Treating a diabetic cat can be a challenge. Some cats just never seem to stay regulated. However, there are several important concepts that make this process much more likely to be successful.

1. Consistency: Our goal is to find an appropriate dose of insulin and to be able to keep them on this level long term. In order to do this, we must eliminate as many variables as possible. Our goal is to give the same dose of insulin at the same time each day, to feed the same food in the same quantities each day, to keep the activity level the same each day, and to keep your cat's stress level the same.

2. Tight control is not necessary in cats. Human diabetics must maintain blood glucose values very close to normal at all times. If they don't, they will develop some disastrous complications, such as loss of fingers, toes, feet, and hands; kidney failure; and cataract formation. These complications do not happen to diabetic cats. In cats, it is better for the blood glucose to be too high than too low.

3. Hyperglycemia (high blood glucose) is always better than hypoglycemia (low blood glucose).

4.  As the dose of insulin goes up, the blood glucose goes down.

5. Food intake causes the blood glucose to rise. Failure to eat allows the blood glucose to fall below normal.

If you are not sure if you gave a dose of insulin or if it was properly injected, do not give it again. If your cat does not eat, do not give insulin. If you must miss a dose or two of insulin (occasionally), do not be concerned. Your cat's blood glucose will get too high for a day or two, but that will not cause great problems.

Understanding Diabetes

There are two forms of diabetes in cats: diabetes insipidus and diabetes mellitus. Diabetes insipidus is a very rare disorder. Your cat has the more cornman type of diabetes, diabetes mellitus. This disease is seen on a fairly regular basis, usually in cats 5 years of age or older. Simply put, diabetes mellitus is a failure of the pancreas to regulate blood sugar. The most common type of diabetes in cats is Type I or Insulin Dependent Diabetes Mellitus. Cats that have Type II or Non-Insulin Dependent Diabetes Mellitus usually progress to Type I.

Classical signs of Diabetes Mellitus

Weight loss Ravenous appetite

Increased water consumption / increased urination

Diagnosing Diabetes

The diagnosis of diabetes mellitus is based on the clinical signs listed above, the presence of a persistently high level of glucose in the blood stream, and the presence of glucose in the urine.

The normal glucose level in the blood is 80-120 mg/dl. It may rise to 250-300 mg/dl following a meal or when the cat is very excited. However, diabetes is the only common disease that will cause the blood glucose level to rise above 400 mg/dl. Excessive blood glucose is filtered out into the urine. A Fructosamine test may be performed to confirm the diagnosis. This test represents the average blood glucose level for the past two-three weeks.

What It Means for Your Cat to be Diabetic

For the diabetic cat, one reality exists. Blood glucose cannot be normalized without treatment. Treatment needs to be given on a regular basis. Most cats require a dietary change. As for the owner, there are two implications: financial commitment and personal commitment.

When your cat is regulated, the maintenance costs are minimal. The special diet, insulin, and syringes are not expensive. However, the financial commitment can be significant during the initial regulation process and if complications arise.

In some cases, your cat will be hospitalized for a few days to deal with the immediate crisis and to begin the regulation process. The "immediate crisis" is only great if your cat is so sick that it has quit eating and drinking for a couple of days. Cats in this state, called ketoacidosis, may require a week or more of hospitaIization with quite a bit of laboratory testing. Otherwise, the initial hospitalization may be only for a day or two to get some testing done and to begin treatment. Return visits are required every 5-7 days to monitor progress. It may take a month or more to achieve good regulation.

The financial commitment may again be significant if complications arise. We will work with you to achieve consistent regulation, but some cats are difficult to keep regulated. It is important that you pay close attention to our instructions related to administration of medication, diet, and to home monitoring. Consistency is the key to prolonged regulation.

Another complication that can arise is hypoglycemia or low blood sugar if severe, it can be fatal. This may occur due to inconsistencies in treatment or because some cats can have spontaneous remission of their disease.

Your personal commitment to treating this cat is very important in maintaining regulation and preventing crises. Most diabetic cats require insulin injections twice daily, at about 12 hour intervals. They must be fed the same food, the same amount on the same schedule every day. If you are out of town, your cat must receive proper treatment while you are gone. These factors should be considered carefully before deciding to treat a diabetic cat.

