So I guess not Diabetic? I'm a bit mindblown

[lisa_michelle]

So I posted here on Tues Oct 29th ( https://www.felinediabetes.com/FDMB/threads/probable-diabetes-sugars-high-vet-appt-levemir.295313/ ) that my 17 yr old kitty had been to the Vet that day, had elevated BGs all day, I'd been monitoring them for 10 days and most were elevated.....at the Vet they dipped her urine and she was trace for glucose.....Vet said we couldn't yet consider her diabetic, that it was best to just keep testing her BG's at home for a few days then call him on Sunday to see where she's at.

Well yesterday, Wed....her numbers were so much better and so much different:

3:00am - 131
7:15am - 166
1:00pm - 130
4:45pm - 131
midnight - 142

Wed she ate:

3/4 can of Friskies Salmon Pate
1/2 can of Fancy Feast Ocean Whitefish & Tuna
Whiskas Perfect Portion Salmon Pate (37.5 grams)

This is just mindblowing to me, how she was so steady and so good all day.......when she'd had numbers like this since Oct 18:

Oct 18:
noon - 243
5:30pm - 252

Oct 19:
08:45am - 260
3:00pm - 234
(NOTE: this day I started her on Purina DM dry food from the Vet, for the odd time she nibbles dry in between her main meals of canned, as it's lower carb than the regular dry)

Oct 20:
07:00am - 270 (as she'd been drinking more, I decided to give her 50cc of S/C fluids)
noon - 156 (figure the s/c fluids that morning caused this improved BG)
7:00pm -187

Oct 21:
08:30am - 253
9:00pm - 189

Oct 22:
06:30am - 266
2:30pm - 176
9:00pm - 183

Oct 23:
8:30am - 122
10:30am - 162
9:30pm - 217

Oct 24:
09:15am -135
9:30pm - 183

Oct 25:
06:00am - 228

Oct 26:
07:00am - 208
7:00pm - 157

Oct 27:
7:00PM - 205

Oct 28:
09:00am - 228
7:30pm - 270 (NOTE: I decided to take away the Purina DM dry food, will feed only wet)
8:30pm - 274
11:30pm - 266

Oct 29:
09:00am - 248 (this was after not eating any low carb fancy feast pate since midnight)
12:30pm - 243
4:00pm - 221

I am trying to make sense of such good BG's yesterday. I'm sure that stopping the Purina DM dry food Mon morning made a big difference. Given her history of Pancreatitis, maybe these previous days of elevated numbers were due to some degree of inflammation of her Pancreas (although she's had no vomiting at all which is the first thing she does w/ pancreatitis) and now that's resolved so back to good numbers? I got a little paranoid at one point and wondered if maybe my meter (newer One Touch Verio Reflect) was giving me wrong readings so I tested myself and my BG was right on the money. I'll keep checking her 4 times a day but I guess it would appear that she's definitely not diabetic ......or could she be diabetic BUT controlled by diet since she's now on strictly low carb canned only? What do you all think?

Thanks

 

[Bron and Sheba (GA)]

Did you get a fructosamine test done at any time. That is the best way to get a diabetic diagnosis in a cat.
I’m sure getting rid of the high carb dry food has made a difference. I would definitely continue forever with a low carb diet. The BG numbers are still slightly up. We like to see them below 100. I would continue to test and we can see in a few days.

 

[lisa_michelle]

Did you get a fructosamine test done at any time. That is the best way to get a diabetic diagnosis in a cat.
I’m sure getting rid of the high carb dry food has made a difference. I would definitely continue forever with a low carb diet. The BG numbers are still slightly up. We like to see them below 100. I would continue to test and we can see in a few days.

Back in end of March 2024, she had a bout of Pancreatitis and sugars were running high, the highest late one night was 333...I got her into the Vet the next morning, got a full senior panel done, T4, urinalysis and Fructosamine. The latter was 276 (range 191-349), so normal. Vet just attributed the spike in her sugars to Pancreatitis. A few days later they were back down normal.

See, you say it would be better if her numbers were below 100 but 2 Vets at this clinic keep claiming that the normal LAB RANGE is 4.2-9.4 (75-169) so if she's below 169, then she's in the normal range....and I don't understand this because this is different than what you say...and everything one reads online about feline diabetes says that the normal range in a non-diabetic cat is: 4.4 - 6.6 (80-120).....so why do you say below 100?

