Q: What Causes Diabetes in the Cat?
For many years, veterinarians have known that obesity in cats seemed
to make the obese patient more likely to get diabetes. In fact, most
of us thought that overweight actually caused diabetes. Today, I do
not believe excess pounds in a cat are a cause of this condition.
I believe that obesity in the cat and feline diabetes have the same
“parent” causes, but are not a cause of one another. Although
we do see many feline diabetics that are also quite overweight, these
cats are probably genetically predisposed to get both of these problems
from the same root causes. Because we often see cats that have one,
but not both, of these conditions, this is undoubtedly because of
each cat’s unique genetic make-up. The significant numbers of
always-slender cats that have full-blown diabetes suggest that being
proper weight does not protect from this disease. Also, we see very
overweight cats that become diabetic, but then recover from their
diabetes easily on proper diet and insulin, long before they lose
the weight they need to lose.
If obesity doesn’t directly cause diabetes, then what does?
Well, with cats just as with people, it definitely pays to have good
genes. Some cats simply have genes that make them more or less likely
to get diabetes, and more or less likely to get lots of other diseases
as well. The story doesn’t stop there, though. Other environmental
factors play a big part in either getting or avoiding a disease such
as diabetes. Without question, for the cat (and for most humans as
well), the most important environmental factor that causes diabetes
is diet. Because today’s indoor cat is almost always eating
dry cat food, with its extremely high processed carb (essentially
sugar) content, a cat with any genetic tendency to become obese and/or
become diabetic will do just that when sugar is a large part of its
diet. In my many years of practice, I have never seen a diabetic cat
that was eating canned food only. Also, I have never seen an overweight
cat that was eating canned food only. The onset of obesity and diabetes
is triggered by constant flooding of the cat’s system with refined
carbohydrate from the dry diet, day after day, month after month and
year after year. This steady sugar rush finally exhausts the small
pancreatic capabilities of the carnivore because the cat’s evolution
never prepared it for a constant high-sugar diet. In some cats, relentless
sugar surges cause the cat pancreas to turn that sugar to fat. Obesity,
with or without diabetes, follows.
Q: How do I know if my cat has diabetes?
The most common signs of diabetes in almost any animal, including
humans, is increased thirst and increased urine output. If you see
these in your cat, see a veterinarian immediately. Some diabetic
cats will also lose weight unexpectedly (many are overweight to
begin with because they are eating dry cat food), begin vomiting,
have diarrhea, and become listless. Any sign of general illness
can be a sign of diabetes.
Q: My cat was just diagnosed! What do I do?
The time right after signs of disease have appeared is a critical
time if the disease is to be stopped and reversed. Diabetes can
be cured but is easiest to cure if the problem does not become chronic.
The best approach to managing a diabetic, whether newly diagnosed
or long-term, is the protocol I use. See the link to “Protocol”
for the information about how this approach works.
Q: Is a diabetic cat doomed to a poor quality of life?
Not at all. Remarkably, because this is a “man-made”
disease, caused by the wrong food for the life of the cat, it can
almost always be reversed by removing the offending dry diet and
aggressive management. See “Protocol.”
Q: What is hypoglycemia, and how do I handle it?
Hypoglycemia is the term for low blood sugar. Diabetics have the
opposite problem, high blood sugar, called hyperglycemia. Diabetics
only develop hypoglycemia (low blood sugar) is they are managed
incorrectly. You will read some scarey stories about diabetics that
“hypo” and have all kinds of problems as a result. However,
no cat ever needs to have any episodes of hypoglycemia if it is
managed without dry cat food and sugar supplements (like Karo, pancake
syrup etc.). I have managed hundreds of diabetic cats and have never
had one that was on my protocol has had an episode of hypoglycemia
that produced these signs.
Q: What is the goal of treatment?
