Dosing Diabetic Cat

What is Tight Regulation?

The Tight Regulation (TR) protocol used on DCI is based on a revolutionary protocol developed by the veterinarian Dr. Elizabeth Hodgkins, DVM, using US Bovine PZI insulin – not to be confused with Hypurin Bovine PZI from the UK, which is a very different type of bovine PZI insulin. (Please note that Dr. Hodgkins is not affiliated or associated with DCI in any manner and is not responsible for any of its content). Since then, based on the test logs of cats using the protocol on various forums, it has evolved and has been adapted and used on all insulin types, helping hundreds of cats.

The goal of TR is to bring diabetic cats into a diet-controlled remission where insulin is no longer needed, or, if that is not possible, into much better health through a combination of a species-appropriate diet and an insulin dosing strategy that can best be summarised as “The right amount of insulin at the right time”.

The aim of Tight Regulation (TR) is to bring cats into, and keep them in, normal range blood glucose numbers:  45-130 mg/dl (Imperial Measurement)  or  2.5 -7.2 mmo/L (Metric measurement).

Note: Which measurement you use depends on what country you live in.  The US, most of South America and primarily southern European countries still use the Imperial Measurement.  Canada, Australia, the UK and many northern European countries use the Metric Measurement.

What is a species appropriate diet?

Cats are obligate carnivores: they need meat to survive. Their entire digestive system has evolved to get the nutrients they need from meat, not from cereals or fruit!

The correct diet for a cat is one that is:

1) High in Protein (45-70% on a dry matter basis)
2) Moderate in Fat (15-35%)
3) Low in Carbohydrates (3-5%)
4) High in Moisture

The above figures contrast with the typical composition of dry cat food with its only Moderate Protein (22-34%), Low Fat (10-25%), Very High Carbohydrates (35-50%) and Very Low Moisture.

A high carb diet, due to the large quantities of inappropriate cereals in dry cat food, is one of the leading causes of Feline Diabetes.

The appropriate food for your cat is a 100% low-carb (under 10% carbs on a dry matter basis) wet food.

For more information on food and its importance, please see  Food Education Links under Food & Felines in the Knowledge Centre.

Information on calculating Carbs on a dry matter basis and a Carb Calculator may be found in Useful TR Tools & Tips in the Knowledge Centre: Calculating Carbohydrates

Additional country-specific information on appropriate low carb wet foods may be found in the individual Country Stickies in the Knowledge Centre.

If your cat is on a high-carb diet and also on insulin at the moment, you need to follow the Detox Process to ensure the transition to 100% low carb wet food is done safely and to protect your cat against a clinical hypo. Do NOT change food without first reading and understanding the Detox Process which may be found in the Knowledge Centre: Detoxing your Cat from High Carb Food

What does “the Right amount of insulin at the Right time mean”?

Normal vet protocols are based on dosing the same amount of insulin at fixed times (usually every 12 hours) – regardless of the blood glucose (BG) level or of the duration of the insulin used – and there are big differences between different insulins.

In most cases the BG is not even known, as home testing is not suggested or done.

With TR, both the dose and the timing are adapted to the cat:

• The “Right Amount” of insulin means using a scale approach instead of fixed dose of insulin: the amount of insulin dosed depends on the BG test at the time you go to dose.

• The scale used depends on the type of insulin being used.

• Higher BGs need more insulin to bring the cat down into normal range (45-130 / 2.5 – 6.7)……… lower BGs need less insulin for the cat to drop into normal range.

• With the scale approach, you therefore administer higher doses of insulin for higher BGs and lower doses for lower  BGs.

• The “Right Time” means dosing insulin when the cat needs it, as long as certain criteria (which depend on the insulin being used) are in place in order to take advantage of overlap between two doses of insulin.  We dose before all the insulin has gone from the previous shot.  As the first dose of insulin is running out, the second is building up and then takes over, keeping insulin support going all the time.  Typical vet protocols are based on dosing twice a day – even though for many insulins, including vet insulins, their duration is much shorter, meaning that the cat has totally run out of insulin from the first shot by the time the second is given.  As a consequence, BGs spike high at the end of the dosing cycle and the beginning of the next, as there is no insulin there to help control them.

• With TR we dose earlier than the vet protocol as long as those criteria are in place.

Please see the information about the different insulins and their starting scales and dosing criteria under Starting TR in the Knowledge Centre : Insulins, Starting Scales & Dosing criteria

What do I need to do to start TR?

There are two absolutely NON – NEGOTIABLE rules for starting TR:

  1. You MUST be testing your cat’s blood glucose at home
  2. Your cat MUST be on a 100% low carb (under 10% on a dry matter basis) wet diet: NO high carb wet food or dry food is allowed.

In addition, if your cat is already on insulin and is on a high carb diet (either dry food or high carb wet) you MUST follow the DETOX PROCESS to ensure that your cat is transitioned safely to a 100% low carb wet diet.

For information on testing your cat’s Blood Glucose, please see the Testing Sticky under Starting TR in the Knowledge Centre: How to Test your Cat’s Blood Glucose.

Please do post on Introductions & Questions and tell us about your cat. We will do all that we can to support you and help you help your cat!

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