Diabetic Cat Care

The information contained in this sticky is provided for educational purposes only and is not intended to replace veterinary advice. The intention of this sticky is to open doors to understanding about the specific medical condition or topic, allowing for educated and on-going discussion with your vet.

La langue principale parlée à DCC est l'anglais, cependant, nous avons quelques membres qui parlent le français. Les informations suivantes ont été traduites en français pour aider à la compréhension du Protocole. Vous trouverez dans ce document : le protocole DCC, le Processus de Désintoxication exigé de la nourriture sèche et Comment traiter correctement les hypoglycémies pour que votre chat soit protégé d’une hypo clinique sérieuse.

Diabetic Cat Care

Canada Info

Canadian Angel Parker

It’s important to be organized before jumping into the protocol, making sure to have all the supplies you need prior to making ANY changes, especially changes to diet. While your vet may have sent you home with insulin, syringes and prescription food, it is more than likely the supplies you have will not be correct for the purposes of TR.

Glucometers and Test Strips

Your glucometer is the most important weapon you will have when it comes to healing your cat’s diabetes. Some meters are more accurate than others; below are some anecdotal findings when it comes to glucometers available in Canada. Ideally you will want a meter that when compared to vet clinic testing is more accurate at higher numbers (most meters are comparable at low numbers), and also a meter that isn’t affected by hematocrit.

Your vet may want to sell you a very expensive “pet glucometer”, but you really don’t need to spend the excessive amount money on a meter made for animals. The variance in glucose readings between pet and people meters is very small, and the truth as you will learn once you start TR is that it is the trends which are more important. Also, pet meters sold by vets require test strips which are ONLY sold by vets – they cost at least twice if not three times as much as test strips for human meters! Not only that, because you can only purchase them at vet clinics, if you happen to run out of strips when the vet clinic is closed, you won’t be able to get more strips until the vet clinic opens again.

Test strips for human meters usually cost about $75.00-$80.00 for 100 strips in Canada; Costco or online pharmacies might be a bit cheaper. Unfortunately, there are very few sources of test strips in the US who will ship to Canada any more, but it may be possible a US member of DCC might be willing to be a “US ship to address” for you so you can take advantage of much lower costs in the US. To give an idea of the cost difference, using Nova Max Plus strips as the example and purchasing through American Diabetes Wholesale at this time (early 2018) – the cost of 100 test strips is USD $25.49, it cost approximately USD $15.00 to have them mailed USPS Priority for a cost of USD $40.49, or CDN $51.04 – the savings purchasing from the US is almost $24.00 per 100 test strips. That’s pretty significant or further cost savings when buying in larger amounts!

Initially we recommend you purchase at least 100 test strips in Canada so you don’t have to wait to start TR. If you are interested in finding a US ship to address, please post on Talking TR or PM an Advanced Member for assistance.

When ordering from the US, request the strips be sent USPS Priority Post with a tracking number, and make certain your “ship to address” records the Canadian Customs Codes for diabetic products clearly on the label to avoid being charged duty or taxes. The Canada Customs Code for importing diabetic supplies (test strips and syringes) into Canada is 3822009010, HST Code 56. If you are inadvertently charged taxes and customs duty on diabetic supplies, you may obtain a refund by contacting your local Canada Border Services Agency in writing (refunds take approximately 30-45 days).

Please note, for Canadian members we do not recommend purchasing glucometers from the US as they use the Imperial system of measurement where we use the Metric system in Canada. This will make a difference when it comes to keeping your log updated and also when dealing with your vet.

Nova Max Plus

The Nova Max Plus tests both for glucose and blood ketones. It’s proven to be a very accurate meter in comparison testing – both on forum and in brand to brand trials. It is not affected by hematocrit and doesn’t require recoding every time you open a new box of strips. One of the benefits of this meter is the blood ketone testing meaning that should there be concern your cat is producing ketones which is common prior to starting TR, you will not have to wait by the litter box with Ketostix in hand to confirm or deny. It is unlikely you will need more than one box of Ketone test strips because once a cat is well regulated on TR, unless there’s a reason to, testing for ketones isn’t usually needed. The Nova Max Plus is not available OTC at all drug stores in Canada just yet so it may be the pharmacy will have to order it and the strips for you initially.

Bayer Contour

The Contour meter requires no coding, and gives a fast 5-second result, requiring a 0.6ml sample of blood. With programmable HI/LO settings, meters can be personalized to account for unique monitoring needs. There is no interference with maltose, galactose, oxygen or many other common interfering substances, and there is an automatic correction for hematocrit.

