?? Possible remission/mis-diagnosed?

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Rascal and Jenni

Member Since 2016
Hello! I'm very confused right now and hoping for some insight from the more experienced. :) Last Friday my cat went to the vet because he has a urinary tract infection. They diagnosed him as diabetic as well due to high blood glucose. I don't know the exact number, the vet didn't share it with me. The vet wanted to start him on insulin right away, but I decided to hold off and over the weekend I switched him to Fancy Feast - I didn't do a gradual transition, just took away his old dry food and feed him only the new stuff.

He adjusted well, no vomiting or diarrhea, so I prepared to start the insulin and home monitoring. I bought a meter (ReliOn Comfort Micro) and read up on the ear "sweet spot" - this forum was a great resource and I felt pretty confident I could handle it.

Yesterday I happened to be home at noon, so I tested him and it was 220 mg/dL. This was 6 hours after he ate, I currently feed him one 3 ounce can twice a day at 6 am & 6 p.m. because my work days are 10 hours long. Last night I fed him at 6 then tested at 6:20 - it was 53. This morning I fed him at 6 then tested at 6:15 - it was 92.

I called the vet and he goes in tomorrow afternoon so they can test with their own meter. They want me to bring mine so we can compare. I'm too continue not giving insulin until then. I plan on testing him tonight about 4 hours or so after he eats to see what it is then.

He is on an antibiotic for the infection. Is it possible he's pre-diabetic and the high BG is from the infection? Or he has slight diabetes that possibly could be controlled with multiple small meals throughout the day?
 
Sometimes just the removal of hard food and the clearing up of an infection/inflammation can reverse symptoms of diabetes. Your cat is still likely diabetic if he is throwing numbers like that and I'd encourage continuing the new low carb wet diet, but it sounds like he might be one to be diet controlled easily :)
 
Rascal and Jenni said:
I called the vet and he goes in tomorrow afternoon so they can test with their own meter. They want me to bring mine so we can compare.
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Just to forewarn you the human meter and the vet meter will likely not have the same number. If the vet is using an Alphatrak it will read higher, usually, than the human meter.
A lot of us use the human meters because the strips are so much cheaper, and the protocols for dosing are based on human meters (though we also have members like Mogs above, who use the alphatrak pet meter), there are compensations in place for those that use alphatrak.

Some members use both, by that I mean, they use the human regularly, but use the alphatrak if the vet requests a curve or specific number, really just to keep the vet happy as they are more comfortable with the numbers.

My vet suggested that I use a human meter as the pet meter strips would be too expensive.:)
 
@Critter Mom
1. Friday was the first day I noticed symptoms, but as I worked a 10 hour day Thursday I want sure how much he used his box that day.

2. I'm not sure but I'll ask them tomorrow.

@Gill & George Thanks, that's good to know! I tested it on myself to figure out how it worked and mine was right at what it's been when they test us at work so I'm pretty sure it's good.
 
Rascal and Jenni said:
Thanks, that's good to know! I tested it on myself to figure out how it worked and mine was right at what it's been when they test us at work so I'm pretty sure it's good.
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I should have said the difference between the human and pet meters is that the pet meters are calibrated for feline blood, the human ones for human blood (obviously) so that's why you'll get the discrepancy between the human and pet meters, but from a practical day to day monitoring point of view it doesn't matter, because we just make allowances for this and really what we look for are trends and patterns to help us decide on dosing. The important thing is to pick one and stick with it.

Your vet may well try to convince you to use a pet meter, but just wanted you to be aware of the cost implication, at a dollar a strip (I think that's what the cost in the US) if you test frequently it can end up being pricey.:)
 
Yep it is about 1$ or more per strip. The freestyle strips made by abbot are about 1/2 the price and side by side is spot on or within 10 fro my experience.
Good luck :bighug:
 
Gill & George said:
Just to forewarn you the human meter and the vet meter will likely not have the same number. If the vet is using an Alphatrak it will read higher, usually, than the human meter.
A lot of us use the human meters because the strips are so much cheaper, and the protocols for dosing are based on human meters (though we also have members like Mogs above, who use the alphatrak pet meter), there are compensations in place for those that use alphatrak.

