Did BG curve - now vet says to go from 1 unit to 3???

{{{{EDITED The subject line and added to this thread to get feedback.}}}}

So today is THE DAY. I am doing my first blood glucose curve on Sammy, female, age 14. She has been on her new food a week, Hills MD, and is eating it well. She seems to feel a bit better, showing signs of being happier. Did our AMPS, and she got her shot (1 unit lantus). The vet told me to try to get a BG every hour for 9 0r 10 hours. Does that sound right???

 

Re: Doing BG curve today on Sammy

When we do a curve, we get a number every 2 or 3 hours for 12 hours, so we catch the number going down, the nadir and then the numbers coming back up. I personally think every hour is overkill and hard on you and the cat.

 

Re: Doing BG curve today on Sammy

I agree - i would test every 2-3 hours unless you see him drop into blue or green in which case I would move to hourly.

Wendy

 

Re: Doing BG curve today on Sammy

Bg curve done. Vet looked at our numbers ans told me to triple her dosw to 3 units. I told her I thought that was rather extreme. I am not inclined to "obey". Thinking 2 uniys or maybe even less. This is a 8 pound cat who is not eating as much as they are aaking me to gwr into her. Comments?

 

Re: Doing BG curve today on Sammy

What numbers did you get? What food is she eating? Dry high carb food can account for higher numbers.

We never triple a dose - we like to start low and go slow so the cat is safe, with small increases based on home testing numbers. If the numbers are incredibly high, the advice might be to increase by .5 units. The usual advice is to increase by .25 units.

 

Re: Doing BG curve today on Sammy

As per my spreadsheet, she was :
527 AMPS She got 1.00 unit Lantus ... Then she was 535 457 443 405 423 445

I am going to go up slower than the vet wants me to. I am also going to look at a even lower carb food, since Hills MD is still up there in carb count at 14%. She is currently being fed 100% on the Prescription Hills MD, as per vet. She was on the Purina DM, but she got all flaky skin from that (and frankly the smell of it was making us gag.).

 

Advise sought re insulin dosage. I cannot in good conscious follow the vets orders to triple her insulin to 3 units from 1. That is way to big a jump. Thoughts??? confused_cat

 

I agree that tripling her dose is not good advice. Given how high the numbers continue to be, an increase is needed, but at most, I would suggest 1.5u.
It isn't easy to base a dose decision on just one curve, but it seems to be the way most vets do things.

Finding a lower carb food than 14% will be easy. And prescription food is not required. I'm not sure what in the DM might have caused the reaction she had. But I think DM's primary ingredient is liver. And it does really stink!

You might try poultry flavors as most kitties seem to tolerate those (rather than beef, liver or fish). Fancy Feast classics Turkey and Giblets, or Friskees Pate are good options.

If you adjust the dose, it's always a good idea to do so on a cycle where you are able to test a couple of times in the first six hours after the shot, in case the increase has an effect quickly.

Switching to a lower carb food will also have a positive effect on the numbers fairly quickly in most cats.

 

I agree with Carl - 1.5 seems good.

And if you find a lower carb wet then it should bring her down more. Many people here feed fancy feast classic pates, frisks pates or wellness grain free.

Wendy

 

This is the vet's office reply to my email:

"Dr. ***** strongly recommends that you keep Sammy on the diabetes diet (M/D). Fancy Feast is definitely not a good veterinary diet. If you are uncomfortable with tripling the dose, you are welcome to go to 1.5 units twice daily. It may take several months at this rate to get the blood glucose regulated.

You will need to do a blood glucose curve one week following every dose change. We do need to charge a progress consult fee when evaluating the curve information for you ($57+tax). This is for the doctor's time to evaluate the numbers and advise regarding any recommended changes. However, there is no charge for this one.

Regarding the tooth, Dr. *** would prefer the weekly blood glucose readings to be under 20. Then, we can certainly go ahead with Sammy's dental procedure. "

Amazing, huh? So she is going to risk a huge hypo or killing her completely for the sake of speeding things up?

Sammy has a bad tooth that needs to be removed. There is most certainly infection there, which I am thinking is not helping the BG levels. When the surgery is sheduled, I am to start her on Amoxicillian for 3 days prior, 7 days post. I wonder if we should do a course of it now?

 

If you're not too attached to your vet, I'd find another vet if I were you.

