Fructosamine Results at 598

[Howiesmom]

HELP! I just had Howie's first fructosamine test today and he was at 598. I literally have NO IDEA how it is that high as his home test results have never indicated anything anywhere near that level (I use the ReliOn meter). With my crazy work schedule, I am doing my best to get some more mid-cyle tests at night before bed as I just can't get them done during the day as I can't come home. I am doing everything I can to just keep him on a 12-hour cycle with all that I have going on (I realize some work from home and have an easier time of getting daily mid-cycle tests...that is just not my reality.). I talked to my vet today about dosage as several people think he is on too high of a daily dose (6 units). So he is reviewing all the home test results, the 3 curves Howie's had done, and the fructosamine results to come up with a new plan. I am questioning whether my ReliOn meter is even accurate???? Has anyone ever experienced something like this? I also have no idea why his BG levels have shot up in the past 2 days. Nothing has changed that I am doing or that I can see him doing. He's eating and drinking fine. But I know he is not himself--he's not playing, doesn't want to be held, doesn't want to sit in my lap, etc. Thanks for your help!

 

[Panic]

Ignore the fructosamine, we don't use them except for diagnosing. My girl had a FRU of over 800 despite being in good numbers until a few days before the test. Still don't fully understand how that number works. If someone could enlighten me on that I'm all ears.

Here's what Deb told me when I was asking her about FRU tests.

Fructosamine is an average of a couple of weeks. Not affected by stress.
It measures one of the proteins in the blood, measuring mean (average) glucose concentration.
Some resources say the average is about 2 weeks, other sources says the average is 3-4 weeks.

Remember, if you take 30 and 100, the average is 65.
If you take 200 and 100 and 50 the average is 116.
If you take 300 and 100 and 50 and the average is 150.
If you take 500 and 100, the average is 300.

So those averages can make things look better than they really are, which is why blood glucose testing is also key to determining what is going on. BG testing tells you more in real time what is happening with your cat. It helps with catching those daily swings in the BG levels.

Basically, the Fructosamine is equivalent to the A1C test in human diabetes, which averages a humans glycemic control over 2-3 months. Gives an idea of how the diabetes is being controlled over a period of time. But no human diabetic would ever rely on an A1C average to help them know how much daily insulin to give themselves.

Same thing for cats. No way to know how much insulin a cat needs, based on the Fructosamine. Nor does the fructosamine test alone tell a vet a cat is diabetic. Vets need to take other signs and symptoms into consideration, to diagnosis a feline diabetic and to see how well the diabetes is being controlled and regulated.

Personally, I think the fructosamine test is not of much use if someone is home testing. But vets run it because so many of their clients do NOT home test their cat's BG levels and never will.

Think of it as another tool in the toolbox, and use at your discretion.

 

[Critter Mom]

Hi,

I've already posted on one of your earlier threads that I am concerned about the safety of the 6IU Prozinc dose you've been using, following a possible overnight hypo event a few days ago.

In the absence of BG data for the night in question it's impossible to say with certainty whether or not Howie's BG went way too low the other night, but there were sufficient reasons to consider it a distinct possibility. For members looking to learn more about this, see the following thread:

Help! Howie Got Into a Bag of Bread

I also have no idea why his BG levels have shot up in the past 2 days. Nothing has changed that I am doing or that I can see him doing.

Something has changed in the past two days: you're giving Howie even more insulin.

Giving too much insulin can sometimes look like giving too little. The body's protective mechanisms drive blood glucose levels upwards to protect the cat from hypoglycaemia. The body cannot do this indefinitely.

We understand the difficulties of trying to manage a diabetic cat as well as all the other commitments we may have in our lives, but without much data there's not much we can offer other than conjecture based on general principles. Also both preshot and mid-cycle tests are needed to determine what a dose is really doing. One mid-cycle test a day will at least give you a better idea of what's happening when the Prozinc is active. It's good that you're starting to get more PM tests down.

In the meantime, I respectfully suggest that you have another chat with your vet before giving another 6IU dose of Prozinc. You have curve data from a few days ago which showed that a 3IU dose of Prozinc kept Howie in a safe range just under the renal threshold. I suggest asking your vet whether it would be safer to give the 3IU dose AM and PM for the time being (unless a dose reduction is indicated on that dose) until he has time to consider Howie's dosing further.

