New, not sure if I trust vet dosing

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by BBelshan, Feb 13, 2019.

  1. BBelshan

    BBelshan Member

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    My cat is 14 lbs. and had a starting number of 571 at the vet. The vet prescribed 3 units of vetsulin 2 times a day. Looking around these posts makes me feel like 3 units might be too high. He gave me the diagnosis over the phone and getting information from him was like pulling teeth. I don't know if he expected me to break down crying, but I just wanted to know my next steps. I found this place to be way more informative. I told the lady at the front desk when I came to pick up the meds that people recommend low and slow and she said that 3 units is extremely low. He seemed to do ok last night but I don't have a meter in yet (strips will be next week before they arrive) and they told me they don't recommend home testing. I gave him 3 units this morning, but I am worried since I can't be there to keep an eye on him. They want to do a curve next week, but I wonder if it is safer to go low until I can check his number at home.
     
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I'm SO glad you came here! :eek: :stop: Your instincts are bang on!

    Three units as a starting dose is far too high. Your vet's responsibility is to arm you with knowledge or at least admit to not having enough experience with feline diabetes. Here are my suggestions for you

    1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
    2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
    3. do extra tests on days off to fill in the response picture
    4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
    5. post here for advice whenever you're confused or unsure of what to do.
    I hope this helps. Oops! Forgot to mention. No dry food at all is best. Friskies or Fancy Feast pate style foods are fine. :)
     
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  3. BBelshan

    BBelshan Member

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    Thanks, hopefully when I get home from work he will still be well. I will drop the dose tonight to 1. I have a meter coming in soon, but not sure if it has any strips with it. The strips were ordered at the same time but they won't be in until next week. I might can grab some at walgreens even if the price is higher there. I do plan on getting both cats on wet only diets, but I was afraid to remove the dry food while he is still on the 3 units. After I switch to 1 unit, I will get rid of the dry.
     
  4. Kris & Teasel

    Kris & Teasel Well-Known Member

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    The meter should have a few strips with it. If you can't test right now you definitely need to drop that dose. You were correct in wanting to keep a little dry in the mix at that high dose.

    Be prepared to go through the mental stress of deviating from the vet's advice. If you like your vet for everything else we can certainly steer you through the minefield of feline diabetes. Many vets have little to no experience treating feline diabetes and it can lead to some boo boos as you've experienced. The best case is a vet who is willing to work collaboratively with you and the worst case is one with a big ego who is sure they are the expert.
     
  5. BBelshan

    BBelshan Member

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    I haven't used this vet very many times. I guess I will see how he reacts to my push back to see if I will keep him or go to another vet. Once I get the meter in I will start filling out the chart. I will study the tips when I get home. It seems that as common as feline diabetes is, they would all be familiar with it.
     
  6. Darwin H.

    Darwin H. Member

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    Your Vet sounds exactly like mine until I had a face to face push back about their protocol with the owner vet of the clinic. I do it all myself and all is well. You are in the right place and Kris gave you all the answers to get you on the path to wellness for your furbaby. I have been on a fast learning curve since Thanksgiving. One more thing. JUST stopping the kibble and transitioning to a 95% only wet food will bring your BG numbers down measurably as it did mine. When doing a blood test we found out that my Walmart Reli-on Prime meter was accurate to just 25pts lower than the digital Lab the Vet uses and better than his animal handheld meter. Good Luck You came to the right place!
     
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  7. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Well, it's certainly common here on FDMB! ;) I don't know how many vets see it in their practice though unless it's a feline only practice. They see more dogs I think and that's sometimes why they make mistakes treating cats. Dogs are very different in their response to insulin and, like humans, suffer the physical effects of diabetes more quickly than cats do.
     
  8. BBelshan

    BBelshan Member

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    Thanks everyone. I will try to learn quickly and update as soon as I can. I am just going to be worried all day. I will probably test the non diabetic cat as well to see if I have a good baseline.
     
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  9. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Love your avatar photo! :smuggrin:
     
  10. BBelshan

    BBelshan Member

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    Thanks, he is sweet to me, but a jerkface to everyone else.
     
