Second opinion, high levels

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Mermelada & Andrea

Mermelada & Andrea

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Good morning! I’m back from the vet's office, where they performed blood tests including fructosamine and ultrasound. For this, I had to stop the insulin injections for 5 days because the vet said they needed the results to be accurate. I just received the results, and his glucose level was high at 502, and fructosamine was 573. The vet said everything else was fine, but I’m not clear on what these fructosamina high level mean for Mermelada. Tomorrow, he will start insulin again, and the vet recommended giving 1.5 or 2 U twice a day, but I’m not sure which dose to start with (she told me to choose one of those). She also asked me to switch her food to Purina DM dry. Is it good food? He is allergic with some types of food and I’m worry to switch and cause him a reaction, I’m from Mexico, and the options are very limited. I’ve checked the recommended list you have here, but many of the brands on it aren’t sold in Mexico. What should I expect? What do this elevated fructosamine level mean?
 
I've never heard of anyone having to stop insulin in order to do a fructosamine before, I never had to. The level just means he's diabetic, but your home testing already told you that.

PM dry is not a good food, it is too high in carbs for a diabetic cat., For diabetics, low carb wet or raw is best. Check out this food list, you want something under 10% carbs: MEXICO AND ARGENTINA FOOD CHARTS What food has he been eating? Dry food also means you are limited to following SLGS for dosing. What dosing method did you follow the first time?

How much does Mermelada weigh? That can be a factor in starting dose, depending on dosing method used.
 
Mermelada & Andrea said:
Good morning! I’m back from the vet's office, where they performed blood tests including fructosamine and ultrasound. For this, I had to stop the insulin injections for 5 days because the vet said they needed the results to be accurate. I just received the results, and his glucose level was high at 502, and fructosamine was 573. The vet said everything else was fine, but I’m not clear on what these fructosamina high level mean for Mermelada. Tomorrow, he will start insulin again, and the vet recommended giving 1.5 or 2 U twice a day, but I’m not sure which dose to start with (she told me to choose one of those). She also asked me to switch her food to Purina DM dry. Is it good food? He is allergic with some types of food and I’m worry to switch and cause him a reaction, I’m from Mexico, and the options are very limited. I’ve checked the recommended list you have here, but many of the brands on it aren’t sold in Mexico. What should I expect? What do this elevated fructosamine level mean?
Click to expand...

Welcome to FDF, Sorry to her Mermelada has such high BG, The recommendation to give Purina DM, is not a good idea, the high content of Carbs in this food, will hike up the BG more, diabetic cats need to have a diet of preferably wet cat food between 0-10% carbs, kibbles and the prescribed foo contains over 14-20% carbs, since you are in Mexico, I will not only post a few other members that might have a Food list from Mexico that will make more sense than the DM, also a member that is very knowledgeable in Glargine. We are here to help you in any concern you may have, thank you for creating the Spreadsheet, will you be home testing? I is very important to home test before each shot, you want to make sure Mermelada's Bg is not too low to give insulin, there are many sticky notes in the main forum with valuable information, you can use a human monitor and strips, they are inexpensive and reliable.:bighug:
:cat::cat:
@Bron and Sheba (GA)
@Diane Tyler's Mom GA
 
Wendy&Neko said:
I've never heard of anyone having to stop insulin in order to do a fructosamine before, I never had to. The level just means he's diabetic, but your home testing already told you that.

PM dry is not a good food, it is too high in carbs for a diabetic cat., For diabetics, low carb wet or raw is best. Check out this food list, you want something under 10% carbs: MEXICO AND ARGENTINA FOOD CHARTS What food has he been eating? Dry food also means you are limited to following SLGS for dosing. What dosing method did you follow the first time?

How much does Mermelada weigh? That can be a factor in starting dose, depending on dosing method used.
Click to expand...
Wendy&Neko said:
I've never heard of anyone having to stop insulin in order to do a fructosamine before, I never had to. The level just means he's diabetic, but your home testing already told you that.

PM dry is not a good food, it is too high in carbs for a diabetic cat., For diabetics, low carb wet or raw is best. Check out this food list, you want something under 10% carbs: MEXICO AND ARGENTINA FOOD CHARTS What food has he been eating? Dry food also means you are limited to following SLGS for dosing. What dosing method did you follow the first time?