As mentioned, the key to successful treatment is consistency. Your cat needs consistent administration of medication, consistent feeding, and a stable, stress-free lifestyle. To best achieve this, it is preferred that your cat lives indoors. Although that is not essential; indoor living removes many uncontrollable variables that can disrupt regulation.

The first step in treatment is to alter your cat's diet. If your cat is overweight, a reducing-type diet is fed until the proper weight is achieved, then your cat is switched to a diabetic diet. If your cat is at a good weight, then the diabetic diet is started right away.

Your cat's feeding routine is also important. The average cat prefers to eat about 10 - 15 times per day, one mouthful at a time. This is desirable for a diabetic cat; however, it is also desirable to monitor to make sure they have eaten each day and how much food is eaten each day. It is best to feed a meal before each insulin dose and then leave food out during the day. We realize that if you have more than one cat, this may be difficult, but please make an effort, as this is an important part of home monitoring.

The second step in treatment is to use insulin to control blood glucose levels. Many people are initially fearful of giving insulin injections. If this is your initial reaction, consider these points:

1) Insulin does not cause pain when it is injected.

2) The injections are made with very tiny needles that your cat hardly feels. The injections are given just under the skin in areas in which it is almost impossible to cause damage to any vital organ.

Insulin comes in an airtight bottle that is labeled with the insulin type and the concentration. Before using, mix the contents. It says on the label to roll it gently, not shake it. The reason for this is to prevent foam formation, which will make accurate measuring difficult. Some of the types of insulin used in cats settle out of suspension in a few hours. If it is not shaken properly, it will not mix well, and dosing will not be accurate. Therefore, the trick is to shake it vigorously enough to mix it without creating foam. Insulin is a hormone that will lose its effectiveness if exposed to direct sunlight or high temperatures. It should be kept in the remgerator, but it should not be frozen.

It is not ruined if left out of the refrigerator for a day or two as long as it is not exposed to direct sunlight. However, we do not advise this. Insulin is safe as long as it is used as directed, but it should be kept out of reach of children.

There are two types of insulin syringes, U40 and U100 syringes. They are made to be used with their respective types of insulin and must not be interchanged or improper dosing will occur.

Drawing up Insulin

Have the syringe and needle, insulin bottle, and cat ready. Then follow these steps:

1) Remove the cap from the needle, and draw back the plunger to the appropriate dose level.

2) Carefully insert the needle into the insulin bottle.

3) Inject air into bottle; this prevents a vacuum from forming within the bottle.

4) Withdraw the correct amount of insulin into the syringe.

Before injecting your cat with the insulin, verify that there are no air bubbles in the syringe. If you get an air bubble, draw twice as much insulin into the syringe as you need. Then withdraw the needle from the insulin bottle and tap the barrel of the syringe with your finger to make the air bubble rise to the nozzle of the syringe. Gently and slowly expel the air bubble by moving the plunger upward. When this has been done, check that you have the correct amount of insulin in the syringe. The correct dose of insulin can be assured if you measure from the needle end or "0" on the syringe barrel to the end of the plunger nearest the needle.

Injecting Insulin

The steps to follow for injecting insulin are:

1) Hold the syringe in your right hand (switch hands if you are left handed).

 2) Have someone hold your cat while you pick up a fold of skin somewhere along your cat's back with your free hand and (pick up a different spot each day).

3) Quickly push the very sharp, very thin needle through your cat's skin. This should be easy and painless. However, take care to push the needle through only one layer of skin and not into your finger or through two layers of skin. The needle should be directed parallel to the backbone or angled slightly downward.

4) Inject the insulin. Withdraw the needle and replace the cap on the needle.

5) Stroke your cat to reward it for sitting quietly.

6) Be aware that some communities have strict rules about disposal of medical waste material, so don't throw the needle/syringe into the trash until you know if this is pennissible. If it is not, we can dispose of them for you.

7) It is neither necessary nor desirable to swab the skin with alcohol to "sterilize" it. A brief swabbing with alcohol does not really kill all the bacteria. The sting caused by the alcohol can make your cat dislike injections.

