Recently a new test for pet diabetes became available. It is the hemoglobin A1C for dogs and cats. I think there are definitely some situations where this test will be good for veterinary patients, but please don’t throw out your glucose meters just yet. A blood glucose curve is still my preferred test to evaluate glucose regulation in diabetic pets.
Doctors use the A1C test for humans as well. This test gives us a reflection over the recent past as to what the patient’s blood glucose has been. It is a longer “look” at past blood glucose than the fructosamine test that we veterinarians have had in our toolbox for years.
A blood glucose reading from a blood glucose meter tells us what the blood glucose is at a moment in time. A fructosamine test gives us an indication of what the blood glucose regulation has been over the previous few weeks. The new hemoglobin A1C test gives us an indication of the blood glucose over the last 110 days for dogs and over the last 70 days for cats.
What Might be a Good Time to Use a Fructosamine or A1C Test?
Fractious pets that won’t allow a blood glucose curve at home or even in the clinic would be reasonable patients to forego a curve and settle on one of these tests. If a pet would harm the owner (while attempting a blood glucose curve) or if the pet becomes so stressed at a vet clinic that a blood glucose curve is tarnished with stress hyperglycemia, an A1C test can be helpful. Given the average situation, a relaxed pet who will allow blood glucose checks by owners, is the better option as I’d still much rather evaluate a blood glucose curve. Curves give us better information as to what we should do next!
Life is easier when pets can receive the same dosage of insulin every 12 hours. It’s less costly and a whole lot easier for diabetic pet owners than adjusting the insulin dosage based on the blood glucose right before the insulin dose. More often than not, we can give the same dosage of insulin each time. Nonetheless, now and then I find a patient that just doesn’t seem to follow the rules and the owners have to check the blood glucose before each insulin injection and adjust the insulin dose based on that reading. Agh!!! When I have one of these patients, even though I continue to urge blood glucose curves, an A1C test (or fructosamine test) might help us know how well we are doing overall.
Oftentimes owners resist purchasing a blood glucose meter. And yet, it really matters to me that my clients with diabetic pets are able to check a blood glucose on their diabetic pets at home! I’m sneaky, so I give financial incentive to families to run home curves. I make my pet owners buy a blood glucose meter starter kit whenever I diagnose a diabetic. I can nearly always educate them so that they can do the curves themselves and text me or email me their numbers after a curve. I tell them it will save them the money of my staff checking glucose values and the recheck exam fee when we run a curve in the clinic! Even if they don’t think they can run a curve at home, I tell them if they force me to do a glucose curve in my clinic, rather than at home, I will charge them half the price if I use their meter and strips compared to when using my clinic glucose meter. That offers them financial incentive to at least buy a meter. On my initial re-checks I show them repeatedly how to use the meter and usually then even the most hesitant clients recognize that it’s not rocket science to check their pet’s blood glucose. I rarely have clients who make me run the curves at my clinic because I show them how easy it can be!
Now, Why Do I Always Harp on About A Blood Glucose Curve?
Running a curve means checking the blood glucose every 2 hours from one insulin injection until the next, 12 hours later. For example, if you typically give Fluffy insulin and food at 7 am and 7 pm each day, you would check a blood glucose and give the insulin and food all at 7 am. Then at 9 am you will check the blood glucose. You will check the blood glucose every 2 hours until 7 pm UNLESS the blood glucose goes below 150 mg/dl. If it drops below 150 I like folks to check it hourly until it starts to rise. By increasing the frequency when it gets lower we hopefully won’t miss the “nadir” (where it bottoms out). We want to run a curve on a day that is as close to “normal” as possible. If crazy Aunt Sue with her 3 dogs is visiting, then wait! If there are fireworks or construction work outside that might affect your pet’s appetite, then wait! Pick a day that is “normal” for your pet.
Why do we want to know the nadir? The nadir tells us if we should increase or lower the insulin dosage. I like the nadir to be around 100 mg/do, but honestly, if we can get it anywhere in the 80 to 150 range I’m pretty pleased. I also like most of the numbers to be below 300 mg/dl. Why do I choose that number? The glucose threshold in the kidneys (when it starts to overwhelm the kidneys’ ability to pull out fluid from the filtrate that becomes urine) is around 300 mg/dl. If most of the glucose numbers are below 300 we won’t have a diabetic pet peeing and drinking excessively. That results in a better quality of life!
Fructosamine test results tell us in broad categories if the diabetes control is fair or good or poor. A1C test results report as normal, pre-diabetic or diabetic. The lower the number the better diabetic control for the A1C test. Running a fructosamine test or an A1C test is pricey compared to checking a blood glucose. In the big picture, someone with a diabetic pet can usually buy a blood glucose meter and whole vial of test strips for less than either a fructosamine or A1C test may cost.
Have a question or comment? Post below or email me at [email protected]. I always enjoy hearing from my readers!