My goal for all of my diabetic patients is to restore the cat to
its previous health without need for insulin. Other veterinarians
may not attempt to achieve this goal, but my years of experience
have taught me that more than 80% of all cats, especially new diabetics,
can become normal again. Therefore, I do not treat my patients with
the goal of just helping them “limp” along as ongoing
diabetic cats. You may read elsewhere that only a lucky few cats,
far less than the majority, ever become normal again. This is simply
not true, a myth that is perpetuated by those with no experience
in using a more advanced, and well proven method of reversing the
processes of diabetes itself. Diabetic pet-owners have nothing to
lose, except a chronically ill pet that will eventually die of its
under-treated disease, by setting the goal of achieving normalcy
in their pets.
Q: How can I find other people with diabetic cats in my
This Forum is designed to connect other owners of diabetic cats
with one another. The site owner, Dr. Elizabeth Hodgkins is also
available for support.
Q: Can I give oral medication instead of insulin?
No, no forms of oral anti-hyperglycemics are useful in cats, and
some may even make the disease worse. The best, most conservative
approach is to treat aggressively, and early, to restore the patient
to normal health. The only oral approach to feline diabetes that
works is removing all high carbohydrate foods from the cat’s
diet. As you will read in the protocol, this is the key to controlling
and curing diabetes.
Q: Can I control this with herbs or something instead of
No, there are no known herbs or minerals (including chromium or
vanadium) which are useful in managing feline diabetes. There are
herbs and other “holistic” substances, such as the mushroom
agaricus blazeii, and milk thistle, that have benefit in other kinds
of conditions. No doubt, there are many other such natural drugs
that will be found to be of benefit in management of disease in
the cat and other species. Insulin is the cat’s natural hyperglycemia
control substance, so insulin is the drug of choice for getting
the diabetic cat back to normal.
Q: What should I feed my cat?
All cats, diabetic and non-diabetic, should be fed only low carbohydrate,
high protein foods. This effectively removes all dry foods from
consideration, including dry foods that say they are “low
carbohydrate” and all dry foods made for diabetic cats.
Q: Can I free-feed my cat?
You cannot free-feed any dry food. Carb-laden dry cat food is the
cause of feline diabetes in the first place. You can leave canned,
pouched, or meat diets down for some period of time (a few hours)
if necessary. Actually, however, cats do not need to “graze”
on any food. Cows are grazers, but cats eat discrete meals after
a successful hunt. Cats are not herbivores like cows are, and their
meals are high nutrient-density and less frequent than the meals
of herbivores, whose diets are low-nutrient-density.
Q: My cat doesn't like / I can't afford the expensive prescription
food. Is there any less expensive substitute?
Yes, the good news is that any low-carbohydrate canned or pouched
food can be used successfully to manage and cure the feline diabetic.
Some good brands include Fancy Feast, Whiskas, Nutro Kitten, ProPlan
kitten, even Friskies and Nine Lives (never feed any cat an “adult”
or “senior” formula. These older cat formulas are packed
Q: How much should I feed my cat?
Most adult cats should get about 6-8 ounces of wet food total each
day, divided into two or more meals.
Q: What kinds of insulin are there?
For cats, the very best insulin is PZI bovine insulin. All of the
human-type insulins, including the newer Lantus and Levemir products
are far less effective in this species than PZI.
Q: Where can I get PZI insulin?
Any licensed veterinarian can prescribe PZI insulin for your cat
once the diagnosis has been made. Idexx makes a very stable PZI
insulin, and there are at least two compounding pharmacies that
also produce this kind of insulin.
Q: What can I expect to pay for PZI insulin?
Insulin costs about $75-$100 per bottle depending on the manufacturer
and the area of the country in which you live. Fortunately, a bottle
will last quite a long time if you use the protocol on this site,
because you will be using small doses in almost all cases and may
not have to use insulin for your cat for any great length of time.
Q: What kind of syringe should I use?
