Conflicting vet advice...

Hi everyone! My cat has been diagnosed with diabetes for about a month now!

I am getting super conflicting advice from my vet than what seems to be common knowledge here. Here's some:

1. Do NOT test for blood sugar for the next week, as it will stress out my cat. However, my cat is actually very calm during the pricks. Isn't it best to do preshot tests just to be safe? I don't know why she was very adamant about this. She has already been okay with me doing an occasional blood glucose curve. I told her that I am concerned about hypo and that our cats are alone in the middle of the day.

2. Is Royal Canin really a lot better than Fancy Feasts Classic? She admittedly did say she was not familiar with the food I was using. I just e-mailed her a link to Dr. Lisa's chart and hopefully she will trust me more on the food front. I know she isn't just trying to make money, but at the same time it's frustrating... We are lucky that wee can afford the Royal Canin food, but really don't see a big benefit difference.

3. Is a urinalysis really necessary every 2-3 months? She mentioned that she would like this done before any refills on the insulin. I understand running it if my cat is showing signs, but bringing him into the vet for that so frequently seems a bit much. Maybe I can just get urine test strips?

4. For those who are wondering, the odd dose in the middle is because I realized I had converted U-100 amounts wrong. I ended up keeping it at that amount because it seemed fine, but upon recommendation went back down. She also seemed very much AGAINST using U-100, even though I told her I am now using a chart every single time I deliver insulin. I think I'm just going to keep silent about this, as I get free unused leftover needles from my cousin. At the same time, I don't want to have a relationship with my cat's health professional that is steeped with lies. :/

I know my vet is really just concerned for the health of my cat, but I am just so surprised on a lot of it. I want to respect her as a professional, but at the same time I consider my knowledge and FDMB's knowledge to be pretty good too.

Need some advice here. u.u even if it's not what I want to hear.

 

Hi Goofysholiday, and welcome!

1. I can't for the life of me understand why vets say not to test. As you've discovered, it does not stress out most cats, and the ones who do get stressed by it at first, usually calm right down as soon as their person calms down . Keep doing what you're doing. You're find, and as you've already said, it's necessary to keeping your kitty safe. If you look at some of our spreadsheets around here, you'll see that there is a lot of testing going on around here, and our kitties are not suffering from stress because of it.

2. No, Royal Canin is not better than Fancy Feast. In fact it's usually worse because most of them are higher in carbs. As you already know from the food list, lower carbs is better, so it's just fine to stick with Fancy Feast Classics.

3. No, you don't need a urinalysis every 2-3 months. I'm guessing she wants that to check for ketones? Or is your kitty prone to UTI's? If it's for UTI's, then I can't really comment if it's necessary or not. If it's for ketones, you can buy test strips at any human pharmacy for about $15. Stick one under his bum when he's using the litter box and you can check right at home. We recommend doing that weekly when a kitty is in higher numbers, so you'll keep a better on it than the vet can.

4. I understand why vets get nervous about us converting from u40 to u100. If we mess up, it can be dangerous. That being said, if you are confident in your ability to do it well, it's safe and more accurate. I don't think you need to lie exactly, you can just not mention that part . If the vet asks for the current dose, you can just round to the closest half unit . Of course if she wants to look at your spreadsheet that might give you away Most vets will eventually shrug and start trusting us when they see that our kitties are doing better than the kitties of folks who don't use this approach.

5. Vets try really hard to be knowledgeable and do a good job, but they have to know a little about so many things, that most of them have very limited knowledge or experience with feline diabetes, and they often confuse what they know about dogs and diabetes. If you like her in other ways, and she provides good care for other health issues, I wouldn't worry too much about her thoughts on this part. Just keep doing your research and manage this part of Chavo's health yourself. We are more than happy to help you figure out how best to care for him.

....speaking of which...are you able to get more mid-cycle tests and were avoiding it because the vet doesn't want you testing? Or are you at work all day? Looking at your numbers, I don't see a reason for giving two different doses AM/PM right now, and I'm concerned that he may not be getting enough insulin which can lead to ketones. If it's possible, I would love to see some mid-cycle numbers to figure out what he needs right now.

 

I totally agree with what Djamila has said!

 

Hi. This is very common. As we learn more about feline diabetes, we often find out there is a lot our vets do not know. Also, I think some of the differences are due to different goals. Many vets are fine with just improving the clinical signs (primarily excess drinking and urinating) while most of us want to do better than that. Personally, my goal is to keep Mia in as healthy a range of numbers as I can for as long as I can while holding out a tiny bit of hope that she could go into remission some day.