If you do agree with your vet that you'll reduce the dose please monitor Howie daily for ketones (a standard safety precaution when insulin dose is reduced) until you get a better handle on his status and treatment approach. Information and tips below:

Testing Your Cat for Ketones

Tips for Collecting Urine Samples

But I know he is not himself--he's not playing, doesn't want to be held, doesn't want to sit in my lap, etc

General information for you to consider: cats in high numbers don't feel well; cats whose bodies are fighting the effects of too much insulin don't feel well either.

Other members may have a different view to mine. All I can do is share in good faith concerns based on my experience of managing feline diabetes.

I see Elizabeth (Panic) is already monitoring this thread. I'm also tagging @Deb & Wink to ask her to review the information you've given here along with Howie's spreadsheet.


Mogs
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[Critter Mom]

I asked the following question on your previous thread but didn't get an answer back from you:

* How did you arrive at the 3IU / 6IU dosing? (Now 6IU / 6IU.)


Mogs
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[Panic]

I agree. 6u is too much, 3u might also be too much. But it is better than 6. The longer you wait to change the dose the harder it will be.

Note you don't have to ask for permission from your vet. If everyone here waited until the vet gave clearance for basic necessities like proper food and appropriate dosing, we'd have almost no cats in remission.

 

[Critter Mom]

3u might also be too much

That crossed my mind too, Elizabeth (hence the question about how the dosing was arrived at).


Mogs
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[Shelley & Jess]

@Critter Mom
From previous thread Feedback on curve results requested

I can’t do mid-cycle tests as I work all day out of my home. As for the flipping between 3units and 6units, my vet told me to give a half dose (3units) if he’s between 200-250 and a full Dose (6 units) if he’s over 250. We started him at 2 units when he was first diagnosed and the vet moved him up incrementally to 6 Units base on increasing water intake/urine output and the curve results done at the vet office. He’s never had big bounces with all the testing I’ve done and at the vet office.

 

[Wendy&Neko]

Reference Ranges for Fructosamine Test
Note that in the UK, reference numbers are lower.

Giving too much insulin can sometimes look like giving too little.

On my soapbox - not true as a generalization, just another one of those things that gets quoted a lot here and elsewhere. Only in the cases where a cat started on too much insulin, not enough testing was done before increases, or too large an increase was done, will you get into that situation of too much insulin giving higher numbers. And if you test enough, the cat will tell you by going low, that it is too much insulin. If a cat starts at a safe dose, testing is done to know increases are done and done in safe amount then continuing high numbers just mean a cat needs more insulin. Off the soapbox.

There are cats with secondary conditions that need higher doses of insulin. When you say the dose was increased "incrementally", what was the size of the dose and what did the vet base the decision on? Were there more fructosamines? FYI - not judging, that's how the vet had me do things the first month before I knew better. My girl was one of those cats that needed larger doses.

 

[Panic]

[S]@Wendy&Neko[/S] if I remember right it was some wonky increases, like from 1u to 2u AM / 1u PM, then 2u AM/PM, then 3u AM / 2u PM etc

EDIT: Take that back, that was another kitty around the same time. I don't think they listed how Howie's dose was increased in previous threads.

 

[Ale & Bobo & Minnie (GA)]

@Wendy&Neko if I remember right it was some wonky increases, like from 1u to 2u AM / 1u PM, then 2u AM/PM, then 3u AM / 2u PM etc

Going from 6 to 3 if he’s in the 200s also seems odd. If 3 works, 6 is definitely too much

 

[Howiesmom]

Hi,

I've already posted on one of your earlier threads that I am concerned about the safety of the 6IU Prozinc dose you've been using, following a possible overnight hypo event a few days ago.

In the absence of BG data for the night in question it's impossible to say with certainty whether or not Howie's BG went way too low the other night, but there were sufficient reasons to consider it a distinct possibility. For members looking to learn more about this, see the following thread:

Help! Howie Got Into a Bag of Bread




Something has changed in the past two days: you're giving Howie even more insulin.

Giving too much insulin can sometimes look like giving too little. The body's protective mechanisms drive blood glucose levels upwards to protect the cat from hypoglycaemia. The body cannot do this indefinitely.

