Help with lab results (fructosamine and kidney values)

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Jade & George

Jade & George

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Fructosamine 433 - vet said her diabetes is out of control but Google showed anything between 350 & 450 is okay. The last few weeks have been rough - my dad died on January 4th and my mom had a hip replacement on the 17th so I have not been home as much as I usually am and therefore haven’t been checking her BGs as often as usual and am sometimes conservative on how much insulin I give if I won’t be home to make sure she eats.

Also her CREAT was 3, BUN 51, BUN/CREA 17 and they said her kidneys are getting worse. I know that’s high but i just looked back and in October it was 2.9, 53, 18.3 - is that statistically significant?

She has IBS (suspected, not biopsied) and only tolerates rabbit protein so I have no option for lower protein foods. She vomits and/or has diarrhea if I fed her chicken, turkey, pork, beef, lamb, guinea fowl, salmon, halibut, tuna, and anything else I could get my hands on. I add fiber and probiotics.

This all started bc I noticed the gumline around one of her (chipped years ago) canine teeth was red and sent my vet a clear picture and they said she needed to be sedated and the tooth removed. I was too nervous about general anesthesia so I asked for them to do bloodwork ahead of time and when it came back they cancelled the surgery and I’m sure said a lot more but I was so upset I don’t remember. The bloodwork was a bad scene - they couldn’t get it from either leg so they shaved a spot on her neck below her chin and when I noticed that I completely lost it. I’m not doing well.
 
Jade & George said:
Fructosamine 433 - vet said her diabetes is out of control but Google showed anything between 350 & 450 is okay. The last few weeks have been rough - my dad died on January 4th and my mom had a hip replacement on the 17th so I have not been home as much as I usually am and therefore haven’t been checking her BGs as often as usual and am sometimes conservative on how much insulin I give if I won’t be home to make sure she eats.

Also her CREAT was 3, BUN 51, BUN/CREA 17 and they said her kidneys are getting worse. I know that’s high but i just looked back and in October it was 2.9, 53, 18.3 - is that statistically significant?

She has IBS (suspected, not biopsied) and only tolerates rabbit protein so I have no option for lower protein foods. She vomits and/or has diarrhea if I fed her chicken, turkey, pork, beef, lamb, guinea fowl, salmon, halibut, tuna, and anything else I could get my hands on. I add fiber and probiotics.

This all started bc I noticed the gumline around one of her (chipped years ago) canine teeth was red and sent my vet a clear picture and they said she needed to be sedated and the tooth removed. I was too nervous about general anesthesia so I asked for them to do bloodwork ahead of time and when it came back they cancelled the surgery and I’m sure said a lot more but I was so upset I don’t remember. The bloodwork was a bad scene - they couldn’t get it from either leg so they shaved a spot on her neck below her chin and when I noticed that I completely lost it. I’m not doing well.
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@Suzanne & Darcy
@Wendy&Neko
 
I'm sorry so much is happening at once in your life. :bighug::bighug::bighug:

Fructosamine ranges vary a bit by lab used, so I wouldn't trust Google for answers, but rather use what is on the lab work results for ranges. For example, one recent Idexx report showed normal non diabetic cats as being in the 191-349 range. 400-450 is fair control in a treated diabetic kitty. Good control is 300-400.

I find Visbiome a really great probiotic for my IBD kitty, and quite a few other people here like it too. It was designed specifically for IBD.

For the possible CKD, has a urinalysis been done? Creatinine and BUN can be high if kitty is dehydrated when the blood was taken. Dehydration is not uncommon if kitty is peeing a lot due to being diabetic. And can explain the difference between 2.9 and 3.0, which isn't a significant difference. Both indicate lower stage 3 CKD. Another important indicator for kidney disease is the phosphorus level. What was Georgia's most recent value? Low phosphorus is important, and if you can't find a rabbit food with low enough phosphorus, a binder may be needed.
 
Jade & George said:
Fructosamine 433 - vet said her diabetes is out of control but Google showed anything between 350 & 450 is okay. The last few weeks have been rough - my dad died on January 4th and my mom had a hip replacement on the 17th so I have not been home as much as I usually am and therefore haven’t been checking her BGs as often as usual and am sometimes conservative on how much insulin I give if I won’t be home to make sure she eats.

Also her CREAT was 3, BUN 51, BUN/CREA 17 and they said her kidneys are getting worse. I know that’s high but i just looked back and in October it was 2.9, 53, 18.3 - is that statistically significant?

She has IBS (suspected, not biopsied) and only tolerates rabbit protein so I have no option for lower protein foods. She vomits and/or has diarrhea if I fed her chicken, turkey, pork, beef, lamb, guinea fowl, salmon, halibut, tuna, and anything else I could get my hands on. I add fiber and probiotics.

