Saw internal medicine specialist today - more confused!

We had a long discussion with an internal medicine vet today and I got told a lot of different things from what I have been told by my previous vet and by all my reading. Here it goes:

* There are 2 kinds of diabetic kitties: Insulin Dependent (pancreas is injured by a protein layer) and Insulin Independent (overweight cat that fat cells act like insulin binders essentially). Only II cats need to be on an "atkins diet" of ultra low carb. ID cats should have more carbs than II cats. ID cats may not ever get better because the protein layer put down in the pancreas never goes away, but sometimes the pancreas can work around it. High protein and very little carbs can cause ketones in ID cats.

* OTC foods: no matter how good, high protein, and expensive they are, they are all variable batch foods. This means that one batch of FF might have a slightly different percentage of each ingredient based on cost and availability of ingredients. Over the period of a few months you might see ingredients move around in a different order on the label. Prescription foods are set batch foods - the same ingredients are added in the same amounts each time. (I still don't like any of the Rx foods out there despite this) She also mentioned about the absorbability of certain foods (bio something she called it, I can't remember). How certain ingredients aren't processed by the cat. She said FF is one of the bad ones for this :?: I wonder if she is basing this off of the 30 some other flavors of FF that aren't all protein and it doesn't pertain to the 6 flavors that are grain free. The prescription foods she suggested are Royal Canin Diabetic DS 44 dry, Purina DM dry and canned, Iams feline low residue dry and canned, and Purina EN gastroenteric dry and canned.

* Diet: should have only 2 meals a day so to not spike the glucose levels when the insulin is trailing off. This isn't an option with Oscar since he wakes us up by 5am most mornings even with a 11pm snack put down. The same flavors should be given at the same time each day to create consistency and to see how it effects the glucose.

* Dosing: should stick with 1 ProZinc dose for 10-14 days and then do a curve at the end of this time.

* Hometesting: should not test because it stresses the cat. The stress could be acting against the insulin we are giving. Only test at the end of the 10-14 day period for the curve. I showed her the times that Oscar bottomed out at +12 through +20 and explained what would have happened if I had given our regular dose with him at 46 and her opinion didn't change. I would have killed my cat if I followed this advice. Oscar knows when it is testing time and usually comes up to me purring and ready. I really don't think it stresses him much at all.

* Asthma treatment: might want us to go down to only bronchiodilators and give flovent only as needed (shows she doesn't know how flovent works - it takes 2-4 weeks to build up before it has ANY effect at all) My worry is that bronchiodilators only treat the symptoms and don't prevent the cause. The bronchiodilators are also in pill form, which means I would be putting a pill down his throat at least once a day. Talk about something that would stress him out!

I asked her what insulin she usually starts off with for patients and she said it used to be Humilin N and now it is ProZinc. This explains her meal protocol of only 2 meals a day with no snacks I think. What is everyone's opinion on all this? I am going to try a few things she suggested:

1. We are going back down to 1u and going to hold it there for at least a week, even though we saw a big jump in drinking and peeing when we were down this low before.
2. We are going to stick to only 2 flavors of FF and give them each at the same time each day (Liver and Chicken feast at AM and Turkey and Gibblets at PM)
3. We got a new vial of ProZinc today since we are at the last 1/3 of our first vial. There might be concentration differences at the bottom of the vial that could account for things too.
4. We are only going to test at amps and pmps for a few days while he settles in.

So I am a bit more confused than I was before. This is a highly recommended internal medicine specialist in our area. I was told that we are great FD parents, but we are doing too much and might be preventing Oscar from doing better with the insulin :!: Sorry for the long winded post, but I want to see if anyone else has heard of these suggestions and 'facts' before.

