Warning: Before reading even the first sentence of this webpage,
you must commit to reading past the STOP sign
section of this paper discusses the
detrimental impact of dietary carbohydrates
on the blood glucose balance and insulin
cats as a species - with pre-diabetic and
diabetic patients being especially
susceptible to the negative effects of high
However, if your cat
is receiving insulin and you switch to a low
carb diet - without lowering the insulin
dosage - you will be putting your cat at
significant risk for a hypoglycemic crisis. This is
discussed under the STOP sign section below.
I receive many
emails each week asking for food
recommendations for diabetic cats.
Cat Food Composition chart and stay
below 10% carbohydrate calories (the third
column). There are many suitable low
carbohydrate choices available depending on
your cat's preference and your budget.
Many cats do well on Friskies Classic Pates
and Fancy Feast.
Stay away from
food with gravy - they are high in
carbohydrates. The same is true for most
food with sauces. Higher protein/lower
fat is also the goal. However, you
will note that most commercial foods are low
in protein and high in fat. Why?
Because protein is expensive and fat is
cheap This is one of many reasons why
I make my own
when you are ready to learn more about
evaluating pet foods. Cats are
obligate carnivores and are designed to eat
other animals (meat, organs, etc.) - not
grains and vegetables which only serve to
enhance the profit margin of pet food
companies and load the food up with
1) and 2) are
very important. 3) can wait until you are
not so overwhelmed.
The two most
important initial goals when faced with a
diabetic patient are:
1) Get them on
a low carb diet
ASAP but pay close attention to the STOP
sign section below.
2) Learn how
to home test.
Note that I do
not recommend any 'prescription' diets
- including the ones sold for diabetes. They are
expensive, low in quality, contain
species-inappropriate ingredients, and are not
necessarily low in carbohydrates.
absolutely no reason to spend your
hard-earned money on veterinarian-prescribed
addicts: I do not support
the feeding of any dry food to any cat for
many reasons (water depletion,
high in carbohydrates, high in
plant-based proteins, bacterial and fungal
mycotoxin contamination, cooked-to-death
which destroys nutrients, very calorically
dense, etc.), but while you are working on
the Tips for Transitioning Dry Food
Addicts to Canned Food, please
substitute your cat's high carb dry food
that neither of these dry diets are healthy
options for your cat long-term. See
Tract Health. Read the content in
the grey box at the top but also scroll down
to Opie's pictures for a sad look at the
tremendous suffering caused by feeding
water-depleted diets to cats.
Urethral obstructions and cystitis are
extremely common problems seen in cats fed
dry food. Urethral obstructions are
painful, life-threatening (ruptured bladder)
and very expensive to treat. Cystitis
is also extremely painful and often causes
the cat to stop using the litter box.
Please do not
say "but my cat drinks plenty of water so
dry food is just fine for him/her!"
Many studies have shown that when all water
sources are considered (food and water bowl)
cats on canned food consume double the
amount of water when compared to a dry
food-fed cat. This is in spite of
the fact that cats on canned food rarely
drink water from a bowl. Cats on dry
food do not make up their water deficit at
the water bowl - no matter how much wishful
thinking humans engage in to justify the
feeding of this type of diet.
It can be
fairly argued that water is one of the most
important 'nutrients' for all living beings.
Dehydration is a very serious issue and your
diabetic cat is in a precarious situation as
it is. We don't need to compound their
disease state by compromising their
In addition to
the fact that all dry foods are
water-depleted, they are extremely
calorically dense and adipose tissue
(fat) causes insulin resistance => diabetes.
EVO and Young Again are even more
calorie-dense than other dry foods because
they are high in fat. Therefore,
careful portion control is very important.
I am a firm believer that all cats will eventually eat canned food if
the human implements a
healthy dose of patience and perseverance as discussed in my
Transitioning paper linked above. It can be harder or easier
with a diabetic cat. The difficult
part is due to the fact that they must eat when
receiving insulin so it is harder to use hunger as an incentive.
diabetic cats have a ravenous appetite which
can aid in the transition to canned food.
I see people 'throw in the towel'
and give up
far too soon on these stubborn, dry food-addicted cats. Some cats
will take several weeks to several months to
make the switch. Be patient and don't
Diabetes is one of the most
common feline endocrine diseases and, while we do not know all of the causes of this complex disease, we
do know that many diabetic cats cease needing insulin or have their
insulin needs significantly decrease once their dietary carbohydrate
level is lowered to a more species-appropriate level than that found
in many commercial foods - especially dry kibble.
Feeding a high
carbohydrate diet to a diabetic cat is analogous to pouring gasoline on a fire and
wondering why you can't put the fire out. While some cats are more
sensitive to the detrimental effects of
carbohydrates than others, the bottom line
is that cats are obligate
carnivores and are not designed by nature to consume a high carbohydrate
diet or one that is water-depleted (dry kibble).
