HOW TO MANAGE YOUR DIABETIC CAT

1. HOW TO MANAGE YOUR DIABETIC CAT

2. Your cat has been diagnosed with a condition called Diabetes Mellitus The following presentation is designed to help you understand this disease, as well as guide you in how to manage your diabetic cat at home.

3. Caring for a diabetic animal can be a big responsibility, but with time and guidance, you will soon become comfortable with the routine of caring for your cat. Let’s begin with a brief overview of the disease itself.

4. DIABETES MELLITUS • Diabetes is essentially a disease of the pancreas, or more specifically, its ability to produce insulin. • Insulin is a substance that regulates the body’s blood sugar levels.

5. DIABETES MELLITUS Whenever your pet eats a meal, glucose (sugar) is absorbed from the intestines into the bloodstream. Glucose is the essential fuel of the body’s cells. The response of the pancreas is to release insulin, which allows the glucose to leave the bloodstream and enter cells where it can be used for energy and growth. Think of insulin as the key that unlocks the door to let glucose into the cells.

6. DIABETES MELLITUS However, in a diabetic animal, the pancreas is unable to secrete enough (or any) insulin to allow the glucose to leave the bloodstream.. This leads to a condition called hyperglycaemia (too much glucose in the blood).

7. DIABETES MELLITUS Without insulin, glucose will remain in the bloodstream and be unavailable for use by the cells of the body for energy. If the blood glucose levels rise too high, glucose will also spill over into the urine. If the body’s cells cannot utilise the glucose for energy, they begin to use other sources of energy, such as fat breakdown. But this process creates toxic by-products called ketones that can make your cat very sick

8. Clinical Signs of Diabetes • By now you are probably familiar with how diabetes presents in cats. The signs associated with an untreated diabetic cat are: • Increased drinking and urinating (called polydipsia and polyuria) • Weight loss accompanied by increased appetite (This can vary between some cats). • Lethargy or depression may be present • Muscle wasting and weakness are often present, and may be evidenced as a reluctance or inability to jump. • Dehydration • Hind limb weakness or plantigrade posture (hocks touching the ground) can occur in severe cases. • Acetone odour on the breath may be evident (only a small percentage of the population can detect this. You may be one of them!) • Poor unkempt scurfy hair coat.

9. We do not want you to be overwhelmed by this process, however it is vital that you understand the importance of all aspects of your cat’s treatment. Now that you understand what is happening to your cat, it is important that you become familiar with all aspects of their treatment, both at home and at the veterinary clinic. You are now one of the most important factors in managing your cats health.

10. INSULIN INJECTIONS

11. INSULIN INJECTIONS • The first thing you must become comfortable with, is giving your cat insulin injections. • Since they can’t produce their own insulin, we have to give it to them instead. • This is done by injections of an insulin called Glargine.

12. INSULIN INJECTIONS Your vet will explain to you how much to give, and this amount may change over time. Normally, your cat will need 2 insulin injections per day at the same time. It is best to select a time that is most convenient for you, to allow the injections to be given as close to 12 hours apart as possible. For example, if you start work at 8:00am, and are home by 5:00pm, you may wish to give the injections at 7:00am and 7:00pm. The time itself is not important, only that it remains the same each day.

13. INSULIN INJECTIONS • You will need the following items to give an injection: 1. Glargine Insulin 2. 0.3ml Syringe (needle is already attached) 3. Your cat!

14. Drawing up the Insulin Dose Step 1. Take your Glargine Insulin bottle out of the fridge (it must be kept in the fridge at all times) and gently swish the bottle in small circles to ensure the insulin is suspended properly. • Try to handle the insulin bottle very carefully. • Do not shake it vigorously or leave it out of the fridge for any length of time. • This could cause the insulin to denature and become less effective.

15. Drawing up the Insulin Dose Step 2 • Turn the insulin bottle upside down as shown. • Uncap your 0.3ml syringe and insert the needle into the centre of the grey rubber port on the lid of the bottle. Take care not to stab yourself!

16. Drawing up the Insulin Dose Step 3 Pull back on the plunger to draw the insulin into the syringe. • It is usually best to pull the plunger back further than the dose you are going to give. • Once the syringe has filled with insulin, it is important to get rid of any air bubbles in the syringe. • Do this by tapping the syringe gently to work the bubble to the top of the syringe. • You can then depress the plunger to expel the air back into the bottle of insulin. • Keep depressing the plunger until the top of the plunger is level with the corresponding dose you wish to give. Again, your vet will tell you how much to give.

