Taming The Feline Curve - Feline Diabetes Management

Using Lantus, aka Glargine, and Detemir in Your Cat

2010-02-25T06:54:00.000-08:00

We were given a prescription for Lantus, and no useful instructions to go along with this as the locum who was subbing for our vet wasn't familiar with it's use. When our boy had previously dropped insulin use we had, thank goodness, discussed with our vet that Lantus could be an insulin worth trying if he did need some again. This means that our chart, "Hamlet's Lantus Experience", starts off a little slow and bumpy until the vet came back of holiday. It also took a few days for me to track down the article written by K Roomp and Jacquie Rand.

The first article, "Dosing protocol for cats on glargine or detemir using daily home monitoring of blood glucose concentrations to adjust insulin dose", is meant only to be used with readings you collect using a human glucometer in the first section, which is what most of us find effective enough for our cats. If you are using a meter developed for feline readings, use Table III only in the same paper. This article is meant for use when you test daily, and gives you recommendations of when to increase or decrease dosages depending upon nadir, (low point in the curve), readings. This isn't an easy reading to find as cats seem to 'surf' as it is put in one article I read, on a level of insulin once the dose has been established. The wonderful part about this is that your cat can stay 'within range', (not too high or low), throughout the 24 hour period, if you give two shots per day, 12 hours apart.

There is a second paper, written by by Rhett Marshall and Jacquie Rand, designed for owners testing on a weekly basis once your cat is stable. That paper is called, "Dosing protocol for cats on glargine or detemir and glucose monitoring every 1-2 weeks". We have been testing on about a weekly basis, and doing so through the lower part of Hamlet's very stable 'surfing' period at the 3rd hour, 6th hour, and 9th hours, as recommended by our own veterinarian.

We found it very effective to maintain a chart online for our veterinarian and others to be able to see easily at short notice. I have a template available for mmol/L readings used over most of the world, and mg/dl readings for US use. Click on the hypertext in this posting to reach the items you wish to access.

If you are using either of the charts provided above, save the one you access under a name of your own choosing. You may then post freely on it. Make sure you have a record of the link to your own copy. Under "Google Docs" at the top of the chart you will find a tab marked "Tools". If you want to provide access for others to your chart, (read only), then you go to this tab and open the link labelled "Protect Sheet". You would then click on the button to choose the second option, "Only Me". You might want to then create a tinyurl link that will allow you to easily remember the URL when sharing with others.

In regard to ongoing testing when your cat is using this type of insulin, there is also another paper put out by The University of Queensland that gives you guidelines for patterns of testing to use to obtain the information you need without doing full curves as with other types of insulin. "General information" gives the pattern to be used, although we don't bother with the "O", or "12" hour tests suggested as they don't fall on either the nadir or apex, (low or high readings), in the curve.

You may also note that point four in the General Information article suggests that if insulin is kept refrigerated it will last longer than the one month suggested by the manufacturer. If you take the insulin out a short time before the shot is needed, you can fill the syringe and leave the syringe on the counter to warm, while returning the insulin vial to the refrigerator. We have found this is working fine for us, with the insulin remaining wonderfully stable, and we are nearing the end of our third month of use with the first vial. In fact, our boy is already dropping his need for insulin so we have had to back off and start again at a lower dosage once making contact with our veterinarian. As he is nearing 19 years of age, and has permanent scarring on his pancreas, this bodes very well for the use of Lantus, Glargine, or whatever term is used in your area for this type of insulin.

I should also point out here that we have run across people who have been told to shake these types of insulin, but as there is no precipitate to mix with the carrier, this will only create annoying bubbles that are of no use to you. DO NOT SHAKE!

I must add, here, that we are very grateful for the work Jacquie Rand has been doing in this area of her research as it has proved to be of such a benefit to us and others at this time in our cats lives.