Although all dry foods are too high in
carbohydrates (except as noted above) and too low in water (causing many
cats to suffer tremendously from extremely
life-threatening urethral obstructions and
please be aware that some canned foods (especially ones with
gravy/sauce) also contain far too many carbohydrates
making them very poor choices for cats.
canned foods made by Hill's are too
high in carbohydrates. This includes
all of their 'prescription' diets including
m/d and w/d.
As a side
note, here is an excerpt from a paper that I
am working on entitled Veterinarian
Prescribed Diets/Over-the-Counter Options:
'Prescription dietʼ is an industry-coined
term trademarked by Hill's and holds no
In other words, these diets contain no
ingredient that actually requires a
prescription. The term 'prescription diet'
is simply a clever marketing tool between
Hillʼs and veterinarians. The sale of these
diets is restricted (by Hillʼs, not by law)
to veterinarians only. In return, Hillʼs
enjoys a boost in perception of quality
brought about by this professionʼs
endorsement of their products.
However, this perception of quality is
undeserved and this incestuous relationship
jeopardizes the integrity of the veterinary
There is nothing magical
about the veterinarian-prescribed diabetes-management
diets. In fact, several of them such as Hill's
m/d and w/d (dry and canned), Purina DM dry,
and Royal Canin DS (dry) are far too high in
carbohydrates making them very inappropriate
choices for all cats but especially diabetic
patients. Purina DM canned is
sufficiently low in carbohydrates (~7%) but
it is expensive and it is predominantly
liver which should not make up the bulk of a
cat's diet. There is absolutely no
reason to spend money on this product.
In addition to the dietary
carbohydrate level, we also need to address the
issue of 'portion control' (managing caloric intake) of any food
that we choose to feed to our cats because obesity is a very
important factor to consider when discussing both the causes and
treatments of diabetes.
Adipocytes (fat cells) secrete a substance
that makes the cells of the body resistant
to insulin (Type 2 diabetes).
Portion control has recently become even
more important because as pet food
manufacturers move toward making more
low carbohydrate foods, this process is selecting for
high fat diets. Keep in mind
that we get our calories from 3 nutrient
classes: proteins, fats, and
carbohydrates. The percentage of
calories that come from these 3 nutrients
must add up to 100%. Therefore, if we
lower the percentage of carbohydrates in the
food to < 10%, that means that 90-95% of the
total calories must come from fat and
protein. Given the fact that fat is
cheap and protein is expensive, you can see
that profit margin drives pet food
manufacturers to produce high fat/low
protein foods when
they make low carb products.
Fat contains 9 calories per
gram whereas proteins and carbohydrates are only 4 calories per gram.
Therefore, fatty foods are very calorically dense making portion control
important to consider.
If your cat is
overweight, please see
Feline Obesity but you need to understand that it is
beyond the scope of a webpage to explain how
to implement a safe weight loss
program at the same time that you are
dealing with an unregulated or newly
diagnosed diabetic cat. This can be a
tricky situation since an unregulated
diabetic cat is starving internally - at the
cellular level - and restricting calories,
in some cases, can be very dangerous.
I am available for
phone consultations if the reader wishes
to discuss this situation in more detail.
(My email address is provided at the bottom
of this page.)
On the flip
side, weight loss exhibited by any cat is
often the first sign of illness - including
diabetes - so I make it a point to
weigh my cats at least every 2-3 months -
more frequently when they reach ~10 years of
urge all cat caregivers to purchase a scale
such as the
American Red Cross Baby Scale or the
Salter Baby and Toddler scale -
especially if you are trying to implement a
safe weight loss program. (I
prefer the Red Cross one because it has a
wide base allowing the cat to walk onto it
without tipping it.) Make sure that
you verify that the scale is reasonably
accurate by weighing items that you know the
exercise (activity level) has also
recently become an issue that is gaining more attention as it relates to
both the cause and management of feline diabetes.
Even though we need to be
careful to not necessarily assume that what is 'right' for a human is
also 'right' for a cat, the need to consider carbohydrates, obesity, and
activity level should come as no surprise since these factors are are
also significant issues in human diabetes.
If you do not read any
further on this webpage, please understand the following principles.
Your cat's life literally depends on your understanding of these issues.
in a diabetic state no longer need any insulin when they are finally fed an
appropriate low-carbohydrate diet.
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 re-read the
previous two paragraphs carefully.
If you change
your diabetic cat's diet to one with lower carbohydrates, he will, in
all probability, IMMEDIATELY (not days or weeks later) require a
reduction in his insulin dosage. He may also immediately go into
'remission' and not need any insulin at all.
