? 12/17 Cassius AMPS 162 +5/151 PER VET HE IS NOT DIABETIC???

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JenniferF

JenniferF

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yesterday at the vet he had no sugar in his urine. My vet said until he gets blood work he would not give insulin. I'm so confused. I have another cat that test in the 200"s and is NOT diabetic cause there is no sugar in her urine. However, Cassius did have sugar in urine when at animal control. UGH, this is more crazy than wonky BG's!
 
Stress hyperglycemia at a shelter or vet's office may raise the glucose 100-180 mg/dL.
A fructosamine test will show if the average glucose levels have been elevated; that is what your vet wants to assess.
If you get home glucose tests between 120 - 200 mg/dL in an undiagnosed cat, we'd suggest checking for any infection - dental, respiratory, urinary, etc - first and treating those if present.
If the home tests are above 200 mg/dL, do report those to the vet; he may revise his decision about insulin, especially if they are over 300 mg/dL, which is clearly elevated.
Take a look at my signature link Secondary Monitoring Tools for some additional assessments you may find helpful in evaluating your cats. In particular, increased thirst, appetite, and urination, plus signs of dehydration, are all non-specific indicators of diabetes and are helpful in ruling in or out the diagnosis.
 
No that's why my vet was questioning him being diabetic. No sugar in urine, no increased appetite or thirst. no excessive urination. His Bg's have been under 200 the past few days and other than the paperwork from animal control my vet said he would never think he was diabetic. I choose NOT to do fructosamine tests because I have a fair amount of data already on his SS that I don't see a fructosamine would tell that much more? He looked at his mouth, did a urinalysis also. BW results come back tomorrow (they are closed today) so will be interesting to see

He was diagnosed last may 2015 per his previous owner notes but never treated and fed dry food.
 
Just got a message from my vet (office is closed but they messaged me) just said do not give insulin he is not diabetic. I assume his BG is lower than 200 in the blood work. No sugar was in the urine yesterday. So now what? Just stop insulin??? He was 151 at +5.
 
What a crazy situation!!

I don't think I'd just stop insulin though.....just because there's no sugar in the urine doesn't necessarily mean he's not diabetic...just that he's below renal threshold

The fact that not that long ago he was in the 300's would indicate to me that he still needs it, but let's see who else we can hear from though!! @julie & punkin (ga) @Jill & Alex (GA) @Sienne and Gabby @Wendy&Neko @Vyktors Mum
 
Jenn, if you do decide to stop insulin, please be sure to check for ketones daily. If he really does need insulin and isn't getting it, he'll start burning fat stores for energy instead of being able to use the food correctly.

If he doesn't need it but is getting it, his numbers may be a perpetual bounce from the liver trying to compensate for the unneeded juice. They may return to the normal range when it is completely out of his body.
 
I agree with Chris. There's a difference between the kidneys spilling glucose into urine vs what you test with blood. Cassius may be under renal threshold but that is not the same as not being diabetic. In addition, urine glucose testing in notoriously inaccurate compared to blood glucose testing. It is particularly inaccurate at the high and low range. I haven't a clue why the vet is relying on a UG test to determine whether your cat is diabetic.


 
For what it's worth, at Neko's last urinalysis, she had negative glucose in her urine, yet her dose was 5.5 units at the time. The comment on her lab work was "control is likely very good". She's actually been negative glucose for the last year of tests. Cassius is getting some good numbers at 1.0u- I too would call it good control.
 
Squeaky and KT said:
Jenn, if you do decide to stop insulin, please be sure to check for ketones daily. If he really does need insulin and isn't getting it, he'll start burning fat stores for energy instead of being able to use the food correctly.

If he doesn't need it but is getting it, his numbers may be a perpetual bounce from the liver trying to compensate for the unneeded juice. They may return to the normal range when it is completely out of his body.
Click to expand...

So am I damaging his liver if I give him insulin? This is crazy. My head is spinning. This is also a vet who doesn't shoot under 200 BG. I don't know the EXACT results of the blood work. I will know that tomorrow. I can't imagine with the high numbers that he got initially that did not need insulin at all. To me the diet change (he was on dry and home cooked before) and insulin are just working.
 
Wendy&Neko said:
For what it's worth, at Neko's last urinalysis, she had negative glucose in her urine, yet her dose was 5.5 units at the time. The comment on her lab work was "control is likely very good". She's actually been negative glucose for the last year of tests. Cassius is getting some good numbers at 1.0u- I too would call it good control.
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I feel ok with the 1u. My vet of course said it's horrible to give if he doesn't need it, risk of hypo (obviously).
 
Sienne and Gabby said:
I agree with Chris. There's a difference between the kidneys spilling glucose into urine vs what you test with blood. Cassius may be under renal threshold but that is not the same as not being diabetic. In addition, urine glucose testing in notoriously inaccurate compared to blood glucose testing. It is particularly inaccurate at the high and low range. I haven't a clue why the vet is relying on a UG test to determine whether your cat is diabetic.

