What is diabetes?
Diabetes is a disease where your cat cannot control the sugar levels in its blood. The pancreas, an organ that produces natural insulin, usually performs this job. (It is also responsible for helping to digest food.

Insulin allows the blood sugar, better known as glucose, to be used as energy by the cells of the body. With little or no insulin, the energy cannot get into the cells (like trying to drive a car on an empty tank of gas); so the body thinks that it is starving, even though there is an overabundance of sugar circulating in the blood. When this happens, the body begins to use other energy sources, such as stored fat and protein (muscle). The body also tries to get rid of the extra sugar in the blood by filtering it into the kidneys and out into the urine in large quantities.

These processes combine to make a cat that is eating like crazy but losing weight and urinating a lot and drinking more to keep from becoming dehydrated. This is what probably brought you and your cat in:

• Increased appetite
• Weight loss
• Increased urination
• Increased drinking

You may notice some or all of these signs.

Basics of Treatment
First and foremost, there needs to be a commitment from you, as the owner, both personally and financially. Your cat will need insulin for the rest of its life. Initially, there is the expense of medication, needles, special diet, and possibly hospitalization. The good news is that once your cat is regulated, the expenses become minimal. What remains is your time commitment.

However, your life does not need to revolve around your cat. You can still go out to dinner, go on vacation, etc. But it is very important to give the insulin on a set schedule and pay closer attention to your cat's actions and needs.

Treatment revolves around three major concepts:

• Feeding
• Insulin administration
• Monitoring

The best feeding protocol for your cat is to have free access to food at all times. This provides the most even level of blood glucose. Fresh water should be accessible at all times as well. You must keep an eye on your cat to make sure that it is eating ... i.e. that the food is disappearing! An indoor cat is obviously easier to monitor than one that goes outside.

A diet that is higher in fiber is better than one that is not; therefore a dry food is better fed than a moist or canned food. A higher fiber content helps to regulate the rate of sugar absorption and create a more even state for your cat. The above-mentioned prescription diets meet the fiber requirement, with the exception of k/d, which is used only for certain types of diabetic cats. There is a promising diet now available for cats, from Purina (CNM feline DM diet) which may enable your cat to reduce or completely stop the insulin.

Insulin administration
In cats, insulin usually has to be given twice daily. It can be administered by needle, needle pen, or by mouth. Each has good and bad aspects. But there is always a way to choose what is best for both the cat and the owner.

The oral (by mouth) medications are not very effective in cats. They may help under certain circumstances, but control is rarely achieved and you, as the owner, must give one or more pills to your cat two or three times daily.

Needles are very intimidating to most people, and the thought of sticking your cat with one twice daily can be scary. As most people find out, most of the worry disappears once they begin treating their pet. Insulin does not sting or irritate when it is given, and the needles used are extremely small when compared to the ones used for your cat's annual vaccinations! Because of the size of the needle and how the insulin is given, it is almost impossible to cause major harm to your pet with the needle. Cats will generally accept a needle far easily than a pill, especially if there is a reward expected afterward (a treat or bit of canned food).

There is a "pen" which is a compromise of a needle and gives a bit more control to the person giving the injection. The dosage is "dialed" into the pen and a simple press gives the medication.

It is IMPORTANT to discard all unused insulin, once it has been opened, after 1 month of usage. The expiration date on the bottle only applies to unopened bottles. After opening, the effectiveness of insulin decreases quickly.

Monitoring
Monitoring your cat includes the following:

• Eating and how well drinking
• Behavior/attitude
• Insulin administration (amount given and time it was given)
• Urine glucose/ketones

Often, it is helpful to create a notebook with these categories and the date to help both the owner and the veterinarian keep track of trends and patterns.

There are a few rules of thumb to follow:

• It is better to have too high blood sugar than too low.
  
  
• If your cat does not eat, do not give insulin.
  
  
• If your cat has a poor appetite, give only ½ the insulin dosage and call the veterinarian if this lasts for longer than 24-36 hours.
  
  
• If you are not sure if you gave insulin or your cat jumped and you are not sure if all of the insulin got in, DO NOT give more. Consider it a done deal and restart with the next dose at the regular time.
  
