? 4.24.18 Bella amps 66,+12.25 77,+13 75 shot given,+1 99,+6.45 141,+7.45 201,Pmps 447,+ 2 440

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But the meters are so different last month the average was 296, I don’t know if I’ve got a bad batch of strips or what his BG at vets was 477, something is going on, I’m gonna say the vets results aren’t wrong, with the test and the BG test
 
It’s okay, no need to panic. Given the low preshot today and you basically only shot a drop, a high preshot is very much to be expected, both from lack of insulin or a bounce from the AMPS. As far as which meter is more accurate, that’s a confusing issue. We already know human meters run slightly lower for cats. It’s not so much our concern to get the exact number as you get from the lab, but in the ballpark and we are mostly looking for trends. Are both of those meters yours? Or is one the vet’s meter?

Did you get a fructosamine test from a lab? Is that what you’re getting the average from?

They do have a big disparity between each other, but it doesn’t surprise me. Your relion, that number could be anywhere between 276-412, the pet meter 359-535 with the 20% meter variance.

A few things you can try. Use control solution and test your relion, test yourself, test another cat, see what’s going on there. Non diabetic humans should test somewhere around 85 so long as you didn’t just eat a loaf of bread or something. If the pet meter is yours, you can use control solution for that too. I think the prime takes a larger drop of blood than the confirm, are you sure you get enough blood for all of the tests? My meter reliably reads lower when I don’t get enough blood, but it usually does the read anyway rather than error out. I’m going to go find a meter comparison list, they have some that are more highly rated than others (the confirm is up there). I’ll be back...
 
Stacy & Asia said:
It’s okay, no need to panic. Given the low preshot today and you basically only shot a drop, a high preshot is very much to be expected, both from lack of insulin or a bounce from the AMPS. As far as which meter is more accurate, that’s a confusing issue. We already know human meters run slightly lower for cats. It’s not so much our concern to get the exact number as you get from the lab, but in the ballpark and we are mostly looking for trends. Are both of those meters yours? Or is one the vet’s meter?

Did you get a fructosamine test from a lab? Is that what you’re getting the average from?

They do have a big disparity between each other, but it doesn’t surprise me. Your relion, that number could be anywhere between 276-412, the pet meter 359-535 with the 20% meter variance.

A few things you can try. Use control solution and test your relion, test yourself, test another cat, see what’s going on there. Non diabetic humans should test somewhere around 85 so long as you didn’t just eat a loaf of bread or something. If the pet meter is yours, you can use control solution for that too. I think the prime takes a larger drop of blood than the confirm, are you sure you get enough blood for all of the tests? My meter reliably reads lower when I don’t get enough blood, but it usually does the read anyway rather than error out. I’m going to go find a meter comparison list, they have some that are more highly rated than others (the confirm is up there). I’ll be back...
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Yes at vet, there was a huge diff, so I wanted to know, so I took him, vet said increase to 2u, his average was way to high and bring him back in 3 weeks so I don’t know what to do, both meters are mine, I started with pet and then went to human
 
Stacy & Asia said:
It’s okay, no need to panic. Given the low preshot today and you basically only shot a drop, a high preshot is very much to be expected, both from lack of insulin or a bounce from the AMPS. As far as which meter is more accurate, that’s a confusing issue. We already know human meters run slightly lower for cats. It’s not so much our concern to get the exact number as you get from the lab, but in the ballpark and we are mostly looking for trends. Are both of those meters yours? Or is one the vet’s meter?

Did you get a fructosamine test from a lab? Is that what you’re getting the average from?

They do have a big disparity between each other, but it doesn’t surprise me. Your relion, that number could be anywhere between 276-412, the pet meter 359-535 with the 20% meter variance.

A few things you can try. Use control solution and test your relion, test yourself, test another cat, see what’s going on there. Non diabetic humans should test somewhere around 85 so long as you didn’t just eat a loaf of bread or something. If the pet meter is yours, you can use control solution for that too. I think the prime takes a larger drop of blood than the confirm, are you sure you get enough blood for all of the tests? My meter reliably reads lower when I don’t get enough blood, but it usually does the read anyway rather than error out. I’m going to go find a meter comparison list, they have some that are more highly rated than others (the confirm is up there). I’ll be back...
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I did use solution for pet meter and it was fine, I don’t have solution for prime, I didn’t know it needed it, it didn’t come with any so I didn’t know, the pet meter did come with solution, they have lab at vets
 
Stacy & Asia said:
It’s okay, no need to panic. Given the low preshot today and you basically only shot a drop, a high preshot is very much to be expected, both from lack of insulin or a bounce from the AMPS. As far as which meter is more accurate, that’s a confusing issue. We already know human meters run slightly lower for cats. It’s not so much our concern to get the exact number as you get from the lab, but in the ballpark and we are mostly looking for trends. Are both of those meters yours? Or is one the vet’s meter?

