Diabetic cat - cpn question

I lost my first draft of this, so here we go again. My beloved little furry friend has just been diagnosed with diabetes and, possibly worse, elevated liver enzymes. When I asked the vet if the bloodwork could be tested for cpn, he was fascinated and says he will check with the lab. First question, does anyone have an idea what kind of dose a 13lb, 7yr old cat would require on abx therapy? Feel free to speculate. I don't need disclaimers; I need intelligent input. The vet is open to anything, though at the moment my boy will go on a diabetic cat food with insulin starting later next week. Help! I'm not giving up on this boy, especially when my cpn could have caused his problems.

Linda, I know you're treating the dog, but any cat insight would be welcome!

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems.  Mohandas Gandhi

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems. Mohandas Gandhi

Hi Mac, its not that rather rotund fellow who I have a picture of?  If it is, it might be type 2 diabetes, needing a change of eating habits.  However, I would guess working it out by weight, as in pre-pubescent children, might be in order:

http://www.medscape.com/viewarticle/463541_6 

  • </= 8 years: 2.2 mg/kg/dose given twice daily
  • > 8 years and </= 45 kg: 2.2 mg/kg/dose given twice daily
  • > 8 years and > 45 kg: 100 mg given twice daily.

Of course, there might be a veterinarian somewhere around........Sarah

An Itinerary in Light and Shadow.Wheldon regime since August 2003, for very aggressive SPMS.  Intermittent therapy after one year. 2006 still take this, now two weeks every three months.  EDSS was about 7, now 2. United Kingdom.

Completed Stratton/Wheldon regime for aggressive secondary progressive MS in June 2007, after four years, three of which intermittent.   Still improving bit by bit and no relapses since finishing treatment.

Yes, Sarah, at that point in time he was around seventeen pounds. He is thirteen and a half pounds now, weighed at the vet's office yesterday. I'm off to take a look at that link right now. Poor fella.

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems.  Mohandas Gandhi

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems. Mohandas Gandhi

This will be fascinating! I know you will keep us posted. My veterinarian daugters will be interested. One lives in Alaska and one in Palm Springs, CA and they both have cats.

 

Rica PPMS  EDSS 6.7 at beginning - now 2.  Began CAP Sept, 2004 with Rifampin 150 mg 2xd, Doxy 100 mg 2xd, added regular pulses Jan 2005. Jan 2006 switched to Doxy, Azith,  cont. flagyl  total 38 pulses NC USA

3/9 Symptoms returning. Began 5 abx protocol 5/9 Rifampin 600, Amox 1000, Doxy 200, MWF Azith 250, flagyl 1000 daily. Began Sept 04 PPMS EDSS 6.7 Now good days EDSS 1 Mind, like parachute, work only when open. Charlie Chan  In for the duration.&am

Hi MacK, About the nutritional aspect of Mr. Kitty's diabetes...you might want to pay attention to the carbohydrates in his food.  By all means, put him on the CAP, but please try also to get other possible factors under control too.  Cats' and dogs' digestive tracts are not really equipped to handle carbohydrates, but they're in their food anyway. The vet on this site has plenty of interesting comments on carbohydrates in pet food, but his comments aren't aimed at diabetes.  Another vet has very specific comments on feline diabetes and feed carbohydrates:

"Feline Diabetes and Diet:  The High Carbohydrate Culprit

Lisa A. Pierson, DVM

Diabetes is one of the most common feline endocrine diseases and, in the vast majority of cases, is directly linked to a high carbohydrate diet of dry food.  Although all dry foods are too high in carbohydrates, please be aware that many canned foods also contain far too many carbohydrates making them very poor choices for cats.  Cats are obligate carnivores and are not designed by nature to consume a high carbohydrate diet.  If you have not read my article on this site entitled Feeding Your Cat: Know the Basics of Feline Nutrition, I urge you to do so.  This article explains why it is terribly illogical to feed any cat dry kibble, but especially one with diabetes.  The rationale also applies to any of the prescription dry diabetes diets such as Purina DM and Hill's Science Diet w/d and m/d which are still too high in carbohydrates and contain several species-inappropriate ingredients.

Many cats that were once in a diabetic state no longer need any insulin when they are finally fed an appropriate diet.  If the diabetes has been a long-standing condition brought about by years of feeding a high carbohydrate diet, or another disease process, these cats may always need some insulin but the amount necessary to maintain proper blood glucose levels is nearly always significantly reduced once the patient is on a low carbohydrate diet.

Please see this thread on the Feline Diabetes Board to read about many caregivers' success with their diabetic cats once all dry food was removed from the diet.

Feeding a diabetic cat a high carbohydrate diet is analogous to pouring gasoline on a fire and wondering why you can't put the fire out. 

Please click on the links below to read more about the key issues associated with feline diabetes.

The basics of diabetes

The cat's unique metabolism

Carbohydrates, obesity and diabetes

Optimal nutrition for all cats

In-home blood glucose monitoring

 

The Basics of Diabetes

All cells in the body use glucose ("blood sugar") as their source of energy.  However, in order for glucose to provide nourishment to the cell, the glucose must get inside the cell.  Insulin, which is produced by the pancreas, is the substance that tells the 'front door' of the cell to open up in order to let the glucose inside.  If this system is disrupted for any reason, the glucose cannot enter the cell and subsequently, the level of glucose increases in the blood stream (hyperglycemia) and the cells go 'hungry'.

There are two types of diabetes.  Type 1 and Type 2.  Type 2 is the more common form in both humans and cats.

Type 1 occurs when the beta cells of the pancreas are not able to produce enough insulin.

