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Diabetes in Cats

What is diabetes mellitus?
Diabetes is a disease of carbohydrate management in the body. In a normal cat, insulin is released from special cells called the beta cells in the pancreas. Insulin regulates the cat's blood sugar levels, helping to shuttle glucose, the fuel used by the body's cells, into the cells as needed. In a diabetic cat, insulin is either not produced in sufficient quantities, or the cells no longer recognize insulin. This causes the blood sugar to rise much higher than normal. Although the blood sugar is very high, the cells do not get any glucose, so your cat may eat more than normal but lose weight. Excessively high blood sugar is eliminated in the urine in a diabetic pet. When there is a lot of sugar in the urine, the body must excrete more water than normal, as the high sugar content pulls more water into the urine. As a result, your cat will drink and urinate a lot more than normal.

Cats with diabetes can live normal healthy lives.

Types of Diabetes
There are two forms of diabetes in cats: diabetes insipidus and diabetes mellitus. Diabetes insipidus is a very rare disorder that results in failure to regulate body water content. Your cat has the more common type of diabetes, diabetes mellitus. This disease is seen on a fairly regular basis, usually in cats 5 years of age or older. Simply put, diabetes mellitus a failure of the pancreas to regulate blood sugar. The pancreas is a small but vital organ that is located near the stomach. It has two significant populations of cells. One group of cells produces the enzymes necessary for proper digestion. The other group, called beta-cells, produces the hormone called insulin.

In cats, two types of diabetes mellitus have been discovered. Both types are similar in that there is a failure to regulate blood sugar, but the basic mechanisms of disease differ somewhat between the two groups.

1. Type I, or Insulin Dependent Diabetes Mellitus results from total or near-complete destruction of the beta-cells. This is the most common type of feline diabetes. As the name implies, cats with this type of diabetes require insulin injections to stabilize blood sugar.

2. Type II, or Non-Insulin Dependent Diabetes Mellitus is different because some insulin-producing cells remain. However, the amount produced is insufficient, there is a delayed response in secreting it, and the tissues of the cats body are relatively resistant to it. These cats may be treated with an oral drug that stimulates the remaining functional cells to produce or release insulin in an adequate amount to normalize blood sugar. Alternatively, they may be treated with insulin. Cats with NIDDM may ultimately progress to total beta-cell destruction and then require insulin injections.

What are the signs of diabetes?

Some cats may develop an unusual gait and begin walking with their hocks on the ground. The hock is the backward pointing joint of the hind leg.

How is diabetes caused?
Diabetes can have a variety of causes, ranging from destruction of the beta cells from pancreatitis or viral infection, to idiopathic causes (meaning the etiology is unknown). Obese cats have an increased risk of developing diabetes, so keeping your cat slim will go a long way in keeping her healthy.

How is diabetes treated?
Most diabetic cats are treated with twice daily injections of insulin. The exact type and dose of insulin varies greatly from cat to cat. Some cats regulate very quickly, while others take a longer time finding their dose. Cats can fluctuate in their insulin needs depending upon their general health and their stress levels.

Injecting your cat with insulin is a lot scarier than it sounds. Insulin needles have very small and thin needles, making the injection virtually painless. Many people couple the injection with a tasty treat, and these cats quickly learn to accept their insulin injections.

How is diabetes mellitus diagnosed?
The diagnosis of diabetes mellitus is based on three criteria: the four classical clinical signs and

The normal level of glucose in the blood is 80-120 mg/dl (3.9-6.1 mmol/L). It may rise to 250-300 mg/dl 13.8-16.5 mmol/L) following a meal or when the cat is very excited. However, diabetes is the only common disease that will cause the blood glucose level to rise above 400 mg/dl (22 mmol/L). Some diabetic cats will have a glucose level as high as 800 mg/dl (44 mmol/L), although most will be in the range of 400-600 mg/dl (22-33 mmol/L).

To keep the body from losing its needed glucose, the kidneys do not allow glucose to be filtered out of the blood stream until an excessive level is reached. This means that cats with a normal blood glucose level will not have glucose in the urine. Diabetic cats, however, have excessive amounts of glucose in the blood, so it will be present in the urine.

What are the implications for my cat and me?
For the diabetic cat, one reality exists: blood glucose cannot be normalized without treatment. Although the cat can go a day or so without treatment and not get into a crisis, treatment should be looked upon as part of the cat's daily routine. Treatment almost always requires some dietary changes. Whether an individual cat will require oral therapy or insulin injections will vary.

