Borderline diabetic. Does 270 require insulin?

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DavidS

Member Since 2016
Hi, we took our cat to the vet recently. At the time she was dehydrated and had a fever, so she got fluids and antibiotics. The bloodtest said the liver is normal, high potassium, creatinine was slightly high, and blood glucose was 270. She ate a whole can of beef baby food before going to the vet. It was hard getting her to eat much else. He called to say she is borderline diabetic and said we'd need to get her insulin and special food.

However, we have been feeding her exclusively canned Friskies pate(Mixed Grill, Poultry Platter, Country Style Dinner) and one canned store brand pate (Stater Bros Mixed Grill) for the last four months. As I understand, these are all relatively low carb foods, and are free of soy, corn, wheat, and fish. I'm afraid whatever the vet is going to try to sell will actually contain some of those ingredients and be worse than what we're already feeding, or even be a dry food. I think a homemade diet would be better than both, and cheaper than prescription. He also asked if she's peeing; she hasn't been going to the litter box much at all, but is eating better and acting better after the fluids and antibiotic.

Also, is 270 blood glucose really high enough to warrant starting insulin? I read it's normal for the level to be between 120 - 300. And we got a new cat recently, which has been upsetting her. We keep them separated, but she growls and screams loudly when she hears him on the other side of a door.
 
Hi David. Has her glucose been tested since the vet? Since she was put on an antibiotic I'm assuming she had an infection. That and the stress of being at the vet can raise glucose numbers.
 
No, she hasn't been tested since. We have no way of testing her at home, and we only just got the call from the vet that the numbers were high. I think he wants to put her on insulin just from that and may not be thinking of testing the level again for some months, although he did mention the numbers could be from stress.
 
I'm not saying she doesn't need insulin, but I had a sick cat once that, at the emergency room tested in the 200's, but once he was well tested in normal range. Is she still on antibiotics or has the infection cleared? You can test her yourself with a human meter. They aren't expensive, and if it turns out she does need insulin, you'd want one anyway. Many of us use the Relion from Walmart.
 
One of my non-diabetic cats just had his glucose come back at 268 on his senior labs. We'd sat in the waiting room for an hour with lots of dogs - aka lots of stress. Because I do have diabetic cats I was able to test him at home several times. He's always in the 50's or 60's, not diabetic. @Sharon14 is right, stress and infections can raise glucose and it doesn't necessarily mean diabetes. You need another test. I think if their glucose is up in the blood but there is none in the urine it can be a sign that it's a stress number.
 
She got an injection of antibiotics on Friday; it's supposed to work for two weeks, so I guess it won't be clear until then. So, should I wait until two weeks from Friday and then test her at home? Or should I test again sooner like tomorrow? We're supposed to see the vet again on Tuesday about the insulin and special food.

Do you have any instructions / videos you'd recommend for the process?

The vet also asks if she's drinking water; she doesn't drink much water, but I think that could just be because she gets enough from canned food? And the other problem is mainly that I haven't seen her going in the litter box and the elevated potassium.
 
Thanks, so, do you think I should wait til the antibiotic injection wears off in two weeks? Or should I do it sooner? And I guess we should tell the vet we don't need the insulin or food yet.

And from what I read on catinfo, it sounds like I need to get a lancet device and test strips separately from the meter? I was looking at this one for the meter:
http://www.walmart.com/ip/ReliOn-Prime-Blood-Glucose-Monitoring-System-Blue/20752266 Not sure about the other two.
 
If it were my cat, I'd test before going back to the vet. When you see the vet ask if it's possible that her elevated number was influenced by stress and/or the infection. Hopefully, it's not diabetes but if it is, it's a manageable condition and you'll find lots of help here.

I'd get the ReliOn Confirm or Micro because they require less blood. A lancet device and 10 lancets are usually included with the meter. you will need to buy a small box of strips.
 
When my cat was diagnosed with diabetes he also had an infection. I asked the vet if the infection could be causing the high number and he told me that infections sometimes unmask the diabetes. Also told me there isnt much different between high numbers they are bad. 270 isnt a normal number. I would not wait two weeks before getting your cat checked again with a number that high. Either get a meter and test yourself or go back to the vet. Also you dont need the expensive food the vet sells you can feed low carb wet canned food from the store.
 