There are two sizes of syringes available. One is typically used
with insulin that has 40 units per cc, and one is used with insulin
that has 100 units per cc. You will usually use the syringe that
matches the concentration of insulin that you buy. There some exceptions
to this, as using a U-100 syringe to administer U-30 insulin actually
allows you to give doses of insulin as small as four-tenths (4/10)
of a unit of insulin. If this sounds confusing right now, don’t
worry about it. You can discuss this with Dr. Hodgkins on the Forum
if you wish.
Q: Do I need a prescription for insulin or syringes?
Insulin is always a prescription substance, syringes may be available
over-the-counter at some pharmacies.
Q: Can I reuse syringes?
No. Unfortunately, you must use a new, sterile syringe every time
you give your cat a dose of insulin to make sure these injections
are as sterile as possible.
Q: How do I dispose of used needles?
Many veterinarians will accept used syringes from their clients.
Also, you can purchase a “sharps” disposal container
at most pharmacies. In any event, you should not put syringes in
Q: My cat hates getting his shot. Now what?
After working with hundreds of feline diabetics, I have never seen
a cat that actually minds the injection of insulin. New needles
are very sharp and all insulin needles are small diameter. When
the injection is done properly, the patient cannot even feel the
injection. Proper technique is important, as is performing the injection
quickly so the patient doesn’t become anxious just waiting.
Usually, the cat objects to being made to hold still and wait for
the injection more than the injection itself. Many of my clients
will give a low carb “treat” right after the injection,
so the patient associates being held for a short time with a fun
reward. Never use regular treats available at the grocery store
for this purpose. Such treats are loaded with carbs and can undo
some the good accomplished with proper diet. Freeze-dried meat-only-type
treats work great for this, and are good for your diabetic.
Q: How long does a bottle of insulin last?
When you use the protocol on this site, you will be using small
doses of insulin, usually only a few units per day total. A bottle
of insulin can last months.
Q: Sometimes I can't be home to give one of my cat's shots;
is it okay to give it late or early?
Although work and family schedules may make it hard some days to
keep to a regular schedule for dosing your cat with insulin, it
is critical to do your very best to give doses at 6-12 hour intervals.
Giving insulin at intervals less than 12 hours has a very beneficial
effect on the regulation of the feline diabetic. This fact is well
understood in the area of human diabetes, where patients typically
test themselves every few hours and give insulin “as needed”
to keep their blood glucose very level. It is keeping the blood
glucose “level and low” over an extended period of time
that allows the patient to feel well, and return to normal in most
Q: How much insulin should my cat receive each day?
This will depend on many factors, most especially your own pet’s
ability to produce some of its own insulin. Avoiding high-carbohydrate
foods also allows much lower insulin doses, and a much more rapid
return to normal function. Most cats on the protocol get only a
unit or two, at most, 2-3 times daily, for a few weeks.
Q: How can I monitor how well the insulin is working?
I recommend that all of my clients with diabetic cats use a glucometer,
available at any pharmacy, to home-test their pets at home. This
procedure is performed by all human diabetics several times a day,
and it is easy to learn. Web sites such as http://www.petdiabetes.org/ear_prick.htm
can give you a very good idea about how to perform this very important
test for your pet.
Q: What kind of glucometer should I get?
I personally like the Freestyle™ Flash because it is so easy
to use. However, there are many models on the market that will also
work well. There is a new model available through veterinarians
that the manufacturer claims is best for dogs and cats. Unfortunately,
I have not been able to obtain this particular meter to test for
myself. Until I am able to do this validation, I do not recommend
this meter because the unit itself, and the reagent strips it uses,
are very much more expensive that the human meters that are readily
available at human pharmacies. What is most important is that you
get a unit you feel comfortable with and use the same meter every
time you test. That way, the numbers are actually secondary to the
trends in blood glucose that you will detect.
Q: How often should my cat's glucose levels be tested?
I recommend that my clients test at least every 12 hours. Ideally,
the cat should be tested three times daily to allow the most level
blood glucose “curve over the 24 hours of each day.
