There are five principles that greatly simplify treatment
1) Tight control is not essential and probably not even desirable
i. Ideal for dogs: 100-200 mg/dl
ii. Ideal for cats: 100-300 mg/dl
a. Cats do not get significant vascular or renal disease secondary to diabetes
b. Cats do not get cataracts due to diabetes
c. Cats usually do not commit housuria
d. The toxic level of glucose is probably greater than 1000 mg/dl in cats.
2) Hyperglycemia is always better than hypoglycemia
i. The toxic level of glucose is very high
ii. But hypoglycemia kills
i. As long the cat is not ketoacidotic, it is not likely to die any time soon.
ii. This principle permits us to do a one month drug trial with an oral hypoglycemic drug
iii. This principle permits us to gradually work into regulation.
i. Human diabetics change their dose (and type) of insulin daily based on changing situations.
ii. We try to find the "correct" dose of insulin for cats and use it for months or years.
iii. Consistency is the basis for doing "the impossible."
5) Clinical signs are extremely important in regulating and maintaining a diabetic cat.
i. "Glycemic control is attained when clinical signs of diabetes have resolved, the cat is healthy and interactive in the home, its body weight is stable, the owner is satisfied with the progress of therapy, and, if possible, the blood glucose concentrations range between 100 and 300 mg/dl throughout the day." Feldman and Nelson' Endocrinology Text, 1996, p. 363.