Confused after talking to Vet

I just got off the phone with my vet and am feeling more and more unsettled by the discussion. I had called asking if we could switch insulins. Right now it's vetsulin and I wanted to go to Prozinc after reading several discussions here about it as well as what medical articles I could find online. The vetsulin seems to be hitting on the 8 hour duration for my cat, not the up to 12 hour.

Also, my cat was not obese or on a high carb diet before diagnosis, so the typical risk factors of diabetes were not present.

So, I was told:
1. Vetsulin was designed for cats and is the best (articles online seem to refute this)
2. It's normal for blood sugars to increase when you start treatment (spreadsheet in sig line)
3. Ignored my questions about worrying about ketones
4. Said he normally treats by jumping 2U doses at 2 week intervals until stabilized, he expects her to stabilize at 6-7U/dose

I'm going to try and get her into a different vet, but is my vet right about the above and I'm just worrying over nothing?

I'm just very confused right now and worried.

Thanks,
Bridget

 

1. No, vetsulin (aka caninsulin) was designed for DOGS.
2. NO. BG's should be going down.
3. Ketones easy to test for yourself. Get keto test strips from your drug store or pharmacy. (Found your other post and see that you are already testing for ketones and Smudge has had HI ketones.)
4. 2 unit increases at a time?!?!? Are you kidding me? You may have bypassed the appropriate dose.

Going to take a look at your SS now.

With BG's that high, it's very important to test for ketones.

What were the symptoms and what was the diabetes diagnosis based on, besides a single BG test at the vet office?

 

Your vet has no clue how to care for a diabetic cat. You need a new vet. If you follow his instructions, your cat could become hypoglycemic if the dose was increased to 6-7 units.

 

Here is the link to your first post, that includes more information about Smudge.

What is very worrisome to me is that your vet says not to worry about the ketones when you have been testing for ketones and Smudge had hi ketones only a few days ago.

 

A couple of articles for you to read/share with your vet.

Managing Feline Diabetes - Current Perspectives is from 2018, published in one of the vet journals.

Vetsulin isn't an insulin recommended for use in cats, because the duration and control just isn't there. If you were treating diabetes in a dog, it would be the appropriate insulin. AAHA Diabetes Guidelines has lots of info. Here is the section from the guidelines about insulins for cats.

To me, knowledge is power, so I like to read some of the current vet journal articles on treating diabetic cats.

 

Here are some guidelines and questions to ask prospective vets.

• Vet Interview/Screening Topics & Check List

 

I hope your vet doesn't have any other diabetic cats for patients. Seems to be clueless about feline diabetes. 6 or 7u to stabilize Smudge is ridiculous. Most cats never get to doses that high and increasing by 2u at time means you'd skip right over best dose while possibly continuing to see high numbers if kitty didn't hypo first. In this case, I definitely think finding another vet would be a great idea. Not just because of the bad info but the fact that the vet ignored your questions. You need a vet with some knowledge and one who will listen and address your questions with credible information. Your vet should be a partner...not a dictator.

 

If you are interested in trying to find a new vet in your area, you may want to create a new post or update the title of this one to say something like "Need vet recommendation" and include your location. We may have members in your area that can recommend a good vet. You can also search the American Association of Feline Practitioners website, https://catvets.com/ for cat friendly vets. Many of these vets only see cats as patients so they have more experience when treating cats.

 

Any steroid use? Nasal, oral, injections?
Where polyuria/polydypsia (PU/PD) symptoms present (excessive peeing, excessive water drinking)?
Any other concurrent health conditions?
Most recent dental for your cat was when?

Some questions I'd ask a vet include:

To gauge how experienced your vet is with diabetic cats (not dogs)
1. How many cats in the practice?
2. How many diabetic cats have you treated? Currently? Recently in last year?
3. How many of those cats have achieved diet controlled remission (no more insulin needed) using your methods. (My cat Wink was the first cat my vet practice had ever seen achieve remission, in a practice of 7 vets, in business 30+ years, no idea how many diabetic cats they were seeing)
4. How many have died?
5. How many have BG regulated? What do you consider regulated?

To gauge treatment goals
1. What should I be looking for at home, to see if my cat is improving?
2. Is regulation enough, or is remission possible with my cat?

To gauge knowledge.
1. Could you (the vet) provide me with some vet journal articles about diabetes treatment in cats?
2. What should I (the caregiver) do if ketones? cat not eating? hypoglycemic?
3. What if my cat won't eat the food you have recommended? Ask about options for food (vets make good money in selling you those 'prescription diets')
4. My cat has other health issues, which are more important to focus on? and Why

 

Definitely look for another vet! This one wouldn't pass an exam in FD, that's for sure. Many of us here have switched vets for reasons such as this and ended up with a much more clued-up vet who is prepared to listen to us and respect the research we've done. Ideally you want a vet you can work with, not one that you're at cross purposes with... that won't improve.

You've had some great suggestions above.

Good luck!

 

You have gotten great advice above and I agree with everything that has been said. If Smudge were my kitty, I would be looking for another vet without delay. A year ago I switched from a vet who didn't know anything about taking care of a diabetic cat and wasn't willing to answer my questions or pay any attention to my observations at home. As a result of this change, my cat has a significantly better quality of life and I have a knowledgeable partner to help me take care of my sweet little guy.

 

At the bare minimum, I would email your vet the AAHA guidelines and suggest that you have a discussion given that his suggestions are at odds with the AAHA. The organization recommends either Prozinc or Lantus for treating feline diabetes. It's very hard to argue with one's professional organization. FWiW, the AAHA has made these same recommendations for the past several years. It is worrisome that your vet is not current on diabetes treatment in cats.

