Q2.4.  Can I free-feed my cat?

A2.4.  Generally, you want your cat to eat around the time he receives his insulin injections.  Some people have set meal times, and others use free-feeding.  Still others put down food at meal times only, but let the cat eat at his leisure.  Insulin type is an important factor in this decision.  Short-acting insulins, such as N (NPH), can be dangerous if the cat has not had a solid meal about half an hour or so before the shot; on the other hand, a cat on a long-acting insulin such as Lantus (insulin glargine) or PZI can follow a "grazing" schedule much more safely.  Most people here would agree that feeding a cat between the time insulin peaks and the next shot is unwise, although a small high-protein, zero-carbohydrate snack such as chicken or tuna should not substantially affect blood glucose.  Whatever you decide, be consistent.

Q2.5  My cat doesn't like / I can't afford the expensive prescription food. Is there any less expensive substitute?

A2.5  Yes. The idea that a diabetic cat must have prescription food is misguided (to say the least), and many people prefer to feed commercial or home-made foods because they are cheaper, or have higher-quality ingredients, or are preferred by their cats.  However, diet can affect insulin requirements, so changes to an existing dietary regimen have to be done carefully for a cat who is already on insulin or pills.  As mentioned above, you should ask your vet if your cat has other medical conditions that need to be addressed with diet.

If you're feeding canned Purina DM, you can substitute any canned cat food which has a similar level of carbohydrate (no more than 10-12% of calories -- mixed with:  1.) a low-fat source of high-quality protein (chicken, turkey, lean beef, egg, the occasional bit of cooked seafood) equal to no more than 20% of the total calories, and 2.) (optionally) 50-100 IU of vitamin E per day.  Keep in mind that this diet may not be appropriate for cats with kidney disease.

If you're feeding dry Purina DM or dry Hills M/D, check out Innova EVO Cat & Kitten, which has about 6% of calories from carbohydrate (warning for guardians of cats with kidney disease: it is somewhat high in phosphorus).

If you're feeding dry Science Diet W/D, any dry food with a similar fiber level will do the trick.  If you're feeding canned Science Diet W/D, Science Diet Feline Light is similar, or you can feed any good quality canned cat food and add extra fiber in the form of psyllium (1/4 teaspoon mixed with 1 tablespoon water) or canned unsweetened pumpkin (1 tablespoon). Check the food tables to make sure the levels of other nutrients, particularly carbohydrate are similar; otherwise, you must make the switch slowly, over a period of several weeks, and monitor your cat's glucose levels carefully.   Changing the diet without changing the insulin dose can result in brain damage or death from hypoglycemia -- be cautious!

In all cases, home-cooking is always an option, so don't feel that you're doomed to feed commercial foods.

The easiest way to give vitamin E is to buy it in liquid form in a bottle or in powder (water-soluble) form in a gelatin capsule (which can be opened and closed).  Another option is to buy the regular 400 IU capsules for humans, and mix the contents of one with the food once or twice a week.   Experiment to find out what's palatable to your cat.   The d-alpha (natural) form is more potent than the dl-alpha (synthetic) form, and if it contains extra selenium, or mixed tocopherols and tocotrienols, so much the better.

Q2.6.  How much should I feed my cat?

A2.6.  As many calories as your cat needs to maintain a healthy weight; typically 15-25 calories per pound of ideal weight, depending on your cat's activity level.   Cats who require fewer calories may benefit from more nutrient-dense foods so that they do not develop nutritional deficiencies.  Unregulated cats may require more food at first because they are not able to properly metabolize what they are eating.  

3. INSULIN

Q3.1.  What kinds of insulin are there?

A3.1.  Insulin comes in all sorts of varieties.  Some are human insulins, and some are animal insulins, usually beef or pork. Some have fairly short durations (N, NPH, Novolin Insulatard), some medium (Lente (now discontinued), Caninsulin, Novolin Monotard (now discontinued)), and some animal-based NPH), and some long (Ultralente (now discontinued), Novolin Ultratard (now discontinued), PZI, Lantus (insulin glargine), and Levemir (insulin detemir)).  For more information, see the Pets with Diabetes page.  We strongly recommend that you avoid using a short duration insulin as your first insulin, because of the significant risk of hypoglycemia.  If your cat does not respond well to the human insulins, many cats here have obtained excellent results from beef insulin (which is closer biochemically to feline insulin), most notably the PZI duration.  For cats who do better with beef insulin but have problems with the PZI lasting too long, Beef Lente (also known as UK Lente) is available from the Wellington Pharmacy in London.