2008-08-02T13:33:00.000-07:00

BELOW YOU WILL FIND THE FOLLOWING TOPICS IF YOU CLICK ON THE SUBJECT:

Sample Curve and Testing Strategies

Glucose Curve Specifics. Terms you need to know

Alternate Methods of Insulin Maintenance. An explanation of methods you have encountered

And most important, Feeding Your Diabetic Cat

We hope this information is of help to you

Sample Curve and Testing Patterns

2008-04-02T13:09:00.001-07:00

While most types of insulin have one nadir per shot, PZI is known to be byphasic, having two nadirs attached to the influence of one shot, as is shown in a recent study "Glargine and protamine zinc insulin have a longer duration of action and result in lower mean daily glucose concentrations than lente insulin in healthy cats." The differences in action should be discussed with your vet so that you know what to expect when doing a glucose curve.

If I haven't done a curve for a period of time, I usually try to do one with a new vial of insulin as this is when changes are most likely to occur for us.

A reminder here that our readings are in metric. For US numbers you would multiply by 18.
12-5-09..........Spreadsheet with Lantus
We are doing a new set of curves with a new insulin as Hamlet is once again out of remission. The new sample information, along with guidelines for mmol/L numbers and what they mean are at this site. For increases or decreases in dosage of Lantus/Glargine, there are guidelines for cats here, and here.

01-30-08.......Hamlet's Curve

This curve done as first four month check since stabilizing him after his crash out of remission last year:
7AM - 9.3 (2.5 units)
8AM - 11.1
9AM - 6.4 (ate 9:30)
10AM - 1.8 (ate)
10:30AM - 1.4
11:00AM - 1.6 (ate)
12PM - 2.1
1PM - 1.6 (Just ate)
2PM - 3.8
3PM - 4.4
4PM - 7.7
7PM - 13.0 (2 units)
Hamlet's fructosamine came in at 335 comment "perfect" stability. Dose was returned to 2.5 units bid based upon the opinion of both his specialist and his GP.

Weight=13lb 4oz

04-02-08.......... Hamlet's Curve, (Changing insulin vial)
7:30 AM - 8.8(2.5 units)
Free fed 8 AM
8:30 AM - 8.6
9:30 AM - 7.0 (ate)
10:30 AM - 6.2 (ate)
11:30 AM - 3.1 (ate a bit of California Natural and Wellness CORE)
12:30 PM - 3.4
1:30 PM - 4.9
2:30 PM - 8.4
3:30 PM - 10.4
4:30 PM - 13.9
(Hamlet Slept)
7:30 PM - 18.2 (2.5 units)

05-13-08.........Hamlet's Curve, (Changing to small vial)

7:00 AM - 12.1
7:30 AM - 13.3 (2.5 units)
8:30 AM - 15.8
9:30 AM - 12.0
10:30 AM - 10.1 (ate)
11:30 AM - 8.8
12:30 PM - 11.2
1:30 PM - 13.9
2:30 PM - 15.9
3:30 PM - 18.3 (ate)
4:30 PM - 19.6
(Hamlet Slept)
7:30 PM - 23.1 (2.5 units)

05-14-08 11:15 AM - Quick check was 5.1, even after travel to vet's office, so a good sign.

05-15-08 - Fructosamine result is 353 - reference range 210-418 is normal

Weight=13lb even

05-19-08 - 12:30PM - Quick check was 5.1, so we will be increasing his insulin to 3 units unless he goes lower today.

06-12-08 - Fructosamine done to check new dosage came in at 314. As per previous fructosamine, the range is 210-418, so Hamlet is now right in the middle of normal range. We won't need to do a curve but I will be checking nadir to ensure he isn't going too low in order for us to maintain his "normal" readings.

Weight=12lb 13oz

06-15-08 - Spot check at 11:30AM is 1.3 - decidedly the lowest point we want to see! We will be checking with the specialist to ensure this is not too low.

Hamlet is free fed on Royal Canin Diabetic DS 44 with a taste of Fancy Feast patés after shot time, and the odd treat of freeze dried salmon, or quail heart purchased through Nature's Kitchen Freeze-Dried Meats

06-28-08 - Margie has suggested we reduce dosage by 1/2 unit bid as the last fructosamine came in at 292, (range 210-418). This was a quick change from 06-12-08 where it was mid range. Just two weeks!

07-09-08- Hamlet had to skip his AM shot for teeth cleaning purposes, during which a lesion was found below one tooth, and the tooth crown amputated. This may turn out to be why appetite has been fluctuating. When he came home he headed straight for his crunchy dish and ate plenty so got his regular 2.5 unit shot.

