Tommy has diabetes

[Ash]

My vet was here today for over an hour. She showed me the bloodwork reports, she said they are in SI units.

(Both the dogs' reports are within normal limits everywhere btw! Yay! )

Tommy's report is normal apart from the blood sugar level of 324 mgm, the blood urea of 56 mgm, and the serum creatinine of 2.0 mgm.

Because of that last value, she said we cannot give Tommy a high protein diet. She advised a low protein (20-25% max) AND low carb diet, but high in fibre. Good news is, she is getting Hills' products already (Hill's deals only with vets here not with private customers or retailers), so she will contact the company and will try to get the Hill's Precription diet W/D for him. (For Noodle - once we retested her and confirmed it's oxalate crystals - she will try to get the Hill's Precription diet X/D.)

If that is not possible she suggested a low fat diet food such as Pro Pac Low Fat or maybe even the vegetarian Pedigree dog food, which is low in protein (20%). She said she will check several foods and get back to me.

In the meantime she advised us to get these diabetic testing sticks to monitor Tommy's urine sugar level twice daily for five days (noting down if he had just eaten prior to urinating, and what). She didn't want another blood test just now because it upset him so much the last time and that might have interfered with the results. So for now we'll monitor his urine, and then if it stays high, probably have another blood test next week.

Also in the meantime, she advised me to start feeding him the low fat Pro Pac food already, and no eggs, no fish, no meat, nor milk products, no bread or other simple sugars.

So, do you agree with her approach?

I asked her about her experience with diabetes and she said she has treated dogs but not cats.

Since three days he has not been getting any bread, and I have the impression that he's more energetic and less whiney.

For Noodle she's advised us to give no milk products, no eggs and no tomatoes, but continue with the canned Whiskas, until she'll get her special diet food.

[Traci]

Actually, those look more like Traditional units rather than SI units,...please re-confirm that with your vet. And, the last that you mention is creatinine, which, if Traditional unit, is within normal range,...it is the BUN that is elevated. In any event, the low protein would be ok at this point, but would want to recheck labs in another week or two, I wouldn't wait any longer on that because you need to get the glucose curves repeated, and include urine glucose as well.

If she is going to use the W/D, then you need to keep a monitor of Tommy's weight, on a monthly basis, you don't want him losing weight drastically or too suddenly. The M/D might be more suitable for his metabolism as your vet determines his need for insulin (or if she can diagnose this specifically at all). If she can get Hill's veterinary diets, then she can call the company and speak to a vet consultant about Tommy's case, get a more appropriate recommendation based on his needs, medical history, weight, labs concerning glucose, etc. They could even probably refer her to some useful sources she can read up on for diagnosing and treating feline diabetes.

You can't give dog food to cats, if that's what you or your vet implied. Dog food isn't formulated properly for cats, and doesn't contain necessary taurine, etc that is essential in the cat's diet. The meat source may not be appropriate, and a vegetarian diet, regardless if it is a dog food or cat food is not appropriate for cats, as they are carnivores and require meat in their diet. Hill's should be able to consult her.

[Ash]

Tommy's blood report states "normal range for blood urea 10 - 45 mgm", and "normal range for creatinine 0.1 - 1.7 mgm". So he is slightly above in both. So it must be SI units after all?

About the Pedigree, I think she meant to check if they do Pedigree cat food as well. (But I don't think they do.)

From tomorrow he'll get the Pro Pac Low Fat for the time being (although I still don't know how fat and carbohydrates are connected ), and we will monitor his urine glucose. Then next week, another blood test.

Thanks for discussing all this with me Traci! It's a big help for me.

I will tell her to consult someone at Hill's, if that's possible.

[Traci]

Unless she's using a very old blood analyzer or from canine values, it's hard to say (they don't match from the SI units I compared with). Regardless, if she used specific feline range values, then yes, they appear out of range. I would restest the BUN and creatinine in a couple weeks to compare or see if there is any significant changes that may warrant fluid therapy, etc.

Hill's consultants are avaible to vets who utilize their products, they have a number for that purpose listed on the veterinary food package.

[Ash]

It's not her that wrote these values, it's the lab, and there are no specific animal labs here. It's a lab for human blood, urine etc testing, but they do animals too. I just compared Tommy's results paper with the ones of the dogs, and they give in fact the same 'normal values' for the dogs! This is not right, is it? Do normal dogs and cats values differ a lot? Or did they simply use human ranges???

Yes, we will certainly re-test him again next week, after we monitored the urine glucose for 5 days. Still were not able to get the strips yesterday, they are supposed to arrive today. Things always take longer here ...

He likes the low fat food which is said to be low in fat AND calories. We give him as much as he wants to eat, don't want him to lose weight since he's not overweight.

[Traci]

Ughhh....no, they are not supposed to be canine reference ranges....there are seperate biochemical reference ranges per species.