Q3.2.  Where can I get PZI insulin?

A3.2.  For lots of good details on where to find PZI, see the PZI page at the Feline Diabetes website. Be aware that not all PZI formulas are  beef- or pork-based; most people who switch to PZI do so because human insulin is not working for their cat, so be sure to ask!  The Professional Arts Pharmacy in Baltimore only compounds human insulin, for example.

Q3.3.  What can I expect to pay for PZI insulin?

A3.3.  UK PZI is currently $63 per bottle (U-100) plus $50 shipping for up to 25 bottles; Blue Ridge is around $60  (U-40, which is much more dilute; minimum order 3 bottles), but your vet may mark up the price.  BCP is $58 per bottle (U-100) plus $10 shipping (Fed-Ex overnight).  Summit is CDN$25 per 5 ml bottle (U-100) plus $5 shipping, next-day delivery.

Q3.4.  What kind of syringe should I use?

A3.4.  Most people here have been satisfied with BD Ultra-fine U100 3/10 cc, Monoject  Ultra Comfort (available from diabeticpromotions.com), or Walmart ReliOn Ultra Comfort.  The latter two measure half-units, are manufactured by the same company with different branding, and are less expensive than B-Ds, with ReliOns being less expensive than the Monojects.  Get the finest needle possible, which is 31 gauge.  Some people have difficulty with the longer (1/2 inch) needles and recommend the 3/8 inch needles to avoid shooting "through the tent"; others experience the opposite problem with shorter needles not delivering the insulin properly, so experiment to find out what's right for your cat.  If you're giving a U-40  insulin, either use the appropriate syringe, or use a conversion factor for giving U-40 insulin in a U-100 syringe.

Q3.5.  Do I need a prescription for insulin or syringes?

A3.5.  Probably not.  Check the chart at the Children with Diabetes site for more information on your state or country.  But even if your state requires a prescription, you may still be able to get supplies via mail order.

Q3.6.  Can I reuse syringes?

A3.6.  Although some people do reuse (generally not more than once), most people here recommend against it.  After the first injection, the needle is no longer sterile, (which can contaminate the insulin and promote infection in the cat), and the coating is degraded.  Take a look at the picture of a reused needle and decide for yourself.  If cost is an issue, try a generic brand.

Q3.7.  How do I dispose of used needles?

A3.7.  Laws vary from one location to the next, and your vet or local waste removal facility should be able to give you appropriate advice.  Some vets will dispose of the needles for you.  The safest way to keep them until disposal is to get a strong plastic "sharps" container which you can purchase at your pharmacy.  You may also want to buy a clipper so that you can dispose of the needle separately from the syringe.

Q3.8.  My cat hates getting his shot.  Now what?

A3.8.  Make sure you're using the thinnest possible needle -- 31 gauge is the thinnest, and 30 gauge is usually acceptable, but many people report success with 29 gauge.  You also need to make sure you aren't hitting a muscle; the insulin is supposed to be deposited under the skin.  To brush up on your injection techniques, and learn new techniques, check out Feline Diabetes, Pet Diabetes, the Auburn University page,  and Jamie's explanation.

Q3.9.  How long does a bottle of insulin last?

A3.9.  Unopened insulin is good until the expiration date when handled gently, stored at the manufacturer's recommended temperature range (36º to 46º F for Humulin vials), and kept covered from light. However, an insulin bottle which has been used, will need to be replaced before the expiration date. There are several reasons for this, including exposure to possible contaminants when the rubber seal is punctured, exposure to oxygen, and imperfect mixing (which may change the concentration of the insulin, even when care is taken to mix well).  Because of this, it's always a good idea to inspect your insulin.  Material settled on the bottom after mixing, or clumps, indicate potential problems.