  11. BBelshan

    BBelshan Member

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    Hmmm, the vet (or tech) called and said that the blood will be hard to regulate until his UTI has cleared up. My meter is scheduled to arrived Friday and others said they did get a few test strips, but until then I am in the dark about his numbers. Would having a UTI make him need more insulin?
     
  12. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, any infection can have an impact on BG levels. However, 3 u is still too high a starting dose. Better safe than sorry with a 1 u dose until you can measure his BG. I recommend that you buy some human urine ketone test strips at any pharmacy and try hard to test his urine ketone level. Here are some tips:
    • put the end of the test strip right in his urine stream as he's peeing
    • slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
    • put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.
    Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

    This is extra insurance until you're testing. Reasons: 1. you're lowering the insulin dose for safety's sake and you don't know where his BG will be at that dose and 2. he has a UTI and infection *can* increase the risk of ketone development. I'm basing all this on the fact that Vetsulin is an insulin that acts strongly to drop BG and that could be to levels that are too low, especially at a higher than ideal starting dose. Hence, the advice to drop the dose. The risk of ketone development isn't as immediate as the possibility of a hypo episode at too high a dose with no BG monitoring.

    How did the vet arrive at the diabetes diagnosis? Was it on the basis of only a couple of BG measurements in clinic (very possibly stress elevated) or was a fructosamine test done? That test gives an approximation of BG levels over the previous couple of weeks and is a good diagnostic.
     
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  13. BBelshan

    BBelshan Member

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    This is his first vet visit in years. I know he should have been checked more frequently, but he gets extremely stressed and bites. He had to be sedated to get this blood sample. They have nothing to compare it to. They are basing it off one test. They did blood and urine and I don't know what test they ran with the samples. I will pick up some ketone strips and the plastic wrap sounds like a good idea.
     
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  14. BBelshan

    BBelshan Member

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    So when I do the test, I am looking for low ketones? If it is high do I move up from the one unit?
     
  15. Kris & Teasel

    Kris & Teasel Well-Known Member

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    You want to see "negative" ketones. If you see "trace" that's a warning bell. The colours for negative and trace are very close so make sure you view the strip in good light at exactly the 15 seconds needed for the test. It continues to darken so the timing is important. If it's higher than "trace" call the vet.

    I don't want to frighten you about ketones but it's rarely mentioned by vets and testing urine at home is quite easily done. As I said above, it's insurance. If they begin to show in urine it's a warning that you need to have him checked.

    Don't feel bad that your kitty hasn't been to the vet. Many get really stressed and that makes those vet visits very difficult. All the more reason for you to take over his diabetes care at home and we can guide you. :) Most of us here don't seek help from our vet for diabetes treatment.
     
  16. BBelshan

    BBelshan Member

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    Ah thanks for the heads up. They didn't mention ketones at all and seem to want to do all testing there. All the ladies seem nice, but info is rather lacking and their need for profit may make me check around.
     
  17. BBelshan

    BBelshan Member

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    Oh, how often do I check the urine? Daily? Weekly? Does it have to be fresh?
     
  18. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I suggest daily until you get your meter, assuming you're going to drop the dose to 1 u. Afterward it's more of an as needed basis - BG running high, kitty feeling ill, not eating, etc. Yes, you need fresh pee. Some people have been able to get a valid test by putting the test strip into very wet litter right after the kitty has done his business. Not ideal but can work in a pinch.

    Many vets want to do all the testing. Yes, it's their business but another big factor is the actual humans they see day in and day out. Many are reluctant to do various things at home or have trouble understanding what's involved, how to react to test results, etc. More than a few owners euthanize their kitty when diabetes appears and vets try to make it all less burdensome for that reason as well.
     
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  19. BBelshan

    BBelshan Member

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    The learning curve is pretty steep. I could see why people would rather let them handle it, but even having decent savings, $50 for every visit then add on lab and meds and it gets expensive quick. I will try your tips when I get home. Hopefully I will get good results.
     
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  20. BBelshan

    BBelshan Member

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    Husband is home and cat is walking around like normal so that's a relief!
     
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  21. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, it's expensive so that's another reason to do the day to day managing at home and hopefully avoid the complications like a serious hypo or diabetic ketoacidosis.