07-10-08- Glucose reading at nadir was 9.3. Not good, but hopefully just adjusting because of the withdrawal for twelve hours.

07-12-08- Glucose reading at nadir is 2.4. Our dear prince is performing well again, and hopefully will improve with time as his tooth may have been an issue. At the moment antibiotics may be interfering with his numbers by reducing them, so we will have to monitor until they are out of his system. I do know there are several studies out there that emphasize tight regulation and improved success of the antibiotics such as
"The patients who received intensive insulin therapy were less likely to require prolonged use of antibiotics than were the patients who received conventional treatment",
"As compared with the use of other broad-spectrum oral antibiotics, including other fluoroquinolones, the use of gatifloxacin among outpatients is associated with an increased risk of in-hospital treatment for both hypoglycemia and hyperglycemia " and "Health Canada has previously warned health care providers about cases of clinically significant hypoglycemia and hyperglycemia in patients taking the drug, usually those with diabetes.1", so it appears antibiotics can have an effect on glucose readings for diabetic patients depending upon drugs and circumstances.

07-15-08- Today Hamlet was fine, right through his nadir, to the point that he was climbing around furniture on the deck through the hour of his lowest normal readings. One hour later he was staggering and having serious neuropathic symptoms with his legs. His glucose was low so I gave him .2cc corn syrup, and then ½ hour later gave him .5cc as he was still showing "LO". We took him to the vet for a check and subq fluids. At that point, with their meter, he was 1.2. This was very interesting as he was back to "LO" when we got him home, and was staggering around again, so got .5cc corn syrup again. This all must have helped as he has been eating up a storm since about 15 minutes after the last corn syrup dose. Hopefully he is on the road to recovery. No insulin tonight!

Weight: 12lb. 6oz.

07-16-08

7:30AM spot check is 7.4. No insulin.

7:30PM spot check is 8.1. No insulin given.

07-21-08

11.30AM spot check is 5.2.

7:30PM spot check is 7.8.

08.08.08

Weight: 11lb. 14oz.

It appears that the possibility of antibiotics influencing Hamlet's glucose levels became an unfortunate reality, as after the antibiotics wore off, and the required two weeks had passed, we had another fructosamine done, which resulted in a reading of 563. This may have been low if there was still antibiotic residue in his system as his readings since reflect that he is right back to needing his previous dose of insulin.

7:30PM apex reading is 27.7. As directed by his new veterinarian, we only gave Hamlet one unit of insulin.

Hamlet didn't eat much overnight, so predictably still had an overlap of insulin resulting in an apex reading at

08.09.08

7:30AM of 15.8. This is consistant with his history. One unit of insulin given.

12:00PM at Hamlet's approximate nadir, he is reading 11.1 so there is room to pull down his apex even further with another half unit of insulin.

The above has given a pattern for owners looking for guidance, however, each cat is an individual, and the complications that may accompany the diabetes are also very individual. I will not be posting further toward this online sample of readings, as that was all it was ever intended to be, and all owners should be working with a qualified veterinarian to conquer the curve and keep that apex as low as possible.

If you are interested in how Hamlet is doing as an individual cat, any further information will be posted on his personal page. There is talk of possibly changing Hamlet to Glargine as he can so easily be bumped off insulin, but that will be a learning curve for me, first, before I am comfortable posting testing patterns online, with choices made.

Glucose Curve Specifics

2008-04-02T13:08:00.000-07:00

The glucose curve:
The glucose readings in a feline can have a lot of variety in characteristics. Part of this depends upon the cat's sensitivity to either insulin injections or glucose absorption from feed. This is why one can't just take a specific point in time for a glucose test for any useful information in feline diabetes management. A high number may not even mean a condition of diabetes as other illnesses can effect glucose levels, and even just the trip to the vet will alter the normal range for your cat. For this reason, I recommend that when you first start managing a diabetic cat, you learn to test for a glucose curve, and I prefer to do hourly readings as that gives you a better chance of judging performance down the road. Some vets may only require tests be done every two hours, and usually only want the test results for the period up to when the nadir starts to recede, which will depend upon the specific insulin being used. As I have seen a Somogyi make very drastic changes in the 11th hour of a curve, I provide the vet with numbers for the time they request, and continue doing the tests for a full twelve hours, for my own peace of mind, at times, but then, I test infrequently when I am comfortable with Hamlet's performance.