 

Hi Kelly
Oh I have heard these stories before.
Most vets don't think hometesting is necessary and they all say the cat is stressed.
I went to 4 vets, the "internal medicine" speciaist that I saw said do not hometest and do a curve once a week.
There was no way I was going to shoot insulin into my cat without knowing if he had a safe BG number to shoot.
None of teh vets that I saw agreed with anything I did for Max. I was told you cannot regulate a cat.
Well, I ignored 4 vets, stuck with the Lantus group and Max has been off insulin for 5 weeks now.
I m nt familiar with how Prozinc work but I do know that hometesting is essential in adjusting doses and keeping your litty safe.
Also, an unregulated cat will be hungfry more as the food is not being absorbed by their body.
Many people work with mini meals - small meals spaced out during the day. This is less work on the pancreas and gives them a chance to heal. Dumping a half day's food at one time into a kitty only makes the pancrease work that much harder.
Dry food is not recommended as it is way too high in carbs. Under 10% si what we look for.
Max has been eating FF since his dx in Nov and as I said he is OTJ (off the juice).

Hope I was able to answer some of your questions.

 

It is comforting to hear that someone else has had to completely ignore advice from a 'specialist'! I was completely floored that she didn't want me to test before each shot, even in light of how his system has behaved before. I flat out said that I refuse to shoot blindly!

I guess my two biggest questions out of that really long list (lol) is about the variable batch OTC cat foods, the 2 meals a day theory, and changing the dose every two weeks instead of every 3-4 days. I know waiting a week is common for lantus users, but I haven't seen many PZI or ProZinc users do this.

You were told that you cannot regulate a cat - I was told something similar. "The best we can hope for is to keep him in the low 200s" Well that is where he was at before giving him insulin! I might as well not give it to him! She didn't want him to go below the mid 100s and wanted him hovering more around 200 all the time. :?:

 

Kelly
Why don't you go and post in the PZI insulin group. They should be able to help you more.
With regards to teh food I don't beieve anyone on the board woudl agree with dry diabetic food.
Most feed FF, friskies, sophisticat, wellness, EVO.
Here is the link for the food list.http://binkyspage.tripod.com/canfood.html
I do not know the realtionship to food and PZI or how they dose.
Please go over to that group and attach this link to your post there.
You go into the top of this thread, highlight in the address bar, copy, paste and start a new topic in PZI.

 

Wow. Just the recommendations not to home test and feed dry food - well, I would have been out of there. I mean how much can you believe of what the good doc said after those two. When Blue cat was on the dry he needed 4 U's of insulin to see any green - vet recommended dry foods. I was lucky he did not hypo before we home tested.

On top of that only overweight diabetic cats are helped by a low carb/ hi protein diet? Please... I'd forget everything she said and move on. She probably has a point about exact nutritional amounts in certain vet recommended foods - but to recommend dry hi carb foods?

Hi protein diets cause Ketones? I've never read anything even insinuating that from this or any other web site. Maybe for people, but not cats. I could be wrong about this one.

I could go on, but all the proof we need is on this website to prove her wrong! Sounds like she was schooled in the 1960's and has not kept up with modern developments in treating diabetes. Try to get your $$$ back for malpractice.

 

This may be true, however, I don't know enough to say one way or other.

Huh? Where is this coming from? I don't think it really matters how the cat got FD. Personally, with Maui she ate dry all her life and got steroid shots frequently. Once all the dry was removed, her Bg's dropped (with help from insulin), her skin issues (reason she got steroids) stopped and her IBD cleared up. Oh and she's one year OTJ!

So, high protein, low carb - I see nothing wrong with that.

I'd like to see her proof regarding this batching concept. While there may be variances to some degree - this stuff is controlled and regulated and they can't just change a batch based on a whim.

And I'm sorry, but RX foods are made the same way as non-RX. So, to me this is just bogus and a way for a vet to scare you and try to make money by selling the expensive RX crap.

Again, huh? Why - she obviously has no clue about food and how small "mini" meals actually help regulate a cat and keep their BG's more steady. I realize you use a different insulin, but come over to Lantus land and you will see many, many people there feed their cats mini meals - that's several small meals throughout the day/night - and it keeps them regulated.

Me - I put out two main meals - breakfast and dinner and leave it out until next meal, my girls graze and eat as they want and it doesn't matter - just look at Maui's ss and you'll see that food and when she ate or didn't eat, didn't matter.

Well, if you get enough spot tests in during this time frame, you actually don't need to a curve. I never did an actual curve, but I also tested at various times during each cycle. Some more than others - again see Maui's ss.

