How you can help your diabetic cat – The Six Commandments
1 – Knowledge is Power
Learn about diabetes and become informed. This will give you the knowledge and confidence to monitor and manage your cat’s diabetes well. Read around the subject – there is a wealth of reliable information on the internet if you know where to look. Be aware that there are differences between US and UK measurement units, insulin types and in some cases food availability. We suggest the following sources:
Boehringer Ingelheim Vetmedica (simple over-view)
Diabetic Cat Register, Cats Protection support and advice network (UK)
Internet forums are fine for moral support, but they do not replace veterinary advice. They may seem to offer a quick answer, or the answer you want to hear, but remember that taking advice from someone on a forum is the same as taking advice from Joe Bloggs who you met on the bus the other day.
In the USA, there is even a non-profit organisation ‘Diabetic Cats in Need’ who help diabetic cats and their owners, including fostering and financial assistance to those who need it.
2 – It’s not as scary as you think!
It can be daunting to receive a diagnosis of diabetes, but once you’re over the shock and have had time to digest the information and discuss a plan with your veterinarian, you will just need a bit of time to get used to the idea. Sure, giving insulin involves injections, but the needles are tiny and most cats will not mind if they are given with a little titbit of chicken or a prawn as bribery!
3 – Aim for remission
Few people realise that not all cats need insulin for the rest of their lives. Most cats need insulin for several months, but if diabetes is well managed, there is a good chance of getting your cat into remission – which means management with just diet, exercise and weight control.
Those cats who are most likely to go into remission are those that are diagnosed early and have prompt, closely monitored and adjusted treatment in the early stages. This means that dedication to doing things right in the early stages can really pay dividends! In a recent study, those cats that start intensive blood sugar control within 6 months of diganosis had an 84% chance of achieveing remission. Those cats started on treatment more than 6 months after diagnosis have only a 35% chance of remission (i.e. most need lifelong insulin). So, time is of the essence!
Cats who have had steroid treatment within 6 months prior to the diagnosis of diabetes are also more likely to reach remission, so long as steroid treatment can be stopped. Cats showing nerve problems due to diabetes (weak back legs being the most common) are less likely to reach remission. Those cats that go into remission are usually the ones that don’t need a very high dose of insulin. No other factors are proven to affect remission – which means it’s always worth aiming for remission!!
4 – Diet, exercise and weight loss are key
Put simply, your cat will need to be on a high-protein, low-carbohydrate diet, ideally in wet form (e.g. Hills m/d). Even if your cat reaches remission and does not need insulin, this diet WILL need to be continued long-term. It does not matter whether you feed once or twice daily, or ad lib (i.e. food available at all times), so long as you are consistent in the quantity you feed each day. Discuss an appropriate diet with your vet.
Cats who are overweight will need to lose weight. Obesity causes insulin resistance, meaning fat cats will need more insulin. Weight loss will mean better blood sugar control, and a greater chance of remission. Weight loss should be controlled and not too rapid – less then 2% of body weight per week (e.g. 8kg cat loses a maximum of 160g per week, and takes about 3 months to reach 6kg).
Exercise should be constant and regular.
5 – Learn how to do a blood glucose curve at home
A blood glucose curve (or BGC) is used to measure your cat’s response to insulin by measuring blood sugar (blood glucose). Most cats will learn to have a glucose test performed at home. There are a number of videos on YouTube explaining how to perform a glucose test. We recommend using the ear vein, and placing a pad of cotton wool behind the ear to protect your finger against the lancet. If you find lancets awkward to use, your vet may be able to supply you with tiny needles as an alternative. Make sure you use the same glucometer and test strips for all your tests. We recommend the AlphaTrak system as this is specifically designed for use in cats. Another tip – if you find your cat’s fur causes the blob of blood to spread out too much, smear a small amount of vaseline onto the fur on your cat’s ear – then you only need the tiniest amount of blood that will form a lovely neat blob!
Being able to test your cat’s blood glucose has two benefits. First, if you are worried about your cat and want to know if he/she is ‘having a hypo’ (see below), you can simply check the blood glucose and act accordingly. Second, it means you can do a blood glucose curve at home – your cat will be more relaxed, you will get more accurate readings, and it will save you money and hassle.