Type 2 is characterized by two problems.  The first, as in Type 1, is a diminished ability of the pancreas to secrete insulin.  The second issue is one of insulin resistance.  In other words, the receptors on the cell wall that would normally open the door to the cell to let the glucose in when insulin 'knocks', stop 'listening' to the insulin. The cells 'resist' the signal that the circulating insulin is sending and the glucose is not transferred to the inside of the cell, resulting in an elevated blood glucose and cellular 'starvation'.  The elevated blood glucose, in turn, sends a signal to the pancreas telling it to secrete more insulin.  The elevated insulin may somewhat override the insulin resistance resulting in more glucose entering the cells, but eventually the pancreas can become exhausted or 'burned out'.

The Cat's Unique Metabolism

In my article, "Feeding Your Cat: Know the Basics of Feline Nutrition", I explain what it means to be an obligate carnivore.  For a more technically detailed presentation of this subject matter, please see Dr. Debra Zoran's wonderful article entitled The Carnivore Connection to Nutrition in Cats.  

Cats are obligate carnivores and, as such, are uniquely adapted to consume a diet that is high in protein, contains a moderate amount of fat, and that includes a very small amount (3-5 percent) of carbohydrates.  Since nature designed them to ingest very few carbohydrates, cats lack many of the important enzymes that are necessary to process this type of food efficiently.

With the above information in mind, consider the fact that the carbohydrate level of most dry foods is between 35-50 percent with some of the lower quality dry foods being even higher.

Image removed. 

Robbie has been designed by nature to eat meat, not grains.

Read on to understand why this disparity in the carbohydrate level found in commercial foods versus nature so commonly results in a cat developing diabetes.

The three main 'take-home' words from my Feeding Your Cat article are "proteins" (animal versus plant), "water", and "carbohydrates".   For this article, the most important of the three subjects is carbohydrates.

Carbohydrates, Obesity and Diabetes

Most people are aware that diabetes is more common in overweight humans than it is in people closer to an optimal weight.  The same is true for cats.  Fat (adipose) cells produce a substance that increases the resistance of the body's cells to insulin.  This increase in insulin resistance is the hallmark of Type 2 diabetes.  As mentioned above, this is the most common form in the cat.

Cats are designed to utilize proteins and fats for their energy - not carbohydrates.  They are lacking the necessary enzymes to efficiently utilize carbohydrates to meet their energy needs.  When the carbohydrate level of an obligate carnivore's diet is higher than it should be - remember that a bird or a mouse is only 3-5 percent carbs and that most dry foods contain between 35-50 percent carbs - the excess carbohydrates are stored as fat.  The increased fat cells, in turn, promote Type 2 diabetes via an increase in insulin resistance.

Image removed.

Mindy (left) is nice and lean and full of energy.  Molly (right) was rescued from  a home where only dry food was fed and she had become terribly obese.  She could barely walk and could not even clean herself.  She has gone from 20.5 pounds to 14 pounds simply by eating a low-carbohydrate canned food (Wellness) and having all dry food removed from her diet.  She now runs, jumps and plays like a normal cat!  For more on her story click here.

Not all carbohydrates are created equal, but it is safe to say that obligate carnivores - especially diabetic ones - do not benefit from carbs at a level above what would be in their natural diet regardless of the type.  But that said, carbohydrates are characterized by their Glycemic Index (GI) and their Glycemic Load (GL) which are measurements that reflect how high and how rapidly a specific carb causes a rise in blood glucose when ingested and the overall impact that particular carb has on the diabetic state.  The higher the GI/GL of a carbohydrate, the worse the result will be for a diabetic patient.

The Glycemic Index and Glycemic Load values of different food sources are very important to consider for people trying to manage their own diabetes.  However, I do not like to concentrate on these values for cats because then it sounds like there may be "good" carbs versus "bad" carbs for cats.  The bottom line is that humans are designed to utilize carbs whereas cats are not.  What we can say is that some carbs are worse (higher GI/GL) than other carbs, but ideally, we should strive to keep the carb level of the feline diet at a level which would be found in nature. 

Please keep in mind that corn, wheat and rice are very common ingredients in many pet foods and that these species-inappropriate grains have relatively high Glycemic Index and Glycemic Load values.  Also, when you see the word "flour" know that the flour of any grain has a higher GI/GL load than the grain when it its whole form.

Please see my list of Commercial Canned Food Choices.  This list was originally compiled in order to benefit the IBD (Inflammatory Bowel Disease) cats that I work with.  The culprit in this disease process is often specific hyperallergenic grains such as corn, wheat, and soy.  In addition to these grains, yeast is also hyperallergenic. So for this reason, you will note that the list is split into two sections - With Grains and Without Grains.   The "With Grains" list only includes products that do not contain corn, wheat, or soy.

For the diabetic cat, however, the caregiver should ideally focus on keeping all grains out of the diet.  While an IBD cat may be able to tolerate rice, this is definitely not an ingredient that you want to feed to a diabetic cat - or any cat, for that matter.  Rice has a very high GI/GL value. On the other hand, the varieties that do not contain grains are naturally very low in carbohydrates.

Image removed.

Buck still needs to lose a bit more weight on his low-carb diet.

Subtracting all of the percentages on the label (using 'nutrient analysis' and not 'guaranteed analysis', preferably) from 100 percent gives you an approximate percentage (of the total weight) of the carbohydrates contained in any product. In other words, subtracting the protein, fat, water, fiber, and ash/mineral content from 100 percent will leave you with the percentage of carbohydrates contained in the diet on an 'as fed' basis which still takes the water content into consideration.  Unfortunately, the math does not stop there because it is much more useful to determine the carbohydrate level on a 'dry matter basis' which results in a value that is not influenced by the water content of the diet.  Using dry matter basis values allow you to compare all foods - both dry and canned - on an equal basis.

As fed numbers are always much lower than dry matter basis numbers.

