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FRUGAL FELINE DIABETES
How to treat your diabetic cat without having to resort to a life of crime


Table of Contents

Prologue
Introduction
Before you start

Supplies
The first insulin shot
Testing urine
The glucose curve
Changes in dose
Diet
Special information for people outside the U.S.A.
Current promotions
Supportive vets and possible friends
What to do with all the money you saved


A Note Before You Begin Reading

This document was written in happier days when there were two excellent, low-cost insulins (Humulin/Novolin Lente and Ultralente) available without prescription in many parts of the United States.  Thanks to the infinite wisdom of Good Corporate Citizens Eli Lilly and Novo Nordisk, these insulins are no longer being manufactured.  This means that cat owners must choose between Humulin N, an inexpensive but very harsh insulin, and expensive prescription insulins such as Lantus (insulin glargine), Levemir (insulin detemir), and PZI.   Many of the money-saving principles in this document are still applicable, but it's no longer feasible to "go it alone" without a vet.  Of course, you shouldn't be doing that anyway, but this document was originally written for some individuals whose financial situation made it necessary.


Prologue

One of the first thoughts to cross your mind upon hearing the diagnosis that your cat has diabetes is likely to be "Can I afford this?"  Although you may feel guilty thinking this, it's a very practical question; your love for your cat may be boundless, but your budget probably is not.  And although diabetes is very treatable, the costs can add up.

The whole process can be much less expensive if you're willing to do some of the work yourself.  One of the major expenses is having your vet test your cat's blood glucose; however, this can be done at home cheaply and easily (human diabetics do it all the time), so "Frugal Feline Diabetes" starts with home-testing.

WARNING! WARNING! WARNING!

Before you start, you must read and  understand the following disclaimers.

1.)  The authors of this piece are a group of educated cat-lovers, not veterinarians. The following techniques should work for most cats, but you embark on this path at your own risk.  We strongly recommend that you hire a competent veterinarian who supports home-testing to guide you and help you if an emergency happens.

2.)  Many cats who are diagnosed with diabetes have other health problems as well, ranging from acute problems such as pancreatitis, liver trouble, urinary tract infections, and ketoacidosis to chronic problems such as renal failure and heart disease.  If your cat is one of these, he will need professional veterinary care and possibly emergency treatment.

3.)  Your cat must be diagnosed with diabetes by a veterinarian before you attempt these techniques.  If you give insulin to a non-diabetic cat, you will likely kill him.  One high blood sugar reading does not mean that a cat is diabetic.  This must be confirmed with other tests and by observation of other symptoms.


Introduction

Your vet will probably quote you a value between $200 and $800 (US) to get your cat regulated.  It can be much cheaper if you're willing to learn how to test your cat's blood at home.  Many of us here do it routinely; it's not as dreadful as it sounds, and some cats even come to enjoy their private time with all the petting and love (and maybe a little treat at the end).

Once your cat is regulated, it costs very little money to keep him going; a bottle of insulin every couple of months (as low as $20, depending on the insulin), and syringes, which can be cheaply obtained via mail order or from discount stores such as Walmart.


Before you start

Start with the Frequently Asked Questions list just to orient yourself.  Also, take a look at Susan & Shadow's "5 Steps to Regulation" document.

Then read the links at the Feline Diabetes site and and the Pets with Diabetes site to learn how to inject insulin (it's best if your vet or a vet tech can show you this, though).

Then read Harry's page, to learn how to test your cat's blood glucose levels. Follow this up with Bob & Simon's page for more ideas.  Practice on yourself until you feel comfortable using the glucometer before attempting to get blood from your cat.  If you can, practice on your cat as well before you give the first insulin shot.

This may seem like an overwhelming amount of information, but diabetic people learn to do this all the time. Just take it one step at a time, print out copies, and read them as often as necessary to get the basic ideas.


Supplies

You'll need the following supplies:
 

Item Approximate cost in USA
Glucometer -- Bayer Ascencia Contour, Life Scan One Touch Ultra,Accuchek Advantage with Comfort Curve strips, or Freestyle/ Freestyle Flash*.  It's important to get strips that "sip" up the blood and require a very small amount (3 microliters or less).

