Starting over. Kitty Fructosamine at 600+

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bbwyo

bbwyo

Member Since 2017
I've been testing and bg#'s were in the 250's or so I thought. The Vet just got results back from the latest Fructosamine test and it showed a # of 600+. All other tests were A-ok! The Vet has started us back on Vetsulin .5 cu 2x daily. and will do another fructosamine test in 3-4 weeks. We discussed the bg tests that showed the Vetsulin was being used up in short time span. My Vet is open to trying another insulin, in fact she had always used Lantus until prices went thru the roof and costs were higher than most of her patients could afford. She is open to switching insulins and is doing some more research into options. I have been reading different comments on the various insulins and since every cat is different am not sure how to assess what if any other insulin to use. Levemir seems to cause less discomfort at the injection site than Lantus. PZI seems to be designed for Cats more than others. There are success stories for all the insulins.

To be really honest even the little .25 cu 2x daily of Vetsulin has made a big improvement in my cat's condition. I am guessing that I overreacted to the low bg #'s when she was on the .5 cu dosing before? I need to look at the spreadsheet to see how long ago the .5 cu doses were given. The .125 cu were a disaster and now I've only been back on the .25 2x daily for a week. Too many changes are hard to follow. I want to figure something out and stick with it. It seems from her spreadsheet that the .5 cu 1x daily was actually having a better effect than the .25 2x daily I'm giving her now.

I really do appreciate all the experience people on this site have had and freely offer. At this point I'm really just more confused and I'm afraid my cat is paying for it. Tonight I will start back with the .5 cu dose and continue that for sure through the holiday. Any insights are welcome.
 
Bev, I would seriously question that fructosamine result given the information on your SS. I firmly believe that the fructosamine tests have a place in diagnosing a cat and may be helpful in some cases for regulated cats where daily testing is not being done but when you are testing every day and can see what is happening, I see no useful purpose to it. I have a high dose kitty whose numbers were considerably higher than Kitty's and her fructosamine came back suggesting she was in good shape. My daily testing said otherwise. The fructosamine can be way off because of other blood values and unless all are run at the same time, the results of the fructosamine may or may not be giving you an accurate picture. It can also be elevated suggesting poor control if too much insulin is being given causing Somogyi effect and read low if the cat has had a few hypoglycemic episodes.

I'd use the readings you are getting at home on a daily basis as your first line of data and skip the fructosamine tests. It's obvious that Kitty is not in seriously high numbers so ignore those results and work with the data you have and your observations of Kitty and how you think she is feeling.
 
Thx. MWM. I studied the SS a little more and need to talk to the Vet about some of the specifics. In the meantime, over the holiday, I'm going to go ahead with the .5 cu shot 2x, which is what we started with and discontinued when gb tests were looking in the hypoglycemic range. (My cat never acted hypo so maybe I over reacted plus I was reducing the amount of dry food she was getting) The other important thing is that she was getting a very low insulin dose over the time period the fructosamine test would have covered and that was evident. I will start testing but might get another glucose meter. thanks for being here on a holiday weekend.
 
Also, MWM, I see you switched to Levemir from Lantus. Can you tell me about this switch?
we are considering other insulins, The Vet has used Lantus in the past so is familiar with it. She is going to check into Levemir.
 
bbwyo said:
Levemir seems to cause less discomfort at the injection site than Lantus
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The vast majority of cats have no problem with Lantus stinging....especially on such a tiny dose as you're on......occasionally a cat that's on high doses will have a problem with it, but we've also seen cats on very high doses that didn't have any issues at all....it's one of those ECID things

As for the price, check out this "Buying insulin from Canadian pharmacies" post.....Marks is where most of us are buying our Lantus and Levemir because it's so much cheaper
 
My switch from Lantus to Levemir was due to the stinging but my kitty was a high dose case and was on about 6u twice daily and still rising when I switched because she suddenly started flinching and meowing when I gave her shots. She'd been totally obvious to the shots until the dose got to 6u. Lantus and Levemir are very similar otherwise.
 
I like the 0.5 dose. Your numbers were good but I think she could have been pushed into double digit greens more. I'd try to aim for like 70-80 for a nadir.
 