How much does Mermelada weigh? That can be a factor in starting dose, depending on dosing method used.
Click to expand...
Thank you so so much, I got his dose from this forum back in 2020 since I couldn’t find a good vet (3 different ones and a lot of money spend) I started with 1.5 U twice a day and slow raised till 5U (vet advice) since he wasn’t getting good Numbers and was more than a month I suspected the insulin was damaged, vet didn’t believe me and wanted to still raise U so relied on my guts, bought new one and started with 2U, he got a hypo 3 days later, I managed to control and “magically” enter to remmision, I got track of all this in his spreadsheet.

While this I changed his food to Virbac Neutered & Entired and since we got the remission and didn’t affect his allergies I stayed with this food until now, only checking his blood a little bit but strict to diet, no treats, today the blood test showed he’s high on cholesterol too so I suspect it was the food who made him fail from remission, other than that the vet (new one) told me he is ok, only high on gluccose, fructosamine and cholesterol, so she recomend me to start insulin again and change diet to purina DM, this is a new vet suposed to be specialized on cats… the other vet who last treat him the first time and went to see a week ago gave me his glargine diluted with inyectable water wich of course didn’t help and wanted a second opinion

His weight is 11lbs, Tomorrow I’m starting the insulin again at 1.5 U and making his curve to see how his body respond, I’m so nervous because I can’t find a vet in my area who knows about cat diabetes

ps. Sorry for any misspelling I speak spanish
 
CORKY said:
Welcome to FDF, Sorry to her Mermelada has such high BG, The recommendation to give Purina DM, is not a good idea, the high content of Carbs in this food, will hike up the BG more, diabetic cats need to have a diet of preferably wet cat food between 0-10% carbs, kibbles and the prescribed foo contains over 14-20% carbs, since you are in Mexico, I will not only post a few other members that might have a Food list from Mexico that will make more sense than the DM, also a member that is very knowledgeable in Glargine. We are here to help you in any concern you may have, thank you for creating the Spreadsheet, will you be home testing? I is very important to home test before each shot, you want to make sure Mermelada's Bg is not too low to give insulin, there are many sticky notes in the main forum with valuable information, you can use a human monitor and strips, they are inexpensive and reliable.:bighug:
:cat::cat:
@Bron and Sheba (GA)
@Diane Tyler's Mom GA
Click to expand...

thank you so much for your repply, we are familiar with home testing, I’m kinda rusty because he was on remission since 2020, only testing him now and then with human meter
 
Mermelada & Andrea said:
the other vet who last treat him the first time and went to see a week ago gave me his glargine diluted with inyectable water wich of course didn’t help and wanted a second opinion
Click to expand...


Glargine (aka Lantus) is never ever diluted for either people or pets. Only use glargine if it's in the original manufacturer's container which is either a 10 ml bottle that looks like this or a 3 ml pen that looks like this.

Did the vet have any explanation for why the glargine was diluted?
 
Mermelada & Andrea said:
thank you so much for your repply, we are familiar with home testing, I’m kinda rusty because he was on remission since 2020, only testing him now and then with human meter
Click to expand...
Mermelada & Andrea said:
thank you so much for your repply, we are familiar with home testing, I’m kinda rusty because he was on remission since 2020, only testing him now and then with human meter
Click to expand...

good job, you got this!! Any other concerns you know we are here for you! :bighug::bighug::cat::cat:
 
The reason I asked about weight is because our TR dosing methodology has a starting dose based on weight, which would be 1.25 units.
Mermelada & Andrea said:
the blood test showed he’s high on cholesterol too so I suspect it was the food who made him fail from remission,
Click to expand...
It's unlikely that he could be on a food for 4 years and it take this long to turn him into a diabetic. High cholesterol is common enough with newly diagnosed diabetics. You could try the canned DM, but it's nothing special either. It is low enough in carbs, but many cats get tired of the taste.

It is really hard most places to get a vet who is really current on feline diabetes. My vet had more dog diabetic clients.
 
squeem3 said:
Glargine (aka Lantus) is never ever diluted for either people or pets. Only use glargine if it's in the original manufacturer's container which is either a 10 ml bottle that looks like this or a 3 ml pen that looks like this.

Did the vet have any explanation for why the glargine was diluted?
Click to expand...
His reason was that the syringes aren’t precise with low U’s, and since he needs between 1-2 U’s the risk range of hypo was higher so he made a diluted mix of 2ml of insulin with 13ml of inyectable water or NaCL
And with that mix, the risk range is wider
 
Bron and Sheba (GA) said:
I have never heard of anyone having to stop insulin for 5 days to test for frustosamine. I would really questions just how much your vet actually knows how to manage and treat feline diabetes.
Click to expand...
I’ve seen 4 different vets now, last one supposed to be a cat specialist, none has treated a diabetic cat before,
Despite my search, I haven't been able to find anyone who has addressed one

If it weren't for this forum, I would be so lost
 
Mermelada & Andrea said:
I’ve seen 4 different vets now, last one supposed to be a cat specialist, none has treated a diabetic cat before,
Despite my search, I haven't been able to find anyone who has addressed one

If it weren't for this forum, I would be so lost
Click to expand...
You must feel very frustrated.
Are you using normal Lantus insulin now? Not diluted.?
And can you tell me what the syringes you are using now please?
It sounds as if you are using a human meter now. Could you put that into the spreadsheet and the signature when you have time please?