If you get the kit, some lancets and test strips may be included. Otherwise, you'll need to pick up some matching test strips and lancets labelled for alternate site testing (26-28 gauge).
 
HI!!
I would test at home as soon as you can...
the drinking could be related to the elevated kidney values ..... these often accompany diabetes but no way to tell without testing glucose
The shot of convenia (I am assuming) should be fighting the infection.... it does last long in the system but starts working fast.
some cats have issues with the convenia shot but some do fine.
Here is a picture that may help with aiming for the least sensitive spot aka the "sweet spot"
laur_danny_famoussweetspot.jpg
 
DavidS said:
The vet also asks if she's drinking water; she doesn't drink much water, but I think that could just be because she gets enough from canned food? And the other problem is mainly that I haven't seen her going in the litter box and the elevated potassium.
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David, this does need to be monitored closely. Raised potassium, especially when combined with a lack of peeing can quickly turn into a major issues for cats - I've been going through exactly this with my Rosa the last couple of weeks. The most usual cause would be CKD, which would fit with the raised creatinine level, but usually the creatinine would have to be very high before a cat stops peeing which then causes their potassium to run high - my Rosa is a difficult case...she had an SUB surgery because of a kidney stone and the acute-on-chronic kidney issues caused her further problems later on even though her creatinine wasn't at the sort of level where this would usually be seen. I don't know for sure, but I would guess that a kidney infection could cause similar issues.
 
The vet wants to give insulin for 10 days and then see if that lowers the numbers. Is this a good idea? Would it be better to test her numbers at home before starting the insulin, before and after eating?

He prescribed 5 glipizide tablets of 5mg each for $19 for 10 days.
 
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Have you started testing her at home yet? I don't know much about Glipzide except I've heard you should not use it in cats as it overtaxes the pancreas and worsens the diabetes in the long run.
 
I would definitely get at least a couple of tests at home before starting treatment - with an infection in play plus vet stress, it is of course possible that her numbers may not be far off normal once both of those are dealt with.

I would not, however, give glipizide if treatment is shown to be needed. Glipizide is not actually an insulin - what it does is force the pancreas, which is already struggling in a diabetic cat, to produce more insulin...of course this puts the pancreas under additional stress. In this respect, treating a diabetic cat is different from treating a diabetic human - because cats, unlike humans, actually have the ability to heal their pancreas, what we actually look to do is supplement with injected insulin to allow the pancreas to rest and hopefully recover enough function to allow the cat to become diet controlled.
 
my take on this? if it was my cat, i would not definitely give the glip, and i would not give the insulin (yet?)

as others have said, blood glucose can be elevated during stress, like vet visits. 270 isn't bad at all. for comparison, my cat was in the 500's and had elevated pancreas enzymes. it was clear he needed insulin. at 270 during a vet visit, i'd say home test and watch closely for signs of diabetes.

is kitty drinking a lot?
is kitty hungry all the time?
is kitty peeing more than usual?

i would watch closely by learning how to home test. there is no rush to get that insulin into your kitty with one reading at 270 during a stressful visit after eating and being stressed out at home with another cat. if you take 3 or 4 readings a day for a few days you will get a much better idea whats going on with kitty. you can post those numbers for everyone to see here and will all gladly give feedback. maybe she will need insulin after all, i dont know, but sure dont want to give it when not diabetic.

as to the elevated potassium and slightly elevated creatinine, i'll leave that advice to others because i'm not familiar with what that could mean.
 
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Thank you for the info about Glipizide; I had never heard of it. No, I have not tested her yet. I still need to get the meter. She doesn't drink much beyond what's in her wet food, her appetite seems normal, she doesn't pee a lot, but strangely she has sometimes been standing in the litter box while peeing instead of squatting, so it goes on the floor out of the box, then she moves the litter around in the box like she's covering it.

We started feeding her a few flavors of Weruva this past week due to it being low in phosphorus since the vet said her kidneys were slightly stressed. The carb content seems low on catinfo's chart, but I don't know if there's really a big difference, for example, with a food with 4 carbs versus one with 9 carbs.

