Newly diagnosed-need help with Portia

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portiarita

Member Since 2013
Hello,
I posted a week back regarding Portia's urine glucose being high. The vet checked her BG last friday and it was normal (130) so we ran a fructosamine as well and that was elevated. That coupled with her 3+ glucose in her urine (urinalysis performed at the vet), suggests that she is in fact diabetic even though her BG reading was normal. The vet has recommended we run a 12 hour glucose curve and has ordered a pet glucometer for me. It was really expensive $188 but its probably worth it right? Have any of you seen this where the BG is normal but fructosamine and urine glucose are elevated? Portia is also back to peeing her normal(2x daily instead of 3x daily which is what prompted my concern) amount since last week so not sure what to make of this situation.

I'm new to this and am not even sure what to ask help with! She also has pancreatitis and has had it since last december. She's on a host of medication to treat her pancreatitis listed below. In addition she is getting hills Z/D, which I've been told is high in carbs. I suppose any input on what I should do will be greatly appreciated.

Prednisolone 2.5mg BID
Metronidazole 62.5mg BID
Ondansetron 1mg BID
Pepcid 2.5mg BID
Ursodiol 50mg SID
Miralax 1/4tsp am and 1/8tsp pm
Buprenorphine as needed but usually 0.2ml BID
Cyproheptadine 1/8 tab every 4 days

I suppose the first thing would be to start tapering her pred ?

Thanks for your help
Rita
 
Can't help with the rest of it but hate to tell you this but a pet only glucometer is completely unnecessary they just read slightly difference. Not only are they grossly over priced the test strips are expensive and only available from your vet or online. Not real convenient if you run out at night or on a holiday.

Most of us here just use human meters. Walmart has a nice little meter for about $20 called the Relion Micro that I can personally vouch for as I use it for my own two sugarcats.

Don't know if you can but I would tell your vet you don't want the pet only glucometer.

Mel, Maxwell, Autumn and The Fur Gang
 
The Prednisolone is likely causing the problem. I would start tapering it if your vet agrees.
I second that the pet meter is not necessary and is very expensive.
 
Ok. I just emailed my vet about holding off on the pet only glucometer. I think she said it might be accucheck or something like that. If I dont hear back, Ill call them tomorrow and ask. Thanks for the heads-up about the meters.One question I have is do that human meters need to be calibrated or are measuring cat and human glucose the same. Also, how much blood do you need for the human meters (relion for eg.). Would the cat meters need much less blood?
Rita
 
Pet specific meters may or may not take more blood than the ReliOn Confirm (aka Arkray Glucocard 01 at our shopping partner ADW), which only takes .3 (Prime takes .5)

Human meters will read on a slightly different scale than her lab instrumets. Its like reading temperature in Celcius vs Fahrenheit. Once you have reference values for understanding the numbers, it isn't a problem.

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- If on insulin, treat as if HYPO
- If on insulin, and at nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.
- If not on insulin, can be normal number.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If on insulin and before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- If on insulin and at nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

= 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- no shot limit for ProZinc, PZI, or other non-depot insulins

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 240 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak} - Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine. (Merck Veterinary Manual gives 240 mg/dL for cats, using a lab)
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mg/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Nope you don't need to calibrate the human meters but they do read slightly lower than a pet only one. normal for a cat on a human meter is between 40 & 120 and normal on a pet only meter is between 70 & 150 And from what I've heard is that the pet only meter takes MORE blood than the Relion Micro that I use. I know mine takes a drop about the size of a pencil point. And 50 strips run me $20 as opposed to over a dollar each for the Alphatrak which is probably the one your vet ordered.

Mel, Maxwell, Autumn and The Fur Gang
 
Wow! Thank you so much for that detailed message about the glucose levels. That will definitely come in handy if she needs insulin. Im still not completely familiar with the terms like nadir for insulin,etc. although I can sort of figure it out based on the context. I will probably need a little more help if it comes down to it but this is a great start. Thank you so much!