Example:  AvoDerm Cat/Kitten canned food contains 3% carbohydrates on an as fed basis but really contains 13.5% carbohydrates when the influence of the water is removed and the nutrient is figured on a dry matter basis.

Remember to never compare as fed numbers with dry matter basis numbers.

A very valuable site that lists the carbohydrate content of many commercial foods is the SugarCats site.  This site lists values that are percentages of calories, not percentages of weight. This can get very confusing and lead people to wonder why two different lists show different numbers for the same product.  For instance, most pet food manufacturers list the ingredient numbers for their products as percentages of weight, not of calories.  Both methods are perfectly acceptable but this does lead to a lot of confusion. 

Unfortunately, many of the foods on my list are not included in the SugarCats list but you can do your own rough calculations or email the companies and ask them for their carbohydrate values.

For more information on how the food tables are compiled, click here

Optimal Nutrition for All Cats

We have all heard the phrase 'locking the barn door after the horse is gone'.  This applies to how we feed our cats with respect to the diseases that they commonly develop secondarily to being fed a low quality, species-inappropriate diet.  For instance, when looking at feline diabetes, notice that the rationale behind the Purina DM prescription diet is to provide a decreased carbohydrate level in the food to treat a diabetic cat.  Why not recommend a decreased level of carbohydrates for all obligate carnivores to prevent diabetes?  Why are we always addressing treatment rather than prevention?  Why aren't more veterinarians making common sense-based recommendations for their healthy patients in order to prevent diseases such as diabetes and IBD that are so often associated with a high carbohydrate diet/high grain diet?

While the optimal diet for an obligate carnivore is one with less than 5 percent carbohydrates, you should strive, at a minimum, to keep their diet below 8-10 percent carbohydrates.

The subject of fiber is also widely discussed with respect to feline nutrition and diabetes.  It was once thought that a high fiber diet would be beneficial for the diabetic cat but this recommendation has since fallen out of favor.  Please see Dr. Zoran's article for more details and also this study.  A cat's natural diet is not very high in fiber and, contrary to what is seen in dogs and humans, it is not in the cat's best interest to feed a diet high in fiber.  Cows and horses are designed to eat a high fiber diet - not cats.

Let's take a look at some of the ingredients and the carbohydrate content in several prescription diets often recommended for diabetic cats.  I have underlined the sub-optimal and species-inappropriate ingredients.  For a more in-depth look at reasons why these ingredients do not constitute optimal nutrition, please see my Feeding Your Cat article.  In summarizing the points in that article, please take note of the fact that the Hill's Science Diet products listed contain no high quality muscle meat.  Cheap, low quality by-products or organ meats are used instead.  In addition, note the high carbohydrate levels in all of the listed products except for the Purina canned DM, the common usage of high glycemic index grains of which some are also known as hyperallergenic ingredients - namely, corn, rice, wheat, soy and yeast - and the use of known carcinogenic preservatives.

Hill's Science Diet dry m/d:   (16% carbohydrates)

Chicken by-product meal, corn gluten meal, pork fat (preserved with mixed tocopherols and citric acid), pork protein isolate, corn meal, powdered cellulose, wheat gluten, dried egg product, chicken liver flavor*, L-lysine, taurine, rice flour

Hill's Science Diet canned m/d:  (16% carbohydrates)

Pork by-products, pork liver, water, corn starch, powdered cellulose, soy protein isolate, chicken fat (preserved with mixed tocopherols and citric acid), guar gum, locust bean gum, carrageenan, rice flour

Hill's Science Diet dry w/d:  (37% carbohydrates)

Chicken by-product meal, corn gluten meal, brewers rice, rice flour, powdered cellulose, chicken liver flavor*, vegetable oil, pork fat (preserved with mixed tocopherols and citric acid), taurine, L-carnitine, preserved with BHT, BHA and ethoxyquin

Hill's Science Diet canned w/d:  (28% carbohydrates)

Pork by-products, pork liver, water, corn flour, powdered cellulose, chicken fat (preserved with mixed tocopherols and citric acid), chicken liver flavor*

Hill's Science Diet canned w/d with* chicken: (26% carbohydrates)

Water, pork liver, pork by-products, chicken, powdered cellulose, starch, oat fiber, guar gum, locust bean gum, carrageenan, chicken liver flavor*

   

*Please be aware that the word "with" means that a product is required to contain only 3% of the ingredient - in this case, chicken.  Also, the word "flavor" means that the product is not required to have any of the ingredient present.

Now let's look at two Purina products:

Purina dry DM:  (15% carbohydrates)

Poultry meal, soy protein isolate, corn gluten meal, soybean flour, beef tallow preserved with mixed-tocopherols (source of Vitamin E), corn starch,.....brewers dried yeast

Purina canned DM:  (8% carbohydrates)

Liver, water, beef, corn gluten meal, trout, fish meal, beef tallow preserved with mixed-tocopherols (source of Vitamin E), wheat flour, soy protein isolate

When comparing the Hill's products with the two Purina DM choices, if I had to choose between them, I would pick the Purina canned DM.  But fortunately, we do have other choices.  One of the biggest mistakes I see veterinarians make is choosing a diet based on addressing a single disease entity.   This is very narrow-sighted.  The Purina canned DM very favorably addresses the overall carbohydrate level but it also contains corn, wheat and soy and it contains predominantly liver versus a muscle meat.  These ingredients are certainly not what a cat would choose to eat in the wild. 

I choose to feed a cat for overall health, not just to address one disease state such as diabetes - especially when there are products available that are even lower in carbohydrates and contain far superior ingredients for carnivores than the products listed above.  When I look at the Hill's and Purina ingredients, these are certainly not products that I would choose to feed my own cat.

