Vet says "Not Diabetic" but BG between 235-300 for days

I'm just so confused and frustrated. My Vet says my cat is NOT diabetic and that we should not be starting her on insulin because the risk of hypoglycemia would be too high, but her glucose levels at home (test her with a One Touch Verio Reflect meter) are definitely not normal!! I had a diabetic kitty years ago, he was diabetic for 6 years, did so well on twice daily Levemir, got him so nicely controlled but sadly cancer took him....but the point is, I'm not a stranger to feline diabetes (plus I'm a retired human RN).

My girl Bitsy is 16 yrs old. She had pancreatitis 3-4 years ago that was managed at home and she recovered. This past Oct 2023 she had 2 days of vomiting, full senior panel + thyroid + fPL which showed Pancreatitis. Managed well at home with subQ fluids initially, Cerenia and appetite stimulant then fine. BG then at the lab was 10.1 (180) which was just attributed to stress from the vet/blood draw. Her BUN and Creat were good, SDMA a little at the high end of the normal range. Urine a bit dilute at 1.018...but told did not have kidney disease but may be on the way. Urinaysis - not UTI, all normal. All other bloodwork normal including thyroid.

I have noticed her at the water bowl a bit more often since then and her pee clumps are a bit larger. She eats primarily very good quality canned food but does nibble on dry a tiny bit.

Last Wednesday evening she had a weird episode where she seemed to very briefly lose strength in her legs, lasted about 10 minutes....then she stiffly walked to her cat bed and seemed quite tired but alert. Back feet nice and warm. I decided to check her BG (as I know that a history of Pancreatitis can increase risk of developing diabetes so I have periodically checked BG)...and was shocked to see it was 18.3 (330). After she woke up in the morning was back to her normal self, walking just fine (past xrays do show a bit of arthritis to her hips), usual bright self. BG then was 13.1 (235)....early that afternoon was down to 8 (144), eating her usual canned food.

I got her into the Vet (Thurs Mar 21) that afternoon, told him about her episode. He did a full assessment including a Neuro exam and wasn't sure why she had the back leg weakness like that, said had very good strength to back legs there in the office. Had blood drawn for full senior panel + urinalysis + fructosamine + thyroid.

Got the results back the next day and he was supposed to call me to discuss but he didn't, nor the next day, I called today and was told he was off until this Wed so had to speak with another Vet.

The results had showed her Fructosamine level was 276 (191-349). Glucose had been 10.4 (to note, I checked her BG with my meter that day just after the blood draw just to check accuracy of meter, I got 9.8 so good).

CBC all good
Liver enzymes all good
Electrolytes all good
BUN and Creat good
Cysplatin B <50 (0-99) so good
SDMA 9 (0-14) so good
Urinalysis - everything negative, no glucose, no ketones of course, no blood or protein etc, specific gravity 1.015 so kinda dilute
Thyroid / Total T4 still normal but a little higher than in Oct; in Oct was 28.3 (range: 10-60) but this time 37.5

She has gained 0.8 lbs since Dec 6, is now 11.5 lbs

Yesterday at home her BG in the morning was 13.1 (236). Appetite good, eating her canned food. Her usual self. Last evening BG was 16.5 (297). I did notice she's been eating a good bit of her upstairs bowl of dry food and I know dry food is higher in carbs so I decided for now only canned food so took away bowls of dry this morning. Note: she doesn't have set meal times, she nibbles canned food frequently throughout the day.

BG this morning was 14.1 (253). So I called the clinic and asked to speak with whoever was covering for my Vet, to discuss last Wednesday's lab results and her increased BG. As he's not her usual Vet I told him about her "back leg episode" last Wed, her high BG that night...and elevated BG yesterday and today...asked him at what point do we start her on some insulin....and he told me she's not diabetic, that on an elderly cat her numbers and labwork don't indicate the need to start insulin.......but he couldn't seem to tell me how it's a good thing to let her sugars keep running high like this. I just did her BG an hour ago (6pm my time) and BG was 15.1 (272).

I explained to him that she's drinking more, her pee clumps are larger....and this is obviously not from poor kidney function as her labwork showed kidneys are great....IMO it's from her elevated BG.

SHe obviously isn't having another pancreatitis flare because she's not vomiting at all and she's the type who will vomit many times a day when having a flare.

He figures her "episode" the other night was likely due to osteoarthritis to hips or spine and suggested we could give her Solensia for that.

I did buy some Methyl B12 that I'll be starting her on to reduce the risk of neuropathy to her back legs from the high sugar levels.

