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Dr. Barbara
Dr. Barbara, Board Certified Veterinarian
Category: Vet
Satisfied Customers: 1614
Experience:  Thirty years experience in small animal medicine and surgery.
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my cat is losing weight. She is on medication for diabetes,

Customer Question

my cat is losing weight. She is on medication for diabetes, renal failure and hypothyroid. Her mediation has been changed but her weight is not responding to this. Help, she is 3.6kg and used to be 5.3. Her vet has now said they will not investigate further so as not to stress her but they are essentially waiting for her to die and she is so happy and alert she has years left. Please help/advise. Desperate.
Submitted: 2 years ago.
Category: Vet
Expert:  Dr. Barbara replied 2 years ago.
Dr. Barbara :

Hi, Welcome to JustAnswer. I am a licensed veterinarian and I'm here to help you. I am so sorry to hear that Macey has all of these diseases and that you are having to balance them all.

JACUSTOMER-qh1aokd9- :

Thanks, ***** ***** Thank you.

Dr. Barbara :

Especially with hyperthyroidism and kidney disease we have to treat each so that the other is not made worse. Sometimes it is impossible therefore to completely treat hyperthyroidism because we can make the toxin build up worse from the kidney disease.

Dr. Barbara :

Do you have her latest numbers? What is her current thyroid level (and please include the reference range for your lab)? What is her BUN and creatinine and phosphorous? What is her PCV (or HCT )? What is her blood glucose level? Thanks!

JACUSTOMER-qh1aokd9- :

I don't have this. Her current insulin intake is 0.5mg. She takes this now once a day in the morning at 7am. The lowest dosage. Her nadar is around 17 around 3pm. I She's on a renal diet only and eats 3 sachets of Royal Canin so her creatinine and phosphorous levels should be low. She only started to lose weight when she was placed on the renal diet. 'm losing her. She needs to retain weight.

Dr. Barbara :

Oh, that's right. . .in the UK you have a different measuring system for blood glucose. I have converted this before, but I need a little time to do this again. Also, do you know what her thyroid level is? How much Felimazole is she taking? I'll be back soon!

JACUSTOMER-qh1aokd9- :

She is on 1 x 5mg at 7am and 1 x 2.5 mg of felimazole. As of yesterday it was reduced back to this from a month on the higher dosage of 5mg for around a year. He thyroid level is 50.

JACUSTOMER-qh1aokd9- :

Higher dosage of 5mg 7pm and 7am of felimazole. Now 2.5mg in the evening as of yesterday. Dr Barbara. I am losing my cat I have had for 15 years. She was found as a stray when she was a year and a half. Please save her. Please don't confine her symptoms to age as an inevitability of her demise. Its not her time yet.

JACUSTOMER-qh1aokd9- :

I promise you she is not ready to go yet.

JACUSTOMER-qh1aokd9- :

If she maintains her weight, she maintains her life.

Dr. Barbara :

Did find the conversion for her nadir blood glucose. She is still too high.

JACUSTOMER-qh1aokd9- :

How can this be reduced?

Dr. Barbara :

It can be reduced with increased insulin. . .but you don't want to do that without your vet there involved. Are you measuring her blood glucoses OH, darn! Do you want to switch to the Q&A mode? You won't have to pay more for that, but it is more cumbersome. . .no immediate chats like here.

JACUSTOMER-qh1aokd9- :

Do you mean emails? I don't quite understand has my time run out?

JACUSTOMER-qh1aokd9- :

Am I on a time limit?

JACUSTOMER-qh1aokd9- :

Do have any fellows at the Royal Veterinary College? I need help.

Dr. Barbara :

What they're saying to me is yes, your time has run out. . .not nearly enough time for us to address your issues. The Q&A mode is more like emails, but through JustAnswer. I've never run into this before that you aren't notified, and I am. Perhaps we should just continue here and if it gets to the point that we can't talk more, I can switch us to the other mode.

Dr. Barbara :

I can help you, I believe, but it just takes time here. We don't have any fellows from the Royal Veterinary College on here. If you still want to consult with them, then you'll have to call the College tomorrow and set up an appointment. I'm thinking and hoping that you won't find that necessary.