17. Drawing up the Insulin Dose Step 4 • Once you have the correct dose of insulin, withdraw the needle from the bottle. • Replace the needle cap to protect the needle until you are ready to inject. • You should not touch the needle directly yourself, as this may contaminate it. Similarly, do not leave the needle uncapped as contamination can occur if the needle touches a bench top, etc. • It is also a good idea to keep the needle capped as much as possible to prevent any needle stick injuries to yourself. • Replace your insulin bottle back in the fridge. • Now you are ready to inject!

18. Injecting the Insulin • This may seem like a scary step when you first begin, but with time, both you and your cat will develop a routine for giving these injections, and it will become second nature. • It is important that you try to make your cat as comfortable as possible when giving the injections. We do not want this experience to be stressful for either you or your cat. • Remember, if you are relaxed, your cat is much more likely to relax with you!

19. Injecting the Insulin Step 1 – Site of Injection • Insulin is injected under the skin, and then absorbed into the bloodstream from here. • It is usually best to inject the insulin under the skin of the flank or side of your cat. • It is often a good idea to alter which side you inject on each time. • If you cat is particularly fluffy, you may need to part the hair first so that you can see the skin clearly. • Insulin injected into the hair coat will not do anything to lower your cat’s blood glucose levels!!

20. Injecting the Insulin Step 2 • Once you have identified where you are going to inject the insulin, try to place your cat in a position that will allow you to give the insulin most easily. • Placing them on your lap and stroking them gently may help to relax them and give you good access to the injection site. • Alternatively, some cats may prefer to sit on a table, bench or chair (or the floor) to receive their injections. • Be careful not to clamp down on your cat when giving the injections. This tends to stress cats and they may begin to resent the process.

21. Injecting the Insulin Step 3 • Once your cat is comfortable and you have good access to your injection site, gently pinch a small area of skin at the injection site with your thumb and middle finger of your left hand (if you are right-handed).

22. Injecting the Insulin • Step 4 • Uncap the needle from the insulin syringe. • Using your left index finger as a guide, insert the needle under the skin just below your left index finger (be careful not to stab yourself!) • Tip for beginners: Make sure your needle is not poking out the other side of the skin, i.e. that the needle is all the way under the skin. That way when you inject, the insulin will definitely be injected under the skin and not end up in the hair coat! Now inject the insulin by depressing the plunger fully.

23. Injecting the Insulin Step 5 • Once you have injected the entire dose of insulin, remove the needle from under the skin. • Replace the needle cap onto the needle, then place the needle and syringe into the yellow sharps container provided to you by the veterinary clinic. PLEASE NOTE - ALL NEEDLES MUST BE PLACED IN THIS CONTAINER AND THE CONTAINER RETURNED TO THE VETERINARY CLINIC FOR DISPOSAL WHEN FULL.

24. Congratulations! You have now given your cat an insulin injection! If you are ever unsure about your technique, or feel like you just need a refresher course, your vet will be only too happy to go through this with you again in the clinic. Please do not be afraid to ask as many questions as you need to become comfortable with the process.

25. DIET FOR DIABETIC CATS

26. DIET IN DIABETIC CATS • Another important aspect of managing your diabetic cat is the food that we feed them. • Diabetic cats require a high protein, low carbohydrate diet to minimise blood glucose fluctuations. • The wrong diet can have a huge effect on the overall management of diabetes, so it is important to get it right. • Some people may prefer to make a home-made diet, however if the diet is not perfectly balanced, this could make the condition worse instead of better. For this reason, we do not recommend you feed your diabetic cat a homemade diet.

27. DIET IN DIABETIC CATS The good news is that there are a number specially formulated diets designed to provide optimal nutrition for diabetic cats. These diets provide a high protein, low carbohydrate formula to minimise blood glucose fluctuations, provide increased fibre to keep them feeling full, and help to reduce fat and increase muscle levels.

28. Hills Prescription Diet m/d • The main diet we recommend is the Hills Prescription Diet m/d (metabolic diet). • This diet comes in both dry and tinned forms, and is usually very palatable to most cats. • Your vet will tell you how much to feed your cat each day

29. Royal Canin Diabetic Cat Food The alternative brand of diabetic cat food is the Royal Canin Diabetic Cat formula. It is very similar to the Hills m/d, although is only available as a dry food.

30. When do I feed my cat? • Generally it is a good idea to offer your cat food after each insulin injection. • However, cats are naturally grazers, meaning they tend eat small amounts throughout the day. • It is fine to leave dry food out for your cat to graze on throughout the day, as long as they have received their insulin injections. • Be sure to only feed them the specified amount given to you by your vet. Eating too much is just as bad as not eating enough in diabetic cats. • The most important thing is to be consistent!

31. Any Questions? If you have any questions regarding anything to do with your cat’s treatment, please do not hesitate to contact the clinic. Phone: 8952 9899