I realize that there are cats who, at first, refuse to eat canned food.  For these cats, the Purina DM dry is the best alternative until a better diet can be fed.  I am a firm believer that all cats will eventually eat canned food if various tricks are tried and the human outsmarts the feline and uses a healthy dose of patience and perseverance.  It is definitely more difficult with a diabetic cat due to the fact that they must eat on a schedule, but it can be done.  I see people 'throw in the towel' far too soon on these stubborn, dry food-addicted cats.  The lifespan of your diabetic cat will be prolonged if he is not fed dry food.

Let's now take a look at look at canned Wellness:

Wellness canned Chicken:  (Most varieties range from 2-5% carbohydrates)

Deboned Chicken, Chicken Liver, Turkey, Chicken Broth, Sweet Potatoes, Carrots, Vegetable Gums, Flaxseed, Potassium Chloride, Alfalfa, Cranberries, Blueberries, Yellow Squash, Yellow Zucchini

Note the absence of any grains and the very low carb content.  Also note the high level of muscle meat - versus by-products and organ meat - and the lack of any dangerous preservatives.  These products are also void of the commonly used hyperallergenic and high glycemic index ingredients such as corn, wheat, soy and yeast.

On a negative note, I wish they would leave out the sweet potatoes and all of the vegetables.  Cats do not need vegetables and many cats simply cannot handle vegetables in their diet.  Be aware that a small percentage of cats will develop diarrhea when fed canned Wellness and I believe it is due to the vegetable content.

Surprisingly, contrary to what the name implies, sweet potatoes have a lower GI/GL than the common white potatoe. Still, it would be preferable for this ingredient to be absent from a cat's diet.  Unfortunately, all commercial diets have some cons associated with them which is why I choose to make my own cat food

The reader may be wondering why I have not listed dry Wellness.  This is because cats - especially diabetic cats - should not be fed any dry food.  My Feeding Your Cat article explains why.  The carbohydrate content of dry Wellness Super5Mix is 28 percent.  This product's ingredients are far superior to the Hill's and Purina dry food choices but no cat - and especially a cat with diabetes - should be consuming a diet with 28 percent carbs regardless of the ingredients.

Switching the Diabetic Cat to a Low Carbohydrate Diet

Caution:  This must be done very carefully and, preferably, with in-home monitoring of the cat's blood glucose (BG).  You need to also discuss any diet change with your veterinarian but be aware that many vets underestimate the degree to which the insulin dosage needs to be lowered when put on a low carb diet.

For example, let's consider a cat that is currently eating Hill's Science Diet dry w/d with a carb content of 37 percent and he is suddenly switched to canned Wellness at 3-5 percent carbs.  If the insulin is not lowered accordingly, an overdose of insulin will occur.  Please do not underestimate the favorable impact that a low carb diet has on decreasing the BG level of a cat. As stated at the beginning of this page, many cats no longer need any insulin once on a low carb diet.  Others have a drastic decrease in the amount of insulin needed to maintain an optimal BG level.

The goal is to get your cat off of dry food and on to a 100 percent canned food diet but this must be done carefully - especially if the cat refuses to eat canned food.   The timing of the eating schedule of a diabetic cat is a critical component to proper blood glucose/insulin regulation.  Many of the tips that I offer in the Transitioning Dry Food Addicts to Canned Food section of my Feeding Your Cat article can be used for diabetic cats but please be cautious as you implement them, remembering to pay special attention to the importance of ensuring that your cat is eating on a regular schedule.   A non-diabetic cat can very safely handle the 'tough love' 12-18 hours period of time without food that is often necessary to get them to change their diet but this does not apply to a diabetic cat.

With a stubborn cat that is a dry food addict, approach the diet transition slowly and with patience.  For cats who like canned food but are still eating dry food, the transition can proceed much more rapidly (within 7-10 days) as long as the blood glucose is being monitored and the insulin is being adequately adjusted downward.  I cannot stress this last point strongly enough.

In-Home Blood Glucose Monitoring

A human with diabetes would never dream of trying to mange his disease without the use of a glucometer to periodically test his blood glucose level.  The glucometers that are advertised on TV for humans can also be used to successfully monitor a diabetic cat.  Two veterinary journal articles can  be found here and here that verify the accuracy of these meters for use in diabetic pets.

There are many models to choose from but I have had very good luck with the Life Scan One Touch Ultra meter which can be purchased online or at most drug stores. This meter is easy to use, comes with an easy-to-understand instruction booklet, and requires a relatively small volume of blood.  I know there are newer models available that require an even smaller drop of blood but I have been very happy with the One Touch Ultra.

It is important to get a meter that uses 'wicking' test strips.  These strips automatically draw the blood into the testing area as soon as the edge of the strip contacts the edge of the blood drop. This is in contrast to the type of meters that use strips requiring that the blood be dropped directly onto the test strip.

The One Touch Ultra uses the One Touch Ultra FastDraw test strips.

There are two choices of companion lancets to the One Touch Ultra glucometer.  The Life Scan One Touch FinePoint Lancets are purple and a bit larger than the Life Scan One Touch UltraSoft Lancets which are white and have a slightly smaller point.  The use of the UltraSoft lancets sometimes results in a blood drop that is too small but the trade-off is that the smaller puncture hole causes less trauma to the ear.  The use of the FinePoint lancets will result in a large enough drop of blood more consistently.  I would suggest starting off with the larger FinePoint lancets until you get the hang of the testing procedure and then possibly move to the smaller UltraSoft lancets for less tissue trauma.  This is more important if running a blood glucose curve because of the multiple tests being run in a short period of time.  But if the UltraSofts do not work for you, don't worry about it and just continue using the FinePoints.  Cats' ears do fine with either one and sometimes the trade-off of struggling to get a large enough blood drop from the UltraSoft lancets can be frustrating.