Dr. Barbara :

Are you having Macey's blood glucoses measured at the veterinary clinic there? If so, the stress of that will always raise the blood glucose level, so Macey's nadir is likely actually lower than 17.

Dr. Barbara :

I do have some basic questions also. Is Macey eating her renal diet well? Would she eat more if offered? Is Macey vomiting or having diarrhea? Is she drinking copious amounts of water or urinating copiously?

Dr. Barbara :

My screen says you are in chat, but not typing. I'm going to switch us to the other mode then. See you there!

Expert:  Dr. Barbara replied 2 years ago.
Hi Rachel,
Here we are in the Q&A mode. Hopefully you see my last questions and can answer them here. . .
Customer: replied 2 years ago.
Relist: Incomplete answer.
There isn't nearly enough time to complete an assessment to provide advice. I have been robbed
Expert:  Dr. Barbara replied 2 years ago.
No no!!!! I'm here!!!!
Dr. Barbara, Board Certified Veterinarian
Category: Vet
Satisfied Customers: 1614
Experience: Thirty years experience in small animal medicine and surgery.
Dr. Barbara and other Vet Specialists are ready to help you
Expert:  Dr. Barbara replied 2 years ago.
Rachel,
I hope that you are still online as I am pretty confident that we can get Macey turned around, but I will need some time to work with you. The Q&A mode provides this time.
Hopefully, I'll hear from you soon,
Dr. Barbara
Customer: replied 2 years ago.
*****@******.***. I needed answers. I genuinely believed in this service and although the doctor was trying to reach me the system would not let me respond unless I paid more this ghetto £28 I had already paid to discuss details I already know. I needed answers and I didn't get them as there is a time limit which was not made clear at the outset. So my assessment/feedback is a bad service *****@******.*** feedback is to justanswer.com not the expert.
Expert:  Dr. Barbara replied 2 years ago.
Hi Rachel,
While I completely understand your frustration, from my side a negative rating reflects only on my service. Also, I am confident that we could help you with Macey and fulfill your needs! If you want to continue with this, I'd like very much to do so. At the same time, I will definitely send your comments to the category moderator as customer comments are very important to them.
Hope to hear more from you. . .
Dr. Barbara
Customer: replied 2 years ago.
Hello Dr. Barbara, I have no further funds to continue this exchange. I don't know how the system works other than your advice in exchange for £28.00. Beyond this I can't explain nor continue. If you would care to provide further details of our conversation I am at my wit send and would appreciate and value your advice @ *****@******.***. I have no other way of providing feedback other than saying I did not receive the advice sort though did and would emphasise that I am referring to the process and not the expert. I have a dying cat and my opinions are shaped by this.
Expert:  Dr. Barbara replied 2 years ago.
Hi Rachel,
I definitely hear your urgency and would like to work through this to the best treatment for Macey. Since we are in the Q&A mode, there should be no more charge for you than your original deposit, which was 28 pounds. . .correct?
Initially, the site does set a time limit for the Chat mode, but when I switched us to this Q&A mode there should be no more charge. Unfortunately, I can't see what appears on your screen, but will send a second message to the moderator for help. I am really sorry about this confusion.
In the meantime, may I ask a few further questions about Macey? Is she eating the renal diet well or is she picky about this change in food (many cats are)? Does she have any vomiting or diarrhea? Is she drinking lots of water and urinating copiously?
Thanks Rachel!
Dr. Barbara
Expert:  Dr. Barbara replied 2 years ago.
Just got a note back from Lori of the support staff. She apologized for the confusion also, and said that there is definitely no more charge for us to continue our conversation.!
So, if you'd like. . .we can! Otherwise, if you want to discontinue, please just request a refund or let me know that that is what you'd like and I'll request one for you. Also, if there is a way to remove the negative rating, I'd appreciate that.
Thanks!
Dr. Barbara
Customer: replied 2 years ago.
Dr. If you feel you can honestly advise how Macey can gain weight I'm happy to continue. I have given you all the information I have and yes, currently she does have a healthy appetite. If your response is to provide advice there's no need for a refund. If what follows is a lengthy exchange I may have the wrong expert and need one that has experience in the field of ailments discussed. I hope that sound too harsh I just have a cat that is dying in front of my eyes and she needs an expert. If we have come to the right please please dispense this or a refund and a removal of the feedback. So sorry to be so very blunt I hope you understand and thank you for caring.
Expert:  Dr. Barbara replied 2 years ago.
Dear Rachel,
