Welcome to the Feline Diabetes Message Board, the group you never wanted to join.  If your cat has just been diagnosed, you probably have lots of questions.  This is a support group of cat-loving amateurs; we're not experts, but among us we've accumulated much experience and information about feline diabetes.  This FAQ contains information on some of the commonly asked questions by newcomers (or questions which they should ask) but if you're unclear on anything, or just need some tender loving care right now, please post!  We've all been where you are now.

1.  GENERAL

Q1.1.  Help!  My cat was just diagnosed!  What do I do?
Q1.2.  Many of the cats here seem to have problems.  Is my cat doomed to a poor quality of life?
Q1.3.  I don't understand all the terminology here.
Q1.4.  What is hypoglycemia, and how do I handle it?
Q1.5.  What treatment will my vet propose?
Q1.6.  Where can I find old postings?
Q1.7.  Where can I find a vet who is knowledgeable about diabetes?
Q1.8.  How can I find other people with diabetic cats in my area?
Q1.9.  I can't afford to treat my cat.  What should I do?

Q2.1.  Can I give oral medication instead of insulin?
Q2.2.  Can I control this with herbs or something instead of insulin?
Q2.3.  What should I feed my cat?
Q2.4.  Can I free-feed my cat?
Q2.5  My cat doesn't like / I can't afford the expensive prescription food. Is there any less expensive substitute?

Q3.1.  What kinds of insulin are there?
Q3.2.  Where can I get PZI insulin?
Q3.3.  What can I expect to pay for PZI insulin?
Q3.4.  What kind of syringe should I use?
Q3.5.  Do I need a prescription for insulin or syringes?
Q3.6.  Can I reuse syringes?
Q3.7.  How do I dispose of used needles?
Q3.8.  My cat hates getting his shot.  Now what?
Q3.9.  How long does a bottle of insulin last?

Q4.1.  How can I monitor how well the insulin is working?
Q4.2.  What kind of glucometer should I get?
Q4.3.  How often should my cat's glucose levels be tested?
Q4.4.  My cat's pre-shot level was way below the usual value.  Should I give the injection?
Q4.5.  I'm not from the United States, and I don't understand your units of measurement.  My cat couldn't have a blood glucose of 300 even if you soaked her in honey for a week.
Q4.6.  I'm following the instructions faithfully, but I still can't get blood from my cat's ear.
Q4.7.  My cat has been off of insulin for several days, and I'm getting glucose readings in the 40s and 50s (2.2-3.3 mmol/L).  Should I treat him for hypoglycemia?
Q4.8.  Are there other signs besides blood glucose that I can monitor at home?

Q5.1.  What are ketones?
Q5.2.  How often should I test for ketones?
Q5.3.  How do I test for ketones?
Q5.4.  How are positive ketone readings usually treated?
Q5.5.  What is Diabetic Ketoacidosis?

Q6.1.  My cat is walking funny / weak in the hind legs / not jumping well.  Is this related?
Q6.2.  My cat has kidney failure.  How do I manage this as well?
Q6.3.  My cat has asthma; how can I avoid using steroids?
Q6.4.  I can't get my cat to eat!  What should I do?

1.  GENERAL

Q1.1.  Help!  My cat was just diagnosed!  What do I do?
A1.1.  Joni & six recommend the following sites for lots of useful information:

Feline Diabetes: Diabetes for Beginners (www.felinediabetes.com/dummies.htm)
Cat Fancier's Association Diabetes Page (www.cfainc.org/health/diabetes.html)
Pets with Diabetes (www.petdiabetes.org)
Max's house (http://www.maxshouse.com/)
Sugar Cats (www.sugarcats.com)

      And Diana & TC have helpfully prepared a flyer for you to share all these good links with your vet.
                    (http://www.sugarcats.net/sites/dmstrickland/printingoptions.htm).

Additionally, there's lots of good information to be found at  Diana & TC's links page (http://www.sugarcats.net/sites/dmstrickland/felinediabeteslinks.htm) .   Read, read, read!  Information is your best health-care tool.  And ask here if you have any questions or anything is unclear.