The One Touch Ultra glucometer comes with a One Touch UltraSoft Adjustable Blood Sampler (lancet pen) that can be dialed for different depths of penetration.  There are 7 settings with the largest circle corresponding with a greater depth of penetration.  I found that setting it on the fifth setting (with the first setting being the smallest circle/less penetration) gave the most consistent results.  Setting it on the fourth also worked, but not as consistently.

The One Touch Ultra can often be obtained at no cost after the rebate is submitted.   The companies are often more than willing to give their meters away for free in order to get you locked into using their strips. The strips end up being the costly part of home testing.

Speaking of test strip cost.....some folks on the Feline Diabetes Message Board have been using the Fast Track because the strips that this meter uses are cheaper than the strips for the One Touch Ultra.  They report that this meter is easy to use and is accurate when compared with the One Touch Ultra.

Here is a pictorial webpage that demonstrates the testing procedure.  There is a nice picture on this page that shows where the vein is in the ear of the cat.  It runs just around the margin of the ear. You will find that there are several different opinions and techniques recommended for the testing procedure and, with time, you will figure out which ones work best for you and your cat.  For instance, this page shows the person approaching the cat head-on (in order to test the inside of the ear, versus the outside) which I find makes many cats nervous.  They tend to want to back away from the person and so I would much rather stay behind them as described below.  However, the author of this page points out that there is minimal hair on the inside of the cat's ear which may be an important consideration when testing a long-haired cat.  Long hair can interfere with the blood drop formation.  This page also discusses the use of warming devices for the ear and the optional use of Vaseline - neither of which I have found necessary.  However, I have not tested any long-haired cats and so the Vaseline may be of benefit in these cases.

Here is a movie  that  demonstrates the testing procedure.  And another movie is located here.  Both of these movies show the demonstrator using a warmed sock or washcloth applied to the ear.  Some people like using this method but I find it cumbersome and annoying to have to use one more item when testing a cat.  I do not apply anything warm to the cat's ear and find that the blood drop gathers just fine.  Sometimes, however, you will need to 'milk' the blood up to the punctured area for just a couple of seconds.  Be aware, however, that if you do not have anything against the inside of the ear other than your own finger, you will get stuck.  As shown in the second movie, a small cotton ball can be used to protect your finger.

These movies show "Punkin" and "Max" being star pupils although Punkin's owner mentions that he was not this good at the beginning of the testing.  Both cats are completely unrestrained.  But in reality, not all cats are this good about testing.  It is very important to be patient and move slowly and calmly.  Also, the best time to try this procedure for the first time is when your cat is sleepy.  Remember, there is a learning curve for both of you and the less nervous you are, the better off both of you will be.  Keep in mind that the procedure will most likely get easier as you polish your skills.

Although certainly not necessary, it may be easier on your nerves if the first test is done under supervision at your veterinarian's office. 

Contrary to what you may think, most cats don't even feel the lancet stick.  I think they 'feel' the nervousness of the human even more!  What bothers them the most is the restraint and sometimes the noise of the lancet pen.  For this latter reason, I click the pen several times around the cat's ear to make sure he gets used to the noise.

Offering the cat his favorite treat in conjunction with the testing may also help keep him calm and persuade him to view this procedure in a more positive light.

Everyone has their preference when it comes to methods used to handle their cat and every cat also has their own idea of what level of restraint they will tolerate.  The least amount of restraint that can be used to get the job done is obviously going to make this less stressful for both of you.  If you can test them, unrestrained, while they are just hanging out on their favorite chair, that is optimal.

Please note that in the following pictures the test strip should already be in the meter but I did not have any at the time these pictures were taken.

Image removed.          Image removed.

Testing Calvin's right ear with minimal          Testing Calvin's left ear with no

bracing of his head.                                  restraint.

The method that works best for me when testing a fidgety cat, is to kneel on the floor with the cat between my knees.  We are both facing the same direction and there is very little firm restraint involved. I just try to prevent the cat from going forward.  I am right handed so it is easiest for me to test the right ear but it is best for the cat to alternate between ears to keep one from getting too sore.  I use gentle pressure with my left hand on the left side of the cat's head to, hopefully, keep him from shaking his head while the blood drop is forming.  I hold the right ear with my left thumb and index finger and my right hand handles the lancet pen.  It is easiest for me to test the outside edge of the right ear but alternating between the inside and outside margins of each ear is optimal.  (Again, please note that the test strip should already be in the meter at this point.)

Image removed.        Image removed.

Testing Calvin's right ear with gentle       Testing Calvin's left ear while gently

restraint.                                            bracing his head.

The blood vessel runs along the margin of the ear. See here for a very good picture of the ear vein.  Aim for the upper outer edge of the ear anywhere from half to three-quarters of the distance up the ear from the base toward the tip. 

A tricky issue to contend with is the cat's instinct to shake his head during those few critical seconds when you are waiting for the blood drop to form.

After the lancet is used, I lay it down but continue to gently hold onto the ear and keep a few fingers of my left hand on the left side of his head to prevent him from shaking off the forming drop of blood.  Of course, if he is allowed to do so, the drop of blood will go flying and you will have to start over again.  If a drop has not formed quickly, you can try to 'pump' the blood into the puncture area with your right hand.  This involves a gentle squeeze and release, squeeze and release just below the puncture site.  Another technique involves gently 'milking' the blood up the vein from the base of the ear.  This whole process takes about 5 seconds or less.

With the One Touch Ultra meter, you have 2 minutes to fill the test strip with blood once the strip is inserted into the meter so don't insert it too soon.  Insert the strip after the cat is in place and ready to be tested.  Two minutes is generally plenty of time but if the meter 'times out' simply remove the test strip and re-insert it.