We understand the difficulties of trying to manage a diabetic cat as well as all the other commitments we may have in our lives, but without much data there's not much we can offer other than conjecture based on general principles. Also both preshot and mid-cycle tests are needed to determine what a dose is really doing. One mid-cycle test a day will at least give you a better idea of what's happening when the Prozinc is active. It's good that you're starting to get more PM tests down.

In the meantime, I respectfully suggest that you have another chat with your vet before giving another 6IU dose of Prozinc. You have curve data from a few days ago which showed that a 3IU dose of Prozinc kept Howie in a safe range just under the renal threshold. I suggest asking your vet whether it would be safer to give the 3IU dose AM and PM for the time being (unless a dose reduction is indicated on that dose) until he has time to consider Howie's dosing further.

If you do agree with your vet that you'll reduce the dose please monitor Howie daily for ketones (a standard safety precaution when insulin dose is reduced) until you get a better handle on his status and treatment approach. Information and tips below:

Testing Your Cat for Ketones

Tips for Collecting Urine Samples



General information for you to consider: cats in high numbers don't feel well; cats whose bodies are fighting the effects of too much insulin don't feel well either.

Other members may have a different view to mine. All I can do is share in good faith concerns based on my experience of managing feline diabetes.

I see Elizabeth (Panic) is already monitoring this thread. I'm also tagging @Deb & Wink to ask her to review the information you've given here along with Howie's spreadsheet.


Mogs
.

I must admit that I'm feeling a little attacked here as someone who is going through a lot of stress and managing this by myself the best way I can. I certainly read your information and had it in notes to bring up at my vet appointment TODAY about definitely reducing his dosage. I want to reduce dosage under his guidance so he knows exactly what is going on. I take the care I have given this cat that I inherited in March very seriously and have spent thousands of dollars trying to chase down root causes of several ailments, treatments, special food, etc. His care is of utmost importance to me or else I would not be asking for advice with trepidation. I have received wonderful advice that has been useful and I'm trying to add it into my daily routines. Please allow a person who has no idea what they are doing and reading a ton of information and getting differing opinions left and right some grace. I am not a bad cat owner or mother.

 

[Howiesmom]

I asked the following question on your previous thread but didn't get an answer back from you:

* How did you arrive at the 3IU / 6IU dosing? (Now 6IU / 6IU.)


Mogs
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I did respond. My vet indicated that in his research and training, if he is between 200-250, he gets a half dose. If he is above 250, he gets a full dose (6 units). That is the medical advice I was provided.

 

[Howiesmom]

Reference Ranges for Fructosamine Test
Note that in the UK, reference numbers are lower.

On my soapbox - not true as a generalization, just another one of those things that gets quoted a lot here and elsewhere. Only in the cases where a cat started on too much insulin, not enough testing was done before increases, or too large an increase was done, will you get into that situation of too much insulin giving higher numbers. And if you test enough, the cat will tell you by going low, that it is too much insulin. If a cat starts at a safe dose, testing is done to know increases are done and done in safe amount then continuing high numbers just mean a cat needs more insulin. Off the soapbox.

There are cats with secondary conditions that need higher doses of insulin. When you say the dose was increased "incrementally", what was the size of the dose and what did the vet base the decision on? Were there more fructosamines? FYI - not judging, that's how the vet had me do things the first month before I knew better. My girl was one of those cats that needed larger doses.

Howie has had 2 curves at the vet office since diagnosis. That is what we based the incremental (1 unit) increases on. He did not suggest .5 unit increases and I didn't know any better to question his opinion. Today was his first fructosamine.

 

[Howiesmom]

I agree. 6u is too much, 3u might also be too much. But it is better than 6. The longer you wait to change the dose the harder it will be.

Note you don't have to ask for permission from your vet. If everyone here waited until the vet gave clearance for basic necessities like proper food and appropriate dosing, we'd have almost no cats in remission.

He has had so many other health issues since I've gotten him, that I did feel like the best judgement was to talk to my vet about it...not to get permission. But to see if he could see other ramifications from stuff we've been dealing with besides diabetes.

 

[jt and trouble (GA)]

I' am sorry you are feeling attacked.It is a overwhelming feeling dealing with so many issues all at once. Its just that we get so many members coming here with vet instructions that are dangerous.. That in itself is overwhelming. These are good people who are just concerned. We strive to help every cat that comes to these pages. Its our calling so to speak. Many here have been through events, just like you are going through and are passionate about HELPING, to keep what happened to them, from happening to you and Howie. We all want the same thing. We all want your Howie to feel better and thrive.