Don't buy the cheapest glucometer, because you'll have a hard time with it. This is a one-time expense -- get a good one!

*Note: we actually do not recommend the Freestyle, because of anecdotal evidence that it tends to underestimate blood glucose at high values, by 100 points or more. 

About $20 after rebate, or even free if you know any diabetic people who are willing to give up an old one (which you can use as a trade-in).

Also sometimes free with 100 test strips as a promotion.

Glucose test strips for your monitor About $35 for 50 -- cheaper if you buy 100 at a time. Some people find good deals on eBay.
Lancets About $7 for 100 BD Ultra-fine II or $10 for 100 Soft Clix.
Lancet device --
Optional one-time expense.  May come with glucometer.
Optional: If you use Soft Clix lancets, you may want the Soft Clix pen lancet device at about $30. 
Insulin About $25-30 for a bottle of 1000 units of Humulin L or Humulin U (10 ml of U-100 insulin).
Syringes $13-$28 for a box of 100 ; cheapest at Walmart.  Whatever brand you choose (BD and Monoject are also good), get the 3/10 cc size, with 30- or 31-gauge needles (the higher the gauge, the thinner the needle).

At Walmart, the SKU number for the Reli-on syringes is 6-8130651123, and the  NDC # is 08881-6080-32.

Urine test strips (Ketodiastix) About $12 for 50, but you won't use them every day
Karo corn syrup (light), or powdered glucose $3 for a bottle at your grocery store for Karo -- emergency use only (in case of insulin overdose).

Good mail-order sources of supplies:

Hocks Pharmacy
Diabetic Promotions
Vetmedic (syringes for European users)

It pays to shop around!  If you're a Costco or Sam's Club member, or you have a Walmart or Target near you, it's worth checking out their prices.  Also, be on the alert for sales on diabetic supplies at your local drugstore or discount store.

WARNING!  There are reports that some vets are renting out the Abbott AlphaTrak at ridiculously inflated prices!  Do not spend money on these.  Our own intrepid Hope has compared this to several regular glucometers on her cats, and it is no better than meters designed for humans.  In fact, the AlphaTrak most resembles the Freestyle in performance, and the Freestyle is notorious for massively underestimating a cat's blood glucose when his glucose values are high.  Also, do not let your vet charge you inflated prices for lancets or test strips.

Some states may require prescriptions for insulin or syringes.  Check the chart at the Children with Diabetes site for more information on your state or country.  You can get a prescription from your vet.


The first insulin shot

If you can at all afford it, it's optimal to have your vet do this.  An experienced vet will start your cat with a low dose of a long-duration insulin (Lantus (insulin glargine) and Beef/pork PZI are good choices, and Levemir (insulin detemir) is looking very promising; many people find that Vetsulin/Caninsulin does not have good duration for cats), keep him for a day or overnight to make sure that the dose isn't too high and to run a preliminary glucose curve, and teach you how to give the shots yourself.  This shouldn't cost more than $150.  (Note: In July 2005, Eli Lilly announced that it was discontinuing Humulins L and U, so there's little point to starting a cat on these otherwise excellent insulins, even if they can be found.)

Other people have reported that the vet simply showed them how to do the shot and then had them bring the cat back after a week to do a glucose curve and assess how well the shot was working, so different vets have different philosophies.

If you absolutely must do it yourself due to budget constraints or lack of nearby veterinary expertise, here's a very conservative approach.  Please note that we believe that you're much better off having a veterinarian guide you in this.

Before you give the shot, you need to understand about hypoglycemia, which occurs if too much insulin is given, and which can kill your cat very rapidly.  Print out Melissa & Popcorn's page on hypoglycemia and have it handy for emergencies.

Start your cat with one of the following doses (substitute your insulin of choice for Lantus):

This is a very small dose, but it's better to start off low and slowly work your way up.

