High Fructosamine, normal blood sugar, no ketones in urine

Laurie G

Laurie G

Member Since 2016
Hi! I'm well-versed in tight regulation of diabetes. This is a different and unusual problem, and I'm wondering if this has been encountered by anyone in the group before and how it was managed. My vet is currently chatting with others on VIN about my cat Smokey. He is 15 and was treated with radioactive iodine 131 for hyperthyroidism in Nov 2024. Relevant info:

Smokey has been on 5mg of pred for environmental allergies for close to 6 years

His blood glucose has risen from a long history of being in the 80s and 90s to 115 (11/24), 174 (2/25), 204 (6/25), 222 (8/25), 226 (2/26) and his water drinking visibly increased, so I had him rechecked 3/26 and it is now 241.

Due to stress impact on blood glucose in cats, my vet typically doesn't check fructosamine unil high 200s. But because I asked for it due to the long steroid use and increased water drinking, we ran it for the first time. She was shocked to see it at 508.

The problem? His BG is so close to normal, the concern is if treated with insulin, he will go low blood sugar.

He is not a candidate for the new drugs because he has flares of pancreatitis somewhat regularly.

Smokey weighs 14.5 pounds and could stand to lose "a little" weight - maybe a pound. He is on a LARGE frame though and comfortably carried 18 pounds, just for perspective. In the picture I'll attach, he was 14 pounds and had lost 3 pounds over a rather short period due to the hyperT (which currently remains cured).

Obviously the thinking is insulin resistance due to the long-term use of steroid. The problem is in an ideal world, we'd leave him on it IF we could treat with insulin. But no vet, so far, thinks it is safe to give him insulin.

* I will work on lowering his weight
* I will see if I can at least reduce the steroid and keep him comfortable. He has developed severe arthritis and the steroid is likely helping control arthritis inflammation - and at this point, this is my biggest quality of life concern for him.
* Smokey eats a high-protein, low-carb diet. I will increase his fat content a bit as he eats a low fat diet (simply due to preference, it is homemade balanced food).

I am wondering if this situation has been encountered before and how was it managed?

Further, before I start digging into the research, are there any supplements know to be safe for cats that may help reduce insulin sensitivity?

Thanks in advance for any insights!

Laurie

Smokey 241122 resized.jpg
 

Attachments

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Welcome to FDMB, I will tag a member that can assist you with Smoke's health concerns, when a diabetic cat is tightly regulated his/her BG will be between 50-120 that's the same BG number for a non-diabetic cat
@Sienne and Gabby (GA)
 
Hi Laurie, do you have a spreadsheet for Smokey? I only see Treebie’s in your signature. Just curious to see some BG data. Hope you get some good advice!
 
Tim & Pookey said:
Hi Laurie, do you have a spreadsheet for Smokey? I only see Treebie’s in your signature. Just curious to see some BG data. Hope you get some good advice!
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Just uploaded it by attaching it via edit on that first post. It's in PDF format, but its his BW / UA history from my excel spreadsheet
 
CORKY said:
Welcome to FDMB, I will tag a member that can assist you with Smoke's health concerns, when a diabetic cat is tightly regulated his/her BG will be between 50-120 that's the same BG number for a non-diabetic cat
@Sienne and Gabby (GA)
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Thank you. Yeah, I understand that. But I'm not looking for help with tight regulation. If that is all the group suggests, then my thanks! I may end up going there, but given his circumstances, personality, quality of life considerations, etc it's going to be a last resort.
 
What is the "bg so close to normal" you are referring to??? Also, is he currently on insulin? This is confusing to me. How do you know/why would you think he is insulin resistant if he's not on insulin?
 
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Mary & Jude said:
What is the "bg so close to normal" you are referring to??? Also, is he currently on insulin? This is confusing to me. How do you know/why would you think he is insulin resistant if he's not on insulin?
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The "close to normal BG" is allowing for stress impact on glucose in the blood stream. Same concept as not treating high blood pressure when it measures 160 and the cat is stressed, it can actually be 120 and giving the cat blood pressure medication would cause low BP. (Actually had a friend whose cat died because of that, it was crazy tragic). And the body makes insulin, diabetes type 2 is the very definition of insulin resistance: when the body doesn't respond to insulin as it should. At least that is my understanding of what the vet was explaining. The long term use of steroid in cats causes insulin resistance - this is why removing the steroid (when possible) puts the cat into remission from the diabetic state. But with a type 1 dad, I'm pretty sure the difference between 1 and 2 is one is impaired pancreatic function and lack of proper manufacture of insulin, and type 2 is insulin resistance, which is what most cats develop due to meds like steroids or diet - like humans.
 
