fructosamine high-glucose normal

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hardrally

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My cat was diagnosed with diabetes at the end of February his urine showed 2,000 glucose with NO ketones.
He was started on 1 unit of ProZinc twice a day & fructosamine 2 weeks later was 794 (ref range 160-450)
He was increased to 2 units twice a day, fructosamine 2 weeks later was 734
He was increased to 3 units twice a day, fructosamine 2 weeks later (last week) was 490, last night I did a random glucose for the first time & got 161.
**I know I should have been testing glucose at home, been trying but not been able to get enough blood**
His vet is hard to get on the phone so I'm still waiting to talk to him.
I am wondering if anyone else has had such a variance with these 2 types of tests?
The vet always wants me to bring him in ($40 visit fee) and run an in office glucose, which is always elevated, even before the diagnosis of DM because Loki is stressed in the office (plus it costs $60 for lab fee). Each fructosamine is $100 and ProZinc is $150, I asked about switching to something cheaper and the vet said, "No nothing cheaper"
I love my cat but if the fructosamine is the TRUE reflection of control ProZinc isn't working... should I switch insulin?
Has anyone had success with NPH for their cat?
 
The fructosamine test is an average of two weeks so it is much less precise than daily blood glucose tests. For example, if a cat was bouncing from low numbers of 40 to high numbers of 500, an average of those could be fairly high. But if you get daily tests and can see exactly how the insulin is working that cycle, a low 40 and high of 500 would give you a much different conclusion. You'd know the insulin was working, a little too well, cursing the cat to drop too low and then bounce up to a high number. (Bouncing is when the body perceives a low number that feels dangerous and releases extra sugar to bring that number up - a very layman like explanation but hope it makes sense.)

161 is a good number. For reference we consider a cat regulated if they are in the mid to lower 200s at present and in double digits at nadir (lowest point that is usually 5-7 hours after the shot) But not below 40. And yes, curves done at the vet are often unreliable as stress raises blood glucose levels, sometimes over 100 points.

If he were mine, I would get the testing down. What is the biggest problem with getting tests? Maybe we will have some ideas to help. For us, the most important thing was to have a big enough lancet (human 30-31 gauge are often too small for cats at first. 25-27 gauge may work better) and warming the ear enough. We used a rice sack and found we had to leave it on his ear for 30 seconds at least to get those capillaries fat enough for a good sample.

Once you can test regularly, then we can help you figure out how the insulin is working and what you might do to improve things.

NH is cheaper but doesn't work as well in most cats. Often the lowest number is 2-4 hours after the shot and the insulin stops working by 8 hours after. I would stick with the Prozinc, tell the vet you are going to test at home and share the numbers with him and save money that way.

There is a protocol we put together for ProZinc in my signature in blue. Hope it will help with some basics.
 
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