Need advice re: shocking fructosamine result

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Jennifer and Hannah

Jennifer and Hannah

Member Since 2014
Hi all,

It's been a while since I posted because I have been home testing my cat, Hannah, successfully for over a year and all of her symptoms cleared up long ago (no more excessive drinking/peeing, no more walking/sitting back on her heels, no more scarfing down her food and constantly begging for more, she gained back the weight she lost, her coat got silky again, etc.) Essentially, we've gotten the routine down and her diabetes has been relatively uneventful. But now something has come up and I need some advice.

For a little over a year now, my vet has let me keep refilling my prescription for insulin without requiring a checkup, which I considered unnecessary anyway since I was doing twice daily (or more) home testing. Fast forward to this week, when I called for a refill and was told I would need to schedule an appointment. I tried to reason with the vet but was denied, so in we went. She examined Hannah and commented several times on how good she looked. She complimented me on my knowledge of the disease and my dedication to doing home testing. She didn't do a regular blood glucose reading because of my home testing, but she did insist on a fructosamine test. I didn't see the point, but I didn't argue. All in all it was a very good visit and I figured the nice, normal fructosamine result might help me to dissuade her from requiring it again in the future. So imagine my surprise when she left me a message today telling me that the fructosamine test showed that Hannah was poorly regulated. Not excellent, not good, not even fair, but POOR! (She didn't give me the actual number so I don't have that to share yet.)

I haven't done a full curve in quite a while, but Hannah's 12-hr numbers right before her next dose are usually always between 225 & 275, with a few oddball high and low numbers occasionally, and when I spot check in between, it's always somewhere between 100 & 200 depending on when I take it. I am only dosing about 0.8 units of Vetsulin every 12 hours because anything higher than that tends to send her into the 300's and sometimes even 400's at the 12-hr mark, which I eventually figured out (after months of trying to increase her dose) had to be due to bouncing back high after going too low or dropping too fast. (I know Vetsulin is not an ideal insulin, but it's what I have easy access to and my budget right now doesn't really afford me the luxury of being choosy.)

I just don't understand how this test could be SO contradictory to my home test results. I realize that I am using a human meter (ReliOn Prime currently, had been using a ReliOn Micro for a while before that) and that there is some degree of variation between the meter reading and the real number, but I read posts from a lot of you back when I first started and I know that it's not going to give me readings in the 100's and 200's if the real numbers are 400's or 500's, which I'm assuming is what this fructosamine result is suggesting.

Honestly, I don't really trust this vet because she had my mom dosing 6 units (6 UNITS!!!) and argued with me about reducing the dose when the cat stopped eating and drinking, despite the fact I meter tested him and got a 34! (Mom's cat died that week, btw.) And, the initial dose she told me to shoot back when Hannah was first diagnosed was 3 units, which I am convinced would have killed her. I know I should switch vets and get a second opinion, but I have limited funds (especially after shelling out $155 yesterday for this appointment) and I wouldn't even know how to go about finding a vet that actually knows something about diabetic cats. Thankfully, she did allow me to take a new vial of Vetsulin with me at yesterday's appointment, so if I do want to make a move, I have enough insulin to last me a while.

The vet wants me to call back on Monday to schedule another appointment for us to talk about how I am going to get Hannah regulated, but I just have a hard time believing she's not. Does anyone here do home testing and regular fructosamine tests? Anyone get odd results? Any ideas why my cat's result could be so off? I tried searching the internet for info on false high fructosamine results, but couldn't find anything so I'm stumped. I'd love some opinions.
 
I would be curious to know what the number is. I know that this is from the Lantus forum, but I don't think the regulation information is Lantus/Levemir specific.
Q6.1. What is regulation?

A6.1. There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum":
  • Not treated [blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs]
  • Treated but not regulated [often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs]
  • Regulated [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia]
  • Well regulated [generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia]
  • Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin]
  • Normalized [60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin]
There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated.

Based upon the limited numbers you have provided, according to this, she could be considered regulated, depending on the nadir numbers.

If you could create a spreadsheet with her numbers, others might be able to provide more information.
 
Typically it's said that fructosamine tests are a waste of time/$ if you're home testing. I had a vet tell me Luna was in remission and to stop giving insulin after a fructosamine test, and we took her to another vet to make sure and he was like "uhh no" and her BG was 380+ that day at the 2nd vet.
 