So if I get that pink kit that includes lancets and a lancet device, then the only thing I need is test strips? (apparently the blue one isn't a kit and only includes a meter) Which test strips should I get with it, and how many?
 
As others have pointed out, BG at the vet can be elevated due to stress. Try testing at home. You may want to try a lower carb food. The omes you have listed are on the high end of what is considered optimal for a diabetic cat and some cats are very carb sensitive. You could also try adding up to 20% poached chicken (no spices, onions or garlic) to her food to reduce the overall carb content. If you think kidney's could be a potential problem you should look for a food lower in phosphorus. Unfortunatey many of the store brands, such as fancy feast and friskies are high P.

ETA: I see we cross posted and you're already trying other foods :)
 
DavidS said:
Thank you for the info about Glipizide; I had never heard of it. No, I have not tested her yet. I still need to get the meter. She doesn't drink much beyond what's in her wet food, her appetite seems normal, she doesn't pee a lot, but strangely she has sometimes been standing in the litter box while peeing instead of squatting, so it goes on the floor out of the box, then she moves the litter around in the box like she's covering it.

We started feeding her a few flavors of Weruva this past week due to it being low in phosphorus since the vet said her kidneys were slightly stressed. The carb content seems low on catinfo's chart, but I don't know if there's really a big difference, for example, with a food with 4 carbs versus one with 9 carbs.

So if I get that pink kit that includes lancets and a lancet device, then the only thing I need is test strips? (apparently the blue one isn't a kit and only includes a meter) Which test strips should I get with it, and how many?
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so the pink kit you mention - that is the RElion Confirm, yes? then they use these strips. http://www.walmart.com/ip/ReliOn-Confirm-micro-Blood-Glucose-Test-Strips-100-count/16795579

you might as well buy more lancets as well. you'll be going through them a lot, and if we're talking about the same kit, the kit only comes with a handful of lancets.

the standing in the litter box makes me wonder---hind leg weakness (diabetic neuropathy) can be seen in diabetics. but maybe with your cat it is a kidney related issue? any signs of hind leg weakness or funny walking?
 
Her walking seems okay, and she's only stood and peed on the floor a couple times so far.

Also, do I really need to get extra lancets and strips since I'm not sure yet if she has diabetes? Maybe the included 10 lancets in addition to these 20 strips( http://www.walmart.com/ip/ReliOn-Confirm-Micro-Blood-Glucose-Test-Strips-20ct/15442743) would be enough if it turns out her numbers aren't high? I read in another topic ((http://www.felinediabetes.com/FDMB/threads/can-lancets-be-reused.109820/) it's okay to re-use the same lancet up to 8 times, so that would be 20 tests with 10 lancets and 20 strips. The lancets are actually out of stock on walmart.com right now, too. And do I need anything like neosporin or pain relief to apply on the ear ? I've read of some others using it.
 
2 main points to that. If you read the link that was attached in the thread you've quoted, it does say that while some people find re-using lancets to be OK, others find it more painful. Especially when you're trying to get your cat used to this new routine, I would avoid anything that could potentially cause pain. An entire box of 100 lancets costs less than $5 - why take the chance? The other issue that you're likely to have is that the lancets that come with the meter are a small gauge. For most cats, at least when you first start testing, you will need the alternate site use lancets to get a big enough blood drop - trying to save on the lancets can actually finish up costing you more in wasted test strips than you can possibly save on lancets...the test strips are the expensive part to all of this. The box of 20 test strips should be sufficient to allow you to determine whether insulin is likely to be needed or not and as they do have an expiry date of just a few months once the package is open, I wouldn't buy a bigger box of those unless you're sure they're going to be needed. Neosporin ointment with pain relief can definitely be used to make the process easier - not only does it relieve pain (of course), but if you apply a tiny amount just before testing instead of just afterwards, it can actually help the blood to bead up to make it more likely to all end up on the test strip where it needs to be instead of being absorbed by the fur.
 
I'm with manxcat! Lancets are so cheap. Most people on that post you referenced said they wouldnt repeat use a lancet, other than maybe in the moment if the first prick fails. Not only is there a dullness issue of repeat use (which hurts), but also a risk of infection. I wont even use a lancet if i drop it on the floor - its contaminated and maybe it fell on the needle and dulled it.
Lancets are soooooo cheap its not worth cutting corners.

