Regulation in 12 Simple Steps
I. FIND A VETERINARIAN THAT YOU TRUST
You need to feel comfortable with your veterinarian. Find out if she has very many diabetic cats in her practice. Ask your friends for references. Make sure your vet knows your philosophy of treating feline diabetes, e.g. if you plan to do home testing. If you ever feel that your veterinarian is not responsive to your needs and the needs of your cat, don’t hesitate to change vets. There are plenty of wonderful veterinarians out there.
II. LEARN ABOUT INSULIN TYPES
If your cat is started on insulin, know what type of insulin it is and be sure to use the right syringe. All human insulins (Humulin and others) in the United States are a concentration called U-100. PZI is often U-40. I am ignorant of insulin in non-U.S. countries. Regardless, the syringe must match the concentration of the insulin. To be sure you get the right syringe, take your insulin (or the insulin box) into your pharmacist when you go to buy syringes and the pharmacist will make sure you get the right syringes. When you buy the next batch of syringes, take the syringe packaging with you to make sure you buy the right type.
You also need to know the activity of your cat’s insulin so you can know when to expect peaks of insulin action that correspond to nadirs (low points) of blood sugar. This will be very important when watching for hypoglycemia (dangerously low blood sugar). Knowing how insulin acts will help you interpret blood glucose results you get. Many insulin manufacturers, such as Eli Lilly, have excellent information about insulin activity. (See references below)
III. DON’T NEGLECT THE DIET
If your cat is obese, he needs to go on a diet. Talk to your vet. He may need to gain weight, however, if his diabetes was undiagnosed for awhile. It is a good idea to have your cat eat around the time (up to one hour before injection) of the insulin administration. This will insure that the cat has food in his stomach (and rising blood glucose levels as a result) to counteract the action of the insulin you have given him. If your cat is having trouble with vomiting, be very careful and watch for possible hypoglycemic episodes.
Most veterinarians will recommend a prescription food for your cat. Hills W/D (dry and moist), a high fiber diet, was “the” food for a long time and may still be a good choice if your cat is overweight or has other health problems. Fairly recent veterinary research has indicated that cats, including ones with diabetes, generally do better on a higher protein diet. Check the nutritional content of the food you give your cat. Several web sites (see below) have excellent tables on the nutritional value of various commercial cat foods.
Use caution - substantially reducing carbohydrates in the diet is a POTENT factor in reducing blood sugars and it should not be done without also reducing insulin, followed by careful monitoring. Additionally, a higher protein/lower carbohydrate diet such as the Purina DM type is NOT recommended for any cat with kidney problems and should only be undertaken with favorable blood test results showing normal kidney function.
Get to know the “glycemic index” or sugar content of food and treats (see references). Many semi-moist foods and also milk can cause big spikes in blood glucose levels. You will want to avoid these foods and treats during the regulation period and use them sparingly afterward.
IV. BE PROACTIVE & HOME-TEST
Using a glucometer to obtain blood glucose results at home is highly recommended with all insulin use. FelineDiabetes.com highly recommends home-testing for the best care of your cat, with periodic tests by your vet. In addition to blood glucose levels, you should also check the “long-term control” tests such as fructosamine and hemoglobin A1c. These long-term checks can be done at the vet although kits for use at home are now available.
Home-testing will greatly assist you in regulating your cat and dramatically decrease the chance of a hypoglycemic episode. It is important to know when the insulin peaks (insulin goes up, blood sugar goes down from the action of the insulin) because the time of the blood glucose nadir varies from cat to cat and also depends on such things as associated illnesses, food intake and exercise. General guidelines for insulin peaks and nadirs in humans are available on many manufacturers’ web sites (see references).
The peak action time of the insulin is very important because it corresponds to the lowest point of your cat’s blood glucose level. If the blood glucose level drops too far, your cat can have a hypoglycemic episode that is potentially fatal. Also, to adjust insulin doses you need both the preinjection glucose and the lowest glucose level (nadir). Do not adjust insulin dosages without your veterinarian’s approval and without knowing ALL the data.
To construct a blood glucose curve, check and record the glucose levels at the following times:
One hour prior to injection. Next, one hour after injection and then every one hour after that the numbers have reached a low point and are starting to increase again. You can then do a check two hours later and stop when the numbers are consistently rising. If you are using a long-acting insulin such as L (lente) or Lantis, you may want to check every 2 hours after injection. Plot these numbers in a simple graph and you will easily determine the nadir.
V. MAKE ALL (INSULIN, DIET, ETC.) CHANGES CAUTIOUSLY
Although short-term reactions to insulin are quick, it still takes days for the cat’s body to fully adjust to a new insulin dose. This can be complicated by changes in diet, exercise, and any associated illnesses. Go slow (unless you obviously need to DECREASE a dose to prevent a hypoglycemic episode) and make one change in your cat’s routine at a time.