If this warning is ignored, you may very well end up with a cat in a
hypoglycemic crisis (dangerously low blood sugar) which can result in
death, or brain damage.
If you take
only one point away from this page, it needs to be the understanding
that if you stop pouring carbs into your cat by switching to a low-carb
canned food diet (or even a dry food diet with lower carbs than you have
been feeding), you MUST be aware of the probable immediate and significant impact on your cat's insulin needs.
If I could shout this from
the rooftops, I would.
Frequently, I hear of
reports of cats that ended up near-death - or actually did die - from
insulin overdoses because lay caregivers and veterinarians did not
understand this basic concept.
often hear my colleagues support the change to a low carbohydrate diet but then recommend "re-testing in a week or two" while the caregiver continues to administer the same amount of insulin. This very common lack of recognition of the immediate effects of low carb diets on the blood glucose level of the diabetic patient often results in a dangerous hypoglycemic state.
Or - the caregiver reads this
article and decides to change the diet on their own and does not
understand the need to lower the insulin dosage.
When someone understands
half of the concept (changing to a low-carb diet), but does not
understand the other half of the concept (the highly probable need to lower the
insulin dosage) disaster often strikes.
Remember the statement that I
made above? The one about pouring gasoline onto a fire? If
you stop pouring gas on a fire, there is going to be an immediate
reaction of that fire when its fuel is taken away. That fire is
not going to take weeks or a month to respond.
In this analogy it would not
be a big issue if you kept 'drowning' that dying fire with water but in
this instance water = insulin and a hypoglycemic crisis
ensue if more insulin is given than is needed by the body.
Of course, carbohydrates are
not the only fuel for a diabetic 'fire' but they play a very significant
part in contributing to high blood sugar levels in a diabetic cat.
If you minimize this issue - and do not lower the insulin accordingly -
you really will be 'playing with fire' with regard to the safety of your
So you say - "OK!! I
get it! I understand that my cat may very well need a lower dose
of insulin - or may not need insulin at all - once I stop pouring
gasoline (carbs) onto his diabetic fire, but how do I know what dosage
of insulin to give? How do I know what impact the new diet is
going to have on his insulin needs? How do I keep my catsafe?"
Trying to manage a diabetic
cat without home testing is a bit like driving a car with a
paper bag over your head.
A human who
cares about his own safety would never
inject himself with insulin without testing
his blood sugar beforehand. The goal
treat our diabetic cats the same way.
The best way to arrive at the
optimal dosage of insulin and the
optimal dosing frequency is by home
testing. Note that I said "optimal." Many diabetic cats have
survived with a set amount of insulin being administered
twice daily with the dosage determined by periodic glucose curves
performed at a veterinary clinic if their owners will not, or cannot,
home test. However, this is not the
safest and most physiologically sound way to manage a diabetic patient
so I urge all diabetic cat caregivers to strongly consider home testing.
Every case is
different and definitive recommendations with respect to how far
to lower the insulin dosage (when you start the diet change) cannot be
given without knowing the specifics of each case. There are many
crucial factors to be considered:
carbohydrate content of
the original diet
carbohydrate content of the
how fast the change to a low carb diet is made
how carb 'sensitive' the
cat's body is
how quickly the cat's body
responds to the decrease in carbs
how the cat, in general,
reacts to insulin
has the cat ever been
positive for ketones in his urine
current dosage of insulin
current blood glucose levels
of the patient
Here are some quotes from
recent studies regarding feline diabetes and how a proper diet impacts
the insulin needs of cats:
The Carnivore Connection to
Nutrition in Cats, Dr. Debra Zoran:
High-protein, low-carbohydrate diets and low-fiber diets are highly
beneficial in the management of cats with diabetes, resulting in a
reduction of > 50% in the amount of insulin required in 8 of 9 cats in
one study. In another study, complete cessation of insulin
administration was reported for one-third of the cats.
Update on Feline
Diabetes Mellitus, Dr. Claudia Reusch (WSAVA 2006):
In previous years, when we did not limit the type of food our remission
rate was 15%-25%. We were able to increase the remission rate to 50-70%
by using a low-carbohydrate high-protein diet. (Remission refers
to no further need for insulin.)
Antech Diagnostic News, December
In one study, 68% of cats with diabetes mellitus fed a
carbohydrate-restricted canned diet lost the need for exogeneous insulin.
I urge you to keep the lines
of communication open between you and your veterinarian while learning
to home test and implementing the diet change. That said, it is
unfortunate that many veterinarians are not well-versed in the
management of feline diabetes and all too often do not fully understand
the strong connection between diet and blood sugar levels.
