The Detox Process, Preparing for Tight Regulation, 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.

Diabetic Cat Care

Preparing for TR

The Detox Process

No doubt like it was for most of us, you're still dealing with the shock of discovering your cat has been diagnosed FD, you've found DCC, read the Protocol page, and have figured out you've not been feeding species-appropriate food to your cat. Maybe it hit you like a bolt of lightning, what you've been feeding actually might even have caused the diabetes. You may also be realizing with all you’ve been doing, your cat isn’t really improving very much. Perhaps you’re now asking yourself, what should I do next?

We want to be really open with you; if NOTHING ELSE about the TR Protocol is of interest to you, if your cat is already on insulin, we strongly urge you, with assistance from experienced members on DCC’s forum, to safely navigate your cat through The Detox Process and literally take the risk of potentially fatal symptomatic clinical hypo off the table for your otherwise healthy diabetic cat.

We cannot emphasize enough the need to follow the detox process strictly in order to keep your cat safe!

The most important thing to do if you’re not yet, is to learn how to test your cat’s BG. Testing blood glucose with a glucometer is a non-negotiable requirement for TR. We do not support blind dosing (not knowing what your cat’s BG is before giving insulin) because there’s no way to know if our cats even need insulin at shot time without testing.

Veterinary clinics usually have “pet” meters for sale, typically the Alpha Trak, with an average in-clinic cost at around $250, test strips themselves run at least $1.00 apiece or more and are only available through vet clinics in some countries. This meter can be purchased for much less online whether at pet sites or from American Diabetes Wholesale in the US (DCC has discount codes available to members for online purchases only). That said, a “pet” meter isn’t necessary, human meters are much less expensive and test strips are far cheaper. With TR we use BG testing to monitor the trends in our cat’s test results, and then base dosing amounts on TR’s sliding scale approach (higher BG means more insulin given, lower BG means less insulin given).

Home testing of BG can be quite intimidating for some folks, so if you’re nervous or having troubles getting the testing down, or have any questions about the many meters on the market, please post on Talking TR for guidance. Each and every member at DCC has gone through the process of learning how to test their cat; they’re more than willing to share tips and tricks to make home testing successful.

After finding DCC, learning about species-appropriate diet, sliding scales and the potential for diet controlled diabetic remission, most folks are quite anxious to get on the road to healing, wanting to jump right in. However, BEFORE YOU CHANGE ANYTHING, it’s very important to perform a detox from dry and high carb wet food. DCC’s Detox Process is specifically designed to protect your cat from preventable symptomatic clinical hypo during the diet switch, and to provide ongoing protection from symptomatic clinical hypo while on insulin.

Depending on what your cat's current situation is; whether or not insulin has started, what insulin dose your cat is currently receiving, as well as your cat's current health condition, you will either withhold insulin completely for up to 24 hours, or give significantly reduced doses for the first 24 hours, starting at the same time you change your cat over to an all wet, low carb diet. As well, testing of BG will occur to assist in determining the amount of insulin to give once detox is complete. We cannot emphasize enough the need to follow the detox process strictly in order to keep your cat safe!

Too often we have learned cat owners have continued to give vet prescribed doses of insulin while they remove dry or wet high carb food, only to have their cats end up needing to be rushed to the ER vet due to symptomatic clinical hypo. This is a very frightening and completely preventable experience. If you are not certain about which form of detox is appropriate for your cat after reading the various approaches, please post on the Talking TR Forum for assistance.

Once you have home testing down, the next step is to make the switch to a species-appropriate low carb wet diet. We know some cats are very finicky eaters, totally addicted to the dry "kitty crack". As long as you keep the dry food in your home, your cat can smell it and many will refuse to eat low carb food, holding out for their kibble. At the time you start the detox, we strongly suggest getting the dry kibble out of your house and then washing the storage area with a strong vinegar solution to remove the smell. Dry kibble is not a normal food for obligate carnivores (cats) –in fact, if kibble wasn’t sprayed with flavour enhancers, cats wouldn’t even touch it – not to forget, it’s likely what caused the FD in the first place. If you need assistance to transition your cat to a low carb wet diet, please know you are not alone and post on forum for assistance. To understand why one of our two non-negotiable rules is a low carb wet diet, please read DCC's Dry Food Policy.

Some cats can be very fussy when it comes to any change-please don’t try to starve your cat into eating because that won’t work! Members on forum are more than willing to share their experiences with you when it comes to a variety of methods and options used to get their fussy cats off the “kitty crack” and on to a healthy, species-appropriate diet. As Dr. Hodgkins’ TR Protocol states, the practice of feeding dry form, high-fiber diets to our diabetic cats is entirely in error. Over and above the nutritional aspect, feeding a high carb diet literally puts the cat's liver to sleep which is dangerous when it comes to diabetic cats. This renders the liver useless when it comes to doing its job of putting out glucagon to protect the brain in the event of clinical hypoglycemia (very low numbers). You need your cat's liver to be wide awake when there's insulin on board!

