Regulating Your Diabetic Cat
Twice-a-day Fixed Dosing)
How diet affects regulation
by the Feline
Diabetes Message Board
by Janet & Binky
Start Low Go Slow (SLGS) methods
Susan & Shadow's 5 Steps To
doesn't bring all cats into regulation. If you have
been using this method as described, but are not satisfied with your
progress toward regulation, or if your cat is reasonably regulated but
you would like to improve his glucose values, it may be time to
consider adding new techniques to your toolbox.
outlines some techniques that are used to attain these goals.
Before you commit to trying this, please review 5 Steps To
Regulation, and make sure you have been following the "Start
Low Go Slow" (SLGS) program
as described in this document. If you have not been running
a curve every
week or so and adjusting the dose based on the low value of the curve,
it's possible that you haven't given the method a fair chance, or that
you haven't found the right dose for your cat.
But if you've given it a good try and you're getting inconsistent
results or too-high blood glucose, some change to the standard protocol
may be helpful for you.
Before you begin
should be familiar with the basic
theory of how food and
insulin affect blood glucose levels, and you should have a good
understanding of how your cat's blood
glucose responds to the food and insulin you are using.
should be comfortable hometesting your
cat's blood glucose.
should know how to recognize and treat
should be testing regularly for ketones
in your cat's urine.
should know, if at all possible, your
cat's typical onset
times, peak times and duration with the insulin you're using. (If
your cat is wildly inconsistent, that counts as knowledge.)
should understand the phenomenon of
Somogyi rebound, and have ruled that out as the reason your cat is not
regulated to your satisfaction.
should be prepared to keep careful
records of what you tried
and how your cat responded, and to analyze them to find any patterns.
and how you feed your cat are very important to the process of
Some important dietary principles are:
be consistent in what you
feed your cat in terms of protein, fat, carbohydrate, and fiber content
of the diet, and when you feed your cat relative to the insulin
sure that the type of insulin matches how
your cat. A shorter-acting insulin such as Vetsulin/Caninsulin
often requires meal-feeding (or at least not feeding
your cat after about 6 hours post-dose); longer-acting insulins such as
PZI, Lantus, or Levemir may be more suitable for a cat who
the content of the diet. Cats on
diets which are low in
carbohydrates (around 5-10% of total calories) usually require less
insulin than cats on high-carbohydrate diets. In addition, a
substantial minority (around 1/3) of cats who were previously on a
high-carbohydrate diet may
end up not needing insulin injections if carbohydrates are restricted.
There is now
research indicating that Lantus (insulin glargine) may improve your
cat's chances of being diet-controlled, especially if the dosing is
aggressive. Caution: a
low-carbohydrate diet may not be appropriate for some cats with health
conditions such as chronic renal failure or pancreatitis; check with
your vet to see if this diet is appropriate.
you become comfortable measuring your
cat's blood glucose,
it can be very helpful to keep track of how your cat's glucose levels
respond to the food or foods that you feed him. For example, if
your cat experiences food spikes, this may affect your decisions about
in cats is differently defined by different authorities, and the
definition is evolving as the standard of treatment changes. Here
is one possible set of definitions (from the FDMB FAQ):
dosing protocol which
involves increasing the risk of hypoglycemia. (Note: there may be
good reasons for taking that risk, including avoiding diabetic
ketoacidosis and other complications of chronic high glucose values.)
Blood glucose generally below 300 mg/dl (16.7
mmol/L) with glucose nadir
near 100 (5.6), good clinical signs, no hypoglycemia
- Well regulated:
Blood glucose generally below 200-250
often near 100 (5.6), no hypoglycemia
- Tightly regulated:
Blood glucose generally below 150
(8.3) and usually
in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving
Blood glucose usually between 60-120
(3.3-6.7) except perhaps directly after
meals -- usually not receiving insulin
Tight regulation. Keeping glucose as close to euglycemic
(70-100 mg/dl or 4-5.6 mmol/L) as
for as long as possible, and under 150-200 mg/dl (8.3-11.1 mmol/L)
almost all of the
time. This is a result, not a method in itself. This is a
desirable goal for the good health of the cat, and the main obstacle to
achieving it is the risk of hypoglycemia. A second obstacle is
inconsistent response to a specific dose of insulin.
regulation method. Any
non-SLGS method which
has, as its aim, to keep a cat tightly regulated.
method may not
succeed in its aim, and other methods might lead to tight regulation;
the issue is the intent of the person using the method.)
or QID dosing.
it is: Giving
insulin three (TID)
or four (QID) times a day, usually regularly spaced.