There is a very good instruction site using either slides or video to show how glucose testing should be done at this hyperlink. Margie Scherk, who provided the site, recommends only curves be monitored, and those only done when necessary. When you read the information below, you will understand the logic of this, and hopefully it will be a help for those who have been urged, in the past, to test at least once per day. Most of the time, at this point, I may test about once a month to ensure that the apex and nadir are where I expect them to be, and do visual monitoring around the time of nadir on all other days. You have to judge for yourself how long you can leave each check, as some cats are more stable and regulated than others. If your cat is not stable, we both recommend doing at least a test for apex and nadir every two weeks, and don't forget to have the fructosamine test done before changing insulin dosages as individual instances in time do not give you an accurate picture of pancreatic health.

Please note, here, that glucose numbers are affected by the eating pattern of your cat, as well as the ingredients in the food, and food quantity.

Also, we find that in hot summer weather, when our boy eats less, there is more chance of a Somogyi type event from lack of glucose supplied to the system. I am a strong proponent of frequent feedings for a diabetic feline, (as described by the National Research Council body of scientists), beyond the system of free feeding if your cat is inclined to have extended periods of nadir, (low point in the curve).
If your cat remains unstable, the chances are you have a secondary concern, possibly developing because of the diabetes, or a weakened immune system.

The curve will have an apex, (high point), a nadir, (low point), and a delta curve between the two that can be short and deep, or a long gentle slope, or any combination of those. An instant in time can't tell you the nature of the curve, or what point in the curve you are at when taking the sample, unless you have previously done a few curves to establish a pattern for a specific subject. You can think in terms of snaring the nadir with a grappling hook and bringing it down to a healthy level. The first step in this is to stabilize that low level in order to be able to aim that grappling hook, (insulin dosage), effectively, and have the body reacting consistently to the insulin being given, and then the adjustment can be slow and steady into a normal range. If your cat is far out of range, be prepared for this to take some time.

Apex:
The apex can be quite extreme in an insulin sensitive feline that is out of control. If the insulin acts strongly, the cat may have to stay with a high apex as the opposite numbers may be very low if the delta is very deep. The expectation is that with stability in insulin dosage, the body will adjust as it settles into the pattern of the dosage of insulin being administered, as well as frequency of feeding, and either the lower number will come higher, triggering a need for higher insulin dosage, or the apex will reduce and your cat will be more stable. The goal is to reduce this apex into normal range with the right dose of insulin, but this may take time, which may be in terms of months.

Delta:
This is the curve between the high, (apex), and low, (nadir), points in the glucose curve. If the apex and nadir are far apart, the delta is said to be "deep". The ultimate goal with this is to create a shallow curve with both apex and nadir in a healthy range of numbers. The delta may also happen very quickly, within possibly three hours, or more, in which case it is considered to be "short". If it takes several hours to go from apex to nadir, it is said to be a"broad" delta.

Nadir:
This is the lowest point in the glucose curve when the dosage of insulin is working at its best, and/or the body is kicking in natural insulin from the pancreas. There are a number of opinions regarding how low this number can be allowed to go. What you want to try to avoid is the body developing what is called a "Somogyi" effect, when the liver jumps in to provide glucagon to replace the glucose that has gone too low for too long. This can happen without your cat developing a hypoglycemic response to the low levels of insulin, so the nadir is the most complex position in the curve.You can see, right away, that if one takes a glucose test, even at a predictable time in the curve, there is a possibility of the Somogyi throwing your decision way out of the ball park, and endangering your cat's health. Cats have been known to go into comas based upon insulin dosages that are too high, however this is an extremely uncommon occurrence. When you learn to understand how quickly, or slowly your cat reacts to a given dose of insulin, this will give you the opportunity to observe your cat within a specific period of the day to ensure that hypos are not happening. Keep in mind that mild hypos also do not have a permanent effect, according to a recent study done on Type I diabetics, so if you make a mistake, it is not irreversible, and will not damage your cat's health long term.