I'm feeling pretty confused.
Maybe this should have been a new post. Please let me know.
1. Testing: I haven't been testing because I feel like the Fructosamine test showed my numbers were pretty irrelevant. Also my cat is indoor/outdoor. The only solid # I could even get would be the AMPS but at night we have "Millers" (nighttime moths) and I know she loves to snack on them. I am ordering the Alphatrak pet glucose monitor today and will start closer monitoring when that arrives. If there is really something unexpected or something off I will check with the Relion but not sure if it would give me info to act on.
2. Feeding: I have been feeding her 3x a day (wet LC only) The mid-day meal is usually split up between late morning and early afternoon. Should I only feed her when I give her the shot? Could this have contributed to the high Fructosamine #'s?
3. The Vetsulin "protocol" says to feed before dosing and then feed some later when the Vetsulin is kicking in and she might feel like she needs food. In the beginning the Vet said to leave food out so if she felt like she needed food it would be available. She would eat all the time so my solution was to feed her a little if she seemed hungry...AS long as it didn't exceed her normal caloric intake. BUT this can cause her to have higher BG's (whether I'm testing or it's a Fructosamine test)? Right? I know ECID but where is the line between contributing to the glucose flucuations
4. Behavior: If I observe her behavior, she didn't have the peeing and excessive water drinking before the Fructosamine test. Now she seems more hungry than ever. She's not drinking excessively but her pee patties have been larger the past couple of days. Also Lethargy? Morning nap (normal) about an hour after I give her the injection she seems to get more lethargic but still active. I dose her 6 am and 6 pm give or take 15 mins. This morning, 3+ she's acting like she's needing food. HOW DO I know the difference between over/undermedicated and cat behavior that is nothing to worry about? We are into day 5 of the new dosing .5cu. She almost seems (behavior wise) to be more "diabetic" than before BUT she seems to be in good condition overall.
5. How long do you wait to determine if another insulin will be more effective?
I want to give her a chance to settle into some kind of "normal" so maybe better to watching this a while before changing insulins (Vetsulin to Lantus/Levemir).
 
bbwyo said:
I'm feeling pretty confused.
Maybe this should have been a new post. Please let me know.
1. Testing: I haven't been testing because I feel like the Fructosamine test showed my numbers were pretty irrelevant. Also my cat is indoor/outdoor. The only solid # I could even get would be the AMPS but at night we have "Millers" (nighttime moths) and I know she loves to snack on them. I am ordering the Alphatrak pet glucose monitor today and will start closer monitoring when that arrives. If there is really something unexpected or something off I will check with the Relion but not sure if it would give me info to act on.
2. Feeding: I have been feeding her 3x a day (wet LC only) The mid-day meal is usually split up between late morning and early afternoon. Should I only feed her when I give her the shot? Could this have contributed to the high Fructosamine #'s?
3. The Vetsulin "protocol" says to feed before dosing and then feed some later when the Vetsulin is kicking in and she might feel like she needs food. In the beginning the Vet said to leave food out so if she felt like she needed food it would be available. She would eat all the time so my solution was to feed her a little if she seemed hungry...AS long as it didn't exceed her normal caloric intake. BUT this can cause her to have higher BG's (whether I'm testing or it's a Fructosamine test)? Right? I know ECID but where is the line between contributing to the glucose flucuations
4. Behavior: If I observe her behavior, she didn't have the peeing and excessive water drinking before the Fructosamine test. Now she seems more hungry than ever. She's not drinking excessively but her pee patties have been larger the past couple of days. Also Lethargy? Morning nap (normal) about an hour after I give her the injection she seems to get more lethargic but still active. I dose her 6 am and 6 pm give or take 15 mins. This morning, 3+ she's acting like she's needing food. HOW DO I know the difference between over/undermedicated and cat behavior that is nothing to worry about? We are into day 5 of the new dosing .5cu. She almost seems (behavior wise) to be more "diabetic" than before BUT she seems to be in good condition overall.
5. How long do you wait to determine if another insulin will be more effective?
I want to give her a chance to settle into some kind of "normal" so maybe better to watching this a while before changing insulins (Vetsulin to Lantus/Levemir).
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1. the opposite. home testing makes the fructosimine tests unnecessary. Fructosimine tests just so the average from the last few weeks. it does not show day to day how the cat is doing. Home tests are much more accurate and telling. I seriously doubt eating a few months would change any of your numbers at all. I would think they aren't carbs anyway. haha I do love the Alphatrak, and as long as you are willing to pay a dollar per strip, it's a great meter.
2. and 3. You can feed any time you want as long as it's not two hours prior to preshot testing. Many of us feed several times a day... some even using timed feeders so their cats can eat when they are working or asleep. cats have to eat. you shouldn't deny her food for the sake of a lower bg. esp. while her numbers are still on the high side. diabetic cats need MORE food than most because their bodies aren't utilizing the nutrients in the food properly.
4. My cats are lazier and sleep more in the summer. Even my kittens. cats like to sleep. haha
5. that's up to you if you want to try a different insulin, but this one seems to be working fine for her. her numbers really don't seem to be that bad. preshots in the 200's, and naidir in the blues.... but I don't know what is happening with the new dose you started giving... we wanted to push her into the low 100's and high double digits, but we don't know if that's happening because you stopped testing. can you get a curve in tomorrow or tonight? not sure why you gave up testing, esp. when you just raised a dose. it is safer to test esp. after just raising a dose, so you know if it's effective or too much or too little!
 