This all started bc I noticed the gumline around one of her (chipped years ago) canine teeth was red and sent my vet a clear picture and they said she needed to be sedated and the tooth removed. I was too nervous about general anesthesia so I asked for them to do bloodwork ahead of time and when it came back they cancelled the surgery and I’m sure said a lot more but I was so upset I don’t remember. The bloodwork was a bad scene - they couldn’t get it from either leg so they shaved a spot on her neck below her chin and when I noticed that I completely lost it. I’m not doing well.
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First, I am so sorry about your father’s death and your mother’s subsequent hip surgery. I hope she is recovering well. You have been under a great deal of stress recently. :bighug:

Do you have (or can you get) copies of her full labwork from the last two visits (for comparison.). It would be very helpful to see all the labs with the particular laboratory’s reference range.
Rabbit is inherently high in phosphorus (I do understand that it’s what she needs to eat.) If her phosphorus level is more than about 4.5, you should start using a phosphorus binder (aluminum hydroxide) to keep phosphorus in check. High phosphorus is damaging to kidneys.
From what you have said, it doesn’t seem like her kidneys are that much worse than before — but again, I would need to see the labs. There are factors that can influence Creatinine and BUN such as hydration status, as Wendy pointed out, and weight loss/gain/muscle mass, etc.
 
Do you have a spreadsheet? If not, we can help you get one started. I can help you with the ProZinc dosing and hopefully we can make sure that she at least stays in numbers that will not further damage her kidneys.
 
I’m sorry things were so stressful at the vet and over the results. With everything else that’s happened you certainly didn’t need this. The lab results were already well explained above, and as a physician I will just re-stress that Google is often inaccurate, more so since AI.

re drawing blood from the jugular and the several attempts at the limb before: I’m so sorry. This probably was stressful to you and Georgia. While not a vet, I do have a very pudgy non diabetic cat Tammuz. His jugular vein is the best, least stressful place to get a good, non clotted sample and I always tell them he and I are fine with that. Here he is modeling his last shave job (he wants me to add the angle of the camera makes him look even more fat) from his vet visit yesterday
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Cats have tiny veins, some more tiny than others. Some veins collapse easily. When I was in training on the vascular surgery service we often had to use femoral or jugular sticks on our sicker patients. I tell you this not to say you shouldn’t have been upset, but to give you information in case it needs to be done again. I think it’s not uncommon for vets to need to do this. Which is probably why cats are often taken “ to the back”— plus there’s usually better light back there and all the equipment is where they need it. I would rather they shave his neck and get a good sample quickly, then repeatedly stick his leg and get a bad sample that needs to be repeated. Usually with a jugular stick the blood can be drawn quickly, and the cat does not need to be restrained as long. At least from my limited experience, seeing things with my own pets. Again, I’m not a vet. I don’t know what happens in your vets office, but I know in mine the technicians draw blood from the legs, and the vet draws blood from the neck. I’ve seen their best technician get blood once from Muz’ leg— and it took so long I was very worried about clotting. All the rest of the times he has sported a bare area as proof of his bravery. I hope Georgia gets better soon
 

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I agree with Colleen. Taking blood from the jugular (neck) is very common practice. It’s generally much faster and easier for the cat. At my vet’s office, they do it like that most of the time. They don’t shave the fur, but they wet it down well with alcohol (yucky smell for the cat) so they can feel/see better. If that is new to you, I can see why it would be upsetting. And you have been through a lot so your stress is already high. Georgia is probably picking up on that stress as well. I know of a few vets who are skilled enough to get blood from a leg vein, but the cats don’t always cooperate. If the cat is old or weak or anemic, it can be even more difficult to draw from a leg vein (believe me, I have experienced this.)
 
Thank you all so much. The information about the blood draw from the neck was super helpful - and I know it’s okay logically it just was the thing that pushed me over the edge. I had a hard time with it back when I had a CGM installed on her when she was first diagnosed too - even though I knew it was coming I still had a very outsized reaction so I think it just triggered some old emotional wounds, especially bc it was close to midnight after a long hard day.

I’ve attached her bloodwork from 01/22/25 “Georgia Bloodwork” and the one from October. Unfortunately they’re different formats even tho they’re from the same vet.

I haven’t been using the spreadsheet in the FDMB format - I had my own paper one for a few years and recently started using the mySugr app - I’m happy to share that if it would be helpful.
 

