Uncontrolled diabetic cat

Re: Uncontrolled diabetic cat

Martin Atkinson — Fri, 17 Apr 2015 19:01:17 GMT

[quote user="Richard Carter"]

and diet should be animal origin only - no cereals - cats survive on a protein and fat metabolism, not a starch and glucose one hence the exhaustion of the poor pancreas trying to cope with the rice or whatever else people thinks cats should eat.

[/quote]I tell them to feed kitten food, most specifically Purina kitten food, for this reason. I don't give special 'diabetic' diets. Unless of course they have concurrent CKD then you have an issue.

One of my cats had concurrent urolithiasis, DM, CKD and pancreatitis. Devising a diet for him was a challenge!

Re: Uncontrolled diabetic cat

Richard Carter — Fri, 17 Apr 2015 17:43:15 GMT

Re: Uncontrolled diabetic cat

Richard Carter — Fri, 17 Apr 2015 14:05:20 GMT

Think if your cat is fractious then your blood glucose measurements are out anyway - fructosamine after 3 -4 weeks of standard starting dose - 1iu /kg sid? Or work on the dose that controls the drinking and appetite and leave blood glucose testing out of the equation completely. Easier for the owners, the cat and you. Cats can be quite good even if hyperglycaemic - they don't get cataracts, less risk of hypoglycaemic attack, owners can relax and you don't lose your fingers every time you come to take another blood sample

Re: Uncontrolled diabetic cat

Luca Poddighe — Fri, 17 Apr 2015 11:20:31 GMT

[quote user="Martin Atkinson"]And of course in retrospect maybe the OP should consider 'idiot owner syndrome' and review their technique. Many a time this had been the problem IME even after having educated them in injection technique and observed them give the injections, clients never seem to run out of ways they can confound you with failing to give medication properly![/quote]

I agree there's always a good way to mess a plainly explained indication. I normally on the first visit for diabetes make sure client are able to inject as I showed them incouraging them to try with sterile water for injection and normal syringes for insulin so to get used to dosing and tecnique, but occasionally I need to repeat it later on if I'm not sure.

Re: Uncontrolled diabetic cat

Martin Atkinson — Fri, 17 Apr 2015 10:36:37 GMT

[quote user="Braden Collins"]RecentlyPTS a problematic diabetic dog. [/quote]I had one a while ago which was ostensibly difficult to control/insulin resistance. Each time we hospitalised it we got it beautifully controlled. The owner finally confessed that they weren't giving the injections because: 'the dog didn't like them and it was cruel'. Once that monkey was off their back they had the dog PTS. Beat that.

And of course in retrospect maybe the OP should consider 'idiot owner syndrome' and review their technique. Many a time this had been the problem IME even after having educated them in injection technique and observed them give the injections, clients never seem to run out of ways they can confound you with failing to give medication properly!

Re: Uncontrolled diabetic cat

Braden Collins — Thu, 16 Apr 2015 14:41:01 GMT

RecentlyPTS a problematic diabetic dog. Owners moderately dedicated but dog kept having repeat DKA episodes. Had concurrent Cushings which we struggled to control. Owner repeatedly declined referral but ended up having so many after hours issues with the dog it would have been much cheaper in the long run to have been referred (over $3000 spent in the last 6 months of its life).

I think as long as you are very clear with the client what the ultimate outcome may be you'll probably find they'll be happy with the feeling on "we're doing our best".

Re: Uncontrolled diabetic cat

Martin Atkinson — Thu, 16 Apr 2015 14:16:43 GMT

[quote user="nobbygonzo"]

And they are nice clients, just not willing to refer etc. Their choice but, yes, it does make things so much more difficult...

[/quote]I know but you can only do as much you are allowed it can be frustrating and we're a compassionate lot as a profession (even me believe it or not) so it can be difficult to dissociate yourself but you have to learn to or your stress levels go up.

Just had a dog die under GA just as it was coughing its tube, There was nothing wrong with the surgery or the anaesthetic but it was a 10 year old greyhound with what was probably in retrospect a haemangiosarcoma on its leg. although we thought it was a lipoma before we started. Could it have had occult DCM, had the tumour spread, should we have investigated these possibilities in an ostensibly healthy dog when 99% of the time this sort of surgery is uncomplicated? We will review anaesthetic protocols and see if we can learn but there is a limit to what you can do and/or change.

Lovely dog, lovely owners. Shit happens, I have to move on.

Re: Uncontrolled diabetic cat

Anthony Dennison — Thu, 16 Apr 2015 11:55:25 GMT

There was a 2hr lecture on the problem diabetic at BSAVA this year, and the lecturer from across the pond said unless clients are going to go all in, it's VERY hard to get the perfect curve.

Re: Uncontrolled diabetic cat

Karen Eggleton — Thu, 16 Apr 2015 11:37:42 GMT

And they are nice clients, just not willing to refer etc. Their choice but, yes, it does make things so much more difficult...

Re: Uncontrolled diabetic cat

Karen Eggleton — Thu, 16 Apr 2015 11:35:10 GMT

Done all I think. Covered for possible UTI although more likely contaminant on basis of sediment (no cysto). 100% certain sick diabetic not stress. Fractious cat so can only check all healthy otherwise within limit of clinical exam & owner's financial constraints :(

Re: Uncontrolled diabetic cat

Martin Atkinson — Thu, 16 Apr 2015 11:19:28 GMT

[quote user="nobbygonzo"]Suggested fPLI check, T4, acromegaly. Owner won't do due to cost.[/quote] I would suggest you don't lose any sleep over it then, They probably are not going to pay for Lantus Glargine either so advise them you can do no more if they won't play ball and the dose of insulin will have to keep going up (provided you really have ruled out Somogyi effect with a glucose curve) or the cat is going to die! Life really isn't that complicated you know we sometimes just make it difficult for ourselves when it isn't our fault. If the clients really are dicks then hopefully they will go somewhere else.

Re: Uncontrolled diabetic cat

Luca Poddighe — Thu, 16 Apr 2015 08:48:38 GMT

My first suggestion would be to try to rule out any concurrent disease and any source of chronic stress as both can cause glucose to raise sensibly in cats. Particularly try to check urine as UTIs secondary to diabetes are not rare at all. Then may be I'm try to teach granny how to suck eggs!