1. Home testing is very important. The vet that diagnosed Mia strongly recommended against it. She said it 'damages the animal-human bond'. That, along with some other bad advice she gave (including about food) moved me to change vets. It is best to test before every shot and to get mid-cycle tests when you can. The pre-shot test lets you know that it is safe to shoot the planned dose. The mid-cycle tests are key in knowing the impact the dose is having. The more data you gather, the more you will be able to see what is going on and to make good dosing decisions. Oh, and it has not damaged my bond with Mia. Quite the opposite is true.

2. The 'prescription' diets are not necessary and in some cases are too high in carbs and contain some not-so-great ingredients. I have seen several cases here of people seeing a big drop in glucose numbers once they stopped feeding them to their cats. It sounds like you have already found catinfo.org, so you can get all the feline nutrition info you need there. There are many high-protein, low-carb wet food options out there to chose from.

3. You can get strips to test for ketones at home, if that is the reason she wants the urinalysis. I asked Mia's internal medicine specialist how often she should have blood work and a urinalysis, and he said no more often than every three months. He did not hold the prescription for insulin hostage based on those visits though. The prescription he gave me was refillable, 3 vials total, so that is enough for 9 months or so. I think I will feel more comfortable if I do have the tests done periodically just so we can quickly catch anything else that comes up, so I will probably take her in every 4 to 6 months.

4. I think a lot of people use U-100 syringes and convert. I personally have not done this. I can get the U-40s, so I do. There is enough to worry about in managing this, so I would personally just rather than have to convert. Nothing wrong with it though! If you are getting the conversion right, I do not see why it is even something you need to discuss with the vet.

My goal was to find a vet that would be my partner in managing this. I wanted someone who had some knowledge of diabetes and who also respected the fact that I have educated myself and that I am the one on the front lines managing this day in and day out. I went through two vets before finding one. I hope that you can get your vet to work with you, or if not, that you can find one who will. You will learn so much here and will get a lot of advice and support.

 

Also great advice from FurBabiesMama!

 

I agree with all the info you’ve gotten here! I will say vets often push prescription food because they’re taught in school that it’s best and is formulated to fix health issues. The problem is they’re taught that from studies done by those food companies...who obviously have a vested interest.

I’ll say my vet told me to test at home. I was lucky. And when I showed my SS she basically left it up to me! Was there for what I needed and to refill insulin but had no problem with me doing what I wanted to manage things.

 

I'm not very knowledgable with feline diabetes, as I am still very new to this too.

What I can do is tell you that @FurBabiesMama @Djamila @Kris & Teasel @Rachel are amazing!! I really think some of these people should be specialists in feline Diabetes. They know their stuff much better than many vets out there! Trust them!

I think many of us find it hard to find the correct balance between telling our vets the truth, avoiding the subject or lying a little bit. My own vet has cats with diabetes-I know she tests their blood sugar, but yet doesn't encourage me to do the same. Hopefully one day I will catch her buying testing supplies.
I just want her to say "Yes, test her blood sugar before any shot. ALWAYS". I live in a fantasy world though.

 

Thank you everyone. This is all really good advice and support. My partner says he's okay with changing vets. I'm going to talk to her more about why we're waiting more than a week to change his dose, and if I could just get her trust. If not we'll have to chsnge.

Djamila: Yeah... I lowered the dose per request of my vet. My entire household is gone from 7am-6pm so the only times I manage to get midcycle numbers is weekends or days off, or sacrificing my sleep haha. I'm going to definitely get more low points though.

 

You can manage I promise!!! 3-4 days a week I'm gone for like 18 hours a day. I was only able to give 1 shot sometimes. and I live by myself.

 

I've gone through so many vets this year, I've lost count. They assume I'm feeding Glycobalance and I just keep quiet. Even the docs at the hospital are clueless. They all seem to be very young and fresh out of vet school. I finally found a regular vet who I like so far. Even though her clinic is a bit of a drive, it's only for cats, which I like. I have an appointment with her next week, so we'll see how I feel about her after that. I go through the same thing trying to find a decent primary care physician for myself and a dentist, too. It seems that all the ones I like retire. Most doctors are egomaniacs who don't know how to listen. As long as they fill my prescriptions, I don't care.

 

I feel ya. I just keep quiet about my food choices too. Although, at the next visit I'm going to say something . . . at least that is the goal! It isn't even her (my vet) that I think will have the food selection problem its their stupid pet "nutritionist". I've got into it with her before over Hills & RC.

I like my vet partly because she is 5 mins from me, and I really do like her. She has diabetic cats herself.

And don't even get me started in primary care providers. I recently switched to an HMO and every time I want to see a specialist she makes me come in--which is a waste of my money. She refuses to do online...it's like you've seen me for 3 years. You know I need to see a Dermatologist. Frankly, I don't care if I get the referral that is fine, but prescribe the medicine I need.

 

I agree. The u-40's are not expensive and it's one less thing to worry about.