Section 14: Other Methods for Monitoring Glycemic Status

Urine Glucose Measurements

UG concentration is only a reflection of the average BG over the time interval since the bladder was last voided. Therefore, routine UG measurement is not typically recommended.

Patients that have consistently negative UG should be screened for hypoglycemia. This finding may indicate tight BG regulation, excessive insulin dosages, or the onset of possible diabetic remission. However, a negative UG reading only means that BG was below the renal threshold (i.e., BG could have been 150 mg/dL or 40 mg/dL). The only way to know is to measure BG.¹

Glycosylated Proteins

Serial measurement of fructosamine over time is more useful than spot determinations to evaluate trends in glycemic control. Declining fructosamine values indicate the average BG is decreasing over time, whereas increasing values indicate the opposite. A fructosamine concentration below the reference range is highly suggestive of chronic hypoglycemia, which should be verified with a BGC or a CGM assessment. Additionally, this scenario may indicate that a feline patient is entering diabetic remission.

Clinicians should consider the limitations of fructosamine as a marker of average BG over time. Short but clinically relevant periods of hypo- or hyperglycemia may not be identified and reduce the clinical utility of the reported result. For example, well-controlled diabetics may appear to have elevated fructosamine concentrations, or conversely, an uncontrolled diabetic may have normal concentrations.² Fructosamine may be elevated in sick, hyperglycemic but nondiabetic cats.³

Hemoglobin A1C (i.e., glycated hemoglobin) is commonly used to monitor diabetes in humans and has been described in veterinary medicine as a marker of mean BG over the preceding 2–3 mo.^4,5,6,7 A dried blood spot mail-in test card is commercially available for use in cats but has not yet been validated in diabetic cats.

Home Monitoring of Clinical Signs

Client perception of clinical signs in combination with serial monitoring of body weight is crucial to effective DM monitoring. Encourage clients to keep a daily log documenting their pet’s appetite, thirst, urinary habits (e.g., increased, normal, decreased), feeding (e.g., diet type, amount), and insulin dose administered, which can be brought in for review during each in-clinic recheck examination. When the patient has no clinical signs and the body weight is steady or increasing, DM is likely well controlled. Because clinical signs are subjective or possibly difficult to fully appreciate (such as water intake in cats), the use of automated devices monitoring food or water intake may improve objectivity as opposed to solely relying on client observations (see Section 11, Client Education).

The 2026 AAHA Diabetes Management Guidelines for Cats are generously supported by Adapet Medical, Boehringer Ingelheim, Dechra, and Merck Animal Health.