It is also very frustrating
to note that many veterinarians either are not aware that home testing
is possible (despite the subject being discussed in many
and at many continuing education meetings) or just simply do not support this life-saving
Additional help and support
can be found on the
Diabetes Message Board
and I urge all diabetic cat caregivers to join this forum as a support
system to be used in conjunction with your veterinarian.
Keep in mind that with all
internet forums, the experience and knowledge base of the participants
If posting to forums is not
within your comfort zone and you would like additional help, I am available for
Please understand that I cannot offer advice via email.
Feline diabetes can be a very complicated disease to optimally manage
and it would not be ethical or time-efficient to attempt to address
individual case management of this disease via email.
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 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 ofinsulin 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 (hyperglycemia) 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'.
results from chronic hyperglycemia. Glucose toxicity wreaks havoc
on the entire body - especially the pancreas and its insulin-producing
cells. A vicious cycle then ensues as the insulin-producing cells
are damaged resulting in less insulin being produced.
Here is a picture of the
pancreas. It is the long, flat, pink organ in the center.
The dark red organ below it is the spleen. The white tissue is all
fat. This is also called "omental fat" and some of you may have heard or read
about this type of fat in humans. It is the fat that is carried
around the abdomen and is associated with significant health problems.
In my article,
Your Cat: Know the Basics of Feline Nutrition, I explain
what it means to be an obligate carnivore. For a more technically
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 includes a very small
amount (2-3 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
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.
Robbie has been designed by nature
to eat meat, not grains.
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.
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 causes the
cells of the body to become resistant 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 2-3 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.
That said, if calories in
exceed calories out - no matter whether the calories come from protein,
fat, or carbohydrates - the cat will gain weight. This is why
portion control is important no matter what diet you are feeding.
is nice and lean and full of energy.
Molly (right) was rescued from a home
where only dry food was free-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 13 pounds simply by eating a
low-carbohydrate canned food and having
all dry food removed from her diet. She now runs, jumps and plays
like a normal cat! For more on her story see
Obesity - Molly's story.
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 although GI/GL of various ingredients has not been
studied in cats like it has been in humans.
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, such as the
grain flours, 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.
Buck still needs to lose a bit more weight on his
Unfortunately, pet food
labels are extremely lacking in useable information. All that is
required to be listed is the 'guaranteed analysis' which are only
minimums and maximums which are, by definition, inaccurate. Also, it is not required to list the
It is sometimes stated that
you can subtract all of the
percentages on the label from 100 percent in order to give you an approximate
percentage 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 in the diet on a 'wet matter' or 'as fed' basis.
However, because the guaranteed analysis values are only listed as
minimums and maximums with no 'floor' or 'ceiling,' you can see where
this type of calculation can lead to a very erroneous conclusion with
respect to the carbohydrate content. Also, you need to convert
this number to dry matter basis or 'calories
from'. If you use 'as fed' values,
they will be misleadingly low.
I long for
the day when veterinarians start thinking outside of the Big Four 'box'
and stop being so 'married' to Hill's, Purina, Iams, and Royal Canin
since there are higher quality - and less expensive - diets available
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
diabetic prescription diets is to provide a decreased carbohydrate
level in the food to 'treat' a diabetic cat.
However, why not recommend a decreased level of
carbohydrates for all obligate carnivores to possibly prevent
diabetes? Why are we always addressing
than prevention? Why aren't more veterinarians making common
sense-based recommendations for their healthy patients in order
to prevent diseases such as diabetes, IBD, urinary tract
disorders, etc., that are, in many cases, strongly linked
to a high
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 blood
glucose control in the
diabetic cat but this recommendation has since fallen out of favor.
Please see The Carnivore Connection
to Nutrition in Cats for more
details. A cat's natural diet is very low in fiber.Cows and horses are designed to
eat a high fiber diet - not cats - yet many veterinarians still
recommend diets like Hill's w/d (a high
fiber/high carbohydrate diet).
Let's take a look at some of
the ingredients and the carbohydrate content in several diets that are often
prescribed by veterinarians 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
Feeding Your Cat.
In summarizing the points in that article, please take note of the fact that
the Hill's Prescription products listed contain no muscle meat.
By-products or organ meats are used instead. (Please see my
discussion regarding by-products which
can be highly nutritious sources of
protein but can also include low quality ingredients and diseased organs.)