I do understand the concern we have when our pets aren't responding in a healthy way, or what seems to be a healthy way. You are her advocate, and I respect and appreciate your "bluntness". I do have much experience dealing with cats that have hyperthyroidism, kidney disease and diabetes, and to maximize Macey's health I do need to have some answers from you. . .
So far, what I know is that she is eating the renal diet well, but is still losing weight. Her latest thyroxine value was 50, which is in the upper range of normal, but this is probably the perfect spot for her since she also has some kidney failure. Was this value of 50 based on 5mg of Felimazole twice daily, or 5mg in the AM and 2.5mg in the PM?
As far as Macey's blood sugar; is she getting measured at home or at the clinic? Her nadir is higher than normal, but where she is getting measured is very, very important! At home where she is relaxed a nadir of 17 is too high. If she had her blood drawn at the clinic where she would have a stress reaction this value is probably OK. So, again, my question regarding the nadir level is where did she have her blood drawn?
Finally, would Macey eat more of the renal diet per day if you offered it? The only reason she is losing weight may be that she isn't taking in enough calories.
I hope this all makes sense!
In short: 1. How much Felimazole was she on when her thyroxine level was measured at 50? 2. Did she have her nadir value of 17 measured at home or in the clinic? 3. Would Macey eat more of the renal diet if you offered it?
Thank you for your answers.
Dr. Barbara
Customer: replied 2 years ago.
Wow, thank you! You understand everything. She is measured at home. She would eat more if offered and was measured at 50 on 2.5mg which is the measure she is on as of yesterday.. Her nadir was measured at home. I'd like to adk if I change my feedback does that terminate our chat? I never responded about you just about the process. I am sending a glimmer of hope from you, please don't stop our chat now. My absences are due to having to look after a family. I apologise for this and for being so blunt. I do not feel I require a refund.
Expert:  Dr. Barbara replied 2 years ago.
First of all, I'm very glad we will be able to work together! Macey's is certainly an interesting, and definitely not an impossible case!
If you change your feedback we can still talk as long as we need to.
I appreciate your being straight forward...no apologies needed.
So, this is my opinion from what you have shared: Since Macey was on 5mg of Felimazole twice daily when she was measured at 50, then I think she should stay on that amount. If you lower the dosage amount Felimazole she will become more hyperthyroid and lose more weight. Did your vet have you lower the dose of Felimazole? If so, was this because Macey's kidney values of BUN, creatinine and phospherous were elevating? Did your vet say that her kidneys looked worse?
It's excellent that you are measuring her blood glucose at home! So her nadir is truly higher than normal which means she could receive a little more insulin. You said her current insulin dose is 0.5mg. . .which insulin are you using? Do you possibly know what her blood sugar levels are at other times of the day and especially right before her insulin dose?
Finally, do you think she would eat more of the renal diet if offered? It is really,REALLY a good sign that she is eating so well!
Customer: replied 2 years ago.
She is on Lantus. I think I should increase the insulin by a fraction. Not by half to 1mg but just short of this. I'll carry out a curve every other hour on Wednesday, the soonest I can arrange leave from work. She is on a constant stream of renal. She grazes but has a constant amount in her bowl which is around 3 sachets a day. I also gave her a little chicken breast cubed today as she wanted something different. I know it's protein but it was a small amount. She likes mash to, potassium I know but I have to ensure she eats. What are yr thoughts on the increase?
Expert:  Dr. Barbara replied 2 years ago.
Thanks Rachel,
So the type of insulin she is on is Glargine. I have a question about how much you are giving her because I think you mean you are giving her 0.5 units once daily (and not 0.5 mg). . .correct? Once I can figure out exactly how much you are giving her, then after you do your glucose curve on Wed., we can make the correct adjustments. . .OK with you? One other thing is that Glargine is usually best given twice daily, but her need will be based upon her glucose curve. So, for her curve, if you can measure her starting right before her morning dose, and then every 2-3 hours until her levels start to go up again, and then let me know, we can then adjust her dose. . .OK?
The sachet you are feeding her is semi moist food. . .correct? A way to make these more palatable is to warm up a fresh serving 3-4 times daily. These foods do tend to dry out if left out. You could also add a little of her last favorite food. You are right, it is important for her to eat, but we want the highest percentage of the special renal food that she will eat well!