Don't listen to this nonsense - what stresses out the cat, is all the vet visits, hypo episodes and watching mum freak out, from it all.

I took have an asthmatic cat - Sydney - I don't give pills nor will I allow steroid shots. I use the aerokat and flovent is given 2 puffs BID (220 dose). I am part of the feline asthma yahoo group - think it's called feline asthma relief and take my instructions from Kat on there, who knows what she is doing.

You need to be consistent with flovent as you don't want to ruin the "shed" build up.
While yes, it may only treat the symptoms, the flovent also serves to reduce the inflammation in the lungs.

I got no clue about pills. But sure if you go to yahoo groups: http://pets.groups.yahoo.com/group/felineasthmarelief/ - they will be able to respond on this part.

Make sure you home test regularly so you know what is really going on.

If you have IBD issues, limiting flavors is a good idea. It's what I do for Maui. So, that's fine, nothing wrong with limiting flavors. Just make sure you give them enough food. Also, you may want to add water to the food.

Yes, it will increase the peeing, but it also makes sure that everything is flowing and kitty has enough water in body. With FF, I use almost one can of water. Just my 2 cents.

Don't know your insulin, so no comment from me.

Not a good idea. No not at all. While you don't have to do a curve or test every hour or two. I strongly suggest that you test more than twice a day. Look, I didn't go crazy testing, but I did test more than twice a day.

These are my opinions and both Maui and Sydney approve it!

 

I have been feeding FF because that's what everyone recommends here. I was wondering if anyone had heard of the variable batch thing before and how it might effect glucose #s. I'll copy this over to the PZI section. I was unsure of where to post it because so many of the topics weren't PZI specific.

Hilary -saw you posted as I did. Thanks for all the back up for what I was thinking. I am majorly questioning everything I was told today. I don't plan on backing down on the flovent dose anytime soon. Kat on that group has been a wonderful support for both me and Oscar, and I would take her advice over any vet any day of the week It was quite obvious that the vet today was not familiar with how flovent builds up effectiveness.

 

I would really not trust this person to treat my cat's diabetes. Too many things just don't make sense--no testing (I'd like to see one actual case that supports this theory), 2 meals, (making the pancreas work harder), feed dry food. If they haven't caught up with research on those things, what value is the rest of their knowledge???

I would probably agree with the idea of prescription food being a little more tightly regulated than OTC food. But because the mins and the maxes need to be met they cannot swing too far.

Sounds like your gut is telling you this person is giving you some bad advice. I'd trust your gut.

 

amazing that someone that wrong about animals can call themselves an animal specialist. or wait, perhaps diet and diabetes is not her specialty? all i can say is i'm sorry you wasted your time with that person and that you are more confused now. grrrrrrrrrrrrrr. so frustrating i know. hopefully others using Prozinc can help you figure this out better.

 

LOL Cindy .... would you be surprised to find out she teaches the diet and nutrition class at the local veterinary school? :shock:

 

The more I think about this the more it ****** me off. :evil: Please PM this 'specialist's' name so I can send her some material for her to peruse. Seriously. I promise not to mention you. Maybe by doing so we can help her help more people and their cats.

 

:lol: Steve, I might have to think about that! Her protocol is about 10 years off it seems and centered around Humulin and not the new insulins. I really wanted to tell her why I didn't want to follow that protocol, but I didn't want to end up with a defensive vet on my hands! Maybe we can give it a few days so possibly another diabetic patient comes in and she won't know which one sent the stuff in :mrgreen:

 

oh god! she's preaching what the prescription food sales guys are telling her then i bet. lordy lordy! don't forget to let her in on dr. lisa's site http://www.catinfo.org

 

I know cats are not human but Diabetes manifests in cats in a similar manner. There are 2 types of Diabetes in humans, one is type 1, ID and the other is type 2, often controlled by diet and oral meds. From what I understand, most cats have what is similar to type 2 but because oral meds don't work in cats insulin is needed if diet doesn't do it. DIET and testing along with the right amount of insulin or oral meds is the protocol for treating diabetes. No one on insulin should ever consider shooting blind so why would we do this to a cat. This specialist makes no sense to me and I have had type 1 for 46 years. Her treatment is in the dark ages for diabetes regulation. I am new to feline D but I can tell that she is way off base here. My Morgaine has been doing well on FF since last Wed. and I haven't had to give her any insulin as yet. She is running around 140-160 when we test. I attribute this to FF tender beef and tender liver and chicken. A week ago her diagnosis showed a 292 BS. There is some proof for FF.

