1-12 Booger Post-vet More questions than answers.... AMBG 217

Status
Not open for further replies.
MartinJA527

MartinJA527

Member Since 2014
Anyone not following along this weekend can find the events HERE.

So... Got up this AM and Booger was her bright eyed normal self.. she ate a full meal, though rather slowly. I Was home to watch her today.. To my amazement she dropped (to the blues) after being off insulin for what has now been 5 cycles... We had no vomiting, her demeanor was good and she seemed to be in normal good cat spirits... I immediately phoned the vet when they opened this AM and took his first available appointment which was 3:30..

The vet gave her a thorough exam, I informed him of all her activity and he had seen my e-mail prior to us getting there.. She did not have pancreatits or DKA. He wanted to do a fructosamine level.. he told prior to the results of the lab tests that her blood was lipemic.. I am familiar with those terms and know what it means.. I also know it doesn't make sense. They had a difficult time getting blood also. He told me it could just be a result of her recent sickness and not have anything to do with the fat % of her food (mainly weruva paw lickin chicken, mack and jack, or her partial raw home made meal with 50-75% fat removed manually)... Her fructosamine came back 598... and she has never been in this range (with my human meter.. and even prior to insulin therapy we were mainly in the 300's (on the alphatrack).. so I don't get this number.. We were discussing the possibility of chronic insulin overdose/rebound.. but he said based off this number he would be inclined to suggest an increase.. He's making some phone calls to see if the integrity of the specimen could be compromised due to the lipemic state..

This aside.. prior to my vet visit.. and being that Booger is feeling so much progressively I have a question.. is it possible that this IS chronic insulin overdose/rebound.. and that we should have been REDUCING?? It seems like we had such better control at lower doses of insulin.. and we took those back to back reductions and then increased and sh*t hit the fan.. (sorry, I don't know how else to put it.. and I'm desperately searching for a clue here). She's DROPPING off insulin.. I would think the shed should be depleted significantly by now.. and any "sickness" would spike sugars.. shes 230 right now and was pretty stressed at the vet.. vocally defying and physically trembling.. I need some guidance and a few prayers, ya'll....

He did give her some medications for pain and nausea..
 
Just one basic question -- you do know that fructosamine numbers are calibrated differently than BG numbers?

For fructosamine, 191 - 349 = normal, 400 - 450 good control, 500 - 650 fair control, > 600 poor control. Looking at Booger's SS, I would say he's in fair control.

As for chronic insulin rebound (aka "Somogyi"), this is a bit of a soapbox issue for me. There is no research to support the existence of Somogyi in cats on a long-acting insulin like Lantus. The concept of Somogyi was started in 1938 based on urine glucose testing of a very small sample of humans on a shorter acting insulin. The results of this one study have never been replicated in humans, let alone any other mammal. At best, the concept is controversial.
 
I do know they're different but I did not know the actual numbers and I was thinking she was in the poor control category with her result. Thanks for your clarification with that.. I still wonder if the number is accurate as the specimen was grossly lipemic as I mentioned

I know lots of people have differing opinions with the rebound effect.. so do you have any theory on why she is coming down if not that? I'm just at a loss so it was a thought..

Thanks again
 
The sample could have been lipemic because she ate too close to the blood draw. I know it can have an effect on some labs and it depends how lipemic it was. When I get a chance I will see if I can find the info I have on it in one of Max's files and it happened to him once. How was it determined it isn't pancreatitis? Just curious.
 
How long would food affect the blood draw do you think Elise? Should she have been fasting overnight? I didn't see it so I can't attest to the degree.. He did a lot of deep palpation to determine if there was a pain response elicited.. he wasn't completely satisfied with that (she didn't move, didn't cry, but really didn't give him any info to go off of). Temperature and other vital signs were normal. CBC was WNL. Amylase and Lipase were good too (still questioning the specimen). Don't have the fpl back yet.. so I guess technically it's not a definitive conclusion..
 
MartinJA527 said:
I still wonder if the number is accurate as the specimen was grossly lipemic as I mentioned
Click to expand...
The fructosamine result could be off because of the lipemic sample according to the Pet Diabetes Wikia:

False fructosamine test results
High levels of Vitamin C (ascorbic acid) or circulating fat in the blood (lipemia) can interfere with fructosamine testing. The breakdown of red blood cells (hemolysis) or hyperthyroidism can also[11].
 
Thanks! He didn't mention hemolysis.. but I'm wondering if it was masked under the lipemia.. the tech brought Booger back and said "she didn't want to give up the blood".. I should have asked if that meant they had a hard time getting it (indicating possible hemolysis as well.. or they had a hard time getting it the first time and went for a second stick)..
 
I'm glad the fPL was run. It is best done on a fast of 12 hours. Most with diabetic cats don't fast any more than 8 hours though. The time Max's sample was lipemic I think he had eaten fairly close to the blood draw. I try to have at least 5-6 hours after food. How are things tonight?
 
Ok so judging by my interpretation of what you're telling me.. my morning feeding her could've caused this lipemic state.. great.. and to top it off, I'm questioning the lab techs draw. and the possible induction of hemolysis. perfect.. and now I have reached the conclusion that the tests may be meaningless.. Horray! :banghead: Yes it was run.. and my assumption is that it will be inaccurate as well.. as she wasn't fasting (about 8 hours). She's doing much better. She hates the medicine he's given her but other than that, same old kitty. Lots of purrs and biscuit making tonight.. follows me to the food bowls... happy meows.
 
Status
Not open for further replies.
Back
Top