The most common problem that I encountered when first starting to test cats with the glucometer was not getting the test strip confirmation window filled.  When this happens, the meter will read Er5 (error message) after the 5 second countdown.  You will then have to get a new strip and start again.  If the blood drop was too small and all of the blood has been drawn up by the test strip - but it is not enough - do not try to get more blood from the puncture site and reapply the test strip to the ear.  That will not work.  As soon as blood enters the strip, the meter starts counting down and adding more blood at this point is futile.

Also, do not try to 'scoop' or 'scrape' the blood off the ear and onto the test strip.  It must be draw up by the test strip via capillary action. 

Try to make a habit of watching the test strip window as you are touching the strip to the drop of blood. If your blood drop is large enough, this will ensure complete filling before taking the strip away and will result in a successful sampling.  With a bit of practice, you will also learn not to 'jump the gun' and apply the test strip before you have a large enough blood drop to fill the confirmation window.  If the drop looks too small, be patient and try to 'pump' or 'milk' the blood into the puncture area as discussed above.

After the test strip is filled, lay the meter down and gently hold off the puncture site with the cotton ball to stop the bleeding.  Necessary holding times will vary but usually 10 seconds or less will be sufficient.

Please be forewarned that you may want to cry and throw the meter when first attempting to test your cat's blood glucose!  There is a bit of a learning curve with this procedure - for both you and your cat - and the frustration level can be very high initially.  Take a deep breath, stay calm, keep a sense of humor, (drink a glass of wine...) and accept the fact that it may take you many tries at different times over the span of a few days to start consistently getting samples.  The calmer you are, the better off your cat will be.  Do not get discouraged if the first few times do not go well.  If success has not been met after 2-3 sticks (or if the cat is very nervous, after only 1 stick) feed him the treat you have standing by and let him go.  You can try again in a few hours.  You do not need to master this on the first try! 

A group of very caring and knowledgeable people can be found on the message board at www.felinediabetes.com.  They can often talk you down off of the 'ledge of frustration' that comes along with learning how to home-test and to interpret blood glucose curves.  These folks are not veterinarians but many of the members have a great deal of very practical experience in dealing with feline diabetes.

Managing a cat with diabetes can be very overwhelming, to say the least, and communicating with others who are faced with the same issues can be very helpful.  As with any online group, be sure to do your homework and conduct your own research, as well as listening to suggestions of other list members and staying in touch with your veterinarian.

Conclusion

While writing this webpage, I decided to see what information is available on the internet with respect to feline diabetes.  I was quite disturbed to see so many authors of the various websites, and posters in chat groups, still continuing to recommend a high complex carbohydrate/high fiber diet. A very critical point is being missed:  Cats are obligate carnivores and a high carbohydrate diet is detrimental to their health and will make the diabetic disease process worse. 

Also, high fiber diets run counter to a cat's natural diet and recent research has shown that high fiber diets, unlike what is observed in a diabetic dog or human, are not beneficial for a diabetic cat.

Fortunately, there has been a great deal of focus on feline diabetes in the past couple of years so when you are searching the internet, be absolutely sure to pay attention to the date on the webpage for the most recent information. 

The "Catkins" diet is in and the illogical high carbohydrate/high fiber diets are, thankfully, out.

For more information supporting the feeding of canned food versus dry kibble, see the October, 2005 edition of Cornell University's CatWatch newsletter.

October, 2006

Lisa A. Pierson, DVM

 

Information on this site is for general informational purposes only and is provided without warranty or guarantee of any kind.   This site is not intended to replace professional advice from your own veterinarian and nothing on this site is intended as a medical diagnosis or treatment. Any questions about your animal's health should be directed to your veterinarian."

Tell him my Scouty wishes him all the best.

Joyce~caregiver-advocate in Dallas for Steve J (SPMS) / Cpn indicated by reactions; Mpn, EBV, CMV positive; elevated heavy metals; gluten+casein sensitive / Wheldon CAP since Aug. '06 - doxycycline+azithromycin+flagyl pulses; antivirals; chelation; LDN.

Joyce~caregiver-advocate in Dallas for Steve J (SPMS).  CAP since August 06, Cpn, Mpn, B. burgdorferi, systemic candidiasis, EBV, CMV & other herpes family viral infections, elevated heavy metals, gluten+casein sensitivity. 

I want to add my agreement to what Joyce writes about cats and carbs. I've studied this issue extensively and have arrived at the same conclusion as Joyce. Cats should not be fed diets that contain carbs.

 Cheap cat foods, high in corn, wheat and rice, ultimately will prematurely kill your cat, usually with a triad combination of pancreitis, liver disease, and diabetes. High-carb cat foods is also what causes obesity in cats.

Cats should never be fed dry food, as these types of foods are by compositional necessity extremely high in carbohydrates.

 I think one of the best commercial canned cat foods is Petsmart's Authority Premium Chicken & Liver Kitten Formula. Max Cat is excellent too, except it uses copper sulfate as a source of copper. The above Authority formula contains no byproducts, corn, or wheat, and is fortified with Taurine, and Omega-6 and Omega-3 fatty acids. Does not use copper sulfate as a source of copper.

I recently took my 4-year old boy cat to the vet for a torn ear and she was amazed at how beautiful and healthy his coat and teeth were.

Remember, you want to feed your cat a "Catkins" diet! Feeding your cat food which is full of corn, wheat, byproducts, and worse is a woeful way to treat your precious kitty! Pay as much attention to your cat's nutritional needs as you do your own!

basil.

If cats are outlawed, only outlaws will have cats.

Basil, Here I thought Science Diet dry was the best, so he has always eaten it, since the day I rescued him five years ago. Will keep reading and researching. He is eating Science Diet kitten dry food as of Friday and the antibiotics are definitely having a beneficial effect, though I can't say why at the moment. Maybe tooth infection, maybe cpn... Will check out the canned food tomorrow, especially since he likes wet food better. (I'm mixing liquid antibiotic, clindamycin hydrochloride, in wet food in order to medicate him.) Does anyone know if this 'mycin' is effective against cpn?

