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

US Info

Information in this sticky is presented in the order of what to tackle first prior to starting TR; home testing, low carb wet diet, insulin, etc.

Glucometers

Informal comparison testing (including limited comparisons to lab results) by forum members has indicated most of the following meters are more accurate at higher numbers, and some are not affected by hematocrit. Test strips for these meters are reasonably priced if purchased wholesale and readily available (see information below).

Nova Max Plus

The Nova Max Plus tests for both glucose and ketones. Test strips can be ordered through ADW or Bargain OTC for a very reasonable price. This meter is very accurate in comparison testing - both on forum and in brand to brand informal comparison trials. It is not affected by hematocrit.

ReliOn - Micro/Confirm/Prime/P remier

ReliOn brand glucometers have performed well during informal on forum test comparisons, giving more accurate readings at higher numbers. These meters require only a small amount of blood for testing. As is consistent with ReliOn products, the prices for both meters and test strips is very reasonable. The ReliOn brand is only available at Walmart.

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 montoring needs. There is no interference with maltose, galactose, oxygen or many other common interfereing substances, and there is an automatic correction for hematocrit.

AccuChek - Aviva

This meter requires a larger sample, 0.6ml 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 but; you only have 5 seconds from the first blood sample being applied. Test strips for this meter are not affected by hematocrit.

Freestyle Lite

While one of the most popular meters available, informal on-forum test comparisons indicate this meter tests much lower at numbers above what is considered "normal range" which is a concern, especially before your cat is well-regulated. When using this meter is it important to work towards achieving and maintaining ideal range numbers (50 to 70/2.8 to 3.8), as these meters compare very closely to other meters in this range. These meters take a very small sample of blood, 0.3ul, which helps make testing easier. The strips are more expensive at the retail level 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.

Test Strips

American Diabetes Wholesale and Total Diabetes Supply have great prices on test strips. Another very cost effective source for test strips and meters is Bargain OTC. In addition to free shipping, it is worthwhile to check out Bargain OTC's "scratch and dent" listings for further savings on test strips (boxes might be dented, or there are short expiry dates). When ordering from Bargain OTC, please let them know you are a member of DCC.

Food Information

If your cat is already on insulin, and is being fed dry kibble or high carb DM canned food, before making any changes to diet, please visit the Detox Process sticky to learn how to make the food switch SAFELY. Once switched to a low carb wet diet, fears of asymptomatic clinical hypo are taken off the table for otherwise healthy cats.

Please note, the sooner you change your cat to a low dry matter carb wet diet, the better. The list provided below is a "Starter List" to help you make the change right away. Once the BG is better regulated and you are more comfortable with testing BG and TR, then there'll be more time to spend on sourcing other low carb wet food choices.

Pet food companies are continuously changing their recipes for pet food. As a result, even though the following list contains foods that were low in carbs at the time lists are compiled, we strongly urge you continue to verify the dry matter carb content from time to time. Also, we recommend to use the Nutritional Analysis figures whenever possible, as these are truer "as fed" numbers for each flavor; Guaranteed Analysis numbers are the "minimim/maximum", so provide averages at best however in North America, pet food manufacturers do not, and are very reluctant to provide ingredient lists based on Nutritional Analysis. Unless otherwise noted, most information here has been calculated using the NA as a result of Dr. Lisa's persistence. If no numbers for Ash are listed, use a median number like 1.5% for all foods other than those that are just meat and water with no supplements, which do not contain any ash.

For your convenience, a tool to calculate carbs on a dry matter basis can be downloaded here.

In order to help you get your cat switched over to low carb canned food right away, the following is an abridged listing of canned foods below 10% carbs based on dry matter compiled by Dr. Lisa Pierson. The link to Dr. Lisa's very comprehensive list of US based canned foods providing complete nutritional analysis is posted below the Fast Start Food List. Please note, if your cat has other health issues, Dr. Lisa's list does contain detailed information about other nutrients, such as phosphorous counts (kidney issues) and fat (pancreatitis or liver issues).

Dr. Lisa does not favor feeding fish-based diets due to their 1) high allergy potential, 2) toxins/mercury levels, 3) PBDE levels (fire retardant chemicals with thyroid-disrupting properties), 4) often high in phosphorus and magnesium, 5) significant addiction issues - cats will refuse to eat anything else. At DCC we recommend not feeding fish based food more than a couple of times a week, more as a treat than anything else, as fish is hard on the kidneys as well.

In addition - it is important to note that while certain varieties of foods calculate to be less than 10% dry matter carbs based on NA, there are some flavors/brands which seem to inexplicably cause the BG to soar when fed. For example Fancy Feast Classic Pates - Cod Sole and Shrimp, Ocean Whitefish are two that have proven time and again to raise the BG - these are more suitable for feeding "stubborn lows".

