First post-dx consultation today

Good morning, new friends!

My cat, Tiger, was diagnosed with diabetes last night. He will be 19 in September, and has been with me for all of those years. In the past month or so, his weight has dropped dramatically, (He is now 7 pounds, I believe he was around 11 pounds in February) he started sleeping a lot more, and began having accidents while he slept. He still has an appetite, still drinks, still uses the litter box. I'll be honest in that I probably should have taken him to the vet a week or two ago, but I was scared about what they would tell me.

So, I am seeing my vet this morning to talk about treatment options. Over the phone last night, he implied that older cats don't always respond as well to treatment and we might want to make other arrangements, but I decided "Forget that noise." If I were diagnosed with diabetes, it wouldn't be a death sentence for me, so why should it be for Tiger? At the very least, even if he DOESN'T respond to the treatment, I at least need to know I did everything I could for him.

So, having made it through all of that - I am preparing a list of questions to ask. I know I tend to get emotional and sometimes having difficulty remembering things, and sometimes difficulty talking. He did send me the test results, which I have included. So ... yeah. Here we go.

/edit
Here's my list so far

How familiar are you with feline diabetes? Are you comfortable with treatment or do you recommend another veterinarian? VCA hospital?


What other test results have serious effects? Is there anything other than diabetes?


If I feel confident, do you feel confident letting me give him insulin at home?


Will he need to be on any other medication? Specifically asking about methylcobalamin for his back legs.


If other medication, obviously, how is it does, administered, and monitored?


How much did he weigh in February?


If I have additional questions - or questions in general - can I follow up through phone or email?

As well, I plan on bringing the "Vet Interview Topics" print out from the "Vet Interview/Screening" thread.

 

Well done!
The vet will probably not have heard of methylcobalamin, or will tell you he can give injections but the methlyB12 you need for the peripheral neuropathy is in tablet form only.......see your other thread for details of where to buy.

You will definitely be giving the insulin yourself at home because it is given twice a day.

Are you going to ask him how he feels about you home testing the blood sugar? It is the most important thing you can do for Tiger to keep him safe.

 

Honestly, I figured administering the insulin would be a bigger concern than the blood testing, but I will definitely swap out questions.

If he says he doesn't want me testing at home, once again, should I like run for the hills, or go to another vet? Or just do it anyway? I've read some other threads where the vet said not to test at home, and folks here suggested to do it anyway, or get a second opinion.

I'll still ask about the methylb12, but I'll also roll my happy little tentacles back over to the first thread and check out the link you posted. Thank you so much!

 

Giving the insulin is not hard at all once you have been shown how to do it. If you ever miss the shot (do a fur shot) and the insulin all doesn't go in, NEVER give the shot again. We have all done that at some point and we call it a fur shot and wait til the next shot is due.
Hopefully he will start Tiger on one of the longer acting insulins like Lantus which is very good for cats.

He can't stop you testing at home and there is no good reason why you shouldn't ...in fact it is really important you do to keep Tiger safe. Just say to him confidently, that you have decided to test the blood sugars at home, and basically it is not up for negotiation.
( you don't have to say ' not up for negotiation' but don't back down.
If he is really against it, he can't know an awful lot about feline diabetes, and I would be looking for a new vet who is willing to work with you....remember they are working for you....you are paying them.

 

Here is a diagram of the sites you can inject the insulin.

 

Welcome to FDMB, and good for you for being proactive! Your list of questions is good, but do add one about home testing and doing curves at home. Bron is so right, home testing is critical, and really the only way to keep your kitty safe.

Bron is right on the money about the methylcobalamin, too. Also, I noticed on your labwork that kitty has low potassium levels; this can have effects very similar to neuropathy, causing hind-leg weakness and the accompanying issues. Please ask your vet about a potassium supplement for Tiger. It's inexpensive, but may require periodic blood tests to check for appropriate levels.

We have a few people here who are really great at deciphering lab results, I'm going to tag one of them for you, @Marje and Gracie , so maybe she can tell you more about Tiger's recent bloodwork.

A diagnosis of diabetes can seem daunting, but really, it is very "do-able"! Before you know it, it just becomes routine. You and Tiger already have the right attitude, so you will do just fine!

