Feline Diabetes FAQs - Feline Diabetes

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Frequently Asked Questions (FAQs) from our Management Board

These questions have been compiled from years of Feline Diabetes Board members. We see many new members each day, and these questions and answers come up frequently.

Getting Started - General Questions

Q1.1: My cat was just diagnosed. What do I do first?

Start by taking a breath. Diabetes in cats is treatable and manageable—often at home and on a reasonable budget.
To get started:

Learn the basics of feline diabetes care. Our Beginner’s Guide covers the essentials: insulin, diet, home testing, and the importance of routine.
Join the Feline Diabetes Management Board to ask questions and see how others manage daily care.
Consider reading some of the educational resources we’ve curated, including advice on vet visits, insulin types, and long-term care.

The most important thing you can do is learn as much as possible. Knowledge is your best tool in helping your cat live a long, healthy life.

Q1.2: It seems like a lot of cats here are struggling. Does this mean my cat will have a poor quality of life?

Not at all. People usually come to forums when they need help—so you’re seeing the tough cases, not the success stories.
Many cats respond well to treatment and go on to live normal lives, often with no visible symptoms once properly regulated. Some even achieve remission and no longer need insulin.

Q1.3: I don’t understand all the terms people are using.

That’s totally normal. Diabetes comes with a lot of jargon, from “nadir” and “ketones” to insulin brand names and dosing schedules.
We’ve put together a Glossary of Common Terms that explains everything in plain language.

Q1.4: What is hypoglycemia, and how do I treat it?

Hypoglycemia means your cat’s blood sugar is too low—often caused by too much insulin or not enough food. It can happen suddenly and is very serious.

Symptoms include:

Lethargy or sleepiness
Loss of coordination
Vomiting
Seizures
Collapse

You should always have something sugary on hand (like Karo syrup or honey). If symptoms appear, rub the syrup on your cat’s gums and contact your vet.
Read our full Hypoglycemia page, keep it in a visible place.

Q1.5: What kind of treatment will my vet recommend?

Your vet may recommend a few different things, depending on your cat’s condition:

A diet change to a lower carbohydrate food
Insulin injections (most common and effective treatment)
Blood glucose monitoring (either in-clinic or at home)
Occasional lab work to monitor health
Oral medications (less common, and not suitable for all cats)

Insulin is typically given once or twice a day in small doses. Your vet will determine the starting dose, but it’s important to monitor and adjust based on your cat’s response.

Some vets may suggest hospitalizing your cat at first, but most stable cats can begin treatment at home. If you’re comfortable learning how to give shots and monitor blood sugar, home treatment is often less stressful for both you and your cat.

Q1.6: What is the goal of treatment?

The main goal is to keep your cat feeling well and living a normal life. In technical terms, we’re aiming for:

Blood sugar levels that are safe (not too high or too low)
Fewer diabetes-related symptoms (like excessive thirst or urination)
A return to a healthy weight
A stable routine of food and insulin
Possible remission, where your cat no longer needs insulin (achieved in some cases with early, consistent care)

Q1.7: How can I find a vet who understands feline diabetes?

If your current vet doesn’t seem confident or collaborative, consider asking other cat caregivers for referrals. You can also bring research and home testing results to your current vet to open a conversation.

A good vet should be willing to work with you, answer questions, and adjust your cat’s care based on home data.

Q1.8: How do I connect with other people who have diabetic cats?

The FDMB forum is a great place to start. Post your general location in the subject line and ask if anyone nearby is around. You may also find local Facebook groups or diabetic pet networks.

Q1.9: I’m worried I can’t afford treatment. What can I do?

Diabetic care can seem expensive at first, but there are ways to reduce costs significantly. Some ideas include:

Home testing to avoid frequent vet visits
Using non-prescription food that meets dietary needs
Finding insulin and syringes at discounted pharmacies or online
Applying for help from organizations like the ones linked here.

If finances are a barrier, please post your concerns in the forum. Members may be able to point you to lower-cost resources, donation programs, or helpful tips. Don’t give up—many cats thrive even with limited resources.