    There's a heck of a lot to learn and it feels like an avalanche at first. You'll be surprised, though, how knowledgeable you become about your kitty's responses. You've mentioned he doesn't like to be handled. You might want to review these BG testing hints:
    http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

    Do you have any low carb treats to use around testing? Freeze dried meat or fish chunks work well. Pure Bites is one easy to find brand.
     
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  22. BBelshan

    BBelshan Member

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    I have a can of tuna but that is all I have on hand at the moment. I was def gonna look to find some. He loves treats. The main issue I am going to have is keeping him still. He paces even when petting or brushing. I will fiddle with his ears until I can get the meter. Maybe that will get him used to me messing with them.
     
  23. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Good plan. You can give little pieces of tuna as a treat to build pleasant associations. :)
     
  24. BBelshan

    BBelshan Member

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    Well, he of course did not pee in the area I laid the plastic wrap. I tried to see if I could get enough from the wet pellets. It did not change color. I will try again in the morning for a better sample. He seems fine for the moment. I only gave him 1u of vetsulin this evening and took away the dry food.
     
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  25. Kris & Teasel

    Kris & Teasel Well-Known Member

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    How is he today?
     
  26. BBelshan

    BBelshan Member

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    He was a little reluctant to eat all of his food. Not sure if he tasted his antibiotics or if he is just getting used to eating more wet food. I didn't get a chance to test his urine this morning, he had already went and I wasn't sure how old it was. He is otherwise acting fine. Urine output is about the same.

    Got a notifications that his syringes will be delivered Saturday. Is there a sticky somewhere of a list of things to have on hand somewhere? Like you will need: meter, test strips, syringes, cotton balls / paper towel, low carb treats, keto test strips, etc.? I saw the link for the hypoglycemia and that is good to know. Just trying to see if there is a central location for general kind of info for newbies. I feel like the mods/veterans of this place may feel like a broken record having to repeat this info to each new person.
     
  27. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Have a look around in here: http://www.felinediabetes.com/FDMB/threads/where-can-i-find-________.127890/

    There's a ton of info here in many different places. The mods work at organizing it for easier access but it's hard to do. It''s worth spending some time looking around as you've done to see what you discover and then bookmark things or print them out.

    We're always willing to answer questions, any questions. :)
     
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  28. BBelshan

    BBelshan Member

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    Ah thanks so much. I will take a look there. Thanks for all your help!
     
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  29. BBelshan

    BBelshan Member

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    So glad I managed to get a reading today. His blood level this evening was 144. While too low to shoot, this number seems above the non-diabetic cat range. If I can get a similar reading in the morning, would I still not shoot or would I decrease his dose? This weekend I am going to attempt a curve again. I've only managed 3 readings so far. I know what I have isn't really enough information to go on. None were near the reading the vet got. Both cats are 100% wet cat food. His urination has decreased.
     
  30. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Let's see what your curve shows. Yes, that 144 is too low for insulin until you've collected a lot more data about his responses. If he's too low tomorrow AM, try giving an eyeballed 0.75 u instead.
     
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  31. BBelshan

    BBelshan Member

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    Thanks, hope the morning test goes smoothly and I get a number. Weekday mornings are a bit more crunched for time, but weekend is coming up!
     
  32. BBelshan

    BBelshan Member

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    Ok, so the last few days I have only given .75 units. Amazon delivered the 28g lancets to the wrong house but I they gave them to us this morning. Glad these are in as I couldn't get enough blood with the 30g on a consistent basis. I have been shooting blind. I tested as soon as I got them at 3.5 hours after the shot. He is at 80. I am trying to do a curve today but that number seems a little low for the amount of time that has passed. Should I test in an hour or is 2 good?
     
  33. Kris & Teasel

    Kris & Teasel Well-Known Member

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    That's an amazing number for that tiny dose. Do try hard to get another test around +4 and/or +5. He could drop low-ish and you'd need to intervene with food. I hope you find the thicker lancets easier to use because those PS tests are very important. He might need to go down in dose but you need data.
     