Did you get a fructosamine test from a lab? Is that what you’re getting the average from?

They do have a big disparity between each other, but it doesn’t surprise me. Your relion, that number could be anywhere between 276-412, the pet meter 359-535 with the 20% meter variance.

A few things you can try. Use control solution and test your relion, test yourself, test another cat, see what’s going on there. Non diabetic humans should test somewhere around 85 so long as you didn’t just eat a loaf of bread or something. If the pet meter is yours, you can use control solution for that too. I think the prime takes a larger drop of blood than the confirm, are you sure you get enough blood for all of the tests? My meter reliably reads lower when I don’t get enough blood, but it usually does the read anyway rather than error out. I’m going to go find a meter comparison list, they have some that are more highly rated than others (the confirm is up there). I’ll be back...
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I have the region prime not confirm
 
Bellasmom said:
I did use solution for pet meter and it was fine, I don’t have solution for prime, I didn’t know it needed it, it didn’t come with any so I didn’t know, the pet meter did come with solution, they have lab at vets
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So it was an in house lab fructosamine?

Here’s a study regarding different meters, the relion prime you have isn’t in the top tier, but the confirm is, it’s also inexpensive. Arkray makes them and they are both sold at Walmart.

https://www.diabetestechnology.org/surveillance.shtml

Maybe pick up the confirm instead and try that, see if the reads are a little closer.

There are many reasons people don’t use pet meters, the main one is expense. The problem I have with pet meters is that TR and SLGS were created using human meters. Most of the SS and data we have are with human meters. The only thing we count on with pet meters is that the action number is 68. None of the other numbers can correlate, so outside of the action number, all the other numbers stay the same be it on a human or pet meter. Lacking significant data with pet meters also creates this problem, when I look at SSs of OTJ cats, if on a human meter, lots of below 50s. A cat without diabetes can often measure below 50, we use 50 as a safety number that we don’t want to be below. If a cat is in remission though, they can stay below 50 and that’s just fine. When I look at OTJ SSs of cats with pet meters, I rarely see a below 68. That worries me because how safe is that 68 number exactly? There’s not the tons of data we have with human meters.
 
Stacy & Asia said:
So it was an in house lab fructosamine?

Here’s a study regarding different meters, the relion prime you have isn’t in the top tier, but the confirm is, it’s also inexpensive. Arkray makes them and they are both sold at Walmart.

https://www.diabetestechnology.org/surveillance.shtml

Maybe pick up the confirm instead and try that, see if the reads are a little closer.

There are many reasons people don’t use pet meters, the main one is expense. The problem I have with pet meters is that TR and SLGS were created using human meters. Most of the SS and data we have are with human meters. The only thing we count on with pet meters is that the action number is 68. None of the other numbers can correlate, so outside of the action number, all the other numbers stay the same be it on a human or pet meter. Lacking significant data with pet meters also creates this problem, when I look at SSs of OTJ cats, if on a human meter, lots of below 50s. A cat without diabetes can often measure below 50, we use 50 as a safety number that we don’t want to be below. If a cat is in remission though, they can stay below 50 and that’s just fine. When I look at OTJ SSs of cats with pet meters, I rarely see a below 68. That worries me because how safe is that 68 number exactly? There’s not the tons of data we have with human meters.
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Well I can get a confirm meter but I can’t until Friday payday, seriously, so is it ok to use pet meter till I get the confirm on friday
 
Stacy & Asia said:
So it was an in house lab fructosamine?

Here’s a study regarding different meters, the relion prime you have isn’t in the top tier, but the confirm is, it’s also inexpensive. Arkray makes them and they are both sold at Walmart.

https://www.diabetestechnology.org/surveillance.shtml

Maybe pick up the confirm instead and try that, see if the reads are a little closer.

