Not sure what to do & feeling bad

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Paula Nowak, Feb 22, 2019.

  1. Paula Nowak

    Paula Nowak Member

    Joined:
    Sep 9, 2018
    I went to a new vet today because I had some issues with my previous vet. Actually the new vet was someone that I had seen before, years ago for other reasons than diabetes. She said that I should not worry about testing his blood glucose for 2 weeks because then you're going to be thinking oh no, if he's too high, and oh no he's too low so just give him a steady 2 units twice a day for 2 weeks straight and then we will do a fructosamine . She said that I should do this because you can't do a fructosamine if you're going up and down in units in thetwo weeks before we will do the fructosamine. She said I have to give a steady number of units so we will know how many we will be able to give him from the determination of the fructosamine so I want you to make sure that you do not test him for two weeks and then do your own curve at home and then I want you to write down all of the information from that curve on paper and then whatever we get from there and then whatever we get from the fructosamine, then we'll be able to decide how many actual units he is going to need and she asked how money units I was giving Elvis in the last week and I said two units so that's why she said that doing the fructosamine has to be an even number of units for 3 weeks since the last week I was giving him two units so then the next two weeks I should also give Elvis two units twice a day everyday. I decided that I was going to start fresh tomorrow morning with this new plan that this vet had but I had a strange feeling ; sort of like a premonition. It was getting time to give him his shot this evening and he went into the litter box and I got some pee from him on a plate that I use especially for him. I tested his urine glucose and ketones, and they were both negative. Then I decided since I'm starting fresh tomorrow morning Saturday, that I would test him one last time because I was feeling a little uneasy within my self because of his urine testing being negative in both the ketones and the glucose. I did a blood glucose test and his blood glucose was 173. I know he was a little agitated so I thought well I'll just take out another strip and I'll test him again and it was 180. Now, I feel that 173 or the little higher, 180, is too low to give 2 units from what I have been reading lately. I had called an emergency veterinary service and they said that to give 2 units when your cat is running those numbers means that you need to be very cautious so he does not go into hypoglycemia. Well this really got me freaked out so I made the decision to give him one unit . Now this new vet was very sure that I should not test him and don't even think about testing him she said and I am going to have to call there in the morning because I want to tell her that I was starting out fresh today but that I tested him last night for the last time before the two weeks that she said that I should not test him and I'm going to tell her of his low number last night and made a decision to give him only one unit because 173 is getting to be low to give two units and I was in fear if I gave him the two units that he would go into a hypoglycemic episode. I just don't know what to do! I gave him one unit tonight because I for sure thought that 2 units would be too much so I don't know what she is going to say to me tomorrow when I tell her that I gave him one unit when she told me to give two units and not to test his blood, when I went ahead and tested his blood anyway and gave him only one unit! I don't know what to do! My roommate said wow, if you're not going to listen to the vet, then what's the use of even going to one. Well I said, then where would I get the insulin from if I don't have a vet to write a prescription so I have to do something and I didn't want to give two units tonight when his blood glucose was just 173 !!! I mean seriously Tom, the cat could have gone into a hypoglycemic state if I had given him those two units with his number being only 173; okay maybe there is a possibility, a small possibility that he might not go into a hypoglycemic state but I sure in heck do not want to test the waters there because Elvis means the world to me and I would just die if something ever happened to Elvis!!! Maybe I could give him one unit twice a day and say to the vet that I thought when she said two units, that she meant that I should give one unit in the morning and one unit in the evening which adds up to two units a day . I don't know! This is very stressing! He also had a lower number four days ago and it was 163 so that's why I'm thinking that maybe I should give him one unit twice a day for two weeks and then say well, I I thought you just meant to units a day, which means one unit in the morning and one unit in the evening. I was thinking about this because I know when you are giving insulin you need to start out small. So I thought that naturally we were like starting over again small , to see where we should go from there.
     
    Last edited: Feb 22, 2019
  2. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Your vet is wrong about not testing. If a parent had a child with diabetes, would they not want to test to make sure it was safe to give insulin? Elvis is your cat, you want to keep him safe. 173 may have been a safe number to give insulin, or maybe not. How long has Elvis been diabetic? How did you find out he was diabetic?

    And welcome. Read the yellow starred Sticky Notes and keep asking questions. There is a lot to learn at the beginning, but we can help.
     