I dont mean to step on any toes here. I hope EVERYONE takes this post, in the spirit with which it is offered.
jeanne

 

[Panic]

Please don't take it this way. You'll have to understand how difficult it can be for the members who have been here a while ... the cats that have lost their lives to bad veterinarian advice. Not malicious, just uneducated. When we see a cat in potential danger (and YES that includes that 6u dosage) it's hard for us as experienced AND educated (because you don't need a degree to be knowledgeable in a subject, and a degree doesn't mean you ARE knowledgeable) cat owners to sit idly by hoping one day someone will take our advice before the cat has to be rushed to the ER.

It is also difficult when the vet is not giving sound advice and the caregiver wants our input, but doesn't want to take it until the vet gives the okay. This board does have studies, articles, and published guidelines done by real veterinarians who have extensively studied diabetes, which we follow, and are happy to share with others to also learn and stay updated on our quest to conquering diabetes. Some vets just roll their eyes and poo-poo them for ... I don't know what reason other than not wanting to feel one-upped by their client knowing something they don't. I don't know. But I don't know a single vet who jumps the dose in unit increments or uses dog insulin etc. that has any sort of research or study to back up their methods, because there aren't any. We try to be medically educated as well as experienced, and when a caregiver comes to the board with questionable methods, we do try to point out the errors we see because we care about all kitties and their well-being.

And I will say from personal experience I took advice from the forum here but wanted to wait to talk with my vet before doing anything - like the forum told me to change the food to low-carb, but to monitor while doing so to keep her safe. I tried to talk with my vet about it and I was waved off and said not to worry about it, it won't affect anything. In hindsight it didn't make sense to ask for advice from someone who didn't know what they're talking about in the first place. That was my experience anyway, but it is a common one.

It's natural to assume our vets know what they're talking about - and why shouldn't we assume that, considering? The hard reality is most vets have not read the recent studies and research papers available on feline diabetes. They don't have time. It makes me sad. And it makes me mad every day I come here and see another story about a vet harming a cat based on old-school methods that could easily have been avoided if only they'd stayed up to date.

 

[Panic]

He has had so many other health issues since I've gotten him, that I did feel like the best judgement was to talk to my vet about it...not to get permission.

Lots of people feel they need to ask for permission before making changes, which is why I pointed that out. Some vets bully their clients into buying food or coming in for curves and not "letting" them home-test. Some people are afraid to question their vets or say no, and some encouragement from others is helpful.

 

[Deb & Wink]

@Howiesmom You do the best you can. You ARE trying really hard to help Howie, and it isn't easy to deal with a diabetic cat that also has other health issues. We know that. We will support you to the best of our abilities.

We know feline diabetes pretty well here on the message board. But it's awfully hard to trust a group of strangers you have never met, with ideas that are different from what your vet has told you. One of our main goals here on the message board, is to get you the knowledge to help your diabetic cat and the resources you need to get him feeling better and get his BG levels regulated and then possibly into diet controlled status, sometimes called diabetic remission or as we like to say here, OTJ (off-the-juice, insulin being the juice.

Having said that, what we DON'T know is what will work for you and what will not work.
So if we say something that you do not agree with, please push back and tell us why it doesn't work for you.
You know your cat and your situation better than we ever will.

It can definitely be overwhelming, at the best of times. And these are not the best of times to have a diabetic cat that needs a lot of attentive care. Covid-19 has upended so many of our lives and routines and we are still trying to adjust to the changes. At times it seems to me like having another part time job in my life, trying to deal with all the changes and the extra work involved to keep ourselves safe.

All we are trying to do here, is to help you the best WE can, to get Howie feeling better. To lessen his diabetic symptoms, to keep him safe from some of the complications of diabetes such as hypoglycemia or ketones that can lead to DKA (diabetic ketoacidosis)
A good vet is always an asset in dealing with feline diabetes.