As for the owner, there are two implications: financial commitment and personal commitment.

When your cat is well regulated, the maintenance costs are minimal. The special diet, the oral medication, insulin, and syringes are not expensive. However, the financial commitment is significant during the initial regulation process and if complications arise.

Initially, your cat will be hospitalized for a few days to deal with the immediate crisis and to begin the regulation process. The "immediate crisis" is only great if your cat is so sick that it has quit eating and drinking for several days. Cats in this state, called ketoacidosis, may require a week or more of hospitalization with quite a bit of laboratory testing. Otherwise, the initial hospitalization may be only for a day or two to get some testing done and to begin treatment. At that point, your cat goes home for you to administer medication. At first, return visits are required every 3-7 days to monitor progress. It may take a month or more to achieve good regulation.

The financial commitment may again be significant if complications arise. We will work with you to try and achieve consistent regulation, but some cats are difficult to keep regulated. It is important that you pay close attention to our instructions related to administration of medication, to diet, and to home monitoring. Another complication that can arise is hypoglycemia or low blood sugar; if severe, it may be fatal. This may occur due to inconsistencies in treatment or because some cats can have a spontaneous remission of their disease. This will be explained in subsequent paragraphs.

Your personal commitment to treating this cat is very important in maintaining regulation and preventing crises. Most diabetic cats require insulin injections twice daily, at about 12 hour intervals. They must be fed the same food in the same amount on the same schedule every day. If you are out of town, your cat must receive proper treatment while you are gone. These factors should be considered carefully before deciding to treat a diabetic cat.

What is involved in treatment?
The best one word answer to that question is consistency. Your cat needs consistent administration of medication, consistent feeding, and a stable, stress-free lifestyle. To best achieve this, it is preferred that your cat live indoors. Although that is not essential, indoor living removes many uncontrollable variables that can disrupt regulation.

The first step in treatment is to alter your cat's diet. Historically, diabetic cats were fed a high fiber diet. Current veterinary medical research now recommends feeding a high protein diet. The easier way to do that is to switch from a dry food to a canned food. We recommend feeding a high quality canned kitten food.

Your cat's feeding routine is also important. The average cat prefers to eat about 10-15 times per day, one mouthful at a time. This means that food is left in the bowl at all times for free choice feeding. However, this is not the best way to feed a diabetic cat. The preferred way is to feed twice daily, just before each insulin injection. If your cat is currently eating on a free choice basis, please try to make the change. However, if your cat will not change or if you have several cats that eat in a free choice fashion, you may find that this change is not practical. If a two-meals-per-day feeding routine will not work for you, it is still very important that you find some way to accurately measure the amount of food that is consumed.

It is estimated that about 25% of diabetic cats have Type II diabetes. This means that they can probably be treated with oral medication instead of insulin injections. There is no reliable, practical test to know if your cat is one of these. Therefore, your cat may be placed on an initial dose of glipizide or glyburide, an oral hypoglycemic drug, for about 1 week. This is usually done at home if your cat is eating well. Weekly blood glucose levels are checked until it is determined whether or not response is occurring. If response occurs and blood sugar declines, this treatment is continued until it is no longer effective. That may be for many years or for only a few months, depending on the progression of destruction of the beta-cells in the pancreas.

The other form of treatment is insulin injections. This approach is used for five classes of cats:

  1. Cats that do not take tablets well.
  2. Cats belonging to owners who cannot give tablets.
  3. Cats that fail to respond to glipizide or glyburide.
  4. Cats that have been ketoacidotic (because Type II diabetics rarely become ketoacidotic).
  5. Cats belonging to owners who find injections easier to give than tablets.
Many people are initially fearful of giving insulin injections. If this is your initial reaction, consider these points.
  1. Insulin does not cause pain when it is injected.
  2. The injections are made with very tiny needles that your cat hardly feels.
  3. The injections are given just under the skin in areas in which it is almost impossible to cause damage to any vital organ.
Please do not decide whether to treat your cat with insulin until we have demonstrated the injection technique. You will be pleasantly surprised at how easy it is. The injection technique is as follows:

About Insulin
Insulin comes in an airtight bottle that is labeled with the insulin type and the concentration. Before using, mix the contents. It says on the label to roll it gently, not shake it. The reason for this is to prevent foam formation, which will make accurate measuring difficult. The type of insulin used in cats has a strong tendency to settle out of suspension. If it is not shaken properly, it will not mix well, and dosing will not be accurate. Therefore, the trick is to shake it vigorously enough to mix it without creating foam. Since bubbles can be removed (as described later), it is more important to mix it well than to worry about foam formation.

