Diabetes in Animals is Not a Death Sentence
Lately, your cat has been exhibiting some pretty strange symptoms. He is losing weight, despite the fact that he is now eating more than ever. His water bowl is his new best friend. You might have even named it for this reason. The litter box? The litter box is constantly flooded. You try to keep it clean, but sometimes it still gets so dirty that your cat refuses to use it. Either that, or he can't make it to the box in time. Instead, he uses your floor. So, of course you take him to the vet. After some blood and urine tests, the results are in: his glucose levels are too high. He has diabetes. Until now, you've always felt that any illness which is commonly treated in humans should also be treated in animals. But... you look at your cat. You can't remember the last time he played or stole your seat for fun. His coat is greasy and matted, because he no longer has the energy required to groom himself. If his glucose levels are high enough, he might even be having some trouble walking. Is it really fair to put your friend through this? Besides, can you even afford it? According to your vet, it could get pretty pricey.
Often when people hear about an animals having diabetes, their first reaction is to laugh. Yet, it is not as uncommon as some people may think. Many pet owners find themselves in the above situation. Sometimes, an owner chooses to euthanize their pet after hearing about the diagnosis. Frequently, that decision is based on some common misconceptions about diabetes in animals. This page is dedicated to rooting out those misconceptions and banishing them, once and for all. Because, as many dogs and cats have proven time and time again, diabetes is not a death sentence. Your pet can and most likely will live a long and productive life if you choose to treat. So what are we waiting for? Let's get started!
I don't have enough money in my budget to treat my pet.
Money is obviously a good thing to be concerned about. Because, if you can't afford to treat your pet, you can't treat. Right? Well... not necessarily. Before you say that, think good and hard about this one question. It is self-explanatory and I won't debate the issue here, but it happens a lot. The question is:
Can you really not afford to treat... or do you not WANT to afford to treat?
Okay, moving on. (I promised I wasn't going to debate the issue.) Now, I will admit, caring for a diabetic pet is a little bit more costly than caring for a pet that is healthy. However, there are many, many things that you can do to save yourself money and still provide effective treatment to your pet. Take some time and research each of these methods. There are many helpful sites which provide excellent help related to caring for a diabetic pet.
For excellent ways to save money, refer to Janet's Frugal Diabetes. Many have found it useful in affording their pet's care.
Method #1: Hometesting
Human diabetics utilize home glucose monitors on a daily basis to manage their diabetes. Why should it be any different in animals? Human glucose monitors are an excellent way of both keeping expenses to a minimum and keeping your pet healthy and safe. Hometesting has many advantages:
- Less risk of hypo: If you take a glucose reading before each and every insulin injection, you minimize the chance of a hypoglycemic episode. Hypoglycemia occurs when the body has too much insulin - the sugar levels in the blood get too low. This can quickly cause death in your pet. To learn how to recognize the symptoms and treat hypoglycemia, please refer to http://www.felinediabetes.com/hypogly.htm.
- Curving at home: A diabetic curve is the result of graphing glucose test results taken every two hours after giving insulin, until the next insulin shot. Most of the time, this means testing every two hours for twelve hours (if your pet is on two shots a day). You can also curve for 24 hours, the result of three insulin shots (again, if your pet is on two shots a day) to get an even better understanding of how the insulin is working. Curving can help determine whether or not the current dose should be changed and tell you when the peak occurs. [According to the FelineDiabetes.com Cat Health Dictionary of Terms (http://www.felinediabetes.com/dictionary/cat-health-dictionary.htm), the peak is "the time period when the insulin is strongest causing the BG level to be lowest." BG is short for blood glucose.] Most of the time, your vet will tell you that curving should be done in the vet's office. However, many owners of diabetic pets do curves in the comfort of their own home. This has many advantages, including saving money having the vet perform the curve. However, there is also a medical reason why curving at home is beneficial. An article in the online site for DVM, The Newsmagazine of Veterinary Medicine says "Because the patterns established from blood glucose curves done in the hospital, in a stressful and unnatural environment, are used to determine the insulin dose the pet will go home on, it is rare if the prescribed insulin requirements do not change over time at home." (You can find the links to two DVM articles farther down on this page.) This means that, for most pets, going to the vet and not being at home is very stressful. Stress raises glucose levels. Therefore, curves performed at the vet clinic are, many times, inaccurate and not as valid for determine dosage requirements. Doing the curve at home and sharing the results with your vet enables you as a team to choose the best dose for your pet.
- Hometesting is quick: Many people think that hometesting will take a long time to do. While it is true that you must sometimes manipulate your schedule to be home in time for testing and insulin shots, the tests itself take no time at all. If you have ten minutes in the morning and evening, and a spare day (weekends, etc) to perform a curve, you have plenty of time to treat your diabetic pet.