I'd stay the course for now. The numbers you have on your SS are good. I suggest you give testing another go even though it's discouraging when you think you aren't getting anywhere. It's easy to convince yourself not to bother.
 
I agree with the idea of continuing your home testing. In my opinion the home testings are much more reliable than the fructosamine test and show the effects of the insulin in "real time" not an average over a 2 or 3 week period. Fructosamine tests are useful as a tool to help diagnose a new diabetic kitty not already on insulin, but home testing is much more exact with what is happening "now".
 
Bev, your home testing tells you a lot more than the Fructosamine test. The fructosamine is not the measure of Blood sugar. It is measuring another blood component that adjusts in relation to BG levels. So if kitty has a lot of high numbers due to too little OR too much insulin, the fructosamine which is an average over a two to three week period, will read higher. Likewise if kitty has a number of lows, the fructosamine will read lower. Neither of these results is very accurate to tell you what is going on with kitty in general because they reflect an average and can be skewed by any extremes that might have occurred in the last 2 -3 weeks. Furthermore, there are other blood components that can effect the fructosamine results. Daily home testing is FAR more accurate because it gives you a movie of what's happening over time and you can see the details. Look at it this way. I write an exam and get 100%. I write another exam and get 50%. Now my average is 75% which isn't too bad overall but is not really indicative of my ability as a student when you look at the two results separately. If all I focus on is that 75%, I can't do anything to improve whatever caused me to get that 50 on the second exam. The same holds true with the fructosamine.

bbwyo said:
4. Behavior: If I observe her behavior, she didn't have the peeing and excessive water drinking before the Fructosamine test. Now she seems more hungry than ever. She's not drinking excessively but her pee patties have been larger the past couple of days. Also Lethargy? Morning nap (normal) about an hour after I give her the injection she seems to get more lethargic but still active. I dose her 6 am and 6 pm give or take 15 mins. This morning, 3+ she's acting like she's needing food. HOW DO I know the difference between over/undermedicated and cat behavior that is nothing to worry about? We are into day 5 of the new dosing .5cu. She almost seems (behavior wise) to be more "diabetic" than before BUT she seems to be in good condition overall.
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Everything you describe suggests to me that Kitty's BG is now either dropping very fast, dropping to levels her body perceives as too low or actually going too low. Please home test and seriously consider lowering the dose to 0.25u because symptoms would only increase if BG is running high and that can occur from too much as well as too little insulin. Since Kitty was better without insulin, it seems reasonable to assume that the 0.5u is too much. Sometimes your general observations speak v volumes and you should never ignore or discount those observations. And please do make sure to get pre-shot readings to ensure it is safe to give Kitty insulin at any dose.

As for purchasing an AlphaTrak meter, know that it will cost you substantially more (at least double the cost) to use it compared with your Relion meter and between the AT2 and useless fructosamine test costs, all you are doing IMHO, is increasing your costs and getting nothing useful back in return.
 
All great advice. Thx. Yes will start testing again but was warned that it would take a few days/weeks for her body to adjust to new dosing. Think it was for my sake:-( I will use the Relion until the new one gets here (already ordered) and maybe can figure out how to compare. When the F test came back so high Vet totally discounted the home testing numbers. I think the .5 dose for now will be good. Even though she only had a couple of days back on the .25 2x daily it didn't seem to be doing what it needed to do...based on behavior..which I know is not a good indicator. I'm going to try and stay the course here unless something drastic happens. Will get SS updated and start posting. The reason I was considering the other insulins was because when she was on the .5 in the beginning she seemed to be dropping very low early then coming back up quickly. Will get a full curve going in a day or so. Even when she was dropping low in 1+ 2+ she was headed back up by 3, 4+...I need to do the curve.
Does anyone have experience with the A1C test for cats? Imagine the same criticism of Fructosamine will apply.
 