Insulin is a hormone that will lose its effectiveness if exposed to direct sunlight or high temperatures. It should be kept in the refrigerator, but it should not be frozen. It is not ruined if left out of the refrigerator for a day or two, although this is not advisable. Insulin is safe as long as it is used as directed, but it should be kept out of reach of children.

Drawing up the Insulin
Have the syringe and needle, insulin bottle, and cat ready. Then, follow these steps:

  1. Remove the guard from the needle, and draw back the plunger to the appropriate dose level.
  2. Carefully insert the needle into the insulin bottle.
  3. Inject air into the bottle; this prevents a vacuum from forming within the bottle.
  4. Withdraw the correct amount of insulin into the syringe.
Before injecting your cat with the insulin, check that there are no air bubbles in the syringe. If you get an air bubble, draw twice as much insulin into the syringe as you need. Then withdraw the needle from the insulin bottle and tap the barrel of the syringe with your finger to make the air bubble rise to the nozzle of the syringe. Gently and slowly expel the air bubble by moving the plunger upward.

When this has been done, check that you have the correct amount of insulin in the syringe. The correct dose of insulin can be assured if you measure from the needle end, or "0" on the syringe barrel, to the end of the plunger nearest the needle.

Injecting the Insulin
The steps to follow for injecting insulin are:

  1. Hold the syringe in your right hand (switch hands if you are left-handed).
  2. Have someone hold your cat while you pick up a fold of skin from somewhere along your cat's back with your free hand (pick up a different spot each day).
  3. Quickly push the very sharp, very thin needle through your cat's skin. This should be easy and painless. However, take care to push the needle through only one layer of skin and not into your finger or through two layers of skin. The latter will result in injecting the insulin onto your cat's haircoat or onto the floor.
  4. To inject the insulin, place your thumb on the plunger and push it all the way into the syringe barrel.
  5. Withdraw the needle from your cat's skin. Immediately place the needle guard over the needle and discard the needle and syringe.
  6. Stroke your cat to reward it for sitting quietly.
  7. Be aware that some communities have strict rules about disposal of medical waste material so don't throw the needle/syringe into the trash until you know if this is permissible. If it is not, we can dispose of them for you.
It is neither necessary nor desirable to swab the skin with alcohol to "sterilize" it. There are four reasons: 1) Due to the nature of the thick hair coat and the type of bacteria that live near the skin of cats, brief swabbing with alcohol or any other antiseptic is not effective. 2) Because a small amount of alcohol can be carried through the skin by the needle, it may actually carry bacteria with it into the skin. 3) The sting caused by the alcohol can make your cat dislike the injections. 4) If you have accidentally injected the insulin on the surface of the skin, you will not know it. If you do not use alcohol and the skin or hair is wet following an injection, the injection was not done properly.

Although the above procedures may at first seem complicated and somewhat overwhelming, they will very quickly become second nature. Your cat will soon learn that once or twice each day it has to sit still for a few minutes. In most cases, a reward of stroking results in a fully cooperative cat that eventually may not even need to be held.

� Illustrated guide of how to give an injection

Why is insulin so important?
The role of insulin is much like that of a gatekeeper: it stands at the surface of body cells and opens the door, allowing glucose to leave the blood stream pass inside the cells. Glucose is a vital substance that provides much of the energy needed for life, and it must work inside the cells. Without an adequate amount of insulin, glucose in unable to get into the cells. It accumulates in the blood, setting in motion a series of events which can ultimately prove fatal. When insulin is deficient, the cells become starved for a source of energy. In response to this, the body starts breaking down stores of fat and protein to use as alternative energy sources. As a consequence, the cat eats more; thus, we have weight loss in a cat with a ravenous appetite. The body tries to eliminate the excess glucose by eliminating it in the urine. However, glucose (blood sugar) attracts water; thus, urine glucose takes with it large quantities of the body's fluids, resulting in the production of a large amount of urine. To avoid dehydration, the cat drinks more and more water. Thus, we have the four classical signs of diabetes: increased eating, increased drinking, increased urination and weight loss.