Accu Chek - Aviva

This meter requires a larger sample, 0.6ul and the lancets are contained in a drum so you cannot lance by hand, but is also very easy to use and allows more blood to be added if the first sample was insufficient. You are only given 5 seconds from the first blood sample being applied. Test strips for this meter are not affected by hematocrit and tend to be priced higher.

Freestyle Lite

While one of the most popular meters available, informal on-forum test comparisons indicate this meter tests much lower at higher numbers when compared with meters we know are more accurate based on vet testing comparisons. This is an important concern, especially before your cat is well-regulated. When using this meter is it important to work towards maintaining ideal range numbers, as these numbers compare more accurately the closer they are to ideal range numbers. These meters take a very small sample of blood, 0.3ul, which helps make testing easier. The strips are more expensive than those for some of the other meters. This meter is often available free with purchase of 100 test strips and at times coupons will be available for free extras with purchase, such as 100 free lancets. The Freestyle Lite also has the advantage of not requiring coding and allows 60 seconds to add more blood to the test strip if the first sample is too small.

Food Information

If your cat is already on insulin and is being fed dry kibble or high carb canned food, please visit the Detox Process sticky prior to making any diet changes. Foods listed with the carb percentage listed in "red" surpass the maximum 10% DM Carbs appropriate for TR and are only included for informational purposes, or for feeding when dealing with an unplanned and/or stubborn low. We do not recommend feeding fish more than a couple of times a week as it is hard on the kidneys, and other than the Seafood Feast (Teal label) just as beef does, fish tends to raise the BG for most cats.

The list below is a "fast start" food list identifiying low carb foods available in the US which are below 10% dry matter carbs and suitable for TR.

Purina Fancy Feast Pate: Some flavors may not be available in Canada
Purina Canada has removed the word "Classic" from their labels and they have only the word "Pate".

Beef Feast (brown label color), DM Carbs: 6.8% , Phos. 0.43% per oz. (This flavor can spike BG in some cats, regardless of the carb count).
Beef & Chicken Feast (red), Dry Carbs: 4.54% , Phos. 0.46% per oz.
Beef & Liver Feast (magenta), DM Carbs: 9.9. % , Phos. 0.42% per oz.
Salmon & Shrimp Feast (blue green), DM Carbs: 8.4%
Savory Salmon Feast (orange), DM Carbs: 9.0% , Phos. 0.44% per oz.
Seafood Feast (teal), DM Carbs 6.81% , Phos. 0.49% per oz.
Turkey & Giblets Feast (olive green), DM Carbs: 6.9% , Phos. 0.39% per oz

The following 2 flavors are too high in carbs for TR
Cod, Sole & Shrimp Feast, 85g, DM carbs 13.6%, Phos. 2.18% per oz.
Ocean Whitefish & Tuna, 85g, DM carbs 12.7%, Phos. 2.18% per oz.

Purina DM Wet Formula DM carbs 6%, Phos 1.27% Many vets prescribe this food at diagnosis - it does contain oat fiber. The dry formula is too high in dry matter carbs for TR.
Please note: Purina has another variety of DM Savory Selects which has ingredients not appropriate and high carb- DO NOT PURCHASE

Purina Pro Plan True Nature has been removed from the list

Feline Cuisine:
Beef Banquet Dinner, 85g, DM carbs 9.09%, Phos. N/A

Compliments Brands

Compliments Happy Tails:
Liver and Chicken Dinner 156g cans, DM carbs 8.2%, Phos. N/A
Prime Entrée 156g cans, DM carbs 8.2%, Phos N/A

Compliments Ultra Gourmet:
Mixed Grill Pate 85g can, DM carbs 9.1%, Phos. N/A
Turkey and Giblets Pate, DM carbs 6.8%, Phos. N/A

Finicky Cat Gourmet Pate:
Liver and Chicken Dinner 85g, DM carbs 9.1%, Phos. N/A
Turkey and Giblets Dinner 85g, DM carbs 6.8%, Phos. N/A

The following products can be found at Mr. Pets,Vancouver, Calgary or Pets only or check your local stores
Mfr. supplied Info. As Fed

Tiki Cat After Dark grain free in Broth
Chicken in Broth, DM carbs 7.07%, Phos. 87.5
Chicken & Beef in Broth, DM carbs 10.0%, Phos 1.25%
Chicken & Duck in Broth, DM carbs minus 1.11%, Phos 1.11%
Chicken & Lamb in Broth, DM carbs minus 1.11%, Phos 1.16%
Chicken & Pork in Broth, DM carbs 4.73%, Phos 1.26%
Chicken & Quail Eggs in Broth, DM carbs 2.22%, Phos. 1.46%

