? Is my cat diabetic? newly diagnosed

Caloucon

Caloucon

Member Since 2018
hi all - Laila was diagnosed in the ER last week. Her glucose was 270. She was sick - nauseated and not walking well. I now think that she was suffering from indigestion, not diabetes. Her glucose numbers since have been steadily declining. She was prescribed 2.5 units of Lantus 2xd. My vet didn’t want me to test too much the first week. I took a couple of AM measurements - 170, 150 and 145 fasting numbers. I tried a glucose curve on Friday. Her fasting was 79 on the Alphatrack. I was stupid and followed the vets instructions to go ahead and give her 2 units of Lantus. Of course, her numbers crashed. Dropping 10 points every hour even with little mini meals. At 55 I started feeding her treats dipped in honey. She eventually got back to the 70s. Spoke to another vet at the clinic who said not to dose below 150. So frustrating. The original vets called me in the evening with the results of the fructosamine(?) which was 220 from the original Sat ER visit. I tested her this AM and her fasting on the alphatrack was 77. I honestly don’t think she is diabetic but the original vet is telling me to continue treatment - dose of 1.5 units. I’m skipping the Lantus shot until she gets above 170. What do you all think?
 
I'm still a newbie so I have no idea if your cat is diabetic or not, but if this were my cat I think I would keep testing all weekend, without giving any insulin, and bring the data and my cat to our regular vet. But again, some experts on here will probably have better advice.
 
A fructosamine of 220 is normal for a non-diabetic cat. HERE are the reference ranges.

It boggles my mind why any vet would be telling you to continue giving insulin with that fructosamine result. The fasting BG's you have done at home are all within normal BG range on an AT2 meter.

If your cat was not feeling well with digestive problems or whatever, that could raise BG. Couple that with the stress of being in the vet's office and a BG of 270 at the ER would not be unusual for a non-diabetic cat. I definitely would NOT be giving your cat any insulin without some further confirmation of high BG.

ETA - I hope your kitty is feeling better now!
 
This is my opinion only, of course. First, a blood glucose done in the ER when the cat is sick isn't a good way to diagnose diabetes. Bg can go way up when the cat is sick and stressed without diabetes being involved. Fructosamine is an average of the blood glucose over the last couple of weeks and is much more meaningful in these conditions. A fructosamine of 220 is normal. (Non-diabetic cat = 190-365) Quite honestly I don't understand why your vet started insulin and even more why they'd tell you to continue it at what's IMO a pretty high dose for a newly diagnosed cat. Here at FDMB we usually recommend starting at .5 or 1 unit.

You've now had some completely normal fasting numbers and a potential hypo situation. You didn't say whether you'd given insulin the night before the fasting tests so it's hard to say what they mean. The 170 you got is a bit above normal range for an AlphaTrac but since she was probably recovering from whatever her illness was that probably isn't significant. BTW if you do start insulin again you need to get tests done during the cycle to see how low she goes. Hopefully someone else can help you set up a spreadsheet which would be very helpful to people giving you advice.

If this was my cat I'd hold off on insulin until/unless I see higher numbers, and then start on a lower dose like .5u and work up if necessary. But really, it just doesn't seem like the diagnosis was based on anything. Again, IMO.
 
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Thanks everyone! I’m a 10 year insulin dependent diabetic (partial pancreotomy) and I’m very cautious in my insulin changes. Cats are so hard - “are they sick? What is going on?” I think the vet was trying to give an answer to an acute illness. My cat had a seizure a few years ago. Ended up being caused by a bladder infection but the practice - different vet - wanted to pinpoint the cause of the seizure. And she was no longer symptomatic. I didn’t go forward with the diagnostics and the practice was peeved at me. But she has never had another seizure. They seem very keen to pick a diagnoses and work it regardless of the cat’s symptoms. Thank goodness for the FDMB - you all have a ton of knowledge and are so generous with your experiences.

My cat is doing great - interacting with us, eating normally, doing cute cat things. Her glucose is in the normal range without insulin. And the vet still wants me to give her insulin. I’m going to do normal fasting testing for a week and go back to the vet and explain that Laila isn’t diabetic. And then change vets......
 
Your experience as a diabetic served you well looking after Laila. She's in good hands with you!:bighug:All things taken into consideration, I'm betting Laila is going to be just fine without insulin but we'll keep our fingers and paws crossed just for extra good luck. So glad to hear she is feeling better!

As ammunition when you speak with the vet, the fructosamine is basically equivalent to the A1C in humans. It is derived based on average BG over a 2-3 week period. That alone should have had the vet questioning the need for insulin but they shouldn't have prescribed insulin without having that test result back. If Laila continues in normal numbers, you'll have more than enough evidence to make your case. If they sold you the AT2 meter, I'd ask for a refund! Any BG reading up to 175 is still normal according to IDEXX lab values even though the AT2 sets the high limit at 150. :)
 
Caloucon said:
Laila isn’t diabetic. And then change vets...
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I read this kinda stuff all the time here. The vet should refund "ALL" your money! You need to go armed with information to interview the next Vet.Check if they even know how Lantus insulin works.

It would be a good idea to read the sticky notes here & maybe print out some of the info to bring to the next vet. I've seen vets give 4 even 5 units of insulin with one high reading! :mad:

They also recommend Dry food sometimes! I've see Kitties go into remission just from eliminating all dry food!

They should be required to take a class to update their information every year. "Do NO Harm" Sorry ,but I get so upset hearing the terrible mistakes that Vets sometimes make with these Helpless little beings!

We need to be their advocates. Ask questions, look it up on the Internet!
Great that Laila has an informed kitty mom to speak up for her!:) Keep up the good work!
Best of Luck to you! (and Laila) :) :bighug:
 
MrWorfMen's Mom said:
Any BG reading up to 175 is still normal according to IDEXX lab values even though the AT2 sets the high limit at 150.
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An aside...
That's really interesting. I didn't think INDEXX set their limit so high. The Merck Veterinary Manual sets the normal fasting value for blood glucose at 75–120 mg/dL for cats.
 
They did check for urine at the ER. They did a bladder punch for the sample. They said there was blood in her urine -( but it was never visible at home either before or after the ER visit) and that there was a low reading for glucose in the urine. I’m fuzzy on the details because it was very late at night at that point. I think that Laila’s acute illness - GI related - precipitated the high sugar and glucose in the urine. I know when I’m sick,
I get all those things with my diabetes . Laila has never shown great thirst, large urine output, unexplained weight loss or any other symptoms of long term uncontrolled diabetes. I think the vet made an initial diagnoses and won’t change her opinion. She is stuck on a single point - the 270 glucose reading in the ER. Nothing else points to diabetes other than Laila is a 24lb cat.

The vet even asked me (ME!) how the ranges differ between human and animal glucometer. I gave her a brief explanation - again with information from FDMB.... honestly you all are amazing! I’ve looked around for a conversion chart for the two glucometer a but haven’t found one yet.
 
Caloucon said:
I’ve looked around for a conversion chart for the two glucometer a but haven’t found one yet.
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There isn't a direct conversion...that's why you won't find one!!

The only guidance we have is that below 50 is the "time to act" on a human meter.....on a pet meter, it's below 68

At lower numbers, the two meters are usually fairly close to the same numbers but as the numbers get higher there's more difference (but that's OK...the most important numbers for safety are the low ones....too high is too high no matter which meter you're using!)
 
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