Diet & Alternative Treatments

Q2.1: Can I use oral medications instead of insulin?

In some cases, oral medications like glipizide or glyburide may be prescribed instead of insulin, but they’re generally not recommended as a first-line treatment. These drugs may help a small percentage of cats (about 30%), but they also carry risks such as liver damage and may delay more effective treatment with insulin.

Most caregivers—and many vets—prefer insulin because:

It tends to work more reliably
It offers better long-term outcomes
It’s often easier to administer than a daily pill

If your cat has liver issues, ketones, or neuropathy, oral meds are usually not a good option. Always discuss the risks and benefits with your vet before making a decision.

Q2.2: Can herbs or alternative therapies control diabetes?

If your cat needs insulin, there is no substitute. While some people explore holistic or integrative options, these approaches should never replace insulin unless your cat no longer needs it (as confirmed by testing).

A holistic veterinarian might incorporate:

Herbal supplements
Glandular or vitamin therapy
Traditional Chinese Medicine
Homeopathy
Dietary adjustments

If you’re interested in these routes, consult a vet who is familiar with both diabetes and alternative care. They may help support overall health but should not replace insulin until and unless it is truly no longer needed.

Q2.3: What should I feed my diabetic cat?

Diet plays a major role in managing feline diabetes. The current best practice is to feed a low-carbohydrate, high-protein diet, especially for cats that are otherwise healthy.

General guidelines:

Canned food is strongly preferred over dry
Carbs should make up less than 10% of total calories
Avoid foods with grains, corn, wheat, or added sugars
Transition slowly to new foods and monitor blood glucose closely

Prescription diets like Purina DM or Hill’s M/D are commonly recommended, but many caregivers choose over-the-counter canned foods that are just as effective and more affordable. Some examples include Friskies Pate, Fancy Feast Classic, and other grain-free, low-carb varieties.

If your cat has other health conditions (like kidney disease or pancreatitis), those needs should take priority when choosing a diet. Always consult with your vet when making a dietary change.

Q2.4: Can I leave food out for my cat all day (free-feeding)?

It depends on the type of insulin your cat is on:

Short-acting insulins (like Humulin N) require timed meals, typically just before each injection
Long-acting insulins (like Lantus or ProZinc) allow for more flexibility, and some cats can safely “graze” or eat small meals throughout the day

Regardless of feeding schedule, be consistent. Sudden changes in when or how much your cat eats can throw off blood sugar regulation.

Q2.5: I can’t afford prescription food or my cat refuses to eat it. Are there alternatives?

Absolutely. Many non-prescription canned foods are not only more affordable but are often better tolerated by cats. The key is choosing options that are:

Low in carbohydrates (under 10%)
Free from added sugars and starches
Made with quality animal-based protein

Our Low-Carb Food Chart can help you find suitable options. Many caregivers use regular canned cat food (like Fancy Feast Classic) and get great results.

Just be cautious when changing food—especially if your cat is already on insulin. Reducing carbs can lower blood glucose, so insulin doses may need to be adjusted.

Q2.6: How much should I feed my cat?

The goal is to maintain or reach a healthy weight. Most cats need about 15–25 calories per pound of ideal body weight per day.

Unregulated diabetic cats may initially require more food due to poor nutrient absorption. Once blood glucose stabilizes, their appetite should normalize.

If your cat is losing or gaining weight too quickly, or has other health concerns, speak with your vet about a tailored feeding plan.

Insulin

Q3.1: What types of insulin are used in cats?

There are several types of insulin available, but not all are ideal for cats. The most common ones include:

Lantus (glargine) – long-acting human insulin; gentle and consistent. Often used twice daily.
Levemir (detemir) – another long-acting option with slightly stronger potency.
ProZinc (PZI) – long-acting insulin made specifically for pets. Beef-based varieties may be better tolerated.
Vetsulin / Caninsulin – intermediate-acting insulin approved for pets, though duration may be too short for some cats.
Humulin N (NPH) – short to intermediate acting; typically not ideal due to sharp drops and shorter coverage.