The following is normal biochemical reference ranges for cats, as it applies to BUN, creatinine and glucose:

Traditional Units: (for normal feline reference ranges):

BUN: (mg/dl): 18-34
Creatinine: (mg/dl): 0.6-2.0
Glucose: (mg/dl): 65-134

System International Units: (for normal feline reference ranges):

BUN: (mmol/l): 6.4-12.1
Creatinine: (umol/l): 106-186
Glucose: (mmol/l): 3.1-6.3

Note: these are general normal reference ranges for cats, they may differ depending on the type of blood analyzer the vet is using. Blood analyzers should always include reference ranges per species when the equipment is purchased. If your vet doesn't have (or know) normal reference ranges for cats, I would suggest running the bloodwork with a vet who does, or ask the human hospital if they have feline reference ranges with their analyzer.

[Ash]

You see what I'm up against here! I just called the lab myself and spoke to the doctor there, and she confirmed my suspicion that what they state as 'normal ranges' are in fact human ranges

And she said they use SI units, although what you wrote above - mmol/l - doesn't turn up anywhere on the report. I have everywhere mgm %.

The values I have look more like corresponding to what you say are Traditional units ... Is this difference very important?

She also said they use a "Fully automated blood cell counter ERMA PCE 210", whatever that is.

So, I have compared the test with what you have on this site as 'normal' feline ranges and it appears that apart from the elevated BUN and glucose levels, the WBC count is low - only 4,900, the direct bilirubin is high - 0.4 mgm, and the serum albumin is high as well - 4.0 gms.

His platelet count is 1.81, couldn't find that in your tables.

Creatinine seems to be within normal range, contrary to what my vet said.

All other values seem to be - compared to your tables - in normal ranges, too.

Any thoughts?

I don't know what to do about this vet. I'm pretty sure others won't be any better! There are no feline-only vets here. I have changed the vet several times over the past years because they all seemed incompetent and/or very uncaring and unreliable. My current one is at least warm, caring and reliable, and has time to sit down and discuss things with me. I have had others who were quite cold and short, never explaining anything, even getting upset when I ask questions. I will not let Tommy be injected with insuline by people I consider not much more than butchers.

I will ask around though, hopefully I'll find a vet who has treated feline diabetes before.

Btw, do you know the normal biochemica and hematological values for dogs? I have searched the net but can't find any charts for dogs.

[turleyhead]

Hi Ash,

Sorry to hear about your cat's health problems. I just wanted to offer sympathy and say I can totally relate to your frustration with the vet situation. If you have someone who is at least compassionate, then you're luckier than I was. I would hesitate to change, because as you said, most the vets here seem incompetent, uncaring, and arrogant and yes, even butchers. I wish I could give you some advice on this, but all I can say is that I know how frustrating it is with the resources you have. Hang in there and hopefully your vet will know the best course. At least you can get the food. Good luck!

[Ash]

Thank you, Laura! Yes, you would certainly understand ... I'm at the point where I check and double check everything vets here tell me. Sadly, you didn't have the time to do that. I hope you're alright ... Best wishes!

[Traci]

I can't even begin to interpret more on the values, because it is obvious she is not using correct reference ranges for felines. Whether the values were for canine or human, the vet is responsible for asking for feline-only reference ranges whenever they use a human lab to do the blood chemistry panels.

The way this works is the vet (or veterinary community), submits blood samples from the specific species, based on age, normal health, environmental factors. This can involve using 50-100 (or more) different pets to submit blood samples to a lab to compare in order to get a general idea on normal reference ranges for that particular species. Once this is achieved, the blood analyzer used should then include a reference chart for that particular species, so the vet can use the analyser and get valid results. The problem sometimes is that different companies will manufacturer different analyzers, so the vet needs to choose one that will provide reference ranges for whatever species he/she is working with. Values can differ slightly between analyzers and the manufacturer's methods.

Now, if your vet or the human lab isn't using normal reference ranges for cats, then you're in trouble.

Here is a link for normal biochemical reference ranges for dogs and cats, and a few other species. At the bottom of the chart includes SI units.

Here is a link for SI Conversion Factors

Here is a Calculator to convert Traditional Units to SI units or vice versa.

To use the calculator:

1) Choose "Creatinine" from the drop down menu.
2) Change the left-side "convert from" the drop-down menu to "mmol/L" and the right-side drop-down menu to "convert to" mg/dL.
3) Enter 2.0 in the "value" box and leave the "answer" box empty.
4) Click on "calculate".
5) Now look in the "answer" box. This is the Traditional Units.
The "factor" box notes what mulitiplication was used to convert SI to Traditional Units.

Now do the same for Glucose and Urea nitrogen (serum), using the numbers your vet gave you from the lab results.
You can also reverse the "convert from" and "convert to" drop-down menu boxes to get the comparisons between Traditional Units and SI Units.

If you use this calculator, you will see an enormous difference between what your lab results are and what they should resemble in a "normal" reference range, using the examples I gave in the previous post. For this reason, it would be best to check around to see what vet(s) actually use a species-specific reference range, in this case, for cats. The human lab should be asked specifically for feline reference ranges.

Note: It's really important to know that different analyzers will produce slightly different values, but they shouldn't be drastically varied.