For guidance in learning enough to feel confident that this page has value for any diabetic feline owner, I have to thank Margie Scherk who specializes in feline illnesses such as feline diabetes and lately her interests seem to run toward geriatric felines, just in time for Hamlet's doddering years. A more devoted cat lover you will not find, and I will never be able to thank her enough for helping retrieve Hamlet's regression from its upward extremes early in the year.

Feeding Your Diabetic Cat

2007-12-29T09:42:00.000-08:00

It doesn't matter how often those who have proper dietary training repeat the concept, there are still many owners and professionals in other disciplines out there who don't understand that if the food doesn't contain the right ingredients for complete feline nutrition, it will create weakness toward one area of disease or another, due to lack of tools to maintain long term health for the whole body; heart, kidneys, liver.......the lot.

In both feline diabetes and feline obesity, there are recent study results emerging showing high fat content to have the major influence on the diseases and if cats are fed appropriately with frequent meals, carbohydrate content doesn't affect glucose levels. Fat also contains twice the calories per equal measure, (carbs 4 for 1 tablespoon and fats 9 calories per tablespoon), and, as Deb Zoran has pointed out in her presentations, what goes into your cat must end up somewhere. While I have not confirmed the specific amount or product involved in the statement, she has commented that one extra teaspoon of food per day can accumulate an extra pound of body fat per year. Once there, it is twice as hard to remove, of course.

Some of the relevant studies and papers are as follows:

Diet in the prevention of diabetes and obesity in companion animals
JS Rand, HA Farrow, LM Fleeman, DJ Appleton
A review presented by Rand, states, "Dietary fat content affects insulin sensitivity in cats. A high fat diet (>46% of calories) is associated with higher insulin-to-glucose ratios, indicative of lower insulin sensitivity, than diets lower in fat (<25% calories). Evidence suggests that low fat diets may improve insulin sensitivity by decreasing non-esterified fatty acid and betahydroxybutyrate concentrations, which inhibit insulin
action.3" It is an interesting obvervation here that the writer of the paper goes on to make an unsubstantiated ASSUMPTION that processing methods make a difference to the impact of the food. I would certainly love to see where that assumption was generated?

Any dietitian can tell you that this is a rather erroneous assumption to make, as can be shown at nutritiondata.com. However, if the fat has been rendered off before the food has been through final processing, such as in dry foods, the caloric count will thereby be reduced based upon processing of a specific ingredient.
Gonadectomy and high dietary fat but not high dietary carbohydrate induce gains in body weight and fat of domestic cats
"In conclusion, the present study shows that high concentrations of dietary carbohydrate, relative to high fat, do not induce body-weight gain or elevation of plasma glucose and insulin concentrations in sexually intact cats when food is made continuously accessible."

The above study followed one from a few short years before......
Effects of high carbohydrate and high fat diet on plasma metabolite levels and on i.v. glucose tolerance test in intact and neutered male cats.
The results of this preliminary study may be the impetus for a long-term study to find out whether it is rather the fat rich ration than carbohydrate rich diet that is expected to impair glucose tolerance and thus might contribute to the development of diabetes mellitus in cats. Whether the alteration in glucose metabolism is due to altered leptin levels remains to be determined.

These data provide evidence that in cats, high dietary fat, but not carbohydrate, induces weight gain and a congruent increase in insulin, while GX increases sensitivity to weight gain induced by dietary fat.
Effects of six carbohydrate sources on diet digestibility and postprandial glucose and insulin responses in cats

The data suggest that starch has less of an effect on the cat postprandial glucose and insulin responses than on those of dogs and humans. This can be explained by the metabolic peculiarities of felines, which may slow and prolong starch digestion and absorption, leading to the delayed, less pronounced effects on their blood responses. (Published online 2008)
Diet in the prevention of diabetes and obesity in companion animals

Dietary fat content affects insulin sensitivity in cats. A high fat diet (>46% of calories) is associated with higher insulin-to-glucose ratios, indicative of lower insulin sensitivity, than diets lower in fat. Guar gum is used to drop weight as a gimmick to reduce or eliminate the need for insulin. Along with the bisphenol-A in the lining causing insulin resistance, this can lead to malnutrition. A cat owner can't repair the ability of a pancreas to perform long term by focusing strictly on the need to provide, or not provide insulin to their cat.