JanetNJ said:
1. the opposite. home testing makes the fructosimine tests unnecessary. Fructosimine tests just so the average from the last few weeks. it does not show day to day how the cat is doing. Home tests are much more accurate and telling. I seriously doubt eating a few months would change any of your numbers at all. I would think they aren't carbs anyway. haha I do love the Alphatrak, and as long as you are willing to pay a dollar per strip, it's a great meter.
2. and 3. You can feed any time you want as long as it's not two hours prior to preshot testing. Many of us feed several times a day... some even using timed feeders so their cats can eat when they are working or asleep. cats have to eat. you shouldn't deny her food for the sake of a lower bg. esp. while her numbers are still on the high side. diabetic cats need MORE food than most because their bodies aren't utilizing the nutrients in the food properly.
I guess I'm asking about the intermittent feedings influencing the results of the fructosamine testing? I think the averages may have been skewed if I was feeding when she didn't have enough insulin, like the .125 days. Thanks for the encouragement because she is much happier when she is "full":-)

4. My cats are lazier and sleep more in the summer. Even my kittens. cats like to sleep. haha
5. that's up to you if you want to try a different insulin, but this one seems to be working fine for her. her numbers really don't seem to be that bad. preshots in the 200's, and naidir in the blues.... but I don't know what is happening with the new dose you started giving... we wanted to push her into the low 100's and high double digits, but we don't know if that's happening because you stopped testing. can you get a curve in tomorrow or tonight? not sure why you gave up testing, esp. when you just raised a dose. it is safer to test esp. after just raising a dose, so you know if it's effective or too much or too little!
Click to expand...
 
Home testing is far more accurate than any tests done at the vet. A fructosamine or A1C are good for diagnosis, but not useful for dosing because it only gives you an average BG over time, and you need daily numbers throughout the day in order to see how the insulin is working in your cat, and make dose adjustments. Too much insulin can look exactly like too little insulin from this tests, since they can't detect if BG is going too low or normal levels, and then high again throughout the course of a cycle. This frequently happens with Vetsulin because it does not have a good duration of action in cats.

You might want to print the AAHA diabetes guidelines out and bring them to your vet: https://www.aaha.org/professional/resources/diabetes_management.aspx

I would especially point out the "precautions and details" section to bring your vet on board with home testing and insulin change (if you need it).

In regards to your question on insulin change, I'm going to disagree slightly with what the others have said. If you can't get him very well regulated or in remission within 8 weeks of following the proper dosing protocol with home testing, I would see about switching to Lantus or Levemir. The very high remission rates with those insulins are only if you start soon after diagnosis (90+% if started immediately, 80+% if in the first 6 months). Vetsulin only has a remission rate of about 25%, and cats that do go into remission on it typically do so within the first 2 months. Lantus is pricy in the US, but affordable if you order from Canada.
 
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Bev, you cannot compare readings from the AT2 and the Relion. There is no conversion formula between the two and the AT2 meter will read higher than the human meter 99% of the time. The readings get further apart the higher the BG. Trying to compare the two is only going to drive you crazy! If I were you, I'd cancel the order for the AT2 meter if you can.

The fructosamine has been deemed a better gauge than the A1C in cats according to veterinary research. A1C is based on glycosylated hemoglobin values and therefore more volatile due to the turnover of red blood cells. These tests have both been used because it's fairly recent that people started home testing their own pets. If home testing is not feasible or the pet parent can't or doesn't want to do it, then the fructosamine or A1C are the only tools that the vet has to determine how well regulated a pet is. If home testing is being done, it should be considered the best indication of the state of glucose regulation.
 
MrWorfMen's Mom said:
Bev, you cannot compare readings from the AT2 and the Relion. There is no conversion formula between the two and the AT2 meter will read higher than the human meter 99% of the time. The readings get further apart the higher the BG. Trying to compare the two is only going to drive you crazy! If I were you, I'd cancel the order for the AT2 meter if you can.

The fructosamine has been deemed a better gauge than the A1C in cats according to veterinary research. A1C is based on glycosylated hemoglobin values and therefore more volatile due to the turnover of red blood cells. These tests have both been used because it's fairly recent that people started home testing their own pets. If home testing is not feasible or the pet parent can't or doesn't want to do it, then the fructosamine or A1C are the only tools that the vet has to determine how well regulated a pet is. If home testing is being done, it should be considered the best indication of the state of glucose regulation.
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I understand the additional expense with the Pet meter but if the home glucose testing completely missed such spikes and high # then wouldn't you be a little suspicious of the human meter? I'll start testing tonight and see where we are but if my meter is that far off what does it tell us?
 