I guess he figures that because her Fructosamine level last Wed was good that she's not diabetic, but that just shows an average of what it had been for 2 weeks prior, not going forward and the numbers I'm getting at home, as mentioned above, can't just be ignored? He commented that her urinalysis last Wed showed no glucose or ketones in her urine but fine...okay....that was a week ago....that was then....now I'm telling you the numbers I'm getting at home yesterday and today.

Her appetite today isn't as great, probably from the elevated glucose levels, that can't feel good.

I realize that many cats are usually diagnosed w/ diabetes with much higher numbers but that doesn't mean to me that because she's not, say, 400, that we should do nothing?

I can't get a second opinion from another clinic, I just can't afford it. Last Wed's visit and bloodwork cost me $450 and I am just trying to financially breathe/catch up from having had 2 other sick elderly cats (kidney failure, etc) who had many vet visits since Dec who sadly ended up having to be put down between Dec and Feb). I am on disability so money is very tight....and I had to borrow the money for last Wed's vet visit.

What are your thoughts please? I don't know where else to turn.

How can it be okay to just sit back and do nothing?

 

I'm only a rookie. But, Pumpkin isn't my first rodeo with aggressively treating my cats for many various feline medical issues throughout all stages of their lives.

Perhaps someone with more experience can offer you more of a leaning towards what those numbers are suggesting.

That being said, I would feel more at ease if I were in the same situation because a doctor said it. Big however... I'd definitely get a second Veterinary opinion whenever you are able to. I've seen a couple of Vet's that can be a little off.

For now, what I would do is call the Vet and speak with them more about it explaining what normal cat numbers are supposed to be and ask how they determined that they were not diabetic.

And perhaps, this can be managed with diet. I am no expert, I am only saying what would go through my head if I was in your place. I really hope you can find more clarification about this issue.

 

Hi and welcome to the forum.
You obviously understand diabetes being an RN.
Cats who get pancreatitis can get elevated BG for a few days. My Sheba when she was in remission used to get pancreatic flares and her BGs always rose but used to go back down after a few days.
The fructosamine test they did probably did have at least a week of normal BGs as well as the few days of elevated ones so it could be unreliable.
How long since she has returned to normal do you think? If you are still getting raised BGs after several days of being back to normal, it is suspicious.
What I would do is:

• Change her over to a low carb wet diet.(which sounds like you are doing)
• Take her BG before food night and morning and then take it again 3 hours after the main meal. Let her keep eating multiple times during the day and night. Let us know the results. If her pancreas is working, food should reduce the BGs.
• Get a bottle of Ketostix and test her urine each day for ketones, as this is my main concern that if she does have diabetes and hasn’t started insulin, she could develop ketones. If any appear she would need to start immediately on insulin.

 

Hello there, thank you so much for your response.

I should mention that Bitsy's Lipase was elevated in her last Wed bloodwork (was 64, range: 0-45) but amylase just fine. My understanding is that lipase and amylase doesn't give much info about pancreatitis in cats (moreso in dogs, tho) so I didn't think much of it and Vet agreed. I didn't think to request a fPL1 be done last Wed as she wasn't having symptoms of pancreatitis at all. When she does, she throws up many times a day but she hasn't thrown up since back in October when she did have pancreatitis.

I'm not sure if I understand your question. Are you asking at what point her BG began to go back up since last Wed?

So to recap:

Mar 20 @10:30pm had that hind leg episode, BG was 18.3 (330)
Mar 21 @6:00am - 12.0 (216)
@9:00am - 9.7 (175)
@1:30pm - 8.0 (144)
@5:30pm - 9.8 (176) ...this was taken with my meter at the Vet clinic just after they drew blood for her labwork

Mar 22 @9:20am - 10.8 (194)
Mar 23 @12 noon - 12.0 (216)
Mar 24 @9:00am - 13.3 (239)
@11:00PM - 16.5 (297)
Mar 25 @8:00am - 14.1 (256) ....noticed she's eaten a good bit of free fed kibble upstairs so removed all access to dry food so only eating wet food which she predominantly eats anyway
@6:30pm - 15.4 (277)

All her life she ate mostly dry food along with my other cats (good quality dry food) but back when she had pancreatitis in Oct 2023, I had another kitty w/ CRF who wasn't interested in ANY dry food so I began feeding them ALL canned food twice a day. At the time, strangely, Bitsy no longer had interest in dry food either.......so even though I still keep a bowl out for her upstairs, she doesn't eat much of it, always has access to fresh canned food. She can be somewhat fussy/picky about which canned food she likes the most so I constantly switch it up.....from various Weruva canned types (Meow Me a River, Pretty in Pink, Outback Grill), Fancy Feast, Fancy Feast Medleys Florentine or Primavera, Friskies Pate, etc. I prefer the Weruva canned as it's a better quality but because she's picky I usually offer her 2 types of canned food twice a day (we're like a regular cat smorg here lol).

