Newly Diagnosed, low HT levels

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damacha

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Hello everyone, Socks is probably around 8-10 years old, indoors only, and was diagnosed with CRF around April of '12 I believe. I took him to the vet on 2/27/13 because he was acting lethargic. I thought maybe his CRF was acting up, but it turned out he had a "significant" UTI and a fever around 104, and they found glucose in his urine if I'm correct, so they did blood-work and found his glucose level was 432. He was in for routine testing just about a month ago, and glucose levels were normal at that time.

The vet diagnosed him with diabetes and gave me antibiotics for the UTI and ProZinc to give 2 units twice a day and come back for retesting in 10 days. I followed the vet's orders, giving him his shots 12 hours apart on 2/28/13 and 3/1/13 and one the morning of 3/2/13. I tested his glucose for the first time at around 11:30am 3/2/13 and was at 55, and 64 5-10 minutes later. His last insulin shot was around 7:30am that day, and he had eaten several times between the shot and the tests. I tested him again at 6:30pm 3/2/13 and he was at 58 if I remember correctly. I was leaving for work so I did not give him his shot because I would not be able to monitor him. This morning, 3/3/13 at 6:30am I tested him again and he was at 74, then I fed him. I did leave some dry Wellness for him to snack on if he got hungry while I was at work, though he never eats much of it, unless he is starving. I regularly feed him Wellness canned turkey. I just retested him now at 7:15am, after he had some food, and he is at 77.

He has improved over the past few days, and is acting close to his usual self, but I the reason I went out and bought a ReliOn micro meter to check him was because I had noticed his whiskers and paws would twitch every once in a while, so I was worried maybe it was a sign of seizures. Otherwise he is acting pretty normal, I wouldn't say he is drinking excessively, although I could be wrong, and has about a normal appetite. He has thrown up a twice in the past two days, but I have been giving him treats after giving him his injections and testing his glucose, and these treats always seem to upset his stomach, which is unfortunate because they are the only treats I have found he will actually eat.

I'm just a little confused with the low numbers I am getting, and am worried about continuing him on his prescribed insulin. The glucose meter seems pretty idiot-proof, but I don't have a control solution to test and make sure it is reading correctly. I called the vet's office, and the vet tech seemed concerned about the slightly low numbers, but one of the vets I spoke to said he didn't really put much faith into home testing and the insulin is such a low dose that I should stop testing and just continue with the injections. Although the vet he saw on the 28th did mention home testing as a way to keep up on his levels, so at least she sees it as useful. I'm a bit torn, I don't know if I should trust these numbers, or just give him the shots as this one vet said and ignore the readings/stop taking them. I am also a bit worried, because when I leave for work, I can't monitor him in case the numbers are true and he goes hypoglycemic.

I don't recall the vet saying anything about ketones, but that does not mean they did not mention it and I just did now know what it was at the time. I am thinking I might just take him back in on Monday to get another round of blood-work done and bringing along the glucose meter to compare results, but was hoping I could get some insight/suggestions from you folks here.

Thanks in advance for any responses/help you guys have.
 
Hello and welcome to FDMB!

Those blood glucose numbers that you have got are beautiful normal numbers!

Absolutely do not give insulin at those numbers. You're cat may well be in remission - if he was ever diabetic at all. It may be that the infection (and possibly vet stress) were raising his blood glucose levels. I'm going to go back and read your post again in case I've missed something...
 
OK, just re-read your post.

A few questions:

How did your vet diagnose the diabetes? Did s/he do a 'fructosamine' test? Or just a single blood test...?

And when did you give the last insulin shot? Yesterday? (and BTW, 2 units of insulin is not a low starting dose...)

Thank heavens you got a glucose meter! They are usually pretty reliable. (Quite a few people here use the Relion Micro...)

You may just have saved your cat's life.....
 
Those are great numbers! We dont recommend new members shoot under 200.

However with these numbers, you may be able to control your cats diabetes with diet alone. The key thing here is to never feed dry food (not even treats!) and instead feed a low carb canned wet such as Friskies pates or Fancy feast classic pates. That will help keep his blood glucose levels down. It also helps to feed small frequent meals to help support his pancreas for a while.

What food/brand are you feeding?

If he can stay within the 50-130 range for 14 days then we consider him in remission.

Keep testing and let us know how you get on.

EDITED TO ADD: what meter are you using? Human glucometers are generally fairly accurate at numbers under 200 so I am fairly confident your numbers are fine. If you arent sure - test yourself! You should be around the 90 - 180 level or so depending on when you last ate etc.
 
Elizabeth and Bertie said:
OK, just re-read your post.