 

Kelly,

I've been there. I've taken H to the "experts," an endocrinologist nonetheless and they did not want me home testing BGs. They actually suggested I test his urine glucose only! They gave me the same line about stressing the cat. They also told me that I would "wear out his veins" for when we really needed to home test - lol. I'm glad I took him [that I expended every effort to try to get him the best care possible] and spent the two days doing it [major drive each way], but in the end I chose to ignore their suggestions. They were very insistent and so self believing in their own expertise and it was difficult because THESE FOLKS ARE SUPPOSED TO KNOW!!! In the end you just kind of have to go, "wow." It can be disappointing to the point of sad.

I think I'll reserve anything more for your cross post in the PZI group or PM.

 

Good lord Kel!! What the *#*$& ?? I think my jaw dropped reading the recommendations. Seriously, after the stories you've told about Oscar, I can't imagine holding his food for 12 HOURS!! Seriously?!? Your boy's BG's would go through the roof with that stress, alone

I was hoping your specialist would be able to give you some information on something odd going on with Oscar, not give you conflicting info. That's just wonky. And *ESPECIALLY* with ProZinc, I can't imagine shooting blind. You've seen/heard the stories we've all gone through going from 1 to 2 units and how crazy that can get. If most of us wait on too low a dose, ketones become an issue!

I'm with Steve... can we get an info flood going to this doc? Is there an agressive version of "Convert a Vet"?

Sweetie, I'm sorry she gave you more conflicting info than good advice. I was very interested in the variable food thing. That does make some sense. I would love to know what her reaction would have been if you brought up a home made diet

I swear I'm getting a t-shirt that says "Cats are obligate carnivores"

 

I don't really have a lot of advice, but I will say this that when I was picking out a feed for my horse, I learned a lot of companies put out variable ingredient foods which for a horse's system freaked me out. I.e. they put in whatever ingredients are cheaper at the time in order to meet the guaranteed analysis, but basically your batch could be different.

It doesn't surprise me that they would do the same with cat food.

I remember being horrified in horse grain they would grind up like limestone for calcium if the other ingredient for calcium was too expensive.

 

I *almost* asked about a homemade raw diet .... *almost* mostly out of curiosity and shock value :lol: One of the foods she suggested had 38% carbs, somehow I think she would try to send me to the loony bin for trying to give Oscar an all raw diet like Dr. Lisa lists!

I am totally with you! She was even talking about how cats don't process stuff like blueberries and crap! But most of what she suggested to me to give Oscar was completely fillers like corn meal, soy protein, and chicken meal. Talk about stuff a cat can't process! To bad I only had access to the ingredients list once I got home.

 

Hey All! I am kind of late to this party, but wanted to throw in my two cents. I do agree with most of what you've said. I just want to share another idea. I know feeding mini meals really helped Pru get to her low doses. I was trying every flavor lc canned to see if and how it affected her bg's too. The last few days I've actually went to only two flavors and kept with it. I also went to feeding every 6 hours. She usually eats a lot twice a day, but eats alittle when I feed the in-between meal. I am rotating Friskies Country Style Dinner & SophistaCat Supreme Gourmet Dinner and all of a sudden Pru is holding in the greens. Again, this has just happened, so we'll see. I guess my point is.... maybe try sticking to the same flavor food and see what happens.

 

Hi Kelly

Just a few comments here ...

Yes, there is batch variability with OTC foods, and probably some (but not all) types of rx foods. The rx foods are going to be made up of very specific ingredients --for example, the batch recipe may call for "feathers" and in the rx food that will be "horse feathers consisting of no more than 2% foal down", whereas the OTC food could have between 4-6 bushels of feathers of variable sorts. This is because the rx food needs to guarantee the analysis on the label. It won't do to put out a food for dogs with pancreatitis that may vary and cause acute bouts of pancreatitis sometimes. Same thing with limited-diet foods. These can't share machinery with other foods because that would cause major issues too. I'm not saying that the rx foods are better quality, just that they are very likely much more consistent.

