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Bear & Lora

Bear & Lora

Member Since 2018
I took my cat to the Vet for a general check and a Fructosamine Test. The Vet told me the results would give us an average of his blood glucose for the past 2 to 3 months.
After I got home I was having some vague recall that I had heard or read something different. I started researching Feline Fructosamine Tests. Everything I found said it was an average blood glucose level for 2 to 3 weeks not months.

I looked at my paperwork and under Doctor's Instructions was: (Bear has had his serum fructosamine sent out to evaluate his blood glucose control over the past 2 months.)

I wanted to give the Vet the benefit of the doubt so I thought possibly there are different types of Fructosamine Tests or the Vet by mistake had used months instead of weeks.

Well, the Vet called me this morning and said Bear's Fructosamine Level was 543. I could feel my anxiety level go up a notch or two. I asked her, "That's an average for how long?" She replied, At the least, 2 months."
So while my mind was trying to decide whether to call her out on a probable mistake it got worse. She asked how many units Bear was on and said I need to increase him to another full unit and that the numbers show that he is poorly regulated. She told me the numbers for a well regulated cat, which I don't remember now.
I was suffering from Deer caught in the headlights syndrome. Then she said I know you are concerned about Hypo but when you get Bear's preshot BG even if it reads say a 60BG to go ahead and shoot him because the prozinc doesn't even go into affect for 4 hours after his shot but make sure to test him like you've been doing.

At this point I had reached a much higher level of shock at the contradictions I was hearing, contradictions of the info I have learned on this forum and on the latest medical research that's been published.
The last bit of icing on the cake was at the end when she said it is possible with Bear's uncontrolled blood glucose and with him pulling out his hair, he might have Cushing's disease and if he continues pulling out his hair we could later test him.

I can use the information I have learned to formulate what is true or false but what I can't figure out is why Bear's Fructosamine level was 543??? Bear's 14 day average on the Relion Prime is 318 and his 30 day average 311?

I know a human meter reads lower than a Feline Meter and there can be a 20% variance with the numbers you get from the human meter but my mind says even taking those factors into consideration 543 seems too high, but lab tests are factual so I do believe his average is 543.

I wanted to share this experience and have as many eyes as possible on this situation and hopefully get some ideas as to why Bear who is definitely not fully regulated but even at that, how can he have such a dismal Fructosamine Level?

I feel like I've screwed up somehow.
 
First off you HAVE NOT SCREWED UP!

Fructosamine tests are not infallible. My experience with it is the opposite of yours. I got told Menace was in good regulation while I was tearing my hair out at red and pink readings that didn't move but a few points through out any cycle. I refused to ever have the test done again because I had daily information that gave a lot more specific information. The problem with averages like the fructosamine is that they are skewed if there are a lot of low or high numbers or exceptionally low or high numbers in the period covered by the test. Fructosamine has it's place as a diagnostic tool and if one is not testing daily but it's certainly a poor tool for determining dose.

A couple of things to take into consideration. Other bloodwork values can effect the fructosamine results and the "543" is a totally different measure of another blood component....not glucose and doesn't correlate to average BG on your meter in any way at all.

Your vet's assertion that the fructosamine gives an average level of regulation over a 2-3 month period is wrong. I'd like to think it was a slip of the tongue but with her repeating it, it sounds like she's not that familiar with the test.

As for the suggestion the hair loss might be Cushings....that is certainly looking for the zebra in the room instead of the horse. Cushings is pretty rare in cats and while symmetrical hair loss is one of the symptoms, I can't see why she'd even suggest it without other Cushings symptoms and until all other possible causes are ruled out.:bighug::bighug:
 
Linda has given you some good information. As far as Cushing's goes, it may not be quite as rare as once thought, merely under-diagnosed. Years ago Acromegaly was considered rare in kitties but more recent research has found that as many as 1 in 4 FD kitties may have acro. That being said, with Cushing's hair loss tends to be symmetrical...all over the body and is not caused by a kitty pulling their hair out. When a kitty is pulling their hair out it could indicate an allergy or fleas.

Fructosamine tests only give an average of a 2-3 week period. In HUMANS the AG1 test covers 2-3 months, so perhaps your vet has confused the two. Fructosamine tests use a different scale than blood tests:


Fructosamine reference ranges for cats
Cats Fructosamine values
(micromol/l)
Normal non-diabetic cat 190-365
Newly diagnosed diabetic cat 350-730
Treated diabetic cats:
Excellent control 350-400
Good control 400-450
Fair control 450-500
Poor control >500

Testing at home gives a much more accurate pattern than the fructosamine test or random tests done at the vets. I can't see what type of insulin you are using, but you have been getting some big drops in the last few days, which can cause the readings to 'bounce' up higher temporarily. with most insulin types you will look more at how low a dose gets your kitty when making dose changes.
 
