I’ve worked with nine diabetic cats now – one of my own that was diagnosed after I adopted her (and responsible for teaching me so much), four adopted diabetics, and four fosters. Five were able to be “diet-controlled” (no requirement for insulin), the other four need/needed small doses of insulin along with an appropriate diet. (Two or three of those four had temporary bouts of remission.) As many caregivers ask my thoughts on feline diabetes, I thought I’d summarize my “personal beliefs” as they presently stand regarding effective treatment. I am always studying and learning new things when it comes to diabetes mellitus, so I expect as I learn more I’ll fine-tune my beliefs further.
* Low carbohydrate WET diets are ideal. Studies show 60% to 80% of diabetic cats may stop needing insulin once switched to a low-carbohydrate WET diet. (As far as I know, there are no studies showing low-carbohydrate diets to be as effective, and anectdotal evidence shows them to be much LESS effective.) Prescription diets aren’t necessary, just find a canned or raw diet with little-to-no grains, vegetables, or fruit. Readily available canned foods like Fancy Feast gourmet feast, 9-Lives ground dinners, Friskies, Evo 95% meat, etc. generally work fine. Avoid the foods in gravy if possible, they generally contain starches or syrups.
* Longer-acting insulins (such as PZI, Lantus/Glargine, or Levemir) are best. These insulins have longer durations and later NADIRs (peaks) than shorter-acting insulins (such as Humulin N or Vetsulin/Caninsulin). By the way – PZI-Vet by Idexx is no longer in production, however compounded beef/pork PZI is still available from sources such as BCP and VPA. BCP will send your veterinarian a free sample vial of PZI upon request.
* Home-testing blood sugar levels enables best management of diabetes. There’s a reason human diabetics are urged to home test! Human monitors are fine and may be purchased at any drugstore. The special veterinary meters are more expensive, and their test strips are more pricey and harder to obtain. I’ve personally tested the special vet meter against my own “human” meter and the differences were insignificant. Meters aren’t designed to be 100% accurate and that’s OKAY! People still use them, with good reason. They tell you if blood sugar levels are high or low, and enable you to see trends.
* Obesity does not cause diabetes. However, both obesity and diabetes are risks of a high-carbohydrate, particularly a high-carbohydrate DRY (kibble) diet.
* Lower fat diets are not always necessary for pancreatitis. While some caregivers of cats with pancreatitis feel their cats are more comfortable on a lower-fat diet, there’s no scientific evidence that shows cats with pancreatitis benefit from less fat in their diet (unlike humans or dogs). Personally, the cats I’ve worked with that have had pancreatitis may have had reactions to grains, vegetables, or fruit, but not fat. If lowering fat intake, by necessity protein or carbohydrates must increase. I personally feel *no* cat, especially a cat with pancreatic conditions, benefits from increased carbohydrate intake.
* Many, if not most, diabetic cats have pancreatitis. Pancreatitis is very difficult to diagnose. While recent advances have led to blood tests that assist in diagnosis, the “gold standard” remains an invasive biopsy or necroscopy. Best estimates are that 60% or more of diabetic cats have concurrent pancreatitis. It’s unknown whether pancreatitis led to diabetes, diabetes leads to pancreatitis, or if they just both occur concurrently due to the same (but unknown) cause – like obesity and diabetes often both occur as they may both be caused by high-carbohydrate diets.
* Glucose (syrup, honey, etc.) or high-carbohydrate dry food given at low blood glucose levels can be counterproductive, and could even be dangerous. None of my cats have exhibited clinical symptoms at lower-than-normal blood glucose readings (and I’ve caught them so low the meter can’t read it, under 20). However, at low blood sugar levels I generally give them a low-carbohydrate raw or canned snack. Giving a dry food or glucose will likely send blood sugars rocketing up, then crashing back down afterward. (Think of how your body reacts when you eat a candy bar or other sugary snack – boost of energy, then crash.) Studies have shown that cats experiencing hypoglycemia were LESS likely to suffer brain damage if they were NOT given glucose, even if they experienced seizures.
* Dry (kibble) foods increase risks of hyperglycemia and hypoglycemia (“hypo” or insulin shock). Not only does dry food (even “low-carbohydrate” dry food) immediately raise blood sugar levels due to its high carbohydrate content and high glycemic index, but carbohydrates raise blood sugar levels quickly, then wear off quickly – putting the body on a roller coaster ride of high to low blood glucose levels. (Think of how you feel after a carbohydrate-ridden snack or meal.) Also, should the cat refuse to eat or vomit, blood sugar levels can plummet and/or be drastically lower than typical – and you can’t “take back” any insulin you’ve injected.
