Frustrated and Looking for a FD Vet in Melbourne, Australia

Discussion in 'Feline Health - (The Main Forum)' started by WickedChiq, Aug 11, 2018.

  1. WickedChiq

    WickedChiq New Member

    Joined:
    Jul 31, 2018
    Hi Everyone! I'm Tracey and I'm a newbie here, so thank you for the add. I am a member of the Feline Diabetes Facebook group too (so you may have seen me there already) but haven’t had a chance to get on to the forum until now.

    I will apologise in advance for this long-winded post, but this is our feline diabetes journey so far.

    We live in Melbourne, Australia and have a 14yo semi-longhaired kitty, named ‘Ash', who was diagnosed with diabetes a couple of weeks ago. He has being showing some symptoms over the last month, with gradual weight loss being the major sign that something was going on, but also refusing to eat his dry food, drinking extra water, and peeing lots. So, we went off to the vets for an elderly-kitty check-up.

    Our vet ran blood and urine tests and Ash's BG level came back at 16 (The vet said it should be 7, but I don't know what unit of measurement this is and forgot to ask the vet). Our vet then added a fructosamine test to confirm the raised BG level was not stress-induced. We had a call from the vets the next day, telling us we needed to get Ash back in ASAP to commence immediate insulin therapy. Our regular vet is usually down-to-earth and no-nonsense, but was away at a conference for a week, so we stuck seeing another vet at the same clinic to go over the dosing, etc. I have a history of animal husbandry from breeding & showing dogs & cats, so giving injections is OK for me to do, but this is our first diabetic kitty, so this has a very quick learning curve for me.

    Ash is a solid & big-boned cat to start with and currently weighs 6.67kg (14.7 pounds). Fortunately, Ash has zero interest in his dry biscuit lately, so we can limit the carbs nicely there and just give him wet food. We have been given an initial dose of 3iu of 'Mixtard', 12-hourly, which the vet clinic wants to review this Thursday (at the 14-day mark since starting insulin) with a curve test.

    I have been reading through various pages, posts and information to get up to speed on treatment, what to expect, side effects to watch out for, etc. and noticed that some people home-test for BG. When we went back to see the second vet (not our regular vet), he surprised us mid-consult and said he wanted to keep Ash for the day to do glucose-curve test before we gave him any insulin (and to confirm the dose was correct) - but this was not mentioned by my regular (down-to-earth) vet. After some lengthy discussion (and assurances from me that if there are any issues, I'll be straight back to the vets), the vet was happy for us to commence insulin but still wanted Ash back in 14 days for a glucose-curve test. Apparently, they keep your cat all day and do 2-hourly BG tests. Now, I could be completely wrong, but I would think they would just be using a glucose meter? Does anyone know?

    I asked the vet about doing home tests with a Blood Glucose Meter and he said "Oh no - Blood glucose testing is really something that needs to be done here in the clinic"....yet, I see numerous discussions about people doing it at home! So, having chatted to a couple of folks on the Facebook page, I immediately held off on giving Ash any insulin and raced into my local pharmacy and grabbed a Contour Next testing kit - We now religiously test Ash’s BG levels at least twice per day (before his Mixtard). I am also keeping a Google Sheets file of his numbers to share with our vet (that is, if they ever show any interest in us doing home BG tests). We started giving him Mixtard on the 2nd of August, and I try to run 4-hourly BG tests each day (some days we only manage 2x tests if we're out or busy with work), but I’ve even run some 2-hourly tests to do my own curve at home.

    Fast forward to now (11th of August), and we are feeling frustrated with our vet team! As our regular vet has been in the US on a conference, I had an appointment booked with him for this coming Monday to discuss us using Mixtard and what levels we are getting from our home BG testing - The clinic called me yesterday to say our regular vet is too busy with other dog-related procedures on Monday and can we just leave Ash at the vet all day for them to do a curve test instead? Roughly $350-400 for them to run this test, including hospitalisation (We’ve already spent about $700 in 2x vet visits, just on basic tests and meds!).

    Yet, I've been doing BG testing here at home, keeping results, and the Mixtard is not sustaining his levels beyond 6-8 hours (I was warned about on the Facebook group). This is precisely why I made the appointment with my preferred vet for Monday in the first place, so I could show him my results and discuss things further. I explained this to the vet nurse, but I cant help but get the impression they are not really interested in my home BG tests. I just kept being told that my home BG results will be completely different and they must run the curve test and then adjust his Mixtard dosage accordingly. (Hmmm, I sense a little bit of secret-vet-talk going on here).