Also, what do you think about leaving her Felimazole at 5mg twice daily?
Expert:  Dr. Barbara replied 2 years ago.
Just want to add. . .on the Glargine, 0.5units is really a tiny dose. The recommended starting point with Glargine is 0.5 units/kg of body weight twice daily. . .so we need to get this straightened out. Glargine comes as 100units/ml. Hmmmmmmmmm!
Customer: replied 2 years ago.
Good morning and thank you for your amazing response. You are right Macey is on 0.5 units not mg. I will try the curve on Wednesday and start to warm up her food. Her sachet is Royal Canin Tuna ( have ttried chicken and beef and KD), and we clip the sachet closed to seal the moisture. She won't eat it dry. I'll contact you again on Thursday. Thank you. Thank you.
Expert:  Dr. Barbara replied 2 years ago.
Rachel,
I'm so glad that we can work together for Macey. You are up early I think for you, it is 2233 here!
Will look forward to hearing what you have on Thursday, but feel free to contact me before that if you need to.
Have a great week!
Dr. Barbara
Customer: replied 2 years ago.
Good morning, I have to ensure My family eat before I go to work and as Macey grazes I have to start her early so that she has taken in enough before I administer insulin to counter an attack. Please have a lovely day. I feel upbeat knowing we now have a plan. Her weight loss began when she started the renal diet and when she went from 2 x 1/2 units of Lantus glargine a day to one (7.00am and 7.00pm). all becoming a bit clearer. Thank you Dr. If I can find a way to pay I will pay again on Thursday.
Expert:  Dr. Barbara replied 2 years ago.
Good Morning to you!
To clear me up. . .what is her insulin dose now? 0.5 units once daily or twice daily, or 1 unit once daily or twice daily???? Sorry that I am confused about this???? (Not a great confidence builder!) But of course my knowing definitely what you are giving is very important! Thank you for clearing this up for me.
I am very happy that you are feeling more comfortable with all this. You are a busy lady!
Have a great day!
Dr. Barbara
Customer: replied 2 years ago.
Hello Macey is on 0.5 units once each morning at 7am. She used to be on 2 units 7am and 7pm but this was reduced to once in the morning. This was around May and she's been losing weight ever since. Thx Rachele
Expert:  Dr. Barbara replied 2 years ago.
Hi Rachel,
She's barely on any insulin, and her nadir value of 17 taken at home is too high. . .too much sugar not getting into her cells so she might gain weight. Can't wait to get your glucose curve on Thursday so we can see what we can do.
I thought of one other question earlier. Did your vet lower Macey's Felimazole dose when her thyroid was at 50? Do you know what her BUN, creatinine and phosphorous were in her latest blood profile? Did they indicate a little greater kidney disfunction than before? If you have these values, would you include your labs reference range for each. . .labs can vary greatly.
Thanks,
Dr. Barbara
Customer: replied 2 years ago.
Good morning Dr. Barbara, the vet increased Macey's Felimazole dosage when thyroid levels increased but also in the good that it might have an impact on her weight gain. When it obviously didn't and her water intake increased slightly he felt that her kidneys were being over worked do reduced it to 2.5 last week. I'll try and find out what her BUN etc. levels are. Thanks for the note. Have a nice day
Expert:  Dr. Barbara replied 2 years ago.
Hi Rachel,
Increased water consumption and urination is also a symptom of diabetes, and we know from the nadir of 17 that she wasn't/isn't completely controlled. I hope that she had her kidneys evaluated to see how they were doing to determine if her increased water consumption was due to kidney disfunction or due to uncontrolled diabetes. Those most recent values will be helpful!
This is a balancing act, and I will do my very best to balance Macey's hyperthyroidism, diabetes, and chronic kidney failure.
Have a good Wednesday, and best of luck with the glucose curve!
Dr. Barbara
Customer: replied 2 years ago.
Good morning Dr. Barbara, Macey's curve will has to be moved to Thursday as I can't get this day off work as I would have preferred. I will contact you on Thursday as planned but with updates through the day rather than the full curve in the morning. Hope that's ok with you. Have a nice day. Rachele
Expert:  Dr. Barbara replied 2 years ago.
That's great Rachel. Thanks!
Customer: replied 2 years ago.
Good morning Dr. Barbara, hope yr well. I just wanted to let you know I have just taken Macey's 1st reading and at 7am prior to insulin The reading was 33.0. She received 0.5 units of insulin straight after. This is her highest ever reading. I'll take it again at 9.00. I'll update you much later tonight. Thank you, Rachele.
Customer: replied 2 years ago.
Hello Dr. Barbara, hope yr well. Today I carried out a glucose curve in Macey as we discussed. Here's the results; 7:00am (prior to insulin) - 32.3; 10:00am-24.3; 14.30-20.1; 17.00-22.1; 19.00-20-1 (before insulin); 21.00-TBD.