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. Please, make things easy for yourself by selecting from the foods on the list in order to quickly transition your cat onto a low carb wet diet and start TR. This list is provided to help you move through the Detox Process and get your cat's BG much better regulated as quickly as possible.

Fast Start Food List for canned foods available in the US, below 10% carb based on dry matter (nutritional content listed in %'s):

Purina original DM Wet Formula, DM carbs 6.0% , Many vets prescribe this food at diagnosis - it does contain oat fiber. The dry food 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

Fancy Feast Classic Pate's (label colors included)

Beef Feast (brown label color), DM Carbs: 9.1% , Phos. 0.43% per oz. (This flavor can spike BG in some cats, regardless of the carb count).
Beef Feast Senior 7 yrs +, Dry Carbs: 3.4%
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.
Chicken Feast Senior 7 yrs +, Dry Carbs: 5.7%
Chopped Grill Feast (kelly green), DM Carbs: 5.5% , Phos. 0.50% 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 but would be good to keep on hand for the lows
Cod, Sole & Shrimp Feast, 13.6% DM Carbs
Ocean Whitefish & Tuna Feast, 13.0% DM Carbs (See Kitten Variety for Whitefish)

Fancy Feast Gourmet KITTEN Pate Varieties

(these foods may contain milk, which some cats react poorly to).

Kitten Turkey Feast, (milk) DM carbs 4.55%, Phos. 0.43% per oz.
Kitten Chicken Feast, DM carbs 4.5%, Phos. 0.20% per oz.
Kitten Tender Salmon Feast, DM carbs 9.1%, Phos. N/A

Kitten Ocean Whitefish Feast, DM carbs 4.55%, Phos. 0.54% per oz. (Only low carb Whitefish available)

Fancy Feast Appetizers are NOT a balanced diet and are therefore not recommended for regular feeding. The only flavor which is under 10% dry carbs is Taliapa.

Hounds & Gatos Available at specialty pet shops and online
(GA)-Guaranteed Analysis)
Beef, DM carbs 0.5%, Phos 1.26%
Chicken & Chicken Liver, DM carbs -0.5%, Phos 1.30%
Duck, DM carbs -0.5%, Phos. 1.79%
Lamb/Chicken/Salmon, DM carbs -1.5%, Phos 1.33%
Lamb & Lamb Liver, DM carbs -1.5%, Phos 1.21%
Rabbit, DM carbs 0.5%, Phos 1.95% 5.5oz (155g) & 13oz. (368g)
Salmon, DM carbs -2.5%, Phos 1.54
Turkey & Turkey Liver, DM carbs: 0%, Phos 1.20%
Paleolithic(Beef,Pork,Lamb,Rabbit)blend, DM carbs: 2.0%, Phos 1.18%
Pork, DM carbs -1%, Phos 1.12%
Salmon/Mackeral/Sardine, DM carbs -3.5%, Phos 1.04%
Trout & Duck Liver, DM carbs -1%, Phos 1.87%
Gamebird(Turkey/Duck/Guinea/Quail & Liver)blend, DM carbs -0.5%, Phos 1.43

Tiki Cat After Dark grain free in Broth (As fed)
Chicken in Broth, DM carbs 7.07%, Phos 0.14%

Chicken & Beef in Broth, DM carbs 10.0%, Phos 0.20%

Chicken & Duck in Broth, DM carbs minus 1.11%, Phos 0.20%

Chicken & Lamb in Broth, DM carbs minus 1.11%, Phos 0.21%
Chicken & Pork in Broth, DM carbs 4.73%, Phos 0.19%
Chicken & Quail Eggs in Broth, DM carbs 2.22%, Phos 0.19%

Additional Food list available:

https://www.diabeticcatcare.com/forum/viewtopic.php?f=4&t=6319&start=0

CAT FOOD NUTRITIONAL COMPOSITION - Data compiled by Lisa A. Pierson,DVM - a very comprehensive listing of canned cat foods available in the US, compiled in September 2012, and is available on Dr.Lisa's very informative and highly recommended website www.catinfo.org. Please note this quote from Dr. Lisa Pierson "Keep in mind new products come out on a regular basis and it would be impossible to keep the composition chart completely up to date."

Raw Feeding

There are a number of options when it comes to raw feeding - either buying ready made raw food or, buying ingredients and equipment to make your own at home. Many cats with health issues such as IBD or allergies do much better on a raw food diet. Please see the Raw Food Info sticky for information on suppliers, equipment, recipes and more. Dr. Lisa's list does contain the nutritional analysis for pre-made raw foods.