A few questions:

How did your vet diagnose the diabetes? Did s/he do a 'fructosamine' test? Or just a single blood test...?

And when did you give the last insulin shot? Yesterday? (and BTW, 2 units of insulin is not a low starting dose...)

Thank heavens you got a glucose meter! They are usually pretty reliable. (Quite a few people here use the Relion Micro...)

You may just have saved your cat's life.....
Click to expand...

The invoice has a chem 10 and a cbc, I could not tell you if they did a 'fructosamine' test, although that word does sound a bit familiar. Last insulin shot was about 26 hours ago, Saturday morning at around 7:30.

Wendy&Tiggy said:
Those are great numbers! We dont recommend new members shoot under 200.

However with these numbers, you may be able to control your cats diabetes with diet alone. The key thing here is to never feed dry food (not even treats!) and instead feed a low carb canned wet such as Friskies pates or Fancy feast classic pates. That will help keep his blood glucose levels down. It also helps to feed small frequent meals to help support his pancreas for a while.

What food/brand are you feeding?

If he can stay within the 50-130 range for 14 days then we consider him in remission.

Keep testing and let us know how you get on.

EDITED TO ADD: what meter are you using? Human glucometers are generally fairly accurate at numbers under 200 so I am fairly confident your numbers are fine. If you arent sure - test yourself! You should be around the 90 - 180 level or so depending on when you last ate etc.
Click to expand...

He eats canned Wellness Turkey, which is 31% protein, 65% fat and 4% carb calorie percentage, according to Dr. Lisa's chart online, compared to the Purina DM at 39/58/3, and the dry kibble is Wellness Healthy Weight for him to graze on while I am gone, but to be honest, he never really even touches the stuff.

I use the ReliOn micro glucometer, and I was actually thinking of testing myself, but I have not had anything to eat in a while, so I thought that might skew things a bit. I thought I was reading some of the posts on here saying the human meters read about 30 points lower, but I didn't see that anywhere on the main page.

Do you guys think I should take him back in on Monday for a retest? I just can't believe that his levels would be back to normal so soon. Then again, he did almost make a full recovery from CRF, this cat is a miracle, I swear.

Thanks for the replies, I do feel a lot better now. I just hope the vet doesn't get mad at me for disregarding his orders or something, lol.
 
one of the vets I spoke to said he didn't really put much faith into home testing and the insulin is such a low dose that I should stop testing and just continue with the injections
Click to expand...

You just saved your cat's life because you did buy a meter, you did home test, and you did not shoot. That 2 units is also not a low dose nor is it a starting dose. I would suggest you continue to monitor his numbers at home, no vet stress, and try and get some KetoDiastix and also test his urine. The KetoDiastix tests for both ketones and glucose in the urine.
 
Thats a fairly reliable meter - the main 30 point difference tends to be at higher numbers, they are more accurate at lower ones so you are ok.

The wet food is a good choice.. do you know the carbs in the dry? If not, or if its over 8-10% I would stop feeding it.

Unless you are concerned about other issues, l I wouldnt take him back to the vet yet because the fructosamine level averages his levels over the last month and he likely hasnt had enough time at lower numbers yet to show any difference in that average. I would monitor for the next few days to see how his BG is without insulin.

Whats his BG like today?
 
damacha said:
...I just hope the vet doesn't get mad at me for disregarding his orders or something, lol.
Click to expand...
If the vet truly does want the animals in his care to be healthy then he should be hugely relieved that you haven't given insulin at these blood glucose numbers. And maybe he might learn something about the importance of hometesting too...

And if he isn't OK with what you've chosen to do, then to be honest (and in the circumstances), if it were my vet, I think I'd be considering giving him a swift kick in the shins. And I'm a pretty placid sort of person.... ;-)

Following on from Hope's post, here is a link to a page of info about using Ketodiastix to test the cat's pee for ketones and glucose:
http://www.sugarpet.net/urine.html
 
I don't know if I should trust these numbers, or just give him the shots as this one vet said and ignore the readings/stop taking them
Click to expand...
That would be the worst thing you could do. Ignore the vet and if Elizabeth needs help kicking the shins I'm willing to join in cat(2)_steam No vet should get mad because an owner becomes proactive and learns how to hometest unless a vet has control/ego problems then it would be time to find a new vet.
 
:lol: hopefully he doesn't need a shin kicking, I'm going to try and see the same vet I saw when he went in anyway, try to avoid that other guy for now at least.

I just tested his BG, he was at 85, he is eating now, I leave for work in just a bit, so I'll try to test him then as well after he has had some food, but unless it shoots way up, I'm going to skip the insulin again.