1. Straight from the AAHA Guidelines, they recommend increasing by only 0.5u at a time (and they also say a curve is every 2-3 hours, not every hour).
2. The only food the AAHA Guidelines recommends is "ultralow carb" (5% or less), which means that your vet's precious M/D isn't even considered a "good veterinary diet" for diabetic kitties.
3. $57 for a curve that you're the one doing?!?!?! :lol: :lol: :lol: :lol: We'll evaluate it for you for free, and better than the vet is obviously (not) doing!
4. Dental procedures are often a catch-22 with diabetics: they can cause higher blood sugar and flatter numbers, but many vets want to get numbers down before doing any anesthesia, but their numbers won't come down until their teeth are fixed. What many people do is find a certified pet dentist to do it instead who has shown they know how to work on diabetic kitties.

 

Sammy has a bad tooth, so it's very likely the cause of much of the high BG numbers.
There is no reason at all to wait to have the dental, but giving the AB to clear some infection first is a good idea, then have the tooth extracted.

Way too many vets say to wait until a cat is regulated before seeing to a dental problem, and that's strike one against the vet who thinks a cat will be regulated quickly.
Any vet who says to feed a high carb food to a diabetic cat earns strike two.
Any vet who says to increase a dose of insulin by 200%, from 1u to 3u, knows absolutely nothing about feline diabetes, earns strike three.

Start looking for a real vet, and I am not kidding. I don't care if this person is family or your best friend. I feel so sorry for other pet owners who will follow your vet's kind of advice for treatment.

I am sure the members on this site will explain the protocol that many have followed and helped them to get their cats off insulin if possible.

[Defamatory remarks removed by Moderator.]I would go to the office, get copies of all tests that have been done so far, just saying that you are keeping a binder of all your cat's records for the purpose of insurance... say if something happens to you, your cat's records will be in your home.
Then run like the wind from this person claiming to be a vet.

Gayle

Gayle, stop with the vet-bashing. One can disagree with a vet's advice without bashing.

 

Ah jeez....I'm wondering what credentials your vet might have as far as determining what a "good veterinary diet" are? I'd be willing to bet he doesn't have the background to even come close to measuring up to Dr. Pierson though. A diploma from whatever school he went to hanging on the wall doesn't qualify him as an expert on feline nutrition.
http://www.catinfo.org
If he really wants to know how he's been "sold" by the Hill's rep who got him to carry their "prescription line" of junk food, tell him to click on that link. Fancy Feast might not be the world's best cat food. But it is certainly an appropriate diet - providing you are feeding "classics" - for a diabetic cat. Every cat or dog he sees that gets prescribed the Hill's prescription food is worse off than if they were eating non-prescription food. All it takes is for the caregivers to do a little research (free online) to find readily available and less expensive foods from a grocery store or pet-chain store like Petsmart. M/D is a terrible choice for a diabetic cat. Both in terms of carb-content and ingredient quality. It's not any better than Fancy Feast or any number of grocery store brands in terms of quality. And costs an arm and a leg. SO, from a "value" standpoint, it fails.

Of course, the thousands of diabetic cats that have been fed non-prescription food and have thrived or even gone into remission could be wrong....and your vet might be right. :roll:

I would ask your vet 2 questions:
1 - How many diabetic cats have you treated in your career?
2 - What percentage of those cats have gone on to remission?

 

Every single diabetic cat becomes regulated at their own pace. Some never do. Some take a few weeks. Mine took ten weeks to go into remission. That is fast, but I have seen plenty of others here take less time.

You don't use insulin dosage as a "sledgehammer" to make it happen faster. There are aggressive approaches, and there are less-aggressive approaches. The primary concern, above any other concern, is that you do things safely. Because an overdose of insulin can kill a cat. Quickly.

Your vet is being aggressive. Very aggressive. He's tripling the dose based on the results of one BG curve? That is unsafe advice, period. If you are going to be aggressive, you can't just run a curve every week or two, and use that one day of BG numbers to evaluate whether a dose is working or not. It's not safe. It's reckless.

Our #1 principle when we make suggestions or give advice is "Above all, do no harm." It is something that people here try to always keep in mind especially when they are "meeting" new members.

If I were to come on here and tell you "those numbers are not good, and you should up the dose from 1u to 3u and run a curve next week and then we can reevaluate".... I would hope that the people who run this board would throw me out. Because I would be putting your cat's life at risk and putting you in a position where you might have to witness your cat go into a hypoglycemic seizure, or a coma, or even die due to my bad advice.

 

I appreciate everyone's advice and confirmation that I should not blindly follow this (female) vet's advice. I am going to find another one, but this time will take the time to interview them before I allow them to treat Sammy. I am holding at 1.5 units for now and will consider going up to 1.75 if her numbers dont get better on 1.5. I am going to go slow.