Insulin is not a 'medicine' you use to cure your cat, but a tool the body uses to digest food, and/or stay healthy. It has to work in tandem with body rythms and chemistry. Each alteration of dosage needs to happen after assessment of the cause for this need. A rise in glucose readings after a shot is given may be caused because the cat is insulin resistant, as previously mentioned, the insulin action overlaps the twelve hour curves, or food, (or lack of it), alters the normal pattern.

The ingredients in food should not be having an influence on the curve unless the carbohydrate content is too high, or the glucose levels in the blood are too low, and that is how you can assess your situation and adjust accordingly.
Here are two studies, as examples, of the latest research results around feline diabetes, and feline obesity as connected to feeding practices:

"These data provide evidence that in cats, high dietary fat, but not carbohydrate, induces weight gain and a congruent increase in insulin, while GX increases sensitivity to weight gain induced by dietary fat."If someone is recommending foods that aren't low fat, question the sources of their information, and when this information was published, as science progresses over time.

"No post-prandial hyperglycaemia was seen in the 10 diabetic cats during a 2-h period following the ingestion of typical cat foods. " shows why I encourage the use of frequent small meals above the recommendations called for in the NRC book on Nutrient Requirements of Dogs and Cats, 2008 which state, as I do, that the minimum controlled meal feeding should be every two hours. The above study is one done in cooperation with Jacquie Rand as far back as 1999, prior to the emergence of veterinary diets for feline diabetes coming on the market. Another statement in the abstract states, "Both groups of cats ate multiple small meals spread through the day and night. There was little or no correlation between the blood glucose and the amount of food consumed over the previous 2-h period, in insulin- or non-insulin-treated diabetic cats, or in normal cats. "That comment is repeated on another site put out by Rand and Martin where they state, "In cats, post-prandial hyperglycaemia is very prolonged (up to 18-24h) in cats fed typical cat foods. Therefore there does not seem any need to match the timing of the insulin dose to meals, which is important in the control of blood glucose in human diabetics." Those statements were issued before recent research pointed at high fat diets causing insulin resistance, although as the term "low carbohydrate" generally seems to include foods that have about 30% carbohydrate content, there is not much to worry about when picking food from the shelves if the food is "high protein" meaning a good 40% or more. Most important is that protein which cats are designed to utilize.

My own training in the control of the glucose curve is human based, and nutrition related and there is a common goal with cats in that levelling out the curve reduces the load on the pancreas, giving it time to heal toward predictability and stable performance. The smaller the load with each little serving of food, the less stress on this ailing pancreas, and, the more evenly distributed, the less highs and lows your cat will experience. For both cats, and humans, this can be established with high protein/low carbohydrate, small "snacks" fed frequently.

A difference in reaction to food may be in how appropriate a "snack" may be for your cat, as some cats can't handle beef, and some can't handle cheese, which are commonly recommended for humans. Quality protein sources, bioavailable to the specific species are always the best choice recommended because the demand on the pancreas is slow, and the food provides a steady form of fuel with a multiple step breakdown in the GIT that will not raise glucose levels, but can still eventually provide glucose, or glucagon to be stored in the liver for future needs. There is debate over how much influence fermentable fiber has on this process, but the studies do show that the best to use for cats are beet pulp and rice bran for low fermentability, and moderate solubility.

