Coltrane update

Hi all,
It's been almost a week since Coltrane started on 2 units of Vetsulin 2x per day. He's taken the insulin like a champ, and seems a bit perkier even (he hadn't been terribly symptomatic, no weight loss yet). I bought a glucometer and tested myself yesterday. Just trying to get the courage to test him. I've had very little contact with my Vet and I am pretty disappointed by that. I called him yesterday because I have noticed that in the evenings, before dinner and shortly afterwards, Coltrane's front paws tremor when he puts weight on them. Back legs are fine. Yesterday, after seeing it about 4 pm, I called my Vet because I wanted to know if I should feed and give insulin earlier (I was noticing it about an hour before he usually eats), but he didn't call me back. That's something I need to think hard about, because when I called again today and requested a call-back, he had his office manager call me to tell me that they will look at that next week during the glucose curve test. I wasn't really satisfied with that, I feel like Coltrane is in a pretty vulnerable place right now, and could use a bit more attention (and we are long time customers), but that's for another conversation. So I was wondering if anyone had thoughts about the front leg tremor? I haven't seen it at other times of the day, so it appears to be around dinnertime/insulin time; but I can't be sure of that. I understand that it might be from potassium disregulation too? Does anyone have thoughts as to whether I should feed a bit earlier if I see that? You'll probably tell me to get testing, I know

My other question relates to the glucose curve test. Because the Vet isn't working full days right now, I am scheduled to drop Coltrane off at 11 am and pick up between 5 and 6. I'm hoping that's enough time? They quoted me between $475 and $675, does that seem in the ball-park? It seems very expensive to me for a series of blood tests. The office manager said that he would not getting the other blood test that looks at the last couple of weeks.

Once I get going with the blood testing, I will set up my spreadsheet. Thanks in advance for any advice. K

 

Well thats a sticker shock smh. I think you can do your own curve...I could be wrong. Let me see if I can find that info.

 

I've tooled around but couldnt find anything put some feelers out. Hang on for more replies.
jeanne

 

That price is unbelievable, My vet told me to do it at home, to Dave money, plus being at the vet might stress him out and you will get higher numbers there than if you were doing it at home. I have done all of them at home

• There are particular considerations when using faster-acting insulins such as Caninsulin (Vetsulin), - especially for newcomers or for those with little or no data about how their cat responds. This is because the insulin can sometimes drop the BG fast in the first few hours of the cycle.
• It can be a good idea to feed your cat 20 - 30 minutes before giving insulin. This ensures there is food on board for when the insulin starts to work. So, the sequence would be: 1. Test BG. 2. Feed. 3. Wait 20 - 30 mins. 4. Give the insulin shot. (If you are not yet home testing it is still advisable to feed and then wait before giving the shot).

 

I agree with everyone. I think that price is insane. My vet was going to charge me $169 for a full day (and I’m in LA!!!) but she encouraged me to do it myself at home because in her own words cats are less stressed at home and the numbers will be more accurate. Given your experience with your vet thus far, I personally would not trust them to do it. What if you have questions after? Do it yourself at home, trust me you’ll thank us later if you do!

 

Me too I did it at home both times

 

How to complete a glucose curve
The procedure is as follows: shortly after your cat has been given its first meal (preferably at home), the first blood sample is taken just before the morning insulin is given. Blood samples are then collected every 2 hours throughout the day, for 12 hours if possible. This data is then plotted on a graph to generate a curve. Veterinarians will use the blood glucose curve to determine if any adjustments need to be made to the insulin dosage and feeding regimens

 

Yeap this is it! Only you’ll plug the numbers on the ss and you can email your vet the results that night of the next morning. I did that because I hated the thought of how freaked out Minnie would be at the vet all day and the added bonus is you’ll have accurate numbers. And in your case, you’ll save about $500!!!

 

That is TOTALLY too much.....even in high priced areas, I've never seen an all day curve cost more than about $200 (and that's ridiculously high too....even using the AlphaTrak and it's totally too expensive strips, testing every 2 hours would be less than $20 in "supplies".....now I know they'll also charge for their "time" to do the test, but that should take less than 3 minutes for each test for a total "labor" time of 36 minutes.

