Cat blood sugar lvl question

Q1.6. What is the goal of treatment?

A1.6. The overall goal is a happy and healthy cat with a normal lifespan. Ideally, this is achieved by using diet and insulin (and possibly drugs and exercise) to get your cat's blood glucose as close as possible to normal glucose values (under 120 mg/dl or 6.7 mmol/L) without ever descending into unsafe hypoglycemic levels (under 40 mg/dl or 2.2 mmol/L). For some cats, particularly that lucky minority that can be controlled with a low-carbohydrate diet alone, normal blood glucose values are attainable ("normalization"). Most other cats, particularly those who do not respond consistently to food and insulin, or those who have health problems which interfere with their ability to get to near-normal blood glucose values, may need to be kept at higher overall blood glucose values in order to avoid the risk of hypoglycemia. For these cats, a more realistic goal is "regulation," see Section 6.

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Q6.5. What is tight regulation?

A6.5. Tight regulation refers to using insulin to keep a diabetic cat's blood glucose levels within normal or near-normal ranges as much of the time as possible. This approach to regulation is very controversial because of the high perceived risk of hypoglycemia. However, it is not merely an exercise in vanity; keeping blood glucose in this range is thought to reduce long-term damage to the organs and nerves. Additionally, some people believe that diabetic cats kept in or near a normal glucose range have a higher chance of achieving diabetic remission, especially if so controlled during their first year after diagnosis. (An alternative explanation, though, is that the cats who achieved remission might have done so under almost any insulin regimen as long as they were fed a low-carbohydrate diet.) The downsides are that heavy monitoring is often required, and that some cats simply cannot be tightly regulated no matter how hard the human tries. If you are interested in this technique, the Feline Diabetes Message Board has a special forum for discussing it.

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Q6.1. What is regulation?


A6.1. There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum":

Not treated [blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs]
Treated but not regulated [often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs]
Regulated [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia]
Well regulated [generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia]
Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin]
Normalized [60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin]

There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated. On the other end of the spectrum, it is possible for a cat who is not getting insulin to have blood glucose as low as 40 mg/dl (2.2 mmol/L) on a home glucometer. If you have a non-diabetic cat, try testing her with the same meter to get a safe comparison figure.

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