DIABETES IN YOUR CAT

To manage their diabetes, your cat has been prescribed ProZinc – an insulin designed with cats in mind. Together, you and your vet will work out the best way of treating your cat with ProZinc to manage your cat’s diabetes. Please take a moment to read this guide: it will help you to understand more about diabetes in your cat, how the condition is diagnosed and managed and how using ProZinc can help to control your cat’s diabetes.

WHAT IS DIABETES?

Diabetes is a condition where there are high levels of sugar (glucose) in the blood. Insulin is produced in the pancreas and is the hormone responsible for maintaining the correct levels of glucose in the blood. High levels of blood glucose are therefore due to reduced production of insulin, and/or the body not responding correctly to the insulin produced. Diabetes in cats is most similar to type 2 diabetes in humans, where the body initially does not respond adequately to insulin produced by the pancreas but then, with time, progresses to a lack of insulin produced from the pancreas.

WHY DOES MY CAT HAVE DIABETES?

There is often no particular reason why a cat develops diabetes – it is a complex condition and many different factors have a role to play. It is usually impossible to know why diabetes develops in an individual cat. It is, in fact, one of the most common hormonal disorders in cats and can affect up to 1 in 250 patients, so is more common than people often realise.

CAN ALL CATS GET DIABETES?

Yes, although it is more common in older cats and those that are overweight. Male cats tend to be affected more than females and Burmese cats have been reported to get diabetes more commonly than other breeds.

WHY ARE INSULIN AND GLUCOSE IMPORTANT?

GLUCOSE AND INSULIN IN THE HEALTHY CAT

Glucose is incredibly important as it is the main source of energy for all of the cells in the body. However, its levels in the blood have to be tightly controlled by insulin, which is responsible for regulating the flow of glucose from the bloodstream into most cells of the body.

GLUCOSE IN THE DIABETIC CAT

Cats develop diabetes when they don’t respond adequately to insulin, and/or don’t produce enough insulin from their pancreas. This means that glucose cannot leave the blood, enter the body’s cells and be used as their main source of energy. The cat’s body then starts to break down muscle and fat as alternative sources of energy. This results in the cat eating more but losing weight. At the same time, levels of glucose in the blood rise since it cannot leave the bloodstream to enter the cells of the body.

WHY ARE HIGH LEVELS OF BLOOD GLUCOSE A PROBLEM?

High levels of glucose in the blood will spill over into the urine. This leads to increased urine production with an associated increase in thirst.

Sustained high levels of blood glucose (glucose toxicity) can damage the cells of the pancreas, which can lead to reduced insulin production.

Very high blood glucose levels can lead to serious complications, such as diabetic ketoacidosis (DKA) – a condition that occurs when the cat’s body needs to break down fat as a source of energy.

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Cats that have high blood glucose levels for long periods of time can experience damage to other parts of their bodies such as their eyes, nerves, and kidneys.

DIAGNOSIS

Diabetes is a complex condition that often develops slowly over a period of time. It is therefore quite easy to miss some of the very early and subtle signs of diabetes, particularly in cats that go outside.

WHAT ARE THE SIGNS THAT MY CAT HAS DIABETES?

Signs of diabetes include:

Eating more
Drinking more
Urinating more
Urinating inappropriately in the house
Losing weight
Poor coat condition
Tiredness
Weakness, especially in the back legs
Signs of a urinary tract infection (e.g. straining to urinate, passing blood in their urine)

HOW IS DIABETES DIAGNOSED?

All of the signs of diabetes can also be found with other diseases, so your vet will need to do more than just examine your cat. In order to diagnose diabetes, your vet will need to perform blood tests and often a urine test too. Cats with diabetes will show several changes:

High levels of glucose in the blood

High levels of fructosamine in the blood (a marker that measures blood glucose levels over the previous 2 weeks)

Glucose in the urine

Your vet may also wish to perform some other blood tests to check whether there are any underlying diseases which may influence the treatment plan.

MANAGEMENT

To manage their diabetes, your cat has been prescribed ProZinc – an insulin designed with cats in mind. Together, you and your vet will work out the best way of treating your cat with ProZinc to manage your cat’s diabetes. Please take a moment to read this guide: it will help you to understand more about diabetes in your cat, how the condition is diagnosed and managed and how using ProZinc can help to control your cat’s diabetes.

HOW IS DIABETES TREATED?

Although diabetes is a serious condition which often cannot be cured, the good news is that most diabetic cats can be successfully managed with the administration of insulin, often combined with dietary changes. This will reduce the high levels of glucose in the blood and allow the body’s cells to use glucose as their main energy source. The overall aim of treatment is to control the clinical signs of diabetes and allow the cat to have a good quality of life.

