Education Is Key to Success with Pet Diabetes Management | Ask Dr. Joi

By |2018-09-18T10:37:11-04:00Updated: October 3rd, 2018|Pet Care, Pet Diabetes, Pet Newsletter|13 Comments

Questions from the diabetic pet owner are the fuel I use to keep myself educated on all things related to pet diabetes. I’ve had some incredible questions asked of me over the years, and quite a few that have made me do some research so I could understand it and then make it easy to understand for all of the diabetic pet owners that I encounter. Today’s question is about feline remission and achieving good pet diabetes management. Maybe this one can help you!

Dear Dr. Joi,

I came across your article regarding feline diabetes and remission. I have been searching the Internet diligently for weeks trying to gather information regarding my cat. He is male, indoor, and 11 years old. He is my most active cat, runs all the time through the house, up and down the stairs, and he is quite the jumper. He has never been overweight, but he has always been a dry kibble cat. He never developed a taste for canned cat food nor human food. Has pretty much always been healthy, with the exception of a urinary blockage in 2011. The vet put him on Royal Canin Urinary Dry SO prescription diet then, and he has eaten that ever since.

In February 2018, he suddenly stopped eating and lost weight. We took him to our vets who said he had pancreatitis and diabetes. His blood sugar level was 361. I successfully weaned him off dry food in about three weeks. He has not had any dry food probably since March, 2018. I also did research and now feed him the highest protein content canned food, fat secondary, and no carb content above 10%. I look for the low phos for his urinary tract issues as well, but that one is hard because he is still fussy about what he eats.

Now I read online that the stress of going to the vet can raise the blood glucose levels, so the periodic tests I have been paying for at the vet office is probably not accurate enough for them to keep raising the dosage of his insulin. I also have read that if you have successfully weaned your cat off a high carb diet, that his insulin dose often will need to be lowered. My vet has consistently increased it, and just last week increased to 3 units.

On 3 units, he does not move, does not raise his head all day. He does not walk around. If he walks to the litter box, he stops multiple times on his way to lie down and rest. I noticed about 4 weeks ago the signs of neuropathy. He is now walking on his hocks, wobbly in his legs and unsteady walking up and downstairs. He misses jumps repeatedly and has fallen multiple times. I have started to give him Vitamin B-12 injections, and I have started to see a very slight improvement.

I am wondering if he actually ever really was diabetic. Can that diagnosis be accurate while also being diagnosed with pancreatitis? His initial level was 361, and he probably was “stressed out”, at the vet at the time, so maybe this was a false read, and his blood glucose really was never out of whack? His second blood test, which was done two weeks later, was 288. Still probably stressed out as he cries all the way there and pants, so if 288 was a stress elevation, it probably really was way lower than that. And they raised the insulin units after that second reading, because my vet said it should not be above 170.

His readings are bouncing all over the map. And the only thing that keeps changing is the insulin dose – higher and higher. I always feed high protein canned food. Never any dry, ever. Stressed out readings at the vet were 200s then increased up to the 400s on his last curve. They also performed a fructosomine test and the results were “fair”. I would be very, very interested in your thoughts concerning my cat. By the way he has gained all his weight back, and his drinking has tapered off.

Fantastic questions! We need to be our pets’ advocate for health care. Heck, we should all be our own advocate for our own health care. When veterinary clients study and educate themselves about their animal’s condition, we achieve better glucose control and improved health and longevity for our beloved pets.

Great job taking away the dry food. One of the most important treatment goals for cats with lower urinary tract disease is dilute the urine as it is hard for crystals to form in dilute urine. Even with his lower uninary issues, with diabetes and canned food he is unlikely to have a repeat issue. You’ve increased the water intake (canned food has 5 times more water than dry food) plus diabetes causes dilute urine as well. In general, as cats age into their teens their urine often becomes more dilute, and the incidence of lower urinary tract disease from crystals decreases dramatically if a pet has dilute urine.

He probably was indeed diabetic at 361, even if part of the elevation was from stress hyperglycemia. Pancreatitis is a common cause of diabetes in pets. Cats often start as type 2 diabetics and then may progress to full blown diabetes if the blood glucose stays high. This negative impact of a high blood glucose on the pancreas is called “glucose toxicity”.