In addition, note the high
carbohydrate levels in all of the listed products except for the Purina
canned DM. Also notice the common usage of high glycemic index grain
flours and the use of hyperallergenic ingredients (corn, wheat, soy, and
Powdered cellulose is fiber
source obtained from plants/trees.
carbohydrates listed are on a dry matter
Hill's Prescription dry m/d: (18% carbohydrates)
Chicken By-Product Meal, Corn Gluten Meal,
Pork Fat, Brewers Rice, Wheat Gluten,
Powdered Cellulose, Pork Protein Isolate,
Old version: Chicken
by-product meal, corn gluten meal,
rice flour, powdered cellulose, chicken liver flavor*,
soybean oil.....preserved with BHT, BHA and ethoxyquin
they finally removed the BHT, BHA, and
ethoxyquin but they made the diet even more
unhealthy than it was previously by making
it predominantly brewers rice instead of an
animal-based protein source (chicken
*Please be aware that the word "with" means that a product is required
to contain only 3% of the ingredient - in this case, chicken.
The word "flavor" means that the product is not required to have
any of the ingredient present.
Now let's look at two Purina
Purina dry DM: (18% carbohydrates)
Poultry by-product meal,
soy protein isolate, corn
gluten meal, soy flour, animal fat preserved with
mixed-tocopherols (source of Vitamin E), corn starch, animal
liver flavor, etc.
Purina canned DM:
Liver, poultry by-products, meat
by-products, water sufficient for
processing, chicken, salmon, oat fiber,
salmon meal, artificial and natural flavors, etc.
Water sufficient for processing, chicken,
liver, wheat gluten, meat by-products, corn
starch-modified, soy flour, artificial and
natural flavors, etc.
If I had to choose between
the Hill's and Purina choices, I would pick the Purina canned
(regular) 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.
Purina canned DM 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. Note that there is a
negative relationship between soy and
thyroid health. Given how common
hyperthyroidism is in cats, I will not feed
soy to any cat in my care.
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 - and are less expensive. When I look at the
Hill's and Purina ingredients, these are not products that I
would choose to feed to my patients or my own cats.
must be done very carefully if the patient
is already on insulin.
See above if you have not already read the
Critical Points section.
If your cat is
not on insulin because he was just diagnosed
with diabetes, then you can change the diet
more rapidly - either immediately ('cold
turkey') or within 2-3 days. More on
this issue below.
patient's clinical signs warrant immediate
insulin administration, I try a diet change
- with no insulin - for 3-5 days to see what
impact the new diet will have on the blood
glucose. In most cases, I do not agree
with waiting much longer than a week to
start insulin. This is because you will
have the best chance of getting your cat
into remission (cease needing insulin) if
both diet and insulin are used very early
on. The longer your cat's body is
under the effects of glucose toxicity, the
more his body will be damaged and the less
chance of remission he will have.
When I have a
new diabetic patient present to me, the two
most important tasks are:
1) getting the
patient onto a low carbohydrate diet -
preferably canned and not dry
2) teaching the client
how to home test
If your cat is already on insulin, the
safest way to implement a diet change is to incorporate home testing
into your management protocol.
You also need to 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 a low-carb
diet is implemented. This puts the patient at
significant risk for life-threatening
For example, let's consider a cat
currently eating Hill's Prescription dry w/d with 37% of its calories coming from carbs
and he is suddenly switched to a canned food with less than 10% 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 blood glucose 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 blood glucose level.
The goal is to get your cat
off of dry food and on to a 100 percent canned food diet but if your cat
is on insulin, this must
be done carefully - especially if the cat refuses to eat canned food.
full dose of insulin to a cat that is not eating can result in
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 patient. Therefore switching a stubborn diabetic
cat can be more difficult. It is not impossible but the process
does have some complicating factors.
With a stubborn cat that is a
dry food addict, approach the diet transition slowly and with a high
dose of patience.
For cats that like canned food but are still eating a 100% dry food diet, the
transition can proceed much more rapidly aslong
as the blood glucose is being monitored **at home** and the insulin is being
adequately adjusted downward. I cannot stress this last point
When defining "rapidly," I
have, as noted above, switched many cats from dry to canned 'cold turkey' without any
digestive problems (vomiting or diarrhea) - especially those cats that
are already eating some canned food in addition to their dry food.
However, you can also error on the side of caution and go slower than I
would - taking ~1 week to make the switch.
With regard to the issue of
diarrhea and a diet change - I don't mind a bit of loose stools (tooth paste
+/- with a bit of
pancake batter consistency) and tend to keep on with the canned
food diet. These loose stools often firm up within a few weeks on
the new diet.
Some cats will vomit when
changed to canned food. The transition must be slowed down for these
patients because it is very important for them to have food 'on board'
in order for the insulin to have something to work with.
