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Disco 11/15 Update

Discussion in 'Feline Health - (The Main Forum)' started by Teri (Disco NoFurNo), Nov 9, 2019 at 1:36 PM.

  1. Teri (Disco NoFurNo)

    Teri (Disco NoFurNo) Member

    Joined:
    Oct 25, 2019
    Just used the last of the AlphTRAK2 test strips in the current vial, so from here on out, I will simplify and just be using the ReliON Prime monitor. I'll keep the unopened vial for his supply kit.

    I sent his vet the latest SS on yesterday (Nov 8) and have yet to hear back from her, probably won't be til Monday now, but maybe she'll have me increase his dose of Vetsulin again? but feel the switch to Lantus will be happening before long as his numbers aren't changing much, and then I'll be learning all about Lantus here, been reading in advance of course.

    So for those who are following Disco and his SS, I'm going to a few PM tests when I 'get up to use the facilities' as recommended and at my age, that’s something I do at least twice a night anyway (HaHaMeow!)
     
    Last edited: Nov 9, 2019 at 7:44 PM
  2. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Teri -

    Can you extend the turquoise coloration across the spreadsheet? (You can also highlight and merge the cells to remove the lines. The merge icon is a couple to the right of the paint can.) I typically work on a laptop and if I scroll to the right, I'll miss the info about your switching meters. Coloring the line all the way across will make sure people see the break.
     
    Teri (Disco NoFurNo) likes this.
  3. Teri (Disco NoFurNo)

    Teri (Disco NoFurNo) Member

    Joined:
    Oct 25, 2019
    I knew there was a way to do that because I see it on other people’s SS, but I didn’t know how. Thanks for the info! I'm not sure I did it in the right way, but think at least jumps out at the viewer now, HaHaMewMew
     
    Last edited: Nov 9, 2019 at 7:26 PM
    Diane Tyler's Mom likes this.
  4. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    The other thing you can do is center the text about the meter switch. Next to the merge icon is another icon with a drop down -- I think it's called horizontal align. Highlight the text then click on the item in the drop down that centers the text.
     
    Teri (Disco NoFurNo) likes this.
  5. Teri (Disco NoFurNo)

    Teri (Disco NoFurNo) Member

    Joined:
    Oct 25, 2019
    Oh yes, life is less complicated using just one meter! A big Thank You to @MargieandGracie for making a new spreadsheet (and one for 2020, too! and for figuring out how to change my user name).

    I did get a phone call from Disco's vet on Saturday and also a follow up email on Monday with details and a link to the AAHA Diabetes Management Guidelines, which I let her know that I found on the group here and printed out. I was able to do a number of evening tests over the weekend, too. His SS is current.

    Here is what the vet said:

    Hope you are well. As we discussed on Saturday, I would continue Disco on Vetsulin 1.5 units BID x 1-2 more weeks and monitor response. Also, I mentioned sending you an email with summary notes and tips on how to help regulate and monitor Disco's Diabetes. Please let me know if you have any questions. Thank you!

    Summary Notes - Provided by VIN (Veterinary Information Network) & 2018 AAHA Diabetes Management Guidelines:

    Blood glucose curves can be very useful in the assessment of diabetes, although they also have limitations and there is considerable day-to-day variation in results. Therefore, it must always be interpreted with caution in light of other clinical information.

    The primary aims of therapy in diabetic cats are to achieve resolution of clinical signs, avoid insulin-induced hypoglycemia, and to optimize the chance of diabetic remission.

    As you previously put so well, this is a marathon, not a sprint... Unfortunately, that is the truth for most medical cases.

    Glucose homeostasis in cats is a dynamic process that can change rapidly. Cats with diabetes have dysfunctional glucose homeostasis and so there is even more pronounced variability of blood glucose concentrations, especially in response to stress or illness. A common error when managing feline diabetes is to assume that the condition can be "stabilized" and that measurements taken on one day are representative of diabetic control on other days. A more appropriate approach is to establish an ongoing monitoring regimen that will detect the changing trends in the cat's response to treatment. Improved activity, resolution of increased water intake and urinations, and weight management are all indicators of improved glycemic control. When this occurs, the cat's insulin requirement will usually decrease substantially and remission might occur. Diabetic remission is most likely when the blood glucose concentration is kept below the renal threshold (250-300mg/dL).