I'll send through the results post insulin as, with the results it was necessary to administer today rather than waiting for yr advice later. I administered 0.5 am and pm. With yr advice advice I'm sure you'll include unit quantities.
Many thanks
Rachele
Expert:  Dr. Barbara replied 2 years ago.
Hi Rachele,
Macey is way too high on her glucose, which explains the weight loss as well as her PU/PD! Before we make the necessary changes, I'll wait to get her values tonight and before her insulin tomorrow. Want to see how she now responds to this PM insulin, and how low her glucose is in the morning before her insulin dose. Then we can make some changes. Also, as we are upping her insulin, I would like you to have some Karo Syrup on hand, in case she has a hypoglycemic episode. We'll be very careful but do want to have that on hand.
I'll be asleep when you give her morning dose of insulin, so just give the 0.5 units as always until I get up to see where she stands. . .Thanks for all of your hard work!
Have you ever had a chance to get her BUN, creatinine and phosphorous values?
Customer: replied 2 years ago.
No unfortunately not. I got stuck in a travel agents today between 11 and 14.30 (hence the gap) trying to extend my egg donor return flight. Took forever as we had to talk visa's. By the time I returned and started on dinner, curves etc. the vet call was the one that got away!
Customer: replied 2 years ago.
Thanks for advice, I always have honeyed glucose on standby. I've made my bed in the lounge so will see how she fares in the night and if she needs glucose. Many thanks, rachele
Expert:  Dr. Barbara replied 2 years ago.
Hope you two have a peaceful night! I really doubt that she will have any problems considering that her glucose levels are still quite high. . .however, better to be safe.
Wanted to let you know that a cat's normal glucose is 4.44 to 6.66. We usually don't get them that closely regulated, but much closer than Macey's values!
Talk with you tomorrow!
Dr. Barbara
Dr. Barbara, Board Certified Veterinarian
Category: Vet
Satisfied Customers: 1614
Experience: Thirty years experience in small animal medicine and surgery.
Dr. Barbara and other Vet Specialists are ready to help you
Customer: replied 2 years ago.
Our sim and her normal range for years has been btwn 12-15. She has been diabetic for 7 years. Tonight at 22.00 local time she is 27.1. The reverse of what u expected which was to climb down from 20.1 not up. She doesn't appear to be responding to the glucose which means within the week rather than after a week and maybe as soon as Sarurday I may have to raise the insulin again. I don't know if she is in a crisis but her readings are not making sense. I may have to repeat the curve tomorrow either at different in-between times or same times for either comparative or comphrensive reasons?
Expert:  Dr. Barbara replied 2 years ago.
An insulin injection doesn't take effect right away, that's why we can give it once or twice daily. Also, we like our pets to settle in on an insulin dose for few days before changing the dose.
She has responded to the insulin. Remember that this morning she was at 32.3. So her cells are able to respond to the insulin.
Since I'm working in a different unit of glucose measurement, just to make sure does your glucometer read in mmol/L? It should. The units we use here are mg/dL. It's just like our inches and your centimeters. Guess we just have to be different!
Macey's not in a crisis; her cells are getting some glucose for their metabolism which is what is important. It wouldn't really be of any benefit at this point to repeat the glucose curve yet. I may change my mind after I get her AM reading before her insulin, but we'll see.
Customer: replied 2 years ago.
Good morning Dr. Barbara, Macey's glucose reading this morning is 27.8. Just as a recap (save email trawling), here are her results.
30/10/14
07.00-32.3
10.00-24.3
14.30-20.1
17.00-22.1
19.00-20.1
22.00-27.3
31/10/14
07.00-27.8
Last night's 22.00 reading was immaterially out by 0.2 units, sorry. I'll contact the vet this morning for the BUN, phosphorous and creative levels. Have a good day.
Regards
Rachele
Expert:  Dr. Barbara replied 2 years ago.
Hi Rachele,
Thanks for the recap, very appreciative that I don't have to "trawl"!
So obviously she is still too high, and sounds like she has never been within normal range and right now is nowhere near normal range. The recommended starting dose for glargine when a cat has a blood glucose greater than or equal to 19.98 is 0.5units/kg twice daily. Macey is 3.6kg so her starting dose would be 1.8 units twice daily.
Therefore, I think we should go to 1 unit twice daily. This is actually conservative, but I prefer this. . .what do you think? Since you seem sure with your experience with this that her nadir is at 3PM for the daytime, I'd like it if tomorrow you could get her blood glucose before each dose of insulin and at her nadir. Good???
Also, what is her current dose of Felimazole (just so I don't have to email trawl (love that phrase!)! . . .and you are getting her BUN, Creatinine, Phosphorous, and PCV (red blood cell count) from your vet. Could your also get the reference range for each (labs vary).