 

Thank you so much! I added about the potassium in my list.

I'll be back shortly with more updates!

 

Yes, please, keep us posted!

 

I'm off to bed.....almost midnight here in Oz.
Good luck with the vet appt.....keep us posted

 

Welcome. After the first one or two, giving the insulin shot is no big deal. You will definitly have to do it at home as you will need to give two every day.

There's a little more of a learning curve with home testing, but after the first week that's not too bad either.
I have a video in my signature showing how I test my cat CC at home.

Don't let him talk you into perscription food.... Not necessary. Just feed a low carb wet food such as fancy feast classic.

 

@Squalliesmom great pick up with the low potassium level. I couldn't open the Tiger file for some reason so missed that.

 

I was given Vetsulin to give Tiger, 1 unit (??? is that the right term?) twice a day. I asked about testing at home, and he said it was better to monitor in the office, and to bring him back in two weeks. I also asked if Tiger would need any other medication, and was asked "For what?" I was not confident enough to say his kidneys or his thyroid or any of the other things that might plague an old kitty and I am SERIOUSLY berating myself for it now. To be honest, I felt a little like ... He didn't think I should bother? He said that treatment might not help as much, considering Tiger's age (Which he kept saying 16) and that if he's suffering I should consider putting him to sleep. Which, excuse me, he's not suffering. I don't think he's unhappy. He doesn't seem depressed.

I don't know. I didn't leave this consultation feeling overly confident with my doctor, and I don't know how to shop around for a new one, without putting a lot of stress on Tiger (and my bank account) with excess "new patient" exams, you know? Should I just ask my current vet to fax Tiger's records over to the VCA and take him there in a few weeks, to see how he's responding to the insulin?

 

Yay! I'm so glad you decided to go for it. A lot of vets do not recommend home testing or even recommend against it, but it is very important. There are many examples here of people who listened to their vets about that then quickly came to regret it due to their cat having a scary hypo episode. Home testing is the only way to make sure you keep him safe. Doctors would not have you shoot insulin into a person without knowing their glucose level, so it makes no sense that a vet would tell you to do it to a cat. Doing it at home also saves you the money, and saves your cat the stress of having to go into the office regularly for testing.

Did he say anything about diet? A high-protein, low-carb wet food diet is an important part of this. Testing is important when transitioning from a high-carb to a low-carb diet because this can have a dramatic impact on glucose levels.

You could always call another vet in your area to see if they seem more knowledgeable about diabetes or at least if they would be on board with you doing home testing. No need to take Tiger in if they are not going to be any better than this vet. When you find someone who will work with you, you could have the records sent over. I do not like the way your current vet seems to want to write Tiger off right away just because he is old.

 

As others have said, home testing is one of the best things you can do for Tiger, no matter what the vet is saying. A meter, lancets, strips, cotton rounds, Vaseline, and pain relief ointment are going to cost you less than a vet visit. Don't shoot blind (inject insulin without testing), it's dangerous for Tiger. Make up your mind to advocate for Tiger, and take the very best care of him that you can. You should not let yourself be intimidated by the vet, this is your fur baby, and you get to decide.

 

He gave me some cans of Hills m/d for food. I'm on my way to the store now to pick up some other stuff. I have a small list of foods to look for, on top of the testing stuff. (And free tropical flavored sour patch kids. Yum.)

But when I was talking in the car with my husband after, about how I would like to still test at home even though the doctor said don't bother, I said the very same thing @FurBabiesMama - It's not like I'm ignoring the doctor's orders and treatments, I'm just testing to see how things are going.

 

At least he gave you the wet food rather than the dry. It is still 13% carbs. Ideally, carbs should be kept under 10%. I guess you have seen the cat food database? (Link in my signature.) It is very helpful when looking for appropriate foods to try.

Enjoy your tropical flavored sour patch kids!

 

Yeah, I've been looking through the different food options. My cats don't particularly care for pate (Or they haven't in the past) so I'll have to see how to shake it up with them.

 

If you purchased the Hill's food at the vet, you can return any unopened cans for reimbursement. We were also sold the "prescription" food (it's not really Rx) and thank goodness Idjit didn't like it. He liked the dry, but it was too high in carbs. Both went back. There are better foods for Tiger.

