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.

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.

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.

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.

You'll need the following supplies:
 

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.

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):

• One unit of Lantus (insulin glargine), once a day, or
• One/half a unit of Lantus, twice a day, 12 hours apart.
• If your cat is small, you might consider just giving half a unit once a day to start with.

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:

• Take your cat's blood glucose (if below 200, do not inject!).
• Feed him.
• Wait 15 or 30 minutes, then give the injection.
• Re-test the glucose level at about hours 4 and 7, if you can.
• If the glucose level drops below 60 mg/dl, or 3.4 mmol/L, treat your cat for hypoglycemia, skip the next shot, and reduce the dose.
• Post the results on the Feline Diabetes Message Board  if you'd like some feedback.  But be sure to be an intelligent consumer of advice!  If you don't understand the thinking behind the advice you receive, ask the person to explain further.

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.

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:

• Take your cat's blood glucose (if below 200, do not inject, unless you have prior experience with this number).
• Feed him.
• Wait 15 or 30 minutes, then give the injection.
• Re-test the glucose levels every 2-3 hours up to 12 hours.
• Post the results on the Feline Diabetes Message Board as they come in for commentary and interpretation, but be aware that not all the advice you receive will be reliable.   It's reasonable to ask people to explain the thinking behind their advice.

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.

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.

U.K.:

• Special rebates are generally not available on glucometers.
• Bayer Glucometer Elite is not sold.
• Bayer Dex is called "Esprit."
• A prescription is needed for insulin, and recommended for syringes.
• If you can't get corn syrup, try powdered glucose or honey.
• Supplies tend to be more expensive than in the USA
 
Cheryl and Rocky write (May, 2002): "In my desperate search for a reliable (and cheaper) UK source of winged IV lines for Rocky's fluids, I've finally found a company that stocks Terumo (hurrah!) much cheaper than anyone else.  Their BD insulin syringes are cheaper, too. (Cheaper than my chemist and also Vet-Medic) However, carriage is a standard £8 per order, so if you order in quantity (or anyone wants to do a bulk-order and post off to anyone else who wants to join in) then I still think we'd save money.
 
Direct Medical Supplies
07041 527007
BD U100 insulin syringes (30g) code 324869 (check the reference on the outer bag for the code for other  sizes/guages. They really need the code to place the order) £14.20 for 100.

Canada:

• Along with the Humulin series, possible insulins include Caninsulin, which is 30% semi-lente and 70% ultralente, and 100% beef PZI which can be obtained from Summit Pharmacy (416-406-3333, Toronto).

• Advantage and Glucometer Elite are now available here but very expensive - over A$100.

• There is also (in Melbourne only) a new Pharmacy called Chemstop where one can buy off prescription drugs and vitamins at a much better price than the regular pharmacy.  They also supply insulin for A$23.05,(elsewhere A$35 - A$60)  50 Test Strips for A$25 (A$35-A$40) (recent wholesale price increase) Ringers Solution A$3.05 ($11.50) - quite a saving, and when you convert it to US$ - roughly half the A$ value - they must be very cheap.

• We do not get "buy the strips and get glucometer free or for a very reduced price" here.

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

Check Hocks and Diabetic Promotions for current deals.

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.

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.

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://https://binkyspage.tripod.com/frugal.html.