    For now, I have declined to leave Ash with them to run a curve test until I can talk about the possibility of changing the insulin to Lantus, Levemir or ProZinc (as suggested on the Facebook group). So now our Monday appointment has been cancelled and we’ve been pushed back to next Thursday because we aren’t a priority (which will be exactly 14 days since we started Mixtard). Our vet is probably more involved with canine health and I'm suspecting they don't know much about feline diabetes and/or just don't want to listen to me.

    We’re in no means denying our boy veterinary care (in fact, the very opposite), and we are happy to do the curve test eventually (if needed), but I would prefer it was after he’s been changed over to a different drug and after we are seeing some consistent home BG results. Right now, I can’t help but be a bit disappointed about the whole scenario and very disappointed with our vets just telling me they must run all tests. From the patterns I’m seeing now, I can’t see how an increased dose of Mixtard is going to change the length of time that Ash's BG comes down. At the moment, his BG starts at 24 and comes down too around 11 at 4 hours post-Mixtard and his BG quickly starts climbing back up around 6-8hours post-Mixtard. At 12 hours, he’s back to where he was (and some days even higher). I fear a bigger dose will only make the peaks and troughs vary more. Maybe I'm wrong?

    So, is there any one here that can recommend a vet in Melbourne, Australia that is confident about dealing with feline diabetes please? Ideally, someone who I can talk frankly with! We are out near Berwick-way (South-East Suburbs of Melbourne), but are willing to travel. Any help would be greatly appreciated! I’ve already been referred to the Australian Diabetic Animals website, but just checking if there are other vets we should see first that folks here have seen and can recommend first-hand.

    On a side note - A huge thanks to the links and help I’ve had so far on the Facebook group. After watching YouTube videos about doing home BG tests and finding the sweet spot, the first day of BG testing was a learning curve, but now Ash knows he needs his tests and is brilliant to poke and prod! He now purrs the entire time during his BG tests and loves his little heat-sock that I made for his ear. We honestly think he appreciates his extra fuss and his insulin as he automatically goes into ‘loaf-mode’ and waits for his jab when it’s due. It must be making him feel better too, because roughly two hours later, the old boy starts getting frisky, racing through the house like a goofball and getting into mischief...just like he's a kitten again!

    Thanks for reading and again, sorry for the long post!
    Tracey.
     
  2. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Hi Tracey from a sunny UK! First, well done for doing so much research and reading about FD, it really helps to understand what's going on and how best to treat your kitty.

    I'm just dashing out but a few things - forgive me if I've misread anything you've said in your post as I read it and am writing fast, but...

    Yes, most people here on FDMB and the Facebook groups home-test blood glucose. Some vets are adamant that there's no need to or that people won't do so correctly, but there is no reason whatsoever why not. Frankly, it's the very best way to keep your kitty safe if you're giving insulin, to make sure you're not overdosing. We strongly suggest that caregivers test before every insulin shot, so usually twice a day. It's also useful at intervals to run a curve showing how the insulin is working throughout its cycle so yes, if you can use a meter to check bg before giving a shot, you can do a curve at home too...

    I have no knowledge of Mixtard but it sounds not dissimilar to Caninsulin which is prescribed on dx here in the UK - it's not a bad insulin as such but doesn't usually have the duration we want to see. It has a fast onset and is used up fast. You may or may not be right in saying that a different dose may not be more suitable - it depends so much on the individual cat and how he/she processes the insulin. But yes, there are other insulins that may be better and it's worth discussing those with your vet, although he may be reluctant to do so until you've given the Mixtard a good try.

    We would usually say that 3u is a too-high starting dose. The "start low, go slow" protocol, beginning with a 1u dose twice a day and increasing *if necessary*, is a safer and more sensible way to treat your kitty. Not only can too much insulin lead to a hypo episode but sometimes too much insulin can look like too little, and the dose is increased too quickly and bg never stabilises. So I would question dosage with your vet. Having said that, I know nothing about Mixtard so it *may* be that recommended starting dosage is different. Don't let me alarm you but check this out!

    You're not alone in experiencing frustration at the vet's attitude to FD. Sadly, most vets get very little training in it at vet school. So it's up to us as caregivers to equip ourselves with as much knowledge as we can. This board is literally a life saver so come here often, keep asking questions, and very soon you'll be more knowledgeable than your vet (actually I think you are already!)

    I hope someone chimes in here with a recommendation for a vet near you. We have a few Australian members although most are from the US, and there are others from Canada, the UK and elsewhere. Between us we have a lot of experience so even if you don't find a vet you're happy with, you can always be sure of solid support here!