 

THANKS Diane I was looking everywhere for that! lol I have Debs response from my asking :
curves at home are best. Since the cat won't be stressed out by a strange environment like they would be at the vet.

Same reasoning for doing the home testing in the first place. Reduce the stress on your cat. It's why we don't recommend having BG checks done at the vet, be it one test or a 12 hour curve. Plus, most vet clinics are not open that many hours, so you can't get a full 12 hours of testing done in a vet clinic. So you can't see if the duration for some of the in-and-out insulins like Prozinc and Vetsulin(Caninsulin) or NPH are very short or long enough for your particular cat.

To top it off, cats don't eat as well at the vet, locked in a cage. Vet clinics are not going to give a cat that is there for a curve or any testing, meals at their normal times. Nor try to "feed the curve" to slow down any steep drops. At home, the cat would be eating as they normally would throughout the 12 hour dosing cycle.

Vet stress can elevate the numbers and you don't want to base a dosing decision on a single number done at the vet. Or on a stress induced curve done at the vet.

I don't know of a thread that talks about the curve at home, except for in a general sense in the Stickies for each insulin dosing protocol.

 

It's been too many years ago for me to remember all this sorry.

 

thank you for the feedback. For those of you who believe the price range is more in the $200 range, is that based on fairly recent experience?

 

Exactly

 

Yes I was quoted the $169 last December. Fairly recently I’d say

 

Its been a long time for me but I KNOW I never spent that much at the Vet.

 

I was thinking about the food too. I know for sure Minnie wouldn’t and doesn’t eat at the vet even when they offer her treats so that would have messed up the BG levels as well

 

the widest time slot they could give me was 11 am-5pm (so 6 hourly tests), so Coltrane would have had breakfast at 630 am, and wouldn't be eating until 4:30 ish. How important is it for the Vet to capture bg around eating? I'm just wondering if this test isn't going to give a valid look at his curve, and for that amount of money, maybe I should cancel it. Thing is, being here on Long Island right now, with Covid, I don't know the likelihood that I can get in with a new Vet any time soon. I feel a bit trapped.

 

I think we are all saying that you should cancel. You’re not going to get the accurate results you need and you’ll likely have to redo it at home anyway. You need to start the curve with the am preshot number. I think it’s pointless if you don’t because you have nothing to compare the +2 and +4 with. Besides, once you start testing we are going to ask you to always test the preshot numbers because you should never give insulin without knowing what your cat’s BG level is.
Are you on Lantus? I forgot so if you could set up your signature that would help us have all that info in front of us Anyway Lantus is a bit more forgiving but other insulins aren’t. you really do need to know those numbers to regulate the dose and consequently the diabetes. Makes sense? If you’re reluctant about testing, don’t worry we’ll literally walk you through it. These guys did for me. I went from 0 to testing 4 times a day and I’m about to do another curve soon.

do you still have concerns and what are they? I won’t give up until I convince you to do the curve at home. Btw, when you get the bg at the vet how do they collect the blood? In my experience I’ve never seen a vet test the ear. They typically use a syringe to get blood from a vein in the leg. And Minnie has to be held down and fights it and it’s so stressful. I just knew I couldn’t put her thorough that multiple times a day the whole day

 

I would just tell the vet I wasnt feeling up to par and that you're doing the curve yourself.
THAT IS IF you are ready for that. I know the feeling about testing but it really is the ONLY way you are going to be able to control Coltrane's diabetes. Once you DO learn how, you will wonder what all the anxiety was about.
This is the perfect time to learn you're stuck at home. Why not give it a go?

 

No, that isn't enough time. A curve needs to be run every 2 hours, from one pre-shot to the next. Only 6 or 7 hours of testing will not tell you much.

What time does Coltrane get his insulin shot? How many hours before that 11 am drop off?

Will he be fed as her normally is, while he is at the vet? If not, again the curve at the vet will not show you a true picture of what is going on with Coltrane.