Note: We strongly recommend that you *not* start off with Humulin N.  For most cats, it carries a significant risk of causing hypoglycemia.  In addition, it generally does not last the full 12 hours between shots.  If a lente insulin such as Vetsulin/Caninsulin turns out to last too long, you always have the option to switch to Humulin N later.

Procedure:

If your cat and schedule will permit, try to get a pre-shot and hour 6 blood glucose every time you give a shot.  But don't feel bad if you can't: most diabetic cat owners do just fine without them.  Always be on the alert for signs of hypoglemia.


Testing urine

Whenever you can get a sample of fresh urine, use the Keto-diastix to test for glucose and ketones.  You may need to stalk your cat to the litterbox and sneak up behind him.  You can catch the urine in a dish or paper cup, or you may put the end of the strip in the urine stream.

It is normal to see glucose; make a note of the level.  If the glucose is zero, your cat may be getting too much insulin, and you'll need to test his blood to see what's going on.

Ketones are very serious.  If you see ketones, contact your vet right away.

More information can be found in the Frequently Asked Questions list.


The glucose curve

After 5 to 7 days, you need to do a glucose curve to assess how well the insulin is working.  Set aside a day when you'll be home and can measure your cat's glucose every two hours.

Procedure:


Changes in dose

There are three main principles to follow when changing the dose.

1.)  Changes in dose should be based on the information contained in the cat's blood glucose curve, particularly the information at insulin "peak", or, more accurately, the lowest point on the curve.

2.)  Increases should be small and infrequent -- raise the dose no more than once per 5-7 days: 1 unit per dose if given once a day, or .5 units if given twice a day.

3.)  Unless your cat's glucose goes dangerously low, the new dose should be followed for 5-7 days to properly assess how well it's working.  If the minimum glucose value drops below 100, you should reduce the insulin dose.

The net result is that during the first month or so, you may run a curve once a week while you're searching for the correct dose.  Once your cat is regulated, it should be much less frequent, although occasional spot-checking is an excellent idea.

If the glucose curve returns to the pre-shot value well before it is time for the next shot, you need to consider giving twice-a-day injections if you're on a once-a-day schedule or trying a longer duration insulin.

For more information on changing your cat's dose, read the Feline Diabetes FAQ.


Diet

Research done by Purina and others in the past few years, as well as more informal anecdotal evidence, suggests that a low-carbohydrate diet can reduce a cat's glucose and therefore his insulin requirements.  In fact, in preliminary studies, 40% of the cats on the Purina CNM-DM diet went off of insulin altogether, and in another randomized controlled trial, 30% of cats on Hill's Feline Growth also went off of insulin.   Although there's no guarantee that your cat will be one of the lucky ones, the vet who helped develop the Purina diet, Dr. Elizabeth Hodgkins, says that an overall lower blood glucose is healthier over long periods of time.  Cats, who are obligate carnivores, have no known carbohydrate requirement, and are capable of converting protein to glucose as needed.

If you choose the low-carbohydrate approach, the easiest time to start the new diet is before you start giving your cat insulin.  It's not necessary to buy the very expensive Purina DM or Hill's M/D formulas; you can duplicate it at home with commercial canned cat foods, especially if you add in extra high-protein foods such as chicken, turkey, and fish, and supplement with some vitamin E (a 400 IU capsule once or twice a week is plenty).  Take a look at the Binky's canned cat food table. Stock up on foods which have 12% or fewer calories from carbohydrates. Foods like Friskies or Whiskas are okay if you need to go really cheap (and they aren't much more expensive than dry "prescription" foods, on a per-calorie basis), but there are also some "premium" foods, including Fancy Feast and Iams, which are good as well, and which may be available for a reasonable price in your grocery store or discount store.  And don't rule out the human-grade specialty foods or home-cooking; it may be more expensive on a daily basis, but if it improves your cat's health or longevity in the long run, it's by definition more frugal.  See Holisticat and Dr. Lisa's page for more information on home-prepared foods for cats.

