Hi Brittney,
As mentioned above some people do switch to low carb food before starting insulin BUT contrary to some of the suggestions given above
it is NOT always a good approach to delay start of insulin treatment in order to do any required diet change first; the decision as to when to initiate insulin treatment must be based on a holistic assessment of the cat's diabetic and overall health status.
Food transitions need to be done gradually over several days to reduce risk of GI upsets. Nausea and inappetence are a problem for any cat because of how the feline metabolism works but for diabetics it is even more important that they keep eating regularly (their bodies are already struggling to use nutrients properly). Also, depending on the cat it may take a few weeks to complete the food transition.
Given that the food transition could take a bit of time, sometimes it is not appropriate to wait to start giving insulin. Delaying treatment can lead to greater risk of a diabetic starting to produce ketones. (Not to scare but to inform you - presence of ketones can quickly lead to a cat developing diabetic ketoacidosis, a potentially life-threatening complication of diabetes.)
Diabetic cats are at greater risk of developing ketones:
1. If the cat's BG is in a high range. (Your vet should have done a fructosamine test as part of his diagnostics to check Emmy's average BG over the last few weeks to get a better picture of her diabetic status. This test result won't be affected by vet stress.)
2. If any infections or other illnesses are present at time of Dx.
3. If the cat is underweight.
4. If the cat's appetite is questionable. (If any signs of nausea these need prompt treatment.)
If the cat is already producing ketones then insulin treatment should be started straight away in a clinical setting until the cat is clear of ketones and stable.
Armed with all the test results, your vets should be able to give you a fuller picture of Emmy's status when next you meet and then you will be able to make a better informed decision about when Emmy needs to start her insulin treatment. (Tip: Bring an orange with you to the injection tutorial; they're great to practice on - far less scary than trying it first on your kitty!)
For some cats the diet change alone can be enough to tip them into remission (i.e. a cat whose blood glucose levels can be controlled with low carb food and who does not need daily insulin injections). However, most cats who have been eating a diet too high in carbs prior to diagnosis (Dx) typically need both the food change and insulin at start of treatment.
The choice of insulin can have a significant influence over the cat's chance of achieving remission. According to the findings of the Roomp-Rand study newly diagnosed feline diabetics stand the greatest chance of remission when treated with long-acting insulins (Lantus or Levemir). These insulins are quite expensive in the US but they can be purchased much cheaper from Canada with a written Rx from your vet (
details here).
Key to successful treatment is to not start at too high an insulin dose and to make dose adjustments in small increments (e.g. with Lantus the recommended starting dose is 0.25 IU per kg of ideal weight unless the cat is underweight in which case the dose is based on the cat's actual weight at time of Dx; dose adjustments are done in increments of 0.25IU.) It takes a bit of time to regulate a cat but the 'low and slow' approach to insulin treatment is generally the safest and most effective way of hitting a 'good dose'. Some vets increase the dose too quickly (e.g. by 1 IU at a time) and this can result in 'skipping over' the dose that would best suit the kitty at that point in its treatment (and which may actually result in BG numbers going higher and therefore impede progress toward good regulation).
As others have already advised, home BG testing is the best thing you can do to keep Emmy safe on insulin. Some vets advocate home testing, some are completely against it. Emmy is your cat; you get to make the decisions about how to monitor her during treatment. Home BG testing will also give you much better information on how Emmy responds to insulin treatment and how effective the dosing is for her. Home testing will spare Emmy the stress of unnecessary vet trips for curves and will give BG readings that are true to Emmy's everyday BG status in the home setting, not falsely elevated by vet/travel stress. Home-run curves therefore provide a sounder basis upon which to determine effective, safe insulin dosage. Recording BG test results using the
FDMB spreadsheet will also help you to track the safety and effectiveness of each insulin dose, and will thus be a great aid to you and your vet as you work to improve Emmy's regulation.
When you go to pick up a glucometer and test strips be sure to pick up some urine test strips for monitoring ketones at home (e.g. Keto-diastix). I would recommend daily ketone testing - especially in the early days. Many US members recommend Walmart's Relion Micro and Confirm meters. They only require a small blood sample and the test strips are affordable. Human meters need to be used with a cat-specific glucose reference range. We can provide you with details here when you need them. More suggestions on which supplies to purchase can be found in the
hypo toolbox forum sticky. Be sure you have honey, karo, or liquid glucose in the house.
Healthy, non-diabetic cats (civvies as we call them!) can also benefit greatly by switching to a species-appropriate, low carb diet. The best site on the web for information on the fundamentals of good feline nutrition is vet-authored site
catinfo.org. We also have food lists here which give info on carb level (and,
I think, phosphorus levels) for a broad range of commercial cat foods. Most members here seem to opt for Fancy Feast Classics patés and, IIRC, Friskies patés. A few tins of FF gravy lovers are useful additions to a hypo toolbox.
Once a cat has started insulin treatment then no food change should be attempted unless the cat is undergoing daily home BG monitoring and only when you are in a position to monitor BG closely during the transition (e.g. over a weekend). The switch to low carb food may quickly and significantly lower BG levels and therefore the insulin dose would very likely need to be adjusted downwards (fewer incoming carbs for the insulin to work on). There is more reading about safely transitioning insulin-treated cats to a diabetic-friendly diet on
catinfo.org's feline diabetes page.
Mogs
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