George 5/12/26 AMPS 113 +6 65

Fructosamine came back 411. They want to postpone the surgery for now. They also want him going up to one unit. But im nervous about his BG being too sensitive to it Thoughts?
 

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borg the gorb said:
Fructosamine came back 411. They want to postpone the surgery for now. They also want him going up to one unit. But im nervous about his BG being too sensitive to it Thoughts?
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I am definitely uncomfortable with a 1u increase bid. You will most assuredly be looking at a hypo.

Could you potentially increase to 0.75u? Perhaps but based on the data right now and how you yourself are feeling, that makes me uneasy. If and when you feel like grabbing a bit more data so we can be sure how low this dose is or is not taking him, I do not advise a dose increase.

Honestly, there is no reason for them to postpone a dental based on a fructosamine. Diabetic cats in this group get dentals with much higher BGs than he is. Please look at my Gracie’s SS on 2/11/2015z. She had a dental and did fantastic and her BG wasn’t anywhere near as good as George’s.

If there are other health reasons to not do it, I get it but dental issues are ones we do not ignore here as they can make the BGs higher and, if there is infection, put the kitty at risk for ketones and DKA.

BTW, you do not need a fructosamine test because you have real-time data. Fruc tests are necessary to help dx diabetes and later when a CG is not home-testing (which we don’t recommend) and has no data. They shouldn’t have made you bear that expense with the data you have. We know he’s still diabetic.
 
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Marje and Gracie said:
I am definitely uncomfortable with a 1u increase bid. You will most assuredly be looking at a hypo.

Could you potentially increase to 0.75u? Perhaps but based on the data right now and how you yourself are feeling, that makes me uneasy. If and when you feel like grabbing a bit more data so we can be sure how low this dose is or is not taking him, I do not advise a dose increase.

Honestly, there is no reason for them to postpone a dental based on a fructosamine. Diabetic cats in this group get dentals with much higher BGs than he is. Please look at my Gracie’s SS on 2/11/2015z. She had a dental and did fantastic and her BG wasn’t anywhere near as good as George’s.

If there are other health reasons to not do it, I get it but dental issues are ones we do not ignore here as they can make the BGs higher and, if there is infection, put the kitty at risk for ketones and DKA.

BTW, you do not need a fructosamine test because you have real-time data. Fruc tests are necessary to help dx diabetes and later when a CG is not home-testing (which we don’t recommend) and has no data. They shouldn’t have made you bear that expense with the data you have. We know he’s still diabetic.
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Ill to a .75 then, I think thats smarter and was what I was thinking as well

Edit: they want to do another fructosamine test in 3 weeks. How would I explain to them that I dont believe its neccessary? I dont want them to refuse treatment for him
 
borg the gorb said:
Ill to a .75 then, I think thats smarter and was what I was thinking as well

Edit: they want to do another fructosamine test in 3 weeks. How would I explain to them that I dont believe its neccessary? I dont want them to refuse treatment for him
Click to expand...
have you tried showing them your spreadsheet and your data on George? Because if you haven't they may think you have no data on how his bg is behaving, but you do!. that may set the a bit more at ease with the fructosamine test if they see it?.
 
zero - sigma & mielconejo said:
have you tried showing them your spreadsheet and your data on George? Because if you haven't they may think you have no data on how his bg is behaving, but you do!. that may set the a bit more at ease with the fructosamine test if they see it?.
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They saw his spreadsheet today and his tracking app, but they still wanted to go through with the fructosamine
 
Zach, I'm saying this because I think I understand the pressure you must be facing from your vet. Please don't let your vet's office push you into a dose increase that is not in George's best interest. I'm not saying .75 is not a good dose because I'm not qualified to give that kind of advice, but I would certainly listen to Marje. Up until now, on your own, you've researched and found this forum. And you've received solid advice so far on the forum, advice that has brought George into some really good numbers, and you've chosen to follow that advice. He's remained safe under that advice. The vet initially prescribed 3 units, which was too high for George--I think that possibly could have created a hypo event. The forum advised you to drop that dose, and you did, and George is doing well.

My question is this (and maybe Marje can answer it): why would the fructosamine show an average of 411 for George, when just a visual of George's spreadsheet reflects that he in no way had an average of that number over the past few weeks. I don't understand that. The only thing that I might consider could have a factor in driving that number is the possibility of higher numbers in the evening hours where you haven't gotten a lot of tests.