Laurie G said:
The "close to normal BG" is allowing for stress impact on glucose in the blood stream. Same concept as not treating high blood pressure when it measures 160 and the cat is stressed, it can actually be 120 and giving the cat blood pressure medication would cause low BP. (Actually had a friend whose cat died because of that, it was crazy tragic). And the body makes insulin, diabetes type 2 is the very definition of insulin resistance: when the body doesn't respond to insulin as it should. At least that is my understanding of what the vet was explaining. The long term use of steroid in cats causes insulin resistance - this is why removing the steroid (when possible) puts the cat into remission from the diabetic state. But with a type 1 dad, I'm pretty sure the difference between 1 and 2 is one is impaired pancreatic function and lack of proper manufacture of insulin, and type 2 is insulin resistance, which is what most cats develop due to meds like steroids or diet - like humans.
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@Sienne and Gabby (GA)
 
CORKY said:
It should be in GOOGLE DRIVE
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Only the spreadsheet needs to be in Google Drive. Laurie was just attaching a pdf which is absolutely fine in the format she chose. She doesn’t need a SS because the BGs were done over time by the vet. Please focus on the questions the member has instead of burdening them with a lot of requests. It’s also best to not assume a member will want to follow any tight regulation method of dosing.

Laurie G said:
His blood glucose has risen from a long history of being in the 80s and 90s to 115 (11/24), 174 (2/25), 204 (6/25), 222 (8/25), 226 (2/26) and his water drinking visibly increased, so I had him rechecked 3/26 and it is now 241.

Due to stress impact on blood glucose in cats, my vet typically doesn't check fructosamine unil high 200s. But because I asked for it due to the long steroid use and increased water drinking, we ran it for the first time. She was shocked to see it at 508.

The problem? His BG is so close to normal, the concern is if treated with insulin, he will go low blood sugar.

He is not a candidate for the new drugs because he has flares of pancreatitis somewhat regularly.

Smokey weighs 14.5 pounds and could stand to lose "a little" weight - maybe a pound. He is on a LARGE frame though and comfortably carried 18 pounds, just for perspective. In the picture I'll attach, he was 14 pounds and had lost 3 pounds over a rather short period due to the hyperT (which currently remains cured).

Obviously the thinking is insulin resistance due to the long-term use of steroid. The problem is in an ideal world, we'd leave him on it IF we could treat with insulin. But no vet, so far, thinks it is safe to give him insulin.

* I will work on lowering his weight
* I will see if I can at least reduce the steroid and keep him comfortable. He has developed severe arthritis and the steroid is likely helping control arthritis inflammation - and at this point, this is my biggest quality of life concern for him.
* Smokey eats a high-protein, low-carb diet. I will increase his fat content a bit as he eats a low fat diet (simply due to preference, it is homemade balanced food).

I am wondering if this situation has been encountered before and how was it managed?

Further, before I start digging into the research, are there any supplements know to be safe for cats that may help reduce insulin sensitivity?

Thanks in advance for any insights!

Laurie
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Hi Laurie

Sorry to hear Smokey has this going on. I just have a few thoughts.

—his BG has been trending up and if he was a cat that shows higher BGs due to stress, he would have been showing it all along. If it was one BG, I’d certainly think monitoring was worth a try;
—his fructosamine is pretty high so he’s likely had BGs higher than 241 and a fruc test over 500 is indicative of diabetes;
—we don’t consider BGs over 150 as close to normal; most vets are cautious because they are not even on board with a diabetic cat on insulin getting close to a BG of 50-120. They always worry about a hypo and it’s understandable because many don’t support home testing and they can’t be there 24/7;
— if you can test him at home (I know he was a feral so I don’t know if he will let you test him traditionally) or put a Libre 3 on him, not only will you know what his BG is doing at home but, if you put him on insulin, you can easily monitor if he starts going low
—you don’t have to do tight regulation. We also have Start Low Go Slow (SLGS) which is much less aggressive and you can always lower the dose as you lower the pred. SLGS would have you start at 0.5u bid which is a pretty low dose.
—between the pred and the pancreatitis, I’m not surprised he’s diabetic but it’s possible a little insulin support before his BG skyrockets might be all he needs.

I tried several herbal and homeopathic remedies with Gracie and none of them worked. She was never on a very high dose and she was steroid-induced.

Please let me know if you have questions. We are here to help and offer support you need.

Edited to add: I know you said he needs pred for environmental allergies but also arthritis. Have you tried Solensia for the arthritis which might let you lower the pred dose while still keeping him comfortable?
 
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I agree with Marje's observations. I'd also add that Marje had the benefit of a very skilled homeopathic vet so she had excellent guidance when she was using herbal and homeopathic options.

Personally, I would find it helpful to see more routine testing, especially when you're at home. I'm wed to our spreadsheet (sorry!!) but I realize you may have limitations. It would be good to see what Smokey's blood glucose looks like when not stressed by being at the vet's office.

One question to run past your vet. The arthritis and allergies are inflammatory conditions. While the pred may help, I do wonder if the inflammation, especially if this is chronic, is what's elevating the the fructosamine/blood glucose levels. Any sort of inflammation or infection may cause a rise in numbers. Also, did the vet check to see if Smokey's teeth were in good shape? One of the more common reasons we see cats drop out of remission is that they need a dental.
 
Sienne and Gabby (GA) said:
I agree with Marje's observations. I'd also add that Marje had the benefit of a very skilled homeopathic vet so she had excellent guidance when she was using herbal and homeopathic options.