Achieving feline remission with glucose meterNow, a normal blood glucose is in the ballpark of 100 mg/dL. Some reference labs say as high as 170 due to stress hyperglycemia in vet clinics. If we keep most of the glucose numbers below 200-300, then pets usually show few of the clinical signs of diabetes. The kidney threshold for glucose is somewhere between 200 and 300 mg/dL, usually lower in the range for dogs and higher in the range for cats. This means that when the number exceeds the threshold, the pet will spill sugar into the pee which then makes it hard for the pet to make concentrated urine. When a pet is urinating out dilute pee it then has to drink lots of water just to stay hydrated. Hence, uncontrolled diabetics pee a lot and drink a lot. Additionally, we want the blood glucose numbers to be near the normal range, particularly under about 200 mg/dL to help resolve the glucose toxicity in cats.

3 units is a big dose for a diabetic cat, especially is he is not overweight. And those numbers you listed (if that was the order of the glucose curve) actually went up after his insulin dose. He might be having somogyi swing. His weakness and lethargy suggest hypoglycemia.

You must start home blood glucose testing to identify his real blood glucose numbers, eliminating the stress of being at the vet, and to identify if his blood glucose is too low. Please, please, please, get a pet blood glucose meter and test his blood glucose at home. Chat with your vet about dropping the dosage if that was his last curve while at 3 units, particularly as he acts weak. Consider altering the dose based on his glucose at each feeding, using his blood glucose level at that time determine how much insulin he gets.

I don’t really like the Fructosamine nor A1C tests unless we can’t get an accurate curve. We get more information from checking blood glucose values. Clearly it is best to run blood glucose curves at home where we remove stress hyperglycemia from the equation. If a client refuses to run a curve at home (i.e. fractious animal or a physical inability of a client), then we might consider a Fructosamine or A1C test. Fructosamine and A1C levels don’t tell us how to adjust the insulin dose; they simply tell us good, fair and poor control.

The B12 shots may help too, but the key to treating diabetic neuropathy is to get the glucose under control. You’ve shown me that you are dedicated to your cat and spent a lot of time educating yourself. I’m proud of you!! Now, get a blood glucose meter.

Have a question or comment? Then post below! I always enjoy hearing from my readers!


NOTE: Consult your veterinarian first to make sure my recommendations fit your pets special health needs.

About the Author:

Dr. Joi Sutton is a 1993 graduate from Oregon State University. She has practiced both in emergency medicine and general practice. Dr. Sutton has done extensive international volunteer work though Veterinary Ventures, a nonprofit organization that takes teams of veterinarians to undeveloped countries for humane medical care. She also runs a small animal practice in South Florida.

13 Comments

  1. Fiona Bryant November 25, 2018 at 5:22 am - Reply

    I’m in Australia and your units of measure are very different. I have a diabetic cat. He’s 18.5 years old and has been insulin dependent for 2.5 years. He’s not overweight. 4.3 kilograms. He’s currently on 0.02 units of lantus (glargene). His levels are currently all over the place. He ranges from 4-25. My vet says between 8-12 is optimum. He’s on wet and dry food (Hills Prescription M/d). He’s been monitored once a week (spends the day at the vet having his BSL’s checked every 2 hours). They are very hard to manage. How do I do tests at home? He hates his ears being touched. The vet draws the smallest amount of blood from a vein in his leg for the one off tests.

    • Dr . Joi Sutton December 2, 2018 at 2:01 pm - Reply

      You would likely have improved glucose regulation of you cut out the dry food. Even the low carb dry folds such as M/d and dm war higher in carbs than most canned foods. I prefer diabetic cats get wet food only, the lower the carbs the better.
      You can read how to check a blood glucose on our archived articles… Go to the “articles” tab then the search box. I wrote in depth how to check a blood glucose. Search “back to basics” and you’ll find a 4 part article on basics pet diabetes info such as how to check a blood glucose and run a blood glucose curve. 🙂

