Recently, I started taking a bit of a "less is more" approach to treating diabetes in cats. Most of my feline patients resent being brought into the veterinary clinic frequently, resent being restrained for blood draws, resent having their ears pricked for at-home glucose monitoring … (you get the idea). Since I believe that the goal of medical intervention should be an improved overall quality of life, I began to ask whether my previously more aggressive treatment approach was really doing my diabetic feline patients any favors.
Turns out lots of veterinarians have been thinking the same thing, and one renowned feline expert, Gary D. Norsworthy, DVM, DABVP, has even put a name to this "less is more" attitude — the Ultra Loose Control Approach. He developed his technique primarily because too many cats were being euthanized due to the hassles and expenses associated with his previous recommendations.
Dr. Norsworthy says that his Ultra Loose Control Approach is built on the premise that
- Cats tolerate hyperglycemia with minimal/tolerable clinical signs.
- Cats do not have significant complications from diabetes such as cataracts, peripheral vascular disease, and renal disease.
- Cats tolerate hypoglycemia with no or minimal clinical signs (though this shouldn’t be overstated because severe hypoglycemia can be fatal).
When trying to simplify the care of a diabetic cat, more emphasis is put on monitoring and resolving the patient’s clinical signs (e.g., increased thirst, appetite and urination; weight loss; reduced activity levels, etc.) than on precisely controlling blood glucose levels.
The process basically boils down to feeding the cat a low carbohydrate diet (canned if at all possible) and if initial blood glucose levels are high enough, starting twice daily injections of a long-acting insulin at a low dose. Cats are rechecked approximately once a week with a single glucose measurement taken when blood sugar levels are expected to be highest (approximately 12 hours post insulin). Based on the results of this single measurement and MOST IMPORTANTLY a discussion about how the cat’s clinical signs are or are not improving, the doctor will decide whether to increase the insulin dose or leave it alone. Weekly rechecks continue until the cat’s peak blood glucose level is under 350 mg/dl and the symptoms of diabetes have resolved.
Once the cat reaches this point, rechecks can be spaced further apart. Usually this starts out to be around once monthly. Again, a single glucose measurement is taken when blood sugar levels are expected to be highest, and the vet and owner go over a detailed history of the cat’s clinical signs. If the blood glucose measurement is 300-350 (or even higher) and the cat is symptom-free, all should continue as is. If the cat has clinical signs of diabetes the insulin dose needs to be adjusted upward in the manner that was described previously. If the blood glucose level is below 250 mg/dl and the clinical signs are gone, either the insulin dose needs to be reduced or stopped entirely. These cats may be heading into a diabetic remission.
Dr. Norsworthy reports the following results with his approach:
- Approximately 30% of cats go into remission
- Hypoglycemia is rare
- Most live 3-6 years and die of non-diabetes related disease\
- 80% or more are over 10 years old at the time of diagnosis
- Many are over 14 years old
Of course, achieving diabetic regulation is not quite as simple as what I’ve written here. For example, any concurrent diseases like pancreatitis, periodontal disease, and urinary tract infections also need to be addressed to maximize the chances of a cat going into remission. The details must be left up to the veterinarian involved in the case. But the general idea, that we should be focusing on how diabetic cats are doing under treatment rather than on specific lab values, could save many feline lives.
Dr. Jennifer Coates
Approaches to the Diabetic Cat. Gary D. Norsworthy, DVM, DABVP. Wild West Veterinary Conference. Reno, NV. October 17-20, 2012.