Tell your vet that you will be home testing and will do the curve yourself. That will shock the life out of him/her.

Is Coltrane really "chill" on the drive to the vet and while he is there? If not, stress induced hyperglycemia is very likely.

That's a rip-off, to put it bluntly. You vet clinic is trying to "take you to the cleaners."

A curve done at the vet should run you $120-175 dollars max. Even on Long Island.

What else does that $475 - $675 price tag include?

 

I really appreciate your advice and support. I just tried to test Coltrane. I used the 28 gauge lancet, with the device on setting 2, then 3 (out of 5). Neither time produced a blood drop. His ears were warm prior, as he was sitting in front of a heater. He didn't seem too upset, but did shake his head. I believe I read sometimes it takes several times to get blood?

 

yes absolutely and you can work your way up to it. You don’t have to start with the curve. You’ll start testing, get comfortable then pick a day to do a full curve

 

Ahh ok you are using a lancet device? I tried that and promptly threw it away. Some members like them I did not. I just used the lancet and it was easier to see where it was poking. It was way easier for me.

 

the ears do have to learn to bleed but did you get lancets as well? The fact he was good about it is so awesome!!! It means you’ll be able to home test smoothly. I’d try the lancet as well without the pen. It’s a matter of preference and trial and error so you can figure out what works best for you and him. So a few things, I’d still warm up the ear with a socket. It was 90 degrees out today and I still did that when I tested Minnie because you really want that spot to be very warm not just “room temperature”
For me personally, I prefer the lancet so I can see the needle going in and I can decide how much pressure to apply myself. Also if I don’t get enough blood the first time, I can prick that same spot again and get more blood out. Others here like the pen so you should try both to see what works. The other thing is once you punctured the ear you can milk it to get a droplet out. What I do is similar to squeezing a pimple only gently but that’s how I get blood to come out. I do it a few times until enough of a droplet has come out. Sometimes the blood just sortta pops out but other times I do have to milk the ear. What am I missing guys..?
Oh some folks also recommend applying a thin lawyer of Neosporin - the ointment not the cream - because it can help the blood droplet form on the spot

 

Aim for the "Sweet Spot". Marje and Gracie's Testing and Shooting Tips

Testing
We all know the basics:

• Warm the ear with a rice sock or a warm washcloth wrapped in a plastic bag.

• Either freehand or use a lancing device; new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed; then progress to a 31g or 33g which are finer.

• Be sure to poke in the "sweet spot" and not the major vein that runs along the length of the ear. Poking the vein will not only hurt, but will result in a lot of blood. The sweet spot is on the edge of the ear.

But did you also know there is a particular way for the lancet to be used? It has one side that is beveled so the sharpest part goes in first, if used correctly.

 

Right! When using the lancet make sure the beveled part or think of it as the tip, goes in first. I try to do it upwards in a 45 degree angle

 

Thanks Deb. Coltrane gets his shot shortly after breakfast, at about 630 am, so that would be 4.5 hours before arriving for his curve. They gave me the "in normal times we would start at 9 am..." He is definitely anxious at the Vet, and I'm sure that his numbers will be impacted. Though, his last two bgs, in 2018 and 2016 came in at 113, and 132 respectively, so even with the stress, he wasn't bad. This time, at diagnosis, they were 455. I'm going to call the vet tomorrow and ask for a full itemization of the estimate I was given. But I am also considering cancelling. How important is it to get the curve done with 2 weeks of diagnosis? I believe I will get to testing Coltrane, and soon. I just don't know if I can pull a curve off in a short period of time. He's a very vigilant cat, and runs when he believes he is going to be seriously handled (except at the vet's...there he just freezes). The insulin is so quick, but the testing seems so much more involved that I'm worried he will avoid me altogether. I'll get there though.

 

I'm definitely waiting to get that food in before giving the insulin. thanks.

 

Not critical. But learning to home test is. So you know that Coltrane is not too low to give him the insulin in the first place.