There are many cases of
success stories on the Feline Diabetes Message Board
that discuss cats ceasing to need insulin once all dry food (or high
carb canned food) was removed from their
Few humans with diabetes
would dream of trying to mange their disease without the use of a glucometer
their blood glucose level prior to injecting
insulin. Injecting insulin blindly -
into a human or a cat - puts the patient at
significant risk for developing
life-threatening hypoglycemia (low blood
This includes feline patients
that have their doses determined with glucose curves done at a
veterinary hospital. This is because your cat's insulin needs can
change for a variety of reasons (infection, stress, anorexia, etc.) and
also because the curve generated at the vet clinic is influenced
by stress hyperglycemia which is a false increase in blood glucose due
to the cat's internal reaction to this stress. This can then result in a
higher dosage of insulin being prescribed than will be needed by the
patient when they are at home.
Believe me, I understand that
the issue of home testing can be quite intimidating at first. Most
people become very stressed when first learning of their cat's diabetes
diagnosis and can't even imagine injecting their cat with insulin, let
alone getting a blood sample from their ear!
Awhile back I decided to
pretend that I was a new diabetic cat owner. I went to test 7 cats
in my home (my own and foster cats). Needless to say, it was
frustrating - and not as easy as I was expecting it to be - but I
finally got them all tested.
Several cats took 5-7 pokes
(in different sessions) to get enough blood for a reading.
Only 1 out of the 7 'guinea
pigs' gave up enough blood the first time to get a reading.
I, on the other hand, was
bleeding like a stuck pig. The lancet was going through the cat's ear
and right into my finger. I was bleeding. The cat was not. I
started practicing what I preach and got a cotton ball to protect my
finger while I kept working to find the 'sweet spot' in the cats' ears
so that I could get a blood sample from them.
The moral of the story?
Be patient. Be kind to yourself. Give it time and it will come.
Maybe not the first day and maybe not even the first week but most
people (and cats) get the hang of home testing.
Oh...and cat ears tend to
bleed a bit easier after they are poked a few times. Do not worry
about this! It is a good thing and your cat's ears will be
A very valuable resource and
a great group of supportive people can be found at the
Feline Diabetes Message Board.
On a daily basis, board members talk newbies through the trials of
learning how to home test. It is always fun to see these scared,
apprehensive new people master home testing and then go on to help others
after they get the hang of it.
If you or your veterinarian
need some convincing that home blood glucose monitoring is critical to
the optimal management of feline diabetes, here is a
list put together by a member of the Feline Diabetes Message Board
of many veterinary and PubMed articles discussing the value and validity
of blood glucose monitoring of cats.
veterinary journal articles can be found
here that verify the
reasonable accuracy of these
meters for use in diabetic pets.
Sadly, many of my colleagues
either do not introduce their clients to this life-saving tool or, worse
yet, dissuade their clients from the practice of home monitoring.
This lack of pro-active management has resulted in the death of many
cats and the less-than-optimal management of countless others.
That said, there are rare
cats that will not allow home testing. I say "rare" because if the
cat allows insulin injections, they will almost always allow you to test
them - eventually - so don't give up too quickly and do not assume that
your cat will not allow you to home test.
test strips, lancets, lancet pens:
The meters that are used
can also be used to successfully monitor a diabetic cat.
not need a meter
designed especially for pets such as the AlphaTrak which costs ~$100 and
uses very expensive test strips (over $1 per strip). The cost of the meter is
not as much of a factor as the ongoing cost for the test strips.
are many meter models to choose from. You can often get the meters
for free (or around $10) when you purchase 50 - 100 strips since the manufacturers want
to get you locked into buying their strips. (Think about cheap printer
prices - they are cheap because the companies want to get you locked
into buying their
expensive ink cartridges.)
Hocks is a good place to buy meters
and strips online.
Ebay is also a good place to
buy strips but watch the expiration dates.
There are two important
factors to consider when buying a meter:
have had good luck managing patients with
Walmart Relion Micro or the newer Relion
Confirm. Both of these meters use
only 0.3 uL. The Confirm has few
more features than the Micro but
they are overkill for what you really need.
Either meter will work just fine. These meters and
their strips are inexpensive when compared
to other strips
and the meters have been shown to be reasonably accurate.
Other favorites include the
Ascencia Contour and the Accucheck Aviva.
The TrueTrack has not been
getting very good reviews on the Feline Diabetes Message Board lately so
you may want to to stay away from that meter.
Freestyle Lite has had several reports of
testing far too low so I would not purchase
suggest that you take your cat and your new
meter to your vet for comparison with their
blood analyzer or the meter they use
in-house (as long as it has been shown to be
accurate by comparison with table top
analyzer). Make it a point to take
your glucometer with you every time you take
your cat to your vet so that you can run
Use the same
drop of blood from the cat's ear for
comparison with your vet's glucometer.
They are not going to be exactly the same
but they will hopefully be within 15 - 20%
of each other or better.
It is important to get a
meter that uses 'wicking' test strips which all of the
meters mentioned above use. 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.
