Fructosamine Results and Scale

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Sparkle

Sparkle

Member Since 2016
This is from Sparkle's lab results:

Fructosamine concentration is a marker of mean blood glucose concentrations
during the preceding 2 to 3 weeks. The higher the average blood glucose
concentration is over this time, the higher the fructosamine concentration.

Cats with transient stress hyperglycemia typically have a fructosamine
concentration within the reference interval.

The chart below can be used to help determine glycemic control in diabetic
patients already receiving therapy. Results should be interpreted in
conjunction with clinical signs and other laboratory results. For cats with
inadequate control, consider a serial blood glucose curve, causes of insulin
resistance and possibility of Somogyi phenomenon before increasing the insulin
dose.

Results for fructosamine may be increased up to 150% by the presence of
hemolysis.

Fructosamine Glycemic control in diabetic
concentration patients receiving therapy
mol/L
------------- ----------------------------
300 to 400 GOOD
400 to 450 FAIR
>450 POOR
<300 Possibilities include:
* The cat has reverted to a non-insulin-dependent
state ("remission")
* Good control
* Prolonged hypoglycemia

Here's what I find confusing:
Sparkle's results:
Fructosamine: 283
Normal range stated as: 191 - 349 μmol/L Is this the range for a normal (non- insulin treated cat?)
The chart next to Sparkle's result (which I could not get to copy) showed Sparkle to be in the normal range, but the vet told me he was hypogylcemic and that I was overdosing him and that I needed to stop giving him insulin based on the bottom scale. (cats receiving therapy).

Thoughts?
 
This site has a listing for cats: It is from the Caninsulin UK site:

http://www.caninsulin.co.uk/fructosamine.asp?context=management_cats

Cats Fructosamine values
(micromol/l)
Normal non-diabetic cat 190-365
Newly diagnosed diabetic cat 350-730
Treated diabetic cats:
Excellent control 350-400
Good control 400-450
Fair control 450-500
Poor control >500

Another site:

http://www.adwdiabetes.com/articles/fructosamine-levels-vs-blood-glucose-curves

Fructosamine levels that are low indicate that the pet’s blood glucose levels have been low over the prior few weeks. Fructosamine levels that are elevated indicate that the blood glucose level has been elevated for most of the prior few weeks. Fructosamine levels help us to adjust the insulin dose. In general, if a fructosamine level is low then the insulin dose is likely too high. If the fructosamine level is high it could mean that the insulin is under-dosed and needs an increase in the dose. However, there are other possible causes for a fructosamine level to be high. For example, if the insulin doesn’t last long enough in that patient or if there is some other cause of uncontrolled diabetes (such as infection), we might see a high fructosamine level. A Somogyi swing (which I explain in a moment) could also cause an elevated fructosamine level.

I am not sure if the test is like an averaging over time, the same way that you can get an average reading from your meter. If that is the case then the fact that Sparkle had several low numbers lately might be why the test is showing on the low side?? Just a thought I really don't know for sure
 
Thanks for the reply. I still am trying to figure out what Sparkle's 283 test result means. I personally read it as pretty good. Maybe it is supposed to be slightly higher? Yes, he had a bunch of lows the night before the test, but it was also not a fasting test. The vet never said anything about him needing to do that.
 
I think you're trying to compare the fructosamine number with his regular BG numbers....they don't compare like that

You might test him right now and get a 89....that wouldn't mean if you did a fructosamine right now that he'd be 89....the "scales" are totally different
 
No, I am looking at his Fructosamine test result as I published above. Nothing to do with his BG home numbers. The scales on the Fructosamine for cats being treated with insulin do not include a 283, just list some possibilities if the number is under 300 and those possibilities range from good things (good control/remission) to bad things (hypoglycemia). My vet is interpreting his 282 like he has been hypo for the last 2-3 weeks.
 
Chris, maybe you weren't responding to me, but to Tuxedo Mom?

Anyone had a fructosamine done that will share the results and interpretation?
 
I think what your vet might have been trying to say is that since his fructosamine was in the <300 range, it meant that over the last few weeks, Sparkle has been in good enough numbers that he's either

1.reverted to a non-insulin-dependent state ("remission")
2. is under Good control
3. Prolonged hypoglycemia (is getting too much insulin)

Since he's on such a tiny dose, your vet may feel that his numbers are good enough that he doesn't need insulin anymore

I'm sorry, but I can't make any sense out of your spreadsheet or I'd try to give you a better explanation
 
Fructosamine
The majority of diabetic animals will not always have optimal control of blood glucose; thus, fructosamine concentrations are unlikely to lie entirely within the reference range for normal cats. Single fructosamine measurements should be interpreted in the light of clinical signs, body weight, and blood glucose concentration. In general, the closer the fructosamine concentration is to the reference range for healthy cats, the better the glycemic control.