    Best of luck!

    Diana
     
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  3. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Tracey and Ash and welcome to the forum. You will find this a wonderful place where you will get lots of support and help as you progress through the journey of FD:)
    I live in Sydney and will help in any way I can.
    It sounds to me as if your vet does not have much idea of FD and how to treat it.
    I have never heard of mixtard being used in animals ( but I could be wrong) but I used it in humans when nursing. An initial dose of 3 units is very high.
    A far better insulin for Ash would be Lantus which is used extensively here in Australia in cats. It is a longer lasting, more gentle insulin.
    Well done with starting to test the blood sugars. That is one of the most important things you can do for Ash, not only to keep him safe but to see how the insulin is working in his body.
    If you are home testing, there is absolutely no need at all to take Ash to the vets for a curve. You will get far more accurate readings at home than at the vets. Make sure you test before every insulin dose and about 4 to 6 hours after the shot to see how low the insulin takes him.
    Are you feeding low carb...under 10% carb canned food?
    Also make sure you have some high carb canned food as well in case Ash needs it if he drops too low.
    Also have some honey in the cupboard in case you need that as well.

    I don't know any vets in Melbourne but I will see if I can find any of our members who do.
    I would ring around and see if you can find a more suitable vet, and ask to speak to the vet and ask him
    ..has he treated diabetic cats before
    ..has he had any cats go into remission
    ..what insulin does he use
    ..is he happy for you to home test the blood sugars.
    Actually here is a link on what to ask a vet
    http://www.felinediabetes.com/FDMB/threads/vet-interview-screening-topics-check-list.156663/

    Keep asking lots of questions. It is a steep learning curve in the beginning.
    Let us know how you get on,
    Bron
     
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  4. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Tracey, you might like to give The Cat Clinic a ring and see if you think they might be good.
    They are in 1 Miller Street, Prahran, Vic.
    Phone number (03)9533 8955
    Link below.
    I have spoken to a wonderful vet who works at The Cat Clinic in Brisbane and have recommended them to someone else who thought they were fantastic. It is the same group of companies so I would imagine they would be good in Melbourne as well.
    They were excellent with FD in Brisbane
    http://catdoctor.com.au/
     
    Last edited: Aug 11, 2018
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  5. WickedChiq

    WickedChiq New Member

    Joined:
    Jul 31, 2018
    Hi Diana - Lovely to meet you and thanks for getting back to me. Firstly, thank you for the info and reassurance!

    The vet gave us Mixtard 30/70 (soluble insulin 30% and isophane insulin 70%), which was developed for human use and I believe it is a NPH? According to the drug's safety sheet: "The usual dose is between 0.3 and 1.0 international units (IU) per kilogram body weight per day. Mixtard is given 30 minutes before a meal. It is usually given once or twice a day when a rapid initial effect together with a more long-lasting effect is needed."
    (Now, this leaflet is for human doses).

    Ash is currently a solid 6.67kg (14.7 pounds) and the vet did tell us that we needed to start low and go slow too and that we might need to raise it so we did not send him hypo. I've read other people's posts about doses and see they are generally on 1-2u, and some even talking about half-doses - so I have been scratching my head about the dose too and pondering just how high of a dose they plan to take him. As I haven't been able to get hold of our regular vet due to him being away, it's been hard to talk frankly with the other vets....they just want us to drop Ash off for the day so they can run their curve! Don't get me wrong, they have been thorough, but the last one we saw was young and new to the clinic and a little vague with it. He also had to check with another senior vet on a few matters (including whether we could start giving Ash the Mixtard at home without them running their curve test first) and that didn't sit well with me, so I re-booked with our regular vet when he got back (annnnd he's now cancelled on me).

    I have been religiously charting every BG test and the exact time Ash has his insulin doses. I also try to make sure his food is recorded with some accuracy too (sometimes hubby forgets to tell me he's fed him a can!). We have not deviated from the 3u dose of Mixtard 12-hourly and the very lowest BG number we've seen was 11.4 (4 hours post-Mixtard) - But if anything, his numbers we are seeing a trend where his number have gone up from the initial vet clinic blood tests, when they had a result of 16 - Ash's highest BG count is usually right before he needs another dose of insulin and sits around the 21-24 mark (his highest was 27.2 yesterday morning). Now, my questioning mind has pondered if the Mixtard is actually increasing the readings because the dose might be too high or is there other factors to consider....I'm not sure. My hubby has noticed that Ash seems to be drinking more water again and his poo's have become a bit paler and more-yellow colour (I haven't seen them and hubby, was wonderful in cleaning his tray and promptly flushed them down the loo - I'm slowly teaching hubby to record everything or at least tell me!). I will keep an eye on this too. One thing we do notice is he turns into a mischievous little kitten in the first fews hours after his insulin. His coat is no longer as greasy and he looks brighter all round. But when the insulin wears off he gets very tired and just sleeps....we really notice the difference.

