Q: I have a 14-year-old cat who was diagnosed with diabetes about three years ago. She was completely healthy and stable; her insulin (glargine) dose was 1 1/2 units. A month ago she became lethargic and indifferent to food. Her fructosamine test showed 400 and there was sugar in her urine. Her insulin was increased to 2 units. She’s had good and bad days since but hasn’t completely returned to her normal self. I’m no longer convinced that Prescription Diet m/d is the best food for her.
Dr. Nichol: Something important is still out of adjustment with your cat. It’s not unusual for diabetics to have other disorders crop up. A diagnosis and treatment plan are essential; any unresolved complication can derail good control. To screen for problems that could upset the apple cart, all diabetics should have a chemistry profile, blood count, and urinalysis every three to six months. Urinary infections are common because high blood sugar leads to excessive sugar in the urine. Bacteria love sugar.
Once those smoldering issues have been resolved, a 12-hour blood curve can be done by your veterinarian to pinpoint the up and down fluctuations in your cat’s blood sugar. A drop of blood is glucose-tested every two hours and the values plotted on a graph so the dosing and timing of insulin and meals can be custom-fitted to your kitty.
The fructosamine test is also important. It gives an approximate average of the blood sugar over the preceding two to three weeks. Based on these lab values, increasing your cat’s glargine insulin dose may be the best move. In cases where glargine loses its effectiveness, we switch to protamine zinc (Prozinc) insulin.
Food also matters. Prescription m/d is best for most feline diabetics because, like their natural diet, it’s high in protein and low in carbohydrates. As a fat cat’s weight diminishes, many become more active and require less insulin. Continuing the same dose can lead to dangerously low blood glucose levels. As they approach a healthy weight of nine to 11 pounds, some actually become normal, no longer needing any treatment other than an appropriate diet like m/d. Your veterinarian gave you good, research-based advice. I urge you and your cat to follow doctor’s orders.
Dr. Jeff Nichol provides medical care for pets at the Petroglyph Animal Hospital in Albuquerque (898-8874). He treats behavior disorders at the Veterinary Specialty Centers in Albuquerque and in Santa Fe (505-792-5131). Questions? Like my Facebook page at facebook.com/drjeffnichol.