Q1.2.  Many of the cats here seem to have problems.  Is my cat doomed to a poor quality of life?
A1.2. People tend to post here when they are having problems. Most diabetic cats are doing just fine, so their owners tend to stay quiet.  Diabetes is highly treatable. Diabetic cats who are well regulated can live normal lifespans with excellent quality of life, and tend to die of other ailments of old age, rather than from diabetes.  See Gorbzilla's Sugarcat Journal for some inspiring stories of our cats' post-diagnosis quality of life.

Q1.3.  I don't understand all the terminology here.
A1.3.  Never fear!  Melissa & Popcorn have compiled a handy glossary of many of the terms.

Q1.4. What is hypoglycemia, and how do I handle it?
A1.4.  Your vet should have warned you about hypoglycemia, which is dangerously low blood sugar brought on by too much insulin.  Hypoglycemia can kill your cat or cause blindness or other permanent damage, so you must always be on the alert for the symptoms.  Read the hypoglycemia page at petdiabetes.org to familiarize yourself with the problem.  Then print out Melissa & Popcorn's hypoglycemia page and post it on your refrigerator, because hypoglycemia can come on suddenly, and you don't want to be running around trying to find this information.  You should always have a bottle of Karo or other sugar syrup handy in your cupboard.

Q1.5.  What treatment will my vet propose?
A1.5.  Options your vet may discuss include:

• diet change (typically to Hill's W/D or Purina DM formula, but see Q2.3 and Q2.5 for further discussion of diet issues)
• oral medications (see Q2.1 for more information)
• hospitalization to take care of any immediate problem
• treatment at home with insulin injections (note: insulin cannot be given in pill form)

There is no consensus here on whether an otherwise healthy diabetic cat needs to be routinely hospitalized.  Hospitalization is necessary if the cat is suffering from ketoacidosis, and is probably a good idea if the cat is extremely dehydrated or has a very high blood glucose (for example, more than 600 mg/dl or 33 mmol/L).  Many vets prefer to keep the cat for a day or two to observe how he responds to the insulin, but some will teach you how to give the shot and ask you to bring your cat in the next day for another glucose reading.  Some of this may depend on your own comfort level and your vet's perception of your ability to manage at home in the early days.  If you already have some medical background or experience with diabetes, you may feel ready to jump right in to treating your cat.  On the other hand, if you find the whole experience completely overwhelming, you may prefer for your vet to get things started for you.  In general, however, your vet does not need to keep an otherwise healthy cat for more than a few days, and regulation of blood glucose levels is not likely to take place in the clinic.

The FDMB in general recommends a conservative approach to regulation and dosage adjustment which you can find at the Frugal Feline Diabetes webpage. You may find your vet's treatment to be similar or more aggressive; however we do not recommend frequent increases each week or large dosage increases for any cat. All increases should be based on an analysis of blood glucose readings taken on the current dosage; this means that the pre-injection blood glucose, the lowest blood glucose, and the duration of insulin activity all need to be taken into account.

Q1.6.  Where can I find old postings?
A1.6.  For recent postings, click on "archive" on the Terms of Use page.

Q1.7.  Where can I find a vet who is knowledgeable about diabetes?
A1.7.  Check out the referral list at IMOM.org, or  the American Association of Feline Practitioners.

Q1.8.  How can I find other people with diabetic cats in my area?
A1.8.  First, sign up with the registry at the Sugarcat Member Directory, and see if anyone else from your area has registered..  You can also post a message to the Feline Diabetes Message Board; be sure to include your approximate area in the title of the post, since not everyone reads every post.

Q1.9.  I can't afford to treat my cat.  What should I do?
A1.9.  A diabetic cat must be treated; otherwise he will essentially starve to death, which is a cruel way to die.  But the good news is that home care can substantially reduce costs.  See Frugal Feline Diabetes for some tips on treating your cat on a budget.  If after reading our money-saving tips, you still believe you will not be able to afford the cost of caring for a diabetic cat, please do not hesitate to post your concerns to the Feline Diabetes Message Board. Someone may be able to help you. DON'T GIVE UP ON YOUR SUGARCAT.