Although the above procedures may at first seem complicated and somewhat overwhelming, they will very quickly become second nature. Your cat will soon learn that once or twice each day it has to sit still for a few minutes and it will get petted as a reward.

Monitoring

It is necessary that your cat's progress by checked on a regular basis. Monitor your cat at home for signs of diabetes. To do this, you need to be constantly aware of your cat's appetite, weight, water consumption, and urine output. If possible, you should be feeding a constant amount of food each day, which will allow you to be aware of days that your cat does not eat all of it or is unusually hungry after the feeding. You should weigh your cat at least twice monthly. If you have several cats that eat together and use the same litter box, monitoring weight is the best because it is specific to this one cat.

Any significant change in your cat's food intake, weight, water intake, or urine output is an indicator that the diabetes is not well controlled. We should see the cat at that time for blood testing.

Determining the level of glucose in the blood is the most accurate means of monitoring. We recommend that your cat's blood glucose levels and fructosamine be done every 3-6months. Testing should also be done at any time the clinical signs of diabetes are present. When your cat comes in for testing, it will need to spend part of the day here. Feed your cat and give insulin prior to arrival.

Diabetic cats are more prone to infections. Regular blood work and monitoring for bladder infection are recommended. Your cat may need to have dental cleanings more often and infections may take longer to resolve.

Hypoglycemia

Hypoglycemia means low blood sugar. If it is below 40 mg/dl, it can be life· threatening. Hypoglycemia occurs under these conditions:

1) If the insulin dose is too high. Although most cats will require the same dose of insulin for long periods of time, it is possible for the cat's insulin requirements to change. However, the most common causes for change are a reduction in food intake and an increase in exercise or activity. The reason for feeding before the insulin injection is so you can know when the appetite changes. If your cat does not eat, skip that dose  of insulin. If only half of the food is eaten,  give a half a dose of insulin. Always remember that it is better for the blood sugar to he too high than too low. 

2) If too much insulin is given. This can occur because the insulin was not properly measured in the syringe or because two doses were given by two family members by accident. A chart to record insulin administration will help to prevent the cat from being treated twice.

3) If your cat has spontaneous remission of the diabetes. This is a poorly understood phenomenon, but it definitely occurs in about 20% of diabetic cats. They can be diabetic and on treatment for many months, then suddenly no longer be diabetic. Since this is not predictable and happens quite suddenly, a hypoglycemic crisis is usually the first indication.

The most likely time that a cat will become hypoglycemic is the time of peak insulin effect (5-8 hours after an insulin injection). When the blood glucose is mildly low, the cat will be tired and unresponsive. Within a few flours, the blood glucose will rise, and your cat will return to normal. If your cat is slow to recover from this period of lethargy, you should give it com syrup (1tablespoon by mouth) or feed one packet of semi-moist cat food. If there is no response in 15 minutes, repeat. If there is still no response, contact us immediately for further instructions.

If severe hypoglycemia occurs, a cat will have seizures or lose consciousness. This is an emergency. If it occurs during office hours, call and then come in immediately. If it occurs at night or on the weekend, call our emergency phone number for instructions.

Summary of Instructions for Cats Receiving Insulin Injections

1) Read and reread this material, so that you understand the specifics of proper regulation and how to recognize and treat hypoglycemia.

2) Give ___ units of insulin at about ____ AM and____PM.

3) Return for a glucose recheck in about one week. Please make an appointment to leave your cat here for the day. Feed and give insulin prior to arrival. Your cat may need to be checked weekly for the first few weeks.

4) Feed your cat the prescribed food as described above. Feed dry food free choice and a dry or canned food meal every 12 hours just prior to the insulin. Give a little canned food or a treat after the insulin injection, so your cat sees this as a reward for taking its injection. After a few days, your cat will "tell" you when it is time for insulin by begging for its treat.

Spontaneous Remission

This is a poorly understood phenomenon that only happens in a few cats. Unfortunately, it can happen rather suddenly, so a hypoglycemic crisis may be created when the normal amount of insulin is given. When it occurs, the cat may be normal for a few weeks or for many months. However, diabetes will almost always return. Therefore, you should watch for the typical signs of diabetes than contact us for insulin instructions.