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  34. BBelshan

    BBelshan Member

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    Thanks, I am going to test soon. If he drops low I will give food and stay with him. If he is in a safe range we will go out to eat and do errands and I will test again when we come back. He has been tolerating me poking him more as long as food is in his face and I do it quick. I will report back in a half hour if I can get another good read.
     
  35. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Whatever works! :smuggrin:
     
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  36. BBelshan

    BBelshan Member

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    Ok, so I got the 5.5 hours test done. 28g lancet on a number 4 setting seems to do the trick. He is at 92 so he is on the upswing but good number for the time I believe. I will test again later to get a good curve and hopefully get a good pre-shoot number. Just really wanting to have a curve completed before his follow up exam next weekend. I don't want them doing a curve but he does need to get his UTI checked on to see if it cleared up. I just hope the stress of the vet visit doesn't set him back.
     
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  37. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Still in good numbers. Has he had food between the two tests? It's not a problem, just trying to put the BG in context.
     
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  38. BBelshan

    BBelshan Member

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    He licked up a bit of tuna I gave him during the tests but it wasn't a large amount. Maybe a teaspoon. Food is available but he hasn't eaten much if any of it. Mostly napping.
     
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  39. BBelshan

    BBelshan Member

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    Not the best curve. Just couldn't get enough blood on the next two tests. Was determined to get a PS though. He was at 140 so no insulin tonight. He was getting super mad and not compliant at all no matter what food he had. Gonna try my best to get an AMPS as I have not be successful so far. Maybe he will be in a better mood after giving him a break tonight. His poor ears are all bruised up. He doesn't sit still long enough to get good pressure after I get the reading. Should I reduce his dose again to .5u?
     
  40. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I think trying 0.5 u is a good idea. Better safe than sorry while you get more accustomed to testing.
     
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  41. BBelshan

    BBelshan Member

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    Thanks, I was rereading the sticky for vetsulin and it said that the aim for nadir is 90-100 for beginners. Since his dropped to 80 I figured it was probably best since it didn't climb high enough to give him a shot tonight. Once you are not a beginner, what number are you aiming for?
     
  42. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Because of the strong action of Vetsulin I'd aim for a slightly higher nadir than you might for Lantus, a depot insulin. It's best to have a little cushion for safety because of Vetsulin's ability to drop BG fast and low. Once you're more experienced you *might* be able to safely aim for 70 - 90. It also depends on what your kitty's tendencies are - calm response to insulin versus dramatic spikes and dives.
     
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  43. BBelshan

    BBelshan Member

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    Good grief. I wasn't able to get any blood this morning and I gave him .5 unit. This evening I got blood on the first poke and thank goodness. He was 125 - even lower than the previous evening. I really need to get a morning read. I am wondering if his pancreas is waking back up and maybe heading towards remission?

    On another note, I think I need to freeze them some food to eat during the day. I think both cats are not really eating enough at the moment. They aren't acting like they are starving and maybe they are just getting used to the amount of wet they need vs what they needed with dry, but each cat maybe eats a little more than a can each. I give half to each in the mornings and again in the evenings. I know that is not enough, but if I give more they don't eat it all. Maybe because it dries out some?
     
  44. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, he's doing really well. Those pre shot tests are really important as you've seen. Freezing some chunks of wet food to leave out while you away during the day is worth trying.
     
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  45. BBelshan

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    Fingers crossed I get a good reading. Not sure why I have such bad luck with the AMPS. I def will not be letting the vet do a curve this weekend. I wish I didn't have to go back for the UTI but I don't want it to get worse if it hasn't cleared up. Hopefully the stress of the ride and test won't stress him out too much. I think it will help I got a bigger carrier, but only a little.
     
  46. BBelshan

    BBelshan Member

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    Got AMPS - 148 yay!
     
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  47. Kris & Teasel

    Kris & Teasel Well-Known Member

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    That's great! You're getting some key data to know if a dose is safe to give. Do the best you can to add in middle cycle and before bed tests to round out the picture. I suspect he might need a teensy dose to get him running in lower, remission-promoting numbers but we need that data. :)
     
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  48. BBelshan

    BBelshan Member

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    I won't be able to do mid-day until the weekend, but I will try to get before bed test. I test him at 5:30 am and 5:30 pm. I can test at 9-9:30pm to see how he climbs after eating. Once I can get those test, should I try .25u? I do have half unit markings, but not sure about figuring out lower than .25 u.
     
