Erratic BGL

I'm at a loss! My cat, Ezra was diagnosed with diabetes 5/09. He was on Lantus until 8/09. As his BGL went down, we weaned him from the insulin. His diet consisted of 7-9 oz of low carb FF over 4 feedings a day. I have continued to test Ezra even though he shows no symptoms of high BGL. His BGL had been between 50 & 130 until December. All of a sudden he had 3 days in the mid to high 200's. I reduced his food to 6oz of FF a day. His BGL dropped again but not to the original levels. Now his levels range between 110 & 170 most of the time. About every 2 weeks or so, he will jump into the 200 or higher range. Example: On Tues 113, Wed 230, Thurs 213. I haven't tested him yet today. He shows absolutely no symptoms. He is active, doesn't drink much, nor is there excessive urine in his litter box. Every so often I fax his readings to our Vet. She doesn't seem to concerned about his erratic levels at this point. She said if Ezra had consistent readings over 230, then we can discuss starting insulin again. Any suggestions out there?

 

How is Ezra's weight doing? I keeping steady maybe I would do nothing. If loosing weight then you may have to feed more and restart insulin.

 

Ezra lost a little weight when I first reduced his food which wasn't a bad thing! He looks healthy and his weight is probably where it should be.

 

Has he had a dental? There could be a mouth issue that would affect his BG's?

How recently was a CBC workup done?

I think what you need to do, is look at all possibilities from dental issue to infection to illness and start eliminating each thing one at a time.

Oh and also do the easiest thing first - check what he is eating to see if he's getting into something he should not be. You mentioned he's eating FF is that the new labels or the old? There have been several discussions (look on community and health) about changes to the FF formula and people getting higher than normal BG readings. So, before doing all the tests, it could be the FF that's the culprit.

Maybe try changing to another brand and see if that solves the problem and if not, then process of elimination as I mentioned.

 

I have noticed, on occasion, that he has a sore on his mouth. He won't let me check the inside of his mouth, so he may have dental issues! I will make an appointment with the Vet. She should probably see him anyway. The last time he was there was September.

I have checked some of the new label FF, but not all. I guess I will check the rest of the labels. Unlike some of the posts I have read in which the cats don't like the new, my cats love it!!

Thanks for the information. I would never have thought of the food lables. I must admit, I have thought of his mouth or dental issues causing the rise in his BGL. I guess I was just hoping it would go away!!!! I will post after I see the Vet.

 

Check out this link - as you can see - FF changes is a hot topic and purina responded about formula changes -- viewtopic.php?f=29&t=8197

This could be the issue - not that they like or don't like, but that purina did something that changed the product.

Oh yeah, and if there is a mouth issue - that could wreak all kinds of havoc internally.

Good luck and keep us posted.

 

If he were my cat, I wouldn't be reducing his food intake to keep his BGs down.

I would be looking for an infection. Dental is probably the most common to cause an increase in BG levels in a diet-controlled cat, but there are also upper respiratory and urinary tract to consider.

My vet recommends that my elderly (17YO) gets a full senior panel, thyroid, and urine workup every 6 months. Ennis has a real trash mouth, so he goes on a course of Clindamycin about every 4 months.

 

I am pretty sure that Ezra was eating too much. Both of my cats are much more active and look healthier since I reduced their food intake. Unless Purina is lying, the low carb food is still low carb. I have checked all of my labels and there seems to be no change in Guaranteed Analysis. The texture is different but my cats seems to like it better.

I am home today and Ezra is great. He is following me around the house and getting into things. Therefore, I suspect some kind of infection. He just isn't acting like a diabetic cat! I am going to call the Vet on Monday and get Ezra in for her to check his mouth and teeth. I may have her do some blood work jut to be on the safe side. Will keep everyone posted.

 

Update! Our vet has been ill so Ezra has not gone yet. Just by coincidence, our nephew's wife, who is a vet, was in town. She looked @ Ezra and became very puzzled. The sore on his mouth seems to be an ulcer which diabetic cats get when they are not controlled. She looked at Ezra's BG levels for the past 4 months and thought they were very good. She doesn't know what to think. Still no diabetic signs and still very, very active. The past 5 days his BG has been below 110. I have an appointment with the vet next Tuesday. Any ideas out there?

 

Wonder what that ulcer really is. Is there any way to test it to see what's going on?

Obviously 110 and under are normal BG's.

I would recommend a CBC workup and maybe even a fructosamine test - just to see what the average comes up with.

 

I had made up my mind that I was going to have blood work done. My nephew's wife said the only other thing she could think of was viral in nature. She also said she wouldn't worry too much because he is not symptomatic. I am going to have the vet check his teeth and gums. He won't let us open his mouth to see if there are any problems inside his mouth! Will keep you posted.

 

Took Ezra to the vet yesterday. The vet doesn't think there is anything to worry about. She said the sores he is getting on his mouth could be caused by several different things, none of them serious. She said an allergy is the most common cause. She doesn't think it is related to his diabetes. She did do a senior panel and fructosamine. She thinks Ezra is weird! His BG, even when on insulin, was crazy, so we are beginning to think that this is just him! Anyway, I am less concerned. Will know for sure next week!

 

Finally got the results of Ezra's blood work. Everything was good except the fructosamine test. It showed he was not controlled! The vet wants me to feed him the Purine prescription food. I already have him on FF low carb. He does not eat anything else! From what I understand, the FF is better! I have an appointment to talk to the vet next week to see what to do next. I think I should keep insulin in the house and shoot him when he goes above 150. He was on Lantus before. I just can't understand all of the low BG readings? HELP!!!! :cry:

 

Chrissy

What are his readings now? Have you been testing the last week or two?

