Advice please - skeptical of vet

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Nan & Amber said:
Many vets don't suggest home testing, because they are afraid owners won't want to make the commitment to their pet and will choose to euthanize if told they should do hometesting. Some don't suggest curves because they are expensive, and, again, many owners won't do it. Not saying that's what is going on with your vet, just giving you a possible alternate explanation for the hands-off approach.

I do think a second opinion would also be valuable, and it's always a good idea to rule out additional health issues when trying to sort out insulin dosing.
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That's exactly what my vet told me Nan. For many vets, it's not because they want the money gained by bringing in kitty for curves, etc. but because many of their clients just won't follow through with hometesting causing bad results or get fed up with it and want to euthanize their cats.
 
Another question, sorry guys!

Wasnt Timmy better off on the 4u 2x a day, even though it was a steep drop/climb, he was still spending a lot longer in greens/blues than he is now? - Asking all these questions to try and build my knowledge. Plus his peak climbs where the same as where he is spending a lot of time now, ie 600-700.
 
Matthew Brennan said:
Another question, sorry guys!

Wasnt Timmy better off on the 4u 2x a day, even though it was a steep drop/climb, he was still spending a lot longer in greens/blues than he is now? - Asking all these questions to try and build my knowledge. Plus his peak climbs where the same as where he is spending a lot of time now, ie 600-700.
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I was looking at that earlier and trying to make sense of it. The thing is, we only started seeing data a week ago and after a 4u dose we saw him drop sharply at +3 and then rise up to the 600s later in the day... that's what suggested the bounce and that 4u - a high dose by most cats' standards - was too much. People better than I am at looking at ss may comment further! But frustratingly, anything is possible with FD. So many factors can affect BG, as we've been saying... stress, infection, pain (cats are very good at masking pain) that it is sometimes almost impossible to suggest a definitive course of action. In most cases we suggest going right back to 1u BID but that would seem insufficient to cope with Timmy's exceptionally high numbers. But we don't know that either.

Perhaps the thing to remember is that you have only been home testing for about a week, and have already tried various permutations of dosing. It is still early days. If the 2u TID isn't doing enough I think you have to try for a dose reduction again for a few days just to collect the data from that. And if BGs are still stubbornly high, get a vet's opinion on other factors that might be going on and causing these high BGs.
 
Hmmm, PMPS more or less as usual... it has to be a bounce after that nice but too low drop at +5. It is looking as if a slight dose decrease may be in order but stick with 2u for another dsy or two and see what happens.
Well done for getting a new vet appt! Did you ask about FD experience when you rang?
 
I'm wondering if dropping back to 1.5u tomorrow for each dose would help. I too think it's those drops of more than 50% that are setting Timmy off leading to high pre-shot numbers and I'd rather see higher mid cycles numbers right now along with lower pre-shots than these huge drops. The pre-shots have come down a tiny bit but the drops are still too steep. Something you may want to discuss with the new vet is a change of insulin to ProZinc or Lantus although I realize that is much harder to approval for in the UK. It might just be that Caninsulin is not the best insulin for Timmy.
 
MrWorfMen's Mom said:
I'm wondering if dropping back to 1.5u tomorrow for each dose would help. I too think it's those drops of more than 50% that are setting Timmy off leading to high pre-shot numbers and I'd rather see higher mid cycles numbers right now along with lower pre-shots than these huge drops. The pre-shots have come down a tiny bit but the drops are still too steep. Something you may want to discuss with the new vet is a change of insulin to ProZinc or Lantus although I realize that is much harder to approval for in the UK. It might just be that Caninsulin is not the best insulin for Timmy.
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Agreed... but then I see we have a pink number this morning... just when we were used to pre-shot blacks he throws a surprise so interesting to see how that plays out today..
 
Don't drop the dose yet.... Stick with 2 for at least today and tomorrow.......... I like that pink amps
 
Matthew Brennan said:
91 at +3. Liking these numbers! Just fed him so he doesnt go any lower.
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excellent matthew... was just posting to say precisely that.
We don't want him dropping any lower so keep a careful eye now.
It looks as if that 2u this morning may have been too much on the lower pre-shot number. Let's just hope he doesn't bounce right back up again.
C'mon Timmy, give your daddy a break, he's trying soooo hard for you!

ETA Matthew, if Timmy does go rocketing again, consider dosing 1.5u at next shot time? I do agree with Janet that it's better to stick to a dose really, but you could try a reduced dose for just one of the three shots perhaps, to avoid too much possible overlap. I think this weekend's numbers will be interesting and will give us some useful clues as to how to proceed... and with a new vet on board as well, we might start to get somewhere.

ETA 2: I should also have said, before dosing at all at next shot time, post the number here... if Timmy is still lowish he may be too low to shoot even a reduced dose... of course we don't know yet, he may bounce right back up as usual, but you have to be prepared for anything. If he is too low to shoot, keep testing hourly until he starts to rise again... and again, post here for dosing suggestions.
 