Eli Lilly, the manufacturer of Humulin insulin, recommends replacing Humulin vials within 28 days after opening.  Many people on the FDMB view this recommendation as overly conservative for single-user vials, and have found that Humulin is often good for somewhat longer. Some people on this board do replace Humulin vials every 4 weeks. Others replace every 6 weeks, every 8 weeks, or when they notice reduced glucose control.

Lantus has mixed reviews, with some people observing that it doesn't last more than a month, and others getting greater usage from it.  A pack of 5 3-ml cartridges may be more cost-effective than the 10 ml vial, even though the up-front expense is higher.

The consensus on the board is that animal-source PZI (protamine zinc insulin) lasts longer than Humulin insulin. Many people here use PZI until the bottle is empty. PZI which has been diluted with sterile saline solution by a vet, pharmacist, or consumer should be replaced every 30 days.

Q3.10. Sometimes I can't be home to give one of my cat's shots; is it okay to give it late or early?

A3.10.  In general, you should keep on a schedule for giving injections. If you give the shot once a day, do it at the same time every day. If you give shots twice a day, do it at the same time twelve hours apart. However, occasionally giving insulin an hour earlier or later isn't likely to cause any trouble. If you need to vary the timing by more than this, it may be prudent to give a reduced dose (at the previous shot if you need to shoot early, and at the current shot if you need to shoot late). If your schedule never permits you to shoot 12 hours apart, you may need to experiment with different morning and evening doses, or even use different types of insulin for the morning and evening shots; however, you'll need to hometest your cat's blood glucose to determine a safe approach.

Q3.11. How much insulin should my cat be getting?

A3.11.  As much as he needs to keep him regulated.  This could be anywhere from 1/4 unit to 10 units twice a day (or even more for cats with rare health conditions such as Cushing's disease or acromegaly.)  A survey once carried out on the FDMB suggested that most cats will not need more than 4 units twice a day if on a low-carbohydrate diet or 8 units twice a day if on a high-carbohydrate diet.  The Cornell Feline Center recommends that "Cats requiring excessively high insulin doses (greater than one to two units of insulin per pound per day) should be evaluated further."

 4.  MONITORING YOUR CAT -- GLUCOSE

Q4.1.  How can I monitor how well the insulin is working?

A4.1.  Many people on this board recommend home-testing for blood glucose.  You will find excellent details, with pictures, at Harry's page (http://www.sugarcats.net/sites/harry/bgtest.html), more tips are available at Bob & Simon's page,  a short movie can be found at Terry & Punkin's page, and a longer movie is at the Veterinary Information Network.

Secondarily, you can monitor your cat's urine, which will tell you if glucose is high at some point during the day, but will not tell you if your cat is getting too much insulin and the blood glucose level is dropping dangerously low.  One very good method for monitoring a cat who is not being hometested besides urine strips is to keep track of the amount of water being consumed; increased consumption usually means that blood glucose is too high.  Finally, you should watch your cat for unusual attributes, such as excessive urination,  rough coat, or dilated pupils, and learn what this tells you about your individual cat's glucose levels.

Q4.2.  What kind of glucometer should I get?

A4.2.  Most of the regulars here use either the Bayer/Ascensia Elite or Elite XL (but see the caution below), LifeScan OneTouch Ultra, or AccuChek Advantage with only the Comfort Curve strips.  A newer model requiring even less blood, the TheraSense Freestyle, appeared promising at first, but our experience is that it can substantially underestimate blood glucose values (if you already own one, don't panic, but be aware of this problem). You want a model that only requires a small amount of blood (2-3 microliters) and which has "sipping" action; it may cost a little more, but it will make your life tremendously easier.  One online source of glucometers which has good prices is diabeticpromotions.com, and another is hocks.com.  You can also get the glucometer at pharmacies, Walmart, Costco, or any similar store.  There's often a rebate coupon included.  Occasionally, you can even get a meter free if you buy 100 test strips.

Caution on Bayer Ascencia Elite meter: The Bayer Elite is generally a good meter, but it has the bad habit of beeping before the strip is filled with blood, leading people to withdraw the strip prematurely and obtain a false low value.  See Terry's graphic of how full the strip should be for a reliable reading.