Her comment about FF probably refers to the fact that they have a lot of ambiguous ingredients like "meat by-products" which could be beaks and hooves (literally) or chicken bones or horse bone marrow--no telling which or how much of which, and it would certainly vary the nutritional content, although who knows by how much.

Please don't use the bronchodilators without the Flovent. Why aren't you using an inhaled bronchodilator (albuterol) anyway?

Also, I dont' know where everyone has the idea that frequent meals make less work for the pancreas? Does anyone have a reference for that? I dont' think it's true. I do think it's true (based on my late cat, at least!) that cats with bad chronic pancreatitis prefer small frequent meals, but to say that it creates less work is a different thing. Huge meals and frequent meals (two different things) both keep the pancreas working. Actually, even seeing and smelling food was shown to start up a dog's pancreas, FWIW.

Jess

PS Most important thing, no bronchodilators without steroid (inhaled or otherwise)!

PPS I also have to say that, although we don't like to admit it, cats can and do digest corn and soy, probably at least as well as they do blueberries and mystery meat by-products

 

Jess thanks for the comments as usual u make us all think about things more. I don't know about pancreas. And mini meals research. What I've seen on ll are several. Beans feeding mini meals like 1-2 spoons at time every few hours and it seems to help the cat keep bgs consistebt and green. Ronnie and luna come to mind as one example of this working for cat.

I don't do that myself, however I do leave food out all the time and my cats will eat throughout. And for them and me it works fine. They aren't hoovers rather grazers n this works for us.

My. Now former vet actually forbade me from home testing - tomorrow maui is one year otj and ill post on ll and attach the link to that first day of posts. I recently read thru it and wow can't belive what we went thru. It was this board that I listened to and have maui in good health as a result.

Just beacause someone has a degree does not mean they know what they are talking about

I took syd to the dentist with her inhalers and he called. Twice cause he did not know what to do and wanted to be sure the techs who took care of her were clear. I spoke withthe tech and she knew all about the inhaler and how to administer

The dentist and I talked about food and he said he does not agree with raw food but did not say anymore. He only said Since teeth were removed and there were stitches to not give raw for two weeks so no possible bacteria would get in. Whether that makes snse or not I had no problem not feeding it for. A couple weeks. And after the recheck we will go back to feeding accordingly.

So guess my point is that everyone has an opinion and whether its based on fact, hype or emotion. You as the caregiver need to weigh all the information, do your own research and come up with a plan that works and makes sense to u.

 

We started off with using albuterol before his flovent for the first few weeks since we couldn't use pred or other steroids. We stopped the albuterol once his asthma was under control with the flovent alone. He hasn't coughed since November, and at our regular vet visit on Friday we were told that his lungs sound better than they ever had before! Right now we have the albuterol for coughing episodes only, which we haven't had to use yet, thankfully.

I may back down on his flovent from three puffs twice a day down to only two puffs of the 220 twice a day here in a few weeks and see how he does. We added the third puff of 110 because he was mouth breathing a bit still, but had no coughing. Because we couldn't use an oral or injected steroid to control things first, I think we had to go pretty high with the flovent dose just to get things under control. After seeing how well he has done, I do not plan on stopping the flovent at all ... ever

I'm sure they can digest it to some extent. I found her argument very interesting because she touted what a cat would eat if he were wild, which wouldn't be blueberries. After saying that, she recommends food that has corn, potato, soy, etc. Seems a little off and biased imho. After hearing how variable the ingredients can be for 'by-products' with FF and others it makes me want to go to a food with no by-products at all! I just wish my bank account could afford it :YMSIGH:

 

I tried this, there just wasn't enough low-carb variety out there to keep mine happy. Its one of the reasons I like Wellness Core and I am trying a few new ones, but it seems like when meat-by-products are taken off the label, grains or veggies replace it.

Meat-by-products is the second ingredient behind liver on my Purina DM cans so I don't think that the by-product issue is only in OTC foods, the quality meats don't show up until after water.