I suppose her Pancreas could be inflamed, causing the elevated BGs but not yet full blown pancreatitis?

Her WBCs from last Wed's CBC were just fine.

Her temp at Vet last Wed was fine at 37.9

She looks very good for 16, like I mentioned above, she's gained 0.8 lbs since Dec and is currently 11.5 lbs.....fur nice and thick and shiny. Most cats I've had (had cats all my life) at this age are well into kidney disease and are much thinner with obvious muscle mass loss. She looks great.

Not sure how I could check her urine for ketones tho......my old boy w/ diabetes was easy to check, I was able to just slide a soup ladel (don't laugh! lol) beneath his butt area while peeing in the litterbox to grab some urine......but with her, even though she's not wigged out by me standing there while she's peeing in the box, she squats so low I'd never get a ladel in there. Due to having had 4 cats until recently, I still have lots of litterboxes; 2 upstairs and 4 in basement, she uses all of them. I guess there is something called ?NoSorb or something you can put into a clean box that will prevent urine from being absorbed so you can test it but I'd have to use it in all 6 boxes because she's not one to always use the same box. Any suggestions?

I think I might give her some SubQ fluids tonight, not sure.......I worry about her getting dehydrated with sugars high for this time? Vet said wasn't necessary but she pees such large amounts.

It probably doesn't help that she nibbles on her canned food all throughout the day/night as opposed to set meal times.......often she'll wake up and have nibbles of canned food each hour. Based on this constant grazing it would seem her BG will always be a little higher from always having food on board?

I noticed in your profile that one of your dear kitties passed of Pancreatic Cancer. Wow, I've never heard of cats having that, I'm so sorry. My Dad passed of this, this past July

 

If she is eating fine and doesn’t seem in pain, I doubt she has pancreatitis.

It is absolutely fine to let her graze throughout the day. It will not affect her BG, in fact it will probably help it.
I feed both my cats 4 times a day as I think that is much better than twice a day. Sometimes I feed them more often. ,just depends if I am running late with food or need to go out.

Yes I had no idea Sheba had pancreatic cancer until a week before she died. I’m sorry you lost your dad to it. It’s a horrible disease.

I will give you a link to our food list so you can see what is low and what is high carb wet food. You need to look for foods 10% and under carbs. I’m not sure about all the ones you mention as I feed a raw diet now so am out of the loop with canned food but I’m pretty sure the FF medley florentine is high carb.
FOOD CHART

CATCHING AND TESTING URINE
Can you put a little plastic container in one of her favourite spots in the LB?
Or there is always a blood ketone meter which is more expensive but is used in the same way as a glucose meter.

 

Thank you again so much for your response. The last couple of days I've been looking at the older website with the food charts (Janet & Binky's etc). Trying to balance lower carb ones with her being such a fusspot. I swear, one day she will devour one kind so I go out and buy 10 cans of it, next time feed it and she isn't that interested.

I am so worried that she's going to go into DKA while my Vet twiddles his thumbs. I was so shocked today when he said he didn't want to start insulin yet because in an older cat, there's a risk of insulin causing hypoglycemia. WHAT? Dude, it's mostly older cats that become diabetic, and if you start out at a low dose and the owner is monitoring BG at home very closely and knows the signs of hypo and when to break out the Karo syrup etc......what is the big concern? What is worse, the slight risk of hypo which I would not let happen or DKA? My vet clinic is not open after hours for emergencies so if Bitsy started going funny, it's a trip on bad winter highways into the next big city......and I am absolutely broke right now, just spent $450 last week. Emergency Vets here are $150 just to walk in the door and until I get paid Thurs this week I literally have $75 in my account.

Here in Canada you don't need a Rx to buy insulin or syringes so one more day of high #'s and if my Vet who is back on Wed does not want to start insulin, I am going to have to just buy some insulin and do this on my own because what choice do I have? Years ago when my other cat was diabetic, Vets here were so clueless....they started him on a huge whopping dose of Humulin (can't remember which one now), way too much to start with......("start low, go slow" is what I learned from this group all those years ago).....I pretty much had to manage him on my own with the help of this group because my Vet was really clueless, didn't even believe in home testing or see the need for it.

Based on the numbers Bitsy has been having the past 2 days, do you think she's high risk for DKA? I know I've read that even cats with lower numbers can go into DKA. I have my own health issues and anxiety disorder is one of them so now I'm so worried about her.

I did just give her 100 ccs of subQ fluids, to ensure she doesn't become dehydrated from the large peeing.....and maybe that will help dilute the glucose in the bloodstream a bit.