    Actually! - I just had a thought and looked up the Merck Manual. It states:
    "It is usually preferable to have blood glucose testing performed at home to avoid changes in the pet’s routine and the stress of in-hospital testing. Studies in both dogs and cats have shown that at-home monitoring improves glycemic control and increases the likelihood of obtaining remission in diabetic cats. In cats, high-protein diets along with insulin therapy are initiated, with reevaluation in 5–7 days. In newly diagnosed cats, insulin glargine is the insulin of choice. Glargine is a long-acting basal insulin. Used in conjunction with high-protein, low-carbohydrate diets, it is associated with remission of diabetes and discontinuation of insulin therapy in 80%–90% of cases within the first 3–4 mo of treatment. NPH, lente, or PZI insulins may also be used in cats, with starting dosages ranging from 1 to 3 units, bid. However, these insulins are not associated with high rates of diabetic remission."

    Ouch. And yet, I keep coming back to was the younger vet told us, in that home BG monitors aren't as accurate as a lab test. If this was the case then how do human diabetics go with these inaccurate monitors (I must ask my diabetic friends about this)?!?!!
     
  6. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Hi again Tracey
    You're well on top of all this I can see :) . FD is a learning curve and you'll find you discover new things every day. You've already seen that vets simply aren't as clued-up as we'd like them to be. They get very little training in FD so a lot of the time in their practice they're just spouting the theory - which isn't always the way to go with a disease like diabetes. Apart from anything else, every cat is different (ECID, a phrase you'll hear a lot here) so if I were you, I'd listen to the vet, ask questions, read up here and ask questions here too... and then make up your own mind about the way forward. What you're experiencing isn't unusual at all, but most people on this board slowly learn the logic of what we're saying and either find a new vet who speaks the same language, as it were, or nod their head obediently but don't follow instructions! We don't advocate making an enemy of your vet so the best bet is to tactfully educate him/her or ring around and find one you can work with.

    I'm glad you're questioning the dose. 3u is just too high for a starting dose. I know it's hard to go against what the vet says but we on this board will pretty much all advise you to drop to 1u. You may well find that the dose doesn't last as long, in which case you start to increase by increments of 0.5u or 0.25u every week or so, until you find the optimum dose. Starting out at 3u may mean that you're inadvertently overdosing and missing the ideal dose. OK, you don't want Ash staying in higher numbers for any longer than he needs to, but it's more important to avoid the risk of hypo which can be scary.

    You say you're keeping a log of bg readings etc which is great. Now what we need you to do is transfer that data onto a spreadsheet and link that to your signature here so members reading your thread can click on the link and see at a glance what dose of insulin is doing at what stage in the cycle. If you're not technically minded we have people here who will set up a ss for you very quickly and you can just keep it updated. This is really important when it comes to us giving advice. Meanwhile, it would be good to give us some data in the following form:

    AMPS (morning pre shot bg number) - xx x units given
    +2 (2 hrs after insulin) - xx
    +4 (4 hrs after insulin) - xx
    +6 - xx
    +8 - xx
    +10 - xx
    PMPS (evening pre shot bg number) - xx x units given

    This is a curve. You don't need to do a full curve every day, but when you do, it will contain the data above. Imagine plotting the numbers on graph paper. Ideally we want to see a nice shallow curve, like a gentle smile, not a steep quick drop and then a sharp fast rise that looks more like a V shape. Does that make sense? At the moment, Ash is feeling better with exogenous insulin in his system, but not so good when it wears off... hence the need to either work towards a more appropriate dose, or switch to a gentler, longer lasting insulin.

    I know you raise other issues but I'll leave it there for now and see what others would like to say.

    You're doing great!
     
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  7. WickedChiq

    WickedChiq New Member

    Joined:
    Jul 31, 2018
    Hi Bron! - Thanks for your advice and reminding me of The Cat Clinic in Prahran! I know of them, but have never been there. Certainly have heard good things about them, ony that Prahran is a nightmare to drive to! I will certainly add them to the list though - thank you.