What is irritating me most is just a few days earlier she had responded to a message I left her and basically told me to take a deep breath and relax, that regulating takes a long time but that going slow was the most prudent course of action. She took great pains to tell me that insulin is a hormone, not a drug, so more is not necessarily better or would stabilize her faster. She explained to me (like I was stupid) that its not like antibiotics where you give a heavier starting dose to knock back the infection and then lower dose over 10 days to kill the infection.

I have no idea how why she had a heaping portion of "stewpid" for breakfast that day, but I suspect that she did. Even after i pointed out her error, and directed her to sources such as those you quoted above, she is sticking with her story. So. Bye bye.Ms Vet, dont let the door hit you...

 

This is the same vet that suggested an increase from one to 3 units? She must have a memory issue?

If you want, you can start a new thread and post your city/state to see if anyone nearby has a good Fd vet.

 

Hows her numbers now? Last update was Oct 30 to your SS?

Wendy

 

We had a few days where she would not eat much, and was unhappy about testing, so I backed off a bit and just observed her. She is eating again now, so I am going to test about +6 and +8hours today and see how low she is going on 1.5 units.

 

Where are you located?

I would suggest doing research to find a dental specialist in your area who can perform the dental, while taking the necessary precautions in handling a diabetic cat. I have two board certified dentists close by and it's the only place I will allow dentals done on my cats.

 

She is pretty high... I hope the high carb wears off soon although it can take 24 hours. See also if you can get some more tests over the next 2 days - a few spot checks during he day and before bed. That way we can comfortably move to 2 units if we don't see any lower numbers.

Also you are testing her pee for ketones right?

Wendy

 

we were at 1.5 units for about a week, with no real good results. Went to 1.75 last night, and her pre shot number this morning was 18.1 Very encouraging, will get some more tests today to see what her nadir is at and go from there.

Linda

 

Today's trial at 1.75 went really well. Yellows and blues!!

Sammy was obviously feeling good today. She played with her brother, and groomed him and herself for quite a while (havent seen that for weeks!). Her numbers got down to a nice range, so I will follow the protocol and hold at 1.75 for the next fews days and then re-evaluate.

Linda

 

Woohoo! Let's hope that Sammy starts showing us some greens soon! :mrgreen:

 

and now she is bouncing? sigh

 

Quite possibly. If you can, try to grab a "before bed" test at night to see how low she might be going.

 

Okay, i just have to brag about my sweet kitty. Samantha has totally clued in to the pokey then treat program. I have set up a pokey station on the kitchen table. I have a pad from a baby change table there, with a couple of soft blankets on it. She loves to sleep on it to begin with, but now she also knows it for the pokes.

When I approach the table and grab the canister with the test strips, if she is not on her pad, she gets there pronto. She knows to jump up, lay down and which way to face. She puts up with the testing perfectly everytime (touch wood). After the test, she stands up to get her treat. Her brother also knows the program, and he stands on the floor beside me waiting for his too.

How awesome is that???

 

Dare I say it? OK I dare.

TOLD YOU SO!!!!!

Isn't it amazing just how well trained they become, especially when treats are involved. Love that the civvie comes too and expects a free treat!

 

;-) Thats great! I hope you can share this with other newbies who are worried about testing! Is she still getting the MD wet?

However her numbers are still really high. I would consider another dose increase - maybe even by 0.5 unit if you can get nighttime tests in. Also please try and get some night time tests in - many cats go lower at night and she could be dropping down then..

Wendy

PS when did you last test her pee for ketones?

 

Hi Wendy, I have been laid up with a back injury, and therefore kinda doped up, especially at night. I will try to get a night time test tonight (not comfortable sleeping anyway!).

I am leaving tomorrow for a 2 week holiday in the sun. Sammy will be cared for by my wonderful son Brian, who is here today being trained in the fine art of sugar kitty care. He will do great. I have told him all about this forum, and he will be looking for help here if he needs it.

I have not tested for ketones, but will do so today. I was avoiding that procedure simply because with all the changes going on, Sammy had gone on that food strike and I did not want to upset her further. Now she is "in the groove" so I think she will forgive me if I insist on a pee test.

While I am gone, Sammy will stay on her Hills m/d. She is eating it fine now, as is my other cat. After I get home, though, she will be transitioned to something cheaper and easier to obtain. I literally had to go to 3 different vets on Saturday to gather up enough cans of it to feed both the cats for the 16 days I will be gone. One stupid vet office insisted on having to call my vet for permission to sell it to me as it is "prescription" . Uh, hello lady?? its just cat food, not medication! How is it that both my cats are allowed to eat it if its so diabetic specific? Gee whiz. $100 bucks later, I have the stockpile ready.