NOTE: Consult your veterinarian first to make sure my recommendations fit your pets special health needs.
Jen, I’m so sorry that you lost your beloved pet.
I do NOT think the strips mentioned (Freestyle and Alphatrak) are the same strip. Alphatrak used to be made by Abbott, who makes freestyle, but no longer. They are the same in appearance, but not the same strip as I understand. I would not advise anyone to use a strip made for a meter other than the meter it was meant for.
We keep watching for the release of Kinostat. Currently the Kinostat website says they are hoping for final approval from the FDA and release of the product at the end of 2017.
Hi Dr. Joi,
I am just seeing your reply and wanted to thank you for the info abt the strips. I didn’t realize Abbot was not making the Alphatrak any longer. I will not tell anyone to use the Freestyle strips with Alphatrak!
This is wonderful news about Kinostat, I hope it is approved. From what I understand having spoken with them, it has shown amazing results in dogs newly diagnosed with diabetes to prevent diabetic induced cataracts.
I miss my boys everyday, they left us far too soon. But we recently adopted a 2 year old Cocker Spaniel from the Westchester SPCA. Our 3 year old Cocker and he are bosom buddies, and they are the exact same color as the two we lost! They definately make life interesting.
Thanks for all you do! ?
Thank You Dr. Joi, for this very informative article! Great news on the A1C test but I am glad you have clarified here and in your practice, for pet owners how important it is to own their own glucose meter and strips and be able to test as needed and run a curve at home. It can save your pets life! You are amazingly knowledgeable on the subject of pet diabetes and this is critical for a veterinarian. Not all are unfortunately. Some mainly focus on making money through routine spay/neutering, annual vaccinations and preventative care and the pushing of overpriced flea and tick products and prescription foods with whichever company pays the most to peddle their wares.
I wish I had had the fortune the read an article such as this and others, such as one about the trial drug Kinostat (an eye drop for canines that prevents cataract formation in newly diagnosed (from date of diagnosis to 6 months) diabetic canines) which at the time was running a trial that my beloved boy would have been eligible for admission to. It only works before the formation of cataracts to prevent their formation. Once formed, it is ineffective in their removal.
My vet never advised me that there was a chance my dog could go blind from his diabetes. The fact is 60 % or more of all dogs diagnosed will form diabetes induced cataracts within 6 months, blinding them completely. When I asked her about it, she said she knew about cataracts but did not know about Kinostat. I found it with a simple Google search, but not until my dog was blind. To me this is inexcusable. She should have had this knowlege and shared it with me. My dog would not have gone blind. Worse, she first misdiagnosed him with “heart failure” when he was diabetic to the point he nearly died and had to be hospitalized for a week because he was severely ketotonic. She mistook a cough he had which was unrelated as fluid in his chest from heart failure because she heard a heart murmer she had “never heard” and he never had prior. But in his records he had always had a heart murmur. He had it when I adopted him 7 yrs prior and our emergency vet also faxed her specifically a year prior diagnosing it along with the emergency visit he had for pancreatitis. She missed it in his records because she never looked.
For a week he took meds to drain fluid around the heart and was given unnecessary tests. And for a week he declined terribly in health. Finally I took him to the ER vet who immediately diagnosed him with diabetes. They were shocked. I bought everything, an alphatrak 2 meter, all the strips, the whole kit (and of course through that same vet who offered me no discount!) She never even apologized for the misdiagnosis! I learned how to do a curve and faithfully kept a diary of his glucose readings. I bought keto strips to have on hand to test his urine and made ice cubes of maple syrup to have just in case of an emergency. He drank and peed all the time and his eating habits changed dramatically.
My normally ravenous dog became finicky. He was already on prescription hydrolyzed food and treats because of his pancreatitis so it was difficult to keep him regulated and his insulin dose was often changed. I mostly dealt with the ER doctor by phone regarding this because I did not trust the vet by now. We went through 2 years like this, up and down, up and down….he was never truly regulated, he adapted to being blind pretty quickly and it did not seem to effect his quality of life. He had 2 brothers who helped a lot. But the irregularity did effect him greatly and his pancreatitis came back. He began to also get abcesses. One had to be surgically drained in his back. Finally he had a pancreatitis attack that led to him being ketatonic and 2 weeks of hospitalization. They could not regulate him. My beautiful boy had to come home only to be euthanized the following day by a hospice vet.
I don’t know how on earth I ever would have cared for him without my Aphatrak 2 meter and strips. It would not have been possible. I realize I had an extremely unusual case but still, it is SO SO SO important to know where your dog or cats glucose numbers are ..at all times. Or you are gambling with their lives when injecting insulin. I think for some pet owners, their pets are just a possession. It is unfortunate but true. This is why our shelters contain so many older pets…abandoned by their families when they become older and sick and need expensive veterinary care or will soon need to be euthanized. Some people just don’t want or aren’t willing to deal with the financial burden. Then there are people like me, completely broke, who would sell everything I own and sleep in a tent, to make sure my pets get the medical care they need and deserve. I gave up my new car that was under contract and waiting to be picked up the day my diabetic dog needed to be hospitalized…I used the down payment for his care…and still ended up owing twice the amount.