Hometesting in animals is relatively new and there are many vets who have never heard of it. Some may be
skeptical at first. However, try introducing the idea to your vet. Have articles from respected veterinary magazines on hand for your vet to read. (Two that
may be helpful: http://www.dvmnewsmagazine.com/dvm/article/articleDetail.jsp?id=5336 and http://www.dvmnewsmagazine.com/dvm/article/articleDetail.jsp?id=13315.) Point out that human diabetics use glucose meters to manage their own diabetes on a daily basis. Also, realize that your vet may be
unsure about the validity of advice found on the internet. If this is the case, tell him or her that the sites on which you have found much of your
information are valid sites. If your vet refuses to allow you to hometest or gets upset with you over it, you may wish to find a new vet. This is completely
your choice, as your pet IS your pet. However, there is no need to be rude or to bash the vet to others. Many times, once you have begun hometesting and your
vet sees how helpful and accurate it is, you will have converted another soul to hometesting for animals. Thankfully, most vets are open to trying something
new and will work with you to learn how to do it. Many are even recommending it to their clients.
How Do I Perform a Hometest?
Hometesting may seem very complicated at first. However, as you practice, you and your pet will become accustomed to it and it will take no longer than ten minutes to gather your supplies and be done with the test. To help you, here is a quick picture guide on how to perform a hometest on a cat's ear. There are other options if your pet will not tolerate ears being touched, such as a paw stick or a lip stick for dogs.
These pictures show how to do a hometest using a lancing device, which I find helpful. However, many people also prefer to use the lancet freehand, without loading it into a lancing device. Experiment to see which way works best for you.
Step 1: Heat a rice sock or wet washcloth in the microwave. If you use a wet washcloth, make sure you put it in a plastic bag before touching it to your pet, as the water could dilute the blood and give an inaccurate reading. My rice sock, courtesy of Laura and Bear (GA), is made from two pieces of fleece stiched together and stuffed with rice. I heat mine for around 20 seconds. Use your judgement based on your microwave as to how long to heat. You do not want to burn your pet, but you do want to get the blood flowing in the ear.
Step 2: Gather your supplies. Having your supplies close at hand is very helpful so
that you don't have to let your pet go and then try to get him or her situated for testing again. Many owners of cats find it helpful to sit on the floor
with the cat in their lap while they test. My Iris is quite easy to test when I sit on the floor. If I have her stand on the counter, she tries to run and
sniff all over the place.
The supplies in the picture below include the monitor and test strip, ready to be loaded, the lancet with the lancing device loaded and barrel cocked (or, just the lancet if you choose to try it freehand), a kleenex, and the warm rice sock. Iris likes a kitty treat after her tests, so those are included in our supplies, as well. You may also wish to have some Vaseline handy to apply to the ear before you begin, as it makes the blood bead up instead of flowing into the fur.
Step 3: Use the warm rice sock (or wet cloth in plastic bag) to warm the ear to get the blood flowing. Be careful not to burn your pet! This is the step Iris dislikes the most about the testing process. You may have to heat both the top and bottom parts of the ear - this is something you'll have to experiment with, to see what works best for your pet. Also note that rubbing the ear can also get the blood flowing if you don't have a warm rice sock handy. Some ears bleed thoroughly without rubbing or heating, as well.
Step 4: Load the test strip into the monitor and place it where you can quickly reach it after poking the ear to obtain the blood drop. Note that I am left handed, which accounts for the monitor being placed on my left knee. You may have to adjust accordingly if you are right handed.
Step 5: Place the kleenex behind your pet's ear to keep from poking yourself. Line the loaded and cocked lancing device up to where you want to poke, and press the button. The diagram below, courtesy of Jen and Squeak, may help you decided where to aim. You may also wish to poke with the lancet freehand. I have heard many say to pretend like you are sewing and the needle is the lancet and the fabric is your pet's ear. Go in at an angle if you choose to obtain blood in this manner.
Step 6: Quickly pick up the meter and wait for enough of a blood drop to form. Touch the tip of the test strip to the blood drop to allow the strip to sip the blood in. We generally recommend meters that use test strips which sip the blood, such as the Ascensia Elite XL, which I use and is pictured in this demonstration. However, there are other meters which sip blood, as well.
Step 7: Set the meter aside while it counts down (the Elite takes 30 seconds to give a reading - this gives me time to get Iris cleaned up) and fold the kleenex over your pet's ear. Hold down firmly for a few seconds and then remove the kleenex. If the ear is still bleeding, apply more firm pressure until the ear has stopped bleeding. This should take no more than a minute or two. You may have a harder time stopping the blood flow if you pricked the ear right on the vein. You may wish to aim more between the vein and the outer rim of the ear.