 

[Bron and Sheba (GA)]

Yes, it is true the range is 50-120.
When we have cats do an ‘off the juice’ trial we like to see all the BG numbers under 100 if possible. It just gives a stronger remission. Does that make sense?
I know some of the lab ranges are a bit higher but they aren’t hometesting ones.
My Sheba used to get pancreatitis when she was in remission and her BGs would always go up high and then come back to normal after a few days.

 

[Sienne and Gabby (GA)]

The numbers you saw yesterday were better than your cat's previous numbers but they are not normal range numbers. The vets may be using either an AlphaTrack glucometer or a serum chemistry analyzer both are calibrated differently than a human meter. The pet specific meters use a different methodology than human meters. For the past 25 years, we've used a range based on a human meter where the data is 50 - 120 for normal range numbers. Not to be too snarky, I would want to know which online site you were getting your information from. Not all feline diabetes sites are created equally.

 

[Wendy&Neko]

I've tested several non diabetic cats, most in the low 50's or even upper 40's, with a human meter. One of my cats when on prednisolone (steroid), tested in the 70's. As said by others, normal range does not start at 80 with a human meter.

Looking at my cat's Idexx reports, the normal range for glucose is 4.0 (72)-9.7(175). That is done with the serum chemistry analyzer which registers higher. You have to consider the normal range for the type of meter you are using.

What type of meter are you using at home?

 

[lisa_michelle]

I've tested several non diabetic cats, most in the low 50's or even upper 40's, with a human meter. One of my cats when on prednisolone (steroid), tested in the 70's. As said by others, normal range does not start at 80 with a human meter.

Looking at my cat's Idexx reports, the normal range for glucose is 4.0 (72)-9.7(175). That is done with the serum chemistry analyzer which registers higher. You have to consider the normal range for the type of meter you are using.

What type of meter are you using at home?

Hi Wendy, I use a fairly newer One Touch Verio Reflect. The Vets at the Vet clinic I go to all seem to think that the 'normal range' of a human meter and lab/serum chemistry analyzer are the same..........so because the lab's range for normal is 4.0-9.7, that that automatically means that that's the normal range for the human meter.........and 2 vets there have told me that if her BG with the human meter is below 10, that her BG is normal. I asked them how this could be, when everything you read online about what the 'normal range for a non-diabetic cat's glucose' should be, it always says: 4.4-6.6 (80-120).....so why are they saying that up to 10 is fine? They can never really answer this, except that they go by the lab's range of 4.0-9.7. They seem to believe that the lab's range is transferable to the what's normal using a human meter. I can't convince them otherwise. Right now if you Google "normal blood glucose non-diabetic cat" you will get numerous reputable websites, including many Vet Clinic websites, that state 4.4-6.6 (80-120).

When I Googled what the Normal Range for the One Touch Verio Reflect is, it says 4.0-7.0 prior to eating....and between 5-10 2 hours after a meal. So I have to consider, also, that Bitsy is a constant nibbler of her canned food. She doesn't go many hours without food in her belly. She can be in the middle of a dead sleep and then wake up for a bite (lol)....sleep another hour, then up for another few bites. So when I'm checking her BG, some of these numbers I'm getting will be reflecting the normal rise from the food. I think it would be safe to say that there's never a 3-4 hour period where she's not eating a little bit of canned. Even in non-diabetic humans (I'm a retired RN), 2 hours after they eat their BG is going to naturally rise above the "normal range of 4-7" but then their pancreas kicks in and produces insulin which then lowers it back into the normal range. Should be no different for cats that are constantly grazing?? No? It's like the insulin her pancreas produces in response to the carbs in the food is never getting a full chance to "peak" because she's constantly grazing....and i don't see any way around this. If I was to put out a half day's worth of low carb canned food in the morning, she would never eat it all in one sitting......until her next meal 10-12 hours later. I've never had a cat (and Lord I've had many cats in my life lol) who would eat a full meal in one sitting.....I don't think cats are made that way. Lots of info I've read online, including from Veterinary Clinic websites and reputable Vet Medicine sites say that a non-diabetic cat's BG can go up to 250-300 following a large meal (or high carb meal)....so I'm thinking that some of her numbers, that are in the 7's are very possibly due to the fact that they are reflecting the fact that she's nibbling her canned food all day and night long and thus the insulin her body is producing is never really able to fully peak because she's always eating...every hour or 2 she's up to nibble more canned.



