If you follow this blog you’ll have seen quite a lot about my boy Finn and his diabetic story. I thought I’d pull together what I’ve learned over now some 4 years of owning a diabetic cat, whose diabetes, to date, is being successfully managed.
Maybe the worst thing about feline diabetes is that it’s a very sneaky disease. Outward signs are minimal until your cat’s blood sugars are seriously high and may have been for weeks to months. No pet owner can be blamed for missing the signs that something might be amiss because at the start, there are virtually no signs. Only when your cat is showing signs of being constantly thirsty, has lost weight, or is urinating large dilute wees outside of the litter box might you have a clue that it’s time to see the vet. I only realised Finn might have some non behavioural cause for his urinating outside the litter box when he hopped off me in the middle of an affectionate cuddle to pee on the floor. I had not noticed the 2 kg weight loss in my large fluffy Maine Coon cat whose normal weight was 10kg. His sugars were up in the 20s (in New Zealand we measure blood sugar in mmol/L and normal blood sugars are in the 4-7 range). A friend’s cat’s first sign of diabetes (probably) was vocalising at night with nothing else obviously amiss and at the time we thought it was behavioural rather than a symptom of medical illness.
Now the good news is that it is often possible manage feline diabetes successfully and sometimes even bring it into remission. Not always, there can be complicating factors that cannot always be identified, that cause insulin resistance. And unless you learn to and are able to measure your cat’s blood sugars at home, it’s expensive as they need to be monitored at the vet clinic on a weekly basis until good control is achieved and then still from time to time in case the cat’s need for insulin decreases. I’m lucky. Finn is an amazing cat and we have a very close bond. He tolerated me doing ear pricks for blood 3- 4 times a day at the start and then twice a day over a period of months. I didn’t always get it right either, so sometimes we had to have multiple attempts to get a nice bead of blood. Truth to tell this still happens sometimes. So I have a great cat who does allow me to keep track of his blood sugars at home. I would say, don’t assume your cat will not be amenable. At least give it a try. Your tools are simple. A human glucometer from the pharmacy works just fine and is inexpensive and you will need a lancet tool to do the ear pricks. Originally I got a kit that included both a glucometer and a lancet tool, but I am now using the Accu-Check Fastclix lancet tool it’s particularly easy to use (easy to load six lancets at a time and no need to prime before clicking the device to do the skin prick). Some people just use the lancets and do the prick by hand.
A more expensive option that works for some cats and removes the need for ear pricks is a continuous glucose monitoring device. These are relatively new, and are designed for humans, but have been used on cats that will tolerate the device once attached. They give a continuous record that can be transmitted to an app on your phone. The monitoring device has to be regularly changed (hence the cost), but does provide a continuous or near continuous record which allows patterns of high and low sugars to be identified. They can be particularly beneficial in the early weeks of establishing an effective and safe insulin dose. Google ‘continuous glucose monitoring’ to find out what is available now, and discuss with your vet.
Otherwise, have a look on YouTube for helpful videos about how to do an ear prick. I found it easiest to do Finn’s ear pricks when he was up on a table or storage chest, not on my lap (he’s too big) and just like other procedures such as pilling and claw clipping I can work much more easily if he’s one way round with my left arm circling him and hugging him to me, to encourage him to stay where he is. Left hand holds the ear, right hand clicks the lancet device. No priming means it’s a little quicker to administer a second prick if the first attempt doesn’t give a suitable size drop of blood. But different people find different ways work for them and their cat.
Finn’s a Maine Coon so his fur has reasonable levels of natural oils. This means that as long as he has not just had a bath the blood tends to bead which make it easier for the glucometer strip to suck it up. However if he’s just been outside and his ears are cold we may struggle to get a reasonable yield because the capillaries have contracted due to the cold temperature. I can usually remedy this by rubbing the edge of his ear vigorously, but if this a frequent issue for your cat, some method of warming the ear can be helpful such as rice in a sock that has been warmed in a microwave. I found a nice discussion here about various ear prick issues and hints: https://www.felinediabetes.com/FDMB/threads/struggling-with-ear-pricks.197553/
Diet is a critical part of successfully managing feline diabetes. For some reason many vets place less stress on this (perhaps because early prescription diabetic management diets weren’t that great), but it makes a huge difference. Just think about it. Diabetic cats, like diabetic humans have trouble processing sugars. Carbohydrates such as rice, wheat, and potatoes are quickly metabolised into sugars. Removing these from the diet reduces the amount of sugar the cat needs to deal with. High glucose levels damage the cells in the pancreas that produce and secrete insulin and prolonged high glucose levels may cause so much damage that recovery is not possible. So anything you can do to reduce the glucose impact while the cat is still not processing glucose effectively is a good thing. Cats don’t need carbohydrates (despite what some cat food manufacturers suggest) and are able to gain the energy they need from protein and fats. If you can’t eliminate carbs completely (picky cat) then seek out foods with low GI starch ingredients such as sweet potato and low proportions of starch to other ingredients.