I just don't get what the Vet's hesitance is. I explained to him that I had a diabetic cat years ago, who was diabetic for 6 years (passed of cancer), he was so well controlled on Levemir, sometimes I had to skip a dose (tho sadly he never quite did go into remission). Clearly my cat is diabetic and the only treatment for diabetes is insulin. Heck I would even start off with a half unit of insulin twice a day to be on the safe side.

I'm going to try to sell a few items around my house so that maybe I can afford to go to another clinic, labwork and BG readings in hand....and ask for a 2nd opinion about starting insulin. I'd really prefer to have a Vet's blessing when starting it versus going behind their back.....but after losing 3 senior kitties over the past few months and this kitty is my last cat......I will do anything to keep her around for as long as I can....so I will do what i have to.

BTW, was your angel kitty Sheba on Levemir the entire time she was diabetic and with you? Hopefully they still make that insulin, it was new when I started using it, only a few sugarcats were on it (in this group), my Vet didn't even know about it.....I had switched to it on my own because at the time, the drug company stopped making the type of Humulin my cat was on so I had to switch to something else. There was someone in this group who was documenting their cat's experience with it and I liked what I saw........I liked that it worked different than the other types of insulin.......a much more flat curve versus a huge dip when insulin peaks.......I found so much better control with it....and I'd opt for it again, assuming it's still on the market here in Canada. I'd start at 1/2 unit twice a day to be safe.

 

I don’t think you need to go to another vet and pay for all that blood work again.
If anything I would get another fructosamine test done if the BG continue to be high just to confirm the diagnosis.
I would just monitor the BGs and try and get a urine test. Can you shut her in one area to do that.
As long as she is eating well and is not showing ketones, she won’t just go into DKA. She would start showing ketones first.
There have been a few changes in the availability of some insulins so I’m not sure what is available in Canada.
I’ll tag @Wendy&Neko as she lives in Canada.
Sheba started out on Lantus and went quickly into remission for 2 1/2 years. Then fell out of remission and I eventually swapped to Lev which I really liked.

 

Thank you for tagging her, much appreciated. GOOD NEWS! So I have a newer bottle of Multistix Urine strips I use for myself periodically to test my own urine to tell if my symptoms are a UTI or an interstitial cystitis flare, they test for ketones, too. So I got them ready to hopefully be able to slip under her butt the next time she pees. *fingers crossed* ....BUT......I decided to check her BG again, last did it at 6:30pm (277).....did it now at 1:10am....and it was 10.6 (190) !!!....and just to make sure it wasn't a wonky number I did it again, got 11.8 (212). Wow. I was so sure (and anxious!) that it was going to be higher than in the evening. Well that proves I really must just continue to monitor for a day or 2 more depending how it goes. Now I can relax enough to get some sleep.

 

FYI you can get pet glucose strips from Chewy. They have one that only tests for glucose and would be easier to slip under her when going to the bathroom. The strips you are using has the glucose block clear at the end of it and it may be more difficult to get the urine on that part of the strip as the goes pee

 

If you get Ketodiastix, you can test for urine in the glucose too. Since that has been negative, as well as the fructosamine, that's probably why the vet has been holding off on starting insulin.

Yes, Levemir is still available in Canada. Not sure if you can get vials, pens and cartriges, but you can get cartridges which is what I used anyway.

Nosorb is expensive, especially for multiple boxes, you can use washed lentils or aquarium gravel instead if you want something that doesn't absorb the pee. Bron posted the link to a post that says more about catching the pee for testing.

 

Try this product: https://checkupkit.com/kit4cat/

I just stick a small paper cup under my cat to collect pee A long handled kitchen ladle would also work.

 

You are absolutely correct -- it's generally older cats that are diagnosed with diabetes. I have no clue what this vet is talking about. Perhaps you could ask the vet for the research articles that support his statement about older cats having an elevated blood glucose level and not being diabetic. (Note to self -- have them put a memo in your cat's chart that your cat should never be scheduled to see this vet.)

The only possibility that I can think of for your cat's glucose level to be elevated is if there's an infection or inflammation present. By any chance, did the vet check your cat's teeth? Dental issues are often the cause for a cat to fall out of remission.

 

Wow I’m impressed with everyone able to put stuff under their cat while peeing. My boy doesn’t even want me in the same room. For those with more modest felines, my vet sells jars or No Sorb (like tiny plastic pellets…black) and even though my boys are litter finicky they will use a box I’ve put some in for testing (don’t use their litter just the No Sorb)—don’t need to fill the box just a little on the bottom. Online pet companies also sell a type that causes pee to pool on top (hydrophobic sand).

 

I'm a newbie here but can vouch for the hydrophobic sand. The urine pools on top for easy siphoning into a test tube for testing. (The sand kit includes an eye-dropper for drawing up the urine.) Clean-up consists of laying down absorbent paper towels.