Im surprised to hear that pet glucometers need more blood than human ones!! Go figure! Ill def bring this up with my vet. Expense is a huge problem now since Portia's vet bills till date exceed 10K in less than a year. So saving every penny is important. Thank you so much for this information.

Rita
 
If you pop over to our shopping partner ADW, the Glucocard 01 is the same thing as the ReliOn Confirm, which many of us have used. If you can, buying the strips in bulk can get you free shipping.
 
Nadir simply means the lowest point in the cycle. There are two cycles in a 24 hour period. A cycle is the 12 hours between shots.

Mel, Maxwell, Autumn and The Fur Gang
 
I see. So insulin is usually given twice a day. Is this for all types of insulin? Also, what does tight regulation mean?
Rita
 
In cats yes all insulin is given at least twice a day 12 hours apart. There are some insulins that may have to be given more often than twice a day although they aren't well liked around here because they tend to be too harsh and wear off too quickly.

The reason for the twice a day is because cats have a fast metabolic rate and metabolise insulin twice as fast as either humans or dogs.

Tight Regulation is a specific protocol used with the depot insulins Lantus and Levemir. There are two different protocols one is Tight Regulation the other is Start Low, Go Slow. The difference between the two is the amount of daily testing, the length of time a dose is held and the target range of where we try to hold the BGs.

Some cats do better on one or the other as well as some care givers real life time commitments fit better on one or the other. Otherwise they are pretty equal. Both aim for regulation with a hope of remission while keeping the cat safe on insulin.

Personally I follow the Start Low, Go Slow since both of mine were adopted as diabetics and I have limited time to test and monitor. So the SLGS gives my insulin dependent one more wiggle room before dropping into hypo range.

Mel, Maxwell, Autumn and The Fur Gang
 
Hello and welcome to the board!

The vet probably recommended the alphatrak. It would be cheaper and almost as good to get a human meter. Shopping list below .

It would be good to taper off the steroids if you can. Also I would look into changing her food if thats possible - z/d is too high in carbs at 34%.. diabetic cats need less than 10% but I don't know if thats possible with her IBD. If you do change food you need to take it slow. Many of us use Fancy feast classic pates, friskies pates or wellness grain free canned foods.

The insulins we recommend- Lantus, Levemir and Prozinc are dosed every 12 hours. You want one of those. (there are some other insulins that can be dosed more often but are too harsh on cats or are for expert use)

Wendy

Getting started shopping list
1. Meter ie Walmart Relion Confirm or Micro.
2. Matching strips
3. Lancets - little sticks to poke the ear to get blood . new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed. Optional - lancing tool.
4. Cotton balls to stem the blood
5. Neosporin or Polysporin ointment with pain relief to heal the wound
6. Mini flashlight (optional) - useful to help see the ear veins in dark cats, and to press against
7. Ketone urine test strips ie ketodiastix - Important to check ketones when blood is high
8. Sharps container - to dispose of waste syringes and lancets.
9. Treats for the cat - like freeze dried chicken
10. Karo syrup/corn syrup or honey if you dont have it at home - for hypo emergencies to bring blood sugar up fast
11. A couple of cans of fancy feast gravy lovers or other high carb gravy food- for hypo emergencies to bring blood sugar up fast
 
Hi Wendy and Mel,
Thank you for your responses. I asked my vet about getting a human meter and she said for right now, she would prefer I use what they use which is AccuCheck not the alphatrek. I looked up some links on FDMB about glucometers and accucheck was listed as one of the top glucometers by consumer reports. What are your thoughts on Accu Check? Of course,I would much rather use the human one since that appears to be so much cheaper but for now, I will use the accucheck because I dont want to antagonize the vet or make her feel like she wont be able to interpret the glucose readings. She was however open the possibility of at some point trying out human meters.

@Wendy, thank you for listing all the things I need to buy. Im not sure we need insulin as yet. My vet wants to do a glucose curve fist before deciding the course of action . We are waiting for the glucometer to come in to try this. But if we do need insulin, I will be sure to buy the stuff you listed.