* Tight regulation, or as close as you can manage, is best. High blood glucose levels can shorter-term cause diabetic ketoacidosis, which is life-threatening. Longer-term it can cause damage to the kidneys, heart, and other organs.
* Insulin given at low blood sugar levels may be counterproductive. Introducing exogeneous insulin when blood sugar levels are perceived as normal by the body may stimulate the liver to release glucose stores – in a process like Somogyi rebound.
* Micromanagement isn’t productive. While I use a sliding scale, adjusting dose based on blood sugar llevels, I generally don’t adjust that scale more often than every three days or so. (More often in the beginning as I figure out how the cat responds, less often after they’re stabilized.) I generally test blood sugar levels at least three times daily in the beginning (before each shot and a spot check in between to see how low they are dropping), and perform curves, testing every two or three hours between shots, every week or two in the first months they’re on insulin (if they’re on insulin that long). Once stabilized, I still test before each shot and do occasional spot checks. Once off insulin, I may test twice daily for a month or two, then once daily, then less often. (My Jellybean has been off insulin almost two years now, and I only test her blood sugar levels every few months. Same for Ralph, who’s been a “diet-controlled diabetic” since 2004.)
For more information, visit Feline Outreach – Diabetes Education.
References:
Feline Diabetes Mellitus – Antech News, Dec 2003
Capillary blood collection valuable tool in at-home diabetes management
Understanding feline diabetes mellitus Drs. Rand and Marshall
Canine and Feline Diabetes Mellitus: Nature or Nurture? Dr Rand et al
Update on Feline Diabetes Mellitus by Claudia E. Reusch, DECVIM-CA, Clinic for Small Animal Internal Medicine, University of Zuerich, Zuerich. World Small Animal Veterinary Congress (WSAVA) 2006.
Feline Diabetes Mellitus by David Church. WSAVA 2006
Feline Pancreatitis by Jorg Steiner (WSAVA 2001)
Feline Pancreatitis: Underdiagnosed and Overlooked Margie Scherk, DVM, DABVP (WSAVA 2003)
Update on the Diagnosis and Management of Feline Pancreatic Disease by Stanley L. Marks, BVSc, PhD, DACVIM, DACVN (Waltham Feline Medicine Symposium, 2003)
Additional links (added February 2010):
Tilly’s Diabetes: 6 important factors
Intensive blood glucose control is safe and effective in diabetic cats using home monitoring and treatment with glargine. Roomp K, Rand J.
Diabetes Mellitus in Cats, Jacquie S. Rand BVSc, DVSc a, and Rhett D.Marshall BVSc a, b (original version with more than one example of a low-carb food choice)
Life of the Lintee Bean 
http://www,yourdiabeticcat.com is a great resource w/ a great forum as well.
Marie,
I agree – that’s why I have a link to YourDiabeticCat.com among the links in the right margin of my blog, and they are listed as a resource at FelineOutreach.org, the site I suggest going to for more information.
For references, I noted only published studies/articles in journals – as otherwise, I could go on forever! 🙂
you state that obesity does not cause diabetes. though this is correct, it is also correct (and important to point out) that those (feline or human) who are obese have a much greater likelyhood of developing diabetes than those with a normal body mass index
. this is believed to be due for a variety of reasons including diet, as you mention, but also inactivity and increased insulin resistance.
weight loss, healthy diet and increased activity in humans has been shown to delay/prevent diabetes. one would imagine the same goes for cats.
Very good article. You obviously have a lot of experience in caring for diabetic cats! It’s important to avoid feeding any cat a high-carb diet, but especially a cat with diabetes. As you say, a high-quality canned food or a grain-free dry food is better for your cat.
Thanks, Darlene.
I’d recommend a canned food highly over a grain-free dry food. All dry “kibble” foods contain a starch of some kind, whether it be corn, rice, potato, tapioca… they must in order to form those little cereal-like pieces. That starch causes more variability and rises in blood sugar than canned food (or raw).