Anyway, since last posting here her much improved numbers all day on Oct 30th (eating strictly low carb canned), these have been her numbers since:

Oct 31

9:15am - 8.4
1:00pm - 7.2
6:30pm - 6.8
10:30pm - 7.4

Nov 1

7:00am - 7.2
3:00pm - 6.0
11:00pm - 9.0 (this is up a bit because I gave her just a little higher carb canned, Fancy Feast Florentine Salmon....that's what she's been eating for months, her favorite, so I added a little bit as a treat to her Friskies Salmon Pate, as a treat, just to see how much it would impact her BG)

Nov 2

08:30am - 7.5
2:00pm - 6.7

She's not drinking water as much as she had been when her numbers a week ago were in the 10-13 range, naturally.....she's drinking maybe a couple times of day, which is great. I'm supposed to phone the Vet tomorrow and let him know what her numbers have been for the past few days to see where we go from there. I know already that he's going to say that because she's consistently under 10, that she's clearly not diabetic....and frankly, I would be nervous to give a cat with BGs like this any insulin. I suppose I could have them do a urinalysis to see if any glucose or ketones in urine but I can't see how there would be any glucose in urine, from what I've read the glucose in the blood has to consistently be running around 250 (13.9) for a bit for any glucose to spill into the urine. She's eating very well, 3 meals a day of low carb canned.....so I know there wouldn't be any ketones. I don't see any value in getting another fructosamine level done because it's going to be reflecting the higher numbers she was having a week ago. If anything it would make more sense, if I'm going to get that done, to go another week and then get it done?

If I was a Vet (lol), I would be inclined to say that maybe she's ?borderline or pre-diabetic.......given her age of 17 years and history of frequent pancreatitis, the latter has probably done some damage to the pancreas (the beta cells) and it's simply not working as efficiently at producing insulin.....or maybe a bit of insulin resistance like humans get?. Her senior panel a few months ago showed kidney function excellent (BUN, creat, SDMA, cystatin B all great) except the specific gravity of her urine was a little more dilute than it should be (1.015).

Stopping the much higher carb canned food and completely stopping all dry food (even the Rx dry food for diabetic cats) has really improved her numbers. I will, however, continue to check her BG twice a day at least indefinitely or if I see her starting to drink more water, acting not as bright, etc....as I do believe that she will inevitably end up full blown diabetic and requiring insulin, probably just a matter of time.

How do you think I should proceed based on all of the above info? I appreciate your and anyone else's input/experience. When I had my diabetic cat Taco years ago (he was diabetic for 6 years before he passed due to cancer), it was very straightforward with him....when he was initially diagnosed, his BG was 500 and he was very symptomatic.....and he was started on insulin immediately.......but with Bitsy, her numbers are much much better.

 

[Wendy&Neko]

from what I've read the glucose in the blood has to consistently be running around 250 (13.9) for a bit for any glucose to spill into the urine.

We have a saying here - ECID or every cat is different. First, you have to qualify that 250 as a human meter or pet meter. On my girl, it was more like 230 on a human meter, but we've also seen cats in the upper 100's on a human meter, as the renal threshold.

Damaged pancreatic beta cells is the cause of most diabetes in cats. Not mine though, she had a secondary endocrine that caused her diabetes.

The Rx dry "diabetic" food is not suitable for diabetic cats, it is too high in carbs. Glad you stopped it. You will note that DM is called dietetic management, not diabetic management which they originally called it, before they were forced to change the name.

when everything you read online about what the 'normal range for a non-diabetic cat's glucose' should be, it always says: 4.4-6.6 (80-120).

Not sure where you are reading this, we aren't "everything you read" here. Like I said, I've tested several non diabetics below 4.4 (79) on a human meter. Even on a pet meter they read down to 3.8 (68). I suspect your vets are talking pet meter numbers which read a bit higher than your Onetouch would.

When I Googled what the Normal Range for the One Touch Verio Reflect is, it says 4.0-7.0 prior to eating

Cats are different.

I've never had a cat (and Lord I've had many cats in my life lol) who would eat a full meal in one sitting

I timed Neko once - about 30 seconds to wolf her entire meal down. Her buddy learned to do the same, or she'd poach his food too!