MANAGEMENT OF ANY UNDERLYING DISEASES

If any underlying or complicating diseases are identified then it is important that these are addressed and treated. Any medications that can cause diabetes should be gradually withdrawn if possible. Your vet will advise what to do if this is the case.

INSULIN

Cats are very good at concealing when they are unwell, so by the time they show clinical signs and are diagnosed with diabetes, their pancreas is usually not producing enough insulin. Most diabetic cats will therefore require twice-daily insulin injections, just as is needed for many humans with diabetes. Although most people find the thought of injecting their cat very daunting, it is actually very easy to do with practice. Insulin syringes and needles are very small; cats usually do not feel a thing. The injection is given under the skin, usually in the scruff of the neck.

DIETARY MANAGEMENT

The diet you feed your diabetic cat is very important, particularly if they are overweight and this is contributing to their diabetes. Your vet will advise which diet is best for your cat and importantly how much of the diet to feed your cat each day. Cats with diabetes appear to benefit greatly from a diet that is low in carbohydrates and higher in protein. Some diets available from your vet are specifically made to meet the requirements of a diabetic cat – talk to your vet about these options.

MY CAT HAS BEEN PRESCRIBED PROZINC, WHAT’S NEXT?

Because each cat reacts differently to insulin, your vet will most likely want to start your cat on insulin injections and assess their initial response at the practice. This will allow your vet to monitor your cat by performing a blood glucose curve. This is when your cat’s blood glucose is measured at various times throughout the day to determine their response to ProZinc. When your vet is happy about your cat’s response to the insulin, and you feel happy and comfortable handling and injecting ProZinc, then your cat will be sent home for you to carry on giving them their injections.

In most cats it takes a while to find the correct dose of insulin that will control their diabetes. Insulin doses should only be changed slowly (e.g. weekly) so it is likely in the early days that you will have to take your cat back to your veterinary practice frequently. Your vet will need to perform blood glucose curves and/or fructosamine tests to determine how your cat is responding to their specific insulin dose.

It is very important not to change the dose of insulin without instruction from your vet. Many factors affect a decision about whether to increase or decrease the dose of insulin and doing so without your vet’s advice can cause severe complications for your cat.

HOW CAN I MONITOR HOW WELL MY DIABETIC CAT IS DOING?

When your cat has been diagnosed with diabetes, your vet will want to monitor them regularly. Usually this is every 3–4 months if everything is going well. At these visits it is likely that your vet will want to perform some tests. These may include:

1	An examination to check the general health of your cat

2	Weighing your cat

3	Blood tests to check blood glucose and/or fructosamine levels

4	Urine tests

To help you and your vet manage your cat’s diabetes, it is extremely helpful if you are able to keep a daily diary and record key things on a day-to-day basis. Looking at trends and changes in these parameters over time can be extremely helpful in understanding how well your cat is doing. Your vet will advise what to record but it may help if you can get into the routine of writing down:

1	Time of injection and the amount of insulin injected

2	Your cat’s appetite and the amount of food eaten

3	The overall demeanour of your cat, noting particularly if they become lethargic or more sleepy than usual

4	Any vomiting or diarrhoea

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If at all possible, measure the amount of water your cat drinks each day. Use a measuring jug to fill their bowl and at the end of the day tip the water back into the jug to see how much they have drunk. Measuring water intake is one of the most useful ways to monitor how well your cat’s diabetes is controlled

If you are at all concerned about your cat please contact your veterinary surgeon.

WHAT IS THE OUTLOOK FOR MY DIABETIC CAT?

The long-term outlook for cats with diabetes varies according to how old they are, how easy it is to stabilise their diabetes, whether they have any other diseases, and how severe these are.

Most diabetic cats have an excellent quality of life, and many can live very happily with their diabetes if they are well managed. Unfortunately, not every cat responds well.

Your vet will want to undertake regular examinations to evaluate your cat’s response to treatment, and if your cat proves difficult to stabilise, becomes unstable, or appears to need very large doses of insulin, further tests may be needed to look for other underlying problems. If you are at all concerned about your cat take them to your vet.

POTENTIAL COMPLICATIONS WITH DIABETES

Fortunately, serious complications associated with diabetes in cats are not often seen in well-managed cases, although there are two important conditions which you need to be aware of, since these can have serious consequences if left untreated:

Diabetic Ketoacidosis – this is due to sustained high levels of blood glucose (hyperglycaemia)
Hypoglycaemia – very low blood glucose levels

If you are concerned about either of these in your cat it is important that you contact your vet straight away.

DIABETIC KETOACIDOSIS (DKA)

When diabetic cats experience prolonged periods of high blood glucose their bodies break down fat as a source of energy. Ketones are a waste product of fat breakdown. If a cat accumulates too many ketones a condition called Diabetic Ketoacidosis occurs. This is a serious condition altering the acidity of the blood, and requires urgent treatment. If you are concerned that your cat may have DKA then contact your vet immediately.