Yeah, it sounds like your vet is way off on the time period the fructosamine test covers. It is supposed to be a 2 to 3 week period, though the internal medicine specialist that I used to take Mia to said that it should really be considered a measure of two weeks/14 days. When it is being used to evaluate the effectiveness of an insulin dose, he said the cat has to be on the same insulin dose for the entire 14 days for it really to have any value. It is really more helpful at diagnosis or for cats whose owners will not home test. He believed the tests do have value as another factor to take into consideration, but that they alone cannot give the full picture. You cannot beat regular home testing when it comes to really knowing what your cat's glucose levels are doing in response to insulin doses.

I actually asked for one for Mia at about the nine month point of her being on insulin. She had had one two weeks after starting insulin, and I wanted to see the results for comparison. It was 513 two weeks after starting insulin and was 339 after nine months on ProZinc. The vet was thrilled with the 339 which is at the higher end of the 'normal' range and better than what they consider 'excellent control'. Because I was home testing, I was still not happy. I knew that her glucose levels were still getting too high a couple of time periods each day (pre-shot). I didn't want to ever see her over the renal threshold, and I knew that the ups and downs we were seeing were still too much and could not make her feel very well. That is a primary difference in regular glucose testing vs periodic fructosamine testing. An average (even of glucose test results) does not give you the data you need to understand what is going on with your cat. You really need to be able to see the highs and the lows and how long they are staying within 'good' numbers versus 'bad' numbers.

Bear's fructosamine is definitely high. You can also look at his spreadsheet and see that his glucose has been running pretty high most of the time. I encourage you to come on over to the Prozinc forum so you can get help with dosing. What your vet said about ProZinc not having any effect for 4 hours is also not accurate. As you can see from your own test results, it usually has it's onset sooner than that. Giving the shot if his pre-shot glucose is 60, as your vet suggested, would be VERY dangerous. Don't do it.
 
No, it's not you. It is beyond frustrating that vets know so little about diabetes, order potentially unnecessary and expensive tests and make a connection between any symptom and a serious disease like Cushings. I won't go into analogies.
Any doctor needs to look at all the symptoms and related medical conditions, things like home life and mental stress (especially with hair loss) and then test and rule out other possibilities.
This may be the only website that actually contradicts "informed" doctors and is actually right. I've never used Prozinc so that's all I can say.
 
MrWorfMen's Mom said:
First off you HAVE NOT SCREWED UP!

Fructosamine tests are not infallible. My experience with it is the opposite of yours. I got told Menace was in good regulation while I was tearing my hair out at red and pink readings that didn't move but a few points through out any cycle. I refused to ever have the test done again because I had daily information that gave a lot more specific information. The problem with averages like the fructosamine is that they are skewed if there are a lot of low or high numbers or exceptionally low or high numbers in the period covered by the test. Fructosamine has it's place as a diagnostic tool and if one is not testing daily but it's certainly a poor tool for determining dose.

A couple of things to take into consideration. Other bloodwork values can effect the fructosamine results and the "543" is a totally different measure of another blood component....not glucose and doesn't correlate to average BG on your meter in any way at all.

Your vet's assertion that the fructosamine gives an average level of regulation over a 2-3 month period is wrong. I'd like to think it was a slip of the tongue but with her repeating it, it sounds like she's not that familiar with the test.

As for the suggestion the hair loss might be Cushings....that is certainly looking for the zebra in the room instead of the horse. Cushings is pretty rare in cats and while symmetrical hair loss is one of the symptoms, I can't see why she'd even suggest it without other Cushings symptoms and until all other possible causes are ruled out.:bighug::bighug:
Click to expand...


Linda I think I would be having mini melt downs and tears on a regular basis if not for you! I can't say thank you enough! :bighug::bighug::bighug:
 
Tuxedo Mom said:
Linda has given you some good information. As far as Cushing's goes, it may not be quite as rare as once thought, merely under-diagnosed. Years ago Acromegaly was considered rare in kitties but more recent research has found that as many as 1 in 4 FD kitties may have acro. That being said, with Cushing's hair loss tends to be symmetrical...all over the body and is not caused by a kitty pulling their hair out. When a kitty is pulling their hair out it could indicate an allergy or fleas.