Does hypoglycemia occur in cats?
Hypoglycemia means low blood sugar. If it is below 40 mg/dl (2.2 mmol/L), it can be life-threatening. Hypoglycemia occurs under three conditions:

  1. If the insulin dose is too high. Although most cats will require the same dose of insulin for long periods of time, it is possible for the cat's insulin requirements to change. However, the most common causes for change are a reduction in food intake and an increase in exercise or activity. The reason for feeding before the insulin injection is so you can know when the appetite changes. If your cat does not eat, skip that dose of insulin. If only half of the food is eaten just give a half dose of insulin. Always remember that it is better for the blood sugar to be too high than too low.
  2. If too much insulin is given. This can occur because the insulin was not properly measured in the syringe or because two doses were given. You may forget that you gave it and repeat it, or two people in the family may each give a dose. A chart to record insulin administration will help to prevent the cat being treated twice.
  3. If your cat has a spontaneous remission of the diabetes. This is a poorly understood phenomenon, but it definitely occurs in many cats. They can be diabetic and on treatment for many months, then suddenly no longer be diabetic. Since this is not predictable and happens quite suddenly, a hypoglycemic crisis ("insulin shock") is usually the first indication.
The most likely time that a cat will become hypoglycemic is the time of peak insulin effect (5-8 hours after an insulin injection). When the blood glucose is only mildly low, the cat will be very tired and unresponsive. You may call it and get no response. Within a few hours, the blood glucose will rise, and your cat will return to normal. Since many cats sleep a lot during the day, this important sign is easily missed. Watch for it; it is the first sign of impending problems. If you see it, please bring in your cat for blood testing.

If your cat is slow to recover from this period of lethargy, you should give it corn syrup (1 tablespoon by mouth) or feed one packet of a semi-moist cat food. If there is no response in 15 minutes, repeat the corn syrup or the semi-moist food. If there is still no response, contact us immediately for further instructions. (Note: Diabetic cats should not be fed semi-moist foods except for this situation.)

If severe hypoglycemia occurs, a cat will have seizures or lose consciousness. This is an emergency that can only be reversed with intravenous administration of glucose. If it occurs during office hours, come in immediately. If it occurs at night or on the weekend, call our emergency phone number for instructions.

Signs of hypoglycemia

Is continual or periodic monitoring needed?
It is necessary that your cat's progress be checked on a regular basis. Monitoring is a joint project on which owners and veterinarians must work together. The exact schedule of recheck examinations is decided on a case by case basis by your veterinarian.

Home Monitoring
Your part consists of two forms of monitoring. First, you need to be constantly aware of your cat's appetite, weight, water consumption, and urine output. You should be feeding a constant amount of food each day which will allow you to be aware of days that your cat does not eat all of it or is unusually hungry after the feeding. You should weigh your cat at least once monthly. It is best to use the same scales each time. A baby scale works well for this.

You should develop a way to measure water consumption. The average 10 pound (4.5 kg) cat should drink no more than 7 1/2 oz. (225 ml) of water per 24 hours. Since this is highly variable from one cat to another, keeping a record of your cat's water consumption for a few weeks will allow you to establish what is normal for your cat. Another way to measure water consumption is based on the number of times it drinks each day. When properly regulated, it should drink no more than four times per day. If this is exceeded, you should take steps to make an actual measurement.

Urine output can be measured by determining the amount of litter that is scooped out of the litter box. This is a little less accurate if you have more than one cat that uses the litter box, but it can still be meaningful. The best way to measure litter is to use a clumping litter and scoop it into a sealable container. After a few weeks you will be able to know the normal rate at which the jar fills. Too rapid filling will indicate that your cat's urine production has increased.

Any significant change in your cat's food intake, weight, water intake, or urine output is an indicator that the diabetes is not well controlled. We should see the cat at that time for blood testing.

Monitoring of Blood Glucose
Determining the level of glucose in the blood is the most accurate means of monitoring. This should be done about every 3-4 months if your cat seems to be well regulated. It should also be done at any time the clinical signs of diabetes are present.

Timing is important when the blood glucose is determined. Since eating will elevate the blood sugar for several hours, it is best to test the blood at least 6 hours after eating. When testing the blood we want to know the lowest glucose readings for the day. The highest reading should occur just before an injection of insulin is given. The lowest should occur at the time of peak insulin effect. This is usually 5-8 hours after an insulin injection, but it should have been determined during the initial regulation process. To help us assess how well your cat's insulin dose is working, we measure the blood glucose during the peak of insulin effect. This means that we measure the blood glucose at about noon. Give your cat her normal breakfast and insulin dose at the time you normally do it the morning of any blood glucose checks.