Signs that your cat may have DKA include:

Drinking excessive amounts of water or no water at all
Excessive urination
Markedly decreased activity
Not eating for 12 hours or more
Vomiting
Lethargy or depression
Weakness
Dehydration
Ketone smell on the breath (may smell like nail-polish remover or fruit)

HYPOGLYCAEMIA

Hypoglycaemia is the medical term for low blood glucose. Diabetic cats can develop hypoglycaemia for a number of reasons but the most common is when they receive too much insulin. Sometimes hypoglycaemia can also occur if your cat starts to produce its own insulin again from its pancreas and goes into diabetic remission.

WHAT ARE THE SIGNS OF HYPOGLYCAEMIA

Signs of hypoglycaemia can occur at any time but are most likely around the time that your cat’s insulin is having its peak effect, which is usually around 6 hours following injection. The lower your cat’s blood glucose levels go, and the more rapidly they drop, the more severe the signs will be. In order of increasing severity, the signs of low blood sugar include:

Abnormal hunger or even disinterest in food
Anxiety and wanting to hide
Tiredness/weakness
Disorientation and/or apparent blindness
Shaking, wobbliness, muscle twitching
Depression
Collapse
Seizures
Coma

WHAT SHOULD I DO

If you think that your cat is showing signs of hypoglycaemia or if you know they have received too much insulin, then you need to contact your vet for advice immediately.

Hypoglycaemia can be life threatening if it is left untreated. Usually your vet will want to see your cat, and you can give some emergency treatment at home prior to taking them to the practice.

If the signs in your cat are mild and they will eat, offering food may be enough to relieve the signs and correct the problem. If they will not eat their normal food then offer them something sweet which contains sugar such as honey, glucose syrup or glucose powder. These can be rubbed onto your cat’s gums if they can’t eat. You may also be able to obtain a specific sugar solution from your vet to keep at home in case of emergencies.

Hopefully you will never see hypoglycaemia in your cat, but unfortunately it is a risk with insulin therapy. Remember to always contact your vet if you see any signs that you are concerned about.

ALL ABOUT PROZINC

These are a few common questions and answers. Don’t forget to ask your vet if you have any further queries.

FAQ

These are a few common questions and answers. Don’t forget to ask your vet if you have any further queries.

What is ProZinc?

ProZinc is an insulin designed with cats in mind. It contains protamine zinc insulin (PZI), which has a duration of action optimised for diabetic cats.

How often do I have to give my cat ProZinc?

When ProZinc has been injected into your cat it releases slowly over time. This means it is ideally suited for twice-daily injections. ProZinc should therefore be given to your cat twice a day, ideally 12 hours apart. It is important to make sure that your cat has eaten when you give them any insulin. Owners often find it easiest to inject their cat while they are eating their food.

How should I store ProZinc?

ProZinc should be kept out of the sight and reach of children and should be stored in the fridge (between 2–8°C). ProZinc should be stored upright in the fridge, away from the back and sides. The fridge door is an ideal place to store ProZinc.

How much ProZinc should I give my cat?

You should give the amount of insulin that your vet has advised you to give. If you are at all unsure how much insulin to give your cat then you should wait to inject your cat and contact your vet for advice. You should not adjust the dose of ProZinc you give your cat without speaking to your vet first.

What if I give my cat too much ProZinc?

If you think you have given your cat too much insulin then you should contact your vet straight away. If a cat receives too much insulin their blood glucose levels can become dangerously low, so it is important your cat is seen by a vet. If you cannot contact your own vet then you should contact an emergency vet. Further information about the signs of low blood sugar levels (hypoglycaemia) in cats is discussed below.

What if I give my cat too little ProZinc?

Do not worry and do not give your cat any more ProZinc. Simply wait until their next dose is due and then give your cat their correct dose of ProZinc.

What if I miss a dose of ProZinc?

Again, do not worry. Simply wait until their next dose is due then give your cat their correct dose of ProZinc.

Should I still give ProZinc if my cat does not eat?

No. If you are concerned that your cat is not eating or if they are vomiting then you should not give any ProZinc and you should contact your vet.

Are there any times that I should stop giving ProZinc?

If your cat is not eating, is being sick or is showing any of the signs of low blood glucose (hypoglycaemia) then you should stop giving ProZinc and contact your vet. If you are worried about your cat at all, then do not give ProZinc and speak to your vet or an emergency vet.

HOW DO I DRAW UP PROZINC?