When doing a blood glucose, you will need to allow at least 12 hours. The first blood glucose test must be BEFORE you give the insulin – it is important for your vet to know what your cat’s glucose is before insulin is given. Typically, blood glucose is checked every 2 hours over 12 hours (if you are giving insulin twice daily) or over 24 hours (if you are giving just once daily), or as recommended by your veterinarian.
6 – Know what else to look for
Diabetes will be better managed if your cat is otherwise healthy. Any infections (such as dental disease) will need to be treated. Urine infections are common in diabetic cats but they rarely show typical signs, so urine samples will be taken by your vet every 3-6 months to check for these and treat them if needed. If your cat is at all unwell, be prompt in going to the vet.
Most importantly, you will need to be aware of the signs of low blood sugar in your cat (‘hypoglycaemia’, or ‘hypo’ for short). This can happen if you accidentally give too much insulin, or if your cat’s insulin requirement is changing, such as if he/she is going into remission. Even if you only suspect a ‘hypo’, if it is safe to do so rub honey on your cat’s gums, and contact a vet immediately. Act quickly because low blood sugar is life-threatening. Signs include:
– Keen hunger
– Agitation or disorientation, unsual vocalisation, hiding
– Aimless pacing, wandering, circling, staggering or falling over
– Weakness and reduced responsiveness
– Shivering, shaking
– Seeming blind
What to Expect
Treatment generally falls into 3, hopefully 4, stages:
1st stage – Starting insulin treatment and weaning onto an appropriate diet. Often insulin treatment is started in the hospital, to ensure the dose is too high (which can cause a ‘hypo’). This stage generally lasts a few days
2nd stage – Adjusting insulin dose while doing regular blood glucose curves. Ideally, to get rapid blood glucose control, blood glucose curves are done 3-7 days after each change in insulin dose, until the correct dose is found.
3rd stage – Maintaining insulin treatment while having regular checkups and being aware of signs of remission
4th stage – Hopefully, remission! Insulin dose will need to be very carefully monitored and weaned down, and blood glucose curves done regularly during this period. Be very aware of the signs of hypoglycaemia (‘hypo’) during this stage in particular.
Because diabetes is a very treatable disease that does not reduce a cat’s quality of life, it is a real shame if cats are not treated due to costs alone. A prescription from your vet will be required for your cat’s insulin, but costs can be reduced by sourcing insulin needles and food yourself. Always make sure you buy the correct insulin needles – get the wrong sort and you risk overdosing on insulin and putting your cat’s life at risk. Although buying the AlphaTrak blood glucose monitoring kit is an outlay, in the long run you will save a lot in veterinary fees and because you may be able to get better control of your cat’s diabetes, you will also save money if you get your cat into remission and insulin is no longer needed.
Holidays and Work
Many cat owners are very worried by the need to give insulin twice a day, as this seems like a real bind that may be impractical at times. However, unlike dogs, you can afford to have some variation in the timing of insulin every now and again – for example, if you usually do insulin injections at 8am and 8pm, but want to be able to go out some evenings, then doing it at 10 or 11pm one night is fine. Equally, it’s not a disaster if you cannot do the injections every 12 hours – 7am and 9pm is better than having to put your cat to sleep or not treating the diabetes at all. With regards to holidays, many catteries and pet sitters are happy to give insulin to a cat if they are otherwise well. Always ensure whoever is caring for your cat has the phone number of your vet, preferably saved in their phone, in case of emergency. Tell your vet the dates you are away, who is looking after your cat, and if possible give your vet some idea of what treatment you consent to should your cat become unwell.
Injections & Needles
Most cat owners are a little scared of the idea of doing injections. Be reassured that the needles are tiny, and your vet will spend time with you teaching you a technique that suits you. You will also have a ‘Sharps Bin’ – a secure box into which used needles are placed to keep them safely out of the way.
Quality of Life
Most diabetic cats are able to lead a normal life with a good quality of life. If your cat has significant other diseases that affect his/her diabetes (such as pancreatitis, kidney insufficiency), you should discuss with your vet what impact this will have on your cat’s quality and length of life, and what you should expect.
We hope you have found this article helpful. Do get in touch if you have suggestions of future articles.