There are feline diabetic dry diets. From my personal experience with Finn, these are not adequate (these days) to keep his diabetes under control, possibly because they still contain carbs. In the earlier stages of his diabetic journey perhaps they would have worked better. Here in New Zealand the choice of prescription diabetic diet is between Royal Canin and Hills. Unfortunately even the wet Royal Canin diet contains carbs (why, Royal Canin, why???? Wet diets do not need to contain carbs). The wet Hills diet (Hills M/D cans) doesn’t, and is ideal. Unfortunately Finn doesn’t like it (he’s not fussed on any canned or pouch food) but he is a stupidly fussy cat when it comes to wet food. When he initially became diabetic I tried valiantly to get him on an all wet, no carb diet. He resisted and I gave in and found a dry diet whose carb element was low GI (ie sugars are released slowly into the blood stream) and was no more than 20%. This was Nutrience Grain Free food, whose carb ingredient is sweet potato which is low GI. Be aware that just because a food is ‘grain free’ it does not mean that it is low GI – many grain free foods contain potatoes or rice, which aren’t.
Although Finn went completely into remission, and has had lengthy periods (months, to over a year) of remission, he has had periodic recurrences of his diabetes. The chances of successful remission are higher if :
- Diabetes is diagnosed early and treatment started immediately
- It first occurs in an older cat
- Glargine (Lantus) or a new synthetic long acting insulin are used
- Control is achieved within a few weeks of starting insulin
Rcecurrences can be caused by change of diet, stress, concurrent infection, or another medical condition such as pancreatitis developing.
Diabetic cats are always at risk of relapses so a) stick to the diet that has worked and b) be mindful that the diabetes can return. I found an excellent explanation of feline diabetes and chances of remission for the lay person here https://vcahospitals.com/know-your-pet/diabetic-remission-in-cats . This article is also very good (aimed a bit more at vets, but is accessible) https://www.vin.com/apputil/content/defaultadv1.aspx?pId=20539&id=8506495
For Finn, some relapses were caused by change of food (thought I would try Royal Canin ‘Calm’ to help manage his behavioural spraying – a mistake, but I was aware it might put him off track and I did test his sugars, which leapt up immediately, another time we got better control of his arthritic pain and he started stealing the other cats’ biscuits which were on a table that he previously could not jump onto), some by stress (when I was away for days or weeks) or concurrent infection (he is prone to UTIs even when his sugar levels are normal).
About 2 years ago I finally managed to convince Finn to transition to a wet food only, raw meat diet. I started by giving him kangaroo, which he loves, and then was able to introduce more complete diets after a few weeks. He still remains quite picky and only some options are acceptable. He also eats a little Fancy Feast. From time to time we try another canned food, as it would be much more convenient if he was willing to eat canned foods as part of his diet, however to date he has not been impressed. Again be mindful that just because it’s in a can, it doesn’t mean that it is carb-free. Always read the label. For Finn even gravy style wet foods that contain wheat gluten are not good for his sugars, let alone the many canned foods that contain, well, you name it, rice, wheat, potatoes and the like. If like Finn, your cat will only consider raw meat, you need to make sure it is a complete or close to complete diet. Muscle meat without added vitamins and minerals, does not meet a cat’s needs long term, although my vet tells me that an incomplete diet for up to 6 weeks so is fine. Here are some options to consider if you are going the raw meat route:
- Commercial diet that states that it is ‘complete and balanced’ – in New Zealand, Max Cat meets this criterion. In some areas there are raw meat pet food suppliers who also advertise complete diets.
- Adding vitamins and minerals to muscle meat. I found this supplement for NZ owners http://www.petswonderland.co.nz/dogs/dog-food/raw-diets/predamax-raw-meat-diet-supplement-200g/ Overseas there are more options – just google.