Some members use both, by that I mean, they use the human regularly, but use the alphatrak if the vet requests a curve or specific number, really just to keep the vet happy as they are more comfortable with the numbers.

My vet suggested that I use a human meter as the pet meter strips would be too expensive.:)
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My few pennies in here:
I use AlphaTrak and had used a few human meters and from my experience I could say that human meters gave me different readings but one of them which is Accucheck Aviva Nano gave me a very close reading to AlphaTrak on low numbers but was reading lower on high numbers (which really does not matter that much).
Marlena
 
His vet appointment was at 4 yesterday afternoon. We live in the country so it was a 45 minute drive and he hates car rides. The clinic also uses a human meter (she didn't tell me which one), and it read 230 compared to 207 on mine. The vet had the day off, so they are going to call today once she has a chance to look things over.

I tested him again last night, 3 hours after he ate dinner, and his BG was 60. This weekend I plan to do a glucose curve. Then I'm thinking I'll set up a feeding schedule based on the results. I have an automatic feeder that has 2 compartments, so I can set it to feed him while I'm at work. Since it's canned food, should I put an ice pack under it or something? I'm not sure how long it can sit out before it starts to go bad.
 
Hi Jenni

Has anyone given you the instructions for the ss it's quite easy to set up but if you run into problems just give us a shout someone will be able to help you with that.

It's a great tool to record monitor BG levels, I find it useful as with it's colour coding it helps you to easily see trends and that has helped me when trying to devise a feeding schedule for George.

The auto feeder is a great idea. I haven't been bothering with an ice pack at the moment as it's fairly cool in my house and I am not gone all day. Some folk use icepacks others divide the food into meal portions an freeze them to keep them fresher.

Funny that your vet is using a human meter, at least there's no problem there, I can empathize with the long drive in to see the vet, we are in the country too and BFG hates travelling. The difference between the two readings is within the 20% meter variance so essentially the same. Getting the curve done at home will save on money and stress for rascal (the readings at the vet's office may have been elevated due to stress, George's goes up by 100pts at the vets take a look at my ss you'll see that happen on Tuesday)

It seems like the readings you have been getting are all quite normal at the moment, I take it you are still not using any insulin??
If you are not giving insulin it might be that the diet change and the UTI clearing up has seen him regain gylycaemic control. :):)
I would continue to keep rascal on a low carb wet diet though even if it turns out that he is ok a return to dry and higher carbs could see his blood sugars go up again.
All seems like good news for Rascal:):)
 
Thanks for all the insight and help! I finally got his ss going. I'm running the glucose curve today so we'll see what it shows. Interestingly his BG was 64 before breakfast this morning.

@Gill & George I do plan to keep him on the new diet. Freezing portions is a good idea! He hasn't gotten any insulin at all since Dx. Originally the vet was upset with me about that (she had wanted me to start it the day he was Dx'ed) but she's come around. And I'm glad I went with my gut instinct and tried the diet change first.
 
Rascal and Jenni said:
I'm glad I went with my gut instinct and tried the diet change first.
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Smart move. Looks really encouraging to see how good Rascal's numbers are after eating.

How often do you feed Rascal? If he goes for several hours between feeds it might be worth checking how his numbers vary the longer he goes without food. This would enable you to establish that he doesn't have any problems with impaired fasting glucose levels. In cats who have this impairment there's a mismatch between the amount of basal insulin secreted by the pancreas and the amount of glucose released by the liver between meals. This can result in blood sugar levels rising too high. Once the cat eats the numbers can then drop down again in response to the mealtime (bolus) insulin pulses produced by the pancreas in response to the incoming food.