Fructosamine reference ranges6
Cats Fructosamine values (µmol/L)
Normal non-diabetic cats 190–365
Newly diagnosed diabetic cats 350–730
Regulated diabetic cats:
Excellent control 350–400
Good control 400–450
Fair control 450–500
Poor control >500
Prolonged hypoglycemia <300

"In general, the closer the fructosamine concentration is to the reference range for healthy cats, the better the glycemic control."
This is what is confusing me. Sparkle's 283 is great on the normal cat range, but is under 300 on the regulated diabetic cat and is also under the scale for newly diabetic cat, so those scales say hypoglycemic?
Wouldn't you then turn to the charted BG tests over that time period and see what was going on and also look at the rest of the lab work and clinical signs?
 
Sorry you can't make sense of my SS, but do appreciate the input on the fructosamine.
 
Sparkle said:
Wouldn't you then turn to the charted BG tests over that time period and see what was going on and also look at the rest of the lab work and clinical signs?
Click to expand...

Makes total sense to me, and in a perfect world, I'd say YES....but your vet may be interpreting the results differently than what we'd think makes sense

With the fructosamine, a lot of it is based on the experience of the vet that's reading the results
 
Oh, to be clear, what I copied to start this thread is from the lab, not the vet. The vet told me she saw it as hypo only, she did not say any of the other possibilities and it was only till I got a copy of the labs did I see them. I'm just trying to understand if the fructosamine result was good or bad in regards to Sparkle's health. It is the only questionable thing since all the other labs, chem, CBc, UA, T4 were very good.
 
Since she has only seen Sparkle one time and I do not think she read any of his extensive medical history and labs over the last year, I'm trying to get other people's opinion's of the test score:283, based on their experience with this test in their cats and yes, looking at Sparkle's SS if they want to.
 
I just had a look at Sparkle's spreadsheet and I see that Sparkle had a reading of 49 at AM+10 on 6 March (human meter). A reading below 50 on a human meter indicates that the Lantus dose is too high. I see that you've reduced the dose from 0.5IU fat to 0.5 IU. Normally dose reductions after a below 50 reading are by 0.25 IU from the very next dose. The 0.5IU dose has been shown to be too high with that 49. Also you're now seeing upside down curves - another pointer to the dose being too high. Add into the mix that you're giving fluids and pain relief to Sparkles and that could increase the possibility of getting unexpected lows. I suggest that perhaps it would be a good idea for you to post on the Lantus and Levemir Insulin Support Group board to ask for input from highly experienced members on Sparkle's dosing.


Mogs


ETA: The low fructosamine reading isn't a surprise given the numbers in Sparkle's spreadsheet. The higher numbers you're seeing on the spreadsheet lately could possibly be bounces off the very low numbers Sparkle has been at.

.
 
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Anyone have fructosamine test results and interpretations that they would like to share? Do you think the fructosamine test is even relevant when you have lots of home data on the actual BG at actual times and notes regarding eating, activity level and meds in regards to the specific BG readings? Some vets do not think fructosamine is relevant in this scenario and I'm wondering what other people's opinions are?
 
I would only use a fructosamine test to confirm a diabetic diagnosis or for periodic monitor for a caretaker who does not home test regularly. Most of use here test before each shot and periodically between shot and for that case a fructosamine provides no useful information.
 
I agree with that, but since I'd never had one done and this vet insisted, I went along. Will not pay for it again. Home testers rule!
 
On the same line, do you think curves are relevant if someone is doing extensive testing daily?
 
Sparkle said:
On the same line, do you think curves are relevant if someone is doing extensive testing daily?
Click to expand...
What do you mean by extensive daily testings?
If that testing includes periodic testing between shots then a fructosamine test provides not useful information. If only preshot are done then a fructosamine test might provide useful information
 
I looked at your SS.
It is not unusual to a BG increase at the +1 and +2 and even sometimes the +3 since it takes a while for lantus to work and the BG may rise because of food.
General observation is that you were right to reduce the dose. However, Lantus is a depot insulin and it takes 3-5 days for BG to stabilize after a dose change. However, when BG go very low like in your case it is right to decrease does like you did on the 1/2 unit. I myself would not have done a cure with 1/2 unit now since this si only the first day (second dose) with 1/2 unit)
 
Actually, I asked if curves were relevant. I think we are in agreement on the fructosamine. I ask about the curves because some vets think they are essential, but then don't have home testing patients or have home testing patients and are not understanding that data so they still request curves. That last vet I saw wanted to do an 8 hour curve in her office or have me do a 24 hour curve at home, yet would not even look at the home tests that I had weeks of records for.

It is just a generic question that I wanted your opinion on. No biggee.
 
Just a bit of advice for you...you'll get a lot more detailed input from experienced Lantus users on your numbers if you format your spreadsheet that way the rest of us do here. It is very hard to visualize your data with the current way you have it formatted.

I know this might seem a pain to you because your formatting is probably easier to see on a mobile device, but it's important to have your PM after your AM cycles rather than below because there is often a difference between BG trends in the AM and PM cycles, and the standard formatting makes those easy to see.
 
Sparkle said:
Actually, I asked if curves were relevant. I think we are in agreement on the fructosamine. I ask about the curves because some vets think they are essential, but then don't have home testing patients or have home testing patients and are not understanding that data so they still request curves. That last vet I saw wanted to do an 8 hour curve in her office or have me do a 24 hour curve at home, yet would not even look at the home tests that I had weeks of records for.