Personally, I would find it helpful to see more routine testing, especially when you're at home. I'm wed to our spreadsheet (sorry!!) but I realize you may have limitations. It would be good to see what Smokey's blood glucose looks like when not stressed by being at the vet's office.

One question to run past your vet. The arthritis and allergies are inflammatory conditions. While the pred may help, I do wonder if the inflammation, especially if this is chronic, is what's elevating the the fructosamine/blood glucose levels. Any sort of inflammation or infection may cause a rise in numbers. Also, did the vet check to see if Smokey's teeth were in good shape? One of the more common reasons we see cats drop out of remission is that they need a dental.
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Thanks Sienne, and @Marje and Gracie (and @CORKY ) - things I forgot to mention:
1) Smokey is FIV+and this is likely related to his inflammation-related health problems.
2) Somke has also finally gone proteinuric - thus more than usual vet visits lately - testing urine and confirming blood pressure (which we have two *extremely* contradictory pressures two weeks apart at two different clinics, third is scheduled for this coming Monday).
3) Smokey gets routine dentals at least every other year and had one this year because of the FIV (prone to stomatitis)
4) Smokey used to stress SO badly that he was given 200mg (max dose) of gabapentin to travel. After traveling close to 1.5 hours in the car to get to Dr. Peterson's HypurrCat clinic in NYC and staying for four days - and, importantly (LOL) - returning home, he finally "got" in some way that he comes home. I only gave him 100mg for the next vet visit. And he got none after that. So maybe it's a coincidence, maybe it isn't? But his rise in BG is *directly* related to the use - and dose - of gabapentin.
5) Smokey is a very big-framed cat. He developed arthritis early despite use of omegas from a young age. He is on solensia, adequan, 3,000mg of omega 3s daily (in addition to the 400mg of green lipped mussel in each of his two meals / day) - and a supplement with glucosamine, chondroitin, MSM and hyaluronic acid.

And MOST interesting is a study I just learned about yesterday: published last month it compares turmerosaccharides (from turmeric but not the same as curcumin - it has no curcuminoids) is effective more effective than glucosamine-chondriotin in dogs with OA.
Frontiers | Protective effects of turmerosaccharides rich extract of Curcuma longa L. in osteoarthritic dogs

Plus, in searching for the newly published article, I found a few articles on curcumin and type 2 diabetes in dogs - and insulin sensitivity improvement in a rat study. Anti-oxidative stress that provided liver and kidney protection .... This is a supplement that has been recommended for FIV cats (among with others) on the FIV Therapy cats io board. It hasn't been emphasized - and it seems it should. It has always had bioavailability problems, and those got solved with time with various processing methods - but it's apparently such fabulous stuff property-wise, research was ongoing. And there is now nano-curcumin and a new slew of research has been published. In the end, it's a powerful anti-inflammatory and these are all diseases of inflammation -
Curcumin exerts beneficial role on insulin resistance through modulation of SOCS3 and Rac-1 pathways in type 2 diabetic rats
Curcuminoid supplementation in canine diabetic mellitus and its complications using proteomic analysis - PMC
Oh - here, better, an overview: The Effects of Curcumin on Diabetes Mellitus: A Systematic Review - PMC

I'll chat with the vet about sticking a Libre on Smokey ... and I asked yesterday and someone from the office left a message: I'm to go ahead and give Smokey 200mg of gabapentin before his BP recheck on Monday. She'll check BG then, see if it's consistent with old numbers or new numbers.


FYI, my vet is familiar with tight regulation. Not as versed as you all are, she doesn't have a lot of clients home testing - but she got me through putting together Treebie's curve and bringing him down the steroid taper and through his going into remission from steroid-induced diabetes. In the end, he needed the steroid but he got almost a year before the need was apparent. In the end, he passed due to a lung tumor.

Ultimately, Smokey's kidneys are more the issue than his diabetes at least in the short run. Whatever was going on that prompted his increased drinking and my request to run the fructosamine test isn't ongoing.

ANyway, thanks for the insights, thoughts, and experience. <3 I'll get his "on gabapentin" BG on Monday during his appointment for the BP recheck to see if his proteinuria is idiopathic and at 1.5 UPC needs treatment or if it's high BP induced. It really appears to be idiopathic. FIV cats are prone to it. Of course the boy has messed up kidney values because he's got one tiny kidney which throws his normals off.
 
Getting the CGM on St is a breeze , watch how the vets put on tge first, and you can do the rest, make sure you get script with multiple sensors refills and always keep a couple at home, in case it falls off or it stops working before the 14 days, the more you avoid insignificant vet visits the less stress Smokey will go thru and is easier on your pocket, just make sure that if you see low two digit numbers to re-test manually, and use the manual test as value. You are doing great and Smokey is lucky to have you😉
 
CORKY said:
Getting the CGM on St is a breeze , watch how the vets put on tge first, and you can do the rest, make sure you get script with multiple sensors refills and always keep a couple at home, in case it falls off or it stops working before the 14 days, the more you avoid insignificant vet visits the less stress Smokey will go thru and is easier on your pocket, just make sure that if you see low two digit numbers to re-test manually, and use the manual test as value. You are doing great and Smokey is lucky to have you😉
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great, thanks for the tips!
 
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