my vet is useless

Hi all, just wanted to have a frustration rant!

My cat Molly was diagnosed 3 weeks ago, and had a glucose level of 24 (432) she was put on insulin, and the vet told me not to worry about changing her diet!!!, after numerous trips to the vet and getting nowhere, and after i had o over the initial shock, i started to do some research and decided to change her diet, the vet had left her on 3 units of insulin, and last Saturday we had her first really low reading as she was on to much insulin, i then got a home testing kit and good job i did, i continued to moniter her glucose levels and a different vet dropped the amount of insulin, she has been on 1 unit and that has proved to be to much for her, as her levels are now reading just over the normal range.

I dropped my chart of test results to my vet who called me and i had the most frustrating conversation with her, she kept asking me the same questions even though i had already told her twice, she didn't seem to understand the readings and info i had given her ( hardly rocket science!!) and she even had the nerve to say oh she was doing so well before!!! what is that about is the aim not to get her to a normal range and for her not to be on insulin, or little insulin???????????? eventually after me getting really frustrated we agreed to not give her insulin tonight and monitor her glucose levels. I am over the moon with the progress we have made with her over such a short time, and it is quite frightening to think if i had just left her care to the vet what state she would be in, so thank you to all the people who put information on the web and for this site for the support and information i needed to help my Molly get better

 

So many of us have had problems with our vets one way or another so people here really do sympathize. And it's perfectly OK to rant here - a lot of us have hit that point more than once and known that this is a safe place to vent where people will understand! A lot of vets seem to think that home testing isn't necessary, if you're going to change the food it needs to be to a prescription food etc. You are doing everything right - you've fixed Molly's diet, you're home testing (and a good thing you are after getting a low reading on the insulin the vet had put her on). My vet also started out questioning everything I did - they didn't like that I'd taken Rosa right back off the prescription food after one meal (she wouldn't eat it anyway), they didn't like the food I was giving her, they didn't want me changing her dose or home testing or just about anything else you can think of. Oh and they hated the idea that I was following a protocol they'd never heard of. What they really wanted was for me to give insulin without knowing what it was doing and to pay for a curve every 2 weeks at their office (which would have given them high numbers anyway as Rosa suffers from extreme vet stress). And what happened with my vet is not all that unusual. Funny how they've gone quiet now Rosa's OTJ!!

Because of problems with vets, a lot of us use the "smile and nod" principle when speaking with our vets and then go home and carry on doing exactly what we've been doing to help our cats. That way we can still get prescriptions for insulin when we need them but we're not questioned every other day about why we're doing this the right way! Unless your vet is refusing to work with you or telling you to do it their way or find another vet, that seems to work quite well for a lot of people.

It sounds as though you're doing a fantastic job with Molly getting her down from 3 units in just a few weeks. Please don't let questioning by your vet (who most likely doesn't understand Feline Diabetes the way people here do) make you think otherwise.

 

Hi, thanks for your response, and nice to know its not me losing the plot! lol, I will also adopt the smile & nod approach, sounds good to me. I am glad they are not refusing to work with me but I think at my practise they are not used to someone taking control and are not quite sure how to deal with it, in fact the reception staff seem much more knowledgeable than the vets, but like you say its great to have like minded people and somewhere you can have a rant and get some advice perfect! Keep up the good work, Lorraine

 

Hi Lorraine! Are you in an area that would have multiple veterinary offices? If so, I'd do some checking around, you might find a vet well versed in the treatment of feline diabetes. I'm glad your kitty is doing so well!

 

I think most of us have encountered that problem at some point - it used to be doctors who didn't like anyone asking questions about their treatment, but a lot of vets still seem to have the idea that none of us self-educate on our cats' conditions so we should just do what they say. Having an owner take control of the situation is all new to them - maybe if we all work on it, we can start to help them learn that people are better informed now and need to be able to be involved in decisions about our pets!

 

My vet tried to push me to buy the Alphatrak...I told her I couldn't afford it....she said "Really, it's only $200.00". I laughed at her and said "Yes, really!" And one of the vets in the same office (not our usual) actually said she wasn't interested in seeing Petey's spreadsheet!!! WOW! We'll only be seeing our usual vet from now on!

 

I have another question please if I have to give my Molly half of 1 unit of insulin to her, do I have to dilute it? my vet made some reference to this but did not tell me anymore ( surprise surprise ) can anyone tell me why you would dilute and more importantly how I would do dilute it. Many thanks Lorraine

 

You shouldn't need to dilute it to get a half unit dose. I don't know what's available in the UK for syringes with half unit markings - @Elizabeth and Bertie do you know if there's anywhere in the UK you can get these? If not, you should be able to see half a unit in the syringe - with smaller doses it is sometimes necessary to either eyeball the dose or use calipers to measure a smaller amount. Or, depending on what insulin you're using you might be able to use U100 syringes with U40 insulin using a conversion chart to make measuring easier. The issue I'd have with diluting is that I'd have thought you'd have to dilute a reasonable amount in advance to make sure you were getting, for example, 50% insulin and 50% water and I'm not sure how long you can keep insulin like that after you've diluted it given that in the main diluting insulin isn't recommended (though I know people have done it successfully).