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The vet is basically saying that he has to have both HIGH blood glucose AND sugar in the urine and he had neither. Do you think I needed to do the fructosamine test?
Can you explain what the renal threshold is again?
 
Chris & China said:
What a crazy situation!!

I don't think I'd just stop insulin though.....just because there's no sugar in the urine doesn't necessarily mean he's not diabetic...just that he's below renal threshold

The fact that not that long ago he was in the 300's would indicate to me that he still needs it, but let's see who else we can hear from though!! @julie & punkin (ga) @Jill & Alex (GA) @Sienne and Gabby @Wendy&Neko @Vyktors Mum
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I am really confused because I have another cat that ALWAYS has blood sugar (with blood work) testing at 200+ and the vets (she has been in the ER a few times as well are regular vets- she't seen 2 because we moved) all say she's NOT diabetic because there was no sugar in the urine. IE- her BG is HIGH but no sugar at the same time where as Cassius BG was low and no sugar. So if she was diabetic high BG would = sugar in urine???
 
I have a question here. If a cat is under renal threshold and getting insulin they wouldn't be spilling would they? Otherwords, it under contol it's getting the right amount of inulin so there is no excess to spill.
 
Am I missing something here?
just going to state the obvious, you appear to be controlling Cassius diabetes quite well, by giving the insulin shots you are managing to keep the blood glucose for the last 4 cycles within a normal range, that is good regulation. Now if your vet does a blood test in these well regulated cycles ( I understand he didn't do a fructosamine) he is only getting a snap shot view, yes Cassius's BG are normal, but this is only being achieved with the insulin, that does not necessarily mean he is not diabetic.

Is your vet aware that he is currently on insulin??

sorry if getting wrong end of stick, sleepy here
Gill
 
Renal threshold is the point at which the kidneys spill sugar into the urine. The exact BG that occurs varies by cat but is somewhere in the high blue, low yellow range. If your cat is regulated with insulin, Cassius may not be spilling sugar into the urine. So both blood and urine would be normal for glucose.

I too have a civie that often reads out of normal blood glucose at the blood work tests, then in the low 50's at home the next day. That's just stress hyperglycemia.
 
Gill is right on track. It's the insulin that you're giving that is keeping the numbers low AND keeping Cassius under renal threshold. Take away the insulin and numbers rise and he's above renal threshold. Keep in mind that the timing of these changes varies. BG gives you a to the minute assessment of where BG is. Urine tests lag well behind the BG numbers and do not capture lows or highs.

 
Many vets do not treat feline diabetes until kitty's blood glucose rises over 200. Your vet sounds like one of them.
No sugar in the urine probably sealed the deal for your vet.

Alex would spill glucose into her urine around 150 - 180 on a meter calibrated for humans... a little higher on a meter calibrated for pets.
 
ah, I think it makes more sense now. So if he is getting good regulation that would explain why my vet "thinks" he doesn't need insulin- not having any data from prior to yesterday. He is just going on yesterdays test. Right before I took Cassius to the vet he tested 73. So even with stress induced increase it would have to be A LOT to be really a concern for my vet, I'm thinking?

Yes, my vet knows he's on insulin but he's one of those vets that "don't allow" insulin when BG is under 200.
 
Jill & Alex (GA) said:
Many vets do not treat feline diabetes until kitty's blood glucose rises over 200. Your vet sounds like one of them.
No sugar in the urine probably sealed the deal for your vet.

Alex would spill glucose into her urine around 150 - 180 on a meter calibrated for humans... a little higher on a meter calibrated for pets.
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yes, that's what I'm thinking. My vet was freaking out that I was going to send him into hypo.
 
if you can afford it, it might help to insist that the vet do a fructosamine. The information may not be that useful to us because we know how to read our spreadsheets, but fructosamine is the "language" many vets know how to speak regarding feline diabetes. If the test can convince them that yes, he is diabetic but well controlled, then it might be worth the money.

I did that when I first started working with my current vet. She was freaking out about some of Lucy's numbers. Now she trusts me, but I think it helped that I allowed her to look at Lucy's regulation in terms that she already knew how to interpret.
 
wow--this is crazy…. dealing with diabetes and having good control is a great accomplishment and then you get a curve ball..errr
lots of experience here thank goodness! good luck ;)
 
Libby and Lucy said:
if you can afford it, it might help to insist that the vet do a fructosamine. The information may not be that useful to us because we know how to read our spreadsheets, but fructosamine is the "language" many vets know how to speak regarding feline diabetes. If the test can convince them that yes, he is diabetic but well controlled, then it might be worth the money.

I did that when I first started working with my current vet. She was freaking out about some of Lucy's numbers. Now she trusts me, but I think it helped that I allowed her to look at Lucy's regulation in terms that she already knew how to interpret.
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I will think about it. I think it's only $70 but I would like to get another cat in for a dental rather than spend the money on a fructosamine test but like you said it might be worth it to show my vet.
 
Jenn, you've had several diabetic cats and you know that the typical path to OTJ is not from 1u to nothing. It may be that you know more about treating your diabetic cats than your vet knows.