There are many reasons people don’t use pet meters, the main one is expense. The problem I have with pet meters is that TR and SLGS were created using human meters. Most of the SS and data we have are with human meters. The only thing we count on with pet meters is that the action number is 68. None of the other numbers can correlate, so outside of the action number, all the other numbers stay the same be it on a human or pet meter. Lacking significant data with pet meters also creates this problem, when I look at SSs of OTJ cats, if on a human meter, lots of below 50s. A cat without diabetes can often measure below 50, we use 50 as a safety number that we don’t want to be below. If a cat is in remission though, they can stay below 50 and that’s just fine. When I look at OTJ SSs of cats with pet meters, I rarely see a below 68. That worries me because how safe is that 68 number exactly? There’s not the tons of data we have with human meters.
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their BG reading was close to my BG reading on pet meter, so I’m pretty sure it’s right, it just worries me how long I’ve been testing with this crappy meter and now Bella’s BG is sky high, I will get the other one, it’s like now we have to start all over
 
Stacy & Asia said:
So it was an in house lab fructosamine?

Here’s a study regarding different meters, the relion prime you have isn’t in the top tier, but the confirm is, it’s also inexpensive. Arkray makes them and they are both sold at Walmart.

https://www.diabetestechnology.org/surveillance.shtml

Maybe pick up the confirm instead and try that, see if the reads are a little closer.

There are many reasons people don’t use pet meters, the main one is expense. The problem I have with pet meters is that TR and SLGS were created using human meters. Most of the SS and data we have are with human meters. The only thing we count on with pet meters is that the action number is 68. None of the other numbers can correlate, so outside of the action number, all the other numbers stay the same be it on a human or pet meter. Lacking significant data with pet meters also creates this problem, when I look at SSs of OTJ cats, if on a human meter, lots of below 50s. A cat without diabetes can often measure below 50, we use 50 as a safety number that we don’t want to be below. If a cat is in remission though, they can stay below 50 and that’s just fine. When I look at OTJ SSs of cats with pet meters, I rarely see a below 68. That worries me because how safe is that 68 number exactly? There’s not the tons of data we have with human meters.
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I just went to that site you gave me and the prime failed, omg
 
Bellasmom said:
Well I can get a confirm meter but I can’t until Friday payday, seriously, so is it ok to use pet meter till I get the confirm on friday
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Of course it’s okay to use it. I would be hesistent to make dosing decisions off a recent switch, let’s see where he is at later tonight and in the morning using the pet meter. You can increase by .25 in the am if everything is looking dreary. What your vet suggested to increase is a lot at once and it’s easy to miss a good dose that way. The difference between reds and pinks and blues and greens really can be .25, sometimes it’s like a light switch.

Did your vet test him with on of their meters by chance? Or just get a fructosamine?
 
Stacy & Asia said:
Of course it’s okay to use it. I would be hesistent to make dosing decisions off a recent switch, let’s see where he is at later tonight and in the morning using the pet meter. You can increase by .25 in the am if everything is looking dreary. What your vet suggested to increase is a lot at once and it’s easy to miss a good dose that way. The difference between reds and pinks and blues and greens really can be .25, sometimes it’s like a light switch.

Did your vet test him with on of their meters by chance? Or just get a fructosamine?
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Their meter and fructosamine
 
Bellasmom said:
I just went to that site you gave me and the prime failed, omg
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In context, it failed one study, I think it read over 21% on average in the high end. It’s a minute difference, really, but I feel more comfortable knowing I’m using a meter that has a solid record. If the pet meter measured closely to what the lab shows, than I would go with that for now. Are those strips really expensive too? I’ve never heard of that brand before.
 
Stacy & Asia said:
In context, it failed one study, I think it read over 21% on average in the high end. It’s a minute difference, really, but I feel more comfortable knowing I’m using a meter that has a solid record. If the pet meter measured closely to what the lab shows, than I would go with that for now. Are those strips really expensive too? I’ve never heard of that brand before.
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The human meter was confirm strips 100 for 18
Advocate pet meter 50 strips 43.00
 
Stacy & Asia said:
In context, it failed one study, I think it read over 21% on average in the high end. It’s a minute difference, really, but I feel more comfortable knowing I’m using a meter that has a solid record. If the pet meter measured closely to what the lab shows, than I would go with that for now. Are those strips really expensive too? I’ve never heard of that brand before.
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https://www.advocatemeters.com/
 
The stuff I read for your pet meter says the readings are wildly inaccurate. But if what you’re getting right now is in line with the vets reading and fructosamine, I would lean towards using that one until you can get something different.

ETA: what is most important is that the number is closer at the lower range, regardless of meter
 
Stacy & Asia said:
The stuff I read for your pet meter says the readings are wildly inaccurate. But if what you’re getting right now is in line with the vets reading and fructosamine, I would lean towards using that one until you can get something different.