I'm going to try find out the carb percentage of the dry stuff, and will stop offering it if it is high.

He seems in good spirits today, I haven't noticed any signs of excessive drinking, if anything, I think his water intake may be a bit lower than normal.

I'm going to stop by the pharmacy after work tonight and pick up some Ketodiastix, I should be able to hold it under his urine stream if I can't collect it another way, correct?

Thanks again for the help everyone, you guys have answered so many of my questions and put my mind at ease.
 
Wendy&Tiggy said:
How is he doing? Did you test his urine? Hows his BG?

wendy
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He had been doing fine and the vets didn't know what to think about it. They said they hadn't seen anything like it. But unfortunately he seems to have decided that he is diabetic after all. Took him in Monday to see if a UTI had cleared up and thought his CRF might be acting up since he had seemed a little off the past few days. His blood glucose was in the 400's and I believe they said there were ketones present as well. They only checked his urine, no blood work. They put him back on 1 unit every twelve hours and we may go see a specialist next week to figure out why he became diabetic then wasn't and is again.

I'm a little concerned right now though because his glucose has gone up from 438 to 490 in 4 hours after giving him 1 unit. He did eat a little after the insulin shot. I am using the Relion Meter so I know the numbers might be a little off, but not sure how much. I just gave him a bit of food because he has been losing weight and his appetite has not been what is normally is. Now I'm wondering if I should not have given him food.

Yesterday his BG was 477 at 1:30AM and 373 at 12:00PM and I gave him his insulin at 9AM.
 
Maybe he has a sputtering pancreas.. Which means you will need to keep a close eye on his blood. You definately will want to test before every shot and spot checks during the day when possible. He could well drop down again. I think it would be a good idea if you set up a spreadsheet too.. I will get u the how to link when I get home tonite..
 
Notes:
Infection raises blood glucose
Vet stress may raise blood glucose 100-180 points
Changing from high carb to low carb diet may reduce glucose 100 points

on a human glucometer:
< 40 = HYPO - follow hypo protocol !!!

40-50 pre-nadir = HYPO possibly coming - steer numbers with food; Read Handling Low Numbers

<40 at nadir = dose reduction for long term diabetics per insulin protocol
<50 at nadir = dose reduction for new diabetics per insulin protocol

50 - 150 = really good numbers for a diabetic

240 = renal threshold - glucose spilling into urine from blood
 
Ah! You beat me too it!!!

Looks like his BG might be coming down. AMPS might be interesting. If its under 200 please post on the lantus tight regulation board so they can advise. Also can you update the sheet to show the low values from previously?

Wendy
 
Wendy&Tiggy said:
Ah! You beat me too it!!!

Looks like his BG might be coming down. AMPS might be interesting. If its under 200 please post on the lantus tight regulation board so they can advise. Also can you update the sheet to show the low values from previously?

Wendy
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Hah yeah, I tried to set it up right. I couldn't remember the times of the first shots the first time around.

Did you mean the PZI board?

Thanks for those guidelines BJM, those will come in handy. I did have him on K/D the week before which I think is high carb, and have switched him to Wellness Turkey since he hasn't been eating a lot. So that may have had something to do with his high numbers in addition to the vet stress.

Latest BG was 108, checked at +14 from yesterday's first pm shot and +12 from the second pm shot given after I called the vet telling them his numbers were not going down when they told me to go ahead and give another. So I did not give him another shot. Going to check again before work this afternoon and go from there. I may recheck in a few hours just to see where he is at.

All this testing had made me feel bad for his poor ears, should I ice them a tiny bit or are they fine?

This cat continues to throw me curve balls. If his numbers stay low again this time I'm taking him to the specialist to figure this out.

At least he seems to be feeling better.
 
...All this testing had made me feel bad for his poor ears, should I ice them a tiny bit or are they fine? ...
Click to expand...

Neosporin ointment (not cream) with pain relief may be applied a few minutes before testing and wiped off. It will reduce the annoyance of testing and help the blood bead up. A small dab post testing will help the pricks heal.
 
I see your cat has CKD and you need to feed lower phosphorus foods. I understand that is probably why your vet has you feeding the Hill's k/d. The only problem with that is that the carb content on the k/d is 27%, rather high for a diabetic cat.

You also say you feed the Wellness Turkey. The grain free has 4% carbs, much better for a diabetic cat.

Here is a good food list we use to find low carb, low phosphorus foods. http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

Did you mean the PZI board?
Click to expand...
Well, you are using PZI but not as many people there. For a quicker response, be sure to put the question mark icon on your post with the word help in your topic header. You are likely to get quicker answers.
 
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