I'd keep on following the Tight Reg protocol and be glad that i had my cat's blood sugar in a range that was not damaging his kidneys.
 
JenniferF said:
So am I damaging his liver if I give him insulin? This is crazy. My head is spinning. This is also a vet who doesn't shoot under 200 BG. I don't know the EXACT results of the blood work. I will know that tomorrow. I can't imagine with the high numbers that he got initially that did not need insulin at all. To me the diet change (he was on dry and home cooked before) and insulin are just working.
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I don't know the answer to that question about liver damage. I think he needs to 'earn' those reductions to OTJ rather than taking him off it but that's just my opinion. My original post - I was just trying to point out things to keep in mind while you're thinking this whole thing through.

HUGS!
 
I'm happy to see so many others agree with what I saw!!

No...you're not damaging his liver by giving insulin...You're protecting all his internal organs from the effects of too much glucose!

His liver only "kicks in" when he drops too low to release stored sugar and hormones to bring his blood glucose back up to where it thinks it should be....think of it as a "leftover" survival mechanism from the days our cats were living wild....if they were starving, their BG would go too low so the liver would kick in to bring it back up....and hopefully keep them alive long enough to successfully hunt.

Of course the liver does a lot more, but that's what we talk about most in here when it comes to the liver.
 
julie & punkin (ga) said:
Jenn, you've had several diabetic cats and you know that the typical path to OTJ is not from 1u to nothing. It may be that you know more about treating your diabetic cats than your vet knows.

I'd keep on following the Tight Reg protocol and be glad that i had my cat's blood sugar in a range that was not damaging his kidneys.
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I gave insulin last night, this morning and tonight even though my vet said not to. I think I'm more nervous that something else is wrong with him. Having had Tidus, who ended up acro with weird BG's and Doodle with Lymphoma and weird BG's (that I totally associate with the cancer), I guess there is a part of me that is nervous/scared of what I don't yet know.
 
That would make anyone nervous. Fortunately, you can also see plenty examples of kitties that just get regulated and have normal blood sugar because of good dosing. In the absence of any concerning symptoms, I'd assume that's what you've got with Cassius.
 
Chris & China said:
I'm happy to see so many others agree with what I saw!!

No...you're not damaging his liver by giving insulin...You're protecting all his internal organs from the effects of too much glucose!

His liver only "kicks in" when he drops too low to release stored sugar and hormones to bring his blood glucose back up to where it thinks it should be....think of it as a "leftover" survival mechanism from the days our cats were living wild....if they were starving, their BG would go too low so the liver would kick in to bring it back up....and hopefully keep them alive long enough to successfully hunt.

Of course the liver does a lot more, but that's what we talk about most in here when it comes to the liver.
Click to expand...
Yes, very reassuring to see others agree. I guess in my gut I agreed as well or I would not have given him insulin after the vet visit yesterday when the vet said not to
 
I think you have to try to see it from the vet's perspective. You can imagine the range of people they deal wI mean, think of the people who DRIVE. Some of them have pets! ;) So they develop simplistic guidelines aimed at doing the least harm. That can be so frustrating to pet parents who really take the trouble to learn. Like you! Good luck with your decision to continue insulin. I would do the same.
 
Lydia & Rosie AKA &Basil said:
I think you have to try to see it from the vet's perspective. You can imagine the range of people they deal wI mean, think of the people who DRIVE. Some of them have pets! ;) So they develop simplistic guidelines aimed at doing the least harm. That can be so frustrating to pet parents who really take the trouble to learn. Like you! Good luck with your decision to continue insulin. I would do the same.
Click to expand...
yes, my last vet used to say I was "micro managing" my diabetics and he would never recommend what we do on FDMB to any of his other clients. He didn't agree with what I was doing however he didn't give me a hard time either. This vet is pretty much like that too. He knows I do a lot of stuff at home (like other meds and fluids) and he was shocked I took Doodle for chemo. So he knows I'm serious and not his average patient. But he was mad that I was treating things (like B12 for the hock feet) with out a real diagnosis. I also have a "rescue" mentality. I do as much as I can to fix "easy" things like worms or diarrhea with stuff we have rather than taking to the vet for every little thing cause it adds up. He wants me to get stool samples done and I'm like "just give the dewormer. what's the big deal". Over all he's a good vet. Does a lot and gives me a good discount so I don't like to complain too much. But I am glad I have taken it upon myself to join groups like this so I am not just relying on one opinion.
 
While mum's diabetic kitty Purrdy was staying with me I took him in to my vet to check for a UTI. Results came back negative for UTI but the vet said to me but Serryn there's something else very strange. Heart in throat what's that I asked. There's no glucose in his urine he said. I cracked up laughing and told him that's what TR is all about! We still laugh about it now, he said it made him so nervous when he saw the result, but he gets it now. That was the first diabetic cat he'd ever seen without glucose in his urine and from your vets reaction it's probably the first one he's seen too.
 
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