ETA: what is most important is that the number is closer at the lower range, regardless of meter
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A3EB1622-FE00-44C8-B0BE-A89746C7634A.jpeg


Just tested again
 
Bellasmom said:
View attachment 35682

Just tested again
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That’s a lot better, I bet they measure close at lower numbers. But the fructosamine makes zero sense with your human meter SS so I would be suspect of that meter regardless. I have the confirm, although I buy it from ADW and it’s made by Arkray instead of the rebranded one. It has always measured pretty close to lab, I test it every time we go for labs, which is unfortunately fairly often.
 
I would honestly use the pet meter for now, the fructosamine and your relion reads are too far apart for my liking, maybe others will have different opinions.
 
The fructosamine test gives you averages over a few weeks. Looking at Bella's spreadsheet, it's only in the last few days that (with the bump in dose) he's seen blue-green pre-shots. Before that, he was mostly up in high yellows, pinks, even reds. That could explain the fructosamine test, especially when you factor in bounces you aren't seeing in the middle of the night, etc. He's probably bouncing right now from those lows this morning (and whatever he got up to before AMPS).

I honestly don't see any reason to doubt your Relion meter. The differences between that and the pet meter that you've posted are pretty much in line with what we usually see with such comparisons + meter variance. Nothing to worry about, really.

If it were me, I'd stick with the Relion for now (less confusing, easier to follow TR), and stick with the current dose. Don't take the vet-recommended increase-- it's based on the fructosamine test, which is not reflecting the very recent improvement in numbers.
 
Nan & Amber said:
The fructosamine test gives you averages over a few weeks. Looking at Bella's spreadsheet, it's only in the last few days that (with the bump in dose) he's seen blue-green pre-shots. Before that, he was mostly up in high yellows, pinks, even reds. That could explain the fructosamine test, especially when you factor in bounces you aren't seeing in the middle of the night, etc. He's probably bouncing right now from those lows this morning (and whatever he got up to before AMPS).

I honestly don't see any reason to doubt your Relion meter. The differences between that and the pet meter that you've posted are pretty much in line with what we usually see with such comparisons + meter variance. Nothing to worry about, really.

If it were me, I'd stick with the Relion for now (less confusing, easier to follow TR), and stick with the current dose. Don't take the vet-recommended increase-- it's based on the fructosamine test, which is not reflecting the very recent improvement in numbers.
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Ok I will stay with set dosage of 1.25 and go back to human meter, would the other numbers besides the ones recently cause the fructosamine test to be high like that?
 
Nan & Amber said:
The fructosamine test gives you averages over a few weeks. Looking at Bella's spreadsheet, it's only in the last few days that (with the bump in dose) he's seen blue-green pre-shots. Before that, he was mostly up in high yellows, pinks, even reds. That could explain the fructosamine test, especially when you factor in bounces you aren't seeing in the middle of the night, etc. He's probably bouncing right now from those lows this morning (and whatever he got up to before AMPS).

I honestly don't see any reason to doubt your Relion meter. The differences between that and the pet meter that you've posted are pretty much in line with what we usually see with such comparisons + meter variance. Nothing to worry about, really.

If it were me, I'd stick with the Relion for now (less confusing, easier to follow TR), and stick with the current dose. Don't take the vet-recommended increase-- it's based on the fructosamine test, which is not reflecting the very recent improvement in numbers.
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But isn’t fructosamine only about 3 weeks worth of data? 526 average still doesn’t make sense to me in the past 3 weeks even with 20% variance on the pinks and reds in that SS
 
Stacy & Asia said:
ETA: what is most important is that the number is closer at the lower range, regardless of meter
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This quote from Stacy's post is what I focus on. I know your trip to the vet and the fructosamine number has really caused you a lot of worry. In each of the photos you posted the human meter is different by about 100 points. For those BG levels this doesn't surprise me. If you had just posted those and not gone to the vet to get a fructosamine test and a BG with their meter you'd probably be just fine with those comparisons. @Nan & Amber said exactly what I was going to say about the fructosamine test result and sticking with your ReliOn Prime meter. To me our BG numbers are no more accurate than us going outside and, without looking at a thermometer to know the exact temperature, deciding whether it's too warm for a sweater (BG too high), cool enough for a light jacket (BG is OK) or "bring on the down parka before I freeze to death!" (BG requires action).
 
