Vet's Opinion vs. Frequent Testing

Hello,
We are in conflict and need advice. Our vet is adament about not doing frequent testing. When Oreo was diagnosed with GI lymphoma and then diabetes, we were told to test only two or three times a week. His numbers were in the 300's at the time. His insulin dosage was slowly increased as well - up to 3.0 units of Lantus. Since September, we started noticing a steady decline in his numbers. On September 23, his BG dropped in the 80's, which was caught on the day we were doing curves. We know this is a normal number , but for Oreo it was very unusual. It was scary, but awakened us to the fact that we were not in control of the situation. Since then we have done testing about three times a day. In the past few weeks we are seeing a steady decline in his numbers. We asked the vet and she was reluctant to decrease the insulin. Using our intuition, we did drop him by half a unit. This morning at the nadir, his BG dropped to 76! After a can of regular cat food, I phoned the vet and told her that we dropped the dose by 1/2 unit, and he still was very low. She was very insistant NOT to drop the dosage. I was told by her assistant that if he goes hypo, I will know it and can just administer Karo syrup. But we don't want to be here 24-7 waiting for him to go hypo! Finally, the vet told us we could drop him to 2.0 units, but no lower.
I was given a lecture today on the evils of frequent testing and that it will cause us to go crazy. (Too late!) Well, we were going crazy with worry when we weren't testing since we didn't know what was going on!

We finally put a spreadsheet together and posted it tonight. We wondered if any of you have had similar experiences dealing with your vets and if you came to any resolution? There seems to be a philosophical difference about how you deal with diabetes - where does it come, from how might we resolve it?

Thank you!
Oreo's Mom

 

Just do it. What is the vet going to do about it? Seriously, how can a vet justify NOT testing? Giving insulin without having any idea if it is safe? Do people ever take insulin without first testing to see if its safe?

Yes, some days I drive myself nuts. I get an out-the-door test and if she's low or dropping rapidly I don't get out the door like I should. But in those cases would it really be better to not know and just walk out the door for a long day at work?

If we didn't test frequently we probably would have killed Smokey recently because her numbers just dropped after a year of hanging in the 200s with some trips to the 300s and 100s. All of a sudden she was running 100s or under all the time and dropped to the 40s and under 60 a couple of times. We skipped a dose once and dropped 2 units off of her dose. Without testing we would have had no clue that she was doing this. Yes, I've had a lot of sleepless nights during this, but they were making sure she was safe.

And cats do go into remission. More and more every day with proper treatment and diet change. To tell you you CAN'T drop the dose seems odd and a bit unsafe.

Test. Tell the vet you are going to test because it is the only way you are going to feel comfortable giving Oreo insulin.

76 is a very pretty nadir by the way :mrgreen:

 

My vet didn't talk to me about testing at all, and then I found this site and was strongly encouraged to start... I am so glad that I did. The Vet is happy with the spreadsheet for Zeus so that he can review how Zeus is doing, but he still thinks that I don't need to test as much as I do. We just changed insulin and he said not to test for a week and then do a curve.... obviously I ignored that advice. Vets don't know everything ... I can't believe you were given a lecture about the evils of testing. Same situation as what Melanie said, there have been a few times where Zeus was much too low to give insulin, and I hate to think of what would have happened if I had shot and not tested first.

Orea is your cat, and you have to do what is best for him, and what YOU feel comfortable with. I agree with everything that Melanie said. Just do it, it's the only way to keep Oreo safe :smile:

Good luck,
Kathie

 

When my former regular vet put Zoozey on insulin, she said I didn't need to test because it would just be too hard and that Zoozey wouldn't cooperate. Well, he doesn't really cooperate, but after reading what people on FDMB had to say about home testing, I decided to test him anyway. The e-vet, who is now Zoozey's regular vet did encourage me to test at least twice a day, and they're glad that I do because I can give them readings I get when my cat is not in a stressful environment. They've even encouraged me to do curves at home periodically.

 

Many vets know a little about a lot of animals but they don't know everything. Most vets get an hour on diabetes and were told they won't see many cases of it. Most of the insulin's they prescribe are outdated and the dosing and food advice is geared more for dogs.

Others don't want you to go against their advise because they don't want you to sue them if you do (or don't) and something happens to your pet. But sometimes their advise is horribly wrong and a pet can die because of it.

With FD you will find that YOU need to do the research and take it back to your vet who is too busy learning about chinchilla ailments than to delve more into cat problems.

You mentioned a spreadsheet- don't forget to link it to your signature so we can see and advise.

Test frequently, often, and see what the dose does. That is a beautiful nadir number to have this early in the run.

 

It's YOUR cat, not the vet's cat. The vet can't tell you how to care for your cat in your home or force you to. If you want to test bg levels daily, go right ahead and do it. You don't need the vet's approval to do it.