 

Thank you all for validating my gut feelings. My old vet recently moved back and in the past she was better about listening to my concerns, so I'm going to try to get in to see her to start. I'll catch up on all the reading posted above (some of which I think I've read) and go from there.

I'll also reply to the questions above shortly.

Hopefully updates to come.

 

Good luck getting into the new vet. I too started with Caninsulin - it's only rebranded Vetsulin in the US because it markets better to cats that way. Didn't last for us either.

As an aside, a couple of people here responding to you, including me, have had cats that needed more than 6-7 units because our cats had other conditions causing a need for higher doses. However and this is the big one, only by starting low, testing, and increasing by safe amounts did we find our cats needed higher doses. This is with just a low carb wet or raw diet. Dry food in the picture can greatly increase insulin requirements.

Maybe the new vet will suggest a human meter?

 

It will be interesting to see what the new vet says. She was my vet before moving away and coming back, and back then she was very open to discussing alternate treatments with me, explaining everything, and looking up new info on issues so here is hoping she hasn't changed in the intervening years.

I have 3 human test meters here, so I can certainly start using them to test and just run the periodic checks with the vet one I have been using. I'm fortunate that the higher test strip cost while a concern, is not currently a limiting one to getting this all straightened out. I really do want to get her insulin switched, so that will be number one discussion topic with the new vet.

Good news is that her numbers are not quite as crazy high as before, and the ketone tests are reading under the 2.4 limit so that makes me happier for now. Or at least, it takes a small measure of stress off of my layers of worries.

Original Symptoms:
1. Noticed not cleaning herself very well (suddenly it struck me one day that she had a mat in her fur, which she's never had before)
2. Possibly increased water intake, about the same as the other cat who is non-diabetic and always drinks a lot so it was not a primary concern
3. refused 2 meals in a row, and gave signs of being nauseated (looked hungry, took one bite and then didn't want more, but keep trying one bite of each offering)

Number 3 is what sent us to the vet the next day. Once there, she had significantly increased breathing with panting, then lost some rear mobility once out of the crate. They ran blood tests and the only number out of whack was the blood sugars, which were at 600 something. Once she got back in the room, she calmed down, breathing went back down and she regained her coordination.

No recent treatments for anything, but she has an ongoing battle with IBS, mostly controlled with a primarily raw diet. No dental cleanings yet, and she is around 13 years old.

 

Your signature says Alpha Tek meter. Not familiar with that one. Is that the pet one you mention you are using? I know about the Alpha Trak pet meter (used it before) and strips at $1 to $2 each can get expensive when testing as much as you are.

With 3 human glucometers, it's best to pick one and stick with using that one. Meters can vary in their readings, so consistently using the same meter gets you better consistency in the BG readings. Which human glucometers do you have available? Plus, thinking that using a separate meter for Smudge the cat would be good, so you don't get confused as to which BG reading is for whom.

Wondering if the severe stress and mouth breathing skyrocketed the BG reading at the vet. Maybe before your new vet visit, take a BG reading at home, take your meter with you to the vet and test the same blood drawn at the vet as they test.

Infection (think bad teeth) + not eating enough + not enough insulin are the classic components leading to development of DKA (diabetic ketoacidosis). Definitely have the vet check over her mouth.

Symptom number 3 sounds like she might have had some pancreatitis.

Raw diet is a good one for diabetic kitties also, and since you are dealing with chronic IBS a good diet to keep her on. Adding more to your signature, especially any other medical conditions would be helpful to us. Then people might not keep suggesting foods that would not work for all the medical issues Smudge deals with.

When are you feeding Smudge? Food available 2 hours or less before pre-shot tests can affect numbers, so we suggest taking up food at least 2 hours before the pre-shot tests. Feeding later in the 12 hour cycle with Vetsulin (after about +4) can skew the numbers also, keeping them high.

p.s. Tried to get my IBS kitty to eat raw, but she refused. Eliminated all grains from my cats diet and that worked.

 

Form your spreadsheet it does not appear that you are getting consistent BGs and thus without consistent BGs it is hard to determine dose. I see this in the most recent 3.5 unit doses. Do you know what may have been different like when fed, how much eaten or other health problems.

 

When fed doesn't differ much, generally I test her BGs, feed and then dose about 30 minutes later. She has been a bit pickier about eating lately, but she generally eats 1 - 2 oz of food per meal. Some snacking if she starts acting hungry. Main meals are all wet food right now, and sometimes a bit of the raw food. I go back to work tomorrow, so her snack opportunities will be greatly decreased. Yesterday and today she hasn't really had any snacks, and I'm guessing that may be affecting the BGs.

When her numbers were in the 700+ range, she was eating a lot more and more often, I suspect from the higher ketone readings at the same time. Now that her ketone numbers are lower, the past few days she's been eating less snacks, and significantly less of the kibble (mostly DM, trying to switch to the Dr. Eisely's) than earlier.

Her crazy numbers are not helping my piece of mind at all, and I really hope the switch to a different insulin will help even this out more. The more I read on the available insulins and which ones are cat appropriate, the more I want to do unkind things to the vet and think that lack of knowledge has made the first month bumpier than it really needed to be.

 

Part of the high numbers are a result of what you're feeding Smudge. The DM kibble is high in carbohydrates. In effect, DM is like feeding your diabetic cat cookies.

Ketones will not cause your cat to want to eat. Ketones generally make a cat (or human) feel lousy. The diabetes, though, causes cats to be ravenous. The product of metabolism (i.e., glucose) isn't getting into the cells so the kitty is eating but the glucose is floating around in the blood versus getting into the cells. Essentially, an untreated diabetic cat is starving.