    I have been doing BG tests every day since we started giving him the Mixtard - with most days being 4-hourly. On a couple of days, he has only been tested twice in the day (once before each insulin dose) and if I hadn't run 4-hourly BG tests on the other days, you would think the insulin did very little for him as the numbers are usually around the same level. I work from home so I've even been able to run a couple of 2-hourly tests but have seen mixed numbers both times with those too - I might try to run another 2-hourly test tomorrow for comparison. After 9 days of home BG tests, I'm not convinced this insulin is the one for him as his numbers are still rather high and his BG doesn't seem to be sustained beyond 6-8-hours - Most times, at the 8-hour mark, his BG is right back up to where we started in the morning.

    My common sense said he needed to be on a low-carb diet (am seeing a dietician to shed some extra pounds myself and carbs/sugars have been cut, so that only made sense that Ash would need to do the same) - Yet, the new, young vet we saw the other week told us we didn't need to change his diet, but that he shouldn't be given any biscuit. Not giving him biscuits has been pretty easy, as that was one of the symptoms that made us take Ash for a check-up because he went off his biscuits and refused to eat them (and he LOVED his bikkies!). - He's a foodie, but also a pain in the butt and can be a picky eater! He isn't overly keen on raw meat or roasted chicken....although, I did manage to entice him with some beef fillet steak the other day (typical of our cats....they like the expensive stuff!!!! LOL!). So we have him on his 'regular' 75-85g canned foods like Fancy Feast (Aust) Gourmet 85g canned, Hills Science Pouches, Royal Canin Pouches, and we've also bought Applaws (I read they were low-carb), IAMS grain-free, and some other gourmet canned....we're currently trying a few different low-carb foods, despite the vet saying we could feed him any canned food we like.

    We also have my kitty 'Boo' (my tubby 8yo Devon Rex civie) here too - so high carb foods are in the house if needed for Ash. Although, technically speaking, Boo could do with shedding a bit of weight too! - We did notice on Day 4 of treatment, that Ash raced over to Boo's biscuit bowl and started munching on his remaining Hills Science biscuits (there were about 6 biscuit crumbs in the bowl) - this was the first time Ash has been interested in any biscuit in a couple of weeks - but we promptly took them up and now make sure he can not access them at all.

    Thanks for the reminder! - I need to get some more honey but we have a range of other liquid sugars ready to go like maple syrup, karo, etc. but with the BG numbers we've been seeing, Ash has been OK so far and has had no hypo signs.....finger's crossed we don't end up there.
     
  8. WickedChiq

    WickedChiq New Member

    Joined:
    Jul 31, 2018
    Hi Again Diana,

    Yes, I don't want to upset my vet (he looks after our dogs, so we still need to remain cool and calm!). I started a Google 'Sheets' doc so I could share the info with my vet withour forgetting to take it withe me - hopefully, this link will work and you can see the data I have so far. I can re-edit it to be a bit easier to read.
    https://docs.google.com/spreadsheets/d/1iWReGEKUVOV6U1l9l8OjcuMbUuNlG8foTNJCiE8QmlE/edit?usp=sharing

    You will see from the numbers that, on average, his BG comes down to around half of the starting figure - but by 6-8 hours, it starts to go back up. Of course, this could be dependent on what he has eaten in the day (and what carb/sugars are present in those foods), and whether or not his pancreas is 'waking up' (so to speak) and producing a littke bit of insulin as well, for example.....and maybe other factors like his fluid intake, energy exerted, etc.! (Or am I over-thinking things?)
     
  9. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Your Google sheet doc is great, Tracey, but there's a template somewhere around here that you can use (sorry not sure where but hopefully someone will link it) that will standardise your data so we're all familiar with the format. Specifically, we don't use clock times as we're all in different time zones, so we use the +1/2/3 etc format so we can see instantly how the insulin is being utilised and whether it's as we'd expect... or not.

    No, you're not over-thinking things! All the factors you mention and more can and do play a part in bg numbers. You may be surprised what affects numbers but you'll find out as you go along. You may have to be prepared for this to take a while - another expression we're fond of trotting out is that "FD is a marathon, not a sprint". But you've got a good head start :)
     
  10. WickedChiq

    WickedChiq New Member

    Joined:
    Jul 31, 2018
    Thank you! - Yes, I just looked at a few of the other's member's SS on their signatures. I just made that SS up myself so I had something to show my vet in a handy location. All good though, I will find the template on the site and transfer the data over. - It's certainly a much better layout than what I have right now!

    Ahh, it's a story for another day, but I'm a bit of nerd and tend to research and read up on medical/science stuff - the result of having family with rare illnesses, you question everything!!!
     