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Ok so up a bit at +4, that's good. Could be a food spike so keep testing... this cycle could be very telling.
Keeping all paws crossed here that the mega-bouncy bounces have calmed down now... time will tell.
I have to go out around 2pm our time but hopefully peeps in the US will look in to see if you need any help. I think you have a good handle on what you're doing now - steep learning curve! - but always good to get other thoughts.
 
Just saw this and am doing a happy dance! Wow! What a difference a day makes! He may bounce again after that 91 but even if he does, this cycle has been very encouraging. He is definitely a dramatic kitty. I was hoping we'd get to a red pre-shot and he went all the way to pink. Will be watching to see what he does the rest of the day. :joyful:
 
Yes... and if he hadn't had that steep drop in the morming I think we'd be looking at even better numbers.
 
It will be very interesting to see what the new vet says. I reckon they might suggest one of three things - go back to basics, ie 1u BID and do a curve for a couple of days on that; increase the current dose; or test for underlying conditions. I would think they'd want to run some tests anyway.

Whatever they suggest, Matthew, hold your own and explain what you've learnt... the vet may not have as much experience in FD as you and may not have heard about bouncing or TID or sliding scale dosing... don't be fobbed off by the vet saying you shouldn't listen to a group of people on the internet, this board has members with collectively a lot more experience of hands-on treating diabetic cats than any vets! Hopefully your vet will be one of the good guys and open to working WITH you on this... not telling you what you should be doing at all costs, but listening to you and coming up with a plan that you can work with to make Timmy feel better asap.

Keep us posted.
 
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If they want to do a curve should I let them or just offer to do a curve at home? From the conversation I had with the new vet the other day they said standardly they do a 24 hour curve first (which previous vet didnt even offer).

However I told her im bringing a curve I done and a spreadsheet. Hopefully she will work with me on it!!
 
Matthew Brennan said:
If they want to do a curve should I let them or just offer to do a curve at home? From the conversation I had with the new vet the other day they said standardly they do a 24 hour curve first (which previous vet didnt even offer).

However I told her im bringing a curve I done and a spreadsheet. Hopefully she will work with me on it!!
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TBH it is much better if you're prepared to do a curve at home... stress at the vets can increase BGs considerably and so give an inaccurate picture of what is "normal", plus the vet will charge you A LOT of money for this which IMO is money wasted. I suppose a lot of vets - no, most vets - won't realise that some clued-up owners are more than capable of taking tests and recording the data correctly, but YOU ARE... show them what you've done so far, there is no disputing that you're well able to do this at home. I can't see a single benefit of the vet doing it.
It is really important to try to establish a good working relationship with our vets so see what happens tomorrow and try to have a good conversation with the aim of both of you working in Timmy's best interests.
 
I am not surprised to see the slightly higher number this morning. Timmy had a great run yesterday and is no doubt bouncing a bit as a result. Some cats bounce a lot and if Timmy really hasn't been as well regulated as the vet led you to believe, it's going to take some time for his body to stop over reacting when he reaches more normal BG levels.

The relationship with your vet should be a partnership and any attempts by the vet to make it a dictatorship is not going to be in Timmy's or your best interest. The vet should realize that doing curves in clinic is going to result in stress elevation of Timmy's BG and appreciate that you can do curves at home which will be far more accurate than any done at the vet clinic. You and the vet don't have to always agree but you do need to respect each other and be able to come to a mutually agreeable decision about the next and best course of action for Timmy and you.

I would also caution you about fructosamine tests. Some vets think they are the holy grail of determining regulation and for some cats they may be but they definitely are not accurate in all cases. Since you have a good bit of daily data already, I see no point in doing a fructosamine test which is supposed to give you a number (not BG) indicating how well regulated kitty has been over the past 2 week period. The results can be skewed if kitty has been experiencing very high or very low BGs in the period being tested and therefore using the daily data rather than fructosamine tests to sort out the puzzle makes far more sense.
 
Good point - really no need whatsoever to do a fructo test, you have far more useful data. The vet will most likely try to convince you but it would be pointless to pay more money for a test that would tell you nothing you don't already know and worse, is potentially misleading.
I'm really hoping the new vet will be pleased to see what you've learned and put into practice already... a good vet would take it on board and treat you with (perhaps surprised!) respect.
Best of luck...
 
Just back from the vet - who wasnt very impressed at all with Timmys health. She said she has no idea what the last vet was at. Bit of a shock to the system considering previous vet said he was in great health apart from the diabeties. His poor coat does make him look a little shabby.