2.  ADDITIONAL TREATMENT

Q2.1.  Can I give oral medication instead of insulin?
A2.1.  Possibly.  You should discuss this with your vet. Oral medications such as glipizide, glyburide, and acarbose will work for about 30% of diabetic cats.  Many diabetic cats can be maintained indefinitely on drugs and possibly changes in diet.  However, because drugs can cause liver damage, and because giving an injection is often easier than giving a pill, most people on this board prefer insulin.  Several people who switched to insulin after using drugs have reported that they thought the oral medication only delayed regulation. Oral medications are not a good idea for cats with elevated liver values (due to the possibility of liver damage), or ketoacidosis or neuropathy (due to the need to bring glucose levels down immediately). See the Pet with Diabetes site for a more detailed explanation.  If your cat shows uncharacteristic lack of appetite, vomiting, lethargy or jaundice, discontinue the medicine and call your vet.  You should also have liver enzymes monitored frequently during the early months.

Q2.2.  Can I control this with herbs or something instead of insulin?
A2.2.  If your cat needs insulin, then you must give it to her.  If you're interested in an alternative approach, your best bet is to find a holistic veterinarian who is familiar with treating diabetic cats.  A holistic vet will take a "whole animal" approach to see if there is any way to strengthen the entire system, using diet, vitamins & minerals, herbs, homeopathy, glandular supplements, Chinese medicine, or whatever approach the vet is personally familiar with.  A good vet will keep your cat on insulin until and unless it is no longer needed.  For more ideas, read the Holisticat page on diabetes, but keep in mind that there often is not a lot of research on these approaches.

Q2.3.  What should I feed my cat?
A2.3.  This is the topic of numerous debates and discussions here, partly because the scientific research is limited.  Here are some general principles:

• If a cat currently has other health problems such as kidney insufficiency or chronic renal failure (CRF), pancreatitis, liver disease, bowel trouble, or urinary crystals, the diet must be primarily based on these considerations and secondarily on the diabetes.
• It is necessary to feed a consistent diet at consistent times in order to keep blood glucose within a predictable range, because blood glucose is closely related to the amount and composition of the most recent meal.
• When changing a cat's diet, it's necessary to change gradually and monitor glucose levels very closely, so that the proper amount of insulin is being given at all times. Too much insulin can kill your cat very quickly.

The traditional approach, which most vets are familiar with, is to feed the cat a diet fairly high in carbohydrates, with extra soluble fiber added to slow the conversion of starch to glucose.  Vets using this approach recommend Hill's W/D, a high-carbohydrate, high-fiber prescription cat food which is designed for weight maintenance.  (Other similar foods are Hill's R/D, and various hairball formulas sold by Hill's and Iams, see below.)  If your cat needs to gain weight, a high-fiber diet may not be the best approach at first; kitten food may be a good alternative until your cat attains his ideal weight..

A newer approach, which has been used with great success by several people here, is a low-carbohydrate diet, which some people have found can reduce their cat's insulin requirements, or, in a minority of cases, even eliminate the need for injected insulin for long periods of time.  This diet may be appropriate for cats who are otherwise healthy and who will eat canned cat food.  Vets using this approach may prescribe Purina DM, a new food with interesting preliminary research but no long-term assessment that we know of, or they may simply recommend canned kitten food.  (You can also duplicate this diet using high-quality commercial canned foods with similar nutrient composition, see below.)  The low-carbohydrate diet may not be appropriate for cats who are currently suffering from any of the health conditions listed above.  Discuss your cat's most recent bloodwork with your vet to be certain that the higher protein and fat levels commonly found in this diet are appropriate for your cat's condition.  Purina DM dry is also high in sodium, which may not be appropriate for cats with cardiovascular problems.  If your cat has a past history of any of these conditions, please consult your vet for specific recommendations.

Some people prepare food at home; these diets can be high or low in carbohydrates depending on whether grains are included in the recipes.  Further sources of information can be found in Dr. Strombeck's Home-Prepared Dog and Cat Diets, the Holisticat raw food page, Feline Future.  Additional sources for recipes are Dr. Pitcairn's Complete Guide to Natural Health for Dogs and Cats and The New Natural Cat : A Complete Guide for Finicky Owners by Anitra Frazier.  Some recipes may contain more grain than is optimal for a diabetic cat, so you may want to reduce or even eliminate the grain content. If you wish to include grains, pearl barley  and rice are both considered good (barley has a low glycemic index; rice is thought to be digested more completely), but corn should be avoided.