Q4.3.  How often should my cat's glucose levels be tested?

A4.3.  As often as is convenient for both of you. Many people test before every single shot, usually because past experience with hypoglycemia has made them cautious. Some people do sporadic testing, but run a curve every couple of weeks (or less often if the cat is regulated).  If you choose to do this, the best times to check are right before the shot and around the time that glucose reaches its low point, typically from 4 to 6 hours post-shot. Some people only test if something is clearly wrong (for example, strange behavior, lethargy, or increased urination) and they need to know what the problem is.

Q4.4.  My cat's pre-shot level was way below the usual value.  Should I give the injection?

A4.4.  There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.   Below 150 mg/dl (8.3 mmol/L), don't give insulin.  Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.  Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.  In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.  Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.  Keep in mind that these are general guidelines, and they should be personalized to your own cat's reactions to insulin.  If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then your experience should be your guide.

Q4.5.  I'm not from the United States, and I don't understand your units of measurement.  My cat couldn't have a blood glucose of 300 even if you soaked her in honey for a week.

A4.5.  Americans have only recently switched from the traditional scruples/quart to the metric mg/dl.  While we were busy patting ourselves on the back for being sophisticated, the remainder of the world moved on to the international system (SI) and now measures blood glucose in mmol/L. Just divide the American values by 18 to see what's really going on.

Q4.6.  I'm following the instructions faithfully, but I still can't get blood from my cat's ear.

A4.6.  In addition to the excellent tips in the above links, here are some extra suggestions:

• Jerri & Opie's Rice Sock: Warm the ear using a sock filled with uncooked regular rice, barley or oatmeal which has been warmed in the microwave (test on wrist to ensure it's not too hot). 
  
• Alternatively, use a small jar filled with hot water - kitty's ear may fit neatly around this curve, or a ziploc baggie with wet paper towel inside warmed in the microwave, or a heat lamp behind the cat's ear to keep it warm (not too close!).
• Or just massage the ear a bit to get the blood flowing.

• Hold something solid against the back of the ear to hold it in place.  (A flashlight can serve double-duty here.)
• Get as close to the edge of the ear as possible.

• If using a lancet device, use the middle depth setting on the lancet device if adjustable. You can adjust depth up or down as needed with experience - you do not want to pierce through the ear although this is not harmful.
• Hold lancet device firmly against the ear.
• If doing a manual ear prick, be sure to prick the ear at a shallow (45-degree) angle, not straight down.

• Fold the ear over the wound, or pinch the ear gently on either side, to help the blood well up.
• If the drop is not forming properly, gently "milk" the ear on either side of the prick by stroking towards the prick, bringing the blood to that area.
• You may attempt to add more warmth to increase size of blood drop depending on your heating method.

• Sometimes it helps to make 2 pricks side by side one after the other to ensure you get enough blood from one or both.
• Try using the other ear.

• To prevent bruising, apply firm pressure on the ear prick with a tissue while waiting for the meter to count down.

Be sure to give your cat a hug and/or a treat afterward to reinforce the idea that this can be a pleasant experience!

Q4.7.  My cat has been off of insulin for several days, and I'm getting glucose readings in the 40s and 50s (2.2-3.3 mmol/L).  Should I treat him for hypoglycemia?

A4.7.  Congratulations!  As long as you're sure your meter readings are based on full test strips, then it looks like your cat is on a  honeymoon.  Although lab printouts indicate that 70-120 mg/dL (4-7 mmol/L) is normal, we have observed that non-diabetic cats can typically have lower values on our meters.  As long as your cat is not showing any symptoms of hypoglycemia or signs of distress, all is well.  You might want to monitor his blood glucose values for the next week or so; after that, occasionally monitor his blood and urine for glucose. Also, you need to keep a close eye on his drinking habits and general health, because it's always possible that this is temporary.  In the meantime, enjoy!

Q4.8.  Are there other signs besides blood glucose that I can monitor at home?