Her main concern was any underlying issues - which she seems convinced he has. Full bloods being done today with results back Wednesday. Bloods where done a yearish ago and all clear, so maybe his coat appearance shocked her in to thinking it was more than just diabeties, or maybe there is more! (Hopefully not!!). Fingers crossed.
 
Matthew Brennan said:
Just back from the vet - who wasnt very impressed at all with Timmys health. She said she has no idea what the last vet was at. Bit of a shock to the system considering previous vet said he was in great health apart from the diabeties. His poor coat does make him look a little shabby.

Her main concern was any underlying issues - which she seems convinced he has. Full bloods being done today with results back Wednesday. Bloods where done a yearish ago and all clear, so maybe his coat appearance shocked her in to thinking it was more than just diabeties, or maybe there is more! (Hopefully not!!). Fingers crossed.
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I'm glad she's doing a full blood panel. I wouldn't be surprised at all if there were something else going on. A shabby coat is actually a symptom of diabetes, so that in and of itself doesn't necessarily indicate something else going on, but the blood panel should pick up on anything. make sure to ask for a copy of the labs when you get them. For the coat you can try giving a Omega 3 fish oil supplement such as Nordic Naturals (I'm sure there are other brands in your area) either added to the food or fed directly.
 
I already givie him an Omega 3 oil in his food, didnt make much of a difference. He was dehydrated too, which was the biggest shock - considering he drinks a lot. So he is getting fluids this morning before they do the bloods this afternoon.
 
Well, at least this vet is taking Timmy seriously which is not something the other vet did, sadly. I would think that not only the condition of his coat but his BG results were a clue that his health could be better. The thing is, long-term high BGs - assuming that this has been going on a while - won't have done Timmy any favours, unfortunately, as well as making him feel poorly.

Let's hope the bloodwork comes back ok again and that this vet will have some suggestions to make about his high numbers. As we've been saying, there are underlying conditions that can certainly affect BGs and make "straightforward" diabetes very difficult to regulate, which is where expert advice and tests come in.

Anyway, good news that you now have a decent vet.
 
Echoing Janet and Diana's comments. Hopefully it's just those high numbers making Timmy feel poorly but if there is something else going on, better to find out and deal with it. Being dehydrated certainly isn't helping either but not unusual with those high numbers. Sounds like the new vet is truly interested in helping Timmy! Fingers crossed Timmy will soon be on a path to better health.
 
Very very cross. My previous vet decided to ring me there (as this new vet had rang requesting Timmy's full backlog/history). They were basically ringing to see why I had changed. I told them the truth, I wasnt convinced what they where doing was good enough. During the conversation, I said the new vet was checking his kidneys etc, to which he said "Oh, Timmy was stage 2 renal failure in December wasnt he". Now, they never ever mentioned this to me at all. I had his full bloods done in December to be told his kidneys where great and well within limits. I am shocked, I have been basically lied to by my old vet.

Fumming!! So it looks like he is Stage 2 kidney failure, and probably will be confirmed by the new vet on Wednesday. I dont even know what to say....
 
I'm not surprised you're mad, Matthew. I'd be very tempted to ring the practice and ask to speak to the head vet or practice manager and let them know in no uncertain terms what's happened, and follow that up with a formal letter of complaint. Not only have they not communicated with you properly, they have been negligent in their "treatment" of Timmy's diabetes and got their facts wrong. This isn't good enough. Your old vet sounds completely incompetent.
I'm so sorry you have to deal with this but you did the right thing seeking out a new vet who sounds a whole lot better.
Let us know how things pan out.
 
Matthew!
I'm sorry I wasn't contributing much recently but you are so lucky to have other members guiding you through this very difficult journey.
You are doing such a fantastic job trying to look after Timmy and well done on finding a new vet.
Your old vet mentioned to you now that they diagnosed Timmy with stage 2 kidney failure but never mentioned that to you. I'm thinking that maybe he meant CKD (chronic kidney disease) stage 2 which is not serious and not advanced and is pretty normal in older cats, it can just indicate that kitty might in the future develop kidney problem and this sort of test should be repeated probably every 6 months to see if it is progressing. At least this is what happens with humans. This is a very unfortunate name for a check of your kidney status! I will have to check that for you and let you know or other member would have a word to say about this.
I really do hope that Timmy's health is poor mainly due to diabetes and that would explain poor quality fur. Of course with ongoing problems with BG it is very likely that Timmy has some kidney trouble but your new vet will certainly treat him.
I'm waiting for your update with anticipation and keeping my fingers crossed for the best outcome.
Sending hugs to you
Marlena
 
Matthew,
there is staging of CKD i cats called IRIS and stage 2 might mean that there is some kidney function lost but it can also mean that your cat will be functioning quite well with this reduced kidney function. The whole investigation to see what's happening with kidney should take place at the vet's with testing of bloods for kidney, testing urine and proper testing of blood pressure. I hope your vet would run all these tests and we will have a clearer picture.
Please don't worry too much about Timmy's kidney failure as yet. See what the tests would show.
Take deep breaths.
Hugs,
Marlena
 
Matthew Brennan said:
Very very cross. My previous vet decided to ring me there (as this new vet had rang requesting Timmy's full backlog/history). They were basically ringing to see why I had changed. I told them the truth, I wasnt convinced what they where doing was good enough. During the conversation, I said the new vet was checking his kidneys etc, to which he said "Oh, Timmy was stage 2 renal failure in December wasnt he". Now, they never ever mentioned this to me at all. I had his full bloods done in December to be told his kidneys where great and well within limits. I am shocked, I have been basically lied to by my old vet.