For humans, my recommendation regarding frequency of snacks was about every three hours, but for felines, who should normally be eating 12-20 meals per day, every three hours is not frequent enough to provide steady slow burning fuel to the body. Mind you, there are some cats who are just not interested in eating that often, and the result will be less steady curves and therefore unpredictability that can become dangerous when you are administering insulin.
Once you stabilize this aspect of the curve with feeding practices, the next step is to bring down the nadir, (low point), as safely as you can, which you sometimes may need to do by increasing the insulin dose by a small amount at a time, until you, and your vet are comfortable with fructosamine results. Increase in insulin will result in increased need for closer monitoring, particularly around the nadir in case of an unexpected drop in glucose, (for example sudden lack of appetite), as abrupt changes may be more life threatening if your cat is on a higher dose of insulin, as I am sure you can understand. If you are very lucky, or your cat has a mild case of diabetes, lowering the nadir should result in lowering the whole curve, which can eventually reduce or eliminate the need for insulin, based upon increased health of the pancreas.

For overweight cats, there is the added issue of fat content in nutrient sources. This is why my personal preference is meat "meal" as the meat has been rendered and thus the fat level is reduced. For cats, the most appropriate ingredient is "chicken meal". Of course, there is no perfect food, and the more restrictions you must make on the ingredient list, the more constricted you are regarding choice of foods. This, in turn, increases the concern that all nutritional needs are met with a narrow selection.

For general cat health, I have provided the National Research Council's adequate amounts of major nutrients, as well as their preferred, or ceiling numbers for these nutrients. As cats are different than dogs, or humans when it comes to nutrient sources, I have also provided another page of notes based upon scientific study results regarding specific ingredients. There is also a separate page for those wanting to make choices based upon toxicity levels. There are so many theories and belief systems out there that have no basis in scientific fact, that I thought providing those might be of use to owners wanting the ability to make informed choices.
Unlike others who profess to know all without adequate nutritional training, our personal choices here are based upon the recommendation from Jacquie Rand, and over 10 years of successful maintenance of our diabetic cat, along with dietary training history in my own background. Other cats in the house like the food we use as well, which makes it easier to feed multi cat households. We use Royal Canin's Diabetic DS 44 as the main food for our sedentary boys. The caloric content, (dry matter basis), is lower than raw or canned in any food I have compared when assessed by daily needs for nutrients.
On top of the recommended daily allowance on the package of the Royal Canin food, we are finding that to reduce weight at all in our situation we use half the recommended daily maintenance amount. Our boy has remained healthy on 119.5 calories per day this way, and has been on the Royal Canin since it's development at the turn of the century. Here, we have experienced a full diabetic remission for over five years, and when stress returned the need for insulin, the methods we used, (see suggestions below), reduced our diabetic's dosage in less than a year from over 7 units of insulin bid, to 2.5, where he has remained steady for a several months again. Depending upon the cause of this regression in his remission, I am, of course, hoping that the pancreas will again eventually heal to a preference of no insulin injections, but that will be up to his pancreas, not our preferred schedule of needs as the source of pancreatic dysfunction may not want to accommodate our preferences.

As a second addition to the pool of nutrient sources, we have small ¼ can meals of Fancy Feast, and choose the high protein varieties only - Flaked 14%, and Patés that have 11% or 12% listed. This is fed when shots or meds have been provided, as a treat. This allows for fish to be part of the daily diet in a small enough amount not to be a concern, as cats should not have more than 30% fish content based upon questions that develop, and have not yet been satisfactorily resolved in science. We actually provide our boys with a Vitamin E caplet per week, (200IU), to counter this concern, so possibly could feed more, except that we are not comfortable with serving a lot of the Flaked as it contains wheat gluten. Our boys all prefer this diet, and have remained healthy on it for six years, now, since the Royal Canin was introduced to the market place.

In our house, we have two cats who react badly to guar gum in canned food, so use of canned is very restricted for a number of reasons. One needs a fairly large amount of canned food to equate the nutritional supply provided by dry to meet dietary needs as recommended by the NRC in the link above. If the guar gum is pushing food through quickly, it can be a gimmick to reduce weight, which may cause your cat to drop the need for insulin, but it IS NOT, in those situations, providing adequate and complete nutrition.
As is shown on the Pet Food Pitfalls page, there are issues around the inappropriate use of fruits and vegetables added to the "no grains" fad you see on store shelves. The USDA Nutrient Data Laboratory and Nutritiondata.com are two sites that can also clarify for you that there are as many carbohydrates in fruits and vegetables, by weight, as there are in grains - sometimes more. Fruits and vegetables are also inappropriate sources of nutrients for felines. Also, the "fructose" in those foods may cause an 'intolerant' or allergic reaction in your cat, as this often happens in humans. At best, these will be a source of instant sugar that you don't want to be feeding your cat.