- Home made or assembled diet – so either a minced mix containing bone, organs and vitamins and minerals or a diet approximating a ‘whole prey’ diet where the cat is given muscle meat, meaty bones, and some organ meat, which over a period of time such as a week matches the proportions found in a natural prey diet. A small amount of vegetable matter or tripe may be included.
- For Finn (who is adult and fully grown) I feel comfortable feeding the following in rotation – Rabbit & Hare raw meat mix that contains bone and organs (the mix I buy also contains some beef), kangaroo (because he likes it), steak and kidney, and Max Cat. The Max Cat and Rabbit & Hare approximate to a complete diet. Possum meat patties also – but Finn’s decided he doesn’t like possum.
- Many sites will tell you not to mix raw and processed commercial foods (because they are digested differently). However this practice is SO widespread among pet owners with no clear harmful outcome, that I’m not sure it’s a real issue
- This site has a lot of useful information about raw feeding. https://www.rawessentials.co.nz/education/raw-feeding-your-cat?
I would recommend immediately changing to a no carb diet if your cat will accept it. Failing that, consider prescription diabetic dry food or a commercial dry food with a low carb percentage that uses a low GI carb source.
If at all possible learn to monitor blood sugars at home. They will be more representative because your cats stress levels will be lower and you will know immediately if your insulin dosage is too low…. or might be too high.
Actually giving the insulin is not hard, it’s a very fine needle and just an injection under the skin. These days most often the insulin prescribed is a product designed for humans (Lantus) which is a slow release insulin that only needs to be given twice a day. Studies show cats are more likely to go into remission on Lantus than other types of shorter acting insulin (designed for animals). This can be given using insulin syringes, or using an insulin pen. However the downside of the insulin pen is that you can only alter the insulin dosage in whole units. This seems to be fine for Finn who is a large cat, but for a smaller cat it might be too big a change up or down. Vet instruction will be that the Lantus should be kept in the fridge and only lasts for four weeks. If you use the Lantus Solostar pen, according to the manufacturer, you do not need to refrigerate it once you have started using it but it should be disposed of after 4 weeks. I will say though that anecdotally (and confirmed by my own experience) if kept refrigerated both the vials and the pen appear to retain effectiveness for several months.
For my large cat, it has been necessary to increase the insulin dosage up to 7 or even 8 units to achieve good blood sugar levels. This is quite high. However it has also been possible during each of his diabetic episodes to eventually reduce his dosage and then eliminate it completely. Dosage changes should always be done slowly (typically after at least 5 days at the set dose). Lantus’ effects are somewhat cumulative so you cannot tell after just one or two doses what the ultimate effect will be. That said, I know my cat, so although having determined that his sugars are up, we’ll start on 4 units, I will raise the dose a bit more quickly if there is no noticeable effect. And if his blood sugar reading is below 4, I’ll reduce the dose by a unit immediately.
Most recently, Finn had a diabetic relapse likely triggered by stress (arrival of new puppy, topped off by me disappearing into hospital for a few days for foot surgery). Despite following our usual processes, making sure he had no access to biscuits, and starting insulin treatment, increasing fairly rapidly to 7 units, he was still having blood sugars in the teens every morning and this persisted for nearly two weeks. I rang my vet who suggested he may have a UTI (my suspicion too, diabetic cats are more susceptible to UTIs as bacteria feed on the sugar in the urine) and started him on antibiotics. Another clue was the fact that his coat had started getting greasy, clumpy and full of dandruff. Coat is a sometimes overlooked indicator of health, especially if there has been a change from normal. I also stepped his dose up to 8 units and finally saw some good sugar readings both morning and night. 3 days into treatment, his sugars started reading lower, and over the past few days I’ve been able to step him down to 5 units. Oh, and his coat has improved. So clearly, he DID have a UTI. It is looking hopeful for another complete remission although if we do need to continue with insulin treatment I know we can manage this.
You may wonder if I have been continually testing Finn’s sugars every day for the past four years. I haven’t. But I like to think I’m quite observant and intuitive where my cats are concerned. Once he’s been OK on no insulin for a week or so I’ll ease up on the daily testing. First time around I went on testing once a week for many weeks. After subsequent episodes I haven’t continued for quite as long. Remission is defined as good blood sugar readings for four weeks with no need for insulin, so continuing to monitor for four weeks is advisable. After that, I do watch for him guarding the water bowl, peeing inappropriately especially large dilute pees, or sometimes just ‘a sense’ that he’s not quite right.