Mogs
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That was a good move going with your gut. The results of the curve were interesting. Rascals numbers are certainly promising, I hope he is one of the lucky kitties to become diet controlled with just a diet change.
Small regular meals throughout the day may be easier on his pancreas and keep his BG more level, at least thtat's what is generally found with diabetic kitties that are going into remission.
 
Gill & George said:
Small regular meals throughout the day may be easier on his pancreas and keep his BG more level,
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This is good advice from Gill. A well-timed feeding schedule can do a great deal to improve regulation (on or off insulin).

Case in point: I wanted to put Saoirse back on a daily maintenance microdose of insulin even though she had formally achieved remission because her pancreas became more irritable digestion-wise after her Lantus treatment was suspended. For various infuriating reasons too long to go into here I could not get support for this from the vets because a specialist to whom she was referred for something else completely stuck her nose in where it was neither wanted nor asked for and, due to her lack of knowledge of the properties of longer-acting, gentler insulins she made it impossible for our own vets to issue and Rx for the Lantus. :mad: Through a highly controlled feeding schedule I managed to keep Saoirse within the normal range for several months senza insulin (although her numbers did drift up to the top end of the normoglycaemic range the longer she went without the insulin support). When Saoirse finally fell out of remission her numbers deteriorated fairly rapidly and I only had to wait a few days before securing a Lantus Rx from our vets. Were it not for the controlled feeding she might have spent several months just below the renal threshold before they would be able to issue the Rx and that would have done her little body no favours whatsoever. As it was, sitting in the high end of the normal range for a significant period didn't exactly help her either. :(

Be sure to keep us updated with developments, Jenni! :)


Mogs
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BG raises in response to pain, fear or infection in every creature, including people, whether or not they are diabetic. In fact, being able to test BG has been a great help in the care of all my cats, whether civvie or diabetic.

I highly doubt that Rascal is in fact a diabetic cat. I think he had a UTI that raised his BG. However, it is awesome that you now have him on a more appropriate diet, and that you know how to use this tool to monitor his health.
 
Critter Mom said:
Through a highly controlled feeding schedule I managed to keep Saoirse within the normal range for several months
.
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I just spoke with the vet about the results of the curve, and now she says his BG is too low. She wants me to bring him in so they can do a curve and also run the fructosamine. While I'd like to do the second I'm not sure what is to be gained from the curve. I already know the numbers will be higher and I feel like my home test is a better baseline. Plus money is tight for us and I've already paid $300 so far, including a bottle of now unnecessary insulin. Other than the 43, is his BG too low? I thought 50 was the bottom normal, and 135 for the top. Wouldn't that also depend on the reader?

For maintenance, how often would you suggest testing? I was thinking once a month as long as he stays in the normal range.

One thing I forgot to mention from the original vet visit for the UTI is his phosphorus was low. The vet said they'd been getting a lot of low readings so she was thinking the machine wasn't working correctly.
 
First up, the home meters are only accurate to within +/-20% so that human meter reading of 43 +20% would be about 50. I've read here that some cats not on insulin may get numbers in the 40s. (@Chris & China - can you add more about this?)

All of Rascal's numbers look fine: the only spikes are when there's a vet visit involved.


Mogs
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Take a look at Ivanas ss she's thrown some numbers in the 40's when on her of the juice trial.

The following is from the TR protocol
Phase 5: Remission
14 days without insulin and normal blood glucose values. Most remission cats are able to stay in the normal range all of the time (50 to 80 mg/dl), although there are a few cases of sporadic higher and lower BGs. Don't stop feeding low-carb and try to avoid cortisone if possible. Test the cat's BGs once per month.

Approximately 25% cats that achieved remission using this protocol relapsed and required insulin again (frequent causes are hyperthyroidism or bouts of pancreatitis). Therefore, it is important to keep your diabetes kit up-to-date. Then you can react immediately by giving insulin and home testing. Importantly, the sooner you react to a relapse (i.e. preventing hyperglycemia and initiating other necessary veterinary treatment), the more likely a second remission will become.