 

When I first started transitioning to wet, pate is all my girls would eat at all - with doctoring. Now, they get Weruva Chicken Frick A' Zee which is not pate. It is shreds of chicken in liquid/gel. I add bone broth and water to it, too.

 

I bought a truetrack meter this afternoon. I tried to test it on myself and got an error twice. Then I looked and noticed the strips were "expired" by a full year!!! I mean I feel that shouldn't matter but I also wonder if that is what is giving me the error. I just wanted to be prepared for everything.

Should I wait until tomorrow morning to start Tiger so I can closely monitor him all day? I was kind of planning on starting tonight (I'm going to be on a 730-730 time frame, since I leave my house at 8 for work and dont get home until about 730)

And the ... series of events is like ... feed, test, insulin, right? Or test then feed? Does it matter? I tried looking at the different faqs and threads and it's still all a lot and I just want a very basic step by step guide lol

 

How big of a sample does it need? If it needs a 0.5 sample you may not have had a big enough drop. Also make sure to dip the strip in the drop so it sucks it up like a straw.... Don't scoop the drop.

 

Test, then feed, then shoot. No food at least 2 hours prior to the preshot test so the number is not food influenced.

 

Iiiiiii am not sure how big the sample needed but I am dipping not scooping, it sucks up the drop and fills the little area ... but even in the little booklet, it says not to use if expired.

I took away the kibble and I'll test before his dinner! Thank you so much.

 

Expired strips should still read.

t.

 

Welcome to you and Tiger to FDMB. First, I’d like to show you a spreadsheet of a 21 year old cat, Asia, whose mom posts on this board. So much for anyone thinking that an older cat won’t respond to insulin and treatment for diabetes. While Stacy shoots three times a day, if you look at her tab for BID dosing, you’ll see that Asia was still doing well with insulin.

It seems your vet might be old school by prescribing Vetsulin. I’d definitely read up over the weekend about the longer acting insulins, Lantus and Levemir, that aren’t so harsh as Vetsulin. They are a much better choice for kitties but they are also much more expensive than Vetsulin.

In looking at his labs, he looks dehydrated and his urine specific gravity is low. These are things we might expect to see with a diabetic kitty who is likely drinking and peeing a lot. I also notice he has 1+ urine ketones and that does concern me especially considering that some of his electrolytes are out of balance. They didn’t do a blood ketone test. I’d suggest you grab some urine ketostix at the pharmacy or Walmart and keep a really close eye on his urine ketones. If you stick a large spoon under his bottom as he squats, you can grab a urine sample and stick the ketostix in it. You want to be sure you time it for exactly 15 secs and then read it. You don’t want to see any ketones. If he’s got trace or higher, you want to call the vet since he’s not yet getting the insulin he needs and his BG is high.

He’s also approaching anemia and since he doesn’t have CKD, there has to be another reason. The fact that his reticulocytes are normal tells me this is regenerative anemia so his body can still make blood cells. It’s just not right now. Things that can cause regenerative anemia include effects from fleas/ticks, internal bleeding, etc. His hematocrit should be up above 40 and it’s almost 30. Low HCT can make a kitty feel lethargic (as if the diabetes weren’t enough to make them feel that way). As Lucy said, his potassium is low. Normally, when we give insulin, we might see a lower serum potassium level because insulin causes potassium to be taken up into the cells. But he’s not getting insulin and wasn’t when this test was done. Therefore, if his serum potassium is low, it means he has even less in his cells where he needs it. Talking to the vet about a potassium supplement is a good idea. His potassium should be 4 or above. You have to monitor it closely because too much potassium is as bad as too little.

The other red numbers don’t bother me so much but I’d definitely be concerned about the ketones in the urine, the imbalance in electrolytes, and the anemia. The first two are attributable to the diabetes. It’s possible once you get him started on insulin, you’ll see these improve but you must watch them closely.

 

Having read what Marje has to say about Tigers lab work....I would definitely take Tiger to another vet. Your current vet has missed/ignored several important tests that need attention for Tiger to fully improve and quite frankly he doesn't seem very interested in helping Tiger... and I don't think he knows much at all about feline diabetes or older cats.
Marje is very knowledgeable about lab results so please take what she says seriously.

