Misdiagnosis?

Good evening!

As I mentioned in my introduction post, my (approximately) 10 y/o cat, Avery, was just diagnosed with both hyperthyroid and diabetes. However, her first at home curve showed very normal numbers.

I'm beginning to think she was misdiagnosed due to stress, UTI, and hyperthyroid. I have no idea what to think of these numbers though... She also had 4+ glucose in her urine test.



Any help decifering is appreciated!

 

We have a couple of people who are very good at reading lab results, I will tag a couple for you. @Marje and Gracie, @Sandy and Black Kitty, can one of you lend a hand here?

 

My understanding is that if there is glucose in the urine, it is a pretty good indicator of diabetes. Though stress from the vet visit can temporarily raise blood glucose, it does not do so to the extent that it would cause glucose in the urine. (That is something I asked about at Mia's diagnosis since she is a major scaredy cat, and I knew her glucose test had to be impacted by her fear/stress.) A fructosamine test is a way to confirm a diabetes diagnosis, if desired. Since it is based on levels over a period of 2-3 weeks, a brief, temporary rise in glucose will not have much impact on it.

 

I read that about glucose in the urine as well. Thanks for confirming. She did read as 4+ last week, but only 1+ two weeks prior.

Should I be testing BG daily?

 

Have you started insulin yet?

 

Oh nevermind, I see no insulin. You have the AT2 meter already? I'd use it here and there just to get an idea of numbers. Test before food and maybe an hour after to see what is going on.

 

We gave her 1 unit of Lantus on Tuesday to begin our first curve. However, when we were getting normal numbers, the vet recommended we not give the 2nd dose.

 

Oh, it's too early for a curve. Did you give insulin yesterday or today? If you are giving insulin, you would want to check at least 4 times a day.

 

Only Tuesday. We haven't given her any since then. I just tested her about an hour after she ate and she was at 5.9 mmol/L which is actually the highest I've seen it since her lab results.

 

That's pretty good! Was it wet food or dry food? Dry food in my guy doesn't show up until about 3 hours later. Either way, looks like Avery is not needing insulin

 

It was Wellness Turkey pate - wet food with a bit of extra water added. I'll keep testing periodically to keep an eye on her, but, man, are those strips pricey.

Do you use the Freestyle Lite with your AT2?

 

Heck yeah they are spendy! I have both strips. I bought 400 strips of the freestlye of of ebay. They work, but have had some wonky numbers when compared side to side and some dead even.

Hopefully Avery statys like this and you'll only need to test sporadically for a few weeks and then maybe monthly!

 

Ah, good to know. Thanks for your help!

 

A cat can have glucose in urine from stress — happened to my civvie Erica (find her name in the forum). Have seen a bunch of cats recently misdiagnosed based on one spot measurement. Was a fructosamine test done?

 

No, it wasn't offered and I didn't find out about it until finding this lovely site.

Due to how this vet office has treated me and Avery, I'm now shopping for a new vet. They tried to charge me $135 for a 2 minute phone call (they called me) which consisted of me telling them Avery's numbers are normal. That was apparently a glucose curve interpretation, despite me being the one to interpret the results. As if they haven't milked me for enough money this week alone.

 

Yikes!- $135.00 for a call they made to you. No wonder you're shopping for a new vet. I hope this doesn't spread as something new to charge for. I had a cat whose glucose spilled over in her urine check all the time when at the vets, but blood work never showed she was diabetic.

 

Just a quick review of her labs:

I would not wait too long to have her blood tested again because I don’t like that both her sodium and potassium are low. Sometimes we see these electrolytes low in unregulated diabetics but her BG looks pretty good right now. You’ll need to have her retested any way a few weeks after she’s been on the felimazole so I’d be sure they check her electrolytes.

Also, her ALP is very mildly elevated. ALP is a liver enzyme which can be elevated due to cholangiohepatitis, bile duct issues, or hepatic lipidosis. Usually with the first condition, you’d also see the ALT elevated. Unfortunately, your vet didn’t do a complete superchem so the other numbers we’d see with bile duct issues would be an elevated GGT. However, let me stress “very mildly”. If your vet does a superchem, as I’ve suggested, you’ll see all the numbers and the complete picture. Don’t let it go ...... follow up. You’re looking for trends as one set of labs is just a snapshot at that moment.

 

Thanks for sharing your expertise! I really appreciate the extra set of eyes. I was thinking her electrolytes were low due to the amount of water she had been drinking (her urine was also dilute). She's been drinking less lately. Since she was diagnosed with both diabetes and hyperthyroid at the same time, I don't know which treatment has had an impact on her thirst drive - diet change or Felimazole.

I will definitely be checking her blood work within the next couple of weeks. Just at a new vet office, I think.