    The principal reason for performing a glucose curve is to find the lowest blood glucose concentration (nadir) resulting from the current insulin therapy. This is usually tracked over a 12 - to - 24 hour period after insulin administration. This is most ideally performed in a home environment. Significant day-to-day variation in blood glucose concentrations has been shown to occur in patients with no variation in insulin dosing or food intake. Stress, in particular in feline patients, can substantially increase glucose concentrations, especially if the cat struggles before or during blood sampling or has concurrent illness.

    That is why glucose curves in isolation are of limited use, but their clinical value can be greatly improved when combined with a detailed history.

    Monitoring/History:

    Urine Glucose - No importance can be attributed to the amount of glucose recorded on the dipstick - that is, there is no important difference between 1+ and 4+ results; it is simply a question of positive or negative glucose. Persistent negative glucosuria identifies periods when the exogenous insulin dose should be decreased.

    Daily recording of urine glucose provides a useful "early warning system" for the risk of clinical hypoglycemia for most cats. Decreasing the insulin dose within 2 weeks of the onset of negative glucosuria will thus ensure that hypoglycemia is avoided in the majority.

    Water intake - Monitoring daily water intake provides a useful guide to the current level of glycemic control. (i.e. Decreasing)

    Body weight - Gaining/Maintaining weight vs. weight loss.

    Appetite, general demeanor and behavior.

    Diet - lowest carbohydrate foods are the best. Most canned or wet cat foods have a low carbohydrate content. Dry foods formulated specifically for diabetic cats, such as Hill's w/d, or Royal Canin Glycobalance are most ideal.

    Fructosamine - An additional way of assessing glucose control in diabetic dogs and cats. It provides an approximate measure of average blood glucose concentration over 2-4 weeks and thus is an indicator of longer-term diabetic control. Best used once clinical signs have improved and patient is on a maintenance dose of insulin.

    Key Points:

    Due to the potential considerable day-to-day variability in blood glucose measurements for Disco, we need to also be adamant about monitoring Disco's overall clinical improvement prior to making adjustments in insulin dosing. (i.e. resolution of PU/PD, stable appetite, improved energy level, and maintaining body wt.)

    At this time, we will continue Vetsulin 1.5 units BID. Monitor the listed items above and see how Disco is overall feeling.

    Diabetic remission is most likely when the blood glucose concentration is kept below the renal threshold (250-300mg/dL). This is our target, with a nadir in the 100-150range.

    Micromanagement of feline diabetes with frequent insulin dose adjustment should be avoided. In general, insulin dosage adjustments should not be made any more frequently than once every 1-2 weeks.

    Feline diabetes that is complicated by concurrent disease and/or medications that are causing insulin resistance (i.e. steroids) will typically present with very unpredictable blood glucose results that vary from 1.5mmol/dL to 30mmol/dL despite consistent insulin dosing.

    If Vetsulin does not work, we will initiate insulin therapy with glargine (Lantus) or protamine zinc insulin (PZI; Prozinc) at a starting dose of 1-2 units (U) per cat q 12 hr.
     
  6. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    I haven't a clue where your vet is getting some of her information. If she is citing the AAHA 2018 guidelines then she should know that Vetsulin is NOT recommended. Either Lantus or Prozinc are the two insulins recommended for cats. Vetsulin does not have the duration necessary for feline metabolism. It was formulated for use in dogs. The sooner Disco is on an insulin that is recommended for cats, the greater your chance of remission.

    This is an incredibly contradictory statement. Hill's W/D is approximately 36.9% and the Royal Canin Glycobalance is approximately 29% carbohydrate. These are very high carb foods. Saying that most canned/wet foods are low in carbs is simply wrong. You can refer your vet to Lisa Pierson, DVM's website on feline nutrition. The site also contains a food chart with carbohydrate values for a huge number of canned cat foods. Your vet may find this enlightening. We consider low carb as below 10%. We suggest that you keep some high carb food on hand to manage numbers if they get too low. High carb is above 15% so the dry food your vet is suggesting as regular food will keep your cat diabetic unless you are dosing a huge amount of insulin. You vet has been drinking the Kool Aid provided by the prescription cat food manufacturers and not doing her own research. There are any number of problems with dry food, including it's not a species appropriate diet as cats are obligate carnivores. Dr. Lisa's site provides excellent detail about a cat's nutritional needs.