We recommend avoiding short-acting insulins (like Humulin R) unless under veterinary supervision for specific situations like diabetic ketoacidosis (DKA).

Q3.2: Where can I get ProZinc or PZI insulin?

ProZinc is available by prescription through your vet or compounding pharmacies. If you’re looking for beef-based PZI insulin (not all PZI formulas are), ask specifically whether it’s made with beef or pork insulin — as some compounded versions use human insulin instead.

Be sure your source is reputable and that the insulin is factory-sealed and not repackaged.

Q3.3: How much does PZI insulin cost?

Prices vary depending on the brand, concentration, and source. As of recent data:

ProZinc (U-40): ~$60–$80 for a 10 mL vial
Compounded PZI: ~$50–$70 per bottle; check shipping costs and minimum orders

Always compare costs between your vet, online pet pharmacies, and compounding pharmacies. Buying in bulk may reduce per-bottle costs, but only do this if your cat uses enough insulin to finish bottles before expiration.

Q3.4: What type of syringe should I use?

Use syringes that match your insulin concentration:

U-100 insulin (Lantus, Levemir): use U-100 syringes
U-40 insulin (ProZinc, Vetsulin): use U-40 syringes

Look for syringes with:

3/10 cc volume
Half-unit markings (especially helpful for small doses)
31-gauge or 30-gauge needles (thinner needles reduce discomfort)
Short needle length (3/8″) is often easier for smaller cats

Many caregivers prefer Walmart’s ReliOn brand for affordability and comfort.

Q3.5: Do I need a prescription for insulin or syringes?

That depends on your location. In some U.S. states, you can buy insulin and syringes over the counter; in others, a prescription is required.

To be safe:

Ask your vet to write a script for both insulin and syringes
Check your state’s laws or pharmacy policies if you plan to order online

Q3.6: Can I reuse syringes?

It’s not recommended. While some caregivers reuse syringes once or twice to cut costs, each use dulls the needle and increases infection risk.

Best practices:

Use a new syringe for each injection
Never reuse a syringe if it has touched fur, blood, or air for an extended period
If you must reuse, do not share syringes between cats, and dispose of after 1–2 uses maximum

Q3.7: How do I dispose of used syringes and needles?

Follow local regulations. Common disposal methods include:

Using an FDA-approved sharps container
Asking your vet if they’ll accept used syringes
Sealing in a puncture-proof container (like a detergent bottle) before disposing per local rules

Do not throw loose needles in the trash.

Q3.8: My cat hates getting injections. What can I do?

Some tips to make injections easier:

Use the thinnest, sharpest needle possible (31-gauge)
Let the insulin come to room temperature before injecting
Inject into loose skin (like the scruff or side flank), not muscle
Reward your cat with a treat or affection right after the shot
Try distracting with food during injections
Practice good technique (see our Home Testing Links & Tips)

If your cat still resists, try a different location or method. Over time, most cats tolerate injections very well.

Q3.9: How long does insulin last?

General shelf life depends on storage and handling:

Unopened insulin: good until the manufacturer’s expiration date when refrigerated
Opened insulin: varies by type, but often lasts 4–6 weeks; some get longer use if stored and handled carefully

Watch for signs of insulin going bad:

Cloudiness or clumps that don’t dissolve when mixed
Weak response (higher blood sugars despite usual dose)
Crystals or settling in the vial

Always mix gently—don’t shake insulin.

Q3.10: What if I can’t give a shot exactly on time?

Consistency is ideal, but real life happens. If your schedule shifts slightly:

A 30 minute difference (early or late) is usually okay
For longer delays, consider giving a slightly reduced dose and return to your normal schedule at the next shot

If your schedule frequently prevents 12-hour dosing, you may need to:

Use different insulin types
Adjust AM/PM dosing
Discuss flexible dosing strategies with your vet

Q3.11: How much insulin does my cat need?