Drawing up the correct dose of ProZinc is easier than you think. If you are at all unsure ask your vet to show you before you inject your cat. It is important that you use the correct syringe. ProZinc must be injected with a syringe labelled ‘U-40’. Using the wrong syringe can cause your cat to receive the wrong dose of insulin which can be dangerous. When you are sure you have the correct syringe follow these steps:

1	Remove the vial of ProZinc from the fridge and gently roll the ProZinc vial between your hands. This mixes the insulin prior to injection (it should have a white, cloudy appearance). Place the vial on the table or surface in front of you.

2	Remove both caps from the syringe, one covers the end of the plunger and the other the needle.

3	Insert the needle through the rubber top of the ProZinc vial. Ensure the needle is pushed all the way through the top so that the base of the needle is touching the rubber top of the vial.

4	Turn the vial upside down with the syringe still inserted into the top. The syringe will not fall out of the vial. Make sure the tip of the needle is submerged in the insulin.

5	Twist the syringe around so that the numbers on the syringe are facing you. These numbers indicate the number of units of ProZinc.

6	Pull back on the plunger gently; this will draw ProZinc into the syringe. If you pull too quickly you will draw air into the syringe so it is important to do this gently, smoothly and slowly.

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The flat, black top of the plunger within the syringe needs to align with the number on units on the side of the syringe that your vet has prescribed. To do this:

– Slowly pull the plunger back a few units past the dose your vet has prescribed. Look for large air bubbles in the syringe. If you see any, gently tap the side of the syringe with your finger to encourage them to float towards the needle.
– Gently push the plunger back in and stop when the black top of the plunger is aligned with the prescribed dose. Take your finger off the plunger and withdraw the needle from the vial.

8	You are now ready to inject your cat with the correct dose of ProZinc.

HOW DO I INJECT PROZINC?

Your vet (and perhaps vet nurse) will help by talking you through the whole procedure and letting you practise before ever having to give insulin to your own cat. Sometimes practising by injecting water into something like an orange can help to get the feel of how to handle the syringe and needle to help you gain confidence.

When you have ensured that the correct amount of ProZinc is in the syringe then it is time to inject your cat. Remember to remove the cap from the needle before you approach your cat. It is usually easiest to try to inject your cat when they are distracted (for example when they are eating and have their head in their food bowl). To begin with it may be easier to have a second person who can help hold your cat, although with practice this will not be needed. Here are the steps to go through when injecting your cat:

1	When your cat is distracted, stroke the fur on the back of their neck and when you feel ready, gently pull up a fold of skin like your vet has shown you.

2	Insert the needle into the skin so the whole of the needle is within the skin.

3	Gently pull the plunger back slightly, watching to make sure that no blood enters the syringe. If it does, remove the needle and start again with a new syringe.

4	When you are happy that the needle is in the correct place, fully depress the plunger so all the insulin goes into your cat, and then pull out the needle.

5	Dispose of the syringe and needle in the sharps box that your vet has provided. Each syringe is for single use only.

6	Ensure that the ProZinc vial is returned to your refrigerator until the next dose is needed.

RESOURCES

Some video guides for your reference

UNDERSTANDING DIABETES

Finding out your cat has diabetes can be a lot to take on board. Here are the answers to some commonly asked questions about diabetes in cats.

What is diabetes?

Why does my cat have diabetes?

How is diabetes treated in cats?

MANAGING YOUR CAT’S DIABETES

Here are some guides on how to inject your cat with ProZinc, as well as the answers to some common questions about treating diabetes in cats.

How to use ProZinc – drawing up the dose

How to use ProZinc – injecting your cat

What should I do if I have given too much ProZinc?

What are the signs of low blood sugar levels and what should I do if I am worried?

MONITORING YOUR DIABETIC CAT

To help you and your vet manage your cat’s diabetes, it is extremely helpful if you are able to keep a daily diary and record key things on a day-to-day basis.

Download a diary which you can complete here

If your vet has suggested that you monitor your cat’s blood glucose levels at home, you can download a chart here to record the results

VETERINARY SURGEONS

If you are a veterinary surgeon or veterinary nurse from the UK or Ireland please proceed to the Boehringer Academy for further information on ProZinc. The Boehringer Academy is home to a full suite of product and disease area information. Equally it contains high quality and independent CPD webinars available to view on demand at your convenience. There are a number of complimentary webinars that may help in your clinical decision making. The Boehringer Academy is available at www.boehringer-academy.co.uk or by clicking on the link below.

Produced by the makers of ProZinc. Advice on the use of ProZinc or other therapies should be sought from your veterinary surgeon. Further information available in the SPC or from Boehringer Ingelheim Limited, Vetmedica, Bracknell, Berkshire, RG12 8YS, UK. Date of preparation: March 2016. AHD9103. Use Medicines Responsibly (www.noah.co.uk/responsible)