The curve in 2 weeks is so the vet knows how Coltrane is doing on the insulin and to discuss any other concerns you may have, than any other reason. To me, waiting 2 weeks to follow up any concerns you may have is too long and should have already been done.

But they choose an insulin that is better for dogs in the first place. Not sure why they choose Vetsulin (Caninsulin), when there are better insulins for cats, namely Prozinc, Lantus, levemir.

Take it slow and easy with the home testing, introducing each step to Coltrane and give him a yummy treat after the test. Just like you do after the insulin shot.

 

Just want to make sure since you are using Vetsulin that you wait 20-30 minutes after he is done eating then shoot the Vetsulin, has to have food on board since Vetsulin kicks in early

 

For what it's worth, Rover's ears were always a 4. Maybe he had thick skin on his ears? My finger on the other hand (pardon the pun) is a 1, occasionally 2.

 

Hi Kim not getting a call back from the Vet would have Excuse my Italian pissed me off ! Then hearing the price they quoted you come on . I took dusty back for a sugar test which was basically an ear prick that cost $12 dollars . Kim in a few days they will put the Freestyle Libre system on her and I thought at over $150 was bad . Let see what everyone else has to say Roe

 

Not to hyjack the thread but you made me laugh Roe when you said excuse my Italian, I'm all Italian and I can't even tell you the words that come out of my mouth lol, I'm from Jersey and that probably makes it worse. Stay safe

 

Diane now you have me laughing I’m from Jersey too ! Lol

 

Me too! I’m Brazilian Italian you two. that’s double Latin lol

Oh Kim, when I called my vet and asked if they could show me how to test Minnie at home they said sure we’ll have a tech show you. When it was done, I totally expected to be charged something for her time and they were like, oh no no charge. I hope you don’t mind me saying this but I think little things like this show you that the vet cares and since you’re already feeling unhappy, my advice is that this my be the time to look for another vet. I’ve always had good luck with referrals via my Nextdoor app and those are the folks who live in your area so they may be able to refer you to vets near you. I got a few then screened them and picked one. Just a thought

 

Get outta here Lol I live my the Meadowlands Racetrack/ Giant Stadium
Fagetta Bout it lol

 

Well hello double Latin lol

 

wow

 

Coltrane update: So last we left off, our Vet had quoted a very high price for a blood glucose curve, between $475 and $675. We confronted the Vet about this pricing and were told that it includes $125 hospital stay fee (not overnight, remember they were taking him between 11 and 5 pm), and $50 per glucose test. Arguing was not successful, but because we wanted to know how our boy was doing, we decided to go forward, and then seek out a new Vet when our area opens up again. We also convinced them to let us bring him in at 10 am instead of 11. He gets his insulin (Vetsulin, 2 units) at 6:30 am :-( Best we could do for now. Here are the results: Our Vet was confused. He believes that we did not administer the morning dose. We strongly disagree. We have had no trouble with the insulin administration, we tent, inject, check for wetness. Coltrane is easy peasy with it. Our Vet then said he doesn't know what to make of the results. I thought I would post here, in case anyone has some ideas. We have some ideas but are very new to this.

Breakfast 6:20-6:30 am: 5 oz Friskies Pate, 2 units of Vetsulin insulin
10:20 am: Blood glucose 217
11:20 am: Blood glucose 246
12:25 pm: BG 292
2:39 pm: BG 472
4:35 pm: BG 479

typical dinner time: 4:45 - 5:00 pm

these results, to me, seem to suggest that he needs a different insulin, and/or a higher dose. My Vet feels strongly that Coltrane didn't receive his morning insulin, and the 10:20 am BG of 217 was "carry-over from the previous evening" !!! which would have been about 5 pm yesterday. So given this, he wants to repeat the test. He did discount the price to $227 because no results were obtained. At this point, we have decided to immediately move on. We just haven't decided if we should just go to another Vet, or see a specialist. But I was curious if anyone had any thoughts about these results. Thanks, Kim

 

Sorry to hop in...the beveled part of the lancet should be down? like the flat side of the lancet against the ear.

