Newly diagnosed and already feeling a bit of pushback from my vet

Discussion in 'Feline Health - (Welcome & Main Forum)' started by mom23seniors, Dec 7, 2019.

  1. mom23seniors

    mom23seniors Member

    Joined:
    Dec 7, 2019
    I have 3 senior cats. Mallie, Tony and Theo.

    My girl Mallie (14years) was just diagnosed with diabetes on Nov.30.
    It was a pre-scheduled appointment for a senior blood and urine workup.

    She was on a short term course of prednisolone (6 weeks) to help treat a bilateral ear infection.
    In the 5 weeks after being fully weaned off the prednisolone, her thirst increased, her appetite decreased (she would turn her nose at the dry and only eat the wet I gave at night) and she experienced weight loss of 1.75lbs.

    The vet seems to think that Mallie may have been on the border of diabetes prior to the prednisolone.
    Her fructosamine levels from Nov.30 came back at 572.
    Since Nov.30 I removed all dry food from Mallie's diet and she has been eating FF each day, and loving it. She actually is eating again.

    I don't have a dosage yet of insulin, the vet said it would be once a day to start.
    The vet would like me to home test.
    The vet wants me to use Purina DM. She said she did not want to talk about commercial foods unless I had the dry matter basis values for them, so I just emailed Purina to find out the specific values of FF and Friskies. Has anyone had any success in obtaining the specific DRY MATTER basis values for these brands from the company?

    The vet indicated that they would order the insulin and supplies and that they would show me how to home test and give injections next week if I was wanting to go ahead with treatment. I am supposed to "think about it" and give them a call early next week.

    The vet implied that diabetes can be costly to treat.
    The vet also said that their may be underlying kidney disease but did not elaborate.
    The vet did not give me any other information about the results of the rest of the bloodwork and urine analysis.

    Because of her comment about not wanting to discuss commercial foods, I already feel like this won't be a positive working relationship and I am feeling overwhelmed.

    Thank you for listening.
     
  2. SidneysMom

    SidneysMom Member

    Joined:
    Dec 6, 2019
    I don't blame you for being concerned. I think a vet that's open to discussion is necessary. My cat just got diagnosed officially today. His fructiosamine test was like 552 or something similar. I'm kind of confused why they are asking you about whether or not you want to go ahead with treatment? If her test is that high, what is the other option?? I am totally new here, but I'd be looking into another vet if I was in your shoes. This is completely overwhelming and you want a vet who is your partner to help your kitty get the best care. They need to elaborate on that possible kidney disease so you can be armed with all of the information you can.
    I just want to offer my support and say that I know how you feel with the new diagnosis. I'm sorry things are challenging with your vet. Hopefully someone will have some good advice for you.
     
  3. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    Sadly, not all vets are really all that knowledgeable about feline diabetes. I do agree with their statement that prednisolone likely only causes diabetes in cats if they were already genetically predisposed and maybe heading in that direction anyway - some cats can be on pred for years and never have an elevated glucose reading, so genetics and an underlying predisposition clearly do play into whether or not diabetes develops.

    What I would do is pick up a test kit you can use at home if you're feeling up for giving that a try so you can see for yourself whether or not the food change is making a difference. It's very likely that her numbers are coming down on the Fancy Feast and instead of making her feel worse (which the high carb dry food may well have been doing), it's making her feel better so her appetite is better. And the great thing is that, as her numbers reduce, she'll also be getting more nutrition from the food. So I would call that a really good start for her. :)

    The high fructosamine is diagnostic, but that 572 doesn't actually reflect what her blood glucose is likely to be at (when you consider that the lab normal for blood glucose is roughly in the range of 70-159 or 75-175 depending on the lab, but normal fructosamine runs to around 349, the 2 numbers aren't ever going to match). So it's likely that her blood glucose isn't in the 500s at all, or at least not most of the time.

    The other thing I would do is ask your vet for a copy of the blood work. Legally, you're entitled to it (as long as they don't have you on some sort of payment plan for it that isn't yet complete...that creates a kind of grey area over who owns the results currently). But assuming it's the normal course of events where the blood work is paid for in full at the time, those results belong to you. We can look at those for you here if you post them and can see where they're noting the possible CKD (although that, too, could be glucose-related if she's been filtering glucose out through her kidneys).

    Did the vet say what insulin they're ordering for you? It's often very possible to buy insulin cheaper online than from the vet if the vet will give you a prescription for it. Even for the vet-only insulins, there are a number of online pharmacies that can supply it for you, often significantly cheaper.