There is no one-size-fits-all answer. A common starting dose is 1 unit twice daily, but this must be adjusted based on:

Home blood glucose testing
Your cat’s diet
Body weight
Insulin type

Many cats do well on 0.5 to 3 units twice daily. Higher doses (above 4 units per shot) should prompt a review of your cat’s case, as they may suggest:

Improper diet
Rebound from overdosing
Underlying conditions (like acromegaly or infection)

Always make dose changes slowly and based on data.

Monitoring Your Cat - Blood Glucose

Q4.1: How do I know if the insulin is working?

The best way to monitor insulin effectiveness is by testing your cat’s blood glucose at home. This gives you real-time feedback on whether your cat’s dosage is too low, too high, or just right.

There are also secondary signs to watch for:

Reduced thirst and urination
More energy and playfulness
Healthier coat
Stable or gaining weight

While some owners use urine glucose test strips, they only show whether glucose was present at some point in the past—not whether the insulin is dropping blood glucose to dangerous levels. That’s why blood testing is strongly preferred.

Q4.2: What glucometer should I use?

Most human glucometers work well for cats. Look for models that:

Require a small blood sample (2–3 microliters)
Use “sip-in” test strips that draw the blood into the meter
Are widely available, with affordable strips

Popular options include:

ReliOn Confirm or Micro (available at Walmart)
OneTouch Ultra
AlphaTRAK 3 (calibrated for pets, but more expensive)

Pet-specific meters like AlphaTRAK may read slightly higher than human meters. Consistency is more important than the brand—pick one, and stick with it.

Q4.3: How often should I test my cat’s blood sugar?

That depends on your goals and where you are in the treatment process.

Before every insulin shot (AM/PM) – strongly recommended to avoid giving insulin when BG is too low
Once every few hours on curve days – a glucose curve tracks how BG rises and falls over 12 hours
When your cat seems “off” – if they’re lethargic, not eating, or acting strangely

Once your cat is stable and regulated, some caregivers reduce testing to a few times per week or month.

Q4.4: My cat’s pre-shot BG is much lower than usual. Should I still give insulin?

If the pre-shot number is unexpectedly low, do not give the usual dose without more information. General guidelines:

Under 150 mg/dL (8.3 mmol/L): Skip the dose or give a small “token” dose only if you understand your cat’s insulin curve
150–200 mg/dL (8.3–11.1): Consider a reduced dose and retest in 1–2 hours
Above 200 mg/dL (11.1+): Probably safe to give the regular dose, but confirm with a mid-cycle reading

Never guess. When in doubt, skip the shot and test again in a few hours. Better a little high than dangerously low.

Q4.5: I’m outside the U.S. — these numbers don’t make sense to me.

Most U.S. meters use mg/dL as the unit. In many other countries (Canada, UK, Australia), glucose is measured in mmol/L.

To convert:

mg/dL ÷ 18 = mmol/L
mmol/L × 18 = mg/dL

Example: 300 mg/dL = 16.7 mmol/L

Q4.6: I’m trying to test my cat, but can’t get blood from the ear.

This is common at first—don’t give up. Here are some tips:

Warm the ear: Use a rice sock, warm spoon, or wet paper towel warmed in a microwave-safe bag. Warm ears bleed more easily.
Massage the edge before pricking to increase blood flow
Aim for the outer edge of the ear, where there are capillaries but no cartilage
Use something firm behind the ear (like a cotton ball or flashlight) for support
Try both ears—some cats bleed better on one side
Use a quality lancet (26–30 gauge), and adjust depth if your device allows

Once you get the hang of it, testing becomes quick and easy. Always give a treat afterward—even if the test doesn’t work—to create a positive association.

Q4.7: My cat hasn’t had insulin in a few days, but BG is in the 40s–50s. Is this dangerous?

If your cat is acting normal and hasn’t had insulin recently, these numbers may be a sign of remission. Non-diabetic cats can have naturally low BG values on home meters (as low as 40–50 mg/dL or 2.2–2.8 mmol/L).

Keep monitoring for several days to ensure this trend continues. If BG stays low without insulin, and your cat is eating and acting normal, you may be entering a honeymoon period or true remission. Continue testing and watch for any signs of relapse.