Step 8: Give your pet a treat, if you choose to, and lots of love and praise. Iris waits for her treat and mews at me if I don't give it to her. When I start to give it to her, she "sits pretty" for me like a little puppy dog and takes it right from my hand.
Step 9: Once the meter has finished counting down, it will display your pet's current blood glucose level. Take note of the level before giving your pet any insulin. If the BG is too low, you do not want to give too much insulin, as this could result in a hypoglycemic episode. Record your pet's BG level in the record book which came with the meter, if you choose to do so.
That's all there is to it! Good luck!
Method #2: Ketostix
Another helpful way to save money is to test your pet's urine for ketones. To paraphrase from petdiabetes.com, ketones occur when there is a lack of insulin in the body (you may be giving too little insulin to your pet). Since insulin enables glucsoe to be used, the body has to find a new supply for energy - and it goes to the body fat to do this. When the body fat is used, waste products, called ketones, are produced. Ketones are toxic to the body, and are usually flushed out in the urine. However, in a diabetic, there can be too many ketones to flush out of the system and the body can go into diabetic ketoacidocis (aka DKA), which is a deadly condition. If ketones are found to be present in your pet's urine, a veterinarian MUST treat your pet. However, by testing regularly and catching ketones early, it is almost guaranteed that treatment will be easier and less expensive than if your pet becomes DKA. Ketones are most likely to happen if your pet's blood glucose level is over 250.
To test for ketones in the urine, go to your local pharmacy and buy some ketostix. You may buy ketodiastix if you wish, but avoid buying only diastix. The "dia" pad on the dipstick tests for glucose in the urine, not ketones. To test, follow your pet to the litter box or outside when going to use the bathroom. You can either collect the urine in a cup or ladle, or place the dipstick right into the urine stream. Some cat owners find it helpful to recognize which area their cat uses in the litter box most often and creating a "trough" of sorts over the litter. Whatever your method, get the stick wet and immediately remove from urine.
Here are charts located on the back of the ketostix and ketodiastix packages. For ketone readings, you must compare the color on the stick and the chart at exactly 15 seconds. Sometimes it is hard to tell the difference between negative and trace. However, I have been told that when your pet has trace ketones, the pad will look almost neon to you and you will be able to tell. Thankfully, Iris has never had ketones, so I don't know what this looks like myself.
Method #3: Diet
You may also find that the prescription food your vet has recommended is very pricey. However, it is not necessary for your pet to eat prescription food, unless there are other medical conditions which require it. If your pet simply has diabetes, there are many other options. For cats, the current diet recommended is one that is high in protein, but low in carbs. The carb level is the biggest concern here. Generally, dry food, simply because it is dry, has higher carbs than canned food. Many cat owners choose to feed their cat an all-canned food diet. Many grocery store brands fit the criteria required for a diabetic cat. There are some owners, including me, who choose to feed dry food to their cat. However, the lowest carb dry foods available are Purina DM and Hills M/D - both of which are prescription foods and very pricey. Still other owners choose to feed an all raw food diet. The most important thing to remember, however, is that if your cat is on insulin, it is crucial that s/he is eating! If you have to feed what your cat will eat, that's what you have to do. If your cat doesn't eat, s/he may experience a hypoglycemic episode, which can quickly kill your cat. For more information about the nutrition in feline foods, visit Janet and Binky's page at http://geocities.com/jmpeerson/. Scroll down to under "Diet Related Documents" and you will see links to the food tables.
If your diabetic pet is a dog, the diet of choice, I've been told, is one that is low fat, low
protein, and high in fiber. I'm sorry I don't know more about diet in dogs, but I do know that many diabetic canine owners choose to homecook foods as
there seems to be a shortage of non-prescription foods that fit this criteria.
So, you've now discovered that you can afford to treat, using some great money (and life!) saving methods. Good for you! But... there's still another problem. Do you really want your friend to suffer? I'm here to tell you that treating a pet for diabetes is not subjecting them to any form of suffering at all. In fact, the reality is quite the opposite.
Based on information given to me by the members of the Feline Diabetes Message Board (http://www.felinediabetes.com/phorum5/list.php?8) and Sweet Talk (http://sweettalkcats.yuku.com), many people see signs of improvement in their pet within two weeks of starting treatment. The needles used to administer insulin are very small and your pet will not feel the needle at all, if the injection is being given properly. If you are queasy about needles - don't worry! So was I! For the first home shot, I had everything ready for the shot, positioned and all, and suddenly handed it over to my husband! However, the next day, I couldn't get him out of bed to do it, so I had no choice. Now, it doesn't bother me at all to stick her. And I still don't like needles! Here's a picture of a syringe used to administer insulin, so you can see for yourself just how small the needle is. This is BD 3/10 CC syringe with half unit markings, with a 5/16 inch long needle.
Guess what? Most of our pets don't fight the glucose testing, either! Some do, at first, but get used to it over time. Kimber's Bunny (GA) used to call her when it was shot time. Pauline's Wee Felice comes to her food area and sits patiently while Pauline administers the blood test. Karen sets alarms for Rambo's test times... when the alarm goes off, he sits by his testing equipment and waits for Karen to show up! Deanie's Boo often has other plans for what he'd like to be doing during test time, but he's a good boy during test time. Many other pets do not struggle at test time, either. Here are two pictures of Iris waiting for me to finish taking pictures of her supplies (for this page) so I could get her test done. Can't you just see her saying, "Dang! If you're going to take this long, I might as well lie down for awhile!"?
If you're worried about a few pricks for blood testing and shots, what do you think happens when an owner choose not to treat diabetes? First, your pet may develop diabetic ketoacidocis and die. (See above for info on DKA.) If this doesn't happen, neuropathy may set in. A pet with diabetic neuropathy experiences pain and numbness in its legs. A pet may walk on his/her hocks because their legs are so weak. They may only be able to take two steps at a time before having to sit down and rest. Using the litter box or going outside becomes near to impossible. They often sleep right next to their food and water dishes. This is pitiful to watch, however, with treatment, neuropathy is curable.
Finally, untreated diabetes results in your pet ultimately starving to death, if DKA doesn't set in first. Insulin carries nutrition... without usable insulin in the body, your pet begins to starve. This is not a "humane alternative" to treating your pet's diabetes. With treatment, Sue's Tuppy lived with diabetes for eight years after diagnosis! Countless other pets and their owners have been living with diabetes for anywhere from a year to five years or more! If humans can treat diabetes and live a full life, why can't your pet?
If you're thinking about giving your pet up for adoption because you don't want to treat, there's something you should know. Being away from home and family will most likely create stress for your pet, which raises blood glucose levels and can create more problems. In addition, various Humane Society websites claim that adult cats have a hard time being adopted. Most people want a kitten. So, if an adult cat has a hard time getting adopted, an adult cat with special needs is near to impossible. More likely, your pet will sit behind the bars of a cage, day in and day out, until his/her time runs up and the shelter has to euthanize. Is THIS fair to your friend? There are some cases where a diabetic pet has been successfully adopted, but those cases are, sadly, few and far between.
Still not convinced that treatment is the way to go? Take a look at these before and after pictures and tell me that treatment doesn't work!
Before treatment, Iris did little more than sit on our laps all day. She was tiny and frail looking, though it is hard to see from this picture of her in her daddy's lap. However, after treatment, she loves to climb and play!
Here is Boo. Deanie took this before picture because she was unsure if Boo was going to make it. His legs were shaved from where they gave him injections, and his coat is unkempt because he didn't feel well enough to groom. But look at Boo now! He's never been better and loves patroling his territory... which means bugging Mom to go outside first, of course!
The two before pictures are classic examples of diabetic neuropathy. In the first, Rambo is splay legged because there was nothing for his feet to grip into. In the second, you see Rambo walking on his hocks. His fur is shaved because of the mats that formed due to his inability to groom himself. Rambo's mom tells me that Rambo is now fine, after treating his diabetes! Take a look at that third picture! "Moo-om, do you have to flash that thing at me again!?"
Doesn't Lara look so much happier? Before treatment, Lara developed cataracts and was so thin you could see her bones. Today, Lara is healthy again, thanks to her parents, who refused to give up on her.
On September 24th, 2003, when my husband and I learned that our new kitten was diabetic, we were also concerned with money problems and how much Iris would have to suffer. However, I did my research and found the Feline Diabetes Message Board, whose members helped me discover the methods of treatment I've just introduced to you. With those methods, we have made treatment affordable and as painless as possible for Iris. For the first time in her young life, she has the energy to chase a ball around the house. I'm glad I chose to treat. I hope that you do, too.
I'll leave you now with three pictures of Iris climbing down from her tree perch - to me, these three pictures are proof that treatment works. There is no way she'd have had the energy or ability to do this before treatment.
On October 8, 2004, my husband and I helped Iris over the Bridge. She was very sick and was rarely happy anymore... having had diabetes since such a young age took a toll on her health. She also probably had Cushing's disease on top of that. We opted not to do surgery to remove her adreanal glands due to the fraility of her health. She had a wonderful year that she wouldn't have enjoyed without treatment of her diabetes... many cats live much longer than that after diagnosis. Iris will be greatly missed.