Fructosamine tests only give an average of a 2-3 week period. In HUMANS the AG1 test covers 2-3 months, so perhaps your vet has confused the two. Fructosamine tests use a different scale than blood tests:


Fructosamine reference ranges for cats
Cats Fructosamine values
(micromol/l)
Normal non-diabetic cat 190-365
Newly diagnosed diabetic cat 350-730
Treated diabetic cats:
Excellent control 350-400
Good control 400-450
Fair control 450-500
Poor control >500

Testing at home gives a much more accurate pattern than the fructosamine test or random tests done at the vets. I can't see what type of insulin you are using, but you have been getting some big drops in the last few days, which can cause the readings to 'bounce' up higher temporarily. with most insulin types you will look more at how low a dose gets your kitty when making dose changes.
Click to expand...

Thank you for the reference ranges.

The irony of the Vet mentioning Cushings in her phone call is that yesterday in her office I told her that I thought Bear's Seresto Collar might had lapsed so I had replaced it. Bear had reacted like other cats I have had, jumping as if bitten, running then licking himself. My other thought was since he pulled hair out on both sides of his spine that possibly some neuropathy had settled in his spine. Djamila had mentioned that as a possibility. :) Bear is now taking Zobaline twice a day and has become more active
The Vet agreed with both ideas as a possibility.

Bear had definitely pulled out his own hair.
 
FurBabiesMama said:
Yeah, it sounds like your vet is way off on the time period the fructosamine test covers. It is supposed to be a 2 to 3 week period, though the internal medicine specialist that I used to take Mia to said that it should really be considered a measure of two weeks/14 days. When it is being used to evaluate the effectiveness of an insulin dose, he said the cat has to be on the same insulin dose for the entire 14 days for it really to have any value. It is really more helpful at diagnosis or for cats whose owners will not home test. He believed the tests do have value as another factor to take into consideration, but that they alone cannot give the full picture. You cannot beat regular home testing when it comes to really knowing what your cat's glucose levels are doing in response to insulin doses.

I actually asked for one for Mia at about the nine month point of her being on insulin. She had had one two weeks after starting insulin, and I wanted to see the results for comparison. It was 513 two weeks after starting insulin and was 339 after nine months on ProZinc. The vet was thrilled with the 339 which is at the higher end of the 'normal' range and better than what they consider 'excellent control'. Because I was home testing, I was still not happy. I knew that her glucose levels were still getting too high a couple of time periods each day (pre-shot). I didn't want to ever see her over the renal threshold, and I knew that the ups and downs we were seeing were still too much and could not make her feel very well. That is a primary difference in regular glucose testing vs periodic fructosamine testing. An average (even of glucose test results) does not give you the data you need to understand what is going on with your cat. You really need to be able to see the highs and the lows and how long they are staying within 'good' numbers versus 'bad' numbers.

Bear's fructosamine is definitely high. You can also look at his spreadsheet and see that his glucose has been running pretty high most of the time. I encourage you to come on over to the Prozinc forum so you can get help with dosing. What your vet said about ProZinc not having any effect for 4 hours is also not accurate. As you can see from your own test results, it usually has it's onset sooner than that. Giving the shot if his pre-shot glucose is 60, as your vet suggested, would be VERY dangerous. Don't do it.
Click to expand...

Thank you for responding and sharing your experience. :)

I have been increasing Bear's dosage in small increments recently on advise from the prozinc forum and Bear just had a green # which set off a very large bounce into a black PMPS. Bear hadn't had a green in over a month and ouch, what a reaction.
After finally getting a green # I felt like progress was being made and Bear was breaking through his glucose toxicity.

I really was slayed that his Fructosamine Test would be 543.

Now since I have gotten some extra sleep that number is making a little more sense. With these recent increases Bear has been bouncing more often into the reds and has had two blacks and that has been happening within the two weeks that the test would be gauged off of.

If the test actually was gauged off two months and I was the Vet I would think Bear is being very poorly controlled also.

When the Vet said to shoot Bear even at a 60 BG my mind couldn't believe what I was hearing. Bear's BG has shown a drop at +1 and a drop every time at a +2. I will never shoot Bear if his preshot is below 200 BG on his current dosage amount.
 
Noah & me (GA) said:
No, it's not you. It is beyond frustrating that vets know so little about diabetes, order potentially unnecessary and expensive tests and make a connection between any symptom and a serious disease like Cushings. I won't go into analogies.
Any doctor needs to look at all the symptoms and related medical conditions, things like home life and mental stress (especially with hair loss) and then test and rule out other possibilities.
This may be the only website that actually contradicts "informed" doctors and is actually right. I've never used Prozinc so that's all I can say.
Click to expand...

I agree and that is why my mind couldn't wrap around the things she was saying.

Bear has made so much progress. He has went from being a grumpy kitty most of the time to a purring, touch me kitty. He is also less stressful, he lays on his back a lot now looking so adorable I almost always have to run my hand down his tummy. His dander and coat look so much better too.

