Why You Should NOT Toilet Train Your Cat

Teaching your cat to use a toilet rather than the litterbox is a relatively new phenomenon that became somewhat vogue after the movie “Meet the Parents” with Ben Stiller and Robert DeNiro. The film featured a cat that was very adept at using the toilet. Pet stores sell kits that are designed to toilet train your cat, and there are countless websites and several books devoted to the topic. At Manhattan Cat Specialists, we take a different view when it comes to toilet training your cat. We’re completely against it.

Cats should not be made or expected to use a toilet designed for people. It is completely unnatural for them. Cats instinctively dig and bury their urine and feces. Toilet training robs them of this instinct.

Toilet seats are slippery. There is always a chance of the cat losing its grip and falling into the bowl, possibly injuring itself in the process. The incident may be frightening enough to prevent the cat from using the toilet ever again. For a kitten or a small cat, it can actually be life threatening.

Cats that use the toilet are required to jump up. For younger cats, this is usually not a problem. Elderly, sick, injured or arthritic cats may find it difficult or painful to do this. Public restrooms provide handgrips, and hospitals and nursing homes provide bedpans for elderly and infirm humans. Why should we expect our elderly and infirm cats to tolerate pain and difficulty when eliminating?

Some medical conditions require monitoring the urine for the presence of blood, or the feces to see if there is blood or diarrhea. Toilet training makes it impossible to see the urine output, and the water in the toilet may change the consistency of the feces, making it difficult to assess diarrhea. Some cats develop medical conditions that result in increased urination. Owners often notice this by noticing more urine in the litterbox. For cats that use the toilet, it is impossible to get an idea as to whether the cat is producing an excessive volume of urine.

If you ever have to board your cat or if he needs to be hospitalized, it can be very confusing for him to be in a cage with a litterbox instead of a toilet. Stress weakens a cat’s immune system, and this kind of stress can only serve to delay recovery in an already sick cat.

Toilet training means that the toilet lid has to always remain up. This seems like a small detail, but if you have guests over, they might not remember to do this, potentially leading to inappropriate elimination and behavior problems.

It’s no wonder that so many cats that have been subjected to toilet training develop behavioral problems. At Manhattan Cat Specialists, we feel that people should just let cats be cats. Tending to a litterbox is part of the bargain we make when we get a cat, and it’s the least we can do for such wonderful companions.

Teaching your cat to use a toilet rather than the litterbox is a relatively new phenomenon that became somewhat vogue after the movie “Meet the Parents” with Ben Stiller and Robert DeNiro. The film featured a cat that was very adept at using the toilet. Pet stores sell kits that are designed to toilet train your cat, and there are countless websites and several books devoted to the topic. At Manhattan Cat Specialists, we take a different view when it comes to toilet training your cat. We’re completely against it.

Cats should not be made or expected to use a toilet designed for people. It is completely unnatural for them. Cats instinctively dig and bury their urine and feces. Toilet training robs them of this instinct.

Toilet seats are slippery. There is always a chance of the cat losing its grip and falling into the bowl, possibly injuring itself in the process. The incident may be frightening enough to prevent the cat from using the toilet ever again. For a kitten or a small cat, it can actually be life threatening.

Cats that use the toilet are required to jump up. For younger cats, this is usually not a problem. Elderly, sick, injured or arthritic cats may find it difficult or painful to do this. Public restrooms provide handgrips, and hospitals and nursing homes provide bedpans for elderly and infirm humans. Why should we expect our elderly and infirm cats to tolerate pain and difficulty when eliminating?

Some medical conditions require monitoring the urine for the presence of blood, or the feces to see if there is blood or diarrhea. Toilet training makes it impossible to see the urine output, and the water in the toilet may change the consistency of the feces, making it difficult to assess diarrhea. Some cats develop medical conditions that result in increased urination. Owners often notice this by noticing more urine in the litterbox. For cats that use the toilet, it is impossible to get an idea as to whether the cat is producing an excessive volume of urine.

If you ever have to board your cat or if he needs to be hospitalized, it can be very confusing for him to be in a cage with a litterbox instead of a toilet. Stress weakens a cat’s immune system, and this kind of stress can only serve to delay recovery in an already sick cat.

Toilet training means that the toilet lid has to always remain up. This seems like a small detail, but if you have guests over, they might not remember to do this, potentially leading to inappropriate elimination and behavior problems.

It’s no wonder that so many cats that have been subjected to toilet training develop behavioral problems. At Manhattan Cat Specialists, we feel that people should just let cats be cats. Tending to a litterbox is part of the bargain we make when we get a cat, and it’s the least we can do for such wonderful companions.