  49. Kris & Teasel

    Kris & Teasel Well-Known Member

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    The before bed tests might give us a clue. The 0.25 u dose could work but I'd give it in the evening so you can get a +2 and +4 to see what it does. There are ways of giving smaller than 0.25 u doses and we can get into that later.
     
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  50. BBelshan

    BBelshan Member

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    Hmmm, also, the AMPS - I left food out for the last night. I didn't think to set an alarm for 3 to pick it back up so I am not sure when he stopped eating. There was still some in the bowl. I will try to remember to do that so I get a better reading. Also, not sure how fast the sugar spikes blood as I can only test when he is eating.
     
  51. BBelshan

    BBelshan Member

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    He tested at 159 so he is slowly climbing. I didn't leave out extra food. Should I shoot or no? .25 or less? Or just check back in the morning?
     
  52. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Was that your PMPS? I suggest you try 0.25 u. Eyeball that as well as you can. Test at +2 and +4 this evening to see what's happening.
     
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  53. BBelshan

    BBelshan Member

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    Ok, I gave him .25u and I will try to measure at +2 and +4. +2 should be easy, waking up 2 hours after I go to sleep will be difficult, but I will try to use that time to set out a bit more food for them.
     
  54. BBelshan

    BBelshan Member

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    Ugh, no good test since the last one. His ears just didn't want to give me blood. I gave him .25 u this morning.
     
  55. BBelshan

    BBelshan Member

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    Ok, he was 135 this evening. I will give him .25u again. I will try to test at +2. I know we don't have a full picture yet due to lack of good test, and you might not can answer this but at what number do you think I shouldn't give insulin?
     
  56. BBelshan

    BBelshan Member

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    Ok, I got the +3 test. He is at 121.
     
  57. BBelshan

    BBelshan Member

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    174 this morning so I nudged the does up - still under .5 but slightly more than .25u.
     
  58. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

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    Do you have a ss? I am looking to see how others' babies are doing on it...I find it very unpredictable..nadirs 10 am...to 3 pm..and high FBG's
     
  59. BBelshan

    BBelshan Member

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    Yes, in the signature, "Link" is a link to his spreadsheet. I haven't been testing long and he seems to be responding well. I haven't gotten a full curve yet.
     
  60. BBelshan

    BBelshan Member

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    Can you take a look at my spreadsheet? His BG is at 122. I am not going to give him a shot tonight. It didn't seem like .25 was enough as his numbers climbed, but with .325 it doesn't seem like he climbs high enough for a second shot. (I am guessing it is .325 as .25 is the thickness of the plunger so I straddle the half unit marking)

    I am off the next two days so I am hoping to get another shot at a curve. I am taking him to the vet to check on his UTI tomorrow and update them on his progress.
     
  61. Kris & Teasel

    Kris & Teasel Well-Known Member

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    It's very difficult to say. I think doing a full curve this weekend will help.
     
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  62. BBelshan

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    So I brought my cat to the vet this morning to check on his UTI. I received no blow back from my home testing. They actually seemed glad I did and thought his numbers looked pretty good and wanted to do a fructosamine test to see a bigger picture since I don't have the full picture yet with my test. He had to be sedated so I will pick him up in a few hours. I told them his BG was running low since I shot blind (69 at +2). I only gave .25 u thinking he must have climbed due to not getting insulin last night. I apparently was wrong or should have attempted a smaller dose. They also noticed he has some tartar built up on two teeth that seem wiggly and think I should schedule a cleaning and possible extraction since he reacted with pain next week. I feel bad he has to keep going back and being sedated each time but he is what they call fractious. He has gained weight since getting insulin. He is now 18.3 lbs.
     
  63. BBelshan

    BBelshan Member

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    He's at 135, I am uncertain if I should give a shot at this number. I will try to get a good test in the morning to see if he climbed or if he is just going to hover slightly higher than a non diabetic cat. Tomorrow I should get his fructosamine results and the estimate for dental/tooth extraction. Perhaps getting rid of bad teeth will help his BG?
     

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