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  3. Carol in Chicago

    Carol in Chicago Member

    Joined:
    Apr 5, 2017
    Hi Paula - I do not agree with the approach your vet has recommended. We strongly advocate for testing before each and every shot. Mid cycle tests are also very important to determine how low the insulin is taking him. Can you please post your spreadsheet with current dose and test results? Data will help you get better advice.

    Regarding the fructosamine test, I see very little value in it if you are home testing. The test is expensive and does not offer the precision or immediacy that home testing does. I think your vet is recommending what they are familiar with (which is not the best thing to do if you are able to home test).
     
  4. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    Just fyi - your glucose test strips will only read positive if their glucose is over the 'renal threshold' and is spilling into the urine. For most cats, that's around 250-ish. It would never tell you a specific number, just a negative or positive.

    I agree with Wendy and Carol - home testing is critical.
     
  5. Paula Nowak

    Paula Nowak Member

    Joined:
    Sep 9, 2018
    Elvis has been a diabetic since November 1st of 2018. I first thought that he was a diabetic when he was urinating a lot and really drinking a lot. I took him to the vet and they tested him and he was quite high; he was in the 600's. The vet said that Elvis had a lot of sugar spilling into the urine and she started him off on one unit but they had increased to 2 units about a month later in December and then they said continue on with the two units and then one time he had gone into the two hundreds and I believe that he was 248 and they said bring him back down to one unit so he's kind of jumping around a bit back then it seems. Then he shot up into the 400s so then the vet said we will give him 3 units and then she said, that should do it. I was a little uneasy about the three units but it seemed like it brought him down but one morning not too long after starting on the three units about four days later he went down to about 168 and then I called her and she said do not give him any units tonight and then if he goes back up then she said give him two or three units whatever you were giving him. So I thought after I got off the phone with her that it was kind of strange that she didn't even know how many units I had been giving my cat and saying that, oh give him the two or three units whatever. I'm not happy about that at all after I got off of the phone with her, after she just said , well just give him two or three units whatever you were doing!!!
     
  6. Paula Nowak

    Paula Nowak Member

    Joined:
    Sep 9, 2018
    Oh my gosh, what to do. If only there was insulin that you could get without a prescription that would really be great! my vet will probably get very angry when I tell her that I did not give Elvis the two units and I only gave him one unit because I was freaked out about giving him 2 units and then she's going to say I told you not to test him and not to worry because you're going to be thinking just like what happened , but the thing is I don't want Elvis to get a hypoglycemic episode because I listened to the vet and didn't rely on my own intuition!!! Now what does this mean? Does it mean that I am going to have to try to find another vet? My sister is helping me out with Elvis's care at this time and she paid the $50 that visit today for this new vet and then oh my gosh I'm going to have to tell her well, I think I have to find a new vet but what I'm getting here is that now I'm thinking that all the vets are going to be like this and it's just going to be an endless road of vets being the way they are being!!! I know there's an insulin that you can get at Walmart and it's called novolin but I don't think it's a very good insulin and I can get it without a prescription but I don't think I can get the syringes without a prescription but then somebody said that I would be able to get the syringes without a prescription. Thi when I was first starting out though with all of this and deciding what insulin I was going to go with because of the cost but my sister said that the best insulin would be the way to go and that was Lantus.
     
  7. Paula Nowak

    Paula Nowak Member

    Joined:
    Sep 9, 2018
    Oh no, I probably have the wrong kind of test strips for his ketones and glucose !!! I'm new at this so I can see where I mistake like that could be made. so what kind of test strips do I get and where can I get them? I thought they were just like human glucose strips for testing ketones and glucose oh no I can't believe I made that kind of mistake I'm a big dummy!!!
     
  8. Paula Nowak

    Paula Nowak Member

    Joined:
    Sep 9, 2018
    well the glucose and ketone strips that I use have a series of colors going from light to dark .
     