Almost all dry foods are fairly high in carbohydrate (see Binky's dry cat food table).  This is because it needs grain for texture and palatability.  However, many, perhaps most, cats can be regulated on a dry food diet, so if you can't afford canned cat food, or your cat won't eat it, you still have options.  Two relatively low-carbohydrate prescription dry foods are Purina DM and Hill's M/D formulas.  A commercial food which is even lower in carbohydrate and similar in cost is Innova EVO, which came out in Spring 2005.

Hills W/D, which is commonly prescribed by vets for diabetes, is high in fiber (which is thought to prolong and "smoothe out" the conversion of carbohydrate to glucose), but is also high in carbohydrate, and it has been falling out of favor for diabetes management for some years.  If you want to try this approach, an alternative is to get a relatively low-carbohydrate and high-fiber dry food (such as the various hairball formulas).

If your cat prefers dry food, and you want to reduce carbohydrate intake, you can also see if your cat will consume some calories as canned food or meat as a treat.

Alternatively, some people feed primarily canned food, and leave dry food out for snacking.  This may help prevent hypoglycemia if your cat will eat when he senses his glucose levels are dropping (but be warned that some cats will not).

It is a good idea to withhold food after insulin activity peaks, since there will be no insulin to counteract the food, but a very small protein snack shouldn't do much harm if your cat insists.

Above all, be consistent!  Insulin needs are directly linked to diet, and you are courting trouble if you don't feed your cat a similar mix of protein, fat, carbohydrate, and fiber at every meal, and give the meals at approximately the same time every day.

WARNING!  If your cat is already receiving insulin, and you want to switch to a low-carbohydrate diet, you must make the transition slowly, over a period of several weeks, and monitor his glucose levels faithfully.  It is likely that you will need to reduce his insulin dose, although this will not happen with all cats.  A rapid transition can result in hypoglycemia, brain damage, or even death.  Don't take the risk!  If your cat insists on transitioning all at once, you should cut his insulin dose severely, and re-start the regulation process.

WARNING!  If your cat has kidney disease (chronic renal failure or CRF), many low-carbohydrate foods are not appropriate!  You must feed him a diet for his health problem and adjust the insulin to match.  Any other approach can do severe damage.  Don't do it!  Other health problems which may affect dietary needs are pancreatitis, liver disease, inflammatory bowel syndrome, and/or feline urological syndrome (FUS).

Most elderly cats require 15-25 calories per pound of ideal weight; a sedentary cat will require less, an active cat more.  If your cat is gaining undesired weight, or still losing weight once blood glucose is consistently below 300, adjust the calorie content accordingly.


Special information for people outside the U.S.A.

U.K.:


Canada:

Australia:


(If you'd like to contribute to this section, send information to binky.cat@sbcglobal.net.)


Current Promotions

Check Hocks and Diabetic Promotions for current deals.


Supportive vets and possible friends

As we all know, reading something is not the same as having someone show you how to do it! To find vets in your area who may be sympathetic to this approach, or to find other nearby humans who are owned by diabetic cats, join and post a query to the Feline Diabetes Message Board.


What to do with all the money you saved

If this information has been useful to you, please consider "paying forward" by making a donation to IMOM, an all-volunteer non-profit organization which was founded to help people help their sick, injured, or abused animals.



Notes to readers:  This document was prepared by the community at the Feline Diabetes Message Board.  It is meant as an adjunct to qualified veterinary advice, not a substitute, and comes out of our collective experience.  It is specifically tailored to cats who are otherwise healthy; very ill cats should be under the care of a veterinarian.

This is an HTML document, and much of the useful information is contained in the links.  If you are reading a printed copy of this, you are not obtaining the full value of the document.  This document is copyright (C) 2000-2006.  You may freely copy and distribute the document, but you may not charge money for it (not even handling costs), and altering the content is prohibited, not to mention really rude to the people who have put so much effort into this.   If you have corrections or suggestions, please post them to the Feline Diabetes Message Board.

Version 2.10; last updated May 31, 2006.
The most recent version can be found at http://http://binkyspage.tripod.com/frugal.html.


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