For details on the protein, fat, and carbohydrate content of various commercial foods, see Janet & Binky's canned food list and dry food list.

Q2.4.  Can I free-feed my cat?
A2.4.  Generally, you want your cat to eat around the time he receives his insulin injections.  Some people have set meal times, and others use free-feeding.  Still others put down food at meal times only, but let the cat eat at his leisure.  Insulin type is an important factor in this decision; short-acting insulins, such as N, can be dangerous if the cat has not had a solid meal about half an hour or so before the shot; on the other hand, a cat on a long-acting insulin such as Ultralente or PZI can follow a "grazing" schedule much more safely.  Most people here would agree that feeding a cat between the time insulin peaks and the next shot is unwise, although a small high-protein, zero-carbohydrate snack such as chicken or tuna should not substantially affect blood glucose.  Whatever you decide, be consistent.

Q2.5  My cat doesn't like / I can't afford the expensive prescription food. Is there any less expensive substitute?
A2.5  Yes. The idea that a diabetic cat must have prescription food is misguided (to say the least). However, diet can affect insulin requirements, so changes to an existing dietary regimen have to be done carefully for a cat who is already on insulin or pills.  As mentioned above, you should ask your vet if your cat has other medical conditions that need to be addressed with diet.

If you're feeding dry Science Diet W/D, any dry food with a similar fiber level will do the trick. Suggested substitutions are Science Diet Light, Science Diet Hairball, or Iams Hairball. The Iams is fairly low in carbohydrate for a dry food, so monitor your cat's glucose levels carefully if you decide to try it, and switch over slowly.

If you're feeding canned Science Diet W/D, Science Diet Feline Light is similar, or you can feed any good quality canned cat food and add extra fiber in the form of psyllium (1/4 teaspoon mixed with 1 tablespoon water) or canned unsweetened pumpkin (1 tablespoon). Check the canned food table to make sure the levels of other nutrients are similar; otherwise, you must make the switch slowly and monitor your cat's glucose levels carefully.  Examples of similar foods are Iams Less Active, Hill's Feline Light, Hill's Feline Senior, and Max Cat Lite.

If you're feeding canned Purina DM, you can substitute any canned cat food which has a similar level of carbohydrate (no more than 10-12% of calories -- see the canned food table), mixed with:  1.) a low-fat source of high-quality protein (chicken, turkey, lean beef, egg, the occasional bit of cooked seafood) equal to about 25% of the total calories, and 2.) 50-100 IU of vitamin E per day.  Keep in mind that this diet is not appropriate for cats with kidney disease.

In all cases, home-cooking is always an option, so don't feel that you're doomed to feed commercial foods.

The easiest way to give vitamin E is to buy it in liquid form in a bottle or in powder (water-soluble) form in a gelatin capsule (which can be opened and closed).  Another option is to buy the regular 400 IU capsules for humans, and mix the contents of one with the food once or twice a week.   Experiment to find out what's palatable to your cat.   The d-alpha (natural) form is more potent than the dl-alpha (synthetic) form, and if it contains extra selenium, or mixed tocopherols and tocotrienols, so much the better.

3. INSULIN

Q3.1.  What kinds of insulin are there?
A3.1.  Insulin comes in all sorts of varieties.  Some are human insulins, and some are animal insulins, usually beef or pork. Some have fairly short durations (N or NPH), some medium (Lente, and some animal-based NPH), and some long (Ultralente, PZI).  For more information, see the Pets with Diabetes page.  Most cats do regulate just fine on human insulins, which are cheaper and easier to obtain, so it is best to try them first. If your cat does not respond well to them, many cats here have obtained excellent results from beef insulin (which is closer biochemically to feline insulin), most notably the PZI duration.  For cats who do better with beef insulin but have problems with the PZI lasting too long, Beef Lente (also known as UK Lente) is available from the Wellington Pharmacy in London.

Q3.2.  Where can I get PZI insulin?
A3.2.  For lots of good details on where to find PZI, see the PZI page at the Feline Diabetes website. Be aware that not all PZI formulas are  beef- or pork-based; most people who switch to PZI do so because human insulin is not working for their cat, so be sure to ask!  The Professional Arts Pharmacy in Baltimore only compounds human insulin, for example.