I also some links on lancets and it looks like the pen might be the best one for me since it does the poking for you. Is that what most people on this group use? Also do glucometers come with their on lancets?

Thanks for your help
Rita
 
As far as I know and I'm sure someone will correct me if not. The accuchek is a human meter.

Mel, Maxwell, Autumn and The Fur Gang
 
Just checked both with a friend that is a human diabetic and the Accuchek website. It is a HUMAN meter and runs about $18.00 @Walmart although the test strips are more expensive than the Relion

Mel, Maxwell, Autumn and The Fur Gang
 
Mel is right - the accuchek is a human meter - its fine to use -just a bit more expensive than the relion.

A vet "curve" is where they keep the cat at the vet for a day and inject insulin and test to see the reaction ..and so judge the dose of insulin to give. The issue with this is that many cats are stressed at the vet and so their blood sugar is high due to stress. Thats means the vet needs to give them more insulin to compensate. But when the cat comes home stress drops .. and the insulin dose recommended was too high .. and the cat has a hypo. We see that a lot!
You are more than welcome to spend the money doing this curve, but i would not start her on more than 1 unit no matter what the vet prescribes as a result of the curve. You can work dose up slowly and safely instead. Ask the vet what insulin they plan to use and Make sure its Lantus, Levemir or prozinc. You don't want humalin or vetsulin - they don't work well in cats.

Its up to you to use the lancet pen or the lancet on its own. If you don't have success with the pen then you might have more control just using the lancet. Also some cats don't like the clicking noise of the pen either. I didn't like the pen cos I couldnt see what I was doing. test tips: https://docs.google.com/document/d/13c_CPZVKz27fD_6aVbsguadJKvjSrSAkD7flgPPhEag/pub

it would be good to get a couple of tests before she starts insulin - baseline data - especially if you are changing food or reducing the steroids as it could already be bringing her down...

Wendy
 
Hmm.. That's strange about the accucheck. My vet specifically mentioned that it was calibrated for animals and required very little blood. Maybe she got the name wrong( ?)

I'm going to be doing the glucose curve at home and as of now my vet hasnt prescribed any insulin yet. Since Portia had a normal BG rreading last week at the vet, I think she just wants to make sure that Portia actually requires insulin. So as far as I know, the plan is to do a glucose curve at home with no insulin, see where her glucose readings are and then decide on a plan of action. If she does need insulin, then Ill talk to her about Lantus since I've seen a lot of people use that. That's the long-lasting depot insulin right?

Thanks for the tip about the pen. I dint realize it clicks. I wonder if the vet has ordered a lancet along with the glucometer since she said the total for the kit was $188!!!!

Rita
 
Not to bash your vet but I would seriously be questioning why you are being charged $188 for an $18 dollar meter and why it needed to be ordered when it is readily availableat any pharmacy the sells glucometers. My vet also uses the human Accuchek but she and just ran side by side tests with my Relion and my Contour and all 3 came in within a few points of each other.

Mel, Maxwell, Autumn and The Fur Gang
 
There are two pet only meters...the Alphatrak and the Ipet. If it isn't one of those its a human meter which would mean the high end of normal for a cat is 120 although most nondiabetic cats run between 45 & 80 or at least my 12 civies and my diet controlled diabetic stay in that range.

Mel, Maxwell, Autumn and The Fur Gang
 
Now I'm really confused!! I love my vet and they really have been very good with Portia's illness over the last year. But you're right. I am wondering why the total was $188 if the meter costs $18????? I tried calling her earlier but she wasnt available and she just sent me an email about why she wanted the pet only meter and not the human one. Hmmmmm.

Maybe she meant alpha trak all along. It looks like those cost about $80 so maybe that + test strips +lancet adds up? Oh gosh!! I dont want to bother her too much but I do want to know what Im paying for!!!