 

It would be good to get her off the Hills M/D as its too high in carbs at 14% and is probably the reason her BG is so high all the time. You really want something under 10% - lower the better and many members feed Friskies pates cos they are 8% .. or fancy feast pates that are 3-5% - or wellness grain free - and they are a good price.

Here are some urine testing tips: https://docs.google.com/document/d/1quta5WLEjdO0Y_t2dAYSwN84h-LNZWxOdtVsJDKZ16A/pub

have a nice vacation!

Wendy

 

Looking forward to helping out your son Brian while he is caring for your kitty Sam during your vacation. Have a wonderful time and sending good back vines to you.

Makes sense to me, to keep Sam on the M/D canned for now. She'll probably be stressed out a bit with you being gone, and trying to do a food change then sounds like a bad idea to me.

I'm with Wendy on trying a lower carb food after you get back. Lots of flavor choices in the Fancy Feast classic pates and Friskies pates. My sugardude Wink sure does love his Fancy Feast! ;-) It got him into remission so he's staying on the FF forever.

 

Brian (son) here. She tested at 10.7 this morning pre shot

She has been falling since I took over. Also switched her food to fancy feast

Not sure if I am supposed to still do the shot. But I did. Should I be worried it will fall too much?

(Spreadsheet is in sig)

 

10.7 (193) is lower than the 200 we usually recommend new members to not shoot under, however it's close enough that it probably won't be a problem. Will you be able to test her right now to see where she's at?

When did you guys switch out the food? That's probably why you're seeing lower numbers already and you'll probably have to decrease the dose soon (perhaps even tonight).

 

I just tested her, shes down to 3.4 .... which is low I believe.

I just put her food infront of her, whipped it with a fork, and shes snarfing down the whole thing right now.

Suggestions?

 

I switched her food last night, so she has had the new food for two feedings, last night and this morning.

 

Talking with my mom. Shes at a dose of 1.75 right now, we are going to go to 1.5 tonight. I'll test in an hour (less now, hour after last test) to see where she is at.

 

The food impact is having a HUGE change in numbers on her. I think you guys should probably drop it back to 1u because I have a feeling even that 1.5u will be too much. If she's under 200 at tonight's shot time, don't give a shot but post here again first. When is her next shot time (I.e. How many hours from now)?

Good job on feeding her low numbers! How is she now?

 

She just tested at 3.2. Her next feeding is normally in 6 hours (we are 6 hours post feeding / shot from this morning). I will however be feeding her late tonight as I won't be able to be here. So her next shot / feeding is scheduled in 8 hours.

She is REALLY REALLY good about her testing, I'll test her again in an hour.

 

3.7 on her last test, so on the rise. She was 3.4(+5), 3.2(+6), 3.7(+7). We are going to skip tonights shot and give her only 1.0 in the morning. I will test her before I skip of course.

So you suggest skipping a shot if she is below 11.2 (200)?

 

200 is the recommended 'no shoot' number for newbies. When you have enough data on how your cat reacts to insulin and can stay home and monitor, 150/8.3 is usually suggested. Since Sammy has improved so dramatically and you therefore don't have up to date data on her, 11ish is probably a good cut-off.

 

You are seeing some really great numbers literally overnight from just the food switch so I say it's a safe bet to skip tonight's shot if she's below 11ish and resume tomorrow at 1u only if she is over 11 tomorrow morning.

Even then, I'd still post here for dosing advice because I'm a little worried that 1u might still be too much. Start a new post tomorrow morning if she's over 11 with the subject something along the lines of "Just switched food and numbers have significantly decreased - dosing advice needed" and maybe even flag it with a 911 for a faster response.

 

You guys are awesome Thank you all.

She was at 4.4 when I left the house, so safely back on the rise. I'll be back over there to check on her and feed her shortly.

I guess the good news is that the food might make a significant difference!

 

linda is going to be so surprised about the food change and what a difference its made so far!

So for now hold the dose at 1 unit unless she drops under 50, in which case you want to drop the dose again immediately by 0.25 units ( i hope you have the syringes with 0.5 unit markings). However you probably won't see a low number now for a couple days because she is bouncing as a result of that low... see below for what that means.

Also don't shoot her under 175 for now. Perhaps stall instead i.e. don't shoot, don't feed and come here and ask for advice. Wait 30 minutes and if the number has gone up by over 20% then shoot. You want to see if her number is rising naturally without food influence. And get a +2.

Bounces - what are they and is my cat doing them?
When a cat isnt regulated, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.

Wendy