 

Hi Lorraine,

Can I just clarify a couple of things:
Are you using Caninsulin? And do the syringes you're using have half unit markings, or just whole unit markings? Or are you using the Caninsulin penlet thingy?

Caninsulin is a 'U40' insulin (40 units per ml) and is usually used with corresponding U40 syringes.
However, as April says above it is also possible to use different syringes (called 'U100', and designed for use with 'U100' insulin) with a conversion chart to make it easier to measure small doses.

If it seems like you may want to try these other syringes I can send you some of mine to try out.


.

 

Ah that's really kind of you to offer, I am using Caninsulin , but the syringes have whole markings, I am being a bit premature with asking about diluting but one unit seems to drop her levels to low at the peak time, so my brain is thinking of the next option lol, I will see what her results are tomorrow Thanks though

 

Yes, it looks like one unit is too much, Lorraine @Lorraine Edwards

On your other thread I think you said that Molly dropped to 3 (54,US). And you're using Alphatrak meter? That reads higher than human meters so we would consider that '3' to be something like 2 (36) and that is too low...
Are you able to 'eyeball' a half unit with the syringes you're using?
(And I would suggest holding off on changing Molly's food at all (to lower carb) until you're confident that you can measure smaller doses of insulin...)

Edited to add: Going to tag BJ @BJM who, I think, has some nifty ideas for measuring small doses.
.

 

What insulin are you using? Most insulin can't be diluted. That includes the human Lantus and Levemir.

 

It's Caninsulin/Vetsulin, Larry.

 

That is a U40 insulin so using U100 syringes can get you a pretty good 1/4 unit increments with 1/2 unit marked syringes.

 

Hi there, it is caninsulin she is on, if the insulin cannot be diluted maybe if 1 unit drops her levels to much I will have to feed her at the drop points to stabalise it?

just read your last post with regards to the syringes thanks for the info that really helps

 

If you have a sturdy ruler with millimeter markings or 32nds of an inch, you can use that to line up the syringe and measure smaller doses than full units. Calipers are even more precise. Magnifiers can be very helpful when measuring smaller increments.

 

Lorraine,

The ones I use are: 'BD MicroFine 0.3 ml demi insulin syringes' (the 'demi' ones have the half unit markings), and I get them from VetUK, but they are available elsewhere also: http://www.vetuk.co.uk/veterinary-s...rofine-0-3ml-insulin-syringes-u100-demi-p-296

Not everyone is comfortable using different syringes and a conversion chart, but if are you OK with it then it can make measuring small doses of U40 insulin a heck of a lot easier, and more accurate.
U40 insulin is 2.5 times as 'strong'* [correction, see BJ's post below] as U100 insulin, so that means that one unit of Caninsulin would be drawn to the 2.5 unit mark in a U100 syringe. If you wanted to measure .4 of a unit then that would be drawn to the 1 unit mark in U100 syringe, etc. Here is the link to the conversion chart so you can see how it works:
http://www.felinediabetes.com/insulin-conversions.htm

Eliz

 

Um slight correction. Not 2.5 times as strong.
U-100 is 100 units per milliliter
U-40 is 40 unis per milliliter; thus it is 40% the concentration of U-100. To get the same number of units, you'd have to multiply by 2.5.
If you measure a U-40 insulin with a U-100 syringe, each tick mark is 0.4 * whatever is indicated.
0.4 concentration * 0.5 U-100 tick mark measures 0.2 units of U-40 insulin

 

Quite right, BJ, thanks for the correction.

 

Hi, just got back from the vet, and I must say it went better than expected lol, eventually she gave two options, one is to not give her insulin, and try and see how just by diet what glucose readings we get, then she was promoting MD which my Molly wont eat, I have tried that before on the recommendation of the vet for weight loss, the other option is to give her half a unit using the same syringe as long as we are happy to do this, she also said to test the glucose between 5-6pm and call her with the readings but not to give 1 unit of insulin if it is 15 or under? with regards to the low reading I had of 3.7 today she said she would be worried but Molly's coping with it well and letting me know she wants food so not sure what that meant. So the moral of the story is we will have to give her half unit measures depending on her glucose levels but at least the vet agreed with this. Thanks for all you advice and help regarding syringes and the conversion site, it is a great help to have this knowledge. Lorraine

 

I'm glad the vet visit went better than expected, Lorraine.

Can I just check if I've understood correctly...
Has the vet said to reduce to half a unit, but not to give insulin if Molly's blood glucose is below 15 (270)? (Given the steep blood glucose drop Molly got on the one unit, that would seem quite reasonable until you see what that half unit does...?)
.

 

Hi, yes that's right, so really its up to us to decide, but yes no insulin under 15, and see what we can do with her diet. I had a look at the link regarding food options and I was really surprised how much selection is available and easy to come by so thanks for that, its made that aspect much easier, in fact ive got the Hi life and some of the others in my Kitty cupboard I give that to my other cat Shelby and I know Molly likes it. You seem to have great knowledge on Diabetes, food etc etc are you self taught and learnt this over many years ??