Purpose: To create a smoother glucose curve with less
distance between the pre-shot value and the glucose nadir (low point).
Who might use it: Cats who have a wide range of blood
glucose values even on a very gentle insulin.
Advantages: Keeps glucose levels more stable over the course
of the day.
Disadvantages: Labor intensive, requires frequent testing,
more restrictive to your schedule than BID dosing, more expensive due
to increased use of syringes and test strips.
it is: Giving insulin
when the cat's blood
glucose goes above a certain amount after the previous dose has
peaked and the blood glucose is clearly increasing, typically
somewhere between 150
and 200 mg/dl (8.3-11.1 mmol/L), without regard to the clock.
Purpose: To keep glucose levels consistently in
Who might use it: Cats who do not have a consistent
insulin, and people who are attempting to achieve tight
regulation with their cat.
Advantages: When the cat cooperates, blood glucose
levels are kept in or near euglycemic ranges. A little more
flexible than TID or QID dosing.
Disadvantages: Requires frequent testing both to
determine when the previous dose of insulin is past peak, and when the
blood glucose rises enough to require a new dose. May cause
confusion if the previous dose did not lead to a clear glucose
nadir. Potentially expensive due to increased use of test strips.
it is: Giving
small doses of
insulin (Humulin R, 70/30, or N), as an adjunct to the usual dose
of long-lasting insulin (PZI, Lantus, or Levemir).
Purpose: To promote a rapid drop in
blood glucose over a short period of time.
Who might use it: Cats who tend to have food
who tend to have too-slow response to their long-lasting insulin; cats
who occasionally don't seem to respond to their usual insulin; cats who
are prone to adverse complications of high glucose, particularly
ketones; cats who have a difficult time coming down from high numbers.
Advantages: Helps handle high glucose values swiftly
and usually predictably.
Disadvantages: Requires keeping extra insulin around, may
require extra syringes; frequent testing needed; risk of hypoglycemia
if too much is given; may inadvertently be used when the real solution
to the problem is to increase the dose of the cat's usual
insulin. More expensive due to
increased use of syringes and test strips.
Comment: Can be given with the
regular shot, or between
shots. Can be given regularly or on an as-needed basis.
Dose can be varied according to blood glucose level.
Warning 1: In some cats, 1
unit of a fast-acting insulin can quickly drop their blood glucose by
hundreds of points in a short period of time. It is crucial to
start with miniscule doses and assess the action of the insulin by
testing every hour until you have data on how much insulin you can
safely give. This is a very dangerous technique if not properly
used. Treat the fast-acting insulins with respect!
Warning 2: If your cat has diabetic
ketoacidosis, she belongs in the care of a vet. DKA
requires making sure electrolyte levels are balanced before
giving insulin. Do not attempt to treat DKA at home.
it is: Basing the
insulin dose on the
pre-shot value -- less insulin if the pre-shot is lower, more insulin
if the pre-shot is higher.
Varying needle length
Purpose: With usual insulin, to reduce the risk of
the cat has an unusually low pre-shot glucose value. With
bolus doses, to handle unusually high pre-shot values.
Who might use it: Any cat who has a low pre-shot
number; users of the Dr. Hodgkins protocol; users of boosters (with the
Advantages: Avoids hypoglycemia.
Disadvantages: Reduced dose may lead to high pre-shot
in next cycle for those dosing by the clock, or short duration for
those using as-needed dosing.
Comment: Primary variations are: a.) having a standard
dose for the cat, but giving less insulin if the pre-shot is
unexpectedly low, and b.) varying the dose from one shot to the next
as a general practice. Use of
sliding scales may not be necessary with very
slow-onset insulins, but that should be determined with data from your
own cat, assuming that a reduced dose is necessary unless you collect
clear evidence that it is not.
are typically available in 1/2-inch and 5/16-inch lengths. For
some cats, needle length has been shown to make a difference in onset
and duration of insulin, possibly because the probability of
inadvertently shooting into the fat layer is different.
Varying injection site
action, and duration of insulin may be different if the injection is
done at different sites. If inconsistency is a problem, you can
try experimenting with injections between the shoulderblades, between
the thigh and the side of the body, or at the abdomen. Do not
inject into muscle: insulin injections must be
subcutaneous. Injecting at the scruff of the neck is
thought to lead to inconsistent absorption.
For more information on
Dr. Rebecca Price's FelineDiabetes.com
(www.felinediabetes.com) and the FDMB Frequently Asked
Questions List (binkyspage.tripod.com/jmpeerson/faq.html).
Version 1.15, August 20, 2006.