? Vet comments

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Julee, Apr 24, 2019.

  1. Julee

    Julee Member

    Joined:
    Sep 19, 2018
    Below are my Vet’s comments about Tooters. He does get stressed when going to vet. I am not thinking what she is recommending is safe. I know my SS isn’t current but his results are about the same. He has been testing in the 300 at shot time. I haven’t done a curve recently and plan one for tomorrow. Please let me know your input/thought.
    Thanks.

    Tooters Housenga- 50278
    Feline, Longhair, Domestic, 15 Yrs. 3 Mos., Neutered Male, 15.3 pounds (10/4/2018) Wednesday, April 24, 2019
    Hi Julee,
    Tooter's fructosamine is 462 and greater than 450 is considered poor diabetic control. I would recommend increasing his insulin to 1 unit twice daily. I don't think it is necessary to do glucose curves or spot check multiple times a week. I think then it is easy to focus on a few low or high numbers. As long as Tooters is eating, I would not expect a problem with low blood sugar. Of course, if his appetite is poor than it makes sense to do a spot check before giving insulin. I would do a curve at home in 2 weeks and go ahead and email us the results. We can then make a decision about changing insulin doses based on that. Please let me know if you have any questions!
     
  2. MindyC

    MindyC Member

    Joined:
    Feb 27, 2019
    I would do a curve tomorrow and then dose based on that...but I’d also think an increase from .5U to 1U might be huge. I’m struggling with whether to do a .25U increase myself.

    And everyone here will tell you that testing is the only way to know what is going on with your cat’s bg, so keep doing it, regardless of what your vet says.
     
    Amina&M'row likes this.
  3. Marc & Jen

    Marc & Jen Member

    Joined:
    Dec 13, 2018
    I agree with @MindyC with regards to the home testing. That said, we are going to the vet on Friday for the first time since we've begun home testing and adjusting FA's dose ourselves and I'm a little nervous what she's going to say. In any case, I am curious to see if the fructosamine matches the data that we have gathered at home.
     
    MindyC likes this.
  4. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    Max would often get very hungry when dropping but not always. Your vet like many clearly does not understand feline diabetes or lantus.If I had followed that advice Max would likely have gone hypo or been in high numbers and built up insulin resistance. Testing is a safety issue.
     
  5. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Testing saved my cat’s life many times. And many others on here. One time Neko was sleeping and she was in the low 30’s. :eek: Many vets get less than a full day in school on diabetes, and that includes dogs too. Here we live it 24x7.
     
  6. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    I really don't mean for this to sound snarky but you're limiting how much we can help you by not giving us data to base our feedback on. No one here wants to give you input that would put your cat in jeopardy. Not only does testing keep your cat safe, it allows you and us to make informed decisions. It sounds like you've been testing but you've not kept your spreadsheet up to date. Can you get some recent numbers off of your meter?

    Keep in mind, a high fructosamine result can mean your cat's numbers are bouncing all over the place or they could be high and flat. Because fructosamine is an average, you don't know what the actual values look like.

    High values at shot time can be misleading. Lantus dosing is based on the nadir - the lowest point in the cycle - not on the pre-shot number. If you're following SLGS, you need to get a curve each week. You also need to get some tests during the PM cycle.
     
  7. Julee

    Julee Member

    Joined:
    Sep 19, 2018
    I am not offended by your answer- I haven’t kept up the spreadsheet but I do test before each shot and try to get a curve in weekly. Just don’t take time to get it entered. I have printed a log so I don’t have to remember it or be on phone/computer to record. It is true my testing/shot schedule is inconsistent in terms of 12 hour intervals but I do the best I can for Tooters. I am hoping that I am doing more good than bad for him.

    My concern is that I am not seeing the same care response from my vet that the forum uses. The forum makes sense versus vet saying just give insulin and don’t worry about testing or low numbers.
     
  8. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    We hear that a lot.....but the sad truth is that vets get less than a day of "formal" education on diabetes in school....and that covers both dogs and cats.

    The people here deal with it 24/7/365....some of us for many years.

    Unless your vet has a special interest in feline diabetes, they just don't have the time to stay up to date on the latest treatments
     
  9. Julee

    Julee Member

    Joined:
    Sep 19, 2018
    So if fructosamine is the average blood sugar. How is Tooters 462 when he is never that high? His average preshota have been in the 200-300
     
  10. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Fructosamine doesn't use the same scale as your meter readings. (That would be way too easy!!) If you've ever gotten your HgA1c tested, it's similar to a fructosamine test. With the HgA1c, the range starts at 4% and goes up from there. If you tested your BG using a glucometer, a 4% would be meaningless in terms of a BG test.
     
  11. Amina&M'row

    Amina&M'row Member

    Joined:
    Jan 2, 2019
    Maybe a different vet would be better? As you observe, some of their comments haven't been very helpful!
     
  12. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    Switching vets is always something you can do....When I was looking for a new vet for China, I called several and asked a lot of questions before finding one I was more comfortable with (and that was just for her dentals)

    I decided early on that I was going to listen to the people here over the vets because everything I read here made sense to me. The only time China went to the vet was when she had her teeth cleaned and when she had a nasty URI.

    When we did go in, I'd just tell the vet "China is on X units of insulin and her blood glucose runs between Y and Z" and that was usually the end of the conversation. If the vet did suggest something, I'd nod my head, smile and say "I'll think about that".....and come right back here and do what the people here told me to do.

    I'm just a big believer in "real life" experience over "book-learning"
     
    Sonia & Leo likes this.
  13. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Here are Fructosamine Reference Ranges for Cats:

    Cats - Fructosamine values (micromol/l)
    Normal non-diabetic cat 190 - 365
    Newly diagnosed diabetic cat 350 - 730

    Treated diabetic cats:

    Excellent control 350 - 400
    Good control 400 - 450
    Fair control 450 - 500
    Poor control >500


    Advantages and Limitations of fructosamine measurements

    • Advantage: Distinguishes hyperglycaemic, non-diabetic animals from diabetics with chronic hyperglycaemia
    • Limitation: Unable to detect short-term or transient abnormalities in the blood glucose concentration, e.g. hypoglycaemia.
    • Advantage: Does not appear to be influenced by transient (stress) hyperglycaemia
    • Limitation: Hyperthyroid cats with diabetes mellitus may have decreased fructosamine concentrations, despite having normal serum protein concentrations due to an increase in the protein turnover rate (decreased protein half-life) due to increased thyroid hormone concentrations.
    • Advantage: Useful in confirming diagnosis in cats
    • Limitation: Increase in hyperproteinaemia (e.g. dehydration).
    • Advantage: Useful in evaluating longer-term control and owner compliance with insulin treatment
    • Limitation: Dogs with hypoalbuminaemia also have a decreased fructosamine concentration (false negative).
     
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