Last night I stayed up to get a +6 and only got 4 hours of sleep, since catching a nap and having a clearer mind I attribute some of that 543 number with Bear's recent bounces due to his dosing increases and breaking out of his glucose toxicity.
 
Bear & Lora said:
Now since I have gotten some extra sleep that number is making a little more sense. With these recent increases Bear has been bouncing more often into the reds and has had two blacks and that has been happening within the two weeks that the test would be gauged off of.

If the test actually was gauged off two months and I was the Vet I would think Bear is being very poorly controlled also.
Click to expand...

Keep in mind that a few individual point-in-time high glucose results are not enough to throw the fructosamine off that much. Based on that fructosamine result as well as the numbers on your spreadsheet, I would say that Bear would be considered poorly controlled. That is not meant to be an insult/attack AT ALL. You are clearly working hard at this and are moving in the right direction, and this process takes awhile... much longer with some cats than with others. It sounds like the clinical signs such as how Bear feels and the condition of his coat have greatly improved, and that is very important. I just would not want you to disregard the fructosamine result completely. It is an indicator. Looking at your spreadsheet, it seems that it corresponds with the numbers there. (Keep in mind, that the numbers are not the same... 543 is a measure of fructosamine, it does not equate to a glucose measure of 543. The point is that both fructosamine and glucose levels have remained too high too much of the time.)

The last post I saw on the ProZinc forum was from 11/20 when it was suggested that you up the dose (that's when you went to 3.8) because you had been on the previous dose 4 cycles at that point and that you continue with the increases. As was mentioned in that thread, you want to see Bear in the blues and greens more of the time so the pancreas can have time to heal. (The renal threshold has always been a point of reference for me. That is the point at which excess glucose begins dumping into the kidneys which can begin to cause damage. That is about 250 on a pet meter, so it is lower on a human one.) With ProZinc, once you hold a dose for a couple of days, you can make a call on whether an increase is needed. You do not have to stay on a dose a week or more when the numbers are staying too high. So, if you would like additional advice related to dosing, please start a new thread in the ProZinc forum so you can continue to move Bear in the right direction.
 
@FurBabiesMama

Thank you for all the great information! :)

I am definitely going to increase Bear up the dosing scale in the recommended small increments. I absolutely want to get him better regulated.

I did keep Bear's dose the same for too long due to a limited observance time and inability to test him frequently. I am my mother's caregiver, she moved in with my husband and I two years ago. As her health needs have become more frequent and now that she requires almost constant supervision (Dementia) I am limited. She is currently at a skilled nursing center in order to regain her strength after battling a bacterial infection in her leg wounds for over a month and having angioplasty placed in her leg Nov. 19th.

I am taking advantage of her absence to try to get Bear better regulated but as I increase Bear's dosage he experiences more bouncing. In fact when I decreased his dose the 27th and then increased him back to the 3.8 yesterday, even though these were such small amounts it has set him into a bounce today.

I have been told that it can take 3 to 4 days to stabilize after a bounce, so I am going to give Bear a little more time between increases because I can tell he feels like poo when he bounces.

I am very fortunate to have Kris and Teasel to advise me since apparently Teasel is an Olympic level bouncer.

Thank you again for responding and sharing your knowledge I am doing my best to learn as much as I can.
 
It looks like you have done a great job of regular testing in spite of your circumstances. (Kudos for taking care of mama! That alone says you are 'good people'.)

Believe me, I understand about bouncing. Mia too was a very bouncy girl for a long time. Thank goodness, she now stays much more level. I found that holding doses for 3 or 4 days worked best for her.
 
FurBabiesMama said:
It looks like you have done a great job of regular testing in spite of your circumstances. (Kudos for taking care of mama! That alone says you are 'good people'.)

Believe me, I understand about bouncing. Mia too was a very bouncy girl for a long time. Thank goodness, she now stays much more level. I found that holding doses for 3 or 4 days worked best for her.
Click to expand...

Thank you!
My mother actually was admitted into the hospital the first part of this month for Emergency IV Antibiotics then a little over a week later into a skilled nursing center to continue the IV Antibiotics.
She will be able to come home soon.
 
Bear & Lora said:
he might have Cushing's disease
Click to expand...
When Frosty got diagnosed with Cushing’s, his Fructosamine was 1500. He was also on insulin at the time. The vet said she has never seen a level that high. He was having skin tears from grooming - large wounds down to his muscle. Those were all the clues she needed to suspect Cushing’s, and we were sent to an internal medicine vet for a workup.

Hope this helps.
 
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