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  11. WickedChiq

    WickedChiq New Member

    Joined:
    Jul 31, 2018
    I found the link to the template! - It's just past midnight here and I'm lacking sleep. I've made a copy, so I will transfer the numbers over tomorrow. Thanks so much for your help and advice! :)
     
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  12. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Yes leave it till tomorrow, there's no panic. Get some sleep!
     
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  13. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Tracey,
    You are getting lots of good information from Diana.
    Glad you found the SS info and how to set it up. If you have any trouble, just yell and someone will help you.
    Too much insulin can look like too little insulin so that is why it is best to start with a low dose and gradually work your way up in small increments (0.25 units) so as not to miss the best dose.
    One of the problems with insulins such as Mixtard is that they are short acting and while it might bring Ash's BSL down for a few hours, by the time the next dose is due, Ash has been back in high numbers for probably 4 hours or more which is far from ideal.
    One of the long acting insulins like Lantus, Levemir or Prozinc will give you a much longer coverage.
    Levemir is relatively new out here so your vets may not have heard of it. When I started it, in probably 2015/6, my vet, who was fairly up to date with FD, had not heard of it but after reading up on it was happy to prescribe it for Sheba. I heard of it from FDMB. Most cats that I have heard of out here are prescribed Lantus.

    I am concerned your appointment for the Monday was cancelled and you were put back til Thursday because 'you were not a priority'. Whenever I rang up for an appointment with Sheba for something to do with her diabetes, I was always fitted in that day. . I think putting off a newly diagnosed cat for 4 days because he is not a priority is terrible. I wonder if your vet made that decision or was it one of the nurses at the front desk?

    If your other kitty Boo is over weight (that is a risk factor for FD) I would check out the biscuits you are feeding him for carbs. If you could get him onto a low carb wet diet, that would be far better for his pancreas.
    Here is a link to various food charts.
    http://www.felinediabetes.com/FDMB/threads/links-to-food-charts.174182/

    Also with regard to the high carb food for Ash in case of low numbers, canned food is recommended, not dry food, as it is not absorbed as quickly as wet food and usually when you need high carb food you need it to be absorbed quickly.
    Also karo is just as good as honey.
    Bron
     
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  14. WickedChiq

    WickedChiq New Member

    Joined:
    Jul 31, 2018
    Hi Bron! Thanks for the info. I've just popped everything into the SS and added it to my signature below (I'm slowly getting the hang of things!). Now that I can see the numbers a bit more clearly, I'm wondering if the Mixtard dose is too high as the numbers pre-dosing are much higher now than what they were in the first couple of days of testing. Hmm. I'm wondering if the dose is giving a false high. I've already given Ash 3 units this morning, but I'm thinking I might pull that dose back to 1 unit tonight and again in the morning, run a 2-hourly curve, and see how he goes....I'm curious now to see if a lower dose has the opposite effect (if that makes sense). I only have BD Ultra-Fine II 0,3ml (30unit) Insulin Syringes that are graduated at 1 unit, so the best I can do at the moment is 1x unit doses (0.25 & 0.5 might not be accurate).

    I'm not entirely sure who is rejigging the appointments at the clinic and I agree with you. I'm far from happy and we've never had this problem with them ever before, so I am in still in a bit of shock to be honest! My initial reaction was to change vets immediately for Ash but I do suspect the nursing/admin staff are being a little tricky too - but I can't be sure. It was a bit of a battle to get the Monday appointment in the first place with one vet nurse, who insisted we MUST do the in-clinic curve before we discussed medications! I was very politely-firm with her in person and told her "No - I want to book an appointment with the vet first please - then, if needed, we can do the curve after we have discussed everything"). One of the other girls (who I normally deal with there) called me Friday to rebook the appointment, and again, tried to convince me to bring Ash in for the curve test first. I told her to give our vet a message that I was home BG testing and that I did not think the Mixtard was lasting as long as it should - that I was not happy with the results I have been seeing. All she said to me was that she "respects my wishes" but that Ash needs to have a curve test as my home BG testing will not be accurate. Sigh! So again, I politely told her I wanted to see the vet first and go over things - that I'm not denying or avoiding testing, but that I want to thoroughly discuss where things are right now, and if needed, we can run the curve after.

    So far, just about everyone I've spoken to in the FD circle have assured me that I'm already running curves each day!!!!! (Which is what I thought too!)