A nadir of 76 is good, really :smile: Normal non-diabetic levels are roughly 60 to 150 or so.

Remember, never give any insulin if the bg is under 200, and especially not under 100.

 

I also agree with continuing testing - at least before shots and occasionally mid-cycle.

We have sometimes seen with a history of cancer -- the cancer may, as it grows, use the excess sugar in the bloodstream - leading to possible low blood sugar / Hypo.

My acro-cat Norton went down from 5.5u TID (PZI 3x per day) to 2.5-3u TID as his intestinal cancer grew (we didn't know about the cancer at first - just saw his blood sugar go down and decreased his insulin accordingly).

Norton did NOT hypo because we were testing him at least 3 times per day - and we reduced his dose gradually as needed.

 

Please test as often as you need to feel you're in control. I almost lost my Buster because I was following the vet's advice and not testing at all. The community on this site is very caring and has a lot of experience because we live it, every day. I don't see how a vet could possibly manage FD from office visits alone. You need to take control of this and you have a great place right here for support! YOU can do this! :YMHUG:

That 76 is looking great Oreo! :mrgreen:

 

I had the same issue as you - the vet told me not to test because the cat would hate it and soon hate me. I was given the usual prescription dry-food crap and told to do 1 unit of lantus per day for a week and then back for blood work.
I had already started looking at this site and, thank God for that!

It was still a difficult decision, do I ignore the so-called expert and go with a bunch of people I've never met?
But, what they said made so much more sense.

After a little over a month, Honey is doing great, testing has gotten so much easier (gee, did I really struggle early on??? ) and the dose has been decreased due to her lovely bg numbers.

Now I have the same issue with my newly diagnosed hyperthyroid cat - again, I'm ignoring the vet's instructions and going with a yahoo group who seem to know so much more.

You have to take the plunge and realise that your vet needs educating on this and definitely doesn't have all the answers!

 

The first vet told me not to home test, said I'd have to poke his feet and that he had to walk on them. Vet #2 (same hospital) said nothing much about testing but when I asked about when not to give a shot she said 50-80 which is too low according to what I've read. Vet #3 said home testing was good, that with Pepe's numbers I may only have to give .5 (I was doing 1 unit twice a day) per day. This is a wonderful site with very knowledgable and helpful people.

Sharon and Pepe

 

When Maui was diagnosed, her FORMER vet actually forbade me from home testing. She said, if I did, she would refuse to treat Maui at all.

The vet also insisted that I leave Maui with her for one week to "get regulated". This was not a 24-7 care facility and they were not following any known protocol. She used lantus and because, again this is my fault, I didn't bring Maui in until 10 am (the earliest appointment I could get), and they closed at 6 pm, there was no way they would dose in 12 hour increments, they would give her the shot at 11 am and again at 5 pm, before they closed up for the night.

I found this board on the same day and when I posted what the vet was saying, well you can imagine the uproar that created on this board.

Having the support from this board helped tremendously (and yes, I put my faith into internet people). My biggest fear was what am I going to do if this vet won't work with me. How am I supposed to find another vet for Maui? Of course, that was just panic talking and the fact is, this was the second vet place I used since having cats. So, duh, if I had to, I could find another vet.

Anyway, she had Maui and I kept pushing the questions all day long, which she didn't like very much. Finally, she got so annoyed she blurted out that she would not be held liable or be sued by me, if I did anything against her wishes! Ahhhhh, so I finally got to the heart of the matter - she was concerned about her license not about Maui's health and what was in her best interest.

Needless to say, I gathered up my courage, picked up my cat and her records and made phone calls to source a vet office that would follow common sense and the protocols of home testing, this board, etc. It was a definite learning experience, just how many vets "required" the cat to be there for regulation and how many were not up on home testing.

Now the only thing I can't seem to agree with the vets about is food. They want to push prescription and dry food at that. So, I just continue to say no thank you, I've got it covered. And whenever a cat needs to stay at a vet, I supply the food with instructions, so that they do not feed anything else.

So, it sounds like a few things are happening to you:

1) you have a vet that is obviously not up to speed on diabetes care
2) this vet has control issues (similar to my vet)
3) I bet if you really pushed it, your vet would admit to liability issues as a reason for being so hard-nosed about it

4) you need to source a new vet - one that you can work and will be supportive and not critical

I bet if you used the argument with the vet that if this patient were their human child/spouse/partner etc. they would NEVER tell them not to test and to shoot insulin blindly. No real doctor would ever suggest this. So, why I ask is it any different, just because the patient is an animal and not a human?

Good luck and hope you find a good vet soon!