Kris & Teasel said:
This quote from Stacy's post is what I focus on. I know your trip to the vet and the fructosamine number has really caused you a lot of worry. In each of the photos you posted the human meter is different by about 100 points. For those BG levels this doesn't surprise me. If you had just posted those and not gone to the vet to get a fructosamine test and a BG with their meter you'd probably be just fine with those comparisons. @Nan & Amber said exactly what I was going to say about the fructosamine test result and sticking with your ReliOn Prime meter. To me our BG numbers are no more accurate than us going outside and, without looking at a thermometer to know the exact temperature, deciding whether it's too warm for a sweater (BG too high), cool enough for a light jacket (BG is OK) or "bring on the down parka before I freeze to death!" (BG requires action).
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Yeah I WISHED I hadn’t gone, wished hubby never text me that pic!!!!!
 
Bellasmom said:
Yeah I WISHED I hadn’t gone, wished hubby never text me that pic!!!!!
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Kris & Teasel said:
This quote from Stacy's post is what I focus on. I know your trip to the vet and the fructosamine number has really caused you a lot of worry. In each of the photos you posted the human meter is different by about 100 points. For those BG levels this doesn't surprise me. If you had just posted those and not gone to the vet to get a fructosamine test and a BG with their meter you'd probably be just fine with those comparisons. @Nan & Amber said exactly what I was going to say about the fructosamine test result and sticking with your ReliOn Prime meter. To me our BG numbers are no more accurate than us going outside and, without looking at a thermometer to know the exact temperature, deciding whether it's too warm for a sweater (BG too high), cool enough for a light jacket (BG is OK) or "bring on the down parka before I freeze to death!" (BG requires action).
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Told to never ever compare the, again, he was sorry and thought he was doing good, funny how fast your day can be ruined
 
I agree it's higher than I'd expect, but given that the spreadsheet is from a human meter and the fructosamine test is (I assume) calibrated similar to a pet meter, I think it's possible.

Here's another question, @Bellasmom: has Bella been drinking and peeing excessively recently? I know you said he seemed to be feeling pretty good recently when he was starting to get into some better numbers. Those kinds of clinical signs are really worth paying attention to, no matter what the numbers are.
 
Nan & Amber said:
I agree it's higher than I'd expect, but given that the spreadsheet is from a human meter and the fructosamine test is (I assume) calibrated similar to a pet meter, I think it's possible.

Here's another question, @Bellasmom: has Bella been drinking and peeing excessively recently? I know you said he seemed to be feeling pretty good recently when he was starting to get into some better numbers. Those kinds of clinical signs are really worth paying attention to, no matter what the numbers are.
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He has not, drinking normal, eating, playing pooping peeing, I have not noticed any thing unusual, now I can’t tell u what he does when I’m at work, I am the one who fills up water bowls and they are not real low
 
Nan & Amber said:
I agree it's higher than I'd expect, but given that the spreadsheet is from a human meter and the fructosamine test is (I assume) calibrated similar to a pet meter, I think it's possible.

Here's another question, @Bellasmom: has Bella been drinking and peeing excessively recently? I know you said he seemed to be feeling pretty good recently when he was starting to get into some better numbers. Those kinds of clinical signs are really worth paying attention to, no matter what the numbers are.
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And he had gained 2lbs, he lost a lot when he was first diagnosed
 
Bellasmom said:
He has not, drinking normal, eating, playing pooping peeing, I have not noticed any thing unusual, now I can’t tell u what he does when I’m at work, I am the one who fills up water bowls and they are not real low
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Bellasmom said:
And he had gained 2lbs, he lost a lot when he was first diagnosed
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I think these are way more important indicators than that one fructosamine number, it sounds like Bella is doing great!

I wonder if it's possible that the fructosamine test was wonky for some reason????
 
Thanks all for the help and hubby is sleeping on couch! He has caused all this lol in the dog house for awhile my nerves are shot
 
Nan & Amber said:
I think these are way more important indicators than that one fructosamine number, it sounds like Bella is doing great!

I wonder if it's possible that the fructosamine test was wonky for some reason????
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That’s what I asked them at vets!
 
Nan & Amber said:
I think these are way more important indicators than that one fructosamine number, it sounds like Bella is doing great!