I'm also dubious about the Fructosamine test as well. The first one we had done on Morrigan was "poor control" of course because she wasn't on insulin.
The 2nd one came back as "good control" though her numbers were still high.
The 3rd came back as "poor control" in spite of her home numbers being as seemingly stable as the 2nd test and even lower than the 2nd.

I don't get it either but, if you're unsure...you might want to have another vet's opinion by getting the fructosamine level (just done) value and taking it with your SS numbers as well as a curve (even a 12 hr curve). Then, you can see where you wish to place your trust.

I know this is hard as I'm in the same boat and wondering. :(
 
Unless I'm mistaken the fructo test won't show anything home-testing doesn't show (in fact it's more or less an AVG of BG's over a few week period I believe). In that essence home-testing is more accurate.
 
Oh Jennifer you are NOT alone by any means. I won't get into details again but here is a link to a previous thread I started because I had exactly the opposite problem......high numbers but well regulated according to the fructosamine!? o_O:banghead: The fructosamine should not be run in isolation. There are several other blood factors (hematocrit, globulin etc. that can and will alter the results so unless a complete blood panel is run along with the fructosamine, I personally think it's a waste of time and money. I also don't see the value if you are doing daily reading at home.
 
I have to be honest here ... I see little value in any in-clinic monitoring of a diabetic cat's blood glucose unless:

- The kitty's bean really & truly cannot manage home BG testing (this does happen sometimes, unfortunately) and/or
- There is some type of additional disease process (a complication in the case) that would require such in-clinic monitoring.

The reason I say this? Because so many cats are known to spike much, much higher BG results due to the stress of being in a veterinary office.
(Why some vets don't seem to realize this is beyond me.o_O)

So unless either of the situations noted above is a reality, the only true "value" of in-clinic monitoring goes to the vet: Extra $$$!;)
 
About the ONLY thing that I can say about this Fructosamine Test is that it's allegedly like the human A1C that human diabetics go through with their docs to get a gauge on how well the diabetes is being managed (food, meds or insulin regulated). It's allegedly, a measure of 2 to 3 month's worth of regulation that they're getting to go by.
In a Fructosamine level, it measures the previous 2 weeks so, if your cat's numbers were wonky over the previous 2 weeks, that will allegedly show up on that test...which does NOT apparently (so I am told) change with stress levels as it uses some other component to judge that by???

I don't know what to think or say because hubby's home numbers on his diabetes (Type 2, diet controlled), are not wonderful...but, his A1C numbers are "excellent control" levels and THAT is what his doctor goes by.

So...what to believe???

ETA: Given all of the debate about the accuracy of our home meters and the debates about the human meters not measuring accurately (reading lower than pet meters etc.), I'm wondering which is best? We are told that the home monitoring is *NOT* meant to be "true values" as much as they are simply "guides" so, given that variable...are our meters just "trends" and the Fructosamine Levels more accurate? I don't know the answer to that. Just posting my confusion over it all too.
 
Fructosamine is measuring a glycated protein in the blood. It is not measuring glucose and the results of this particular test will not be affected by a cat's stress reaction at the vet. This protein level is something that waxes and wanes each day depending on the level of control being maintained so what you should end up with is a picture of the glucose control over the period of approx. the previous two weeks. I'm skeptical to it having any value whatsoever unless someone is not monitoring at home. This is one tool, accurate or not, and certainly should not be used in isolation to determine if a dose increase or decrease is warranted.
 
MrWorfMen's Mom said:
The fructosamine should not be run in isolation. There are several other blood factors (hematocrit, globulin etc. that can and will alter the results
Click to expand...
OK, so Wikipedia isn't the gold standard for 100% accurate articles but when researching new stuff I often find it helpful as a springboard. The Wikipedia article on fructosamine (which focuses on human diabetes, granted) doesn't exactly have a glowing review of its significance as a diagnostic tool, and concludes that it is "of limited clinical value."


Mogs
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The fructosamine test can be of limited value, especially in newly diagnosed diabetics to make sure that a one time high number at the vets is backed up by a high "average" for the last few weeks at home....other than that, it's a fairly useless test if you're home monitoring.