Tiki Cat Grain Free
Puka Puka Luau Succulent Chicken, DM carbs 0.6%, Phos. 1.0%
Hanalei Luau-Wild Salmon, DM carbs 1.7%, Phos. 1.08%
Hookena Luai Ahi-Tuna & Chicken, DM carbs -0.5%, Phos. 1.04%
Napili Luau-Wild Salmon & Chicken, DM carbs -0.5%, Phos.1.18%

Raw Catfood

3p Naturals Basic Instincts Raw Information available from BC supplier: https://basicinstinctcat.ca/meals/

We suggest reading through the supplier site to obtain comprehensive information about each formula before ordering from a retailer. There are feeding schedules available on site and on packaging.

Retailers available:
https://nupetfooddelivery.com/collections/raw-cat-food
https://www.moonlightpetstore.com/category/s/466/3p-basic-instinct-raw-pet-food/

Fish
Salmon Formula - Non-medicated, Bone, Organ: DMC 0.2%

White meats
Chicken Formula - Non-medicated, Bone, Organ: DMC 0.10%
Turkey Formula - Non-medicated, Bone, Organ: DMC 1.69%
Rabbit Formula - Non-medicated, Bone, Organ: DMC 0.70%

Red Meats
Beef Formula - Non-medicated, (Boneless-replaced with steamed lamb bone meal), Organ: DMC 2.40%
Lamb Formula - Non-medicated, Bone, Organ: DMC 0.9%
Elk Formula - Non-medicated, Bone, Organ: DMC 1.20%

Exotic Meats
Kangaroo Formula - Non-medicated, Bone: DMC 1.00%
For any cat with extreme food sensitivities or allergies, Kangaroo provides a true game meat. *Must be feed with other formulas or supplementation as this formula does not contain organ meats.*
Camel Formula – Non-medicated, Bone: DMC 0.3%
No organs: Used as a ‘novel’ protein source for shorter periods of time.
Duck Formula - Non-medicated, Boneless, Organ: DMC 0.2%
Duck should only be used a supplemental meat unless otherwise directed by a veterinarian. Duck does not fall into the same white meat category and therefore should not be fed a sole source of white meats.

Acceptable Treats

Pure Bites Freeze Dreid Turkey and Chicken are acceptable for cats, Duck is high in fat; the rest of the flavours are either fish or vegetable based. Please note the Beef Liver treats are not recommended as liver is very high in Vitamin A and can be toxic to cats in excess.

Pet food manuafactures are now making lickable wet toppers or mixers to entice your cats to eat when they have backed off their foods when not well.

Pure Bites lickable wet chicken breast is appropriate. Do not use any other flavors except for the chicken breast for our diabetic cats.

Benny Bully’s Note: The Sweet Potato Chops are NOT suitable for FD cats.

Insulin

We are very lucky in Canada because we do not require prescriptions to purchase human insulin such as Lantus, Levemir and NPH which are available OTC (over-the-counter). All types mentioned above are U100 strength insulin. Levemir or Lantus are the best of the three alternatives above. When purchasing Levemir, Lantus or NPH, it is recommended to buy the 3ml cartridges (without the accompanying pen) rather than the 10 ml vials because there is less waste. The pen device is NOT suitable for TR because it is impossible to measure the small increments most often needed by our cats. Labels on most insulin claim it expires 28 days after opening the vial, however, proper handling and storage in the fridge does prolong vial life significantly – a minimum of 6 months or more. Wal-Mart and Costco usually have the best prices on OTC insulin. Hospital pharmacies are also a good place to buy insulin and tend to be much cheaper than anywhere else. Many vets sell human insulin types at their clinics but if costs are a factor, it is highly recommended to do some homework first to avoid having to pay what can be significant markups, sometimes 15% to 25% more than you pay buying it yourself. If your vet’s prices are higher, most will price match if you take proof of the price difference with you to the clinic. The same goes for syringes as addressed below.

Vet Prescribed Insulin

There are only two manufactured “vet insulins” available in Canada, Caninsulin and ProZinc. Caninsulin is a pork based insulin type, approximately 4 amino acids away from a cat’s own insulin. It was originally made for dogs, hence the name “canin-sulin”. ProZinc is a salmon based insulin type, it is not what we consider “real” PZI as it is not bovine-based. For cats with known intolerances or allergies to fish or pork, it may be worth considering a human based insulin type.

For more detailed information about various insulin types, please see the Specific Insulin & Starting Scales sticky.

Ketone Test Strips

Tight Regulation generally does not require checking your cat's urine for ketones. That said when most owners find DCC, their cats have been in very high numbers for a long time, and in some cases, their cats are in the process of recovering from DKA (diabetic ketoacidosis). Until your cat is better regulated on TR, it is wise for some owners to periodically check their cat for ketones. You will need to buy Ketostix (available at most pharmacies /$10 for 50 strips). There is no need to purchase urine sticks that measure both glucose and ketones as they cost a fortune and are not essential. The presence of ketones may indicate the beginning (or a recurrence) of diabetic ketoacidosis (DKA); a dangerous and sometimes fatal condition primarily caused by prolonged hyperglycemia. Until the cat is consistently reaching BG below renal threshold (12.5/225), it is wise to check the urine at least once daily for ketones. This also has the additional bonus of making you aware of what is ‘normal’ when it comes to your cat’s urine – colour, smell and clarity all of which can change when other health issues are in play. Alternatively, glucometers such as the Nova Max Plus have the capability to check Blood Ketones which is much easier and more accurate than using Ketostix.

Syringes

Syringes in Canada are typically very expensive. The highest quality brand is BD, available at drugstores without prescription. Your vet will likely want to sell you syringes at a much higher cost than purchasing them yourself, we have heard a price of $65.00 or more a box of 100 being the norm when purchasing through the vet. We recommend calling the drug store to compare prices with the vet’s cost, and if needed, only purchasing one package of 10 syringes or asking the vet to price match. One big problem when buying syringes through the vet is the syringes typically do not have Half Unit Markings. These are very important when practicing TR because of the very small incremental doses, sometimes as small as only 0.125 units of insulin. Without those half unit markings, accurately and consistently measuring out those very small amounts is next to impossible. Many vets adopt the approach of using half unit (0.5u) or full unit amounts for all cats; we do not agree with this approach! When dealing with small cats, they’re just like infants and a very small amount of insulin can go a long way. If your vet recommends pens, please tell them you would rather use a syringe. Whether it is U40 insulin or U100 insulin you decide on for your cat, syringes with half unit markings are available – it is important to note, once a box of syringes has been purchased, most stores and clinics will refuse to exchange them or allow a refund.

As a member of DCC, you are able to order both U40 and U100 insulin syringes with half unit markings through a company called EliMedical located north of Toronto. EliMedical's Special Order Program can be viewed here. You will need to download the order form on their site to access special program pricing details which are approximately half the cost of purchasing syringes retail or through the vet. We suggest following up with EliMedical directly by phone once you have placed your order to confirm what method of shipping you want to choose and what the costs will be.

Once you have started TR, it may be ordering syringes from the US (as explained in the Glucometers & Test Strips section above) will be a great way to help reduce costs; for example even with the currency exchange (early 2018), a box of 100 3/10cc BD syringes with half unit marks is approximately $26.50 compared to $45.00 or more when bought in a drug store – a savings of $18.50 CDN a box at the drug store, or almost $40.00 CDN a box saved when buying through the vet.

The Canada Customs Code for importing diabetic supplies (test strips and syringes) into Canada is 3822009010, HST Code 56. This should be clearly marked on all shipping documentation to avoid having to pay Canadian Duty and Taxes when importing diabetic supplies. If you are inadvertently charged taxes and customs duty on diabetic supplies, you may obtain a refund by contacting your local Canada Border Services Agency in writing (refunds take approximately 30-45 days).

Sub-cutaneous Supplies

For Sub-Q suppliers in Canada, please visit Scooter's website for CRD cats. Fluids and the tubing can be very expensive to purchase through your vet. Also, the cost to ship due to their weight can be substantial. Depending on your cat's situation, the need to spend for a full case of fluids may not be necessary. It may be worthwhile asking your local pharmacy if they will order it in for you. The product code for a 500 ml bag of Lactated Ringers - intravenous fluids and electrolyte replenishment, NaCl 0.9% Sodium Chloride, manufactured by Baxter is JB1323 - DIN00060208. To give an idea of the difference between buying fluids through the vet ($33.90 for a 1000 ml bag), versus from the drug store ($7.98 for a 1000 ml bag) – a difference of $25.92 per bag! Again, it may be possible your vet will be willing to price match when you let them know what you can get it for when sourcing it on your own.