VI. “START LOW, GO SLOW” WITH THE INSULIN
This is a popular saying on the Feline Diabetes Message Board. Of course, you want to get your cat regulated quickly (especially for your sake!!) but if you start at too high a dose of insulin, you greatly increase the risk of hypoglycemia and also prolong the time it will take to get your cat regulated. Many cats have their glucose levels regulated with ½ to 1 unit twice a day (BID). Don’t panic if your cat ends up requiring more insulin than this, but take it slow. Increase by only ½ or 1 unit if the cat clearly needs more insulin.
If your cat requires high dosages of insulin, she needs to be checked for other illnesses and have her diet evaluated. The Cornell University Feline Health Center defines excessively high insulin doses are those greater than one to two units of insulin per pound per day. Felines who use more insulin than this should be evaluated more intensively. Other diseases may be underlying or complicating the diabetes mellitus and as a result, necessitate high insulin dosages. Problems with insulin injection, poor absorption or too rapid metabolism of insulin, or even insulin overdose are potential causes of an apparently excessive insulin requirement.
VII. KEEP THE SUGAR AWAY FROM THE CAT UNTIL….
So you’ve learned about the glycemic index, you’ve learned carbs aren’t the best for your cat, but know we’re going to tell you to keep sugar around to give to your cat. You need to keep a source of simple sugars (glucose, fructose, dextrose, etc.) on hand in the case of an apparent hypoglycemic reaction. Karo syrup, honey, maple syrup, and molasses are cheap and available. If you even suspect a hypoglycemic reaction, immediately rub the syrup on the gums or inside of the cheek. If the cat is unconscious or having seizures, be very careful not to give too much at once as this can cause choking and aspiration. It’s even possible to put it in the rectum if the danger of choking is great. In this case, you must be cautious in administration and get to an emergency vet immediately.
Don’t worry about your cat’s glucose going too high (hyperglycemia) from having sugar syrup rubbed on his gums. If the cat is truly hypoglycemic, it is critical to get the blood glucose level increased. Hyperglycemia will not kill immediately and short-term hyperglycemia is unlikely to have any adverse affects. Conversely, hypoglycemia can kill, often rapidly. Forget the mess you’ll make, forget checking blood sugar levels. If you suspect low blood sugar, rub a sugar syrup on the gums, and repeat even if you are on your way to the ER.
VIII. GET REGULAR EXAMINATIONS AT THE VETERINARIAN
Current recommendations from the Association of Feline Practitioners are to get a fructosamine or A1c test every 6 months if regulated, every 3 months if not regulated. Again, you and your vet will best determine the frequency of your cat’s visits to the vet. Diabetes affects many organs, so function of the kidneys, liver, heart, etc. must be done periodically, at least once per year. Your cat can get other diseases besides diabetes and regular checkups can help in early diagnosis for optimum treatment. Dental problems should be treated promptly. A full blood workup can reveal developing problems. Although home tests are now available for fructosamine and A1c, there are still many reasons to have your cat periodically examined.
IX. PAY ATTENTION TO YOUR CAT
Numbers are great, theoretically. Just because your cat’s blood glucose levels are in a “normal range,” he may still be symptomatic. Note the cat’s gait, the water intake and amount of urination, the weight. Your cat may need glucose levels that are higher or even lower than “ideal.” Work with your vet and make sure you get at least annual exams that include a full blood workup.
If your cat has hypoglycemia, watch for unusual behavior that may give you a clue that something is wrong. Some cats yowl, some get glassy-eyed, some are lethargic when their blood sugar decreases. Learn to recognize the more subtle signs of dropping blood sugar in your cat. It could save his life.
X. PAY ATTENTION TO YOURSELF
You didn’t give your cat diabetes. You can give your cat a good quality of life with this disease. Make sure your quality of life is good, too. Diabetes takes good care but it doesn’t have to rule your life. Learn to relax, accept your mistakes, and be patient.
XI. GET SUPPORT
The best place for almost immediate support is the Feline Diabetes Message Board. Often, you will get nearly instantaneous replies to your questions, frustrations, and news. Develop a good relationship with your veterinarian and make sure you know where to take your cat for emergency treatment. Find neighbors, older school kids, relatives, and pet sitters who will learn about feline diabetes and give insulin injections. A lot of people may be reluctant at first, but I’ve always found plenty of back-up support.
XII. DON’T GET DISCOURAGED!
Thousands of us take care of cats with diabetes. You can, too.
American Association of Feline Practitioners, http://www.aafponline.org
Cornell Feline Health Center, http://www.vet.cornell.edu/Public/FHC/diabetes.html
Feline Diabetes Dictionary, 2004, http://www.felinediabetes.com/dictionary/index.html
Feline Diabetes Education, http://www.felinediabetes.com/faq.htm
Feline Diabetes Message Board, http://www.felinediabetes.com/terms.htm
Glycemic Index, Rick Mendosa, http://diabetes.about.com/library/mendosagi/nmendosagi.htm
Human Insulin Time Activity Profiles, http://www.lillydiabetes.com/Products/TimeActivityProfiles.cfm
Nutritional Tables for Commercial Cat Foods, by Janet & Binky: http://www.sugarcats.net/sites/jmpeerson/
©2004 Updated January 2004
Updated January 2004