Periodically we will also do another type of blood test called a fructosamine level. The fructosamine level gives a better idea of how the average blood glucose has been over time. Think of the mid-day blood glucose as a snap shot, while the fructosamine is a videotape of the same event. Both give different kinds of information that together are used to best manage your cat's diabetes.

This section contains general principles about home blood glucose testing for pets. The different techniques used to obtain a blood sample from cats and dogs are described. Detailed instructions are given for the ear and paw prick methods for cats, and the lip and leg-callous stick for dogs. Managing diabetes is very complicated. Blood glucose readings can change depending on food consumption, exercise, stress, and normal daily fluctuations. There may also be other diseases or conditions that are affecting your cat's health. Home blood glucose monitoring should be performed in consultation with your veterinarian.

Purpose of Home Blood Glucose Monitoring
Home blood glucose monitoring is a useful tool to help you and your veterinarian get your cat's diabetes regulated. It can be used to determine how well the current type and dose of insulin is controlling the diabetes. This determination is best done under typical daily conditions where the pet's feeding, exercise, and stress levels are normal. One common problem with doing blood glucose testing in the vet's office is that many pets, especially cats, become severely stressed, refuse to eat, are confined to a cage for a long period of time, then restrained for a blood test. These are not normal conditions and the blood glucose values obtained at the vet's office may not accurately reflect what the blood glucose is doing on a typical day.

If your cat's diabetes is pretty well regulated, home blood glucose monitoring can be used to check the blood glucose on an occasional basis or to fine tune the control. You can perform a blood glucose test at any time, quickly and conveniently.

If your cat's diabetes is difficult to regulate, home blood glucose monitoring can be used to obtain the information that is necessary for your vet to determine the appropriate adjustments to the insulin therapy.

Will My Cat Hate Me?
Many owners are discouraged from doing home blood glucose monitoring because the vet suggests that the pricks may make the pet dislike the owner. None of the people I've spoken with who do home blood glucose monitoring have had this problem. Sure, this is not the pet's favorite activity, but it is relatively quick and painless. But not all pets will tolerate being restrained or having a prick performed. If you have a pet who hates being handled, lightly restrained, or is otherwise uncooperative, home blood glucose testing may not be appropriate for you and your cat. Even if your cat is cooperative, you do not want to become "prick-happy". You and your vet can discuss the appropriate amount of home blood glucose testing for your cat. Some vets also believe that the home blood glucose meters are inaccurate - this is not true. These meters are relied on by human diabetics for their daily diabetes management, and for the purposes of diabetes regulation in pets, these meters have adequate accuracy.

Will I Hurt My Cat?
Probably not. Some vets suggest that the ear can be seriously damaged doing an ear prick. Of course it is possible to cause a bruise, an infection, or a more serious injury that requires veterinary attention, but in over 3 years of corresponding with other owners, I have never heard of an owner having any problems with excessive bleeding, bruising, infection, tearing, or any other problems. By taking proper precautions, these methods can be safely used on your cat. If a problem does arise, contact your veterinarian for advice.

Which Meter Should I Purchase For My Cat?
There are several very good meters for use with pets. These meters require a very small blood sample and have test strips that use capillary action to "suck" the blood into the test chamber. Always be sure to read, understand, and follow the instructions provided with your meter and the test strips.

Where to Prick

Dogs and Cats
Clipping a claw too short in order to get blood is not recommended. This is very painful for the pet and can not be used on a regular basis.

Cats
The edge of the ear, or a paw pad works well. You will have to determine the best site for you cat. Some cats hate their paws being touched, while others hate their ears being played with. At first, we tried drawing blood from a front paw vein, but our cat was not cooperative. Unless you have a very cooperative cat, I would not recommend this method. You only need one drop of blood, and one of the prick methods usually works well.

For the ear prick, there is a small blood vessel that runs around the outer edge of the cat's ear. To locate the blood vessel hold a flashlight (or sit near a bright lamp) with the light shining into the inside of the ear. Look on the back (furry side) of the ear. You should see the a thin red line - this is the blood vessel that you will prick.

Dogs
Ear pricks usually do not work on a dog because they don't have the prominent marginal vein that cats do. Most dog owners who perform home blood glucose testing prick the inside of the upper lip. Have your dog lay on its side and gently lift the upper lip and roll it outward so you can work on the inside surface. The area near the canine tooth is often a good spot. Wipe the area with a clean cloth so all saliva is removed. Pricking towards the edge of the lip often works well. You will have to figure out the spot that works best for your dog. Dog owners who use the lip prick technique report it is very easy, and it does not hurt the dog. Some even do it while the dog is sleeping. Be careful that your dog will allow you to do this and you don't get bitten. Another owner has success pricking the outside of the lip.