A4.8.  There's no substitute for knowing your cat's blood glucose.  But it's always a good idea to keep the "whole cat" in mind.  Signs that your cat may not be getting enough insulin include excessive urination, high glucose in urine (although for some cats it's always high), weight loss, lethargy, depression, dull or dry fur, dandruff, lameness (may indicate neuropathy), and change in pupil size (for some cats).  Signs that your cat may be getting too much insulin include all the symptoms of hypoglycemia, sleepiness or lethargy an hour or two after receiving insulin, all the symptoms just mentioned for hyperglycemia (if he is suffering from chronic rebound), and little or no glucose in the urine.  Signs that your cat is doing well include the 5 P's [purring, playing, peeing (normally), pooping (ditto), and preening], as well as normal appetite and thirst.

Q4.9.  I'm interested in home-testing, but my vet won't let me.  What should I do?

A4.9.  You don't need your vet's permission to home-test.  Ideally, of course, you and your vet should have a partnership in the care of your diabetic cat.  But many vets aren't familiar with home-testing, or they're worried that the client will arbitrarily change the dose of insulin.  Your vet may be persuaded to change his or her mind by the following articles by veterinarians: Capillary blood collection valuable tool in at-home diabetes management; Blood glucose monitoring; Home Testing of Blood Glucose for Diabetic Cats;  or Home Blood Glucose Testing for Diabetic Cats.  If not, and you still want to home-test, you have that right.  After all, human diabetics wouldn't dream of injecting insulin without monitoring their blood glucose, and no reputable physician would recommend against it.

5.  MONITORING YOUR CAT -- KETONES

Q5.1.  What are ketones?

A5.1.  Ketones are a source of fuel manufactured from fatty acids by the liver and utilized by the body when glucose is unavailable due to a lack of insulin or glucose supply.

Q5.2.  How often should I test for ketones?

A5.2.  If your cat is well-regulated and behaving normally, test for ketones on an occasional basis.  However, if your cat has been refusing to eat or seems ill,  you should test for ketones as soon as possible.  Ketone testing should be part of standard diabetic care.

Q5.3.  How do I test for ketones?

A5.3.  Ketones are tested in the urine using Keto-stix (R) or Keto-diastix (R), which you should be able to buy in the diabetic supplies section of your local pharmacy.  If you can catch your cat on the litter box, you can either hold the end of the stick in the urine stream, or collect the urine in a small paper cup and dip the stick in (for a female cat, a deep plastic ladle kept by the litter box may be helpful for urine collection).  If you see any signs of ketones, contact your vet right away.

Q5.4.  How are positive ketone readings usually treated?

A5.4.  The remedy depends on the reason ketones appear but it will either involve feeding more food to anorexic kitties, a switch to a 2 injection schedule, a longer duration insulin or a higher insulin dosage or a combination of any of the above.

Q5.5.  What is Diabetic Ketoacidosis?

A5.5.  Diabetic ketoacidosis is a life threatening condition caused by an accrual of too many ketones in the bloodstream altering the pH and blood chemistry.  As the condition worsens, dehydration, anorexia and vomiting usually appear.  If untreated, seizures and then death occur. Crisis treatment includes restoration of the blood chemistry through hydration and electolyte replacement and returning the main fuel source back from ketones to glucose by using small doses of fast acting insulin and a glucose drip.

6.  REGULATION

Q6.1. What is regulation?

A6.1.  There are different definitions of regulation.  As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of.  Janet & Fitzgerald propose the following "regulation continuum":

• Not treated [blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs]
• Treated but not regulated [often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs]
• Regulated [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia]
• Well regulated [generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia]
• Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin]
• Normalized [60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin]

There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin.  We don't know why it happens, but such a cat probably should not be considered to be regulated.  On the other end of the spectrum, it is possible for a cat who is not getting insulin to have blood glucose as low as 40 mg/dl (2.2 mmol/L) on a home glucometer.  If you have a non-diabetic cat, try testing her with the same meter to get a safe comparison figure.

Q6.2.  Which definition of regulation should be my goal?