Are you testing for ketones since you stopped the insulin for 5 days? . If not and you are able to get some Ketostix from a pharmacy, I would check those too.

Keep posting and we will help you
 
Bron and Sheba (GA) said:
You must feel very frustrated.
Are you using normal Lantus insulin now? Not diluted.?
And can you tell me what the syringes you are using now please?
It sounds as if you are using a human meter now. Could you put that into the spreadsheet and the signature when you have time please?

Are you testing for ketones since you stopped the insulin for 5 days? . If not and you are able to get some Ketostix from a pharmacy, I would check those too.

Keep posting and we will help you
Click to expand...

thank you so much, I’ll start again with normal Glargine insulin in the morning, 1.5 U, I’m affraid because I learned that syringes could be not precise with that small amount, I’m using BD ultra-fine 6mm 0,3mL U-100 ones and if I put them next to each other I can see very slight differences between lines, could be less than a dropled difference but according to the diluted vet this difficult precise doses (and that was his reason for mix)

I’m using a human meter, named Abra

I bought ketone strips from amazon because pharmacies just sell blood ones, supposed to be delivered tomorrow, he has to be fasting to take them? He pees after eating this affect the result?, it’s my first time with those

Again thank you so much for all your help, I know I did this back in 2020 but I’m so scare of other hypo
 
You have the correct size U 100 syringes so that’s good!
With Ketostix you collect a urine sample or just put it under the stream of urine and read it exactly 15 seconds later against the colours on the side of the bottle. You can test the urine anytime and you never need to withhold food for that test.
Make sure Mermelada eats well before the insulin and then give him 2 or 3 snacks of low carb food during all of the cycles. But don’t feed for the 2 hours before the next Preshot BG as we don’t want that test to be food influenced.
Test the BGs a couple of times during each cycle until you get an idea of how the dose is going to affect the BGs. Make sure you have some honey and some carb higher carb food in case the BGs drop low.

Post anytime for help. :)
 
Yeei, I’ll be doing that, thank you! when diagnosed I did my best and got remission in less than two months, he got a hypo at 3:20 am on monday, managed to control with honey, all alone in my house, I feel a little bit traumatized, but i’m so thankfull for this forum, and people like you. :cat:

What do you think about those inconsistencies with the lines, do you think I should worry? I’m very nervous with the idea of hypos and not being here and able to help him
 
I did use calipers. To find precise dosing fit your particular syringes I can’t do but I can give you tips to start. Maybe someone else can do the calculations. Find a couple of used syringes that seem to have the lines lined up correctly. Measure 1 unit using the calipers. Divide that by 4 and you will have your .25 also. I hope that makes sense.
 
Mermelada & Andrea said:
I understand, and it’s ok, I need to be strong, It’s time
Click to expand...
Good morning:coffee: :coffee: it sounds like you might be frustrated, you have not been alone most of us, especially me, at the beginning when Corky was diagnosed I was alone without a Vet without this Forum, so there were many sleepless nights, crying till there were not tears, I was certain I was going to loose Corky, then I found this Forum, since day one, I followed every, every single suggestion I trust these member that have giving me help on every concern possible , I trust the blindly for dosing increase/reduction, when Corky became at the point of Hypo with 33 BG at 10PM one day they were with e till 4:30 in the morning but the first thing I was told was:" take a step back, breath in and breath out, cats are sensitive to stress, we are stress they stress and if testing example the reading could be inaccurate, Hopefully you will not have another Hypo episode, but if you do you are not alone, post us PM type 911 HELP HYPO, I am sure someone will answer you, and we ca walk you thru it, you are not alone:bighug::bighug::bighug:;):cat::cat:
 
tiffmaxee said:
I did use calipers. To find precise dosing fit your particular syringes I can’t do but I can give you tips to start. Maybe someone else can do the calculations. Find a couple of used syringes that seem to have the lines lined up correctly. Measure 1 unit using the calipers. Divide that by 4 and you will have your .25 also. I hope that makes sense.
Click to expand...
this would be my next step, do you recommend any brand and size of calipers?
Today I recieved my first ketone strip box, I'll be testing him the first chance I got, never tested him with those before
 