So, what would happen if they refused to treat him? Is it possible for you to find another vet that is more willing to work with you, one that will look at George's spreadsheet and try to understand and trust what you are doing for your little buddy?
 
borg the gorb said:
  • Normal Healthy Cat: ~137–286 \(\mu mol/L\) (new, updated range) or 190–365 \(\mu mol/L\).
  • Newly Diagnosed/Uncontrolled Diabetic: Often 350–730 \(\mu mol/L\).
  • Well-Regulated Diabetic: 350–450 \(\mu mol/L\).
  • Poorly Controlled Diabetic: \(>500 \mu mol/L\)
Ill to a .75 then, I think thats smarter and was what I was thinking as well

Edit: they want to do another fructosamine test in 3 weeks. How would I explain to them that I dont believe its neccessary? I dont want them to refuse treatment for him
Click to expand...
I’m sorry I might not have been clear. My question was a bit rhetorical and if you read the rest of that paragraph, where I said, “Perhaps but based on the data right now and how you yourself are feeling, that makes me uneasy. If and when you feel like grabbing a bit more data so we can be sure how low this dose is or is not taking him, I do not advise a dose increase.”
Tell them you can’t afford it especially in light of the real-time data you have. And if you don’t want to get into the data, tell them you can’t afford it. I would not want to go to a vet that pushed me to run tests I told them I can’t afford.


Mary & Jude said:
My question is this (and maybe Marje can answer it): why would the fructosamine show an average of 411 for George, when just a visual of George's spreadsheet reflects that he in no way had an average of that number over the past few weeks.
Click to expand...
The fructosamine test doesn’t correlate with actual BGs. Here is the range (the underline is mine):
  • Normal Healthy Cat: ~137–286 \(\mu mol/L\) (new, updated range) or 190–365 \(\mu mol/L\).
  • Newly Diagnosed/Uncontrolled Diabetic: Often 350–730 \(\mu mol/L\).
  • Well-Regulated Diabetic: 350–450 \(\mu mol/L\).
  • Poorly Controlled Diabetic: \(>500 \mu mol/L\)
As you can see, George is well-regulated with a 411.
 
Marje and Gracie said:
I’m sorry I might not have been clear. My question was a bit rhetorical and if you read the rest of that paragraph, where I said, “Perhaps but based on the data right now and how you yourself are feeling, that makes me uneasy. If and when you feel like grabbing a bit more data so we can be sure how low this dose is or is not taking him, I do not advise a dose increase.”
Tell them you can’t afford it especially in light of the real-time data you have. And if you don’t want to get into the data, tell them you can’t afford it. I would not want to go to a vet that pushed me to run tests I told them I can’t afford.



The fructosamine test doesn’t correlate with actual BGs. Here is the range (the underline is mine):
  • Normal Healthy Cat: ~137–286 \(\mu mol/L\) (new, updated range) or 190–365 \(\mu mol/L\).
  • Newly Diagnosed/Uncontrolled Diabetic: Often 350–730 \(\mu mol/L\).
  • Well-Regulated Diabetic: 350–450 \(\mu mol/L\).
  • Poorly Controlled Diabetic: \(>500 \mu mol/L\)
As you can see, George is well-regulated with a 411.
Click to expand...
Ahh I see now. I understand. I will inform my vet of this regarding the data
 
Mary & Jude said:
Zach, I'm saying this because I think I understand the pressure you must be facing from your vet. Please don't let your vet's office push you into a dose increase that is not in George's best interest. I'm not saying .75 is not a good dose because I'm not qualified to give that kind of advice, but I would certainly listen to Marje. Up until now, on your own, you've researched and found this forum. And you've received solid advice so far on the forum, advice that has brought George into some really good numbers, and you've chosen to follow that advice. He's remained safe under that advice. The vet initially prescribed 3 units, which was too high for George--I think that possibly could have created a hypo event. The forum advised you to drop that dose, and you did, and George is doing well.

My question is this (and maybe Marje can answer it): why would the fructosamine show an average of 411 for George, when just a visual of George's spreadsheet reflects that he in no way had an average of that number over the past few weeks. I don't understand that. The only thing that I might consider could have a factor in driving that number is the possibility of higher numbers in the evening hours where you haven't gotten a lot of tests.

So, what would happen if they refused to treat him? Is it possible for you to find another vet that is more willing to work with you, one that will look at George's spreadsheet and try to understand and trust what you are doing for your little buddy?
Click to expand...
My only issue is I work for this pet store that the vet works in and i get free exams and a 20% discount, so thats why im sticking with them, I cant afford another vet in all honesty
 
borg the gorb said:
My only issue is I work for this pet store that the vet works in and i get free exams and a 20% discount, so thats why im sticking with them, I cant afford another vet in all honesty
Click to expand...
I see. That complicates things. And this disease can be expensive to treat so every little cost break matters. I hope they will understand your reluctance to go through another fructosamine test because of the expense.

In terms of the dosing, maybe if you can grab a few more tests at night like Marje suggested, you can at least get a better picture of how low this dose might be taking George, and that would make the dosing decision a bit clearer for you.

I'm sorry you're facing this conflict from your vet! Hang in there--you're doing a great job with George--he's very lucky to have you in his life.
 
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