 

Hi Carol,

I little while ago I sent you some veterinary documents that discussed how frequently cats should tested on Lantus--I would print those out and bring them to your vet. If she still argues with you despite the evidence you're providing otherwise, then I, personally, would switch vets. I wouldn't feel comfortable with a vet that chooses to ignore documented studies for any reason--money, ego, whatever. However, if you still want to stay with the vet, then you'll simply have to put your foot down and tell her that you're testing according to the documented recommendations for Lantus, and that you're not budging on that subject, so that's the end of the discussion on that matter. In the large, large majority of cases, vets will get on board with you if you bring them the research. Most vets aren't greedy or egotistic--they are just unaware of the current recommendations.

 

After I had a close call with Bubba 3 days in on Lantus (2units twice a day) I put my foot down and bought myself a meter (thanks to the super helpful people on this forum). My vet was also questioning me doing at home testing since I had been doing my own research too before he went on insulin (I was able to bring his numbers down with diet change the few weeks prior but not enough).

Honestly, I didn't care if I offended my vet, he wasn't the one that would have to deal with another potential hypo. Luckily he was reasonable after I told him about the hypo and my home testing. I took his advice into account, read the forums (incredibly helpful) and did what I thought was best. I restarted Bubba on a much lower dose and every few days I had to keep reducing his dose because his numbers kept falling, I would even have to skip some shots. If I had turned a blind eye I don't even want to think what would have happened. I got Bubba all the way down to less than 0.1u (a drop) and he was acting odd (his morning BG was 160). At pmps time his number was in the 80s. After talking to the vet who recommended not shooting under 150 or even 200 I decided to do just that. Bubba has been off insulin for 5 days and his numbers keep falling (I'm hopeful it's remission!).

My point is, if I had been blind dosing and not testing I don't know where he would be today. Please at least test before each shot if you can and listen to your inner voice that will tell you what is right for you. Wishing you all the best!

 

If I had not routinely tested my cat over these past six years he would have been dead (or brain-damaged) a long time ago... Feline diabetes is an illness that is managed at home. Vets may not all be comfortable with what we choose to do. That doesn't matter. What matters is that we educate and inform ourselves and then give our cats the best care possible. You are doing a really terrific job! :smile:

PS. It's not true that hometesting makes us go crazy. Some of us were crazy long before we started hometesting! haha_smiley

 

When I first lurked here, someone raised the same question as you've posed. Several people replied along the lines of, if this were a child, do you think a pediatrician would tell you to not test? Parents test their children to make sure it's safe to administer insulin. Humans routinely self-test before they self-administer insulin. They test before they shoot and they monitor their glucose levels. Why would we do anything differently with our kitties?

My vet used to give me a hard time for testing too much. I pointed out on Gabby's spreadsheet that she has a tendency for her numbers to drop early and fast. Once she saw that, she backed off. She also strongly agreed that there was no point to my bringing Gabby in for a curve since I could more easily do this at home and fructosamine tests were unnecessary since my daily testing gave more accurate data.

 

Pepe hasn't had to have insulin since Tues am. If I had followed my vet's advice on not testing and giving 1 unit twice a day who knows that would have happened. I'm printing out information to take them when I go Wednesday. I am shocked as to how many vets know little to nothing about diabetes. They remind me of some people I work with. They muddle through their jobs and don't want to get better or learn. It's a shame, and we are the ones that have to pay - literally.

My vet didn't know how to tell me to give smaller doses than 1 unit. He said they didn't make smaller needles but as I learned here, use U100 needles for U40 insulin. I am taking him the conversion chart.

If I don't feel more comfortable with my vet after next week I am going to start shopping around. I am so happy I found this site and all these great people! Thanks everyone for their knowledge and help!!

Sharon and Pepe

 

A lot of us go through this with our vets. A couple of the vets in the office where I take my cats also keep telling me that I do not need to test. Which considering that when I had my first diabetic cat, it was this office that taught me how to test and encouraged it, is ironic.

You are the one that is responsible for your cat's health. You do not need your vet's permission to test. I test before every shot. Even though my vet & I don't agree on how often to test, this is one of the the things we generally agree to disagree. Because I test before every shot, I am able to determine when there are strange patterns in my cat's BG levels and am able to point these out to the vet and have the data to prove it. For almost every one of my cats, I usually have at least a couple times a week where the BG levels are too low to shoot. I am able to show this pattern to my vet. I also have on occasion had to board my cats at their office and leave strict instructions about testing and using my meters. Because they do follow my instructions, they have also been able to see these patterns occur. My vets know that since I have had four diabetic cats (two of which I adopted knowing they were diabetic) over the past 10 years, I really do know what I am talking about. :mrgreen:

Sometimes you have to stand firm in your decisions for caring for your cat. Unless your decisions are actually causing harm to your cat, your vet should support you. They may not agree with it, but they should not criticize you for it.

 

Go with your gut! Testing = freedom from the unknown, as well as a tool for determining dosage. Without it, it's kind of a stab in the dark.

Side note about your spreadsheet - isn't it cool to see your ss trend from pink to yellow to blue and end with today's note of "Playing today!" -- awesome