    If there is any way to push your vet to prescribe a better insulin, I would encourage you to do so. I don't know how she can cite the AAHA and then prescribe Vetsulin. I would not follow her recommendations about diet.
     
    Teri (Disco NoFurNo) likes this.
  7. Teri (Disco NoFurNo)

    Teri (Disco NoFurNo) Member

    Joined:
    Oct 25, 2019
    No fears, I’m not changing his diet! I have followed Dr Lisa long before I joined this group and I will send the vet the link to the carb chart, too, when I update her at the end of the week.

    And i just feel he is not going to respond to Vetsulin and let her know in the beginning that based on the info i learned at the cat clinic I worked at before moving here that I was wanting to go to Lantus or ProZinc if he didn’t respond to the Vetsulin and I have learned so much more since joining this group.

    I also have an appt on Tuesday with a new vet AAHA and AAFP Gold Feline Friendly with Disco and Brighton for their Purevax Rabies 1 yr and to review Disco’s records and SS and will let everyone know how that visit goes. This is only the 2nd time in over 47 years that I have been a “client” rather than staff member at a vet clinic with my cats (except for specialist visits) and am finding it both unnerving and disappointing on various levels.

    Last edited: 9 minutes ago
     
    Last edited: Nov 12, 2019 at 10:38 PM
  8. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    I'm sorry!! I have been very fortunate in that in both Chicago and Columbus I use cat only practices and the vets were/are wonderful. I know how frustrating it can be to do your homework and have to argue with a provider -- even if it's a plumber or mechanic, let alone a medical professional.
     
    Teri (Disco NoFurNo) likes this.
  9. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I agree with Sienne that a lot of the info your vet gave was incorrect. Lantus, Levemir, or PZ are better insulins with the two former being gold standard.

    If you decide to switch, let us know and we will help you determine the dose of the new insulin. If the new vet just says “1u”, we would probably disagree with that :)
     
    Teri (Disco NoFurNo) likes this.
  10. Teri (Disco NoFurNo)

    Teri (Disco NoFurNo) Member

    Joined:
    Oct 25, 2019
    Updated SS, had a number of 'in the blue' readings this week at +3 and +4 tests. His appetite has lessened from ravenous this week and he has enough after meals to graze a while. His weight is stable at 11# 11oz and I think he is drinking and peeing less, but hard to tell with 2 other cats on the water consumption. I forgot to make a note if I gave him his budesonide on Monday but know I forgot on Wednesday (he gets it M-W-F, 3 x a week) but gave it this morning. I wonder if that is why his readings were better? Guess we'll see if they change again this coming week. Any thoughts? (Other than get on PZ or Lantus soon-hope to make that change before too much longer but he's only been on the Vetsulin 3 weeks now--sure seems like longer!

    Also, I was having trouble computing the carb % in w/d and glycobalance and wanted to give his vet those numbers. No, I'm not changing to Rx diets, but when she cited the AAHA 12% ME numbers. I usually use the Hilary Watson calorie calculator (http://www.hilarywatson.com/tools.htm) as it's user friendly (but my previous vets used some other way to calculate it) and I wanted to be accurate when saying that Glycobalance dry says ME 355kcal per 100g (about 1/2 cup), but that's not a percentage. Math was never my strong suit.
     

    Attached Files:

    Last edited: Nov 15, 2019 at 3:39 PM
  11. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    I cannot use the above link as I do not have Flash installed on my Mac. Using two other simple calculators, Glucobalance dry comes in at 29%.
    For an accurate accuracy, I'm tagging
    @Marje and Gracie
    for you. She has written up the math here but I do not know if it applies to dry food. (I'm not great at math either.)
     
    Teri (Disco NoFurNo) likes this.
  12. Teri (Disco NoFurNo)

    Teri (Disco NoFurNo) Member

    Joined:
    Oct 25, 2019
    I couldn't get that link to work, but did find her math page and really feel math challenged now! http://www.felinediabetes.com/FDMB/threads/calculating-calories-from-carbohydrates.204051/
     
    Last edited: Nov 15, 2019 at 3:40 PM
  13. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    The Glycobalance is approximately 29.2% carb and W/D is 36.9% (it's on their website). This is the calculator I use. Also, the numbers are approximate since Royal Canin provides the guaranteed analysis information, not the "as fed" information.
     

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