Q: If my cat has a blood glucose level that is in the normal
range of 60-120 when I test, should I still give insulin?
No, you do not want or need to give insulin if your cat’s
blood glucose is in the normal range. However, this number may change
rapidly without an insulin shot, so retest within 2-3 hours. If
the number remains normal, great! If the number rises above the
normal range, you will need to give that missed dose.
Q: 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.
In the US, we use a different system of measurement for the amount
of blood sugar in circulation. To convert European values to American
values, multiply by 18. Conversely, to change US values, divide
Q: I'm following the instructions faithfully, but I still
can't get blood from my cat's ear.
Make sure your cat’s ear is fairly warm, meaning that blood
is flowing in the vessels of the ear. Relax, tension can cause this
to be harder for you than necessary. I suggest using the very edge
of the outer side of the ear for the prick. I also suggest using
a clipper to remove some of the hair from the edges of the ear as
this will make the small drop of blood easier to place into the
test strip in the meter.
Q: 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?
No! Your cat is actually at the normal level for the cat. What most
people do not realize is that the cat IS NOT hypoglycemic at these
levels of 50 or less. I have seen many normal cats with these kinds
of numbers when they are tested at home without the excitement of
being at the veterinary hospital. In fact, numbers well below 100
are absolutely normal for the diabetic as well as the non-diabetic.
I cannot over-emphasize this point. Those who believe that a cat
is having a “hypo” when blood glucose numbers fall below
100 are in error.
Q: What is a “hypo” and why is everyone so
afraid of it?
When someone talks about a “hypo” episode, what they
are usually talking about is the clinical signs we see in cats when
the brain does not get enough glucose, including weakness and even
seizures. This can happen at many different levels of blood glucose,
sometimes a cat will have these signs at levels that are not that
low, say 70, and other cats show absolutely no signs whatsoever
at blood glucose levels as low as 20! Therefore, the absolute number
is not the whole story, not by a long shot. The cat’s liver
is just as important to the control of blood glucose as the pancreas
is. The liver and pancreas work together, with the pancreas keeping
the blood glucose from going too high and the liver keeping the
blood glucose from going too low. The cat on high carbohydrate foods
loses both its normal liver function and its normal pancreatic function.
This loss of normal liver function is what causes the signs of hypoglycemia.
When a diabetic cat is consuming low carb foods instead of high
carb foods, the liver resumes its ability to make enough glucose
to meet the brain’s needs, and hypo signs DO NOT OCCUR. Low
carbohydrate-feed cats have tremendous resistance to hypo signs
because their livers work to keep this problem from occurring.
Q: Why Are Dry-Food-Fed Diabetics So Prone to Hypoglycemia?
Many diabetic cats on insulin experience periodic episodes of “hypoglycemia”
when their blood sugar plummets. These cats, like Punkin, become
weak or even comatose, and may even have a seizure. These signs
all result when the cat’s brain isn’t getting enough
sugar (glucose). This serious complication is all too common in
dry food fed diabetics. However, we do not see clinical hypoglycemia
in diabetic cats that are eating low carbohydrate wet foods. Why?
To answer this question, we have to understand how the pancreas
and liver in the cat work together. As we have discussed, one of
the pancreas’s most important jobs is to make sure that the
cat’s blood sugar level does not go too high. On the other
hand, one of the liver’s most important jobs is too make sure
that the blood sugar level does not go too low. The pancreas and
liver work together as a team to keep the blood sugar level steady
in the normal range for health. The pancreas produces constant small
bursts of insulin over the course of the day and the liver produces
constant small bursts of glucose by converting amino acids to sugar
to balance the insulin. In the healthy cat, these two organs work
seamlessly together to keep the cat’s blood sugar in balance
at all times.
In the normal cat, when the liver senses that blood sugar is dropping
significantly (as when a cat exercises vigorously), it begins making
a greater amount of glucose from the amino acids from protein. This
is a very well-developed liver activity in this species, because
the cat in nature gets very little of its sugar from its food. Dietary
protein and amino acids are the sugar reservoir in this species.
As we have discussed previously, dry cat food has high levels of
carbohydrate and sugar. These levels stress the pancreas, causing
some cats to become diabetic. This is not the only derangement in
the dry food fed cat, however. When the cat’s diet is high
in carbohydrate and sugar, the function of the patient’s liver
also becomes abnormal. Instead of responding to small drops in blood
sugar with production of sugar, the liver in the dry-food-fed cat
fails to respond. The constant high dietary sugar load has caused
the liver to lose some of its ability to respond quickly to the
event of falling blood sugar. Thus, in the dry-food-fed cat, the
pancreas cannot respond to high sugar any more, and the liver cannot
respond to low sugar. The cat has become a complete carbohydrate
“cripple.” This crippled cat is completely dependant
upon exactly the right amount of insulin from the outside. It is
extremely difficult to provide such precise amounts of injected
insulin. This is why owners find it extremely frustrating to try
to manage the dry-food-fed cat.
Q: Isn’t it better to be conservative with treatment
rather than testing and giving insulin so often to achieve normal
or near-normal blood glucose levels?
Definitely not. What we know is that high blood glucose levels intoxicate
the pancreas, and suppress the normal functioning of the liver.
Until blood glucose in the cat begins to be normal or nearly so
for much of the time, these organs will not begin to work effectively
together. Once they begin to work properly together again, permanent
normalcy is possible, even probable.. If a cat is maintained at
hyperglycemic blood glucose levels, it cannot be said to be well-regulated
at all, and will not resume normal pancreatic and liver function
and cease dependency on insulin shots.
Q: What is a “honeymoon’?
You will hear some owners talk about how their cats achieve temporary
independence from a need for insulin. This temporary state of “normalcy”
is followed usually within a few days or weeks by relapse back into
the diabetic state. It is this phenomenon that makes some people
think that permanent independence from a need for insulin shots
is impossible, or nearly so. What these people fail to understand
is that “honeymoons” always follow a severe hypoglycemic
episode, usually caused by an insulin overdose or repeated overdoses,
which actually does activate the pancreas for a short time. Unfortunately,
when the correct protocol isn’t used after the honeymoon begins,
for example if the cat is still eating a high-carbohydrate food,
or is on a poorly-effective insulin like human insulins, normalcy
will always be short-lived. Permanent independence from insulin
is NOT the same as a “honeymoon.” The protocol does
not seek to achieve these transient remissions. It is permanent
normalcy that is the goal, and is achieved in the majority of cases,
without clinical signs of hypoglycemia.
Q: Are there other signs besides blood glucose that I can
monitor at home?
It is not necessary to check for glucose in the urine or ketones
when you are using the protocol. Urine changes like this occur when
a cat’s blood glucose swings into the high hyperglycemic ranges
for long periods of the day, or all day. The protocol stops this
from happening, so sugar or ketones in the urine do not occur.
Q: I'm interested in home-testing, but my vet won't let
me. What should I do?
Glucometers and test strips are OTC (over-the-counter) items in
human pharmacies or online. You do not need your veterinarian’s
“permission” to test your cat’s blood glucose.
This testing is easy to do and there are a number of online references
that clearly show how to perform this simple procedure at home.
Millions of humans test their own blood glucose every day using
these techniques. No human doctor would even consider discouraging
their diabetic patients from keeping close tabs on their own blood
glucose at home, in fact, home testing is central to competent management
of the human diabetic. The very same principles apply to cats (and
dogs, for that matter). If your veterinarian becomes resentful of
your caring for your cat in this way, which is rare these days,
you may want to find another veterinarian.
Q: What are ketones?