  2. Suzanne December 18, 2018 at 2:32 pm - Reply

    I’ve had a high blood glucose reading for my Norweigian Forest Cat (9yr old female at 13.4 lbs) 363. We’ve also noticed an increase in urination and drinking. We’ve switched her diet to wet Fancy Feast (she shares 2 3oz cans twice a day with her sister) and 1/8c low carb dry once per day. Her readings are dropping (223) and I’m spot checking about 4hours after her am feed. She’s not on insulin yet and we really want to get this controlled so she’s not a full blown diabetic. What time of day and how frequently should I be testing her? Does a glucose curve make sense at this point? Thank you

    • Dr . Joi Sutton December 18, 2018 at 8:44 pm - Reply

      Suzanne, your cat IS a full blown diabetic. If we get her off dry food altogether we might be able to get her into remission, likely with the assist of some insulin to get her out of glucose toxicity.
      Since you’ve already seen a nice drop with some diet change, try taking her off the dry food altogether. A curve is checking blood glucose to see where the glucose bottoms out after an insulin injection. Doing spot checks for a pet not on insulin is a great idea. Chat with your vet about insulin. Insulin and low carb canned food and close glucose monitoring are the most likely way to get her into remission. Remission may last a short while or possibly could last long term. And, if she is tubby, be sure to get her to a lean body weight.
      Have a chat and exam with your vet.

  3. Lori Merriman December 17, 2019 at 12:16 pm - Reply

    Hello,
    I have a couple of questions regarding my kitty. He was recently diagnosed with diabetes. His sugar level was at 500 when he was tested to see if he was positive for the disease. He is unfortunately obese. He weighed in at 18 lbs and probably should weigh about 12 to 14 lbs. My goal is to get his weight down, and get him in remission if possible.

    He is currently eating wet food, “Fancy feast classic” as it is low in carbs and high in protein. My first question is, how much of the can should I feed him? Currently, I have given him the whole can as he tends to vomit if his tummy gets empty. He is on a strict twice a day meal, however after consulting my vet about the vomiting, he gets a tablespoon of Fancy feast late morning and at bedtime to hopefully prevent further vomiting episodes.

    How much should I reduce the full can for his morning and evening feedings to balance out the snacks?

    My second question is, when I do his morning feeding and then inject the insulin, he sometimes stops eating for about 15 min. Then he is ready to finish the rest of his meal. This is within a 30 min window of time from when he takes his first bite of food, the insulin injection, and then his finishing up the meal. Is it okay to allow him to finish eating the rest of his food in that time frame? I wasn’t sure how long to let him eat once the insulin has been given.

    He hasn’t had a blood glucose curve test yet as we just started insulin 5 days ago. I will be doing home testing in 2 weeks with the glucometer to see how well the dosage is working. He is on 2 units twice daily for the moment.

    If you have any further suggestions on how to get him in remission I would appreciate it. I plan to keep him on a very tight schedule!

    Thank you for any advice and coaching to get him in remission! 🙂

    • Dr . Joi Sutton December 22, 2019 at 4:52 pm - Reply

      First of all, you are doing a great job by having him on a low carb canned diet and that you plan on doing home glucose testing. Those 2 items alone will greatly increase our chance of getting him into remission.
      Since I’ve not examined him I can’t tell you exactly how many calories you should give per day to get the weight off of him. Chat with your vet about his total calories and be sure to have regular weigh ins every 2 or 3 weeks to keep you on track. Good job giving the majority of calories at mealtime and letting him ingest those calories over half an hour should pose no issue. If he continues to vomit you might ask your vet for some Cerenia or Zofran or mirtazapine which all help decrease nausea for cats.
      Happy holidays and great job!

  4. Lori Merriman February 11, 2020 at 11:21 am - Reply

    Thank you so much for replying to my questions and for your feedback!

  5. Lori Merriman February 11, 2020 at 11:45 am - Reply

    Update on Tuffy…..
    I did his first BGC Jan 15th. His ranges looked good. He was 210 prior to insulin and after insulin dropped to 100 and basically stayed in that range just prior to his next insulin injection where he jumped up to 230 on his last test. I will be doing his next BGC test next week and hopefully his ranges will still look good. My vet is keeping him at 2 units twice a day for now. A question I would like to ask is how will I know he is in remission? What should I be watching for?

    He isn’t drinking large quantities of water that I can observe when I’m at home, however, he still is producing alot of urine. Will that eventally decrease over time or is it still to early to see a decrease in output?