Fumming!! So it looks like he is Stage 2 kidney failure, and probably will be confirmed by the new vet on Wednesday. I dont even know what to say....
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Wow to not tell you is awful. Stage 2 is early enough that with interventions the progress of the disease can be slowed. At stage 2 with my Zimmy we started sub q's and also discovered he had Proteinuria and high blood pressure which is common with kidney cats.

Ask your new vet for a copy of the labs.
 
Matthew Brennan said:
How does stage 2 affect diabeties? Anyone with experience of that?
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I don't have much knowledge of kidney disease - I expect one of the others here will have - but I do know that it can work the other wsy round, ie diabetes can affect the kidneys.
When you get the blood test results back, you may want to start a new thread with a new heading - you will probably get more eyes on any new queries then.
Hoping things pick up for you and Timmy soon.
 
Hi Matthew and Timmy,

George appears to be IRIS stage 2 CKD. His bloodwork just after he went into remission pointed to that. George is asymptomatic. For now I take preventive measures, he still has low carb, but also low phosphurus. Additionally to help his kidneys I add a bit of water with every meal, and as some ckd kitties can suffer with acid tummy (leading to puking) I feed every three hours to avoid any issues with this.
Getting the BG's under control is a priority, as unregulated diabetes is hard on the kidneys. Finding Low carb food that is also low in phosphorus can be challenging, I'm in Eurorpe, the foods I use are not available in the US. Somo folk opt for home made raw, using a low phosphorus supplement, that may be the way to go if finding low carb and low P foods is an issue.


Tanyas CKD site is a really great resource. There's a lot of info there.
You'll find great explanations of the iris stages of ckd, info on appropriate foods, phosphorus levels, explanations of blood test results, you name it it's there.

I took a look at the ss, can't see any lab results on there, if you have the blood work results, if you post them on your ss, there are some folk on the board that are very good at reading them and can give you some pointers on concerns to discuss with your vet.

FWIW, my vet also told me Georges numbers were ok, but after checking here, and flagging it with her she admitted that his values were slightly off, and his results were suggestive of early renal problems..

Did Timmy have an SDMA test when he had his blood work?
 
if you are on facebook there's a great group for cats with kidney failure called Cats with Chronic Renal Failure.
 
Oh Matthew! I can only imagine how upsetting this is for you. It is inconceivable why the vet would not have alerted you to this issue and made recommendations for how to keep Timmy as healthy and comfortable as possible. This makes me very angry too! For the vet not to communicate those findings to you is criminal. If it's any consolation, my now 19 yr. old has had diminished kidney function for a few years and has managed just fine. I know waiting for the tests is going to be difficult but it sounds like your new vet will be able to guide you to help Timmy far better than you former vet.
 
Matthew,
it all boils down to test results now.
If your kitty has diminished kidney function and it progressed from the time he was tested by the first vet you could complain about that vet's negligence. You can start with the vet in charge at that clinic. It would be important to find out the results of the original test and your new vet could help you with that. Your original clinic should take action and if they indeed neglected Timmy's health they should rectify it and offer further testing and care for free.
Now, could you please tell us what the situation is with Timmy's food as it is very important for kidney health too.
 
I had not ever seen this post before, I see that it is a few weeks old. I did notice though that someone had posted that pretty much any meter was okay though a lot of people use the relion brand from wal-mart, which is a good choice. However, they also mentioned Wal greens, and I had been told last year after purchasing wal greens meter that that is the one place to avoid getting a meter from, that they are very often inaccurate. Just wanted to pass along those words of wisdom from when I started. Incidentally the BG results I got with the Wal greens meter were way way off and I did return it and go get the relion micro from wal mart instead.

wanted to add after having read through thread more that I am so sorry you have had such a hard time with your vet situation Matthew. I certainly hope your new vet can help you improve Timmy's health. We all love our sugar babies so much, it is hard to deal with Diabetes, let alone Kidney disease. :bighug:
 
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How are things, Matthew? Have you heard from the vet with the results of Timmy's blood tests?
I just had a look at your ss and see you're trying 2u BID - sounds a good move.
Let us know if we can help with anything.
 
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