    Ultimately, unless you can bring the vet around to your way of thinking, you might do better with a different vet. Just like everything else, when it comes to vets, each of us will work better with some than with others simply based on personality and approach to things. There has to be a lot of trust between us and our vets, especially when we need to work as a team for the best benefit for our pets - and if that trust isn't there on both sides, then it may be that changing vets is the only real viable option to get a team approach you're comfortable with.
     
    Noah & me (GA) likes this.
  4. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    First, on a positive note, it is a good thing that the vet actually wants you to home test SO many vets tell people not to. So, the vet gets points for that.

    It is your cat, and I assume you paid for the bloodwork and urinalysis, so you should be able to request the results and get them without any issue. It is your right to have them. When you get them, feel free to post them. There are members here who can look at them and give you feedback. It is also your right to question the vet as to why she mentioned kidney disease. You have a right to ask questions and to have input in your cat's care!!!

    The best nutrition information to have on cat food is the metabolize energy (ME) profile. This is the percentage of calories that come from protein, fat and carbs. Perhaps you could refer your vet to catinfo.org which is a website created by Dr. Lisa Pierson who is well respected in feline nutrition. Dr. Pierson created a cat food list (I have a link to the database version in my signature which allows you to filter by the desired criteria) that provide the ME profile information on a lot of wet foods. Most cat food companies do not provide that information (Weruva does - it is on their website), so you have to request it, and even then, some don't provide it. Dr. Pierson has done the work for you on a lot of foods, so her list is very helpful. Dry Matter figures are available on a lot of cat food websites, but I don't think Fancy Feast is one of them. They should give it to you if you emailed them, but it may take them awhile to get back to you. Again though, ME profile info is the better way to get info, and the FF info is already on Dr. Pierson's list. (Dr. Pierson's site also has info on the truth about so-called 'prescription' cat foods, as well as info on why dry food is not good.

    There is, of course, cost in involved in treatment, but there are ways to reduce it. Find out what supplies the vet plans to order and what she plans to charge. You can get supplies from other places besides your vet, and probably cheaper. Also, if cost is going to be a concern going forward, be aware that the cost of strips for an AlphaTrak are very expensive. Most people use a human meter/strips and save a LOT of money. They give lower results than animal meters but can still be used to manage this. I also suggest finding out what kind of insulin she plans to give you. Longer-lasting insulins are best... Lantus, Levemir (both for humans but work very well for cats) or ProZinc. She may try to give you Vetsulin/Caninsulin which is more appropriate for dogs. It is not as long lasting and tends to cause sharper drops in glucose. It can be used in cats but is not the best choice.

    If you speak with your vet and let her know you have been doing research and share with her resources like catinfo.org, maybe she will be willing to be reasonable and work with you. Explain to her that you want what is best for your cat, and that you want to be actively involved in her diabetes management. If it turns out that the vet is not willing to work with you, you may have to change vets, you would not be the first person to have to do that!

    This is overwhelming at first, but you can do it. You will get a lot of support and advice here to help you.
     
    Noah & me (GA) likes this.
  5. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    OH, and I meant to say that insulin should be given to cats twice a day (every 12 hours) NOT once a day. It is concerning that your vet thinks that dosing should be once a day to start. That is not accurate.
     
    Si am cat mom likes this.
  6. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Dry matter basis numbers for cat food is available on Tanya’s CRF website.https://felinecrf.org/canned_food_usa.htm
    You will see than Fancy Feast ranks well down the list. It is higher in phosphorus do not a good choice if there is any kidney disease present. Yes, you can handle both at once. You just might need another choice of low carb wet food with better phosphorus numbers.

    Many cats don’t like DM food. You can always buy one, then tell the vet your kitty doesn’t like it.

    Diabetes is a lot cheaper to manage if you home test, and use us to help you figure out dosing. And depending on the type of insulin you will use, you don’t need to buy supplies from the vet.
     
  7. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    The canned DM is about 7% carbs. That's still considered low carb (less than 10% is low carb by our standards here). However is the vet is pushing the DM kibble, ask the vet what the carbs are. the dry food is very high in carbs.

    Do you know what insulin the vet plans on prescribing? Lantus and Prozinc are the two types of insulin that are recommended by the American Animal Hospital Assn. I would push back if the vet is considering anything other than Levemir (the action is very similar to Lantus). Lantus is expensive. However, you can purchase one pen which will last your for a couple of months. Make a copy of the prescription and you can purchase Lantus from Canada where the cost is about 1/3 of what it costs here. We can provide you with information on ordering.
     
  8. mom23seniors

    mom23seniors Member

    Joined:
    Dec 7, 2019
    Thank you for your words of support. I have seen your threads and I have learned things from them as well! Everyone is so helpful! I’m in Canada too-Calgary to be exact.