You can get the meters…and the strips…on Amazon for much less than anywhere else. Also, the strips that are made for people by the same company as the Alphatrak 2 (they are called FreeStyle Lite) are literally 1/4 of the price and they are the EXACT SAME STRIPS. I read this online and decided to test it out so ordered a small amt. Tested both strips 5 times…both with test fluid and with blood and got the same result on each strip. So they are just putting a different label on them and jacking up the price for dogs and cats!
Anyway, Thank You for spreading your knowledge on this subject, from someone who went through the most awful pet diabetes experience and wishes her vet had been like you. BTW, I no longer go to that vet…another Doctor there also misdiagnosed my other dog…he had a small tumor on the tip of his docked tail, we brought him in to have it examined for removal and a biopsy was done. I still have the email report showing it as a benign growth that does not need to be removed unless it becomes too large or oozing and unsightly. A year later he was limping and we brought him back. The “benign growth” on his tail had spread internally to the size of a football inside his entire pelvic area. Too large for surgical removal.
We took him to a new vet who removed the tail growth and correctly diagnosed him. Squamous Cell Carcinoma. 2 months of Chemotherapy and Radiation at the Veterinary Cancer Center. A catheter sewn in so I could drain his bladder 4 times a day bc the tumor blocked his ureter. Then he died unexpectedly in my arms on a Saturday morning as we tried to rush him to the vet. He was 9. They were both 9. Which left only our puppy who was by then 2. Even he was not unmarred by that vet. He had to have 2 cherry eye surgeries (on the same eye) at our new vet to repair the damage done by that old vet in a botched cherry eye repair that was done during his neutering surgery. It popped out within days and caused terrible scar tissue. They refused to fix or redo it without payment. Then the notated in our account that I caused the damage myself by pulling on the stitches because I mistook them for a hair! We had 2 vet tech there that we loved who were so good to our dogs. Both left that practice because of the things they saw. One works at our new vet and one at the Cancer Center where we took our other dog!
I found this quite interesting. Glad to know about this new test If one has this new test done, what then if the cat is diabetic? How does one proceed after that.
One of our cats, Lucy, purportedly now 15 years old (the shelter guessed she was 10 when we got her) was on insulin when we adopted her and they told us she’d need it for the rest of her life. I doubted that, and I was right. We immediately instituted a very low-carb diet (no dry food at all and low-carb wet; and for the past year and half we’ve been feeding all our seven cats raw meat I grind, with supplements and they’re very healthy). We bought a glucometer and began testing Lucy several times a day, and were able to get her off insulin in a couple of weeks. (She’s wonderful about having her ears pricked repeatedly, not to mention the actual insulin shots.) That lasted FOUR years.
A bit over a year ago her blood glucose started rising again, for whatever reason (an SDMA test showed very early kidney disease; could that be a factor?). So we began regular testing and dosing again. We’re pretty much using the tight regulation protocol developed by Dr. Elizabeth Hodgkins. Perhaps because of being used to Dr. Hodgkins’ experience/recommendations, I’m a bit surprised at the numbers here considered low and high. We consider 150 the optimum BG number (“normal”), and for Lucy anything above 250 is quite high. I don’t like to see her above 200 at all, actually. And if her nadir is 50, that’s fine. She doesn’t drink excessively (any more) and is quite active and interactive, especially for an old girl — assuming she is indeed that old.
Interestingly, at first and for some months we used the cat insulin ProZinc, but began to be dissatisfied with its ability to regulate Lucy’s BG. We found that Levimir (for humans) works much better. It’s longer lasting and requires only minimal doses. Lucy may need insulin after 12 yours, but often alternating with days going to 20 or even 24 hours before needing another shot. Since Levimir doesn’t last THAT long, clearly her pancreas and liver ARE helping her out.
I totally agree that tight glucose regulation that you mentioned is the best chance of getting a cat into remission when first diagnosed. I’m all for tight diabetic control for cats to increase the chance of remission. Unfortunately, many clients are not on board with checking a pet’s blood glucose before each dose.
I, too, want diabetic cats (not dogs) on low carb canned food, and get a high percentage of my feline diabetics into remission even without the tight glucose regulation protocol. If owners are on board with checking a blood glucose before each insulin injection the chance of remission in cats is highest… I’m all for this protocol. I should have made this clear in my newsletter. Thanks for posting!
Again, the A1C test has its place, but it will never replace a good old blood glucose curve. 🙂 Joi