Steps to Regulating Your
"Start Low - Go Slow"
you start -- How Diet Affects
by the Feline
Diabetes Message Board
by Susan & Shadow
- One cat
with a confirmed diagnosis of
complications such as diabetic ketoacidosis)
bottle of long-acting insulin
- .3 cc
syringes with 30- or 31-gauge needles
(with half-unit markings if you can get them)
for measuring blood glucose,
such as a home
glucometer and test strips
bottle of Karo or other glucose syrup
printed copy of Melissa & Popcorn's Treating
bottle of Ketostix or Ketodiastix, for
monitoring urine for
treats to reward
very large bar of chocolate to reward
the human (bottle of
wine or carton of ice cream may be substituted or added as needed)
This document is a description of a safe and conservative procedure for
determining the proper dose of insulin for your cat. However, what
and how you feed your cat are very important to this process.
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. 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.
Five Steps to
Start at a low dose
of PZI, Lantus, or Levemir insulin, as recommended by your
vet. (Note: Humulin and Novolin Lente and Ultralente, two
insulins with good track records in cats, have been discontinued by the
conservative starting dose is 1.0-2.0 units, twice per day. If your
cat’s blood glucose was less than 400 mg/dl (22.1 mmol/L) at diagnosis,
or if your cat is on a low-carbohydrate diet, the starting dose should
be only 0.5-1.0 units twice per day. Fast-acting insulins such as
Humulin Regular, Humulin 70/30, and Humulin N (NPH) are not suitable
insulins for cats, in the experience of FDMB members because of the
high risk of hypoglycemia; Humulin N
may be appropriate later on if you discover that longer-acting insulins
cause problems for your cat.
Vetsulin, also known as Caninsulin, is less harsh than Humulin N, but
still appears to carry a risk of hypoglycemia, particularly for cats
who are not meal-fed high-carbohydrate food, so please be aware of the
Step 2. Don’t increase the dose until your cat has
been on it for at least a week. If you have reason to be concerned
about hypoglycemia, or if your cat won’t eat, do decrease the
dose and contact your vet. Do test your cat’s urine
frequently during the regulation process using Ketostix or Ketodiastix,
and contact your vet immediately if the cat tests positive for ketones.
Do be consistent in the timing and type of food. Do
give the shots at about the same time every day.
3. After 1-2 weeks at
dose, you or your vet should perform a serial blood glucose curve
(blood glucose tests every 2 hours, starting at shot time and
continuing until the next shot). Follow the cat’s normal feeding
schedule during the curve. The curve should be evaluated by someone
experienced at interpreting feline blood glucose curves, in order to
signs of rebound and other possible problems. If no rebound is present,
follow these guidelines for dose adjustment (smaller adjustments may
be appropriate for cats on PZI or Lantus):
If the lowest point of the curve
150 mg/dl (8.3 mmol/L), increase the dose by 0.5 unit.
Repeat the cycle of curving
and waiting 1-2 weeks. As your cat’s blood glucose begins to fall
mostly in the desired range [lowest point of the curve approaching 100
mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6
do lengthen the waiting time between dose increases. If you
decide to change another factor (e.g., diet or other medications), don’t
increase the insulin dose until the other change is complete (but do
decrease the dose if your cat's glucose numbers consistently fall below
90 mg/dl (5.0 mmol/L) as a result of the change). Don’t be
to rush the process along by increasing the dose more quickly or in
increments-- no matter how high your cat’s blood glucose is! Rushing
regulation will cost you time in the long run, because you may shoot
the right dose.
If the lowest point of the curve is
90 and 149 mg/dl (5.0 and 8.2 mmol/L), keep the dose the same.
If the lowest point of the curve is
mg/dl (5.0 mmol/L), decrease the dose by 0.5 unit.
Once you can
no longer increase the dose without the cat dropping below 90 mg/dl
(5.0 mmol/L) at the lowest point, evaluate the duration of the
insulin’s action. If your cat’s preshot blood glucose values are still
consistently above 350 mg/dl (19.3 mmol/L), or if your cat’s blood
glucose usually returns to preshot values more than an hour before the
next shot is due, ask your vet about longer-duration insulins or
possible adjustments to your cat’s food or feeding schedule.
— 5 steps! These
steps are general guidelines that work for the majority of cats.
Because every cat is different and exceptional situations may arise,
your cat’s progress should be closely monitored by someone with
regulating feline diabetics.
For more information on
Dr. Rebecca Price's FelineDiabetes.com
(www.felinediabetes.com) and the FDMB Frequently Asked
Questions List (binkyspage.tripod.com/faq.html).
Version 1.08, July 31, 2006.