A6.2.  That depends on your individual situation.  Generally, it's thought that a cat will suffer less long-term organ and nerve damage if his average blood glucose is lower rather than higher.  However, because preventing hypoglycemia is a top priority, it may not be practical to try for normal numbers.  The ability of your cat to respond to food and insulin in a consistent manner and your own ability to monitor your cat are both important factors in setting your goal.  For most cats who are receiving insulin, "regulated" is a reasonable first goal, after which you can try for "well-regulated".  For the lucky minority who can be diet-controlled, normalization is often achievable.  It’s important to realize that some cats never consistently stay in regulation range in spite of all efforts, and yet they can be happy and healthy anyway.  Ultimately, you should tailor your goals to your cat's individual situation, and you should always consider your cat's quality of life as well as the numbers as you evaluate how well your treatment protocol is working.

Q6.3.  How do I achieve regulation?

A6.3.  We recommend following a systematic protocol, the “Start Low & Go Slow Approach”. This method has been tested and improved by hundreds of members of the Feline Diabetes Message Board over the years, and it typically produces improved blood glucose control, without risking rebound or hypoglycemia.  

Q6.4.  My cat has been on insulin for a while and her diabetes is still out of control. Why can’t I regulate her?

A6.4.  The most common causes for poor control of blood sugar are:

• Somogyi rebound from too much insulin-- especially if the insulin was started at more than 2 units twice per day, and/or was increased more frequently than 0.5 unit every 7 days.  In some cats, rebound occurs at normal or high blood sugar levels, keeping blood glucose levels high all the time.  For more on Somogyi rebound, see Gorbzilla's mini-FAQ and Steve & Jock's Wikipedia page.
  
  
• Wrong insulin type for your cat (especially Humulin 70/30 or Humulin N (NPH), which don’t last long enough for many cats).

• Wrong insulin schedule for your cat (most commonly, shots once per day when the cat needs them twice per day).

• Not enough insulin -- the insulin dose needs to be increased, slowly and cautiously.
  
  
• Food issues (e.g., constant free feeding on high-carbohydrate food such as Hills W/D or inconsistency in feeding times, amounts and/or types of food)
  
  
• Poor or irregular absorption of insulin (may happen with long-lasting insulins or injections in the scruff)

• Ongoing infection or inflammatory condition (for example, dental problems, subclinical pancreatitis, or urinary tract infection) which is keeping the blood glucose values high.

Other medical issues (such as insulin resistance, acromegaly, and Cushing’s disease / hyperadrenocorticism) may also cause obstacles to regulation. These problems are relatively uncommon, and should not be prime suspects until the more common causes have been ruled out. More details can be found at The Hard-to-Regulate Pet.

If a previously regulated cat suddenly starts showing poor response to insulin, two likely reasons are infection and loss of potency of insulin.

A6.5.  Tight regulation refers to using insulin to keep a diabetic cat's blood glucose levels within normal or near-normal ranges as much of the time as possible.  This approach to regulation is very controversial because of the high perceived risk of hypoglycemia.  However, it is not merely an exercise in vanity; keeping blood glucose in this range is thought to reduce long-term damage to the organs and nerves.  Additionally, some people believe that diabetic cats kept in or near a normal glucose range have a higher chance of achieving diabetic remission, especially if so controlled during their first year after diagnosis.  (An alternative explanation, though, is that the cats who achieved remission might have done so under almost any insulin regimen as long as they were fed a low-carbohydrate diet.)  The downsides are that heavy monitoring is often required, and that some cats simply cannot be tightly regulated no matter how hard the human tries.  If you are interested in this technique, the Feline Diabetes Message Board has a special forum for discussing it.

Q6.6.  Is remission possible?

A6.6.  It is possible for some diabetic cats to be controlled without insulin.  There is increasing anecdotal evidence that a low-carbohydrate diet (5-10% of calories from carbohydrates) and perhaps a short course of insulin can result in a cat whose diabetes can be controlled by diet.  However, this can't be guaranteed for any specific cat.  Our historical estimate is that about 1/3 to 1/2 of newly-diagnosed cats may respond this way, and whether your cat belongs to this group is a matter of luck.  There is also preliminary evidence which suggests that this rate may be higher in cats who are given Lantus (insulin glargine). Remission is also possible for steroid-induced diabetics; in some of these cats, pancreatic function resumes over time.  

Q6.7.  I just can't get my cat's glucose into regulation range -- is he doomed?

A6.7.  Not necessarily.  Your cat may benefit from a different approach besides the standard twice-a-day fixed dosing.