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems.  Mohandas Gandhi

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems. Mohandas Gandhi

The only thing I know about Clindamycin is that it is effective against most of the same things Baytril (Cipro for humans) is used for...usually, Clindamycin is my preference since I don't like to think about using Baytril for my Pomeranians unless nothing else will work. Diana

Hey MacK, I know you said cat, but here is the recent research on a RAT (might apply to cats and humans).

http://tinyurl.com/yxo3bt

I didn't read all the other responses, but this points to diabetes not being autoimmune after all (big gasp from the crowd!!). An interesting article for everyone here, actually.

I say yes, turn your cat into our first LAB CAT and see how he/she does on the old abx. And isn't it funny how DVM's are so often more open to new thinking than MD's, kind of makes one wonder who's getting treated with better medicine--us or them?

Lexy (with two cats, a dog, a hampster that lived waaay longer than its obligatory two years, other assorted creatures at various times, and too many kids!)

--------------- "Chance favors the prepared mind." --Louis Pasteur Husband treating MS with CAP

Lexy, SO COOL! I read the first three paragraphs and (she puts back of hand to forehead and feigns a swoon) was MOST impressed. I never fail to learn something when I visit this site. I am going to DEVOUR that article tonight. This is such an exciting time for medicine!

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems.  Mohandas Gandhi

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems. Mohandas Gandhi

Joyce, That's a lot to digest, but I'll plow through it today and tomorrow. Thank you SO much! The vet told me to feed him kitten food until we can work out the diet, as it's high protein, lower sugar. He is currently on an antibiotic for infection associated with a broken tooth, so we have a good start for abx, as soon as a protocol is worked out. As I said, the vet is quite open-minded and I think he'll bite on the entire CAP if I can present him with a simple rationale and program to follow. I'm printing out everyone's responses and I'll take them to Saturday's appointment, along with a urine sample. Before this happened, I was planning to ask for abx for him, anyway, thinking he probably had SOME cpn infection from me. Now, hopefully we'll ALL get better insight into housepet infection and treatment. If we could get a read on his bloodwork, I'd feel better. (Jim, two wordplays included just for you...)

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems.  Mohandas Gandhi

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems. Mohandas Gandhi

Bearing in mind that in the wild a cat would probably feed on offal and small creatures, I used to feed my cats a diet of raw pig spleen with small amounts of tinned and dried cat food.   They have gone to cat heaven now, but they were healthy throughout their long life with glossy coats and strong teeth.

Michele: on Wheldon protocol since 1st May 2006 for a variety of long standing ailments including IBS, sinusitis, alopecia, asthma, peripheral neuropathy, also spokesperson for Ella started Wheldon CAP 16th March 2006 for RRMS

Michèle (UK) GFA: Wheldon CAP 1st May 2006. Daily Doxy, Azi MWF, metro pulse.

lee

Here is another article. What is bcg you might ask it is live bacteria used as a vaccine for tuberculosis and bladder cancer called bacillus. She is in stage one clinical trials in humans. My guess is that the immune does not recognize what ever bacteria causes diabetes but when given live bacillus our immune system turns on and inadvertently kills the the mystery bacteria as well as the bacillus. http://www.iacoccafoundation.org/ny_times_a_diabetes_researcher.htm sjogren's diagnosed 2/03, 200mg minocin daily, mwf zithromax, flagyl every 3 weeks.

200mg doxy daily, 500 zithromax mwf,flagyl 1000 m-fri.rifampin 2x daily,chloestryramine 2x daily

Ugh! Raw pig spleen! Ah, but they probably loved it. p>Joyce~caregiver-advocate in Dallas for Steve J (SPMS) / Cpn indicated by reactions; Mpn, EBV, CMV positive; elevated heavy metals; gluten+casein sensitive / Wheldon CAP since Aug. '06 - doxycycline+azithromycin+flagyl pulses; antivirals; chelation; LDN.

Joyce~caregiver-advocate in Dallas for Steve J (SPMS).  CAP since August 06, Cpn, Mpn, B. burgdorferi, systemic candidiasis, EBV, CMV & other herpes family viral infections, elevated heavy metals, gluten+casein sensitivity. 

With dogs (I had a diabetic for 11 years who needed shots every day) diabetes can be a result of Cushings - and of course with Cushings, the alkaline phosphatase (?) liver enzyme is elevated...when liver enzymes are not elevated, it is considered to be simple diabetes and therefore the prognosis is very good. Dogs and cats always need insulin injections, other blood sugar lowering drugs do not work (You probably know that). I know they give Azith to dogs and probably cats also...they caution against the first day on Azith giving them upset stomach and/or diarrhea, but it seems that after the initial day or two on Azithromycin the digestive is no longer affected. Antibiotics and many other drugs given to pets are dosed by weight, and I believe they go by the usual dose of a med as given to a 150 lb person. Good luck with your kitty!! Diana

Mr. Diabetic cat is doing a bit better after a course of antibiotics. We investigate insulin in the nex few days, since the 'trench-mouth' seems to have been cured with abx. --- Now, a question on cpn testing. The lab says there is no commercially available test for cpn. I am assuming they mean no animal test? Can anyone recommend a lab where I can have the sample sent? This seems inaccurate, especially in an area like the Chicago market. I want him tested, but the vet will do abx without the test, I think.