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Dear (deluded) Pat,
I am not sure why you are so hostile, but your hostility indicates a clear display of your own insecurity. I have chanted for you this morning because your dogmatic refusal to consider any other perspectives demonstrates a fundamentalistic attitude that is not open to growth. Yu are holding yourself back and by preaching your slanted view you are doing the same to others. I would strongly suggest that you jump off your little soap box and try to open that narrow little mind of yours. If this is too hard for you, let someone with a broader mind and IQ to match give you a few pointers on how to do this…
Science is not an absolute fact. Science is only limited to what we know. Knowledge that we have not fully understood is therefore, by your standard, not science. So, if we consider how we have changed scientific theories as we have discovered more, we realise that we have benefitted from things that we thought we understood. I clearly remember the solenoid rule changing from the left hand rule to the right hand rule because suddenly the science proved the flow was in the opposite direction. Yet for years before that, we benefitted from batteries. We also thought we would benefit from things that brought us horrible unplanned side-effects. Does thalidomide ring any bells? We thought we knew it all but obviously we did not. Are you able to see a parallel yet? I doubt it, so here is some more thinking work that I did for you.
The amazing thing about diabetic cats is that they are already older than the cats studied by the pet food industry. In fact, there are diabetic cats out there who are so old that they are more than twice the age of a senior cat as specified by a leading brand whose defines senior as 7+. Did you, the owner of a cat who was already eleven years older than this random number even consider questioning the science that you accept so blindly? Lynette does. And surprisingly, when you start to think out of that tiny little box, you will discover that there are other diseases like heart disease, hypertension and kidney disease that are also more prevalent in older cats. I am talking cats twice the age of senior as defined by Hills. Gee, if humans are classified as senior at 70 years, then my cats are equivalent to more than 140 years and yours are 180 years! By extending the logic (I am kind and omitted the inverted commas) espoused by these kibble brands, these cats should be dead, not showing signs of old age! That MUST be a fair comparison because it is scientifically proven that cats are senior at 7. It says so on the packaging! So it must be true! Do you see the point? Or is your little mind so focused on trying to prove that you are right that the obvious is in oblivion? I still think you are thinking the latter.
I would love to extend myself further, but I also know when to cut my losses. If the two points I have brought to your attention are still not understood or have not opened your mind even a tiny crack, then I sincerely believe that I have encountered someone who may be intelligent but simultaneously extremely stupid and naive. Your logic is based on a slanted view of carefully selected facts. I strongly suggest you go to the creation museum in Kentucky where you can meet others with a similar grasp on how to twist facts to weave your own hilarious though rather sad interpretation thereof. You will maintain it is true because you have the facts. However I will reserve the right to laugh at you loudly because I can think.
I was searching for important information on this matter. The information was crucial as I am about to launch my own blog. Thanks for providing a idea in my blogging.
Hey Lynette, I see you deleted ‘Pat’s’ comments above. I remembered reading this previously and I think this is the same person who likes to comment on petmd.com as “Westcoastsyrinx”. Stating things like… “less than 10% of cats in Hodgkins group went off insulin” and “…the cats from Elizabeth Hodgkins group to end up on the feline heart group at Yahoo.” Utter lies and utterly insane. I think this woman has real mental issues. And she also thinks canned food causes feline heart disease apparently because of the higher fat content (geez, even the low fat thing/ fat and cholesterol causing human heart disease is being questioned, but apparently she wants to transfer that idea over to felines.)
“For example, I have seen a number of cats in one group where the owners were raving that the cats had stopped using insulin. Unfortunately the high fat content in the canned foods had caused the need for those cats to turn to heart medication to maintain life, and often owners reported losing the cats within two or three years after going into remission.”
Dieing of what? Which feline heart issues? And ummm, hmmm, older cats do die.
And this one: “Hodgkins was a writer, always has been – not a nutritional expert – and she sure puts a nice spin on her stint with Heska. NO nutritional training in the credentials above, so where do you think she would get the expertise to create a pet food? Out of a cook book, maybe? One more time, the formula she tried to create was rejected and she is capitalizing on the fact that other companies, including the one she worked for, did come up with formulas as recommended by scientific papers. No one, to my knowledge, is paying fees to Hodgkins for this privilege, which they would have to do if her patented formula had been used.”
Here is the thread and comments, there is much more: http://www.petmd.com/blogs/thedailyvet/ktudor/2013/march/the-case-for-feeding-wet-foods-to-your-pets
Sorry to blast your blog with this negativity, but I just had to share this insanity with others who know. I’m going to try to go over there and take on these fabrications, but this woman has real mental issues.