The longer a cat has had diabetes, the less likely it will go into remission. Many long-term diabetics get stuck in Phase 3 or 4. Yet there is a benefit of using this method for such a cat as well: keeping the cat's BG levels as normal as possible is much healthier for it long term. Insulin requirements will often decrease to very low levels too.

A vet who is not used to clients home testing is unlikely to see these sorts of numbers in a curve, due to vet stress, and a 50 on a human meter would roughly equate to 68 on a pet meter.(this is the conversion we use for a reduction point when dosing lantus) So the numbers are probably not as low as your vet may think.

If Rascal aside from the UTI that has cleared up, is otherwise healthy, eating normally and no vomitting etc I would not bother with the vet curve there is no mileage in that, the one you have done at home will be a better reflection of what her BG is doing, the fructosamine will give you an idea of the BG for the last two-3 weeks I believe, so if it were me, I would continue to monitor at home for a bit, in effect, why don't you try doing an OTJ trial of sorts for 2 weeks? testing am and pm (12hours apart) and making sure you take up food 2 hours before you test, so that the test isn't food influenced.

These are the typical instructions for an OTJ trial

Start the trial on the next green pre shot.

If he/she is green at your normal test times, no need to test further until the next "PS" time; just feed small meals and go about your day. If he/she is blue at your normal "PS", feed a small meal and test again after about 3 or 4 hours. If his/her number is lower 3-4 hours after a meal, then the pancreas is working!

Post every day so we can monitor your progress and see if any tweaks are needed. He/she may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.
After 14 days of no insulin, we have a party!!

Sometimes the trial doesn't work the first time and we have to give a little more support in the form of resuming insulin. It's not the end of the world if that happens; we just give him/her the support needed. Our goal is a strong remission and it's better to take our time to get that than to rush into remission just to have it fail later on.

Good luck with the trial!!!

Once he/she is through the trial successfully, you enter a new phase. Your cat is still diabetic but has now become diet-controlled. Continue feeding low carb food in the manner successful for your kitty. If you decide to change his/her feeding schedule, let your meter be your guide to the best times to feed. Avoid medications with sugar in them and steroid medications unless they are medically essential. Continue testing blood glucose weekly for the first month and then monthly forever. It's a good idea to weigh him/her monthly. Weight should remain stable. If he/she seems "off" or sick, or is showing signs of diabetes (excessive drinking, eating, urinating, weight loss), test his/her blood glucose right away. Keep the teeth and gums clean and healthy; dental issues can bring a cat out of remission. If you see rising blood glucose numbers, it's time for a visit to the vet!

Would that make sense to you??

Or if the vets wants another curve, run another curve yourself. 12hrs testing every 2hrs or 18hrs testing every 3 hours, you can do this yourself I don't think there is anything to gain by the vet doing it. My vet actively suggested that I home test and run the curve at home as she felt the results at her office would be too skewed due to vet stress influencing the readings.
 
Those are totally normal non-diabetic numbers. My two civvies (who I test occasionally) usually run in the 40's and I've caught one who was in the high 30's one day

It looks like your kitty's blood glucose was only high due to the infection and now that it's cleared up and he's on a low carb diet, he's fine, but you'll want to continue testing occasionally to make sure he stays that way

There's absolutely nothing to be gained by having your vet do a curve other than to help pad his wallet. If you want to try to placate him, I'd do a curve at home and call with the results.

If you continue Rascal on a good low carb diet and test him occasionally, I wouldn't let your vet bully you into spending money on tests you don't need and can't afford.
 
I concur wholeheartedly with Chris' post above: you are well capable of home testing and the curve you run at home will provide far more reliable data than any vet-run curve. I offer the only two elevated blood glucose readings in your spreadsheet in support of this argument. :)


Mogs
.
 
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