    I do know that our regular vet is constantly very busy and does a lot of urgent & specialised procedures for dogs (we take our dogs to him and he IS very highly regarded) - I completely understand that emergencies happen, but to be pushed back 4 days doesn't sit well with me either. I'm not sure what to do. Hubby & I are thinking we will keep the appointment with him for now as I'd really like to get a copy of the lab blood results for reference (I haven't viewed them, and have only been told the BSL number was 16) and I would like to see what the vet says about my home BG testing and my concerns. We have pet parrots living in the house here too (yes, we're quite the mini-zoo!) and we see a completely different avian-specialist vet for them as our regular vet does not treat birds at all - So we are quite OK in changing to a FD-specialist if needs be. Having dealt with our vet a lot in the past, it doesn't sound like he's the one rejigging things....he's usually very down to earth and open to home monitoring. Ahh, I'm very frustrated & confused!!!
    Thanks again, Tracey.
     
  15. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Good job getting the SS up and running and good info in the remarks column.
    Try and get some tests in, in the PM cycle....at least a 'before bed test' to check Ash is not dropping too low.

    I have to admit I know nothing about Mixtard dosing with cats, so can't really help you there at all. I don't know what syringes are used with Mixtard either but I imagine the ones they gave you are correct.
    I used to give doses of Lantus in 0.25 increments using 1 unit syringes. I used to eyeball the dose with the help of a magnifying glass.
    We don't have syringes with 1/2 unit markings here in Australia, but we can buy them from overseas and they arrive in about a week. But you will need to wait to see if he will swap you over to the Lantus before ordering anything.

    If you go back to 1 unit, you will need to be testing the urine for ketones. You can buy Ketostix at chemists for about $12.
    You just have to collect a sample of urine from Ash and test it as per instructions on the bottle. Anything above a trace of ketones needs a vets attention.

    I would definitely push to get him changed over to Lantus. You will have longer duration and hopefully not so much spiking of the numbers. And you will be able to get help here on the forum as many of us use Lantus.

    If your vet specialises in dogs he might not be the best person for Ash and FD. Diabetes in dogs is not treated exactly the same way as it is in cats. I understand emergencies as well but emergencies a week in advance doesn't add up:rolleyes:

    The bottom line is you have to be comfortable with it all. You are paying the bills and the vet is working for you, not the other way around. Ask for a copy of all his test results...they are yours....you paid for them..if you decided not to go back to them I am sure your next vet would ring and have them faxed over ....also you could ring for them to be emailed to you.
    You are Ash's advocate so don't be afraid to stand up for yours and Ash's rights.
    Bron
     
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  16. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Ditto to everything Bron says - ketone testing, new insulin, poss new vet.

    You could also consider at this point, or soon, starting a new thread and leaving out mention of your location in the heading - it might be putting people off reading it, thinking that they don't know any vets in Australia. You have other, ongoing queries for discussion as well so you could summarise the situation in two or three sentences and then I think you'll get more eyes on the thread.

    Well done on getting your ss going, it's vital to help us understand what's going on, and the evidence will be there in black and white when you ask the vet for another insulin!
     
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  17. WickedChiq

    WickedChiq New Member

    Joined:
    Jul 31, 2018
    Thanks Diana,
    Oh, I know! - I'm only just scratching the surface at the moment! And ketones?! Yes, I have read about them, but I am yet to discuss these with the vet! Sigh.

    Should I edit the title of this thread or just start another? I have had some great responses and help so far, and I can't thank everyone enough for the great advice. :)
     
  18. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Ketones can be nasty so VERY important to be aware. You're getting very high numbers, although if both food and insulin are in the picture, the risk *may* not be as great. You can test at home.

    As for a new thread, you could carry on with this one but a lot of people who would otherwise be commenting aren't clicking on it because the title says you're looking for local knowledge in Australia, and very few people here would be able to help with that. We've covered most of the basics here but maybe if you think you have a specific query, start a new one then... and say upfront that you've already posted and got the general idea (you could link to this thread for completeness) ... and then ask your new or ongoing questions. You may get some duplicate replies of what we'e said here, but there's no harm in inviting more people to get to know you and your story - it all helps in the long run.
     
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  19. WickedChiq

    WickedChiq New Member

    Joined:
    Jul 31, 2018
    Great! Another curve ball...and just when I thought I was nearly under control! I have no idea how we will be able to capture urine from him. I have watched my old (now retired) vet palpate our old cat to obtain a urine sample but I have never had to do it myself. He did tell me it was a little bit of an art some days, but I think I will resort to a blood ketone meter for that one!