28 gauge are great for beginners. I believe that kit comes with 30 gauge. Higher number means smaller needle, and bigger is better for newbies. I buy freestyle 28 gauge on amazon, $10 for 100, but i'd wager you could find a packet of lancets at walmart or a pharmacy for less.
 
Misterbeesmom said:
I buy freestyle 28 gauge on amazon, $10 for 100, but i'd wager you could find a packet of lancets at walmart or a pharmacy for less.
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I'm pretty sure the box of 100 ReliOn 26 gauge come in around $4.79, though it's a few months since I bought any. Now Rosa is off insulin, a box lasts ages with once a week testing...though with Roxi now allowing us to test her some days, we'll be getting through them faster again.
 
manxcat419 said:
I'm pretty sure the box of 100 ReliOn 26 gauge come in around $4.79, though it's a few months since I bought any. Now Rosa is off insulin, a box lasts ages with once a week testing...though with Roxi now allowing us to test her some days, we'll be getting through them faster again.
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I'll take a look, thanks!
 
Actually, they're an even better price at the moment - I just checked Walmart's website...they don't have them available online, but they're currently selling 100 lancets for $1.48 in-store. That looks to me like it has to be some kind of deal - I know they were more than that the last time I bought some. I'm tempted to go and buy a few boxes myself at that price!
 
I can't be 100% certain, but they probably will as the description does say they fit most commonly used lancing devices. I've bought other brands on occasion when our local Walmart has been out of stock on the ReliOn ones and I've really needed them immediately - most do seem to fit almost all the lancing devices.
 
Also you can freehand poke without the lancing device. I found it easier to control and see where I was poking. And there was no noise to spook kitty.
 
here's another nice buy. will *probably* fit the device. i'm going to buy some myself.

https://www.amazon.com/gp/product/B00V3RGCYW/?tag=felinediabetesfdmb-20

just a side note, i only use my device to hold the lancet. i do the pricking action manually. the device makes a noise if you use the button release. this may or may not spook kitty. if it was me getting my ear pricked, i'd rather not hear a sudden sproing noise so nearby. some folks dont even use the device at all - they just hold the lancet and prick manually.
 
Misterbeesmom said:
here's another nice buy. will *probably* fit the device. i'm going to buy some myself.
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Nice fine Jen! Most of these things are pretty universal (though our local Walgreens will try and tell you otherwise and suggest buying their meter and lancing device kit)! :rolleyes:

I have to say none of our cats seem to be fazed by the clicking noise...even Regan who is usually terrified of random noises doesn't worry about it, but I might just have got very lucky with them all here.
 
manxcat419 said:
Nice fine Jen! Most of these things are pretty universal (though our local Walgreens will try and tell you otherwise and suggest buying their meter and lancing device kit)! :rolleyes:

I have to say none of our cats seem to be fazed by the clicking noise...even Regan who is usually terrified of random noises doesn't worry about it, but I might just have got very lucky with them all here.
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thats good they're not fazed by it. i even turned off the beeping sound on the meter, just in case. then again maybe the beeping is more annoying to me than it is to my cat! ;)
 
It should be just fine - I think some of the Canadian members use that meter and I don't recall hearing anything bad about it. The only possible downside I can see is that it requires a bigger blood drop than the ReliOn Confirm/Micro but even 0.6 microliter is a very small amount.
 
I got the Contour meter, tried poking next to her vein on the outside of her ear twice with the included lancet devices. The first time no blood came out, the second time a little blood came out I got an insufficient blood error despite using the highest blood setting on the lancet device and rubbing her ear a lot with my thumb prior, and trying to squeeze more blood out with my fingers. (I don't have a microwave to do the sock thing.) I was thinking maybe the lancet device is the problem, but I wouldn't know how much pressure to use or how long to hold it or how deep to hold the lancets in without the device.

Also should I try pressing my thumb against the opposite side of her ear directly from the lancet while using the device? That seems to be the only way to get the lancet to press firmly against her, but then it might poke my thumb at the same time. Hope I can get at least one good reading before using up all 10 of the included strips.