Treats

There are a number of low carb treats available which are suitable for FD cats; in particular we recommend "freeze-dried" treats made by PureBites, which are available at most pet food stores and Walmart. In the "cat food" sections, the bags are small - so we recommend purchasing these treats from the dog food aisle for better value. Chicken and turkey flavors are very popular with cats; cheese, duck and beef liver flavors are higher in fat, also liver contains a high amount of Vitamin A which can be toxic to cats in excess. There are fish flavors available, however as fish is hard on the kidneys, it is best to limit fish-based treats to no more than once or twice a week. One of the benefits of freeze dried treats is they can be slightly moistened and used to wrap around pills should you need to medicate your cat. We do not support dry pilling as it is a choking hazard; it is recommended to give a small amount of water by syringe after using these treats for giving medications.

Pet food manuafactures are now selling 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.

US Insulin Information

Local prescription laws with regards to obtaining insulin and syringes, State by State listing for the US.

There are a number of different types of insulin available within the US for use in cats. Protamine Zinc (PZI) is Dr. Hodgkin's insulin of choice as it is only one amino acid away from a cat's own insulin however there is no manufactured bovine based insulin still made in the US so variances between batches may occur when it comes to compounded insulins. ProZinc is an hrDNA PZI insulin type made exclusively for cats and only available in the US however it is a salmon based insulin which may cause issues for some cats. Levemir is an insulin type which is showing to be well suited to cats. Lantus is another available in the US, as well as Humulin N/NPH. Vetsulin (aka Caninsulin) is available from vets only. Please see the Specific Insulin Info & Starting Scales sticky for further information about each insulin type.

BCP Veterinary Pharmacy Compounded PZI:

Phone: 1-800-481-1729
Toll Free Fax: 866-PET-CHEW

In Houston call: 713-771-1144
Fax: 713-771-1131

1614 Webster Street
Houston, TX 77003

Hours: 9:00AM – 6:00PM CST – Monday - Friday

A compounded, beef based insulin with an amino acid count only one away from the cat's own. Go to their website for a printable form your vet can fill out and fax to them. They will send a free 5.0ml vial of U100 PZI to your vet (takes approximately 3 weeks), which you should mention you'd like to have passed along to you. Make sure your vet gives them your name and RX number so you can reorder direct which will save a bit of $$. U40, and U100 are the recommended strengths available. Less expensive than manufactured insulin, but a shorter shelf life of only 6 months, although it lasts longer for many if handled carefully.

All prices are subject to change.
The following was priced on 11/28/17

U-100 is available in 2 sizes: 5ml - $65, 10ml - $85

U40 available in 10ml only - $56

Overnight Shipping to all contiguous United States; $12.00 (commercial), $13.50 (residence)

PLEASE NOTE: When an order is placed for a new patient, BCP offers a number of "goodies" to your vet, one of them being a vial of PZI insulin (100ml). When speaking to your vet about ordering BCP PZI ask them to pass along the free vial to you. While it isn't a lot of insulin, every little bit helps!

Stokes Pharmacy Compounded PZI:

Phone: 1-800-754-5222
Fax: 1-800-440-5899

18000 Horizon Way, Suite 700
Mt. Laurel, NJ 08054

Hours: 9:00AM – 7:00PM EST – Monday – Friday, 9:00AM – 1:00PM EST – Saturday

Stoke's no longer compounds U100 (beef based) insulin,

they do however compound U40 beef base insulin with an amino acid count only one away from the cat's own. A compounded insulin, available thru your vet or with vet’s RX. Comes in U40 and U100 strengths. Cost of insulin is a little less than BCP; overall cost is less than BCP when using standard shipping. With overnight shipping, cost is the same (5ml) or a little more.

All prices are subject to change.
The following was priced on 11/28/17

U40 (beef based) available in 10ml only - $115

Shipping costs: $13 - Standard (2-3 days), $25 - Overnight (next day). Because PZI is temperature sensitive and requires refrigeration, it is recommended to select Overnight shipping.

Prozinc, the replacement insulin for Idexx PZI Vet, is made exclusively for use in cats. ProZinc is salmon based, human recombinant DNA insulin with an amino acid count four away from the cat's own.

Boehringer Ingelheim Vetmedica, Inc
Companion Animal Technical Services, USA
(866) 638-2226
8:00AM – 5:00PM CST – Monday - Friday

Comes in U40 strength only, and must be purchased through the vet, or from various online sources with a prescription from your vet. Online companies like PetMeds will price match if you provide the URL from another website selling ProZinc cheaper. (For example, you can save yourself $30 by price matching at PetMeds with the URL for ProZinc from AtoZVetSupply).

Levemir is a relatively new insulin being used for cats which your vet may not be aware of. Over time, it is proving to be a good insulin, especially when it comes to harder to regulate cats. There may be a $50 off coupon on the Levemir site for use when purchasing the first vial.

Levemir may also be obtained through Canadian Pharmacies at a lesser price which will have a standard shipping charge.

All prices are subject to change

Marks Marine Pharmacy online

Toll free: 1-877-888-9265 for quotes

Lantus has been used very successfully with TR. There is a discount available on the the Lantus site for use when purchasing the first vial.