Thank you so much!
Dr. Barbara
Customer: replied 2 years ago.
Hello Dr. Barbara, I would like to increase Macey's insulin but slowly. U think Sunday gives us almost 5 days and so her body will have steadied with the increase twice a day. After which we can raise it gradually again. I am reluctant to up the dosage from 0.5 to 2.0 in less than 10 days because her kidneys and thyroid ism also needs to adjust too. Thoughts? In July of this year these were the results of her blood test;
Creatine: 196.6
BUN: 11.1
Phosphorus: 1.09
She is currently taking 5 units insulin am and 2.5 units pm.
I will take her insulin levels today at 7pm and administer 0.5 units.
Looking forward to yr reply.
Regards
Rachele
Expert:  Dr. Barbara replied 2 years ago.
Hi Rachele,
I agree that increasing her insulin slowly is good. We can't really adjust her kidney problem, but can adjust her hyperthyroidism.
I apologize for my apparent absence today. I was travelling and couldn't bring up JustAnswer on my smartphone. . .I'll have to figure that out now that I'm home.
I think she should be fine on 1.0 units of insulin twice daily, but I'll look forward tomorrow AM to hear where she was at 7PM tonight on 0.5 units twice daily.
Her BUN, creatinine, and phosphorous are just a little above normal (if I'm converting correctly. . .I really need your lab's normal reference ranges), and this could easily be explained secondary to dehydration because Macey has never been on enough insulin to cause her kidney's to be able to conserve fluids in her body. . .in other words she was somewhat dehydrated.
Please tell me again. . .so I don't have to trawl. . .what dose of Felimazole was she on when she measured 50 for her thyroid?
Please also tell me what your normal ranges are for the BUN, creatinine, and phosphorous at your lab there?
Please also send to me her latest glucose curve values and how many units of insulin she was on at this time?
I promise. . .I'll be here at my computer and not travelling over the next few days so I don't run into the smartphone snafu again!
Dr. Barbara
Customer: replied 2 years ago.
Good morning Dr. Barbara, have been busy dropping the children to Saturday activities. Macey was on 2.5mg felimazole pm and 5mg in the pm whilst the measures were being taken. I cannot obtain lab readings. I can only obtain the readings I provided. Sorry, I tried. The good news is Macey appears to have responded to the additional insulin intake in the evening and this morning her glucose level before administering in the morning was 11.8. Night and day difference to Thursdays reading. I'll take a measure again around 14.30 as I did previously and again before and after intake at 6pm.
I'm also going to place her on the scales today to see whether the glucose measure has had an effect on her weight.
Sunday was the day we were considering an increase in dosage so after today's readings maybe we can make a decision about this together?
Thanks
Rachele
Customer: replied 2 years ago.
Sorry, at the time of the full blood count in July Macey was on 2.5mg pm and 5mg am of Felimazole.Also I her intake is at 7pm not 6pm. The reason for this update is because my iPhone auto checks and changes my words and in onto the next sentence before I realise!! Sorry.
Expert:  Dr. Barbara replied 2 years ago.
At least you can contact me on your phone! The auto checks are also a nuisance!
Macey sure is responding to the insulin well! I agree that taking glucose readings today on 0.5 units twice daily is good with a possible increase in insulin tomorrow. Just to think about it, we may want to try 1.0 units in the morning and 0.5 units at night. . .but not today, but is also a possibility.
:-)
Customer: replied 2 years ago.
Hello Dr. I'm pleased to say after insulin this morning Macey was 14.8 this afternoon then 19.2 before insulin at 7pm this evening. Her weight has SLIGHTY increased from 7.63 last weekend to 7.64 today. I'll take what ever improvements are on offer! Whereas before her readings went down after insulin not up as the reading is below the 20 and 30 ranges I'm taking this to be positive.
Iwe can think about the 1 unit and 0.5 units. Bit sure which to apply to the am or pm but also asvhr readings are so near 20 might we monitor her response to the additional evening intake for a little longer? Guided by you and thank you, Rachele
Expert:  Dr. Barbara replied 2 years ago.
I think so. She's doing so much better and responding well! Let's stick with 0.5 units twice daily, since she was still lower today, for probably another day or two and monitor her blood glucose before each insulin dose and at her nadir time. I'm so glad she is improving, but we have to remember and aim for a glucose level that is about 1/2 of where she is. . .slowly! Glargine's beauty is that it provides a more even 24 hour glucose than other insulins.
Glad she is also gaining a little weight. . .going in the right direction!!!! :-).
"Talk" with you tomorrow. . .
Dr. Barbara
Expert:  Dr. Barbara replied 2 years ago.
Hi Rachele,