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I tried a couple phos binders a while back but one made her vomit and the other I think I stopped using after the vet said her phos level was ok. I still have it so I could add that back in if necessary. The fiber I’m using is just powdered psyllium husk that I put about 1/3 capsule into the can I just put in her bowl, add about 1/4 of warm water, and swish around to make a liquidy gravy then pour on top of the food and mix in. I’m using Nutramax Proviable probiotics and given she hasn’t had bad diarrhea in months I’m not all that eager to change that up (esp. bc I just got two new boxes autodelivered yesterday!) - I give her half a capsule with one can (10/11am and 4/5pm) and a full capsule with her two overnight cans (10/11pm/12am).

Thank you all, again, for all your support. Today is the first day I’ve been able to get out of bed before noon. <3
 
Hi Jade

I’m going to attach a link to something that explains the SDMA test. It’s a more important indicator of kidney function than just the BUN and creatinine (which as was discussed is influenced by other things). Georgia’s has increased and is on the cut off of normal range. This is probably what your vet was talking about. I wonder if he was saying it’s worse so looking like the start of kidney problems or that kidney problems were probably likely to begin soon? As opposed to saying her kidney function is bad. In other words, not bad now but something to monitor and that may need intervention at some point?

https://www.idexx.com/en/veterinary/reference-laboratories/sdma/interpreting-your-sdma-results/#:~:text=What is considered a normal,found and establish next steps.
 
Kidneys. The tooth doesn’t seem to bother her. Honestly she’s acting totally normally but I’m falling apart. This cat literally saved my life. I was in an abusive marriage and she turned up and I left bc I was afraid he’d hurt her. On my hardest days I get out of bed bc of her. Don’t worry I’m in therapy and I’m much better but life is HARD sometimes!
 
Jade & George said:
Kidneys. The tooth doesn’t seem to bother her. Honestly she’s acting totally normally but I’m falling apart. This cat literally saved my life. I was in an abusive marriage and she turned up and I left bc I was afraid he’d hurt her. On my hardest days I get out of bed bc of her. Don’t worry I’m in therapy and I’m much better but life is HARD sometimes!
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I’m so sorry about all of that and so glad the two of you are now safe.
I’m not a vet but no I don’t think she’s in pain. Her SDMA is technically normal but it has increased and that plus the BUN and Creatinine may (again not the species i treat) may be signaling to your vet that she may have some early kidney problems coming. Many cats do as they age and I’m sure many here have cats they’ve treated for many years with kidney disease. It is important to regulate her diabetes to help her kidneys and I think @Suzanne & Darcy will help you.

:bighug:
 
Jade & George said:
Thank you so much. I know her kidneys aren’t great bc she pees more than she used to. I’ll keep focusing on doing better w her bg. I just want her to be happy ❤️
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That’s great—you are helping Georgia so much, and I know it’s stressful. Have you looked at the sticky on spreadsheets? If you need help making one there are people who can help. If you could start one and enter some of the data you have it will help Suzanne help you get Georgia where she needs to be. I need to start getting my kitties set for dinner but will check on you later. I hope your vet calls you soon.
 
Jade & George said:
I tried a couple phos binders a while back but one made her vomit and the other I think I stopped using after the vet said her phos level was ok.
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I do not see the phosphorus results in the most recent bloodwork. The previous results were below the upper normal range. What binders have you tried in the past? I have used powdered Al(OH)3 which is tasteless but can cause constipation.
 
Thanks for attaching those labs. The first set was more comprehensive and also had the August results for comparison. It does appear that there is a gradual increase in some of the kidney function markers like BUN and Creatinine (from August to October to the most recent results.). It’s something to just keep an eye on at this point. The phosphorus in October (5.2) was a little higher than optimal for a kidney cat. Like, I said, it would be beneficial if you got it down to about 4-4.5. That would help spare Georgia’s kidneys. What types of binder did you try before? Can you look up the names? Since it’s not really high, you could try Epakitin which is mixed into food once or twice a day. Then just check calcium levels at the next check up since it may cause an increase in Calcium. It’s been very well-tolerated in my cats and I have seen decreased phosphorus with it as long as they weren’t too high to begin with.
The SDMA has gone up and down. I don’t completely trust that test because it goes up and down so much in my own cats. I guess we are just looking for trends. A urinalysis with a specific gravity result would be helpful in assessing how well her kidneys are concentrating urine.

It would be so good if you could get a spreadsheet set up and we can try our very best to keep her in BG numbers that also will protect her kidneys.
 
Oh, about the tooth. Since the vet doesn’t want to do anything involving general anesthesia right now, how about asking them to do some “pulsed antibiotics” where you give some clindamycin one week out of the month or one week on and two weeks off, etc. There are different ways of doing it. In o e of my cats with a bad tooth and kidney disease, we had to do this, and it kept her tooth in check and prevented an abscess. Someone here recently had their vet recommend a gel to rub on around the tooth, but I never did hear back about how that turned out. I imagine it must taste horrible.
 
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