Good Fructosamine levels / bad daily readings

[NyCatMom]

I am admittedly confused. I’ve been testing my cat before meals and her blood glucose levels aren’t great (high 300s / low 400s). We went to Cornell this week for a check in with her internist and they called this afternoon with her results. Blood work looks great and fructosamine levels show good control. How is that possible? What am I missing?

Spreadsheet attached to profile. Honey has chronic pancreatitis, small cell lymphoma and recurrent UTIs in addition to her diabetes.

 

[Bron and Sheba (GA)]

Hi,
Fructosamine tests can sometimes be misleading.
Looking at your SS I can see you rarely test inbetween the preshot BGs. so there is a possibility that Honey is dropping low during the cycles and bouncing back up at peshot and you would have no idea. A fructosamine test is the average of the last couple of weeks BGs....so you could easily get a good result with high preshots and low during the cycles........which is not well regulated.
I would trust your SS much more than a fructosamine test.

Lantus dosing is based in the nadir or lowest point in the cycles not the preshot.if you are not getting any mid cycle tests in you have no idea what is happening at all during the cycles.
If I were you there are several things I would do that should improve things a lot

• start getting at least one test in every cycle. Mix it around. Get a +2 one day, a+4 another day, a +6 another day and a +5 another day.
• Always get a before bed test in every night. If that test is lower than the preshot BG that is telling you that it would be a good idea to set the alarm and get up and test a few hours later.
• Are you offering snacks during the cycle as well as the main meals.
• Follow one of the dosing methods. Either Start Low GO Slow or Tight Regulation ( although you need to be testing at least 5 times a day to do that and be only feeding a low carb wet diet.
• You are holding the dose far too long...but you must base the dose increases on the lowest point of the cycle not the preshot, otherwise you run the risk of giving too much insulin
• Areyou testing frequently for ketones in the urine ? I see there were ketones back in November
• I would post daily over on the Lantus forum for help and guidance

Hope to see you over there!
Bron

 

[NyCatMom]

Hi,
Fructosamine tests can sometimes be misleading.
Looking at your SS I can see you rarely test inbetween the preshot BGs. so there is a possibility that Honey is dropping low during the cycles and bouncing back up at peshot and you would have no idea. A fructosamine test is the average of the last couple of weeks BGs....so you could easily get a good result with high preshots and low during the cycles........which is not well regulated.
I would trust your SS much more than a fructosamine test.

Lantus dosing is based in the nadir or lowest point in the cycles not the preshot.if you are not getting any mid cycle tests in you have no idea what is happening at all during the cycles.
If I were you there are several things I would do that should improve things a lot

• start getting at least one test in every cycle. Mix it around. Get a +2 one day, a+4 another day, a +6 another day and a +5 another day.
• Always get a before bed test in every night. If that test is lower than the preshot BG that is telling you that it would be a good idea to set the alarm and get up and test a few hours later.
• Are you offering snacks during the cycle as well as the main meals.
• Follow one of the dosing methods. Either Start Low GO Slow or Tight Regulation ( although you need to be testing at least 5 times a day to do that and be only feeding a low carb wet diet.
• You are holding the dose far too long...but you must base the dose increases on the lowest point of the cycle not the preshot, otherwise you run the risk of giving too much insulin
• Areyou testing frequently for ketones in the urine ? I see there were ketones back in November
• I would post daily over on the Lantus forum for help and guidance

Hope to see you over there!
Bron

Hi,
Fructosamine tests can sometimes be misleading.
Looking at your SS I can see you rarely test inbetween the preshot BGs. so there is a possibility that Honey is dropping low during the cycles and bouncing back up at peshot and you would have no idea. A fructosamine test is the average of the last couple of weeks BGs....so you could easily get a good result with high preshots and low during the cycles........which is not well regulated.
I would trust your SS much more than a fructosamine test.

Lantus dosing is based in the nadir or lowest point in the cycles not the preshot.if you are not getting any mid cycle tests in you have no idea what is happening at all during the cycles.
If I were you there are several things I would do that should improve things a lot

• start getting at least one test in every cycle. Mix it around. Get a +2 one day, a+4 another day, a +6 another day and a +5 another day.
• Always get a before bed test in every night. If that test is lower than the preshot BG that is telling you that it would be a good idea to set the alarm and get up and test a few hours later.
• Are you offering snacks during the cycle as well as the main meals.
• Follow one of the dosing methods. Either Start Low GO Slow or Tight Regulation ( although you need to be testing at least 5 times a day to do that and be only feeding a low carb wet diet.
• You are holding the dose far too long...but you must base the dose increases on the lowest point of the cycle not the preshot, otherwise you run the risk of giving too much insulin
• Areyou testing frequently for ketones in the urine ? I see there were ketones back in November
• I would post daily over on the Lantus forum for help and guidance

Hope to see you over there!
Bron

Thank you for your very helpful message. I am calling Cornell back today to try and get a rationale for holding her dose at the current levels. Admittedly I have not been testing as much as I would like. Lately she has been protesting being ear pricked ,even though I am fast and use fine lancets. I think she is fed up of all the tests drugs and medications so I was giving her a little break.

To answer some of your questions, she’s on low carb Tiki Cat and fancy feast pate canned food. She has had no ketones in her urine but plenty of glucose as well as chronic UTIs. Her primary care vet (not the internist) was a big fan of go slow technique so that was what we had been using until the internist took over to manage her small cell lymphoma and chronic pancreatitis. The internist was delighted that she is gaining weight but I would feel better if we could get her blood glucose under better control. I know the prednisolone complicates the DM management but since I am still working from home, it’s the perfect time since I can see how she is during all day long.