 

Tues. 4/5 BG 215, Wed 4/6-Sun 4/4 BG high 200's (289-304), Mon 4/5 BG 215, Tues 4/6 BG 131, Wed 4/7 BG 151. I haven't tested him today. I just can't understand why he is not symptomatic?

 

And these are without insulin? SOrry for the questions but your posting frequency is infrequent and you don't have a profile set up with this information....

 

He is not "symptomatic" because those blood glucose levels on average are barely at or above the renal threshold, about which there is some debate, but BGs over 250 may produce PU/PD for some cats. If he is not spending more than a few hours at those levels every day that is probably why you aren't seeing those symptoms.

Exactly what symptoms of feline diabetes are you expecting to see? Some of us here had our cats diagnosed prior to any classic symptoms, such as PU/PD (excessive thirst & drinking because of the sugar being filtered through the kidneys) or excessive eating while losing weight. Do you have the fructosamine value? Here is a chart -

Cats
Fructosamine values (mmol/L)
Normal non-diabetic cats 190−365
Newly diagnosed diabetic cats 350−730
Treated diabetic cats:
excellent control 350-400
good control 400-450
fair control 450-500
poor control >500
prolonged hypoglycemia <300

Diabetes symptoms often don't present until the disease has progressed. If caught early and treated with insulin, cats have a good chance of going in to remission. Your cat may also have what we call a sputtering pancreas, which means it is producing insulin but maybe not enough to maintain blood glucose at normal levels all the time. It will need insulin to help rest it so that it can work properly. Diet is also key to helping a sputtering pancreas and you're correct, low carb Fancy Feast is better than higher carb M/D.

As for the sore in his mouth, has he had that anywhere else on his body, like outside his mouth or on the pads of his feet? There is a probable allergic reaction which results in sores called eosinophilic granuloma: http://en.wikipedia.org/wiki/Eosinophilic_granuloma

The unfortunate thing is this condition responds very favorably to steroid treatment, which is bad for cats and especially bad for diabetic cats. Steroids are sometimes indicated as causing diabetes in cats and should be considered a last resort.

Hope this helps.

 

I will try to answer all questions. First, I am technologically challenged, so I don't know how to set up a profile! If someone would guide me, I will set up a profile.

The BG i have posted for Ezra is without insulin. I don't know what his Fructosamine value is. A Vet's assistant just told me that he wasn't controlled. I thought he would be drinking and urinating excessively, but he is not. The only sore he has is in the front of his mouth. The vet thinks it is allergy. It comes and goes and it doesn't seem to bother him, so that is not a concern at this point.

I want to gather as much info as I can before I see the vet next week.

 

Ok, so his pancreas is working but he's showing some diabetic numbers (anything over 120) but not crazily so. What might help you/us understand the variance might be the test results in relation to when he ate, as this will affect bgs.

As far as symptoms, some cats tolerate higher bgs better than others. My suggestion is to continue once a day or so, and also test his urine for ketones as insufficient insulin can cause them to develop and you do not want that complication (see faq for more info). if he goes consistently over 200 then you may need to consider a very tiny amount of insulin.

Jen

 

Jen & Squeak...You confirmed what I was thinking! I think his BG is high enough to start Ezra on a tiny bit of insulin. Ezra weighs about 10 1/2 lbs. I feed him between 6 and 7 1/2 oz of FF low carb daily over 4 feedings. He is maintaining that weight, and seems to be satisfied with that amount of food. His BG was 209 yesterday. So, I think he is going to have more higher days until I get him back on insulin. Thanks for your input. I am still open for more comments.

 

Have you considered a food trial? You feed him FF regularly/exclusively? If so, I would pull out the good old Food Chart and pick a different brand and go with the lowest carb contents you can. I've read 5% or lower is said to be ideal, so that's what I'd shoot for. I'd change him for 3-5 days and watch his numbers. My cats seem to love the new label FF too... which makes me suspicious, because they've always hated canned food but now they love it, since the label change. I feed a lot of FF flavors and have experimented with others and they like FF the best. I suspect they've done something to the taste to make it sweeter or more yummy to carb addicts at least. I'm getting good numbers on Tugger with it, but he never had the old stuff on a regular basis, he ate kibble so anything is going to be an improvement for him. I've found a few cans of it so am making note on his ss when I feed those, not sure if it's making any difference in his numbers yet but I'm watching. If this were my kitty, I'd switch brands before hitting the juice but I'd probably have the juice on hand just in case. I'm really new here and to this whole thing so take that for what it's worth :smile:

I do hope you get it figured out soon, whatever it is!

 

I do feed him FF low carb exclusively. I give him different flavors every day because he gits picky! I hesitate changing because I have tried to do that before and his BG did go up a little! I think I'll stick to the FF and wait to talk to the vet!

 

I had a consultation with the vet last Thurs about Ezra's BG. His fructosamine value was 503. This didn't surprise me because his BG readings have been higher for a few weeks prior to the test. We decided to try the oral medication for a month or so to see how he does on that. I know it is not usually successful, but Ezra is sensitive to the Lantus and went hypo a few too many times for the vet to be comfortable giving it to him again. She also thought I may be feeding him too much.

Well, I got the prescription filled and cut his food from 7 1/2 oz to 6 oz of FF low carb. I did not start the medication, because, since Friday, his BG has ranged from 47-124! He got stubborn and wouldn't eat one morning-therefore the 47 reading! I am so puzzled!

One question--is 6oz of FF enough for a 10 lb cat?