 

Ha-ha! You're very kind, Lorraine. The fact is that I knew nothing at all until Bertie became diabetic and I joined this forum.
But Bertie's been diabetic for quite a while now, which has given me ample time to pick up a few things along the way...

 

You might find my signature links Glucometer Notes and Secondary Monitoring Tools useful.

 

Hi BJM,
Thanks for the links, they are very useful, I need all the help I can get at the minute lol

 

Lorraine @Lorraine Edwards ,
How is Molly doing today?
.

 

Hi there, well we was just sitting talking about our options, we gave her 1/2 a unit this morning and her glucose was 18.6, by 10am it was 8.1, by 11.15 it was 6.5, which was ok, but an hour later 12.15 it has started to go up and was 8.1 and at the time she was due another insulin injection tonight 7.30 pm she was only a twelve so not high enough to give her another shot, so then we are on this cycle where shes missing her evening insulin!!! so we have either got to try the other syringes so we can give her a 1/4 insulin and monitor that or try another insulin. This one curves down but doesn't stay very long before it goes back up. So kinda feel like weve taken two steps back again. I have looked into the other insulin types and I will have to try speak to the vet tomorrow and see what she says. Hows you and Bertie, I take it Berties in a controlled regime? how long did it take you to get him there? Lorraine

 

Improvement can bring it's own complications....
Lorraine, I can get some of my U100 syringes in the post to you tomorrow morning. If you're interested just let me have your address.

Regarding trying another insulin for Molly, that is always be a possibility. But her numbers seem to be continually improving as it is.... You may want to hang on a bit longer to see if that improvement continues...

Bertie has been a really tricky diabetic! Initially he was in very high blood glucose numbers for a long while, quite unresponsive to insulin. But things got better over time for us. In the early days he was on three shots of insulin a day, totalling about 19 units a day at times. These days he sometimes goes 3 days on one small shot of insulin.

Molly is doing really well, Lorraine. And her situation is improving all the time. I've got a good feeling about your girl....

Eliz

 

Can we get you started using our grid to record your glucose tests? It will help us give you better feedback. Instructions are here. Be sure to get the international version.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.

 

Hi ya, I wanted to start filling out the Glucose chart for Molly, is there a link for it please? Thanks Lorraine

 

Hi Lorraine,
Here is the link to the main instructions for setting up a spreadsheet and linking it to your signature:
http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/
You'll see there are two templates available. Because you're outside of the US you choose the 'World' template. That template automatically converts the 'world' BG numbers that you enter into US ones; (there will be 2 tabs/pages visible, one showing World BG numbers and one showing the converted US ones (nifty!))
Also there are instructions here for setting up from Ipad:
Setting up SS and link from iPad

If you have any questions at all there are some smart techy people here who can help you. (Sadly, I'm not one of them.... )

Eliz

 

Thanks I have done it not sure if its linked though lol

 

oh ive just seen it is linked lol

 

Lorraine, when I click on the SS link I get a message saying "resource unavailable"... Not sure if it's just me......?

 

Im not surprised lol in hopeless with computers, I have set it up I will try to link it again, here goes!!

 

yeah done it, when you get a chance see if you can bring it up for me thanks

 

Looks like it's working now, but you need to share it so people can see it - at the moment it says I need permission to view it. In the file drop down at the top, if you choose Publish to the web, that will make sure it's available. Then choose Share and the option I think is share with anyone who has the link.

 

what about now?

 

Working now - I can see it fine!

 

One slight tweak to make on it.
There are 2 pages - US and World. You enterde the tests on the US page, rather than the world page. This means the formulas to convert mmol" to mg/dL were replaced by your test entries.
You need to enter each of those onto the World page. Once you have, I'll tell you how to fix the formulas on the US page.

 

Hi thanks for letting me know, I have now entered them on the world page I got there in the end

 

A spreadsheet! Well done, Lorraine. (And for getting hold of those U100 syringes too).

It looks like Molly is getting nice duration from the Caninsulin. (In many cats it doesn't last a full 12 hours).
Very promising numbers there. (And because those are Alphatrak numbers we'd actually 'read' them as being slightly lower than they appear on the SS too.)
.

 

Great!
Now, to fix the US sheet, copy (CTRL-C on a Windows PC) any cell you haven't ever used (like down a few rows) and paste it any of the old ones where you'd directly entered the numbers. The formula in the cell will automatically adjust to the correct location and present the US version, which is mmol/L * 18.

 

Hi Ya, Yes I know I was impressed to ! lol, Yes we are definitely getting to a point where we are settling on certain numbers of insulin and got a much better understanding of what is working for her, my husband did a full curve chart yesterday, I had the day of lol, the only thing at the minute is when I came home last night approx. 10pm she kept on and on to be fed, which I really struggled with, half thinking was she asking because her levels had dropped or just because mum had come home lol as she does not pester my husband for food. So I did another glucose test just to put my mind at rest and she wasn't low, was cause mum was home, then she woke me up at 6.50am by licking my chin to be fed, bless her, but we are in a routine with the meals. We are letting her have a day of peace today. Lorraine