Ketones are molecules which build up in the blood stream and urine
of cats that are poorly regulated or not regulated at all, as might
be the case before a cat is diagnosed with this disease. Ketones
are not a problem with cats on the protocol because high blood glucose
levels necessary for ketones to become a problem do not occur in
cats on the protocol, so it is not necessary to test for them.
Q: What is Diabetic Ketoacidosis?
This is the medical term for a build-up of ketones in the cat’s
blood stream. It can be dangerous and sometimes is the first sign
that the cat is diabetic. One of the great advantages of the tight
regulation achieved by the protocol is that this condition does
not occur in cats on this regulation method. I have experience with
hundreds of feline diabetics on the protocol and am very confident
of this aspect of tight regulation. Others may disagree, but their
basis of disagreement is theoretical, not based on this kind of
Q: Some say that there are a number of different levels
of regulation, and that no one way that is good for all cats. Is
No. In human diabetic regulation, the objective is always the same:
to keep the patients blood glucose level as close to normal as possible
at all times. There are no “different methods or goals”
of regulation in humans. There is no justification for asking a
diabetic cat owner to participate in maintaining a poorly-regulated
diabetic state in their pets. None whatsoever! Not only is this
a slow death for the cat, but it is not at all necessary. Years
ago, before we understood human or feline diabetes as we do now,
this may have been acceptable. It is no longer appropriate or necessary.
Q: My cat has been on insulin for a while and her diabetes
is still out of control. Why can’t I regulate her?
Read the protocol that is linked to the home page. If there are
any steps in that protocol that are not being followed in the management
of your cat, the answer is there. If you are already following the
protocol, contact Dr. Hodgkins through this site for additional
Q: What is tight regulation?
It is the method that is set out in the protocol.
Q: Is remission possible?
Using the protocol, permanent independence from insulin injections
and constant testing is not only possible, but highly probable.
Q: My cat is walking funny / weak in the hind legs / not
jumping well. Is this related?
Diabetic cats that are poorly regulated can develop a condition
known as diabetic “neuropathy,” or nerve damage, which
is common in cats that have been hyperglycemic for extended periods.
Any weakness, especially in the hind legs or back in a diabetic
cat may be signs of this condition. The way to relieve and reverse
this damage is to achieve better regulation.
Q: My cat has kidney failure. How do I manage this as well?
Because unregulated diabetes damages the vessels of the body, all
organ systems can be negatively affected by vessel damage, and the
kidneys are often the first organs to show this damage. Therefore,
achieving good control of chronic hyperglycemia is imperative to
controlling kidney problems in diabetic cats. Beyond that, there
are a number of other very effective approaches to managing kidney
problems in any cat. These include the use of drugs like benazapril
(an ace-inhibitor), fluid therapy, phosphorus binders and others.
Once the underlying diabetes is controlled or reversed, kidney problems
become much easier to deal with.
Q: My cat has asthma; how can I avoid using steroids?
It is absolutely true that steroid drugs such as injectable depomedrol
or oral prednisolone should be avoided in diabetic cats. Often,
it is these very drugs that have pushed the cat over the edge into
diabetes when it was treated with these drugs while consuming high
carbohydrate dry foods. There are a number of ways of dealing with
asthma and other allergic diseases without using oral or injectable
steroids. These include hypoallergenic diets, inhalers with bronchodilators
or inhalant steroids (not usually as much a problem in diabetics
as systemic steroids), antihistamines, or a new drug called cyclosporine
which is a non-steroidal immunomodulator. You will want to discuss
using one or more of these approaches to manage your cat’s
Q: I can't get my cat to eat! What should I do?
Diabetic cats under tight regulation generally eat their wet foods
very well. Until this kind of control is achieved, it is useful
to try very palatable “treat” foods at first, and appetite
stimulants like ciprohepatidine (periactin) can also be used. Other
owners that participate in Your Diabetic Cat Forum or Dr. Hodgkins
can help you with this transient problem.