    I’d like to think that my vet was telling me that I could take the weekend to “think about it” as to help ease any guilt I might have if I was leaning toward not treating. It definitely comes across as that she is not wanting to discuss treatment unless I commit to following her prescription (food, in particular) exactly.

    I’m going to call on Tuesday when they are open again prepared with my list of questions and possibly a few firm yet politely direct statements on the treatment protocols I would like to try to follow.
     
    SidneysMom likes this.
  9. Chloe007

    Chloe007 Member

    Joined:
    Oct 27, 2019
    Just yesterday I had a check up at my vet for Oscar and the vet tried pushing the Purina DM dry food. He hasn't fully transitioned completely off wet food yet, so I couldn't use that as an excuse and told her how the dry food I'm currently using has 4-5% carbs, and unless the DM was similar, I didn't want to switch. She told me yes, it's low carb, when I asked her how many, she turned the bag over and it read a whopping 18%. The rest of the appointment was kind of weird after that...but yeah the DM dry states it has 18% for anyone wondering. Might be better than some commercial dry foods if the kitty must be on dry for some reason, but still there are much better options (at least in the US, I don't know what low carb dry foods are available internationally) and the DM isn't cheap anyways.
     
  10. mom23seniors

    mom23seniors Member

    Joined:
    Dec 7, 2019
    Thank you all for your replies! I appreciate that you took time out of your afternoon and evening to help reassure me.

    The vet did not specify what brand of insulin she would be prescribing nor the dosing. Nor the accompanying feeding schedule.

    I am in Canada, just for information as far as available blood meters and insulin and supplies go.

    Even with all the reading I have been doing on FDMB I am still feel like I haven’t wrapped my head around what a typical feeding/dosing/testing schedule would look like for me and my girl.

    When I call on Tuesday I’m going to ask for a copy of the blood and urine work up. My account is paid in full so there’s no grey area there. I will also be prepared with my list of questions.

    My mom said that I should approach the vet with a statement something along the lines of “this is the information I have found (I will absolutely refer her to the websites and forums) and I would like to try to treat with these protocols and wet food first of all and if you are not able to support that then I will be needing to find another vet to work with.” and leave the ball in her court essentially.

    Amazon just delivered my case of Friskies pate today, so I now have a lower phosphorus wet food available for my sugar cat.

    And just as an aside-I have decided to switch my other two senior cats to a low carb diet as well, in hopes of lowering their chances of developing diabetes.
     
    MrWorfMen's Mom and manxcat419 like this.
  11. mom23seniors

    mom23seniors Member

    Joined:
    Dec 7, 2019
    I can confirm this. The vet today gave me the dry matter value for the Purina DM wet and dry and she said 17% and I replied “oh that’s high!” and she said that it’s still a lower carb option for diabetic cats. It uses soy flour as the binder.
     
    Noah & me (GA) likes this.
  12. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    As you're in Canada, I doubt there's much to be gained financially from using, say, Caninsulin given that Lantus is actually pretty reasonably priced there and generally gives better control throughout the entire day for cats. Great news that you should be able to get copies of the lab work too.

    Dosing, really, depends on your personal schedule as far as timing is concerned. I've dosed as early as 6 am and 6 pm, and as late as 10 am and 10 pm depending on mine (and DH's) schedule. Obviously changes as significant as 4 hours have to be done in stages, but the key really is to pick what works for you personally to give you the best chance of being able to dose close to 12 hours apart most of the time. I say most because I know I've had to skip shots on occasion if we've been out too late to get back on schedule...and there are days when I've dosed on an 11/13 hour schedule or similar due to time constraints. We can't always know those are going to happen in advance, so we just do the best we can. If we can make a 12 hour schedule most days, that has to be good enough because us humans have to be able to do what we need to as well.

    You'll find testing falls into place after a while. Many of us don't really do formal curves (testing every 2 hours throughout the day) very often - I only do them if our vet has specifically requested one. Instead, we do pre-shot tests, then 2 hours after the shot as often as possible, and later tests really depend on the numbers you've got so far that day, your schedule, and as you get to know how your girl generally responds to her dose you'll start just knowing when the best times to test are. That sounds vague, and it does take a little practice, but every cat is different, so often our test schedules will differ depending on the individual cat and their needs. I have days where I don't test again after +2 until the next shot time - if Roxi is running high and hasn't dropped at +2, then I can give her a break from being poked for the rest of the cycle...but I've been handling her changing needs for over 3 years now, so I've got a fairly good idea of where she's likely to go based on those early numbers. It's almost 6 years now since my first diabetic, Rosa, was diagnosed and I would say I was probably pretty confident with knowing when to test after the first month or so, so although it feels overwhelming right now I know, you'll soon find you're gaining confidence. And until you do, everyone here is here to help you figure things out.

    Feeding schedules, again, tend to be kind of personalized. I free feed low carb wet food and have done so with all 3 of the diabetics I've managed personally at home. The only time we didn't do that was when Roxi's Cushing's disease was in full swing because she'd eat everything (her own food and all the other cats) inside of 10 minutes and then go looking for more and she was gaining too much weight. Now that's been cured, we're back to free feeding everyone. It may not work for everyone, but it does work just fine for us. Some people prefer to feed 2, 4, or more meals per day at set times. Again, it's figuring out what works best for you and your cat.

    I agree with your mom. Once you know what insulin the vet is ordering for you, print out a copy of the protocol for that insulin and let your vet see that you're following something that's been properly figured out and written down. As an example, the Tight Regulation Lantus protocol is actually taught as the way to best use Lantus, at least for current purposes (I was re-taught it as part of my vet tech course, although obviously I already knew it)! So your vet will be able to verify that it's supported by the veterinary community in general. If they can see that and still aren't prepared to work with you on it, then it is time to find a vet who will.

    Friskies pate is a great choice. All 10 of our cats (ranging in age from barely 1 year old to 11) eat it as their primary food. The youngsters do get a little dry food as well or we'd never sleep at night, but their meals are all Friskies and have been since they were 3 or 4 months old. One of the reasons (other than cost and carb level) that many of us like the lower carb commercial options is that all the cats in the house can eat them and do very well on them - which makes feeding time so much easier as there's no need to separate everyone. I also fed Fancy Feast when we had just 2 or 3 cats in the house (can't afford it for 10, and we never expected to have 10 but we failed horribly at fostering so that's how many we have). I haven't honestly noticed any difference in glucose levels between Fancy Feast and Friskies, so of the 2 I would go with what you can reasonably afford and what the cats are prepared to eat.
     
    Noah & me (GA) likes this.
  13. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    I want to underscore what April (Manxcat) mentioned so it's clear. Insulin, especially depot-type of insulin (Lantus, Basaglar, Levemir) do best if you are on a twice a day, 12-hour schedule. The presence of a depot is what gives this type of insulin its duration and gentle action. If you shoot very early or very late, it has an effect on the depot. An early shot acts like a dose increase whereas a late shot acts like a dose reduction. If you gradually move the shot time, it moderates the effect. If. you shoot 2 hours late one at the evening shot and then 2 hours early the following day, in all likelihood you can end up with wonky numbers even though you're back on schedule. It also takes several days for the depot to stabilize. Once you get to know your cat and how your cat is responding to insulin, you may have a bit more flexibility. That said, if you're off by 30 min, it's not that big of a deal.
     
    manxcat419 likes this.
  14. April & Quincy

    April & Quincy Member

    Joined:
    Sep 6, 2019
    Not to hijack this thread but simply making a copy works? What if, for example, your vet just sends the prescription right to their own apothecary (which mine does)??
     
  15. Noah & me (GA)

    Noah & me (GA) Well-Known Member

    Joined:
    Dec 3, 2016
    Many clinics have a business model that is partially based on income from selling "prescription" foods. I regularly use two clinics that have these gigantic displays, it's just the way it is. I can accept that but it is borderline unethical for any vet to paint you into that corner.
    Being made to feel guilt is not part of being a good cat owner.
     
    Last edited: Dec 9, 2019
    Reason for edit: more PC
  16. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    @April & Quincy

    It's fine for the vet to call in or fax the prescription. My point was that if you need insulin immediately, mail ordering from the US to Canada will take at least a week. It's more expedient to make a copy of the prescription and take the original to a pharmacy and get one pen. Then, fax or otherwise send the copy to the Canadian pharmacy so you can then order a box of pens.
     
  17. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    Since your in Canada you can just go into pharmacy and ask for insulin. You don't need a script. I think but not sure you need one for syringes. Somthing to keep in mind, get syringes with 1/2 unit marks. Doses are changed in 0.25 increments so its easier with 1/2 unit marks.
     
  18. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    Nope. No prescription needed for syringes.
    A lot of Canadians use the FreeStyle Lite meter. It requires a small amount of blood. The vet may push you to use a pet specific meter – an AlphaTrak. That is fine but a word of warning. The strips for the AlphaTrak are roughly $2/strip and you will be going through more strips than you can imagine. The FreeStyle Lite strips are roughly $0.80/strip.
     
  19. April & Quincy

    April & Quincy Member

    Joined:
    Sep 6, 2019
    Thanks! I meant my vet calls in the script for the pen to an apothecary right in town. I guess I'll have to ask her for the prescription so that I can order from Canada. I never see the script as she just calls it in to the vet's prescriber, which clearly is a lot more expensive than Canada's pharmacy that many here use!
     

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