Mermelada & Andrea said:
this would be my next step, do you recommend any brand and size of calipers?
Today I recieved my first ketone strip box, I'll be testing him the first chance I got, never tested him with those before
Click to expand...
If you call calipers the lancets I just discovered a very thin lancet ReliOn extra thin they are so much better 33,gauge, hope this is what you are referring to :bighug::bighug::cat::cat: Although if it’s ketones I have never tested for ketone Corky never had
 
CORKY said:
If you call calipers the lancets I just discovered a very thin lancet ReliOn extra thin they are so much better 33,gauge, hope this is what you are referring to
Click to expand...
A caliper is used for measuring the exact dose in a syringe. For very small doses it is hard to get consistent does just using the marking on a syringe.

Are you using 33g lancets to get blood? For most cat caretakers a larger diameter lancet is required. fzor one of my cats I have to use a 26g lancet.
 
CORKY said:
Good morning:coffee: :coffee: it sounds like you might be frustrated, you have not been alone most of us, especially me, at the beginning when Corky was diagnosed I was alone without a Vet without this Forum, so there were many sleepless nights, crying till there were not tears, I was certain I was going to loose Corky, then I found this Forum, since day one, I followed every, every single suggestion I trust these member that have giving me help on every concern possible , I trust the blindly for dosing increase/reduction, when Corky became at the point of Hypo with 33 BG at 10PM one day they were with e till 4:30 in the morning but the first thing I was told was:" take a step back, breath in and breath out, cats are sensitive to stress, we are stress they stress and if testing example the reading could be inaccurate, Hopefully you will not have another Hypo episode, but if you do you are not alone, post us PM type 911 HELP HYPO, I am sure someone will answer you, and we ca walk you thru it, you are not alone:bighug::bighug::bighug:;):cat::cat:
Click to expand...
You are so right, this forum is full of good hearted people, I felt so blessed when I found this page, I think I need to be more like you and trust more, most of my fears are because the lack of knowledge with vets here in my country and bad experiences, but I'll focus for the better, I saw Corky's Spreadsheet and I have to say it is amazing you have a very long journey I'm so impressed, how do you get those .75 U? do you use caliper? I'm thinking getting one
 
CORKY said:
Good morning:coffee: :coffee: it sounds like you might be frustrated, you have not been alone most of us, especially me, at the beginning when Corky was diagnosed I was alone without a Vet without this Forum, so there were many sleepless nights, crying till there were not tears, I was certain I was going to loose Corky, then I found this Forum, since day one, I followed every, every single suggestion I trust these member that have giving me help on every concern possible , I trust the blindly for dosing increase/reduction, when Corky became at the point of Hypo with 33 BG at 10PM one day they were with e till 4:30 in the morning but the first thing I was told was:" take a step back, breath in and breath out, cats are sensitive to stress, we are stress they stress and if testing example the reading could be inaccurate, Hopefully you will not have another Hypo episode, but if you do you are not alone, post us PM type 911 HELP HYPO, I am sure someone will answer you, and we ca walk you thru it, you are not alone:bighug::bighug::bighug:;):cat::cat:
Click to expand...
You are so right, this forum is full of good hearted people, I felt so blessed when I found this page, I think I need to be more like you and trust more, most of my fears are because the lack of knowledge with vets here in my country and bad experiences, but I'll focus for the better, I saw Corky's Spreadsheet and I have to say it is amazing you have a very long journey I'm so impressed, how do you get those .75 U? do you use caliper? I'm thinking getting one
 
Mermelada & Andrea said:
this would be my next step, do you recommend any brand and size of calipers?
Today I recieved my first ketone strip box, I'll be testing him the first chance I got, never tested him with those before
Click to expand...

I have the calipers in the video. Just look at the size and be sure it’s easy to lock. I don’t think you need any special brand. So get 4inch digital calipers.
 
The BD Ultrafine have a plastic "collar" below the zero line. As a result, I used the thinner arms on the caliper, the ones used to measure the insides of things. Make sure the calipers have thin inner measuring arms, or they won't fit between the collar and the zero line.
 
I did it slightly different than the BD picture - I had the syringe facing the other way. The caliper on the left doesn't move, so I had it against the zero line.

There is just one additional thing I'd look for in calipers that aren't in the ones you linked. You can get some that have a thumb screw that locks the arm in place. That way you set the length you want to measure and it stays there.
 
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