Met with my Vet today

Armed with all of the information I've learned/gathered here! Started out the meeting with me thinking I would be switching Vets but by the end I feel like we were at least meeting in the middle. Or maybe she just realized I wasn't going to follow everything that she was saying...I feel like I spent $45 to spend 15 minutes (sans cat) telling her what I was doing and why, and what I am considering for the future. A bit annoying, but oh well.

The bullet points:
She thinks the wet DM food is best and really tried to get me to switch to that. I politely declined especially after hearing 24 cans would be $38.

She said the problem with meters meant for humans is that they are off anywhere from 20-40pts. No news to me! She really wants me to bring Kazi in for a fructosamine test because its "an average and more accurate". I countered with what is more accurate than actually SEEING the numbers every single day at specific hours. I am using the same meter every day, so while those numbers are probably off by 20pts or so its that same degree of difference on a daily basis...so its accurate within her numbers.

She still wants to see her "at least every once in awhile" and didn't think the quick blood draw it took would stress her enough to jack her BG up. (IS there a valid reason for the fructosamine test when I am doing hometesting?)

She said the 2 insulins she uses are lantus and Vetsulin. They always start with vetsulin because it is so much cheaper, and feels that the issues w/vetsulin have been worked out. No issues in any of her clients and has only switched 1 cat over. Said the lantus can cause your cat to hypo more readily than the vetsulin. Kazi has been giving me increasingly good numbers (she agreed) on the vetsulin so I will be sticking with it for a few weeks yet. If at that point I am not satisfied she said she was more than willing to give me a script for the lantus.


By the end of our meeting she seemed to understand I wasn't fumbling around in the dark and pulling info from random places. I knew what she was talking about and was able to bring things up or respond to things with the 'correct' answers. So while we don't necessarily agree on everything she seemed okay with what I was doing. At one point she did ask who "they" was though. LOL

 

Your vet doesn't seem too bad.

Regarding a fructosamine test, the only reason I would get one if I noticed continued extremes in BG like from 50's to 400's. The test would show if the average was OK. Otherwise, I would not have one done.

Regarding Vetsulin, I do not see any update on Vetsulin's site that says the problem is resolved. The lasted in for is the Nov 2009 page stating the problem. I would go with the Lantus. If you buy the 5 pack of 3 ml disposable pens or cartridges the cost (except for initial cost) is not that bad. Buying the lantus by a vial is expensive since it usually goes bod before less than half is used.

 

My vet does not believe that fructosamine tests have much value.

Since you are hometesting, you can compute a 14 day average - it won't capture all the highs/lows - only the times you are testing.

We just did a 30 day average of Tiggy and Rusty;s PRE-SHOT numbers --
Tiggy was 111 and Rusty was 115

Both are well regulated on Levemir and Wellness canned.

 

I am a human diabetic and the standard of care for humans is to use both daily meter readings and HbA1c (human equivalent of a fructosamine). I don't think a fructosamine is absolutely necessary, but Angus got one every 6 months. First, I wanted his standard of care to match mine. Second, it gives your vet lab proof that your meter readings are accurate and that your cat's diabetes is in control. Remember, vets have to deal with some owners who claim to be following instructions, but really aren't. Finally, meter readings are only a spot check. The fructosamine gives an average so it catches aberrations like dropping too low overnight or high spikes after food which a meter may not catch since you are not testing continuously.

If budget is a concern, skip the fructosamine. If not, I would get one done when you think you have Kazi regulated.

 

I second L&K's concern about using vetsulin. It is a faster acting insulin - so I don't know why your vet would be more concerned about hypo with Lantus, and there can be quite a bit of variance in the stability and effectiveness per vial. I would strongly consider going with Lantus imo.

 

We were on Vetsulin too, and our vet wouldn't give us anything else til they ran out of supplies last month! They huffily told us, "It hasn't been recalled, it has been discontinued." :roll:

Your vet sounds like ours. She isn't really down with the hometesting thing at all, but understands that we're going to do it anyway. Sebastian hasn't been back since he was diagnosed a year ago. And we don't plan on taking him back unless they just force us to (refuse to give us insulin anymore without seeing him.)

 

Sounds like you have learned a lot and are heading in the right direction.

Your vet sounds typical, not completely up-to-date and sticking to what they've learned. Really, what professional likes to be told that you don't want to listen to their advise because you found a better answer on the internet?? Thankfully there are vets out there that see the value in a concentrated network of hands-on information that a site like this gathers.

Mine, thankfully will only prescribe Lantus to newly diagnosed cats because it has the best regulation and reconversion rate (her words) and it baffles when that any vet thinks that a cheaper insulin in more important than that. How is it cheaper to be on insulin forever than get off of it? I paid $300 for insulin with $160 worth of that in unopened pens still in my fridge, and, being off the juice, hope to never put another nickel into the stuff.

Keep learning, keep educating. Maybe the next diabetic cat that crosses your vets path will get better treatment.

 

> it baffles when that any vet thinks that a cheaper insulin in more important
> than that. How is it cheaper to be on insulin forever than get off of it?

I agree with this. However, I also know that my vet, who is extremely caring, and who knows me very well and knows that I would do anything for my cat, was also afraid to give me the diagnosis. *Literally* afraid. Because she had to ask me, "Do you want to treat?". If she had to ask *me* that, and was afraid of my answer, how many other, otherwise-healthy cats has she had to euthanize?

Not that this was our situation, but for many folks, you have a cat who's been healthy all of it's life, with maybe $150 a year in medical bills, and then she acts a little off. So you bring her in and go through all the diagnostic tests and everything and get hit with a multiple-hundred dollar charge for the tests, and *then* are told that you need to buy a couple hundred dollars worth of supplies to treat ...

Given that, I can see vets trying to find ways to minimize the financial shock and decrease the chances of euthanasia. It's probably easier to get folks to agree to the more expensive insulins once they've had time to afjust to the diagnosis -- and recover from the initial bill for the diagnostics -- and have already committed to treating the diabetes. If/when the Vetsulin doesn't work, you can say, "Well, she's not doing well on Vetsulin, but there's another insulin available and it actually has a better chance of getting your cat into remission, but it's a bit expensive. Would you like to try it?", and have a much better chance of getting a Yes.

And I also know that I would *not* want to be a vet having to deal with situations where folks decide not to treat otherwise healthy family members.

 

I am just glad I found this message board- if not for you guys she would be on dry food that costs an arm and a leg and not being hometested. I am POSITIVE she would have hypo'd by now if not for hometesting.


For today I am doing a happy dance. AMPS were 147 so no insulin, PMPS were 136 (I checked twice, the first time it said 133!). :mrgreen: