Elizabeth and Bertie
Very Active Member
Welcome, UK Member. 
Please know that diabetes is treatable! With good care a diabetic cat can often live as long and as happily as a non-diabetic. What's more, quite a lot of cats have the potential to go into 'remission' from their diabetes and become diet-controlled diabetics.
THE MOST IMPORTANT THINGS TO KNOW AND DO FIRST...
This is a long post, and let's face it, you may not read it all,
. So I'll briefly summarize the most important things here, and you can read on further for more detail. Let's get started...
1. MAKE A HYPO KIT. Hypo may never happen to your kitty, but it's wise to be prepared in case you need to raise blood glucose in a hurry. You'll need some liquid glucose, syrup, or honey. And it would be good to have some high carb food in gravy. Get a few little tins of Gourmet Gold 'in gravy' food. High carb palatable treats are good too, such as Webbox 'Lick-e-licious' salmon cat treats.
Also make sure you have plenty of test strips for your glucose meter. You don't want to run out in an emergency. See further down the page for how to deal with hypos...
2. TEST FOR KETONES. Get some ketone test strips from a pharmacy and test your kitty's pee on a regular basis. Anything above a 'trace' result is a reason to talk to your vet ASAP.
3. LEARN TO HOMETEST BLOOD GLUCOSE. 'Hometesting' may sound a bit daunting at first, but it saves lives and makes managing diabetes so much easier. Most people can do it. And most cats can be tested. It shouldn't hurt them. And they'll still love you. Honestly.
Most of us use ordinary glucose meters made for humans.
4. FEED AN APPROPRIATE LOW CARB DIET. If your cat is already on insulin learn to hometest before switching to low carb. (You may need to reduce the insulin to avoid hypo...) If your kitty is waiting to go onto insulin you can switch to low carb first. There's a link to a low carb food list further down the page.
5. DOES YOUR KITTY HAVE NEUROPATHY? (Weak back legs?). It's caused by nerve damage. Supplements of methyl B12 can really help with healing.
6. THE 'THREE KEYS' TO MANAGING DIABETES. In a nutshell, the three main keys to optimal diabetes management are;
Hometesting of cat's blood glucose
Appropriate low carb diet
Insulin
OK, that's the summary over. Let's look at things in more detail...
When dealing with diabetes 'knowledge is power'. So it's a good idea to spend some time learning how to best manage your cat's condition. Further down the page there's info on urine and blood testing, blood glucose levels, insulin types, diet and treats, obtaining supplies, glucose meters, and other miscellaneous info.
URINE TESTING
KETONES: It is advisable to monitor all newly diagnosed diabetic kitties for ketones; and also to check again whenever the kitty seems unwell or is off her food.
Ketones, (created when the body breaks down fat for energy) are dangerous for diabetics, and can lead to a life-threatening condition called DKA (diabetic ketoacidosis). Fortunately, testing for ketones is simple, and just involves dipping the end of a ketone test strip into a drop of pee, timing it, and reading off the result. Anything above a 'trace' result is considered to be a reason to talk to your vet, ASAP.
Crumpling clingfilm loosely in the litter tray (over the litter) is often a good way to catch a pee sample.
'Ketostix' or 'Keto-Diastix' should be available from most pharmacies. 'Ketostix' test only for ketones, 'Keto-Diastix' test for ketones and for urine glucose. (The latter may be useful if you are not testing your cat's blood glucose at home. But it doesn't give 'real time' information about your cat's blood glucose. It only shows you how much glucose your kitty is excreting in her urine since the last time she peed.)
Note: Be aware that not all ketones are registered by the ketone test strips. If you notice that your kitty's breath smells fruity or like acetone this can also indicate ketones.
If your kitty has had DKA (diabetic ketoacidosis), or has previously tested positive for ketones, then you may wish to invest in a ketone blood test meter. This is more accurate then the urine test strips. Some UK folks recommend the the 'On Call GK Dual' ketone meter, available from Amazon.
Some helpful info on urine testing from the Sugarpet website:
http://www.sugarpet.net/urine.html
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HOMETESTING BLOOD GLUCOSE
FDMB strongly recommend 'hometesting' (testing your cat's blood glucose at home).
Once learned, hometesting can quickly become completely routine. However, while some people (and their cats) take to it like proverbial 'ducks to water', others do find it a little harder to get the hang of at first. Be patient. You will 'get it'! And most cats come to be just fine with the process - especially if they are rewarded with treats...
In a nutshell, testing typically involves pricking the outer edge of your cat's ear to get a teensy weensy drop of blood, transferring that blood to a test strip in a glucose meter (the end of the test strip will suck up the drop of blood from the edge of your cat's ear), and reading off the result on your glucose meter. Then reward your cat with a treat or a cuddle. Job done!
FRUCTOSAMINE TESTS - Your vet will probably have done a fructosamine test on your kitty as part of the process of diagnosing the diabetes. It is very useful for this. But, once a kitty is on insulin the fructosamine is far less useful and can even be misleading. That is because it only gives an indication of 'average' blood glucose levels over the preceding couple of weeks. But it shows no detail at all, so doesn't tell us about the highs and lows along the way. This is why hometesting blood glucose on a regular basis is SO important...
Want to give hometesting a try? Great! Scroll down the page for information on glucose meters in the UK.
And you can get lots of advice about testing on the main forum. Just ask.
IMPORTANT BLOOD GLUCOSE INFO FOR NEWCOMERS
For newcomers to feline diabetes it is generally recommended here that NO insulin is given if the blood glucose is below 11 mmol/L as measured on a human glucose meter. If you're using the Alphatrak meter you may want to raise that number a tad.
If it is just a little too low you can wait for 20 - 30 minutes without feeding to see if the blood glucose comes up high enough to give the shot.
This initial 'no shot' number of 11 mmol/L is just to try to give some buffer of safety while you're learning to hometest blood glucose, and learning how the insulin is working in your cat's body.
Note: If your cat has had ketones different advice may apply. Ask on the forum if you need more info.
The normal blood glucose range for a non-diabetic cat is considered here to be around 2.7 to 6.6 on a human meter, or 3.6 to 8.3 on a pet meter such as Alphatrak. The numbers you aim for will depend on the insulin you're using, your experience, and your own cat's response to insulin. You may or may not be able to aim for numbers toward the lower end of the normal range while using insulin. Safety is key!
HYPOGLYCEMIA
Numbers below 2.7 on a human meter, or 3.6 on an Alphatrak can be considered potentially hypoglycemic; and if you see these numbers, or your cat's blood glucose is dropping fast toward these numbers, appropriate action must be taken to keep your cat's blood glucose at a safe level.
Your 'Hypo Kit'
You may well never need this, but it is really useful to put together some supplies in case you do need to deal with hypo.
It is vital to ensure you have some source of simple sugar available, such as honey or liquid glucose. It's also good to have some high carb food such as the Gourmet Gold ‘in gravy’ foods here: UK, high carb gravy food for Hypo Kit. (Make sure you get the 'gravy' ones, the 'pate' ones are low carb.) The gravy is the most useful bit; you can squish the food down with a spoon and scoop the gravy up.
The Webbox 'Lick-e-Lix' liquid treats are also good. They vary in carb content but the highest carb are the yoghurt ones, of which the Chicken and Salmon seem easiest to obtain.
Also be sure that you have plenty of spare test strips for your glucose meter, and maybe a spare battery too.
Note: Glucose or honey rubbed onto the gums is the fastest way to raise blood glucose in an emergency.
Emergency HYPO INSTRUCTIONS ~ see link immediately below:
How to treat HYPOS - THEY CAN KILL! Print this Out!!
If you think your cat’s blood glucose is dropping too low please post on the forum, or call your vet for advice.
INSULINS IN THE UK - and other diabetic supplies:
Your vet might prescribe an insulin made for animals, or one made for humans.
The ISFM (International Society of Feline Medicine) and the UK's RVC both recommend the use of longer-lasting insulins, Prozinc, Lantus/glargine, or Levemir/detemir, over lente insulins such as Caninsulin for new cases of feline diabetes. (Of these, Prozinc is the only longer-lasting insulin actually licensed for cats in the UK.)
For more on the ISFM's and the RVC's guidelines on managing feline diabetes, please scroll to the 'USEFUL REFERENCE' info toward the end of this post.
There are two insulins licensed for cats in the UK, Caninsulin, and Prozinc. If it turns out that a veterinary insulin isn't controlling the diabetes sufficiently well your vet is able, by law, to prescribe a human alternative. However, some vets are unwilling to prescribe a human alternative. And, despite the UK guidelines that the first insulin prescribed should be one that is licensed for cats , a teensy weensy minority of vets (who prefer to use human insulins) will actually prescribe a human insulin as the first choice.
Attitudes between vets vary a lot when it comes to prescribing insulin for your cat...
VETERINARY INSULINS
Caninsulin and Prozinc are the the most commonly prescribed insulins for cats in the UK.
The RVC has said the current guidelines are that all newly diagnosed cases be prescribed Prozinc, the only long-lasting insulin in the UK currently licensed for cats.
Cats who are currently on Caninsulin and who are not doing well on it may benefit from switching to Prozinc (or one of the human insulins, such as Lantus or Levemir).
The RVC's research found that Prozinc can drop the blood glucose more slowly and last longer in the cat's system; thereby giving overall better glycaemic control than Caninsulin. This can lead to improved clinical signs, and an increased chance of remission. (Recent research has proved what some of us have long observed - that Prozinc has similar remission rates to the human insulin, Lantus.)
Even so, many vets still seem to prescribe Caninsulin. Prozinc has only been available in the UK for a couple of years, and old prescribing habits seem slow to change. Caregivers may need to be pro-active in specifically asking their vet for Prozinc.
SYRINGES
Caninsulin and Prozinc are U40 insulins; that means they have 40 units of insulin per ml of liquid. They are used with corresponding U40 syringes.
Syringes are usually far cheaper to buy online than from your vet. You could use the Caninsulin or Prozinc branded syringes, but many UK'ers use the generic U40 syringes as they are very much cheaper. However, these are all 0.5ml which, while the same size as the Caninsulin syringes, are larger than the (0.3ml) Prozinc syringes.
There are some generics made by VetUK, and there are also 'Sol-Vet' syringes, which cost a little more. (Some UK folks consider that the Sol-Vet U40's have clearer markings and sharper needles):
VetUK U40 syringes: https://www.vetuk.co.uk/veterinary-...nsulin-syringe-with-needle-box-of-100-p-11335
Sol-Vet U40 syringes: https://www.petdrugsonline.co.uk/sol-m-u40-insulin-caninsulin-syringes-0-5ml
https://www.viovet.co.uk/SOL-V-Insu...u-bmMgyt3OomMGToKpkmtKE0G7ktXXvhoCklAQAvD_BwE
For basic information on using, handling and storing Caninsulin and Prozinc see the FDMB info stickies in the Caninsulin and Prozinc subforums (links below). You can also post in these forums for advice specific to your insulin. But if you need help quickly please post in the main health forum.
Beginner's Guide to Caninsulin (Vetsulin)
Caninsulin/Vetsulin subforum: http://www.felinediabetes.com/FDMB/forums/caninsulin-vetsulin-and-n-nph.19/
BEGINNER’S GUIDE TO PROZINC/ PZI INSULIN FOR DIABETIC CATS
Prozinc/PZI subforum: http://www.felinediabetes.com/FDMB/forums/prozinc-pzi.24/
HUMAN INSULINS
If a veterinary insulin is not producing good results in your cat your vet can, by law, prescribe insulin that is made for humans, such as Lantus/glargine or Levemir. These insulins can often produce longer, flatter, blood glucose curves than the veterinary insulins.
The human insulins - Lantus/glargine and Levemir are U100, and have 100 units of insulin per ml. They are used with the corresponding U100 syringes.
Most UK'ers use BD U100 syringes with half unit markings ('BD microfine + demi' syringes). The cheapest place to buy them currently (July 2019) is online at Alldaypharmacy:
http://www.alldaypharmacy.co.uk/products/BD-Micro%2dFine-Demi-0.3ml-Syringe-0.3mm-(30G)-x-8mm-Box-of-100.html
For basic info on Lantus and Levemir see the info stickies on the Lantus and Levemir forum. And you can also post on this forum for advice specific to your insulin.
Lantus and Levemir subforum: http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/
UK BLOOD GLUCOSE METERS
You can use a glucose meter made for pets or one made for humans. Both are fine. They do however 'read' the blood glucose slightly differently. It's important to be aware of this.
The most popular human meter for kitties in the UK currently (March 2020) seems to be the SD Codefree. This has a reputation for being the cheapest to use. However, there is now a new meter made by the same manufacturer, the Gluco Navii. The new meter appears to have a couple of advantages over the SD Codefree. It takes a smaller blood sample, and is advertised as having improved accuracy.
https://www.amazon.co.uk/GlucoNavii-Blood-Glucose-Monitor-Starter/dp/B082MP5XN5/ref=sr_1_4?keywords=sd biosensor gluconavii&qid=1583674045&s=drugstore&sr=1-4
Other popular human meters include the Accu Chek meters, and the One Touch Verio meters.
The most popular pet meter is the Alphatrak. This is a nice meter but probably the most expensive to use.
The main cost of testing is the test strips. The SD Codefree is currently the cheapest meter to use. The Alphatrak is probably the most expensive.
Pet meters, such as Alphatrak, usually give slightly higher readings than human meters, and may give readings closer to those that you would see at your vet's clinic. They are typically more expensive to use than human meters. The GlucoRx Vet meter, from Wellnostics, is a cheaper alternative to the Alphatrak.
If you use a PET meter please let people here know this if you are asking for advice. And add that you are using a pet meter to your 'signature'.
Human meters usually give slightly lower readings than pet meters. And they may give a reading slightly lower than your vet might get. They are usually cheaper to run (sometimes much cheaper) than pet meters such as Alphatrak. Most people here currently use human meters.
Note: All of the insulin dosing protocols used here were devised using data from human glucose meters. So an adjustment will need to be made if you are using a pet meter.
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WHAT TO FEED A DIABETIC CAT?
FDMB recommends that diabetic cats eat wet/canned/raw foods that have less than 10% calories from carbohydrates. (And some cats do best on carb levels in the region of 4% - 6%.). See below for a list of low carb UK foods.
If your cat has other health issues, for example kidney disease, IBD, or pancreatitis, this may further affect your food choices.
A note of caution about switching to a low carb diet...
If your cat is already on insulin and is currently eating a higher carb food then we recommend that you only transition to lower carb food if you can hometest (test your cat’s blood glucose at home) and are able to monitor the effect of the change on your cat’s blood glucose.
That’s because lowering the carb content of the diet can greatly reduce your cat’s blood glucose level, and the insulin dose may need to be reduced accordingly.
Too much insulin can cause hypoglycaemia.
If your cat has not yet started on insulin this is the perfect time to transition safely to low carb wet food. Be sure that your cat's blood glucose is properly tested after the diet change, so that any reduction in blood glucose can be taken into account when deciding the insulin dosage.
POPULAR FOODS
Current favourites (July 2020) include: Nature's Menu, Butcher’s Classic, Sheba 'fine flakes', Lily’s Kitchen, Thrive complete; and from Zooplus: Smilla, Granatapet, Catz Finefood, Feringa, Macs, Animonda. (For more details on these foods click on 'UK Food List' link below.)
POPULAR ONLINE SUPPLIERS include: Zooplus http://www.zooplus.co.uk/; Bitiba http://www.bitiba.co.uk/; Nature’s Menu http://www.naturesmenu.co.uk/; Fetch (offshoot of Ocado): https://fetch.co.uk/
UK FOOD LIST <<< click on link for a long list of foods
Note: Be aware that some apparently low carb foods might still spike your cat's blood glucose levels. There are a number of possible reasons for this, but it may be due to a food intolerance (not uncommon).
Sometimes, finding out what works for your cat will be a matter of 'trial and error'.
LOW CARB CAT TREATS/REWARDS
Many of the most popular commercial cat treats are laden with carbohydrates. Avoid if possible.
Try to stick with treats that are entirely made from meat or fish. These are the lowest in carbohydrate.
Popular freeze dried treats include; Thrive, Pet Munchies, HiLife 100% meat, Wilko freeze dried treats, Orijen freeze dried treats, Iams 'naturally' pure meat treats. Also from Zooplus; Zoolove 'cat snacks', Cosma snackies (avoid the Cosma ‘Thai’ treats as these contain rice.), Wild Freedom lamb lung or chicken hearts (chicken hearts are a great source of taurine too!), Purizon cat snacks.
Another option is the semi-moist treats, often in stick form. These tend to be a bit higher in carbohydrate but should still be below 10% cals from carbs (often below 5%). Nature's Menu 95% meat treats, Waitrose 7 deli snack sticks, Tesco cat sticks, Asda tiger '6 Stix', Webbox 'tasty sticks'. And from Zooplus, Feringa meat/fish cat sticks, Feringa fish snacks, Tigeria cat sticks, Catessy cat sticks, Sanabelle tasty treats.
Little pieces of plainly cooked or raw meat, or cooked fish, also make good treats. And some cats like a tiny piece of cheese or a lick of plain unsweetened yoghurt.
Treats to hide tablets in - and make pill-giving easier;
Nature's Menu soft 95% meat treats seem to be really good for this. Break off a piece, flatten, and mould around the pill. (If you find the treats too stiff or dry, just moisten with a touch of water.) Then follow with a couple of pieces of treat that have no pill inside to leave the cat on a 'happy'
.
Tasty toppings to encourage kitty to eat:
A sprinkle of something yummy on top of food can help transition a kitty to low carb wet foods, and can help to tempt a jaded appetite. Crushed freeze dried cat treats are really good for this (especially dried liver treats). Other options include a little bit of grated cheese, Engevita yeast flakes, and 'Fortiflora' probiotic.
DRY FOOD
We do not recommend dry food for cats.
Firstly, almost all dry foods are far too high in carbohydrate. Secondly, dry foods are....um.....'dry'. Cats have a low thirst drive and may not get all the water they need on a dry diet.
However, some cats come here 'addicted' to dry foods, and it can take time to transition them to low carb wet. In the meantime, it may be possible to transition them to a dry food that is lower in carbs than the one the kitty is currently eating.
There are also some cats who seem determined to only eat dry food despite their caregiver's best efforts to convert them to wet. So these foods may also be suitable for these kitties.
There are currently (May 2020) three dry kibble foods in the UK that are relatively low in carbohydrates (close to 10% cals from carbs or a bit above). These are: Porta 21 Sensible 'grain free' from Zooplus, and Thrive premium plus ('chicken' and 'chicken & turkey' flavours - NOT the fish flavour..)
There is also Ziwi Peak air-dried cat food which is less than 10% calories from carbs. This is really dried meat with nutritional additives, so the texture is not like that of regular kibble.
Be aware that, if switching to a lower carb food - even if that food is dry - it is still important to be monitoring the cat's blood glucose at home and reducing the insulin dose if necessary in order to avoid hypoglycemia.
'CONVALESCENCE' FOODS - For when an older or sick kitty needs a little extra support.
Liquivite is a liquid food for cats. The consistency is a bit like thick chicken soup. Many cats find it very palatable, especially if warmed. It is low in carbohydrates, and phosphorous, but also fairly low in calories. Very useful for helping kitties to stay nourished and hydrated. For more info see here: http://www.liquivite.co.uk/
Gourmet Gold pates are quite high in calories have been used by some folks for getting extra calories into kitties, or for 'syringe feeding'. The food is smooth and quite easily mixed with water to make it into a good consistency for syringing. Miamor pates from Zooplus and Little Big Paw would probably do a similar job.
Ingredients to avoid feeding my cat?
Some things you may wish to be aware of:
Cats with CRF/CKD may wish to avoid cranberry (acidifying) and dandelion (diuretic) . Thanks to Critter Mom for raising awareness of this.
More info on this can be found on the Tanya CRF website:
http://www.felinecrf.org/holistic_treatments.htm#cautions
Allergies/intolerances: Beef, fish/salmon, chicken, grain and soya seem to be most common.
Carageenan has been observed to affect some kitties. (And carageenan is known to be an inflammatory agent.)
'Vegetable protein extract' is used in a number of cat foods and has been found to raise blood glucose in a minority of kitties, sometimes quite dramatically. ('VPE' may be made from soya or other vegetable protein). Felix 'As Good As It Looks' seems, historically, to have been the main culprit in this regard, but there are newer foods that also list this in their ingredients.
Soya: Some folks choose to avoid this because of a possible link to thryoid problems. Dr Lisa Pierson of catinfo.org says;
"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.”
www.catinfo.org
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OTHER GENERAL INFO
METHYL B12 FOR DIABETIC NEUROPATHY (weak back legs)
Back leg weakness is fairly common in newly diagnosed diabetics and those who remain in high blood glucose levels. This can resolve entirely! Many people have found that supplementing methyl B12 (methylcobalamin) helps speed the healing process. (Although some cats will not recover completely unless they get into a healthier blood glucose range.)
People in the US often use a methyl B12 supplement called 'Zobaline' specifically made for cats. And UK folks used to use that also, but it has now become expensive to import.
One alternative is to use 'Dr's Best fully active B12' methylcobalamin. To equal the 3mg Zobaline dose you will need two of the Dr's Best capsules. Zobaline also contains a small amount of folic acid. And if you want to copy the Zobaline formula you can add the folic acid also. One drop of 'BioCare Vitasorb Folic Acid' liquid should contain the 200 mcg necessary (but check the product details beforehand to be sure).
'Bodykind' is one place where both supplements are available:
Folic acid: https://www.bodykind.com/product/81...id-folic-acid-15ml.aspx#ctl00_cpBody_contents
Dr's Best B12: https://www.bodykind.com/product/4749-best-fully-active-b12-60-x-1500mcg-vegicaps.aspx?Referer=Froogle_Best-Fully-Active-B12-60-x-1500mcg-Vegicaps&utm_source=froogle&utm_medium=price comparison&utm_campaign=Best-Fully-Active-B12-60-x-1500mcg-Vegicaps&gclid=CjwKEAjwps2_BRC5jduHor-h8xESJADGT-Lt7IdposUdW87VD_9f6kVU9lGGBcs984M-fsFHOpJdkxoCP3Tw_wcB#ctl00_cpBody_contents
Methylcobalamin has no discernable taste, so can mix easily into a little bit of the cat's food.
POTASSIUM DEFICIENCY - another possible cause of leg weakness...
Some diabetic kitties can also become low on potassium, especially if they are peeing a lot. A blood test will be needed to see if the cat's potassium levels are low. If low, potassium can be supplemented. But this must be done carefully, under the guidance of your vet.
CARB CALCULATORS - calculating 'percentage of calories from carbs'
If you're considering a food that isn't on the food list, or the food you've bought seems to have different data to that same food on the list, then you can easily calculate the percentage of calories from carbs yourself. You just need to look at the label and get the %'s for protein, fat, ash, fibre, and moisture. Then you can use either of these calculators.
Online calculator from 'Balance IT':
https://secure.balanceit.com/tools/_gaconverter/index.php?
Calculator created by FDMB member 'Hellolucy':If you click on the link below you can open with Google sheets and save a copy for your own use.
https://drive.google.com/file/d/1NOyUfaKxNa580Wnz-0c0_kRQgvlMJgnu/view
DRY MATTER CALCULATOR
http://fnae.org/dmb.html?inputboxm=77&inputboxi=1.7&button.x=75&button.y=21&button=Click
Some things are best compared on a dry matter basis; phosphorous for example (for cats with kidney disease.) This 'dry matter calculator' is a useful tool for this; and could also be useful for comparing fat content (especially for those pancreatitis kitties who’ve been found to benefit from lower fat intake).
GETTING SUPPORT
UK Feline Diabetes Support Group (Facebook).
This is a really friendly and helpful little community of UK folks with diabetic kitties. It is a great place to chat (and occasionally laugh) with other UK folks, or to find the latest info on food and/or supplies in the UK, or to get advice/support with injecting, or with testing blood glucose.
Note: The group is completely independent and is not directly affiliated to any other group.
https://www.facebook.com/groups/196780940826285
USEFUL REFERENCE INFORMATION ON MANAGING FELINE DIABETES
The full international ISFM guidelines on managing feline diabetes are here:
http://journals.sagepub.com/doi/full/10.1177/1098612X15571880
UK-specific info from the Royal Veterinary College is here: 'Guide to feline diabetes. Diagnosis and treatment guidelines of the RVC Diabetic Remission Clinic'.
https://www.rvc.ac.uk/Media/Default/small-animal/documents/feline-diabetes-guide.pdf
GETTING A CAT USED TO INJECTIONS OR HOMETESTING
Many cats are fine from the outset with insulin injections and/or hometesting. Establishing a routine, and the use of rewards, can help a lot. Many people will just give the cat her insulin injection while she's eating a meal, for example, and all is fine.
But for some sensitive cats it can be helpful to deliberately build positive associations to make the process easier and more comfortable, even 'pleasurable'...
For cats who enjoy food or treats it's possible to use the pleasure association of food to make the injections easier. This really good little video shows the principles of 'desensitisation and counter-conditioning':
Please know that diabetes is treatable! With good care a diabetic cat can often live as long and as happily as a non-diabetic. What's more, quite a lot of cats have the potential to go into 'remission' from their diabetes and become diet-controlled diabetics.
THE MOST IMPORTANT THINGS TO KNOW AND DO FIRST...
This is a long post, and let's face it, you may not read it all,
. So I'll briefly summarize the most important things here, and you can read on further for more detail. Let's get started...1. MAKE A HYPO KIT. Hypo may never happen to your kitty, but it's wise to be prepared in case you need to raise blood glucose in a hurry. You'll need some liquid glucose, syrup, or honey. And it would be good to have some high carb food in gravy. Get a few little tins of Gourmet Gold 'in gravy' food. High carb palatable treats are good too, such as Webbox 'Lick-e-licious' salmon cat treats.
Also make sure you have plenty of test strips for your glucose meter. You don't want to run out in an emergency. See further down the page for how to deal with hypos...
2. TEST FOR KETONES. Get some ketone test strips from a pharmacy and test your kitty's pee on a regular basis. Anything above a 'trace' result is a reason to talk to your vet ASAP.
3. LEARN TO HOMETEST BLOOD GLUCOSE. 'Hometesting' may sound a bit daunting at first, but it saves lives and makes managing diabetes so much easier. Most people can do it. And most cats can be tested. It shouldn't hurt them. And they'll still love you. Honestly.
Most of us use ordinary glucose meters made for humans.
4. FEED AN APPROPRIATE LOW CARB DIET. If your cat is already on insulin learn to hometest before switching to low carb. (You may need to reduce the insulin to avoid hypo...) If your kitty is waiting to go onto insulin you can switch to low carb first. There's a link to a low carb food list further down the page.
5. DOES YOUR KITTY HAVE NEUROPATHY? (Weak back legs?). It's caused by nerve damage. Supplements of methyl B12 can really help with healing.
6. THE 'THREE KEYS' TO MANAGING DIABETES. In a nutshell, the three main keys to optimal diabetes management are;
Hometesting of cat's blood glucose
Appropriate low carb diet
Insulin
OK, that's the summary over. Let's look at things in more detail...
When dealing with diabetes 'knowledge is power'. So it's a good idea to spend some time learning how to best manage your cat's condition. Further down the page there's info on urine and blood testing, blood glucose levels, insulin types, diet and treats, obtaining supplies, glucose meters, and other miscellaneous info.
URINE TESTING
KETONES: It is advisable to monitor all newly diagnosed diabetic kitties for ketones; and also to check again whenever the kitty seems unwell or is off her food.
Ketones, (created when the body breaks down fat for energy) are dangerous for diabetics, and can lead to a life-threatening condition called DKA (diabetic ketoacidosis). Fortunately, testing for ketones is simple, and just involves dipping the end of a ketone test strip into a drop of pee, timing it, and reading off the result. Anything above a 'trace' result is considered to be a reason to talk to your vet, ASAP.
Crumpling clingfilm loosely in the litter tray (over the litter) is often a good way to catch a pee sample.
'Ketostix' or 'Keto-Diastix' should be available from most pharmacies. 'Ketostix' test only for ketones, 'Keto-Diastix' test for ketones and for urine glucose. (The latter may be useful if you are not testing your cat's blood glucose at home. But it doesn't give 'real time' information about your cat's blood glucose. It only shows you how much glucose your kitty is excreting in her urine since the last time she peed.)
Note: Be aware that not all ketones are registered by the ketone test strips. If you notice that your kitty's breath smells fruity or like acetone this can also indicate ketones.
If your kitty has had DKA (diabetic ketoacidosis), or has previously tested positive for ketones, then you may wish to invest in a ketone blood test meter. This is more accurate then the urine test strips. Some UK folks recommend the the 'On Call GK Dual' ketone meter, available from Amazon.
Some helpful info on urine testing from the Sugarpet website:
http://www.sugarpet.net/urine.html
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HOMETESTING BLOOD GLUCOSE
FDMB strongly recommend 'hometesting' (testing your cat's blood glucose at home).
Once learned, hometesting can quickly become completely routine. However, while some people (and their cats) take to it like proverbial 'ducks to water', others do find it a little harder to get the hang of at first. Be patient. You will 'get it'! And most cats come to be just fine with the process - especially if they are rewarded with treats...
In a nutshell, testing typically involves pricking the outer edge of your cat's ear to get a teensy weensy drop of blood, transferring that blood to a test strip in a glucose meter (the end of the test strip will suck up the drop of blood from the edge of your cat's ear), and reading off the result on your glucose meter. Then reward your cat with a treat or a cuddle. Job done!
FRUCTOSAMINE TESTS - Your vet will probably have done a fructosamine test on your kitty as part of the process of diagnosing the diabetes. It is very useful for this. But, once a kitty is on insulin the fructosamine is far less useful and can even be misleading. That is because it only gives an indication of 'average' blood glucose levels over the preceding couple of weeks. But it shows no detail at all, so doesn't tell us about the highs and lows along the way. This is why hometesting blood glucose on a regular basis is SO important...
Want to give hometesting a try? Great! Scroll down the page for information on glucose meters in the UK.
And you can get lots of advice about testing on the main forum. Just ask.
IMPORTANT BLOOD GLUCOSE INFO FOR NEWCOMERS
For newcomers to feline diabetes it is generally recommended here that NO insulin is given if the blood glucose is below 11 mmol/L as measured on a human glucose meter. If you're using the Alphatrak meter you may want to raise that number a tad.
If it is just a little too low you can wait for 20 - 30 minutes without feeding to see if the blood glucose comes up high enough to give the shot.
This initial 'no shot' number of 11 mmol/L is just to try to give some buffer of safety while you're learning to hometest blood glucose, and learning how the insulin is working in your cat's body.
Note: If your cat has had ketones different advice may apply. Ask on the forum if you need more info.
The normal blood glucose range for a non-diabetic cat is considered here to be around 2.7 to 6.6 on a human meter, or 3.6 to 8.3 on a pet meter such as Alphatrak. The numbers you aim for will depend on the insulin you're using, your experience, and your own cat's response to insulin. You may or may not be able to aim for numbers toward the lower end of the normal range while using insulin. Safety is key!
HYPOGLYCEMIA
Numbers below 2.7 on a human meter, or 3.6 on an Alphatrak can be considered potentially hypoglycemic; and if you see these numbers, or your cat's blood glucose is dropping fast toward these numbers, appropriate action must be taken to keep your cat's blood glucose at a safe level.
Your 'Hypo Kit'
You may well never need this, but it is really useful to put together some supplies in case you do need to deal with hypo.
It is vital to ensure you have some source of simple sugar available, such as honey or liquid glucose. It's also good to have some high carb food such as the Gourmet Gold ‘in gravy’ foods here: UK, high carb gravy food for Hypo Kit. (Make sure you get the 'gravy' ones, the 'pate' ones are low carb.) The gravy is the most useful bit; you can squish the food down with a spoon and scoop the gravy up.
The Webbox 'Lick-e-Lix' liquid treats are also good. They vary in carb content but the highest carb are the yoghurt ones, of which the Chicken and Salmon seem easiest to obtain.
Also be sure that you have plenty of spare test strips for your glucose meter, and maybe a spare battery too.
Note: Glucose or honey rubbed onto the gums is the fastest way to raise blood glucose in an emergency.
Emergency HYPO INSTRUCTIONS ~ see link immediately below:
How to treat HYPOS - THEY CAN KILL! Print this Out!!
If you think your cat’s blood glucose is dropping too low please post on the forum, or call your vet for advice.
INSULINS IN THE UK - and other diabetic supplies:
Your vet might prescribe an insulin made for animals, or one made for humans.
The ISFM (International Society of Feline Medicine) and the UK's RVC both recommend the use of longer-lasting insulins, Prozinc, Lantus/glargine, or Levemir/detemir, over lente insulins such as Caninsulin for new cases of feline diabetes. (Of these, Prozinc is the only longer-lasting insulin actually licensed for cats in the UK.)
For more on the ISFM's and the RVC's guidelines on managing feline diabetes, please scroll to the 'USEFUL REFERENCE' info toward the end of this post.
There are two insulins licensed for cats in the UK, Caninsulin, and Prozinc. If it turns out that a veterinary insulin isn't controlling the diabetes sufficiently well your vet is able, by law, to prescribe a human alternative. However, some vets are unwilling to prescribe a human alternative. And, despite the UK guidelines that the first insulin prescribed should be one that is licensed for cats , a teensy weensy minority of vets (who prefer to use human insulins) will actually prescribe a human insulin as the first choice.
Attitudes between vets vary a lot when it comes to prescribing insulin for your cat...
VETERINARY INSULINS
Caninsulin and Prozinc are the the most commonly prescribed insulins for cats in the UK.
The RVC has said the current guidelines are that all newly diagnosed cases be prescribed Prozinc, the only long-lasting insulin in the UK currently licensed for cats.
Cats who are currently on Caninsulin and who are not doing well on it may benefit from switching to Prozinc (or one of the human insulins, such as Lantus or Levemir).
The RVC's research found that Prozinc can drop the blood glucose more slowly and last longer in the cat's system; thereby giving overall better glycaemic control than Caninsulin. This can lead to improved clinical signs, and an increased chance of remission. (Recent research has proved what some of us have long observed - that Prozinc has similar remission rates to the human insulin, Lantus.)
Even so, many vets still seem to prescribe Caninsulin. Prozinc has only been available in the UK for a couple of years, and old prescribing habits seem slow to change. Caregivers may need to be pro-active in specifically asking their vet for Prozinc.
SYRINGES
Caninsulin and Prozinc are U40 insulins; that means they have 40 units of insulin per ml of liquid. They are used with corresponding U40 syringes.
Syringes are usually far cheaper to buy online than from your vet. You could use the Caninsulin or Prozinc branded syringes, but many UK'ers use the generic U40 syringes as they are very much cheaper. However, these are all 0.5ml which, while the same size as the Caninsulin syringes, are larger than the (0.3ml) Prozinc syringes.
There are some generics made by VetUK, and there are also 'Sol-Vet' syringes, which cost a little more. (Some UK folks consider that the Sol-Vet U40's have clearer markings and sharper needles):
VetUK U40 syringes: https://www.vetuk.co.uk/veterinary-...nsulin-syringe-with-needle-box-of-100-p-11335
Sol-Vet U40 syringes: https://www.petdrugsonline.co.uk/sol-m-u40-insulin-caninsulin-syringes-0-5ml
https://www.viovet.co.uk/SOL-V-Insu...u-bmMgyt3OomMGToKpkmtKE0G7ktXXvhoCklAQAvD_BwE
For basic information on using, handling and storing Caninsulin and Prozinc see the FDMB info stickies in the Caninsulin and Prozinc subforums (links below). You can also post in these forums for advice specific to your insulin. But if you need help quickly please post in the main health forum.
Beginner's Guide to Caninsulin (Vetsulin)
Caninsulin/Vetsulin subforum: http://www.felinediabetes.com/FDMB/forums/caninsulin-vetsulin-and-n-nph.19/
BEGINNER’S GUIDE TO PROZINC/ PZI INSULIN FOR DIABETIC CATS
Prozinc/PZI subforum: http://www.felinediabetes.com/FDMB/forums/prozinc-pzi.24/
HUMAN INSULINS
If a veterinary insulin is not producing good results in your cat your vet can, by law, prescribe insulin that is made for humans, such as Lantus/glargine or Levemir. These insulins can often produce longer, flatter, blood glucose curves than the veterinary insulins.
The human insulins - Lantus/glargine and Levemir are U100, and have 100 units of insulin per ml. They are used with the corresponding U100 syringes.
Most UK'ers use BD U100 syringes with half unit markings ('BD microfine + demi' syringes). The cheapest place to buy them currently (July 2019) is online at Alldaypharmacy:
http://www.alldaypharmacy.co.uk/products/BD-Micro%2dFine-Demi-0.3ml-Syringe-0.3mm-(30G)-x-8mm-Box-of-100.html
For basic info on Lantus and Levemir see the info stickies on the Lantus and Levemir forum. And you can also post on this forum for advice specific to your insulin.
Lantus and Levemir subforum: http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/
UK BLOOD GLUCOSE METERS
You can use a glucose meter made for pets or one made for humans. Both are fine. They do however 'read' the blood glucose slightly differently. It's important to be aware of this.
The most popular human meter for kitties in the UK currently (March 2020) seems to be the SD Codefree. This has a reputation for being the cheapest to use. However, there is now a new meter made by the same manufacturer, the Gluco Navii. The new meter appears to have a couple of advantages over the SD Codefree. It takes a smaller blood sample, and is advertised as having improved accuracy.
https://www.amazon.co.uk/GlucoNavii-Blood-Glucose-Monitor-Starter/dp/B082MP5XN5/ref=sr_1_4?keywords=sd biosensor gluconavii&qid=1583674045&s=drugstore&sr=1-4
Other popular human meters include the Accu Chek meters, and the One Touch Verio meters.
The most popular pet meter is the Alphatrak. This is a nice meter but probably the most expensive to use.
The main cost of testing is the test strips. The SD Codefree is currently the cheapest meter to use. The Alphatrak is probably the most expensive.
Pet meters, such as Alphatrak, usually give slightly higher readings than human meters, and may give readings closer to those that you would see at your vet's clinic. They are typically more expensive to use than human meters. The GlucoRx Vet meter, from Wellnostics, is a cheaper alternative to the Alphatrak.
If you use a PET meter please let people here know this if you are asking for advice. And add that you are using a pet meter to your 'signature'.
Human meters usually give slightly lower readings than pet meters. And they may give a reading slightly lower than your vet might get. They are usually cheaper to run (sometimes much cheaper) than pet meters such as Alphatrak. Most people here currently use human meters.
Note: All of the insulin dosing protocols used here were devised using data from human glucose meters. So an adjustment will need to be made if you are using a pet meter.
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WHAT TO FEED A DIABETIC CAT?
FDMB recommends that diabetic cats eat wet/canned/raw foods that have less than 10% calories from carbohydrates. (And some cats do best on carb levels in the region of 4% - 6%.). See below for a list of low carb UK foods.
If your cat has other health issues, for example kidney disease, IBD, or pancreatitis, this may further affect your food choices.
A note of caution about switching to a low carb diet...
If your cat is already on insulin and is currently eating a higher carb food then we recommend that you only transition to lower carb food if you can hometest (test your cat’s blood glucose at home) and are able to monitor the effect of the change on your cat’s blood glucose.
That’s because lowering the carb content of the diet can greatly reduce your cat’s blood glucose level, and the insulin dose may need to be reduced accordingly.
Too much insulin can cause hypoglycaemia.
If your cat has not yet started on insulin this is the perfect time to transition safely to low carb wet food. Be sure that your cat's blood glucose is properly tested after the diet change, so that any reduction in blood glucose can be taken into account when deciding the insulin dosage.
POPULAR FOODS
Current favourites (July 2020) include: Nature's Menu, Butcher’s Classic, Sheba 'fine flakes', Lily’s Kitchen, Thrive complete; and from Zooplus: Smilla, Granatapet, Catz Finefood, Feringa, Macs, Animonda. (For more details on these foods click on 'UK Food List' link below.)
POPULAR ONLINE SUPPLIERS include: Zooplus http://www.zooplus.co.uk/; Bitiba http://www.bitiba.co.uk/; Nature’s Menu http://www.naturesmenu.co.uk/; Fetch (offshoot of Ocado): https://fetch.co.uk/
UK FOOD LIST <<< click on link for a long list of foods
Note: Be aware that some apparently low carb foods might still spike your cat's blood glucose levels. There are a number of possible reasons for this, but it may be due to a food intolerance (not uncommon).
Sometimes, finding out what works for your cat will be a matter of 'trial and error'.
LOW CARB CAT TREATS/REWARDS
Many of the most popular commercial cat treats are laden with carbohydrates. Avoid if possible.
Try to stick with treats that are entirely made from meat or fish. These are the lowest in carbohydrate.
Popular freeze dried treats include; Thrive, Pet Munchies, HiLife 100% meat, Wilko freeze dried treats, Orijen freeze dried treats, Iams 'naturally' pure meat treats. Also from Zooplus; Zoolove 'cat snacks', Cosma snackies (avoid the Cosma ‘Thai’ treats as these contain rice.), Wild Freedom lamb lung or chicken hearts (chicken hearts are a great source of taurine too!), Purizon cat snacks.
Another option is the semi-moist treats, often in stick form. These tend to be a bit higher in carbohydrate but should still be below 10% cals from carbs (often below 5%). Nature's Menu 95% meat treats, Waitrose 7 deli snack sticks, Tesco cat sticks, Asda tiger '6 Stix', Webbox 'tasty sticks'. And from Zooplus, Feringa meat/fish cat sticks, Feringa fish snacks, Tigeria cat sticks, Catessy cat sticks, Sanabelle tasty treats.
Little pieces of plainly cooked or raw meat, or cooked fish, also make good treats. And some cats like a tiny piece of cheese or a lick of plain unsweetened yoghurt.
Treats to hide tablets in - and make pill-giving easier;
Nature's Menu soft 95% meat treats seem to be really good for this. Break off a piece, flatten, and mould around the pill. (If you find the treats too stiff or dry, just moisten with a touch of water.) Then follow with a couple of pieces of treat that have no pill inside to leave the cat on a 'happy'
.Tasty toppings to encourage kitty to eat:
A sprinkle of something yummy on top of food can help transition a kitty to low carb wet foods, and can help to tempt a jaded appetite. Crushed freeze dried cat treats are really good for this (especially dried liver treats). Other options include a little bit of grated cheese, Engevita yeast flakes, and 'Fortiflora' probiotic.
DRY FOOD
We do not recommend dry food for cats.
Firstly, almost all dry foods are far too high in carbohydrate. Secondly, dry foods are....um.....'dry'. Cats have a low thirst drive and may not get all the water they need on a dry diet.
However, some cats come here 'addicted' to dry foods, and it can take time to transition them to low carb wet. In the meantime, it may be possible to transition them to a dry food that is lower in carbs than the one the kitty is currently eating.
There are also some cats who seem determined to only eat dry food despite their caregiver's best efforts to convert them to wet. So these foods may also be suitable for these kitties.
There are currently (May 2020) three dry kibble foods in the UK that are relatively low in carbohydrates (close to 10% cals from carbs or a bit above). These are: Porta 21 Sensible 'grain free' from Zooplus, and Thrive premium plus ('chicken' and 'chicken & turkey' flavours - NOT the fish flavour..)
There is also Ziwi Peak air-dried cat food which is less than 10% calories from carbs. This is really dried meat with nutritional additives, so the texture is not like that of regular kibble.
Be aware that, if switching to a lower carb food - even if that food is dry - it is still important to be monitoring the cat's blood glucose at home and reducing the insulin dose if necessary in order to avoid hypoglycemia.
