorry I’ve been in and out all day today. It’s currently +7.5 so I can’t get a full curve done today even if I went and found her and tested right now as I’ve already missed a lot this morning. But I could do more this afternoon/evening. I can try getting a night time test too.

I cannot possibly feed the curve every single day and night as I’m not always home enough to do that. And she doesn’t always drop so fast to need any feeding of it?

You’re right though, she does need changing still. I was hoping the vet would call with the other results too and we could go from there, but she hasn’t called yet. I might write her an email as I am better in writing than in person!!