Vent

my vet doesnt get it

'Fructosamine level is normal' she chirrups.

Despite there being glucose in the urine sample taken at same time.

I tell her about the tons of water mr b drinks daily, sometimes he just rests by the bowl, and the many trips he takes to pee it all out. And the hind leg weakness, the front leg weakness, the muscle wasting, the weight loss, the restlessness - nobody can nap when they have to drink and pee all the time.

I tell her our numbers are usually in the 300's preshot, and she says that is ok. I tell her we get into the 200's at nadir, sometimes stick in the 300's all day, and rarely see 100's. she says that is ok.

I think she is a bright, open minded vet but like many vets has a huge blind spot when it comes to diabetes.

We've seen several vets, even vets who themselves have diabetic pet cats, and yet still there is a general lack of knowledge. Or maybe it is the fact that my cat has been unusually tricky to treat. I dont know. Its very frustrating.

 

Could it be that he needs a higher dose of his thyroid meds? I know you've checked that recently.

 

This.

We home testers are in a tricky - and very frustrating - position: we have the skills and knowledge to enable us to be far more ambitious in our treatment goals for our kitties than those who just monitor water consumption or who don't do any monitoring at all and rely on fructosamine tests and BG spot checks at the vets. My own feeling is that the majority of vets are so obsessed with minimisation of hyperglycaemia risk that they make insulin treatment decisions which leave many of their patients living with unnecessarily high blood glucose levels - and all the problems which may accompany poor regulation. This 'one size fits all' approach to diabetes management is absolutely crazy-making for those of us in a position to help our kitties to become better regulated - and healthier - than those who 'dose 'n' hope' as so many vets seem to recommend.

Jen, I'm so sorry to hear about MisterBee's clinical signs at the moment. I know how very much you love him and how worried you must be. I think it is very wrong of your vet not to be concerned that your boy has glucose in his urine at the moment - and about his other clinical signs.

I've been looking over MisterBee's spreadsheet and I have a couple of questions:

1. Has he ever been tested for high dose conditions?

2. Would you possibly consider trying again with an L insulin? (His numbers were better on Lantus.)

Sending you an extra big hug. I really feel for you.




Mogs
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Jen,

Did the vet say anything about the dilated pupils? Also the restlessness. Both can be symptoms of feline hypertension:

http://catclinicofroswell.com/2012/07/feline-hypertension-meowing-dilated-pupils-restlessness/

Also, if he's hovering by his water bowl it might be a symptom of nausea. It might be an idea to get another appointment to get MisterBee's blood pressure checked and also get some blood work done to see how his kidneys and pancreas are doing.


Mogs
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Vent away. We listen. The 1st time I went to ER with Smokey (where the ultrasound is done) I asked IM about treating diabetes thinking they would be more knowledgeable. Smokey was ranging 200's with occasional pops of high 100's. The doctor said it was too low, they like the kitties consistently in the 300's. I'm like hmmmm, okay about his ultrasound..........

It wasn't worth discussing with them since I didn't like the requirements they had if they treat. Weekly fructosamine and all day curve every 3 months.

 

Jen, if it's any consolation, the one time I had a fructosamine done on my girl, it came back saying she was in normal range, well regulated but her daily numbers and behaviour were like Mr. B's. My weapon was to simply hand over the spreadsheet with daily readings and ask the vet to explain to me how the test could possibly suggest she was regulated when my daily readings told the opposite story. Thankfully my vet isn't suggesting I keep my girl in the 300's and admitted she couldn't explain it. But then she has always been pro home testing and could see the wisdom of trusting weeks of data over a one off test. I will NEVER waste my money on a fructosamine test again unless it's for the purpose of getting a final confirmation of diagnosis because it's not reliable to determine regulation in my opinion.

I'm with Kris and Mogs. Getting his BP checked and his hyperT under optimal control could help immensely. How are his thyroid numbers? Uncontrolled HyperT can cause insulin resistance. He could also have a high dose condition even though his dose has not exceeded 6u BID. If you get him tested and he is a high dose fellow, you'd at least know why you are having such difficulty despite putting your heart and soul into helping him.

Sending lots of hugs. I've walked your path and understand how truly upsetting it is. I can also attest to the fact that knowing I wasn't dealing with a "normal" diabetic cat has made my journey so very much easier.

 

Glad you mentioned this, Linda. The thought did cross my mind when looking at MisterBee's Lantus numbers earlier but I neglected to include that thought in my earlier post on this thread.

This.

@Misterbeesmom -

Jen, I know how very hard you work to care for dear MisterBee and I feel for you. I read your threads and I sit here wishing so hard for you to get a breakthrough. I pray that you'll be able to find a vet who can help you both.

If love were a medicine MisterBee would be the healthiest kitty going.




Mogs

 

@Misterbeesmom - IMPORTANT!!!

Was just doing a scan of FH thread titles and I see that Misterbee is howling as well as having the dilated pupils and restlessness. I think it would be wise to get another vet appointment as soon as possible to get his blood pressure checked and also to have his eyes examined as a precaution. He has three clinical signs which may possibly be attributable to hypertension (howling, dilated pupils, restlessness). If he were mine I'd probably see if the vet could fit me in later today; tomorrow at the very latest.




Mogs
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I also suggest you ask the vet to do bloodwork (especially the kidneys and probably a Spec fPL to see how MisterBee's pancreas is doing).


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Thank you. In the wee hours i was googling dilated pupils and saw bp come up as a possible cause.