I wonder if it's possible that the fructosamine test was wonky for some reason????
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When I went and got their flea control yesterday I took bella with me and of course they took him from me they love bella and vet got ahold of him give him a quick look over and said he was absolutely great
 
Some reading for you:
________________________________________________________________________________________________

Feline Diabetes Mellitus
Claudia E. Reusch, in Canine and Feline Endocrinology (Fourth Edition), 2015

Serum Fructosamine Concentration
Fructosamine is the product of an irreversible reaction between glucose and the amino groups of plasma proteins. Its concentration mainly depends on the blood glucose concentration (e.g., extent and duration of hyperglycemia) and the lifespan of plasma proteins; it is generally assumed that fructosamine reflects the mean blood glucose concentration of the preceding 1 to 2 weeks. The reference ranges differ slightly between laboratories but are usually between approximately 200 and 360 μmol/L. To enable comparison between consecutive measurements, serum samples should always be sent to the same laboratory. Fructosamine is measured in serum using commercially-available test kits adapted to autoanalysis. Shipping should be on cold packs if samples will be in transit for more than 24 hours. Lean cats have lower fructosamine concentrations than normal weight or obese cats, whereas age has no influence. In two older studies, fructosamine did not differ between male and female cats, whereas in the most recent study, fructosamine was higher in male cats (Thoresen and Bredal, 1995; Reusch and Haberer, 2001; Gilor et al, 2010b). In the vast majority of newly diagnosed diabetic cats, fructosamine levels are more than 400 μmol/L and may be as high as 1500 μmol/L. Fructosamine is not affected by short-term increases in blood glucose concentration and thus is usually normal in cats with stress hyperglycemia (Reusch et al, 1993; Lutz et al, 1995; Crenshaw et al, 1996).

However, fructosamine is not a foolproof parameter, and certain aspects need to be considered. In cats with a very recent onset of diabetes or with mild diabetes, serum fructosamine may be in the normal range, rendering the differentiation between stress and diabetic hyperglycemia impossible. In a recent study, two groups of healthy cats were infused with glucose to maintain either a marked or a moderate hyperglycemia (540 mg/dL, 30 mmol/L; or 300 mg/dL, 17 mmol/L) for 42 days. In the group with marked hyperglycemia, it took 3 to 5 days until fructosamine exceeded the upper limit of the reference range; in the group with moderate hyperglycemia, fructosamine concentrations mostly fluctuated just below the upper limit of the reference range (Link and Rand, 2008).

Fructosamine is also influenced by plasma protein concentration and by protein turnover. It has been shown that cats suffering from hypoproteinemia or hyperthyroidism have significantly lower levels of fructosamine than healthy cats (Reusch and Tomsa, 1999; Graham et al, 1999; Reusch and Haberer 2001). It is possible that diabetic cats with concurrent hypoproteinemia or uncontrolled hyperthyroidism may have normal (or even low) fructosamine levels, which would then be misinterpreted as indicative for stress hyperglycemia. In those situations (e.g., cats with concurrent hyperthyroidism or hypoproteinemia), fructosamine should be interpreted only if it is increased, which then indicates diabetes mellitus. There are arguments for and against correction of fructosamine for the serum protein level. Correction, however, may lead to falsely high concentrations and is not recommended. In the majority of situations, fructosamine is a helpful parameter to differentiate between stress- and diabetes-related hyperglycemia.

After initiating insulin therapy, blood glucose concentrations usually start to decrease, which is followed by a decrease in fructosamine after a few days. We consider 50 μmol/L to be the so-called critical difference (i.e., the difference between two consecutive fructosamine measurements has to exceed 50 μmol/L to reflect a change in glycemic control; Reusch, 2013). Another study found a lower critical difference of 33 μmol/L (Link and Rand, 2008). Generally, fructosamine concentrations increase when glycemic control worsens and decrease when glycemic control improves. As mentioned earlier, serum fructosamine concentration is not affected by a short term increase in blood glucose concentration, which may be seen in cats in the hospital. It is also not affected by lack of food intake, which is common in hospitalized cats and often leads to much lower blood glucose concentrations than what is seen with food intake. Routine measurement of fructosamine is therefore helpful to clarify the effects of stress or lack of food intake (e.g., to clarify discrepancies between history and physical examination and blood glucose measurements). Most well-controlled diabetic cats are slightly hyperglycemic for some time during a 24-hour period, and consequently, fructosamine concentrations will not become completely normal during therapy. In cats that achieve diabetic remission, however, fructosamine concentrations decrease into the normal range (Fig. 7-17).