Q3.3.  What can I expect to pay for PZI insulin?
A3.3.  UK PZI is currently $63 per bottle (U-100) plus $50 shipping for up to 25 bottles; Blue Ridge is around $60  (U-40, which is much more dilute; minimum order 3 bottles), but your vet may mark up the price.  BCP is $58 per bottle (U-100) plus $10 shipping (Fed-Ex overnight).  Summit is CDN$25 per 5 ml bottle (U-100) plus $5 shipping, next-day delivery.

Q3.4.  What kind of syringe should I use?
A3.4.  Most people here have been satisfied with BD Ultra-fine U100 3/10 cc, Monoject  Ultra Comfort (available from diabeticpromotions.com), or Walmart ReliOn Ultra Comfort.  The latter two measure half-units, are manufactured by the same company with different branding, and are less expensive than B-Ds, with ReliOns being less expensive than the Monojects.  Get the finest needle possible, which is 30 gauge.  Some people have difficulty with the longer (1/2 inch) needles and recommend the 3/8 inch needles to avoid shooting "through the tent"; others experience the opposite problem with shorter needles not delivering the insulin properly, so experiment to find out what's right for your cat.  If you're giving a U-40  insulin, either use the appropriate syringe, or use the conversion factors at Pets with Diabetes.

Q3.5.  Do I need a prescription for insulin or syringes?
A3.5.  Probably not.  Check the chart at the Children with Diabetes site for more information on your state or country.  But even if your state requires a prescription, you may still be able to get supplies via mail order.

Q3.6.  Can I reuse syringes?
A3.6.  Although some people do reuse (generally not more than once), most people here recommend against it.  After the first injection, the needle is no longer sterile, (which can contaminate the insulin and promote infection in the cat), and the coating is degraded.  Take a look at the picture of a reused needle and decide for yourself.  If cost is an issue, try a generic brand.

Q3.7.  How do I dispose of used needles?
A3.7.  Laws vary from one location to the next, and your vet or local waste removal facility should be able to give you appropriate advice.  Some vets will dispose of the needles for you.  The safest way to keep them until disposal is to get a strong plastic "sharps" container which you can purchase at your pharmacy.  You may also want to buy a clipper so that you can dispose of the needle separately from the syringe.

Q3.8.  My cat hates getting his shot.  Now what?
A3.8.  Make sure you're using the thinnest possible needle -- 30 gauge is the thinnest, but many people report success with 29 gauge.  You also need to make sure you aren't hitting a muscle; the insulin is supposed to be deposited under the skin.  To brush up on your injection techniques, and learn new techniques, check out Feline Diabetes, Pet Diabetes, the Auburn University page,  and Jamie's explanation.

Q3.9.  How long does a bottle of insulin last?
A3.9.  Unopened insulin is good until the expiration date when handled gently, stored at the manufacturer's recommended temperature range (36º to 46º F for Humulin vials), and kept covered from light. However, an insulin bottle which has been used, will need to be replaced before the expiration date. There are several reasons for this, including exposure to possible contaminants when the rubber seal is punctured, exposure to oxygen, and imperfect mixing (which may change the concentration of the insulin, even when care is taken to mix well).  Because of this, it's always a good idea to inspect your insulin.  Material settled on the bottom after mixing, or clumps, indicate potential problems.

Eli Lilly, the manufacturer of Humulin insulin, recommends replacing Humulin vials within 28 days after opening.  Many people on the FDMB view this recommendation as overly conservative for single-user vials, and have found that Humulin is often good for somewhat longer. Some people on this board do replace Humulin vials every 4 weeks. Others replace every 6 weeks, every 8 weeks, or when they notice reduced glucose control.

The consensus on the board is that animal-source PZI (protamine zinc insulin) lasts longer than Humulin insulin. Many people here use PZI until the bottle is empty. PZI which has been diluted with sterile saline solution by a vet, pharmacist, or consumer should be replaced every 30 days.

4.  MONITORING YOUR CAT -- GLUCOSE

Q4.1.  How can I monitor how well the insulin is working?
A4.1.  Many people on this board recommend home-testing for blood glucose.  You will find excellent details, with pictures, at Harry's page (http://www.sugarcats.net/sites/harry/bgtest.html), more tips are available at Bob & Simon's page,  a short movie can be found at Terry & Punkin's page, and a longer movie is at the Veterinary Information Network.