  9. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Paula, welcome to you and Kitty.......is his name Tom or Elvis?.
    Well done testing the blood sugars! Can you tell us if you are using a human meter or an Alphatrak meter to test the blood sugars please?
    Can you also tell us what insulin you are using please?
    I have to say I have never heard such rubbish as the vet saying you can't test for the frustosamine if you are adjusting the insulin dose and testing the blood sugar levels (BSLs). That is simply not true. And it is not necessary to do that test anyway when you are testing the BSL.
    We recommend you test before EVERY insulin dose to see if it is safe to give the shot.
    We also recommend you test somewhere about 4 to 6 hours after the dose (+4 to +6) so you can see how low the insulin is taking the cat. If it is dropping a lot, check 1/2 to an hour later to see it isn't going down further. If the BSL is too low, then you can give some food to bring up the numbers..
    Always have some honey and higher carb food at home in case of low numbers. You won't have time to go out and get the food if the numbers have dropped low..
    We also recommend you don't give any insulin if the BSL is under 200 in the beginning until you get more data on the numbers. So you did the right thing not giving insulin.. 2 units is too much to start with as well. 1 unit is far safer.
    Here is a link to our spreadsheet which I would recommmend you start. If you have any trouble setting it up ask for help and we will help you.
    http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

    Also if you could setup your signature which is in the top right of this page under your user name......click and look for signature...write down yours and kitty's name, dateof diagnosis, type of insulin and dose, type of meter, anyother health problems and save. People who help you will always look at the SS and the signature for information.
    Keep asking lots of questions. We are very happy to help you.
    A lot of vets do not know much about feline diabetes.....they don't get much training in it and it has changed over the years to more up to date treatments......and they have not updated.
    Here is a link to food charts to find some higher carb food.
    http://www.felinediabetes.com/FDMB/threads/links-to-food-charts.174182/
    Bron
     
    Sue and Luci likes this.
  10. Carol in Chicago

    Carol in Chicago Member

    Joined:
    Apr 5, 2017
    I think your ketone strips are fine. They just aren't precise enough to be used to manage insulin.

    Don't panic. Trust your intuition. You know you should be testing more. We are asking for data. The next step is to set up a spreadsheet. Do you have one yet?

    The next thing is food. People will ask what Elvis is eating. Is he eating a low carb wet food?

    Don't worry about a vet being mad. Many here can offer advice re how to work with your vet. You need to be comfortable with the treatment plan.
     
  11. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    What brand of glucose strips and meter are you using? Most of us use human ones because the test strips are so much cheaper, but it’s good to know what kind you are using.
     
  12. Paula Nowak

    Paula Nowak Member

    Joined:
    Sep 9, 2018
    Hi, Elvis is my cat's name and he is on Lantus insulin . I am currently giving him one unit since last night because last night has blood glucose level was 173 so that's why I did that and I did not listen to the vet who said to give 2 units and not to test which I know is not the right thing to do.Ekvis was diagnosed with diabetes on November 1st 2018. I am also using the ketonix blood glucose and ketone strips. Elvis is eating Fancy Feast turkey and giblets classic pate and he does not eat any dry food at all. Elvis used to eat dry food but that was taken off him the week before I went to the vet for the very first time when I noticed that he was urinating and drinking a lot. He always used to eat wet and dry food but I took him off of the drive food when he started acting unusual by going to the bathroom so much and drinking so much water I thought right away that oh no he probably has something like diabetes or maybe hyperthyroidism or maybe a urinary tract infection but I was more leaning towards the fact that he had diabetes which he did when I took him to the vet that first day in November.
     
  13. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Are the Ketonix strips for testing urinary ketones and glucose or is this the brand of meter you're using? The urinary test strips do have a color key to determine the presence of ketones or whether there is glucose in the urine.

    Like everyone else who's posted, I disagree with your vet. Wendy's perspective regarding whether your vet would give the same advice if this were his or her child is exactly echos my thoughts. Home testing is the best way to insure your cat is in safe numbers and for you to not be worrying all the time.

    I would encourage you to read through the sticky notes at the top of the board. It will also be helpful if you can set up a spreadsheet. The spreadsheet (SS) will allow you to track your cat's progress and it will allow us to offer guidance.
     
  14. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Hi Paula,
    and Welcome.
    I would say, trust your intuition, your instinct is sound.

    I also disagree with your vet, and like Wendy and Sienne I do wonder what your vet would say if you suggested giving an insulin shot to their diabetic child without doing a BG test prior. I think we can all imagine the response.

    The fructosamine test gives an average, so it won't tell you how low the dose has taken Elvis, and you are quite right in thinking that it's not safe for you to do what the vet is suggesting, frankly with a CG that is willing to monitor BG at home fructosamine is not the best or most effective way to manage his BG. Home monitoring is the safest and most effective approach to regulate a diabetic cat in my honest opinion. I was lucky that this was also my vets opinion.