As long as fructosamine is elevated (even if only slightly), we do not consider cats to be in diabetic remission. In those cases, insulin therapy is continued under close supervision. Fructosamine concentrations between approximately 350 and 450 μmol/L reflect good glycemic control, concentrations between 450 and 550 μmol/L suggest moderate, and concentrations above 550 to 600 μmol/L suggest poor glycemic control. In the latter situation, fructosamine is not helpful to identify the underlying problem because the various possible reasons for poor regulation (e.g., application error, insulin underdose, too short duration of insulin effect, diseases causing insulin resistance, or Somogyi phenomenon) are associated with high blood glucose concentrations and therefore have the same impact. Generation of one or several BGCs and revision of the owner’s injection technique are usually the next steps in those cases. Fructosamine concentrations less than 350 μmol/L suggest diabetic remission, hypoglycemia or concurrent hypoproteinemia, or hyperthyroidism (Reusch, 2010). It is important to note that there are substantial differences in glycation between individuals. In healthy cats in which blood glucose was maintained at 540 mg/dL (30 mmol/L), fructosamine concentrations ranged between 400 and 633 μmol/L when the plateau was reached (Link and Rand, 2008). The study underscores that diabetic cats with similar quality of glycemic regulation may have quite different fructosamine concentrations. The ranges of interpretation listed earlier therefore should only be used as rough guidelines. Fructosamine is useful if followed in individual cats over time; however, it should never be used as the sole indicator of the quality of metabolic control. The parameter is less important than the evaluation of clinical signs and body weight and generation of BGCs.

DKA, dehydration, acidosis, and other unidentified factors may influence fructosamine concentrations. If a diabetic cat is hospitalized for any reason, fructosamine levels measured at the time of admission may be considerably different from concentrations measured a few days later. It is therefore reasonable to repeat the measurement at the time of discharge and to use this concentration as a reference point. See Serum Fructosamine Concentration in Chapter 6 for additional information.
 
Kris & Teasel said:
Some reading for you:
________________________________________________________________________________________________

Feline Diabetes Mellitus
Claudia E. Reusch, in Canine and Feline Endocrinology (Fourth Edition), 2015

Serum Fructosamine Concentration
Fructosamine is the product of an irreversible reaction between glucose and the amino groups of plasma proteins. Its concentration mainly depends on the blood glucose concentration (e.g., extent and duration of hyperglycemia) and the lifespan of plasma proteins; it is generally assumed that fructosamine reflects the mean blood glucose concentration of the preceding 1 to 2 weeks. The reference ranges differ slightly between laboratories but are usually between approximately 200 and 360 μmol/L. To enable comparison between consecutive measurements, serum samples should always be sent to the same laboratory. Fructosamine is measured in serum using commercially-available test kits adapted to autoanalysis. Shipping should be on cold packs if samples will be in transit for more than 24 hours. Lean cats have lower fructosamine concentrations than normal weight or obese cats, whereas age has no influence. In two older studies, fructosamine did not differ between male and female cats, whereas in the most recent study, fructosamine was higher in male cats (Thoresen and Bredal, 1995; Reusch and Haberer, 2001; Gilor et al, 2010b). In the vast majority of newly diagnosed diabetic cats, fructosamine levels are more than 400 μmol/L and may be as high as 1500 μmol/L. Fructosamine is not affected by short-term increases in blood glucose concentration and thus is usually normal in cats with stress hyperglycemia (Reusch et al, 1993; Lutz et al, 1995; Crenshaw et al, 1996).

However, fructosamine is not a foolproof parameter, and certain aspects need to be considered. In cats with a very recent onset of diabetes or with mild diabetes, serum fructosamine may be in the normal range, rendering the differentiation between stress and diabetic hyperglycemia impossible. In a recent study, two groups of healthy cats were infused with glucose to maintain either a marked or a moderate hyperglycemia (540 mg/dL, 30 mmol/L; or 300 mg/dL, 17 mmol/L) for 42 days. In the group with marked hyperglycemia, it took 3 to 5 days until fructosamine exceeded the upper limit of the reference range; in the group with moderate hyperglycemia, fructosamine concentrations mostly fluctuated just below the upper limit of the reference range (Link and Rand, 2008).