    We had to increase his snacks as he started “Piking.” He ate a 9 ” ribbon and ate part of my wicker chair. Thankfully he passed both of those items. Apparently Piking is a side effect of diabetes? Bumping up his food intake has helped with that issue but I still have to keep an eye on him to make sure he isn’t eating other foreign objects! That was an expensive trip to the ER.

    I did some research and contacted Fancy Feast regarding how many calories per can. I found out the pate ranges between 80 and 95 calories per can and the flaked food is a little higher in calories. The flaked trout is 105 calories per can. Hopefully if anyone reads my post, this might help them. I also researched how many calories a 17 lb cat needs per day…it comes out to about 280 calories. With Tuffy’s morning and evening feeding plus the snacks, he is getting about 240 calories per day. He seems to be losing weight on this diet plan. I will know more on his next doctor check up. Please let me know if I need to adjust the calorie intake…it was a rough estimate I found online.

    One thing I am wondering how to treat is his developing hyper extended carpals from the diabetes. Any thoughts for treatment of that? I found a website that makes braces for cats and dogs with that condition but I don’t know how well the braces would work with a cat? Any suggestions related to that issue brought on by the diabetes?

    Thank you so much for you help and my fuzzy Siamese thanks you too!

    • Dr . Joi Sutton February 16, 2020 at 10:15 pm - Reply

      How to tell if he is entering remission: continue to monitor his blood glucose frequently.
      As far as how to help his diabetic neuropathy: that is giving him time and controlling his blood glucose as best you can. I’m so glad you are doing home monitoring. Some vets will give weeklyinjectins of vitamin B12 for cat diabetic neuropathy, but as far as I know there is no proof that it helps. If I have a cat with diabetic neuropathy I give B12 injections as it’s not going to hurt!
      You are doing a great job. Continue the communication with his family veterinarian.
      🙂 Joi

  6. Lori Merriman February 26, 2020 at 3:14 pm - Reply

    Thanks so much for your input. I appreciate the opportunity to ask you additional questions. My veterinarian has been great about keeping an open door for communication as I attempt to get Tuffy in remission. Your feedback has been additionally helpful. Having the opportunity to have another resource to guide me in treating this disease is key to getting him under control again. If my doctor didn’t suggest something for treatment, it’s a strong possibility you might add something to his regiment…..for example the vitamin B shots for the neuropathy. She didn’t mention doing that to see if it might help him. When he goes in to be checked in March, I will ask her about trying the vitamin B shots to see if he would benefit from it. I deeply appreciate your help and guidance through this process! I want my little Buddy to be healthy again!
    BTW, his last glucose curve i did last week looked good. The insulin is still keeping him within the normal ranges. Continuing to work on getting his weight down to around 12-14 lbs. He’s about 17 lbs currently.
    Thanks for your support!

  7. Helen Conlan April 14, 2020 at 8:11 pm - Reply

    I HAVE A DIABETIC POODLE……DIAGNOSED 15 MONTHS AGO…..HAVE MANY UPS AND DOWNS …….I Have started monitoring her with urine tests miday and during the night ..I adjust her insulin slightly..never going over 4 units as prescribed by the vet…..her weight is consistent….she is playing for the first time in A long time…she does not always eat when required so I dont give her insulin till her next meal….but I do give her food when she decides she is Hungary . This appears to be working very well. Is a urine test reliable for altering insulin levels….vet is happy with her progress.

  8. Trudie Baggett June 5, 2020 at 12:25 am - Reply

    Given that blood sugar readings can be influenced by stress in the vet office, is it also true that if you have to struggle at home to test, those readings will be increased also? Any suggestions how to get the most accurate readings?

  9. Trudie Baggett June 5, 2020 at 1:12 am - Reply

    Hi, forgot to mention my chiuaua mix is 10 yes old. If they can’t get her regulated, what might her life expectancy be? I know it’s almost certain the diabetes will eventually blind her. Vet said it could take awhile or sometimes it comes on sudden. Is this contingent on how well controlled the BG is? I’m scared to death I’ll wake up and see her already passed. I lost a dog previously to cancer that only lived to the age of 10. I went into a prolonged severe depression that lasted 5 yrs. So faced with this little one the chance of not surviving diabetes upsets me greatly.

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