Because feeding exclusively low carb wet food is a non-negotiable requirement for TR, the cat's liver is wide awake and ready to respond in the event of low BG with the assistance of small amounts of food. We do not typically even need to use syrups when our cats drop to low BG and offer this advice on How to Handle Low Numbers while practicing TR. For country specific lists of low carb wet foods available to start TR quickly, please see your individual country's information sticky in DCC's knowledge library, the College of TR Knowledge, aka The COK.

The Detox Process is relatively short, typically taking only 24 hours for carbs to for the most part leave the system. With regular BG testing, the data will present to allow you to quickly start your cat back on insulin and then to increase doses more aggressively as needed in short order to obtain "ideal" normal, non-FD numbers at Nadir (the insulin's peak action/lowest BG on the shot).

Once the Detox is complete, the goal of TR is to navigate your cat's BG down consistently below renal threshold of 250/13.9 within the first week, and ideally to achieve the goal of BG in the range of 50-70 (2.8-3.8) where optimal healing can occur. Then, the goal turns to keeping the BG below 126/7.0 as consistently as possible, shot after shot, for as much and as long as possible so the pancreas can heal to the point it is able to resume full functioning on its own without further need for insulin or needles.

Depending on your cat’s situation, here are the various forms of The Detox Process, required before you can safely start TR:

Your cat has just been diagnosed with FD, is being fed dry/high carb food but has NOT yet started insulin.

If there has to be an optimal stage to be in, this is it. Some cats do go into diet controlled diabetic remission simply by switching them to a low carb, all wet, species-appropriate diet. Even if it turns out that your cat needs insulin after making the diet switch, the BG will typically drop significantly by removing dry/high carb foods and it is likely their insulin requirements will be much less. Change your cat’s diet immediately to a low carb all wet diet and test BG at least 4 times a day over the period of a day or two. At this point, the cat isn’t on insulin and multiple tests daily will be enough to determine whether insulin is necessary. If the testing shows the BG consistently remains close to or higher than 150/8.3, then your cat will need insulin. Members can help you when it comes to choosing the best insulin for your cat based on your situation, and can also provide suggestions as to the amount of insulin recommended to start TR.

Your cat has started insulin injections and is already on a low carb wet only diet.

If your cat has already started insulin and is already on a low carb wet diet for longer than three days, it is likely that timing of shots is the first adjustment that will need to be made when it comes to starting TR. It is possible that an adjustment to your doses will be called for, but, until you have done a BG curve or two on your cat, you won’t know. Experienced members will help you adjust either the timing of shots, and/or your dosing scale and guide you through the process of tightening up your shots to achieve maximum results.

Your cat has already started insulin injections and is being fed dry or high carb foods, and/or has developed ketones or has/is recovering from DKA, and/or vet prescribed insulin doses are very high.

This is where things can start to get dicey because completely withholding insulin for 24 hours only increases the risk to your cat and is not generally recommended. When the carbs are removed from your cat’s diet, BG will typically drop significantly - by as much as 100 points (imperial) or possibly more. The doses you are currently giving will usually be far too high once the carbs start to leave the system.

Experienced members will be able to help you navigate through this form of Detox to help you SAFELY avoid clinical hypo. We cannot emphasize enough, this is the most challenging form of detox if your cat is prone to ketones, has or is recovering from DKA, vet prescribed doses are high, or your cat has had a symptomatic clinical hypo previously. Please, let us help you!

While you are significantly reducing your cat’s insulin doses, or might be completely withholding insulin doses for the first 18-24 hours as you're going through the Detox Process, you will test your cat’s BG periodically. The tests done between +10 and +24 hours after the last shot of insulin are of particular importance. Depending on your cat’s individual situation and BG results, once the 18-24 hour detox period has passed (or sooner depending on your cat’s situation), you will begin giving insulin again based on your cat's test results. On TR, insulin is given using a sliding scale approach rather than fixed amount dosing; the higher the BG - the higher the dose: the lower the BG - the lower the dose. This is very much the same way humans approach treating their diabetes.

The Sliding Scales provided are conservative doses and it is to be expected that increases will be necessary within the first few days, but ECID (every cat is different). Curves must be done on the first few shots in order to determine what adjustments to doses are necessary. It is imperative that you keep your test log up to date in order for experienced members to help you make dosing adjustment decisions on a timely basis as you are starting TR.

Information to understand how specific insulin types work in cats is available on the Specific Insulin & Starting Scales sticky on the TR College of Knowledge (COK).

As mentioned previously; if NOTHING ELSE about the TR Protocol is of interest to you, if your cat is ALREADY on insulin, we strongly urge you, with assistance from experienced members on DCC’s forum, to safely navigate your cat through The Detox Process, then back onto insulin so you will literally take the risk of potentially fatal symptomatic clinical hypo off the table for your otherwise healthy diabetic cat.

We cannot emphasize enough the need to follow the detox process strictly in order to keep your cat safe when transitioning from a high carb diet to a species-appropriate one!