Secondarily, you can monitor your cat's urine, which will tell you if glucose is high at some point during the day, but will not tell you if your cat is getting too much insulin and the blood glucose level is dropping dangerously low.  One very good method for monitoring a cat who is not being hometested besides urine strips is to keep track of the amount of water being consumed; increased consumption usually means that blood glucose is too high.  Finally, you should watch your cat for unusual attributes, such as excessive urination,  rough coat, or dilated pupils, and learn what this tells you about your individual cat's glucose levels.

Q4.2.  What kind of glucometer should I get?
A4.2.  Most of the regulars here use either the Bayer Elite (but see the caution below), Bayer Elite XL (ditto), LifeScan FastTake, or AccuChek Advantage with only the Comfort Curve strips.  A newer model requiring even less blood, the TheraSense Freestyle, appeared promising at first, but our experience is that it can substantially underestimate blood glucose values (if you already own one, don't panic, but be aware of this problem). You want a model that only requires a small amount of blood (2-3 microliters) and which has "sipping" action; it may cost a little more, but it will make your life tremendously easier.  One online source of glucometers which has good prices is diabeticpromotions.com, and another is hocks.com.  You can also get the glucometer at pharmacies, Walmart, Costco, or any similar store.  There's often a rebate coupon included.  Occasionally, you can even get a meter free if you buy 100 test strips.

Caution on Bayer Elite meter: The Bayer Elite is generally a good meter, but it has the bad habit of beeping before the strip is filled with blood, leading people to withdraw the strip prematurely and obtain a false low value.  See Terry's graphic of how full the strip should be for a reliable reading.

Q4.3.  How often should my cat's glucose levels be tested?
A4.3.  As often as is convenient for both of you. Many people test before every single shot, usually because past experience with hypoglycemia has made them cautious. Some people do sporadic testing, but run a curve every couple of weeks (or less often if the cat is regulated).  If you choose to do this, the best times to check are right before the shot and around the time that glucose reaches its low point, typically from 4 to 6 hours post-shot. Some people only test if something is clearly wrong (for example, strange behavior, lethargy, or increased urination) and they need to know what the problem is.

Q4.4.  My cat's pre-shot level was way below the usual value.  Should I give the injection?
A4.4.  There's no hard and fast rule, but the general consensus here is as follows.  Below 150 mg/dl (8.3 mmol/L), don't give insulin.  Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.  Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.  In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.  Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, increasing the dose may be appropriate, depending on what the whole glucose curve looks like.  In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.  Keep in mind that these are general guidelines, and they should be personalized to your own cat's reactions to insulin.

Q4.5.  I'm not from the United States, and I don't understand your units of measurement.  My cat couldn't have a blood glucose of 300 even if you soaked her in honey for a week.
A4.5.  Americans have only recently switched from the traditional scruples/quart to the metric mg/dl.  While we were busy patting ourselves on the back for being sophisticated, the remainder of the world moved on to the international system (SI) and now measures blood glucose in mmol/L. Just divide the American values by 18 to see what's really going on.

Q4.6.  I'm following the instructions faithfully, but I still can't get blood from my cat's ear.
A4.6.  In addition to the excellent tips in the above links, here are some extra suggestions:

• Warm the ear using a sock filled with uncooked regular rice, barley or oatmeal which has been warmed in the microwave (test on wrist to ensure it's not too hot).
• Alternatively, use a small jar filled with hot water - kitty's ear may fit neatly around this curve, or a ziploc baggie with wet paper towel inside warmed in the microwave, or a heat lamp behind the cat's ear to keep it warm (not too close!).
• Or just massage the ear a bit to get the blood flowing.

• Hold something solid against the back of the ear to hold it in place.  (A flashlight can serve double-duty here.)
• Get as close to the edge of the ear as possible.

• If using a lancet device, use the middle depth setting on the lancet device if adjustable. You can adjust depth up or down as needed with experience - you do not want to pierce through the ear although this is not harmful.
• Hold lancet device firmly against the ear.
• If doing a manual ear prick, be sure to prick the ear at a shallow (45-degree) angle, not straight down.

