12/11/2024 Aida AMPS 130, +3 75

[Daphne and Aida]

A quick update: we went to an internal vet for Aida's potential IBD/SCL, and they didn't seem too overwhelmed by her multiple health issues (the previous 2 vets won't answer my emails anymore, hot potato!).

Apart from a seriously wrong claim outed by one of the nurses (hyperthyroidism is good for senior cats because it helps their kidneys) and a mildly wrong testing schedule by the IM (retest T4 levels after 10 days from initiating methimazole, all feline endocrinologists say retest 3 to 4 weeks after), it went well.

The IM was more concerned about the diabetes though, and the fact that her BG drops when she's not well.
He questions whether she truly has DM or if it isn't secondary to something else. He proposed that, once her hyperT is regulated, we'll put on a freestyle libre and monitor her BG for 2 weeks. Also, he wants me to switch her to Purina DM canned food and he wants her to lose weight
Aida isn't obese, she has a pot belly but no fat around her ribs, so I'm not really sure about that. Senior cats shouldn't be skinny as per the AAHA senior care guidelines, so I don't plan to follow his advice. I don't know about the Purina DM either, it's so high in phosphorus, at her age she should have a reduced P food. So, if I do introduce it, it'll be with a phos binder. Again, I'm not planning on informing him of that, I've ruffled too many ego-feathers already, would hate to be sacked by a third vet.

He's dead serious about home testing not being reliable, almost amounting to torture (you have to prick the poor cat's ears so many times a day) and with devices that aren't made for felines. When I said that the same applies to the freestyle, he responded that it has been tested and we approximately know how to read the readings.
Ok, overall not a bad idea to put it on and see how her BG is on a continuous reading device. BUT he wants the first week to be with no insulin at all. And back to insulin after 7 days, to a dose that is appropriate to her.

Unfortunately, I didn't think to ask him to include a fructosamine test…

Oh, I forgot, according to him, we make 1U changes. The 0.5U change amounts to zero change. And there is no 0.25U change.

Anyway.
He's an internal vet, not an endocrinologist. He sent some blood to test for her GI function, that's what I was expecting him to do.

Thinking of bringing her to a 4th vet that specializes in endocrinology, specifically DM. That would make more sense to me to follow their advice. Because there's clearly something wrong, you don't drop BG when sick!

Previous thread: https://felinediabetes.com/FDMB/threads/11-29-aida-amps-133-2-67.296104/

 

[Tim & Pookey]

Not sure I follow his logic about home testing, but whatever… glad to hear it went well otherwise!

 

[Staci & Ivy]

Wow, that seems like some crazy logic to me.
I’m so glad you’re trusting your own instincts because it seems they’re more on point.

And if you really want to monitor 24/7 you could do a Libre sooner rather than later while waiting for the thyroid situation to be regulated. Who knows how long that could take. It may or may not happen overnight.
I’ve been dealing with hyperthyroidism since March and I don’t feel that we’re anywhere near Regulated. I’m testing pretty much every month to see where her T4 is.

 

[Daphne and Aida]

Thanks both of you for confirming my doubts!
He's a very reputable vet (he teaches in Greece and the US) so it feels a bit odd that a layperson such as myself would doubt him…

About the hyperT yes, you're totally right. Not sure I remember your story, I'll be reading it now.

 

[Wendy&Neko]

Sigh, sorry to hear about the IM vet's comments. People have been pricking ears and writing dosing protocols (TR) with that data, long before the Freestyle was even invented. Very few people here have gone to diabetes specialist vets to manage the diabetes, but rather followed the dosing methods.

When I first took Neko to an IM vet for inappetance, the vet was all worried about her blood sugars and said that low blood sugars could have caused her to lose her appetite. Um, NO! She had acromegaly, was very food focussed and I tested regularly. I told him I wasn't there for her diabetes which I was managing. He was still concerned about her numbers, so I told him he could go ahead and BG test her during the exam (and bill me ) but that she was going to be in the mid blues. I'd tested her right before we left for the vet and it was a flat blue day. I was right - he stopped bugging me about the diabetes. And discovered she had SCL and congestive heart failure. Which explained the appetite issue.

I wouldn't bother with the DM, many cats get tired of it anyway. And it's nothing special should Aida have IBD. And if she does have either IBD or SCL, I wouldn't worry about a little extra weight. Either of those conditions can cause weight loss so a little cushion is good.

 

[Daphne and Aida]

Thanks Wendy! Omg, low BG causes huge appetite, not inappetance!!

I wish I had your presence of mind at that moment, I was surprised, he’s a very reputable GI vet with publications in reputable magazines and teaching positions both in Greece and the US, and he was focusing on her diabetes!
My guess is that he thought I did all that on my own accord with no vet guidance. He also questioned how come I had done the u/s in April since Aida presents no GI symptoms. I had to explain again that it was done after my vet’s recommendation in a referral clinic.
Anyway.
Still trying to figure out how to proceed with the IBD/SCL differentiation diagnostic.
I’ve booked another appointment to a 4th vet. Let’s hope she’s the good one!