    You are not the first and won't be the last individual to arrive on this site with this dilema. Your vet cannot stop you home testing, just don't tell them if you don't want the confrontation.
    As for the dosing, I would read up on all the stickies at the top of the forum, this one covers the dosing methods we use on the board http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/ most of us have followed one of these methods, we achieved remission following the Tight Regulation Protocol (TR), we were able to get George regulated quickly and safely by following this method and this then led to his remission, at the outset regulation was our objective.
    It is not unusual for many of us here to go to our vet for insulin and manage the dosing ourselves, my vet was happy for me to do this, I gave her a copy of the protocol and access to my online Spreadsheet we talked about his BG and general health but she left the insulin shots and decision making up to me. She was a bit wary of me taking on line advice at first, but giving her the written protocol helped appease her fears.

    If you could set up the Spreadsheet http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/ we can use the data you have already gathered to help you make the right decisions for Elvis.

    It's great that you have got rid of the dry food, that may have significantly reduced his insulin requirement. You say you stopped the dry food one week before he started insulin, and a week before you took him to vet, did you run a curve before starting Lantus?
     
  15. Paula Nowak

    Paula Nowak Member

    Joined:
    Sep 9, 2018
    No I did not run a curve before starting the Lantusbecause I knew very little about diabetes in cats. I hear what you're saying about not wanting a confrontation and of course I don't think anybody does.I'm just concerned for the fact that my vet wants to do a fructosamine and she said like you probably have read here with my post, that she said to give to units and don't test them for two weeks and then do a curve on your own at home. I think I don't know what I'm going to do because I'm not just going to give my cat to units and not test and just keep on giving him to you and that's without testing! I think that is insane but then I'm thinking that my vet may say, wow you don't appreciate my advice so go look for another vet. I am so sort of exhausted and looking for vets at this point but I need the insulin. I will just have to figure out how I'm going to work around this. I distinctively remember when I first started all of this my other vet started Elvis on one unit and decided to go from there to see if his dose needed to be changed. Yes, his dose did need to be changed and it went up to 2 units. I am a little hazy as to when we exactly went up to two units, but I think it was like about almost a month later. Elvis started getting insulin in the first few days of November of 2018. I just wish this could all be easier. Like I said before, my vet said to give to units. I'm wondering if I should start all over again, and give him one unit twice a day and then when she wants me to do a curve or I'll so she may get ahold of me, I will say to her that I thought when she meant to units that she meant 2 units a day and not to units twice a day. I know this is going around it a little bit but I'm so afraid that she's going to say oh I don't think I should be your vet anymore because you're not listening to me so if I say sort of that I made a mistake and thought that she meant just two units a day instead of 2 units twice a day, then well, I'm not so sure but of course people can mistake 2 units thinking that you mean two units a day and not to units twice a day which means the two units a day would mean one unit in the morning and one unit in the evening. I don't know I feel like I'm just trying to cover my tracks with my vet because the way she is, she's not going to like it if I was to say exactly what was going on and that I decided to just take it upon myself to give him the dose that I feel is right . Many vets if they hear this they would say that you don't really need me as your vet if you're going to make your own decisions. So oh, I am going to go with my plan and give him one unit in the morning and one unit in the evening. Of course, I will test his blood glucose. The reason my vet wanted me to do the constant dose for two weeks, was because she wanted to see where that particular dose was taking Elvis when she finally would look at the blood glucose curve that she told me to do after the two weeks. Like I said, I could just say that I made a mistake I think and I was giving Elvis one unit in the morning and one unit in the evening which I think I'm going to do because I feel like I want to start all over again and see where it takes us. Also, I was wondering can kitties who are diabetic eat in between the two shots that they get you know the morning shot and the evening shot. Can they eat something during the day.? Elvis gets hungry in the middle of the day but I remember my other vet saying that he is not supposed to eat anything at all for 12 hours that is the time between the two shots of Lantus because if he eats in between the day his blood sugar will Spike and none of this is going to work. From what I have been reading it says that it's okay if your kitty who is diabetic has an afafternoo snack. I'm wondering how other people who give their cat Lantus insulin does they're feeding schedule??
     
  16. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    You didn't make a mistake - those are the only kind of test strips available for urine testing. You need a test meter and test strips to see where his glucose actually is. You can get those at most pharmacies altho' a lot of us use one of the 'Relion' brand ones from Walmart. You'll also need a lancet pen and 28 gauge lancets.
     