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Reader Question: My Senior Cat Meows Loudly

My Senior Cat Meows Loudly

Dr. Arnold Plotnick is one of CatChannel's feline health experts. Check out more of his CatChannel answers.

Q: My cat, Bailey, just turned 22 this past Easter! She is a seal point Siamese mix. Bailey still gets around fairly well, and even jumps onto our kitchen counter to get to her food. Aside from some occasional random places we have caught her urinating, she seems to be aging well. For the past several years, however, Bailey has made some incredibly loud meows, mostly at night. She actually wakes me up at night. They sound similar to a cat in heat and seem to becoming more frequent. Do have any idea what the cries are?

A: Increased vocalization is fairly common in senior cats. As pets get older, they will sometimes experience a decline in cognitive function. Changes in memory, learning, perception and awareness are well documented in aging people, and similar changes have been described in aging companion animals.

In dogs and cats, this decline may manifest itself in several ways. Forgetting previously learned behaviors such as housetraining, acquiring new fears and anxieties, changing sleep-wake cycles, acting generally “disoriented” and failing to recognize people, places and other pets are the most common behavior changes described by owners of aging pets.

In my feline practice, I’m often asked to evaluate a senior cat whose only clinical sign seems to be pointless, strident meowing, mostly in the middle of the night. While primary behavior problems may develop in aging cats and dogs, the possibility of a cat's underlying medical condition should first be considered. Hyperthyroidism, a glandular condition in which the thyroid gland produces excessive thyroid hormone, is one possible cause. Diagnosis is usually straightforward, using as simple blood test. In most cases, no medical problem underlies the behavior. Although it’s tempting to call this condition “senility,” a more correct term would be Cognitive Dysfunction Syndrome.

Have your cat’s thyroid checked. If it is normal, I’d venture that CDS is the cause. The drug used to treat this in dogs is not approved for use in cats. You can administer other supplements, however, to cats that often cause significant improvement. One of them is called Novifit-S, which is a tablet that is given once daily. Ask your veterinarian about this product.

Dr. Plotnick's Feline Articles 

More Questions and Answers with Dr. Plotnick

Dr. Plotnick on CatChannel

My Senior Cat Meows Loudly

Dr. Arnold Plotnick is one of CatChannel's feline health experts. Check out more of his CatChannel answers.

Q: My cat, Bailey, just turned 22 this past Easter! She is a seal point Siamese mix. Bailey still gets around fairly well, and even jumps onto our kitchen counter to get to her food. Aside from some occasional random places we have caught her urinating, she seems to be aging well. For the past several years, however, Bailey has made some incredibly loud meows, mostly at night. She actually wakes me up at night. They sound similar to a cat in heat and seem to becoming more frequent. Do have any idea what the cries are?

A: Increased vocalization is fairly common in senior cats. As pets get older, they will sometimes experience a decline in cognitive function. Changes in memory, learning, perception and awareness are well documented in aging people, and similar changes have been described in aging companion animals.

In dogs and cats, this decline may manifest itself in several ways. Forgetting previously learned behaviors such as housetraining, acquiring new fears and anxieties, changing sleep-wake cycles, acting generally “disoriented” and failing to recognize people, places and other pets are the most common behavior changes described by owners of aging pets.

In my feline practice, I’m often asked to evaluate a senior cat whose only clinical sign seems to be pointless, strident meowing, mostly in the middle of the night. While primary behavior problems may develop in aging cats and dogs, the possibility of a cat's underlying medical condition should first be considered. Hyperthyroidism, a glandular condition in which the thyroid gland produces excessive thyroid hormone, is one possible cause. Diagnosis is usually straightforward, using as simple blood test. In most cases, no medical problem underlies the behavior. Although it’s tempting to call this condition “senility,” a more correct term would be Cognitive Dysfunction Syndrome.

Have your cat’s thyroid checked. If it is normal, I’d venture that CDS is the cause. The drug used to treat this in dogs is not approved for use in cats. You can administer other supplements, however, to cats that often cause significant improvement. One of them is called Novifit-S, which is a tablet that is given once daily. Ask your veterinarian about this product.

Dr. Plotnick's Feline Articles 

More Questions and Answers with Dr. Plotnick

Dr. Plotnick on CatChannel

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Feline Gum Disease

By Jamie Conrad, eHow Contributor

Dental disease is the most common disease in cats, affecting nearly every cat 5 years and older, according to Dr. Arnold Plotnick of Manhattan Cat Specialists. