Case Examples of Tight Regulation of Diabetes

Fortunately, after 2 weeks on doses of insulin that I decreased as his blood sugar levels started to become normal again, Punkin was able to keep his blood sugar in the normal range all by himself and I stopped giving insulin. Punkin never got dry food again and never needed insulin again, either. This was an important lesson for me and all of my diabetic patients. Cats that have been diabetic will always tend to become diabetic again quickly if they eat high-sugar foods, even if they have been "normal" for long periods. They don't have the ability to resist the effects of high sugar foods, even for short periods, like they did before they became diabetic. We have seen many cases like Punkin's where a "recovered" diabetic cat eats dry food again and immediately starts to need insulin again. I make it a point to emphasize to my clients that their recovered diabetic cat will never be able to have high carbohydrate foods again in its lifetime.

 

While many cats recover from their diabetes quickly, as Maggie, Goldstein and Punkin did, some are much slower to become normal. Unfortunately, cats that have been diabetic for a long time seem to take longer to improve. Many of these will still go off insulin eventually, but the longer a cat is diabetic before its diet is changed to low-sugar foods, the harder the process of recovery.

 

 

"Rascal" was a 6-year-old neutered male short-haired cat that weighed 20 pounds when I first saw him. He was at least 8-9 pounds overweight for his frame. Rascal had been diagnosed as a diabetic by a veterinarian 2 years earlier in another state where the Simons lived at the time. Rascal had been getting 6 units of Humulin™ Lente insulin (this is a type of human insulin, not PZI that I prefer) twice a day and was eating one of the high-fiber, high-carbohydrate dry foods for diabetic cats. Rascal's owners were not happy with his lack of progress during the two years of his treatment for diabetes. His previous veterinarian would check his blood glucose once each month and adjust Rascal's insulin dose depending on those tests. Sometimes Rascal's blood sugar was very high, as high as 520 mg/dl, and the insulin dose would be increased. Sometimes his blood sugar would be lower, as low as 100 mg/dl, and his insulin dose would be decreased. Once, Rascal even had a seizure because his blood sugar dropped all the way to 35 mg/dl! When this happened, Rascal's owners rushed him to the vet's and he was hospitalized for 3 days while his doctor gave him IV fluids and adjusted his dose of insulin again. It was a never-ending see-saw. The Simons were about to give up when they moved to Orange County, California and a neighbor told them to bring Rascal to my clinic.

 

When I first saw Rascal, he weighed 18 pounds, and was still obese. His coat was dull and he had dry flaky dandruff coming off his skin. The Simons told me that Rascal drank lots and lots of water and went to the litter box to urinate at least 10 times a day. Every day they had to empty all of the litter and what seemed like quarts of urine from the box. Rascal was always starving; he begged for food whenever his bowl was empty and would steal any human food, even pretzels and potato chips that he was able to get to. He never seemed content and didn't socialize with the family at all. The Simons were giving him 6 units of Humulin™ insulin every 12 hours.

 

We hospitalized Rascal and found that his blood sugar ranged between 300 mg/dl and 450 mg/dl throughout the day, even though he was getting so much insulin every day. We stopped giving Rascal any insulin at all and changed his diet to low-carbohydrate canned food only. At first, he ate only a small amount of the canned food. Rascal was "carbohydrate-addicted" and wanted his dry food. Even so, his blood sugar the first day off dry food and with no insulin ranged from 250 mg/dl to 375 mg/dl, a respectable improvement for a cat without insulin injections. We started him on 2 units of PZI insulin every 12 hours and within 2 days his blood sugar levels ranged from 125 mg/dl to 200 mg/dl. His excessive thirst and urination stopped altogether and he started eating the canned food well. We sent Rascal home with his owners on 2 units of PZI injected under the skin every 12 hours and canned food as an exclusive diet. We taught the Simons to hometest Rascal's blood glucose 2 to 3 times per day.

 

One week later, we rechecked Rascal's glucose and found it ranged during one 12-hour period between 60 mg/dl and 150 mg/dl. We stopped giving insulin for one day and his blood sugar started rising to over 200 mg/dl at the highest. We started insulin back at 1 unit PZI every 12 hours and sent him home for two weeks. This process of readjusting Rascal's insulin as he responded better and better to the canned diet and insulin continued for another 2 months. Eventually he was getting less than one-half unit of PZI every 12 hours, and finally, after 3 months of proper diet and the right insulin, Rascal went off insulin altogether. He has been off insulin for eight months now, has lost 3 of the 8 pounds he needed to lose, and his coat is starting to shine. He uses the litter box 3-4 times daily, and drinks very little water because his food has most of the water he needs. The dandruff is gone, and the Simons can't believe how active Rascal has become. He no longer begs for food all the time, eats his canned food at mealtime only, and is more affectionate than ever. Rascal's owners continue to home-test him every few days.

 

 

 

"Case Examples of Tight Regulation of Diabetes in Cats" originally appeared on Your Diabetic Cat and is re-posted here with Dr. Hodgkin's kind permission.