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems.  Mohandas Gandhi

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems. Mohandas Gandhi

Hi Mac, Garth Nicolson has some info on veternary testing on this page: http://www.immed.org/illness/clinical_testing.html We just took two cats to the vet this morning for annual shots and I asked about the big fat one--could he have Cpn? Vet said it was possible. He has runny eyes and some very foul stools at times. The vet is going to take a stool sample. We'll see where it goes from there. Glad to hear your kitty has such a wonderful human to take care of him. Raven

Feeling 98% well-going for 100. Very low test for Cpn. CAP since 8-05 for Cpn/Mycoplasma P.,Lyme, Bartonella, Mold exposure,NAC,BHRT, MethyB12 FIR Sauna. 1-18-11 begin new treatment plan with naturopath

Raven, And he's REALLY lucky to have YOU looking out for him, too! I just printed out the page you recommended and will take it to my formerly fat fella's vet to see what we can do about shipping a sample out posthaste. Thank you!

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems.  Mohandas Gandhi

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems. Mohandas Gandhi

 Pet food recall!! Okay, you know I took all that good advice and put my Wentworth on a wet-food diet, basically kitten food (rather than adult) when I can find it.  He's lost fat, looks and feels better and we're due for more bloodwork this week. I'll fill you in on the plans for abx therapy for him after we see the nice vet on Thursday.

The bad new is, there's a huge WET pet food recall today (dog and cat) due to contamination at a plant supplying many major brands here in the U.S.   I've taken care of my stash of cans, as renal failure (terrifying) is the overriding symptom in both species, but you all might want to take note, as well. Here's the link to the press release: http://www.menufoods.com/recall/Press_Recall_03162007.pdf

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems.  Mohandas Gandhi

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems. Mohandas Gandhi

I've re-evaluated the labels of the Authority kitten food and have decided that the Chicken and Lamb Formula for kittens is healthier than the Chicken & Liver Formula. This latter formula uses carrageenan as a thikener, whereas the former does not. Carrageenan is bad news for people and animals alike:

 

http://tinyurl.com/2ohmxn

If cats are outlawed, only outlaws will have cats.

This isn't from PubMed, but it puts it quite simply: http://www.notmilk.com/carrageenan.html and makes me agree with Basil. I would like to see the new-look Wentworth, though, he has such handsome markings......Sarah     An Itinerary in Light and ShadowWheldon regime since August 2003, for very aggressive SPMS.  Intermittent therapy after one year. 2006 still take this, now two weeks every three months.  EDSS was about 7, now 2. United Kingdom.
Completed Stratton/Wheldon regime for aggressive secondary progressive MS in June 2007, after four years, three of which intermittent.   Still improving bit by bit and no relapses since finishing treatment.

Hi Basil,

What is the “bad news” you know about carrageenan?

The nutritional pre-CAP protocol that I was on prohibited this and EDTA (ethylene diamine tetra-acetic acid).

Carrageenan is in many foods for animals and people, alike (e.g. soy milk, creams, etc.). And EDTA is in virtually everything—baby formula, even!

If I recall correctly this was because carrageenan contributes to elevated homocysteine levels and that EDTA is some sort of an enzyme inhibitor? Sound familiar?

Sarah, will have to take a look at that carrageenan link.

--Minai

 RRMS, diagnosed 2/04. NAC 4/06. Started Wheldon regime 8/30/06. Doxycycline, 8/06, Azith, 10/06. Switched to Roxithromycin 11/06. Pseudo relapse/die-off with hospitalization 1/07. Gad-enhanced MRI of brain and spine shows NO NEW DISEASE ACTIVITY. Restarted CAP with NAC and Doxy 2/07. USA.

The link Basil supplied against carrageenan leads to a study which injected the stuff into rat paws. This means nothing as regards food value, since most foods are bad for you when injected. It's why we have stomachs and all.

The link Sarah supplied is to a piece that reads a lot like this parody. Insofar as it actually gets down to details, it too relies primarily on direct exposure of cell cultures to carrageenan.

Oops, I posted the wrong link. The correct link is below. This study was done on human intestinal cells. People with gut infammation should be interested in this study.

BTW, carageenan is used a whole host of foods, but is used primarily as a milk thickener. Most ice cream, table cream, and canned milk contains carageenan.

One of the big concerns with carageenan is when the gut lining is damaged, in which case carageenan could enter the bloodstream intact, resulting in incredible inflammation in other parts of the body, similar to that found in numerous studies that have found carageenan to be an ideal agent for injecting into rats to produce reliably strong inflammation for various inflammation studies. I have a strong sense that carageenan in combination with leaky gut syndrome is at the root of a whole host of inflammatory illnesses, including illnesses like lupus.

http://tinyurl.com/3256so

 

basil.

 

If cats are outlawed, only outlaws will have cats.

Hi Norman,

 

 

 

 

I liked being reminded of that about foods. In a mandatory drug education program in 5th grade, we were warned that smoking food, as one smokes marijuana can kill. I think the example given was banana peels. We, of course, thought it too ridiculous to be true and I think some of my classmates said that they went home and tried it to prove that it didn't! I hadn't thought about this for years, until now. I can appreciate the parodyImage removed.

 

 

 

 

Basil, thanks for that link! Not comforting about carageenan at all to see that study and such results!

 

 

 

 

I think I shall just stick with eating carageenan-free Haagen-Dazs ice cream and buying carageenan-free cream from a dairy in MA that produces it. Am just glad that the Trader Joe's store near me carries it.

 

 

 

 

--Minai

 

 

 

 

RRMS, diagnosed 2/04. NAC 4/06. Started Wheldon regime 8/30/06. Doxycycline, 8/06, Azith, 10/06. Switched to Roxithromycin 11/06. Pseudo relapse/die-off with hospitalization 1/07. Gad-enhanced MRI of brain and spine shows NO NEW DISEASE ACTIVITY. Restarted CAP with NAC and Doxy 2/07. USA.