Other sites that owners prick include: a paw pad, the calloused area on the leg, the chin area, a pinch of skin on the rump. Others have had their vet show them how to draw a tiny amount of blood from their dog's leg vein. An unused insulin syringe is perfect for this - it has a very tiny needle.

General Precautions

You must wait until the area is completely dry before you can perform the prick. Moisture will cause the blood drop to spread out and it will be difficult to perform the blood glucose test. Moisture will also dilute the blood sample and cause a faulty blood glucose reading. If you are pricking a cat's ear, it must be warm. It is very hard to get a drop of blood from a cold, or even cool ear. Warm the ear by massaging your cat's head and ears or use a warm washcloth inside a plastic bag or a rice bag you can heat in the microwave. Whatever you use, make sure it will not burn your cat.

If you are pricking a paw pad, it will also help if the paw is warm.

What The Numbers Mean
The blood glucose value tells how much glucose is in blood. Meters in the U.S. report the units in mg/dL - that is milligrams of glucose per deciliter of blood. Normal values are around 80-120 mg/dL.

Your vet will help you interpret the blood glucose numbers and decide if any changes are needed in your cat's insulin dose, insulin type, or other aspects of the daily care routine.

Things To Remember

Conclusions
This is how some owners perform blood glucose tests on their pet. The ideas are for you to use or modify to best suit the needs of you and your cat.

Tips For The Glucometer Elite
This is a great meter for doing home blood glucose tests on pets. It is easy to use and requires a very small drop of blood. The test strip automatically pulls the drop of blood into the test chamber, so you don't have to try to drip the blood onto the strip. Also, you can move the meter up to the pet - you don't have to keep the meter laying flat on a table.

Partially insert the test strip before the pick, then fully insert it (you hear a beep) just before you are ready to do the prick. The meter beeps when the test strip is correctly inserted. After the beep, the meter allows 3 minutes to get a drop of blood. The 3 minute time is a battery saving function of the meter. The test strip is still good after 3 minutes.

If you can't get a drop of blood in 3 minutes, remove the test strip, wait a few seconds, and then re-insert the strip. This will give you another 3 minutes.

You must get the required amount of blood into the test strip all at once. The meter beeps when it has enough blood. If you try to get blood into the meter and the meter doesn't beep, you can NOT do another prick, then get more blood into the strip until it beeps. The blood glucose value may be invalid. If you don't get enough blood on the first try, discard the test strip, use a new test strip, and try again. One "fault" of the glucometer elite is that is can "beep" to tell you it has enough blood, when it really doesn't. Look at the test strip and compare it to the picture of a "full" test strip in the gluc. Elite users manual. If you question the validity of a test, try to repeat it. Also, be sure your meter is properly coded to the right "F code". A coding strip comes with each new box of test strips.

Bayer has a new meter, the "Dex". Some owners prefer this model because it has a wheel of test strips that stay in the meter, so you don't have to fuss with a test strip for each test. The Dex is more expensive than the elite, but both models work very well.

Other Sources Of Information
Your vet should be able to help with most questions about your technique. If you have questions about the meter, read the instruction book or call the 800 phone number for the manufacturer. Many of the popular meters, the website, and users manual link are available at: http://www.sugarcats.net/sites/harry/bgtest.htm. Most manufacturers have an 800 number that you can call for questions. Many members of the Canine diabetes E-mail list perform home blood glucose testing. If you would like to discuss the pros and cons of home testing with people who actually do it, they are a great source of information. There are also members who do not do home blood glucose testing, so you can get both sides of the story.

SUMMARY OF INSTRUCTIONS FOR CATS RECEIVING INSULIN INJECTIONS

  1. Read and reread this material so that you understand the specifics of proper regulation and how to recognize and treat hypoglycemia.
  2. Get the supplies for treatment. Your prescription will specify the type of insulin and syringes.
  3. Give the first injection of insulin as directed.
  4. Return for a blood glucose test, at about noon when recommended. Feed your cat that morning and give insulin as you normally would in the morning.
  5. The next recheck will be in 3 weeks for another blood glucose test and a fructosamine level.
  6. Rechecks after this are made every 2 weeks to every month or so. A well regulated healthy diabetic cat usually need 3-4 rechecks per year.
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