Being regulated question.

Hi
Sorry if this sounds silly but if anybody can help answer my questions please regarding being regulated.
If you could you take a look at Dukes spreadsheet please and tell me if you think he is "treated but not regulated, regulated or well regulated", plus do you think he's now below the renal threshold.
I have read this section in the FAQ list but it doesn't say whether the figures given are pre shot figures or just in general figures throughout the day.
Thanks.

6. REGULATION

Q6.1. What is regulation?

A6.1. There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum":

• Not treated [blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs]
• Treated but not regulated [often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs]
• Regulated [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia]
• Well regulated [generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia]
• Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin]
• Normalized [60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin]

 

Hi Tee,

The regulation guidelines refer to the maximum and minimum BG levels over recent days. Typically higher BGs are seen at preshot but sometimes they might appear mid-cycle if the cat gets a food rise, is bouncing, or - as you've seen recently - experiences a temporary stressor such as a vet visit. Also, sometimes you can see late nadirs, possibly at preshot time. You're looking for the overall picture.

Looking at Duke's data, his BG numbers point to his being very much in the 'Regulated' camp (particularly when you take into consideration that his readings are taken on an Alphatrak and that pet meters typically read higher than the human meters the guide is written for) but you need to also assess his clinical signs alongside his numbers, so you'd take into consideration:

* fluid intake and urine output.
* whether his appetite has normalised.
* whether weight is now OK and is being maintained (especially if he had previously lost weight due to the diabetes).
* energy levels and mood.
* condition of the hair coat.

Assuming they're all OK then I'd consider Duke to be doing really well.

While I've not used your insulin, I've seen a fair few spreadsheets for Prozinc kitties and Duke's response looks really good, especially as he's only been on insulin for just over a month. There are some members who would give their eye teeth for their cats to have a spreadsheet like your boy's.

I understand that Duke's due for a dental soon. All going well, you may see further improvement in Duke's regulation thereafter.

With regard to the renal threshold, to the very best of my knowledge FDMB doesn't have any formal guidelines (but I could be wrong, might be I've just not come across them in the wealth of info posts on the site). I have looked to the online Merck Veterinary Manual for a guide on this. According to said reference, in places they give the glucose renal threshold as c. 16mmol/L (c.280mg/dL) but elsewhere in the manual I've seen them give the range 14-16mmol/L (c. 250-290). These would be values measured on equipment calibrated for veterinary use. The actual threshold varies from cat to cat. Using the value of 16mmol/L as a guide, Duke would be likely to be below the threshold most of the time. The best way to find out is to actually test his urine and see what the readings were in the hours between the time the pee sample was collected and the previous time he voided his bladder to get a rough idea of where his 'tipping point' range is. (Not an exact science!). If you check his pee regularly and it's consistently negative you'll have more confidence in whether he's spending most, if not all of the time under the threshold.


Mogs
.

 

PS: An afterthought: I once had a feline internal medicine specialist tell me that the renal threshold was around the 11.1mmol/200mg/dL mark.

As I mentioned above, it's helpful to actually test the urine regularly.


Mogs
.

 

Wow, thanks for the detailed answer Mogs, it's really appreciated.
Can i answer some of your questions.

* fluid intake and urine output.
Duke does not drink much now since he started insulin but before that his nose was always in the water fountain. He does drink now and again but most of his fluid comes from his food with about 25ml water added. His urine output is strange as he only goes twice a day, he's been the same for years just twice a day, regular as clockwork.

* whether his appetite has normalised.
I'd say his appetite has got better again since he's been on insulin, he's not ravenous and begging for food all the time anymore, he would even try to pinch food of our plates at one time, but now he's content after his meals.

* whether weight is now OK and is being maintained (especially if he had previously lost weight due to the diabetes).
He did lose a lot of weight and muscle mass with back leg weakness, but he's put back on 100 grams (weighed at the vets yesterday)

* energy levels and mood.
He's a lot happier now and plays a bit although he's never been one for playing but he does chase our other cat around a lot more now (much to George's disgust lol)

* condition of the hair coat.
His coat is looking good again with a nice shine but it was terrible at one time being really greasy with lots of dandruff basically looking really unkempt.

Regarding the renal threshold we check Duke every single day for Ketones and Glucose in his pee with the Diastix strips and they are both negative now although the glucose was showing brown at 1% (5th box up on the little chart on the bottle) but it came down to negative gradually. Ketones have always been negative.
Let me know if i have missed anything.
Thanks again Mogs.

 

That's a very good whole cat report, Tee. Great news about the glucose- and ketone-negative urine tests too! Looks like you're doing a grand job altogether caring for your boy. (((Duke)))


Mogs
.

 

Is Duke's back leg strength back to normal now, Tee? For any neuropathy issue, good regulation is the main thing that helps but it may be worth your considering the introduction of a B12 methylcobalamin supplement by way of a little extra support. Eliz has included info on where to get diabetic-friendly methyl-B12 and folate supplements in the following thread:

https://www.felinediabetes.com/FDMB...-vit-b12-and-other-need-to-know-stuff.137376/


Mogs
.

 

Hi Mogs
He has got some strength back but he has arthritis so it's hard to tell and there is no way he's having Loxicom as the vet suggested.
He's actually on two capsules B12 with the folic acid everyday but i thing his bulk i starting to come back slowly.