Results of Feline Diabetes "Initial Treatment" Survey
May 13, 2003

The Survey

An informal survey was taken on the Feline Diabetes Message Board (FDMB) on May 1, 2003 and May 3,2003 to assess the experience of the members with respect to very first treatment that their vet recommended when their cats were first diagnosed with diabetes.  This survey is in no way scientific or representative of all diabetic cats.  The specific questions were:

1.) Month and year the cat was diagnosed.
2.) Initial type of insulin or name of drug.
3.) Initial dose of insulin or drug.
4.) Once or twice a day?
5.) First diet recommended by vet.

Data were entered into Excel and analyzed with SAS (R) for Windows (Cary, NC).

The Results

Number of observations: 119 cats were represented for 121  observations (a couple of cats were diagnosed with diabetes twice).

Month and year of diagnosis:  The survey was, not surprisingly, very heavily weighted to the recently diagnosed, with about 26% of the cats being diagnosed before mid-2000, 24% between mid-2000 and the end of 2001, 30% during 2002, and 19% during 2003 (roughly).

Initial treatment:  The vast majority responding -- 86% -- said their vets started their cats with insulin.  This may be because vets prefer insulin, or it may be because insulin users are more likely to end up on the FDMB.  This trend did not change over time (p=0.78, chi-square test).

Type of insulin: 33% of cats were started with N, 19% with L, 28% with U, and 13% with PZI.  The remaining 7%  received 70/30, Caninsulin, Iletin II, or Iletin NPH.  There were no changes in the relative proportions of type of insulin over time (p=0.94, chi-square test on common insulins only).

Frequency of insulin: 71% of cats were started on insulin twice a day, which also did not change over time (p=0.41, chi-square test).  However, frequency was related to type of insulin; about 50% of Ultralente and PZI users were started with once a day dosing, whereas about 85% of L users and 90% of N users were started with twice a day dosing (p=.0006, chi-square test).

Initial Dose:  Total daily dose prescribed ranged from 0.5 to 34 units, with the median at 3.0 units daily, the first quartile at 2.0 units daily, and the third quartile at 4.0 units daily.  After removing the vets who prescribed massive doses of 70/30 (10 units and 30 units respectively), there was no relationship between total daily dose and type of insulin (p=0.83, ANOVA).  However, cats who were prescribed insulin twice a day tended to receive more (4.4 units vs 2.15 units, p=.005), or, in other words, the dose at each injection was the same regardless of whether one or two doses were prescribed.  The total daily dose has not been changing over time (p=0.54, ANOVA).

Diet: The type of food prescribed has been changing over time (p=.0006, chi-square).  Before July 2000, 69% of cats were prescribed high-carb food and none low-carb food; between July 2000 and December 2001,  60% of cats were prescribed high-carb food and 13% low-carb food; during 2002, 31% of cats were prescribed high-carb food and 42% low-carb food; during 2003, 30% of cats were prescribed high-carb food and 39% low-carb food.

Relationship between Diet and Dose: Somewhat disturbingly, the total prescribed dose was not lower for cats put on a low-carbohydrate diet (3.75 units daily for high-carb vs 2.83 units daily for low-carb, p=0.78), although research, anecdotal evidence, and our own insulin dose survey indicate that insulin requirements are less for cats on a low-carbohydrate diet.  Prescribed diet was also not related to prescribed insulin type (p=0.39, renal diet and non-common insulins excluded).

Comments:  Except for diet, vet practices have not been changing much over the past few years.  And although vets seem to be more open to recommending low-carbohydrate diets, it appears that they have not in general changed the type and dosage of insulin to match the physiological consequences of this diet.  These conclusions might be seriously flawed by "selection bias," however, since cats who do not develop problems may be less likely to send their humans to the Internet in search of answers.

Note to readers:   This document is copyright (C) 2003 by Janet M. Peerson.  You may freely copy and distribute the document, and you are especially invited to link your web page to it, but you may not charge money for it (not even handling costs), and you may not claim credit for the contents.   The original version was created May 13, 2003, and was edited on June 24, 2003.

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