One good article to share with your vet, is the (2018) AAHA Diabetes Management Guidelines for Dogs and Cats. It's a vet journal/ vet website article that takes some of the recent research on diabetes and a task force came up with consensus guidelines on how to manage diabetes in cats, and how to manage diabetes in dogs. I hope you will read this article and then feel that you can share this article with your vet and the vet clinic you go to. The AAHA is the American Animal Hospital Association, and many vets are members. Perhaps your vet is one of those members.

Hang in there sweetie, it does get better. Please trust us on at least that. OK?

By the way, the BG tests you do at home, and the fructosamine test done at the vet measure 2 different things. So you can't compare the numbers at all.
Here are the Reference Ranges for Fructosamine Test and what they mean. The reference ranges have changed for outside the US, such as Europe, and our thread on the fructosamine ranges has not been updated.

 

[Howiesmom]

@Howiesmom You do the best you can. You ARE trying really hard to help Howie, and it isn't easy to deal with a diabetic cat that also has other health issues. We know that. We will support you to the best of our abilities.

We know feline diabetes pretty well here on the message board. But it's awfully hard to trust a group of strangers you have never met, with ideas that are different from what your vet has told you. One of our main goals here on the message board, is to get you the knowledge to help your diabetic cat and the resources you need to get him feeling better and get his BG levels regulated and then possibly into diet controlled status, sometimes called diabetic remission or as we like to say here, OTJ (off-the-juice, insulin being the juice.

Having said that, what we DON'T know is what will work for you and what will not work.
So if we say something that you do not agree with, please push back and tell us why it doesn't work for you.
You know your cat and your situation better than we ever will.

It can definitely be overwhelming, at the best of times. And these are not the best of times to have a diabetic cat that needs a lot of attentive care. Covid-19 has upended so many of our lives and routines and we are still trying to adjust to the changes. At times it seems to me like having another part time job in my life, trying to deal with all the changes and the extra work involved to keep ourselves safe.

All we are trying to do here, is to help you the best WE can, to get Howie feeling better. To lessen his diabetic symptoms, to keep him safe from some of the complications of diabetes such as hypoglycemia or ketones that can lead to DKA (diabetic ketoacidosis)
A good vet is always an asset in dealing with feline diabetes.

One good article to share with your vet, is the (2018) AAHA Diabetes Management Guidelines for Dogs and Cats. It's a vet journal/ vet website article that takes some of the recent research on diabetes and a task force came up with consensus guidelines on how to manage diabetes in cats, and how to manage diabetes in dogs. I hope you will read this article and then feel that you can share this article with your vet and the vet clinic you go to. The AAHA is the American Animal Hospital Association, and many vets are members. Perhaps your vet is one of those members.

Hang in there sweetie, it does get better. Please trust us on at least that. OK?

By the way, the BG tests you do at home, and the fructosamine test done at the vet measure 2 different things. So you can't compare the numbers at all.
Here are the Reference Ranges for Fructosamine Test and what they mean. The reference ranges have changed for outside the US, such as Europe, and our thread on the fructosamine ranges has not been updated.

Thank you so much for your empathetic message. I certainly acknowledge that everyone on here has been generous in offering thoughts and advice. Working in higher education right now on a campus that has high COVID test #s has been stressful enough These past two weeks and Howie’s condition has been added on top of that. There is just no explanation for his increasing #s and his fructosamine results completely took me, my vet and his techs all off guard. Tonight his PMPS was 290. I only gave him 3 units and now his +1.5 test just came back at 398. I know this is not healthy at all. I was finally able to get some ketone strips but missed his one peeing moment since I’ve been home...grrr. My vet is going to do a test tomorrow to now see if Cushings is a possibility. The little bit I’ve been able to read about that sounds like a horrible prognosis. I hope it’s not that but am unsure how to drop his dosage if these #s just keep spiking this high.

 

[Red & Rover (GA)]

Tonight his PMPS was 290. I only gave him 3 units and now his +1.5 test just came back at 398.

It could be a bounce from seeing numbers that he is not used to. Not necessarily hypo low numbers.


Definition of a bounce: Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Basically, his body thinks the numbers are too low (even if they are not) and responds by temporarily releasing a whole pile of sugar into the system. But increasing the dose is not the answer. That leads to too much insulin. The numbers will come down. You have to wait it out.

 

[Critter Mom]

@Howiesmom -

I regret that my earlier post on this thread upset you. It most certainly was not my intent and I apologise unreservedly for having done so. I was just trying to help.


Mogs
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