• Fold the ear over the wound, or pinch the ear gently on either side, to help the blood well up.
• If the drop is not forming properly, gently "milk" the ear on either side of the prick by stroking towards the prick, bringing the blood to that area.
• You may attempt to add more warmth to increase size of blood drop depending on your heating method.

• Sometimes it helps to make 2 pricks side by side one after the other to ensure you get enough blood from one or both.
• Try using the other ear.

• To prevent bruising, apply firm pressure on the ear prick with a tissue while waiting for the meter to count down.

Q4.7.  My cat has been off of insulin for several days, and I'm getting glucose readings in the 40s and 50s (2.2-3.3 mmol/L).  Should I treat him for hypoglycemia?
A4.7.  Congratulations!  As long as you're sure your meter readings are based on full test strips, then it looks like your cat is on a  honeymoon.  Although lab printouts indicate that 70-120 mg/dL (4-7 mmol/L) is normal, we have observed that non-diabetic cats can typically have lower values on our meters.  As long as your cat is not showing any symptoms of hypoglycemia or signs of distress, all is well.  You might want to monitor his blood glucose values for the next week or so; after that, occasionally monitor his blood and urine for glucose. Also, you need to keep a close eye on his drinking habits and general health, because it's always possible that this is temporary.  In the meantime, enjoy!

Q4.8.  Are there other signs besides blood glucose that I can monitor at home?
A4.8.  There's no substitute for knowing your cat's blood glucose.  But it's always a good idea to keep the "whole cat" in mind.  Signs that your cat may not be getting enough insulin include excessive urination, high glucose in urine (although for some cats it's always high), weight loss, lethargy, depression, dull or dry fur, dandruff, lameness (may indicate neuropathy), and change in pupil size (for some cats).  Signs that your cat may be getting too much insulin include all the symptoms of hypoglycemia, sleepiness or lethargy an hour or two after receiving insulin, all the symptoms just mentioned for hyperglycemia (if he is suffering from chronic rebound), and little or no glucose in the urine.  Signs that your cat is doing well include the 5 P's [purring, playing, peeing (normally), pooping (ditto), and preening], as well as normal appetite and thirst.

5.  MONITORING YOUR CAT -- KETONES

Q5.1.  What are ketones?
A5.1.  Ketones are a source of fuel manufactured from fatty acids by the liver and utilized by the body when glucose is unavailable due to a lack of insulin or glucose supply.

Q5.2.  How often should I test for ketones?
A5.2.  If your cat is well-regulated and behaving normally, test for ketones on an occasional basis.  However, if your cat has been refusing to eat or seems ill,  you should test for ketones as soon as possible.  Ketone testing should be part of standard diabetic care.

Q5.3.  How do I test for ketones?
A5.3.  Ketones are tested in the urine using Keto-stix (R) or Keto-diastix (R), which you should be able to buy in the diabetic supplies section of your local pharmacy.  If you can catch your cat on the litter box, you can either hold the end of the stick in the urine stream, or collect the urine in a small paper cup and dip the stick in (for a female cat, a deep plastic ladle kept by the litter box may be helpful for urine collection).  If you see any signs of ketones, contact your vet right away.

Q5.4.  How are positive ketone readings usually treated?
A5.4.  The remedy depends on the reason ketones appear but it will either involve feeding more food to anorexic kitties, a switch to a 2 injection schedule, a longer duration insulin or a higher insulin dosage or a combination of any of the above.

Q5.5.  What is Diabetic Ketoacidosis?
A5.5.  Diabetic ketoacidosis is a life threatening condition caused by an accrual of too many ketones in the bloodstream altering the pH and blood chemistry.  As the condition worsens dehydration, anorexia and vomiting usually appear and if untreated seizures then death occur. Crisis treatment includes restoration of the blood chemistry through hydration and electolyte replacement and returning the main fuel source back from ketones to glucose by using small doses of fast acting insulin and a glucose drip.