'pokers') range in size
from a large 25 gauge to a very small 33 gauge. However, most
companies do not state the gauge size on their lancet boxes so it can be
confusing when trying to figure out which lancets to buy.
Generally speaking, when you see lancets labeled "ultra-fine"
or "ultra thin", that denotes a very
fine lancet size (31,32,33 gauge). Exception to the word "ultra"
is the LifeScan One Touch UltraSoft lancets. They are 28 gauge and
many people have good luck with those.
chart for lancet sizes. Keep in mind that the lancet has
nothing to do with the meter. You do not have to use the same
brand of meter and lancet.
The larger the number, the smaller the
lancet point. The smaller the lancet point, the harder
it is to get enough blood but the more comfortable it will be for your cat so
you can see that it is a trade-off.
However, 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
This noise of
the pen is
why some people do not like using it
and, instead, just use the lancets freehand.
Most people like to use a
lancet in the 28-29 gauge range especially when first starting out
since it can be frustrating enough to get blood without having to deal
with an ultra-fine lancet.
Some people like to use an
even larger lancet (25 - 27 gauge). They are happier with the
blood flow and their cats don't seem to mind the larger size.
Other people have had great luck with the lancets that are much finer -
more in the 31-33 gauge range. It all depends on how good of a
'bleeder' your cat is.
You will have to experiment
to see what size of lancet works best for you and your cat but you will
probably be able to use a smaller lancet
after a few weeks as your cat's ears 'learn'
One example of the lancets
that I have used is the Life Scan One Touch
FinePoint Lancets(purple ones) which,
according to the chart above, is a 25 gauge lancet. (No gauge number is listed on the box
but I assume that the chart is accurate.)
have also used the
Scan One Touch UltraSoft Lancets(white ones shown in picture above) which are 28 gauge.
The FinePoint lancets will provide a large enough drop of blood more
consistently than the UltraSoft lancets. Again, you can start with a
larger lancet but then move to a smaller
lancet once your cat's ears start to bleed
easier and you start to get the hang of
where to test on the ear. Many people
start to use smaller lancets within 2-3
weeks (or sooner) of learning how to home
test. Or...they need to use the
smaller ones right from the beginning
because their cat does not favor being poked
with the larger ones.
Most meters come with 10
lancets but they vary in size depending on the company.
Each meter kit should also
come with a lancet device (lancet pen) that you can adjust to
give a deeper or more shallow penetration of
the lancet. The pen that I have has 7
settings (7 is the deepest penetration) and
I find that the 5 works well.
As mentioned above, some people prefer to 'freehand' the lancet. In other words, they do not use the pen but, instead,
they just hold the lancet in their hand and poke their cat's ear that
way. The nice part about doing it freehand is that you can see
exactly where you are poking relative to the
blood vessel. When using the pen, you
can't tell exactly where the lancet tip is
going to end up.
sure to test yourself first so that you become familiar with the use of
the glucometer - especially the way the strips 'sip' up the blood drop.
common mistake that I see people make is that they do not hold the ear
gently but firmly against the tip of the lancet pen. Instead, they
let the ear fall away from the pen. If this happens, the lancet
will not penetrate the ear.
Vein location - notice the
vein (red line) running along the perimeter of the ear:
Aim for the shaded area shown
Here is a pictorial webpage that demonstrates the testing procedure.
It is outdated (2001) with respect to meter brand and the comment on
blood drop size. (Thankfully, the newer meters do not require a 1.5 uL
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, the pictorial page linked above 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 and shown below.
as the author of this page points out, 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. Vaseline may help with the formation of the blood
drop on these cats.
This page also discusses the use of warming
devices for the ear which I have never tried. Maybe if I had
warmed the ear on my test subjects discussed above, I would have had
better luck getting blood the first or second time.
Be aware that if you do not
have anything against the ear other than your own finger, you may stick
yourself especially if using a lancet pen versus freehand. As shown in
the third movie below, a small cotton ball or tissue can be used to
protect your finger.
Here is a
that demonstrates the testing procedure. This movie shows
the operator using the lancet free-hand.
here. This movie shows the veterinarian using a 25 gauge
needle instead of a lancet. I do not recommend this method.
A 25 gauge needle is overkill and will cause more trauma and pain for
your cat than is necessary - especially since the newer meters do not
require a large blood drop. The blood drop shown in this movie is
about 20 times more than you need.
Some people like
to use a warm sock filled with rice to increase the blood flow to the ear but I find it cumbersome and annoying to have to use one
more item when testing a cat. Do what works best for you.
After you have poked the ear
with the lancet, you may need to 'milk' the blood up to the punctured area
for just a couple of seconds.