'CONVALESCENCE' FOODS - For when an older or sick kitty needs a little extra support.
Liquivite is a liquid food for cats. The consistency is a bit like thick chicken soup. Many cats find it very palatable, especially if warmed. It is low in carbohydrates, and phosphorous, but also fairly low in calories. Very useful for helping kitties to stay nourished and hydrated. For more info see here: http://www.liquivite.co.uk/
Gourmet Gold pates are quite high in calories have been used by some folks for getting extra calories into kitties, or for 'syringe feeding'. The food is smooth and quite easily mixed with water to make it into a good consistency for syringing. Miamor pates from Zooplus and Little Big Paw would probably do a similar job.
Ingredients to avoid feeding my cat?
Some things you may wish to be aware of:
Cats with CRF/CKD may wish to avoid cranberry (acidifying) and dandelion (diuretic) . Thanks to Critter Mom for raising awareness of this.
More info on this can be found on the Tanya CRF website:
http://www.felinecrf.org/holistic_treatments.htm#cautions
Allergies/intolerances: Beef, fish/salmon, chicken, grain and soya seem to be most common.
Carageenan has been observed to affect some kitties. (And carageenan is known to be an inflammatory agent.)
'Vegetable protein extract' is used in a number of cat foods and has been found to raise blood glucose in a minority of kitties, sometimes quite dramatically. ('VPE' may be made from soya or other vegetable protein). Felix 'As Good As It Looks' seems, historically, to have been the main culprit in this regard, but there are newer foods that also list this in their ingredients.
Soya: Some folks choose to avoid this because of a possible link to thryoid problems. Dr Lisa Pierson of catinfo.org says;
"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.”
www.catinfo.org
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OTHER GENERAL INFO
METHYL B12 FOR DIABETIC NEUROPATHY (weak back legs)
Back leg weakness is fairly common in newly diagnosed diabetics and those who remain in high blood glucose levels. This can resolve entirely! Many people have found that supplementing methyl B12 (methylcobalamin) helps speed the healing process. (Although some cats will not recover completely unless they get into a healthier blood glucose range.)
People in the US often use a methyl B12 supplement called 'Zobaline' specifically made for cats. And UK folks used to use that also, but it has now become expensive to import.
One alternative is to use 'Dr's Best fully active B12' methylcobalamin. To equal the 3mg Zobaline dose you will need two of the Dr's Best capsules. Zobaline also contains a small amount of folic acid. And if you want to copy the Zobaline formula you can add the folic acid also. One drop of 'BioCare Vitasorb Folic Acid' liquid should contain the 200 mcg necessary (but check the product details beforehand to be sure).
'Bodykind' is one place where both supplements are available:
Folic acid: https://www.bodykind.com/product/81...id-folic-acid-15ml.aspx#ctl00_cpBody_contents
Dr's Best B12: https://www.bodykind.com/product/4749-best-fully-active-b12-60-x-1500mcg-vegicaps.aspx?Referer=Froogle_Best-Fully-Active-B12-60-x-1500mcg-Vegicaps&utm_source=froogle&utm_medium=price comparison&utm_campaign=Best-Fully-Active-B12-60-x-1500mcg-Vegicaps&gclid=CjwKEAjwps2_BRC5jduHor-h8xESJADGT-Lt7IdposUdW87VD_9f6kVU9lGGBcs984M-fsFHOpJdkxoCP3Tw_wcB#ctl00_cpBody_contents
Methylcobalamin has no discernable taste, so can mix easily into a little bit of the cat's food.
POTASSIUM DEFICIENCY - another possible cause of leg weakness...
Some diabetic kitties can also become low on potassium, especially if they are peeing a lot. A blood test will be needed to see if the cat's potassium levels are low. If low, potassium can be supplemented. But this must be done carefully, under the guidance of your vet.
CARB CALCULATORS - calculating 'percentage of calories from carbs'
If you're considering a food that isn't on the food list, or the food you've bought seems to have different data to that same food on the list, then you can easily calculate the percentage of calories from carbs yourself. You just need to look at the label and get the %'s for protein, fat, ash, fibre, and moisture. Then you can use either of these calculators.
Online calculator from 'Balance IT':
https://secure.balanceit.com/tools/_gaconverter/index.php?
Calculator created by FDMB member 'Hellolucy':If you click on the link below you can open with Google sheets and save a copy for your own use.
https://drive.google.com/file/d/1NOyUfaKxNa580Wnz-0c0_kRQgvlMJgnu/view
DRY MATTER CALCULATOR
http://fnae.org/dmb.html?inputboxm=77&inputboxi=1.7&button.x=75&button.y=21&button=Click
Some things are best compared on a dry matter basis; phosphorous for example (for cats with kidney disease.) This 'dry matter calculator' is a useful tool for this; and could also be useful for comparing fat content (especially for those pancreatitis kitties who’ve been found to benefit from lower fat intake).
GETTING SUPPORT
UK Feline Diabetes Support Group (Facebook).
This is a really friendly and helpful little community of UK folks with diabetic kitties. It is a great place to chat (and occasionally laugh) with other UK folks, or to find the latest info on food and/or supplies in the UK, or to get advice/support with injecting, or with testing blood glucose.
Note: The group is completely independent and is not directly affiliated to any other group.
https://www.facebook.com/groups/196780940826285
USEFUL REFERENCE INFORMATION ON MANAGING FELINE DIABETES
The full international ISFM guidelines on managing feline diabetes are here:
http://journals.sagepub.com/doi/full/10.1177/1098612X15571880
UK-specific info from the Royal Veterinary College is here: 'Guide to feline diabetes. Diagnosis and treatment guidelines of the RVC Diabetic Remission Clinic'.
https://www.rvc.ac.uk/Media/Default/small-animal/documents/feline-diabetes-guide.pdf
GETTING A CAT USED TO INJECTIONS OR HOMETESTING
Many cats are fine from the outset with insulin injections and/or hometesting. Establishing a routine, and the use of rewards, can help a lot. Many people will just give the cat her insulin injection while she's eating a meal, for example, and all is fine.
But for some sensitive cats it can be helpful to deliberately build positive associations to make the process easier and more comfortable, even 'pleasurable'...
For cats who enjoy food or treats it's possible to use the pleasure association of food to make the injections easier. This really good little video shows the principles of 'desensitisation and counter-conditioning':
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