  17. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    I have yet to hear any vet say that! I didn't take any of the vets advice that I've seen (three so far) seriously. My logic is this: First vet said 'if it were my cat, I'd put her down' - and then proceeded to tell me about a couple that had 'tried' to treat their diabetic cat and came home to find it dead...after learning about diabetes and insulin, etc. from THIS forum - I believe that the reason they came home and found their cat dead is because of HIS ADVICE! He gave me a script for Novalin - said I wouldn't be able to test her at home - give her the insulin and hope for the best. I didn't do any of that! 2nd vet was nicer about the whole thing but of course wanted to do a fructosamine test (I declined due to expense)...and I'd already been testing Luci at home - so I at least knew how to do it...he gave me a script for Lantus - go home and give TWO UNITS - bring her back next week for testing and dose adjustment - I didn't do that either - I tested and tested and tested and listened to the advice I was getting here. Two units was TOO MUCH! So I backed off immediately...and started testing/dosing based on recommendations from this group. I sent him my spreadsheets for a while...it was getting very clear to me by now that this group knew FAR MORE than any vet about feline diabetes and I trusted their cautious approach to insulin administration much more than that of the vets. 3rd vet, pretty much the same story - wanted me to bring her in for testing and dose adjusting...I kindly thanked her (for the dental exam/cleaning, which is what I was there for) paid the bill and left... I don't need their bad advice to keep my cat healthy...

    So please listen to the members of this group. I know it's a lot to take in...but you'll get it. And I know it seems to go in the face of everything to rebuke what these professionals say - but it's been proven time and time again that they simply do not have the depth of understanding of feline diabetes required to manage these cats. Unless they're exclusively feline endocrinologists or feline diabetic specialists - they're training is too broad to be of much use with this disease.

    I've said this before, and I'll say it again - you're the one paying the bill...you have choices....
     
  18. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Paula, all I can say is your vet is not with you at home, so you can choose how much you want to tell her. Most of us refuse to have the fructosamine, because we test enough that the information from the fructosamine is not needed. It's a useful test in diagnosing FD as it's not affected by stress of a vet visit, but now you know that your kitty has FD if you are testing at home the numbers will not be affected adversely by stress so they give a true representation of your kitties BG.

    Again with lantus this is not the best approach, I believe that with the faster/shorter acting insulins this is a reasonable feeding strategy.
    They tend to do better with several meals/snacks during the day, it's normally better not to feed too late into the cycle as this can cause the BG to spike. But upto about +6 is fine so if you were shooting at 6 am then you could be giving your kitty food up until then.
    To give you an idea, this is my usual feeding schedule with George
    • 6am amps test/ feed 75g LC food/
    • +2 8am 3tsp LC food/
    • +4/+5 10/11am 3 tsp LC food
    • 6pm amps test/ feed 75g LC food/
    • +2 8pm 3tsp LC food/
    • +4/+5 10/11pm 3 tsp LC food
    As I monitor during the day, if for any reason I feel like he is dropping too low, or if I have to go out and I'm worried, I might give him an extra snack here and there to keep him safe. If you click on the link for his Spreadsheet in the signature, you can see exactly what I feed on a day by day basis. You'll see that I am shooting green numbers confidently, I would not advise you to do this without some guidance, you need to become data ready to do this safely, we can help you get there.

    I'm not sure if taking him back to 1u is necessarily the best thing to do, it could really set him back, without seeing the numbers you have gathered so far it's impossible to tell. 2u might be a good dose, or it might be too much. I always worry about taking down the insulin too much, as it can result in prolonged high numbers which are in themselves problematic, and not healthy for your cat in the long run. But by the same token too much insulin and the risk of hypo, is also a consideration if the dose is too much.

    Please do download our spreadsheet format. Pop on the numbers you have, your meter will have a memory. By looking at that we will be able to give you much better guidance and assistance.

    One other thing that stands out in your comments is the amount by which you are taking the dose up and down, most vets tend to recommend 1u steps, experience tells us this is too much change, and leads to you missing a good dose. If you go up to fast this risks hypo, if you go down too fast it risks kitty spending lots of unnecessary time in high numbers. We usually do our dose changes in 0.25u steps, but you will need the correct U100 syrninges to do this, they need to have 1/2u markings.
     

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