Fructosamine is also influenced by plasma protein concentration and by protein turnover. It has been shown that cats suffering from hypoproteinemia or hyperthyroidism have significantly lower levels of fructosamine than healthy cats (Reusch and Tomsa, 1999; Graham et al, 1999; Reusch and Haberer 2001). It is possible that diabetic cats with concurrent hypoproteinemia or uncontrolled hyperthyroidism may have normal (or even low) fructosamine levels, which would then be misinterpreted as indicative for stress hyperglycemia. In those situations (e.g., cats with concurrent hyperthyroidism or hypoproteinemia), fructosamine should be interpreted only if it is increased, which then indicates diabetes mellitus. There are arguments for and against correction of fructosamine for the serum protein level. Correction, however, may lead to falsely high concentrations and is not recommended. In the majority of situations, fructosamine is a helpful parameter to differentiate between stress- and diabetes-related hyperglycemia.

After initiating insulin therapy, blood glucose concentrations usually start to decrease, which is followed by a decrease in fructosamine after a few days. We consider 50 μmol/L to be the so-called critical difference (i.e., the difference between two consecutive fructosamine measurements has to exceed 50 μmol/L to reflect a change in glycemic control; Reusch, 2013). Another study found a lower critical difference of 33 μmol/L (Link and Rand, 2008). Generally, fructosamine concentrations increase when glycemic control worsens and decrease when glycemic control improves. As mentioned earlier, serum fructosamine concentration is not affected by a short term increase in blood glucose concentration, which may be seen in cats in the hospital. It is also not affected by lack of food intake, which is common in hospitalized cats and often leads to much lower blood glucose concentrations than what is seen with food intake. Routine measurement of fructosamine is therefore helpful to clarify the effects of stress or lack of food intake (e.g., to clarify discrepancies between history and physical examination and blood glucose measurements). Most well-controlled diabetic cats are slightly hyperglycemic for some time during a 24-hour period, and consequently, fructosamine concentrations will not become completely normal during therapy. In cats that achieve diabetic remission, however, fructosamine concentrations decrease into the normal range (Fig. 7-17).

As long as fructosamine is elevated (even if only slightly), we do not consider cats to be in diabetic remission. In those cases, insulin therapy is continued under close supervision. Fructosamine concentrations between approximately 350 and 450 μmol/L reflect good glycemic control, concentrations between 450 and 550 μmol/L suggest moderate, and concentrations above 550 to 600 μmol/L suggest poor glycemic control. In the latter situation, fructosamine is not helpful to identify the underlying problem because the various possible reasons for poor regulation (e.g., application error, insulin underdose, too short duration of insulin effect, diseases causing insulin resistance, or Somogyi phenomenon) are associated with high blood glucose concentrations and therefore have the same impact. Generation of one or several BGCs and revision of the owner’s injection technique are usually the next steps in those cases. Fructosamine concentrations less than 350 μmol/L suggest diabetic remission, hypoglycemia or concurrent hypoproteinemia, or hyperthyroidism (Reusch, 2010). It is important to note that there are substantial differences in glycation between individuals. In healthy cats in which blood glucose was maintained at 540 mg/dL (30 mmol/L), fructosamine concentrations ranged between 400 and 633 μmol/L when the plateau was reached (Link and Rand, 2008). The study underscores that diabetic cats with similar quality of glycemic regulation may have quite different fructosamine concentrations. The ranges of interpretation listed earlier therefore should only be used as rough guidelines. Fructosamine is useful if followed in individual cats over time; however, it should never be used as the sole indicator of the quality of metabolic control. The parameter is less important than the evaluation of clinical signs and body weight and generation of BGCs.

DKA, dehydration, acidosis, and other unidentified factors may influence fructosamine concentrations. If a diabetic cat is hospitalized for any reason, fructosamine levels measured at the time of admission may be considerably different from concentrations measured a few days later. It is therefore reasonable to repeat the measurement at the time of discharge and to use this concentration as a reference point. See Serum Fructosamine Concentration in Chapter 6 for additional information.
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Omg that makes me feel better, seriously
 
Hi, This condo is really moving along!
If you will send me a "Conversation" (private message; to find the Conversations page, click on your user name at the top, right of your condo) with your name and mailing address I will send you an Arkray Glucocard 01 meter kit that contains the Arkray Glucocard 01 meter (the Relion Confirm is Walmart's branding of the Arkray meter), instructions, test solution, lancet device, lancets, log book, and 10 strips. You can buy more strips online from American Diabetes Wholesale. I have been using this meter for years and find it very good and accurate. I have quite a few of the meter kits because ADW sends them free with a purchase of strips (you can buy 50, 100, or 200 strips). I always order a meter kit when I order strips because 10 strips come with the kit!

I hope Bella has settled down and that tomorrow will be a good day of numbers.
 
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