    We already reduced Ash's Mixtard insulin dose tonight, right back to 1u - I did a BG test at +2 hours and he had dropped to 18.3 from 25.1mmol/L. I will try to do another BG test at +4 hours (1am here! - If I can last that long!). He is actually being very frisky at the moment....and being quite a goofball, trotting about the house and bashing on all of the closed doors (he likes to do this to every closed door....it's his way of telling us the door should be open!) - I've just fed him a low-cal, canned chicken meal and he seems quite OK.

    I have nothing here tonight to measure his ketones, so I will have to try and find something tomorrow....or do I just put his dose back up to the 3u the vet originally prescribed.
    Thanks for your help!
     
  20. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Yes I know it's tough to hear that there's something else to worry about and certainly it's not always easy to get a urine sample from our kitties! You may have to resort to all sorts of devious ways. We have a newish member in France, @Tilou , who I recall has a feral cat - she may have some tips for you. As Ash is looking so good atm, he's probably fine, this is just something to be aware of.

    As for insulin dose whilst you work out a way to test for ketones - I'd probably plan to stick to the 1u but let's see what results you get for the rest of the day. That's actually a decent drop at +2 and it will be very interesting to see what duration you get now. It may be that the 1u won't last long but maybe it will do nicely... we just don't know, this is all trial and error. The only thing I would say that it's best not to tweak the dose too often, especially in the early days, as the waters start to get a bit muddied and it's hard to see a true picture. This is why a ss is so very important - without bg data it's impossible to see what's going on and what to try next.

    Hang in there!
     
  21. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Just a thought...
    One of the leading researchers on feline diabetes in Australia is Rhett Marshall. He's a former associate of the world renown Jacquie Rand (U of Queensland). He's with the Cat Clinic (scroll to the bottom): http://www.thecatclinic.com.au/meet-our-staff. If you ring him up or send him an email he'll probably be able to refer you to a vet in your area who is well versed in the use of Lantus and feline diabetes.
     
  22. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    @Jill & Alex (GA)
    Great idea to give Rhett a ring or email him.
    Rhett Marshall was the vet I was referring to in my above post. I emailed him several years ago, before I found FDMB, when I was having trouble regulating Sheba, and he rang me back and spoke to me. I was at my wits end, my vet had run out of ideas and I didn't know what to do next. Rhett was wonderful. Talked to me for nearly half and hour and gave me the confidence and tools to keep going. Also said if my vet wanted to ring him he was fine with that. I also recommended him to one of our members as she lived in Queensland and was looking for another vet, and she found him great too. (That kitty has sadly gone to the rainbow bridge from an unrelated illness).
     
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  23. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    @Bron and Sheba
    I had a brief email correspondence with Dr. Marshall about an aggressive approach to treating feline diabetics with Lantus many, many years ago. I also found him to be very gracious, kind, and helpful...
     
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  24. Tucker

    Tucker Member

    Joined:
    May 22, 2018
    Hi There, I'm in Adelaide and our vet told me her 'go to' person for advice about diabetes is Dr. Linda Fleeman from Animal Diabetes Australia and they are located in Melbourne. Here is the link to the practice: https://www.animaldiabetesaustralia.com.au/services/

    If I lived in Vic I am pretty sure this is where I would be taking Tucker. The fact that the head vet always sees your cat so that she is in tune with him...wonderful and also that they loan out glucose monitors shows that unlike most vets in Aus, they are into home testing. Take a look at the link and see if this might be a good place to go for a second opinion if you are not getting what you or your baby needs from your current vet. Good luck!
    Services
    Personalised expert diabetic control
    Every diabetic dog or cat is different and so requires individualised care. Their owners are also unique and must incorporate caring for a diabetic pet into their current lifestyle. The Animal Diabetes Australia service finds solutions for the particular challenges of each case. A key to success is that the same vet (Linda Fleeman) sees the pet each time.

    Diabetes education
    Diabetes is a disease that requires life-long management in dogs and cats. The treatment is mainly administered by the animal’s owner and thus is associated with considerable responsibility on their part. To succeed, it is crucial that owners of diabetic pets have a very good understanding of the disease and its management. The Animal Diabetes Australia service provides personalised education for owners on all aspects of diabetes care.

    [​IMG]
    Loan of blood glucose meters honours the memory of Mr Cosmo

    Loan of blood glucose meters
    Glucose meters are available for loan to any clients of Animal Diabetes Australia interested in trying measurement of blood glucose at home. Testing a cat or dog’s blood glucose can often assist with management of their diabetes, especially when other means of monitoring in the home environment do not provide sufficient information.
     
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