These movies show the
patients being star pupils with minimal restraint. However, in reality, not all cats are this good about
testing. Most of them, however, do improve with time.
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. Keep in mind that there is a learning curve for both of you and
the less nervous you are, the better off both of you will be. Rest
assured that the procedure will most likely get easier as you polish
your skills so please do not get discouraged early on in the learning
When first starting to test a new
patient, Iclick the pen several
times around the cat's ear to make sure he gets used to the noise.
Depending on the cat, I may or may not poke him in that first session.
When first testing very
skittish cats, I simply lightly restrain them and click the pen
a few times - without poking them - and then feed them a treat and let
You do not have to get a
test on the first try or even on the first day. Most people are not successful on the first day.
Give it time and try
again later that day or the next day.
Offering the cat his favorite
treat in conjunction with the testing may help keep him calm and
persuade him to view this procedure in a more positive light.
steps and positive reinforcement (treats) are very important when
approaching any type of training.
impressions are lasting ones so there needs to be a balance between
being gentle but firm with your cat.
Although certainly not
necessary, it may be easier on your nerves if the first test is done under
supervision at your veterinarian's office. You can also check in
with the Feline Diabetes Message Board
to see if there are any members living
near you who can help you learn how to home test. There are many
wonderful members of this board who are spread all over the world and
who are willing to help a newbie learn how to home test.
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.
Testing Calvin's right ear with minimal
Testing Calvin's left ear with no restraint
bracing of his head
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
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
(Again, please note that the test strip should already be in the meter
at this point.)
Testing Calvin's right ear with gentle Testing Calvin's left ear while restraint.
bracing his head.
The blood vessel runs along the margin of
the ear. Aim for the upper outer (or
inner - toward the other ear) edge of the
ear anywhere from half to three-quarters of
the distance up the ear from the base toward
the tip. (See pictures above where I
marked the ear with a pen.)
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.
meters, you have about 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.
Once you have a large enough
blood drop, touch the tip of the strip to the edge of the blood drop
so that the strip will sip the blood into its chamber. Do not try to 'scoop'
or 'scrape' the blood off the ear and onto the test strip. It must
be drawn up by the test strip via capillary ('sipping') action.
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 give you an error message. 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.
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 gently '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 that you were using to protect your finger. 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 definitely 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...eat some chocolate......) 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!
As already mentioned, a group of very caring and
can be found on the
Diabetes Message Board. They can often talk you down off of
the 'ledge of frustration' that comes along with learning how to
home-test. 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 own homework.
ketoacidosis (DKA) is a very serious
and life threatening condition which can
result from unregulated diabetes.
DKA can result
of insulin resistance secondary to
infection, inflammation, obesity, etc.
cannot get inside of the cells for any of
the reasons above, the body ends up starving
at the cellular level so it starts to burn
fat for fuel. When this happens,
ketones are released into the blood stream
and then end up in the urine.
is important to be able to test diabetic
cats for urine ketones - daily, if possible
- whenever there is a threat of DKA.
With regard to
using urine sugar (glucose) levels to manage a
diabetic cat, I must stress that this is
very far from optimal. Urine glucose testing
is a very crude way to manage a diabetic cat
but if home testing as described above is
not possible, then urine glucose testing is
better than no monitoring at all.
See this video
for more information:
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 diabetic regulation much more difficult and diabetic
remission (no longer needing insulin) almost impossible.
high fiber diets
run counter to a cat's natural diet and research has shown that
high fiber diets do not favorably impact a diabetic cat like that
observed in a diabetic dog or human.
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 sure to pay attention
to the date on the webpage for the most recent information.
The "Catkins" diet
(high protein, moderate fat, low carbohydrate) is in and
the illogical high carbohydrate/high fiber diets are, thankfully, out.
As is evident by my website, cats are my
passion and my goal is to help as many as I
can before I depart this earth. To
this end, I have spent a tremendous amount
of time over the past 12 years reading and
responding to thousands of emails that have
been sent to me asking for help/advice and
"further explanation" of information on my
Unfortunately, this has resulted in a
significant sacrifice of my personal time
and I have reached a point where I can no
longer read or respond to the large volume
of emails that I receive.
On a very good
note, the emails make me smile because I
know that the message is being heard and
more cats are receiving better nutrition and
On the other
hand, the large volume of people asking for
my time has become overwhelming. Therefore,
this statement will appear throughout this
site as well as the bottom of every page:
No individual advice or further explanation, for any reason,
will be provided via email.
That said, if
you desire personalized help and would
like information regarding my phone/Skype consulting
service, please send your request to DrPierson (at) catinfo.org.
Make sure that you put "Consultation
Service" in the subject line which may
help prevent your request from ending up in
my spam folder and increase your chance of
hearing back from me.
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 a veterinarian.