It is just a generic question that I wanted your opinion on. No biggee.
Click to expand...

I personally find curves (or at least, mini curves) extremely important when first attempting to get BG under control, but not as important once the cat is well regulated and you can easily predict the nadir.

Of course, the more hometest data you have at any point the better informed your dosing decisions will be, but those of us with busy work and personal lives sometimes must make concessions where we can.
 
Posted on Health because the thread is about FRUCTOSAMINE TESTS which is something any diabetic cat may have done regardless of insulin type.
There is a thread in Think Tank if you want to discuss SS styles.
Thank you for you reply about curves. I'm curious what other people's general thoughts on them are. That's why I asked the question.
 
Peek-a-Boo just had a fructosamine done. His score was "a little over 300"....I don't have specific number since this was via a voicemail, but the vet's words were, "this is right about where we want him, so that is good".

I am pro home testing, but during the time I was struggling to get him regulated (he also has acromegaly), the constant testing was putting a horrible strain on us. He would let me test, but didn't want any part of me the rest of the time. I kept going because "it was for his own good," but really struggled with it. Fortunately, he somehow settled into his 4U BID and the improvement was like night and day, so I felt better backing off. The fact that he is blind probably plays a role in him being so fractious.

For now, I get the fructosamine tests every 3 months. I still test for ketones often. He has been under good control for about a year now and his fruc scores have ranged 300-350, so these tests do have their place.

I can't offer much more than my own cat's numbers, so I apologize for that, but you were asking so I offered.
 
I understand and appreciate that you want to keep the discussion on this thread about fructosamine and curves, but there's a link to a forum sticky that I don't know whether you've seen yet but which I think is important for you to read for safety reasons (re the two recent preshot tests less than 50 on human meter followed by insulin injections).

http://www.felinediabetes.com/FDMB/...regulation-shooting-handling-low-numbers.147/

The forum sticky is for people following the Tight Regulation Protocol. I don't know whether or not you are following TR but if you read through the document it will give you some idea of important safety considerations when faced with low preshot and mid-cycle numbers. As advised in the forum sticky, the TR NO SHOOT preshot number is 50 on a human meter.

If you do get really low preshot numbers again I really do recommend that you either post on the Lantus & Levemir board for help and advice or contact your vet before giving the next dose of insulin. (If you haven't already done so I think it would be a good plan to make sure your vet knows about the low nadirs and preshots.)


Mogs
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Sparkle said:
Posted on Health because the thread is about FRUCTOSAMINE TESTS which is something any diabetic cat may have done regardless of insulin type.
There is a thread in Think Tank if you want to discuss SS styles.
Thank you for you reply about curves. I'm curious what other people's general thoughts on them are. That's why I asked the question.
Click to expand...


My spreadsheet comment is relevant to this (and almost every) post in the health forum. I mentioned it because I wanted to look at your spreadsheet to check if your vet's assertion that your cat was hypoglycemic had any evidence to support it in your home data, and I had difficulty reading your spreadsheet. As others have mentioned, fructosamine tests are only useful for diagnosis and dosing decisions should be based off daily home tests.

Even at diagnosis they may not be necessary. If a urinalysis confirms glucose is being spilled into the urine, that is also confirmation and much cheaper than a fructosamine. Bandit has been diabetic for seven years and never had a fructosamine.
 
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Sent the labs to my other vet and got this response: "Fructosamine is overall very good. Maybe a TINY bit too low. Could try to reduce insulin slightly and recheck fructosamine in 1 month."
Glad to know she reads it like I'm reading it.
 
Dawn and Peek a Boo: Thank you for sharing your fructosamine results and experiences. Sparkle is starting to get annoyed with me too and today is curve day. Poor baby. I'm pretty sure we will be OTJ very soon and once he gets his mouth healed, I think life will be very, very good.
Sparkle has never had any ketones in his urine, even when he was first dxed and the weird thing is, for as many vets who have seen him, no one has suggested that I test for it, so I don't.
Four minutes till test time...got to go. :)
 
My BunBun has a fructosamine of 480 before I adopted him as an untreated diabetic from a shelter. The BG in that blood panel was 328.
After a month of treatment I can maintain his BG below 125 on about 0.3 units Levemir
 
Sparkle said:
Dawn and Peek a Boo: Thank you for sharing your fructosamine results and experiences. Sparkle is starting to get annoyed with me too and today is curve day. Poor baby. I'm pretty sure we will be OTJ very soon and once he gets his mouth healed, I think life will be very, very good.
Sparkle has never had any ketones in his urine, even when he was first dxed and the weird thing is, for as many vets who have seen him, no one has suggested that I test for it, so I don't.
Four minutes till test time...got to go. :)
Click to expand...

Wow that is awesome...I just looked at Sparkle's SS...OTJ party on the horizon!
FYI...I named my favorite fat little goldfish Sparkle when I was a little girl..it brought back good memories when I saw your kitty's name. :joyful: My little cousin would call it Sprinkle instead :rolleyes:.

Dawn
 
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