Wondering if you were able to test Macey as she is receiving 0.5 units of glargine twice daily. I am very eager to see the results and to see how much she is weighing!

Thanks,
Dr. Barbara
Customer: replied 2 years ago.
Dear Dr. Ruth, I am delighted to say Macey has gained 20 grams! This is a remarkable achievement and it's all down if you confirming that Glargine is set to be taken twice not once a day. This is the only thing that's changed. I'd like to thank you for being so knowledgeable in yr field, caring in your approach and supportive from a distance - this saved my little one's life. Thank you😘😘😘😘
Customer: replied 2 years ago.
Dear Dr. Ruth, I am delighted to say Macey has gained 20 grams! This is a remarkable achievement and it's all down if you confirming that Glargine is set to be taken twice not once a day. This is the only thing that's changed. I'd like to thank you for being so knowledgeable in yr field, caring in your approach and supportive from a distance - this saved my little one's life. Thank you😘😘😘😘
Expert:  Dr. Barbara replied 2 years ago.
Hi Rachele,

Definitely think the glargine should be given twice daily. This decision is based upon the last glucose curve you gave me. However, the values that you got were still about twice as high as the normal range for blood glucose, so if you could now take some measurements of her glucose levels 3 times. . .before AM insulin, at her nadir about 3PM, and then before her PM insulin, and send those to me, her insulin dose will probably need to be adjusted upward just a little.

I'm thrilled that she has gained weight!!!!! Thank you for being so diligent with her. . .very much a sign of love! I know you are busy with work and with kids, so I'll be patient!

Dr. Barbara
Customer: replied 2 years ago.
Dear Dr. Barbra, I just wanted to wish you a very merry Christmas and thank you for the most wonderful Christmas present I could wish for, my little one Macey, here with us today happy and healthy. Seasons best and Happt Holidays! Rachele
Expert:  Dr. Barbara replied 2 years ago.
Rachel,
Thank you so much for writing! It's such a Christmas present to me to hear that Macey is doing so well and that you all get to spend a lot more time together!
Merry Christmas and may 2015 be a wonderful year for you both!
I'll be very happy to help you with any future problems and adjustments in Macey's needs.
Dr. Barbara

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