I agree with Marje that Lantus or Levemir are better insulins for cats so try and find a vet who uses one of the longer lasting insulins.

Are you saying that the test strips you bought were 1 year out of date? That is disgraceful! Definitely take them back....you won't get accurate reading with ones that far out of date, I would not think.

I would not swap to low carb food until you are testing the BSL because the changeover will probably result in a lowering of the blood sugars which is great, but you need to be testing the BSL so you can adjust the insulin dose if needed to keep Tiger safe which is the most important thing.

Please look for a new vet. Write down all the things that Marje has mentioned plus things like do they agree with home testing, long acting insulin, low carb wet diets.
I know it feels daunting to ask these questions of a new vet but you are Tigers advocate and the only one who can stand up for him and get the best treatment for him. If you are just asking the new vet questions about his treatment of diabetic and older cats, I don't think you need to take Tiger in...but I would take the lab results in. If he is good he will answer all your questions and the next Time you can take in Tiger.
When you are asking these questions just think of us all standing behind you supporting what you are doing. We have your back!

 

I got a different meter, with different strips. I was able to succussfully test MY BSL but when I tried to get Tiger this morning, I couldn't get the drop of blood from his ear. I watch the video posted by Janet, so I am pretty sure I did it right. I know the little lancet pricked, because he jumped and it actually stuck in his ear a little. I'm still so nervous. I'll get an appointment at the VCA down the street, but it won't be until Friday at the earliest.

I'm not feeling great about today. I feel like I let Tiger down. He's peeing in the litter box behind me instead of the one in the bathroom just to let me know how let down he is. I gave him insulin (probably) even though I didn't get to check his levels. I'm scared about that but I didn't want to wait another week. I'll keep an eye on him today, try to check his levels again when he's sleeping instead of antsy for food. I might have to work out another plan for feeding him. I usually leave the kibbles out and feed him in the evening so he can graze while I sleep.

 

You haven't failed him! You are doing all you can for him. And I am sure he knows it.
Well done on testing yourself.
Very few people test successfully the first few times on their cat......it will get better.
Did you warm the ear with a sock filled with a tablespoon or two of uncooked rice? Warm it in the microwave and test it isn't too hot before placing it on the ear. Hold for a couple of minutes then try milking the ear from bottom to top then try testing. You can also milk the ear after pricking it.

I always used to give Sheba a tiny bit of low carb food in the beginning when I tested her to distract her.
Always give a treat whether you are successful or not so they learn to associate the testing with a treat.
Keep trying, you will be successful.
I can't tell you the number of people I have seen here on the forum who started out just like you with the testing, and now they are testaholics!

 

There's a learning curve to it... And the capillaries haven't formed yet. That first week I was only successful half the time.

 

I got a test done before dinner! I had my husband help hold Tiger a little steadier so that probably contributed to our success. It still took two pricks because the first one didnt bead well but the second was good.

His level was 432 which is higher than when the vet tested Friday. I hope it's just that is just because the meter is made for humans.

I need to figure out a nice treat to get him for when we test because I would like to try my hand at a curve (maybe?) I want to know more about what a going on in my little dudes body. I've only been to the regular super market and they only have like regular friskies treats and I think I want to try something a little better. Or does carb value not matter so much with treats as it does with food?

 

Congratulations on your test. It gets easier, trust me. My husband and I are a team at testing also, Idjit is a big, feisty boy and I only have two arms and hands! So, Dad holds and settles the boy, and I do the poke. Whatever works for you.

Carb value matters very much, even with treats. I bake or boil chicken breast, dice it up and freeze the little chunks on a pan, then the chunks go into a freezer bag. Thaw a little in the microwave..Idjit loves this. We also use a freeze dried chicken product, Pure Bites. We got a small bag to see if he liked (he did) and next bag will be the big bag for dogs, Same stuff, less unit cost. We call it Kitty Crack here on the board. Perhaps a tiny bit of deli lunch meat that isn't too processed, if you have that on hand. What does Tiger really love?

 

Just FYI human meters run lower then pet meters.

Congratulations on getting the test!