Rita
 
Also, Portia's reading at the vet last week was 130 and the vet said that was normal. So I'm guessing she wasnt using a human meter if the upper range of normal on human meters is 120 for cats?
Rita
 
Its not a curve if you aren't giving insulin .. the "curve" refers to insulins action to pull the blood sugar down over the day. It sounds like the vet just wants to see how the blood sugar is at home.. the only variance you will see will really be in relation to food.

130 is low for the vets without insulin - normal cats are 50-130. I am wondering if the vet is thinking she is in remission. When you get the meter we will see!

Wendy
 
That's were I'm confused as well because a 130 fasting reading on a human meter might explain why she showed sugar in her urine on a dip stick test since those read from when the bladder was last emptied. And would be considered boardline or prediabetic by most vets. But that's a human meter. So I'm as confused as you are. Guess we'll both know when the meter gets here.

Mel, Maxwell, Autumn and The Fur Gang
 
Hi Rita,

I'm a 38 year insulin dependent diabetic who also has 6 diabetic cats that I am caring for. 4 are on insulin and two are in remission.

I use the AccuCheck Nano for all of us. I don't have to worry about the cost of strips since I am covered by prescription and insurance. If I had to pay for strips myself, I would use the Relion Micro or Confirm. Strips are much less expensive than either AccuCheck or AlphaTrac.

AlphaTrac is made by Abbott who also makes the Freestyle meter. They have sold the technology to vets for a premium, and it kind of annoys me. Care for our diabetic felines is expensive enough without a company charging 3x as much for the meter and the strips. Now off my soap box.

The Relion is an excellent meter and well rated by Consumer Reports. It will stand you in good stead. And, I've yet to figure out the difference between human and feline blood. Blood is blood according to my old biology texts.

All the best to you and Portia.

Claudia
 
Hi Mel and Wendy,
I emailed the vet about the meter again and she said she got the name wrong but basically its the alphatrak. That explains why a BG of 130 at the vet was considered normal and why we were wondering why her fructosamine was 666 and her urine glucose is 3+ despite BG being normal. I guess thats why she wants me to test glucose at home to see whats going on!! Im waiting for the instrument to come in (which will hopefully be early this week (?)) and will post as soon as I get the results.
Rita
 
Hi Claudia,
Hats off to you for dealing with so many inslin dependent cats. I just have one that may or may not need it and Im already stressed out like crazy!!!

The vet prefers that I start off with alpha trak since thats what shes used to so I dont want to fight her too hard. However, I think I will eventually switch over to a human meter because of the cost of the strips. Good to know that everyone likes Reli On. That sounds like the most widely used one. Thanks for information.

Rita
 
That makes more sense! Ok let us know when you get the meter. Meanwhile you can start preparing her for testing. Spend a few times a day rubbing her ears to get them warm, followed by a treat.

Wendy
 
Hi Rita and sugarkitty Portia and welcome to the FDMB.

I started out using the Alphatrak 2 meter, pet specific meter, because that is what the cat shelter provided when I first started fostering Wink. Then they complained about testing too much and the cost so I bought the Relion Confirm which costs 1/3 the price for the test strips and 1/12th of the price for the meter in comparison to the Alphatrak meter. DCIN has tons of donated Alphatrak meters they can not give away because of the cost of the test strips which are very pricey. Human meters are accurate enough. They are a great way to save money over the cost of a pet specific meter.

If you have not started the insulin yet, and I don't see that you have, a diet change could help. I realize that you are dealing with multiple health issues, the pancreatitis being one of them and a diet change may not be possible. Pancreatitis is painful and can raise the BG (blood glucose) levels so until the pancreatitis flare is passed, the BG's will be elevated.

You can try to taper the pred, but sometimes you need to prioritize the illnesses and treat the most serious one and work around the other conditions. What I mean is, she may need to stay on the pred to help with the pancreatitis and you dose the insulin to compensate for the side effects of the pred, one of the side effects being the higher glucose levels.
 
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