NOTE:
When you sharply increase your cat's intake of bioavailable protein, his/her BUN reading could increase a small amount above what is considered "normal range" by laboratories. This does not necessarily mean your cat is developing CRF. In fact, there is a site referring to high protein fed dogs, which lists specific measurements for dogs, which will be similar to cats as this phenomenon is across species.
Timed Feeders Available
So far, we have tried two, both of which work:
One is the PetSafe Automatic Pet Feeders For Dogs or Cats that will cover two feedings at specific times you set. The dial on this was more difficult to use than the Cat Mate C20 Automatic Pet Feeder which allows easier control of the dials. It can also be found on Amazon at times. At present we are awaiting the arrival of the small Ergo Systems Automatic Pet Feeder, which is more expensive, and doesn't get reviews that are quite as good. I will update this site after using it.

02.10.08
Hamlet has settled into using the new feeder, and we are having an added bonus in that he 'bustles' to catch the food before Pepper gets there. As it only provides 8 meals per day, we are still using the old ones to make up the other for servings. For all his sensitivity to carbs and insulin, the only time the carbohydrate content showed any influence on Hamlet's glucose levels during the last curve done a couple of weeks ago, was at nadir, where he went up .2 compared to the reading either side of the carbohydrate influence. For the rest of the day, his numbers were high enough that the small blip didn't show, and, as his numbers stayed within normal range all day, I am very please with the combination of Royal Canin Diabetic, and the two hour feedings.
I have nothing against the ingredients in canned foods, if they are feline appropriate, but I don't feel that I can, in good conscience, recommend them for use as a gimmick to reduce weight because of the low nutrient content, thereby dropping the need for insulin in transient diabetics. For one thing, Canned foods generally have a high fat content and if a person is feeding enough to maintain good health in the cat, usually there is an excessive portion of fat content. Again, as I said above, if the tools aren't there, the body can't heal, and I seriously mean the WHOLE body. With the fat content there is an added concern around the bisphenol-A leaching into the contents from the can lining, and that I do have serious concerns about. The bisphenol-A, (BPA) may exaggerate the impact of the fat according to this advanced scholar:

"If the threat of cancer is too far into the future for you to care, then consider this: BPA causes fat cells to grow larger. That’s right, BPA might make you fat! The fat is deposited around visceral organs, which can lead to diabetes and heart disease."

We do use small portions of canned as treats here, but understand that by doing this we compromise the diabetes somewhat based upon the following study:

The Estrogenic Effect of Bisphenol A Disrupts Pancreatic β-Cell Function In Vivo and Induces Insulin Resistance

"Insulin resistance is a crucial constituent of the metabolic syndrome, and its presence predicts type 2 diabetes and atherosclerotic cardiovascular disease (DeFronzo and Ferrannini 1991). In addition to insulin resistance, type 2 diabetes mellitus is also characterized by a progressive β-cell dysfunction. In most patients, both symptoms are present several years before the onset of hyperglycemia."
which supports the information in the other article, and then there is another page recently forwarded to me by a researcher, here with a number of cited references.

As you can see, we feed according to peer reviewed, scientific studies and reports put out with well documented factual information. We are grateful to have a healthy, ALIVE, boy who lost his heart murmur using low carb, high protein dry food, as recommended by all the accredited experts you find online. His weight is under control, (13 pounds 4 ounce Ragdoll), and whose sensitivity to insulin is great, as is shown with every curve we do.
Perhaps you can understand why certain self proclaimed experts who don't have adequate credentials, (post graduate studies in nutrition and endocrine issues for felines), insist that glucose curves and fructosamines are unnecessary? I speculate that if you are told that, the fear motivating this advice is that it might cause the owners to know what dangers lie ahead.............always look for the research and learn to assess the food for yourself so that you can feed with confidence, as we do after such a long period of success. Most importantly, have a good line of communication going with your own veterinarian, who sees your cat on a regular basis and can help you decide what information is, or isn't accurate.