 

I’m confused as well, but it’s hard to judge numbers at the vet since they’re always elevated. Do you have a ss set up yet? How does it compare to the numbers you get at home?

Let’s see what other folks think so hang on

 

Oh did you happen to do a +2 at home that night? Those are important to get as well so you can see where he’s headed overnight

 

I haven't been able to successfully test yet at home. I'm going to try again this weekend with assistance from my husband.

 

I understand your instinct of wanting to switch insulin. I personally think Lantus is great for cats, but I don’t know that you have enough data to support that yet or at least for us to say you should. Again, let’s wait for others like @Deb & Wink to hop on

 

For $227 you could buy yourself a human meter, and hundreds of test strips for that meter, lancets, and cat food for quite some time. A Relion Prime meter is $9 and 100 test strips are around $17-18 bucks. Plus you could get the Lantus insulin from Mark's Marine Pharmacy in Canada. You do need a prescription first.

Vetsulin was made for dogs. Hence the name outside the US, Caninsulin (canine + insulin).
Vetsulin only lasts 8-10 hours in a typical cat.
It appears to me that your vet doesn't understand the use of Vetsulin in cats, and has never seen a cat lose duration, when the insulin has "pooped out" later in the 12 hour dosing cycle.

That 10:20 AM test at the vet, would have been the +4, or 4 hours after the shot of insulin. With Vetsulin, that is normally the peak effectiveness of that insulin in cats, or what we call the nadir (the lowest point the insulin drops a cat). It's no wonder that Coltrane's BG levels kept going up for the rest of the tests at the vet, since the insulin was "used up" by then to process the food that Coltrane ate earlier in the day.

Vetsulin is an in-and-out insulin. Which means the effects are done in the dosing cycle, with no carryover. There is NO carryover with Vetsulin. None. Zero. At least I've never seen a cat here on Vetsulin/Caninsulin that has any more duration than 10 hours.

Maybe in dogs, but not in cats.

No need to find a specialist. Just a good vet that understands feline diabetes and is current on the most recent research. Interview a new vet practice. Ask them what insulins they use for CATS and how many cats they have seen become diet controlled. Ask them if they follow the (2018) AAHA Diabetes Management Guidelines for Dogs and Cats.

Here is a thread for you Vet Interview/Screening Topics & Check List so you can ask them even more questions than I have covered.

We have HUNDREDS of cats that have been diet controlled, and that is on Lantus. Could not tell you how many cats using Prozinc have become diet controlled. Prozinc is a MUCH better insulin for cats than Vetsulin.

Get Coltrane used to each little step in the testing process. Use bribes, like little pieces of chicken or another of his favorite foods, to gain his cooperation.

Become the "cat whisperer" with Coltrane, using this method: •Ear Testing Psychology•

Where do you live Kim? Maybe we would have vet practice recommendations for you.

 

Deb, thank you thank you. This is so helpful. You concisely summarized what I was beginning to understand, after reading about a week here of the nature of Vetsulin. I am concerned it isn't appropriate for him, and it seems the data from today points to that. My vet is sadly in over his head here. I appreciate your advice that an experienced vet will know what to do. I live on Long Island, NY, if anyone has a recommendation. I DO want to test at home. I've tried a couple of times, but he's so defensive to any behavioral changes by us, such as bringing the lancet and glucometer close to him. He takes off. We've been afraid that if he starts to avoid us, we will begin to have trouble getting the insulin in. I will try the pairing with a preferred snack, but I'm not sure that will be more powerful than the urge to escape if he feels threatened. The insulin syringe is so simple and quick, but I was clumsy the 3 times I tried to test his BG. I will read what you have shared and continue to try. I understand why it's so important. Thanks again.

 

Thank you Deb and I can’t believe I had never read the Ear Testing Psychology before!

 

TREATS! He gets a treat after each time you test. Pretty soon he will associate treats with pokes. Watch some of the new animal planet shows at zoos. They get lions to lean up against the bars to get a shot...treats!