Julia & Bandit said:
Home testing is far more accurate than any tests done at the vet. A fructosamine or A1C are good for diagnosis, but not useful for dosing because it only gives you an average BG over time, and you need daily numbers throughout the day in order to see how the insulin is working in your cat, and make dose adjustments. Too much insulin can look exactly like too little insulin from this tests, since they can't detect if BG is going too low or normal levels, and then high again throughout the course of a cycle. This frequently happens with Vetsulin because it does not have a good duration of action in cats.

You might want to print the AAHA diabetes guidelines out and bring them to your vet: https://www.aaha.org/professional/resources/diabetes_management.aspx

I would especially point out the "precautions and details" section to bring your vet on board with home testing and insulin change (if you need it).

In regards to your question on insulin change, I'm going to disagree slightly with what the others have said. If you can't get him very well regulated or in remission within 8 weeks of following the proper dosing protocol with home testing, I would see about switching to Lantus or Levemir. The very high remission rates with those insulins are only if you start soon after diagnosis (90+% if started immediately, 80+% if in the first 6 months). Vetsulin only has a remission rates of about 25%, and cats that do go into remission on it typically do so within the first 2 months. Lantus is pricy in the US, buy affordable if you order from Canada.
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Thank you. I'll be discussing the switch with my Vet after the holiday. I appreciate the links. Is protocol with Lantus or Levemir more difficult?
 
bbwyo said:
if the home glucose testing completely missed such spikes and high #
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Looking at your spreadsheet my explanation is that the fructosamine is not suggesting there were any spikes or extremely high numbers that you missed using the human meter. It is suggesting that the lows are not lasting long enough to balance out the higher numbers you are getting and making it look like things are worse than they really are. I do agree that the Vetsulin doesn't seem to be lasting long enough through the cycles for Kitty and that a change of insulin to something longer lasting may be the key to getting her more regulated but whichever meter you use, the pattern will look the same and the pet meter isn't going to pick up spikes or higher numbers any more than the human meter does.
 
MrWorfMen's Mom said:
Looking at your spreadsheet my explanation is that the fructosamine is not suggesting there were any spikes or extremely high numbers that you missed using the human meter. It is suggesting that the lows are not lasting long enough to balance out the higher numbers you are getting and making it look like things are worse than they really are. I do agree that the Vetsulin doesn't seem to be lasting long enough through the cycles for Kitty and that a change of insulin to something longer lasting may be the key to getting her more regulated but whichever meter you use, the pattern will look the same and the pet meter isn't going to pick up spikes or higher numbers any more than the human meter does.
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makes perfect sense i get it
 
bbwyo said:
Thank you. I'll be discussing the switch with my Vet after the holiday. I appreciate the links. Is protocol with Lantus or Levemir more difficult?
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I wouldn't say it's more difficult, it's just different. It does take a little commitment because you want to try and get three tests a day...once before each shot to make sure it's safe to give insulin, and then another test during the middle of one of the cycles to adjust the dose, but I would say you'd want to do that to get good control with any insulin--in fact, I'd probably test more frequently with Vetsulin because in my experience it's less predictable. I was working two jobs and going to grad school when I was first learning how to adjust Bandit on Lantus, and I was able to manage ok. Lantus also really works best on a 12/12 schedule, which means it's important to be able to shoot every 12 hours without a lot of variation, but there are workarounds with that when occasional things pop up and you need to move the shot..it just takes a little more planning. Regardless of what insulin you choose, the insulin forums here can help you out alot with dosing advice until you get the hang of it! If you want to read through the dosing protocol, you can do that here...but don't let it scare you if it seems complicated! It's really not hard once you're testing regularly and getting the hang of it and there's lots of people here and in the Lantus forum to answer questions.
 
I can also give you an article to bring to your vet that specifically discusses Lantus and dosing/ treatment, but I don't have access to that file until after the holiday because I'm traveling...I'll be back Thursday and I can post it for you then. :)
 
Julia & Bandit said:
I can also give you an article to bring to your vet that specifically discusses Lantus and dosing/ treatment, but I don't have access to that file until after the holiday because I'm traveling...I'll be back Thursday and I can post it for you then. :)
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I would appreciate that. I have read the dosing protocol which seemed a little more involved than the Vetsulin but that may have been because I've been using V. Thanks for taking time on your holiday.
 
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