Q4.8: Are there signs I can monitor besides blood glucose?

Yes. You’ll learn to recognize how your cat “looks” when well-regulated versus unregulated. Signs your cat is doing well:

Good appetite and energy
Normal urination and thirst
Healthy skin and coat
Purring, playing, grooming (we call these the “5 Ps”: purring, playing, peeing, pooping, preening)

Signs that something is wrong:

Excessive urination or drinking
Lethargy or poor appetite
Unkempt fur
Wobbly walking or hiding

Trust your instincts—if your cat seems “off,” check blood glucose and consider a vet visit.

Q4.9: I want to home test, but my vet says no. What should I do?

It’s your cat, and home testing is both safe and recommended by veterinary endocrinologists. If your vet discourages it:

Share research and articles from credible veterinary sources
Emphasize that you won’t adjust doses without guidance
Offer to share test results with your vet

If they still refuse to support you, consider finding a more collaborative vet. Most experienced feline diabetes caregivers agree—home testing saves lives.

Monitoring Your Cat - Ketones

Q5.1: What are ketones?

Ketones are substances produced when the body breaks down fat for energy—usually because it’s not able to access glucose due to a lack of insulin. While small amounts of ketones can appear during illness or fasting, persistent or high levels are a red flag in diabetic cats.

Ketones in the urine (or blood) can indicate:

Insufficient insulin
Prolonged high blood sugar
Lack of food intake
Infection or inflammation
Risk of DKA (diabetic ketoacidosis)

Q5.2: How often should I test for ketones?

At least once or twice a week when your cat is stable
Daily or more often if your cat isn’t eating, is lethargic, vomiting, or has consistently high BG readings (over 250 mg/dL or 13.9 mmol/L)
Immediately if you suspect illness, dehydration, or a drop in appetite

Regular ketone testing can alert you to early signs of trouble, often before symptoms of DKA appear.

Q5.3: How do I test for ketones?

You can test ketones in two ways:

1. Urine Ketone Test Strips

Buy Ketostix or Keto-Diastix from most pharmacies (no prescription needed)
Collect a urine sample using a clean ladle, spoon, or non-absorbent litter
Dip the strip into the sample and compare the color change to the chart on the bottle

Tip: For female cats, use a shallow ladle or spoon when they squat. For males, slide a collection container behind them mid-stream.

2. Blood Ketone Meters

Meters like the Nova Max Plus or Precision Xtra test for blood ketones using a small blood drop (similar to glucose testing)
More accurate than urine strips and useful in early DKA detection

Q5.4: What if my cat tests positive for ketones?

It depends on the amount and your cat’s condition.

Trace to Small Ketones

Encourage food and water intake
Ensure insulin is being given as prescribed
Monitor frequently (every 6–12 hours)
Watch for symptoms of worsening (vomiting, lethargy, refusal to eat)

Moderate to Large Ketones

This may indicate early ketoacidosis, especially if your cat is not eating, appears sick, or has very high BG levels
Contact your vet immediately—DKA can develop rapidly and requires prompt treatment

Q5.5: What is Diabetic Ketoacidosis (DKA)?

DKA is a medical emergency where high levels of ketones make the blood acidic, upsetting the body’s chemistry. It can quickly become life-threatening if not treated.

Signs of DKA:

Vomiting
Not eating or drinking
Lethargy or collapse
Dehydration
Fruity or acetone-smelling breath

Treatment usually includes:

Hospitalization
IV fluids and electrolytes
Fast-acting insulin
Careful glucose and ketone monitoring

DKA is often preventable with regular home monitoring of blood glucose and ketones, timely vet care, and not skipping insulin doses (unless advised).

Regulation & Remission

Q6.1: What does “regulation” mean?

Regulation means your cat’s blood glucose (BG) is consistently within a safe, manageable range. This reduces symptoms, prevents complications, and improves quality of life.

There are several levels of regulation. Here’s a simplified spectrum:

Unregulated: BG frequently above 300 mg/dL (16.7 mmol/L); ongoing symptoms like excessive thirst or urination
Regulated: BG mostly between 100–300 mg/dL (5.6–16.7 mmol/L); cat is acting normal and feeling well
Well-Regulated: BG mostly under 200 mg/dL (11.1 mmol/L), no clinical signs, steady appetite and weight
Tightly Regulated: BG usually between 70–120 mg/dL (3.9–6.7 mmol/L); requires consistent home testing
Remission: BG remains in normal ranges without insulin

Note: Some cats may show few symptoms even at higher numbers, and others may struggle even in moderate ranges. Monitor both the numbers and your cat’s behavior.

Q6.2: Which regulation level should I aim for?

It depends on:

Your cat’s overall health
Their response to insulin
Your ability to test at home and make dosing adjustments
Your vet’s recommendations

For most people, the first goal is to reach “regulated” (clinical signs under control). From there, some pursue tighter regulation or hope for remission.

Tight regulation may help reduce long-term damage and improve the chance of remission, but it requires frequent testing and careful insulin management.

Always prioritize safety—especially avoiding hypoglycemia (low blood sugar). Don’t sacrifice your cat’s well-being just to hit “ideal” numbers.

Q6.3: How do I achieve regulation?

The best path to regulation is a structured, gradual approach. Most experienced caregivers recommend:

The “Start Low, Go Slow” Method:

Begin with a low insulin dose (usually 1 unit twice daily)
Monitor blood glucose at home regularly
Only adjust the dose after reviewing a full glucose curve
Wait at least 5–7 days between increases (unless hypoglycemia occurs)

Avoid rapid dose increases or big jumps—this can trigger Somogyi rebound, where the body overcompensates and raises BG dramatically.

Also:

Feed a consistent low-carb diet
Minimize stress and sudden changes
Keep a log of food, insulin, BG values, and behavior

Q6.4: My cat is on insulin but still not regulated. Why?

There are many reasons a cat might be hard to regulate. Common causes include:

Wrong type of insulin (too short-acting or too weak for your cat)
Inconsistent feeding schedule or diet
Incorrect insulin dose or timing
Underlying infections (urinary tract infections, dental disease, etc.)
Other medical conditions like acromegaly, Cushing’s disease, pancreatitis, or thyroid issues

Before making big changes, review:

Your home testing data
Your cat’s current food and feeding routine
Recent health checkups and bloodwork

A well-documented log can help pinpoint issues.

Q6.5: What is tight regulation?

Tight regulation involves keeping blood sugar in a normal or near-normal range throughout the day—typically between 70–120 mg/dL (3.9–6.7 mmol/L).

This approach may:

Reduce long-term complications
Improve energy, appetite, and coat condition
Increase the chance of remission

But it comes with increased risk of hypoglycemia if not done carefully. It also requires:

Testing before every shot
Mid-cycle checks (to find the “nadir” or lowest point)
A willingness to make small, data-driven dose changes

Tight regulation isn’t for everyone, and that’s okay. Many cats do just fine with more moderate targets.

Q6.6: Is remission possible?

Yes. Some cats can go into remission, meaning they no longer need insulin and maintain healthy blood glucose on diet alone.

Chances of remission are higher if:

The cat is diagnosed early
Insulin is started promptly
A low-carb diet is introduced quickly
Blood glucose is well-controlled within the first few months

Remission is more common with long-acting insulins like Lantus and with tight glucose control. However, remission cannot be forced—some cats never achieve it, and that’s perfectly okay.

Even cats in remission should be monitored occasionally for relapse.

Q6.7: What if I just can’t get my cat regulated?

Don’t panic. Some cats take longer to respond. Others may never achieve perfect regulation but still live long, happy lives.

If you’re struggling:

Reassess the type of insulin, dose, and schedule
Ensure your diet is consistent and low in carbs
Test for other illnesses
Ask for help—our forum and experienced members are here for you

Sometimes, a different strategy—like micro-dosing, trying a new insulin, or managing food around insulin peaks—can make a big difference.