6.  RELATED HEALTH PROBLEMS

Q6.1.  My cat is walking funny / weak in the hind legs / not jumping well.  Is this related?
A6.1.  There is a condition specific to diabetic cats called peripheral neuropathy, which causes weakness in the hind legs.  Symptoms include: weak hind legs; feet slipping out from under him/her on the floor; walking down on the hocks in back and/or on the wrists in front; lying down more frequently, especially after short walks   If your cat has this condition, it is a sign the cat's blood glucose is still too high, which is causing nerve damage. Improved regulation is the best way to reduce neuropathy, but check out Jasper's page for additional treatment options using methylcobalamin.  This is useful as an adjunct to good regulation, but should not be considered a substitute. (The Life Extension Foundation also has some interesting supplement ideas.)

If the symptoms do not match the above list, your cat may have arthritis, for which you should consult your vet.  If your cat is wobbly and walking in circles or erratically, you may be dealing with a hypoglycemic episode, in which case go immediately to question 1.4.  If your cat can't walk at all, or has his head tilted, get him to the vet immediately.

Q6.2.  My cat has kidney failure.  How do I manage this as well?
A6.2.  Read Melissa & Popcorn's page on Chronic Renal Failure and Diabetes for an excellent summary of these issues.

Q6.3.  My cat has asthma; how can I avoid using steroids?
A6.3.  See Nancy's document on giving inhaler medicines to a cat.

Q6.4.  I can't get my cat to eat!  What should I do?
A6.4.  It depends on how long this situation has been going on.  If it's just one or two meals, it's probably not a serious situation.  Your cat may have a hairball or a minor infection.  Try to tempt him to eat something tasty (see next paragraph), reduce his insulin to compensate for the reduction in intake, and check for ketones as soon as you have the opportunity (see Q5.3 above).

If a diabetic cat persistently refuses to eat, this is a very serious situation and should not be ignored.  First, you need to verify whether your cat will eat absolutely nothing, or just won't eat the food that you've offered.  Try a variety of tempting dishes.  Your cat may be suffering from a poor sense of smell, so dishes which are very fragrant (such as tuna or liver), or heated up, may excite some interest.  Alternatively, your cat may prefer something bland like Hill's A/D (a prescription food) or baby food (meat flavors are best; make sure there are no onions or garlic added).  Sometimes, a cat will not eat from a dish but will eat from your hand.  Although eventually you need to feed your cat the most healthful diet, getting food into your cat is the most important thing in this situation, so feed whatever he'll eat.

If your cat won't eat anything at all, contact your vet.  Persistent lack of appetite can result from a variety of causes, including respiratory or urinary tract infection, pancreatitis, hepatic lipidosis, or even more serious conditions.  Be alert for vomiting or signs of nausea (such as excessive salivating or lip-licking).  You should also test for ketones (see Q5.3) as soon as you have the opportunity, because ketones can cause lack of appetite.  Get your cat to the vet immediately if you detect ketones in his urine, or if his urine or breath smell fruity or like acetone.

Your vet may recommend syringe-feeding. Sometimes, if you put some food in the cat's mouth by hand (behind the teeth is fine), this will be enough to jump-start his appetite a little. If this doesn't work, buy an oral syringe (usually in the baby supplies at the grocery or pharmacy).  Dilute a smooth food such as baby food with a little water and put it into the syringe (it may help to pack it from the top and shake it down).  Put the syringe in his mouth, sideways, behind her back teeth, and slowly deliver the food (give him time to swallow!).  Give the cat as much as he will eat, but don't force too much, because he may not be able to tolerate more than a tablespoon or so of food at a time.  Many small feedings may be necessary.  If all else fails, your vet may need to prescribe appetite stimulants or even install a feeding tube (in the case of hepatic lipidosis).  For more ideas, see Louise & Chorniy's syringe-feeding FAQ.

You may need to give a reduced insulin dose or even skip a shot, because blood glucose is related to food intake.  However, it is dangerous to skip many shots, because ketones may develop.  Monitoring your cat's blood glucose at home can be very valuable in helping you and your vet make this decision.

If the information in this document was useful to you, please consider "paying forward" by making a donation to IMOM (www.imom.org), an all-volunteer non-profit organization which was founded to help people help their sick, injured, or abused animals.

Version 2.40; last updated October 21, 2002.
The most recent version can be found at  http://www.sugarcats.net/sites/jmpeerson/faq.html.

back to Binkyworld entrance

back to Gorb's home page