  
• When in doubt on ANYTHING, call the veterinarian.
  

Appetite
Eating is essential for a diabetic. Giving insulin to a cat that has not eaten may cause LOW blood sugar, which may quickly escalate to an insulin crisis, coma and even death. See rule "b" above.

Drinking
As your cat becomes better regulated, you will notice a decrease in the frequency and amount that your cat is drinking. Fresh water is a MUST and must always be accessible to your cat. If it is not, your cat may very quickly become dehydrated.

Behavior
You, as the owner, know best of all what is normal behavior for your cat. It is important for your cat's behavior to be included in the notebook for two reasons. First, as your cat becomes better regulated, you will notice a more active and playful cat ... more like the normal behavior before he/she became ill. Second, depression, sleepiness, vomiting, etc., may be serious warning signs that changes may need to be made in the insulin dosing or that an emergency trip to the veterinarian may be required.

Signs that your cat's blood sugar may have dropped too low (like from an overdose of insulin) are: sleepiness, unresponsiveness, drooling, stumbling, seeming to have gone suddenly blind, seizures, loss of consciousness. The most likely time to see these signs is 5 to 8 hours after the insulin is given, when the insulin is at its maximum effect. Should any of this occur, you need to do the following.

• Call the animal hospital (757) 595-3337
• Or the Emergency Veterinary Clinic (757) 874-8115 if it is after hours.
• Give 1 tablespoon of corn syrup (light or dark) by mouth OR
• Give a packet of a semi-moist cat food, such as Tender Vittles.
• Bring your cat to the hospital for care immediately

Insulin Administration
It is important to note the time and amount so that any patterns that develop can be monitored with respect to the insulin.

Urine Glucose and Ketones
This is THE most important way for you, the owner to monitor your cat's progress and health with respect to diabetes. This is measured using a urine dipstick that is easily obtained from any pharmacy. The urine stick has two squares on it, one to measure glucose and one to measure ketones. While it is not expected that you can catch every episode of urination, the more frequently it is obtained, the more vital information we have.

How is it done? The best way is to get the stick into the urine stream as it is coming from your cat. Many cats are "litter box shy" and will stop midstream or avoid their owners and urinate only when they are not around. A way to get a sample is to watch your cat and notice when he/she goes into the box. Once finished, you may place the stick in the wet spot, wipe off the excess litter and read the sample. If this method is used, it is important to test the litter first. Take a sample of litter, soak it with water and place a stick in the litter. If there is ANY color change, you cannot use this method or you must find a litter brand that does not cause the stick to react. Usually, the unscented versions of litter are best.

If at ANY time the ketones read POSITIVE or you are getting persistently HIGH glucose readings (after your cat is regulated), this is cause for IMMEDIATE concern. You need to contact the animal hospital at once! A persistently high glucose reading means that more than 3 readings are high.

Getting the Correct Levels
The best way to monitor how well the current dosage is controlling your cat's diabetes is by a blood test, called a Fructosamine, or Serum Fructosamine, level performed at the veterinary hospital during a brief visit. It requires a small amount of blood to be taken to monitor the average blood sugar level over the previous three weeks.

This may be required every three weeks until your cat is regulated, but once a good dosage is found, it need only be done quarterly (about every three months), unless a problem arises.

Protocol for YOUR pet

1. We are starting your cat on units of insulin twice daily at am and pm (about 12 hours apart).

2. Obtain the insulin/needles/urine glucose & ketone strips from the pharmacy of your choice.

3. The food selected for your pet is . You may obtain this from your veterinarian. Remember that snacks and treats will change sugar levels.

4. Our first glucose curve will be on _________________. (One week after starting the insulin). You are to FEED your cat, but DO NOT give the insulin. Bring your cat into the hospital between 7 and 8am. Please schedule this appointment with the receptionist. Please bring your insulin with your cat so that we may use it at the appropriate time.

5. Pick-up time will be at _____________pm, when the doctor will discuss the next steps in your cat's treatment.

6. Emergency telephone numbers:

Warwick Animal Hospital: (757) 595-3337

Emergency Veterinary Center: (757) 874-8115