Now she's upset and got more upset due to hearing the other cat on the other side of the door, so I'll try again later.
 
DavidS said:
I got the Contour meter, tried poking next to her vein on the outside of her ear twice with the included lancet devices. The first time no blood came out, the second time a little blood came out I got an insufficient blood error despite using the highest blood setting on the lancet device and rubbing her ear a lot with my thumb prior, and trying to squeeze more blood out with my fingers. (I don't have a microwave to do the sock thing.) I was thinking maybe the lancet device is the problem, but I wouldn't know how much pressure to use or how long to hold it or how deep to hold the lancets in without the device.

Also should I try pressing my thumb against the opposite side of her ear directly from the lancet while using the device? That seems to be the only way to get the lancet to press firmly against her, but then it might poke my thumb at the same time. Hope I can get at least one good reading before using up all 10 of the included strips.

Now she's upset and got more upset due to hearing the other cat on the other side of the door, so I'll try again later.
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Put a cotton pad behind the ear to protect your thumb.
 
The depth you need to use on the lancet does vary from cat to cat and even over time as an individual cat's ears learn to bleed. I would start with a fairly deep setting and gradually adjust it to a lower setting once you find you are getting enough blood for a test. If you don't have a microwave, you can always try filling a small plastic bottle with some warm water and using that to warm her ear instead...there is always a way even if you can't quite use the same method that many of us do! If you're getting blood but it isn't enough for a reading, you can try poking her ear twice with the second poke right next to the first...that makes a slightly bigger hole in the skin to get more blood out of.

You will want to use something behind her ear to press against - I use a folded up piece of paper towel...it means you get a firmer poke on her ear so are more likely to get blood and the paper towel protects your fingers. I tried using a cotton pad, but it makes Rosa freak out...I don't know if it's the slightly squeaky noise a cotton pad can make when it's compressed or if it just tickles the inside of her ear, but I find a paper towel provides a firmer backing to press against without making her jump and run off.

Oh and no more than 3 attempts before giving her a break whether you get any blood or not. It doesn't have to be a long break - 20 minutes or so is usually enough, but you do want her to associate test time with something that's over quickly and gets her a treat, not a time when her ears are messed with constantly for several minutes.
 
Thanks for those suggestions. I just tried again using the water bottle full of hot water to rub on hear and pressed a folded paper towel on the opposite side of her ear from the lancet device. After one more failed attempt where I didn't have a good hold on her and she moved away while the strip was still sucking up the blood causing an insufficient blood error(she starts trying to escape when she hears the lancet device click), I tried again making sure to keep her still and got a blood reading of 66. I almost missed it again because the meter seems to turn off on its own a few minutes after inserting a strip and you have to re-insert it to turn it on again. This is when she hasn't eaten in some hours. So I gave her a bit of food and left her alone.
 
Awesome job on getting that reading! It does get easier with practice - I promise. :) Though if she keeps reading somewhere around 66 (normal for a cat not on insulin is 40-120) then you may not have to attempt it too many times. :) The meters do turn off automatically after a few minutes - you can avoid having that happen by not pushing the strip all the way into the meter until you get blood, but the downside to that is that then she would need to hold still for a few seconds while the meter reaches the point where it can accept a blood sample.
 
So when will be the best times to take the next tests? Should I try immediately after a meal? Or just test again tomorrow around the same time I did it today, once a day? Or does the timing only matter when they're on insulin? Thanks.
 
The timing is only really critical when they're on insulin. What can be useful is to test right before you feed to get a fasting test, which it looks as though you pretty much got today, and then test around 3 hours after you give food. You would expect the numbers to be close to level on those 2 tests, or for the after food number to be a little lower - that proves that the pancreas is working to produce insulin while the food is digested.
 
Awesome job getting the reading! Hopefully you only have to test a few more times then forget about this chapter :blackeye:
 
I tested again today around 12 and her number was 53, then again 6 hours later, which was a bit over 3 hours after eating, and it was 52.
 
I think she's good. If you're getting readings like that, I don't think there's much to worry about. One of our non-diabetics once had a reading of over 300 at the vet...it was 90 when we tested her at home a few hours later!
 
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