Yes, it can tell you the "average" for the last few weeks...what it can't tell you is if your kitty is going from 400 to 40 and back to 400 again in one cycle

The numbers on the fructosamine are also very different from our home glucose test numbers....and even these values are different depending on where you look!! Here's one set of numbers that show you how different the numbers are from home testing numbers

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
 
Chris & China said:
The fructosamine test can be of limited value, especially in newly diagnosed diabetics to make sure that a one time high number at the vets is backed up by a high "average" for the last few weeks at home....other than that, it's a fairly useless test if you're home monitoring. Yes, it can tell you the "average" for the last few weeks...what it can't tell you is if your kitty is going from 400 to 40 and back to 400 again in one cycle. The numbers on the fructosamine are also very different from our home glucose test numbers....and even these values are different depending on where you look!!
Click to expand...
@Chris & China - Thanks for providing those two fructosamine ranges. (Which leads me to say: Eye-yi-yi :facepalm:... and HOORAY for home monitoring!:))
 
You're very welcome!! I think most people don't understand that the fructosamine results are SO different from our home testing results so they see a fructosamine result of 400 and think "but my cat's always in great numbers at home!...that makes no sense!!"

There's nothing like throwing a totally different scale out there to further confuse us poor beans, is there?;)
 
Rhonda & Chris - Thank you for the charts - I had found something similar on the internet, but those help clarify.
Larry - No number to post yet. All the vet told me in the message was "poorly regulated" and that she was going out of town for the weekend.
To all who concurred that the fructosamine test seems irrelevant when home testing - THANK YOU! This vet doesn't seem to have any other patients who home test so, to her, the fructosamine test is the Holy Grail...

Well, it sounds like I'm not the only one who has gotten contradictory results using this test, so I feel somewhat better. I know my cat and I can usually tell just by how she acts (how much she eats, sleeps, pees, and her general demeanor) if she's having an "off" day, which is usually confirmed by the meter. I plan to do a couple of full BG curves over the next few days to try and catch her nadir a few times. I think you all confirmed what I already knew, which is that it's time to look for a new vet who believes in home testing as much as I do. Thanks everyone for your input!
 
Louellen said:
I'm also dubious about the Fructosamine test as well. The first one we had done on Morrigan was "poor control" of course because she wasn't on insulin.
The 2nd one came back as "good control" though her numbers were still high.
The 3rd came back as "poor control" in spite of her home numbers being as seemingly stable as the 2nd test and even lower than the 2nd.

I don't get it either but, if you're unsure...you might want to have another vet's opinion by getting the fructosamine level (just done) value and taking it with your SS numbers as well as a curve (even a 12 hr curve). Then, you can see where you wish to place your trust.

I know this is hard as I'm in the same boat and wondering. :(
Click to expand...
Jennifer and Hannah said:
Rhonda & Chris - Thank you for the charts - I had found something similar on the internet, but those help clarify.
Larry - No number to post yet. All the vet told me in the message was "poorly regulated" and that she was going out of town for the weekend.
To all who concurred that the fructosamine test seems irrelevant when home testing - THANK YOU! This vet doesn't seem to have any other patients who home test so, to her, the fructosamine test is the Holy Grail...

Well, it sounds like I'm not the only one who has gotten contradictory results using this test, so I feel somewhat better. I know my cat and I can usually tell just by how she acts (how much she eats, sleeps, pees, and her general demeanor) if she's having an "off" day, which is usually confirmed by the meter. I plan to do a couple of full BG curves over the next few days to try and catch her nadir a few times. I think you all confirmed what I already knew, which is that it's time to look for a new vet who believes in home testing as much as I do. Thanks everyone for your input!
Click to expand...

We had a strange experience too. The last vet decided that Oliver didn't have diabetes because his fructosamine test came back at 127 - it worried me that it was so low. But he had all these clinical symptoms and she was going to give him dexamethasone pills to see if they helped his neuropathy. If they did, she would think it was a spine disorder and we would have been heading for an MRI. She never re-did the basic blood screen because he had one at his physical in mid-June when glucose was 200+ but she thought it was stress. But I thought then that the fructosamine test was the definitive test for diabetes. But now I now that's not so.
 
Actually in your case @PeggyS-bb it sounds like the fructosamine did one of the few things it IS good for...if his BG was 200+ in the office, that could have been due to the stress of being at the vet, but if the fructosamine came back as normal, then over the past several weeks (when he was home and just being a cat) his BG was probably fine!
 
That, Chris & China, is the weird thing. Because when the new vet did the regular blood test he was over 400, so the fructosamine is not always definitive after all. He had all the clinical symptoms though with the neuropathy getting worse.
 
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