His pupils thankfully are not dilated all the time (I wouldve gone to ER!), they just seemed more dilated than necessary, which i attributed to perhaps being in pain, which ended up being why i booked a vet appt today. I was watching him closely all morning and his eyes were fine, making me think i had imagined the whole thing. He has had his bp tests in the past and it was fine. He hasnt been howling, just a plaintive meow at the bowl once in a while, which after this morning i'm blaming it on his numbers going too low when i wasnt looking. And as far as restlessness goes, he has had that off and on for months, its just it was more extreme and along with the other symptoms i was worried he was in pain.

The other thing is we did just have blood done a couple weeks ago and his kidneys were in question but it turns out they appear to be ok. And i just got word that his urine has no proteins. The spec fpl has not been done recently but it was elevated last we looked a few months ago. He has never had symptoms of nausea or pain normally associated with pancreatitis.

This is all a very long answer, sorry. The short answer is we've been through so much that i hate to bring him to the vet unless he needs to. that, combined with the knowledge that my vet is limited in terms of how they view and treat diabetes.

And the little goofball's eyes are nicely constricted right now while he is resting in the sunshine. Little stinker will be the death of me!

 

He is slightly hyperT which the vets said dont increase his methimazole because it'll put his kidneys at risk, which were in question at the time. I said to myself screw that and i increased his methimazole. That was 20 days ago, so from experience i'd imagine he's back down in the normal range.

Funny thing is after more testing it appears his kidneys are just fine. And i'm starting to feel like i pay for way too much veterinary care.

Thank you so much. I too will never do another fructosamine test. This morning's little escapade http://www.felinediabetes.com/FDMB/threads/108-at-3-had-a-little-scare-but-ok-now.169929/ totally sealed that for me. Useless!

 

Thank you everyone for chipping in! Its been rough! It really helps to have your support.

 

Yes. He was just outside of the normal range. I bumped up his thyroid meds which by now should be having an effect.

 

At the beginning, my vet wanted also to perform fructosamine tests every week.
No way : my cat changes himself into a devil creature at the vet, and needs to be sedated for anything.

So, I proposed to share my SS with him, as I'm sharing it on this board. He put the link in his favorites, checked it quite often, sent me emails or SMS when he wanted to give advise.

Now, even after 6 months of remission, my vet still have my SS in his favorites, and shows it to new diagnosed diabetes caretakers (also to show them the power of wet food).
He completely changed his mind after having seen the SS, and obliges all the new diagnosed to home test. He also wants to create a support group for sugar kitties owners in our neighborhood!

Thus being said, nonetheless you need to find a vet competent in diabetes, but also an open-minded one, and if he is also a geek, that's a must!

 

That is awesome!

 

Hi Jen...i am with you in the whole hyperthyroid then diabetic situation. Elmo is also a senior, diagnosed hyperthyroid in 2013( just like Mr B) ...was "controlled" by science diet yd whose high carb content contributed to the diabetes( my supposition)...after diabetes dx and DKA stay in hospital he was put on methimazole..just had to up it yesterday to one full 2.5 mgs 2x daily.Was interested that MrBs pupils can concern you..Elmo can do that to me too from time to time. Going to ask holistic vet about this today and if i get anything definite i will share with you. BTW, as of yesterday we r in process of switching vets and insulins from vetsulin to Lantus.

 

And , Mr B is a beauty

 

I'm sure that you can find such a vet!

The most important part is to find an open-minded one.
I know that vets have also dedicated boards, in which they can share and ask for advises.
As soon as you find an open-minded vet, a little bit geek, and who is a member of a dedicated board, go for him!

 

Thank u. Sadly he doesnt look as buff or healthy as he did in that pic which was taken pre dx.. He has had a tough time. He's still my handsome boy.

 

Thank you! I hope you like the new vet and insulin. Elmo is a lucky boy!

 

He's very handsome, Jen.

 

@Capoo -

I wish it were possible to clone your vet, Sophie!


Mogs
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@Misterbeesmom -

Another thought, Jen. If you notice odd behaviours again (like the mewling near the water bowl) it may help to keep a brief note of them and also to log the time of the behaviour in relation to insulin dose time. If you keep track in the spreadsheet Remarks column it may help you to determine whether there's any pattern relating to MisterBee's insulin cycles.

I see after this mornings escapade his nibs is up in the rafters at PMPS.

(((Jen)))


Mogs
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Whoa! Mr. B doesn't mess around does he?!!! That PMPS makes me wonder if he went even lower prior to the +3 reading of 99 and that the 99 could be an uptick number. Tomorrow I would be inclined to keep a close watch on Mr. B from +1.5 just to see what he is up to. That said, the drop may not be as dramatic with the lower dose.

Jen, I have a high dose cat (she was up to 16u twice daily at one point in our journey) and with a dose that high, dose adjustments of 1u or more are not unreasonable however, I found with my girl that if I take things slow and steady and adjust in half or even quarter unit doses and try not to panic or be aggressive, she holds dose decreases much better. So if Mr. B is a bit higher tomorrow creating another "what now" moment for you, don't get discouraged. You may have to go up and down the dosing scale a few times before Mr. B starts getting more comfortable at lower numbers. I know all too well how scary and frustrating all this is for you but believe me, patience is a really big part of this dance!

 

I keep a paper journal with all sorts of notes as well as his doses and bg numbers, so yes definitely now i know, in theory, that when he acts a certain way it might indicate a specific problem.
So glad i took that +3 this morning. It really was on a whim.
Thanks mogs. Whew what a day.

 

He really wanted to make a statement today.
Maybe its just because i'm exhausted but i'm not freaking out. We have more info now, and hope that it'll show us the way. Thank u!

 

When I started keeping Saoirse's journal I just recorded *anything* I observed - good, bad, or indifferent. Over time all those observations really paid dividends.

We're all glad you took that +3, Jen!




Mogs
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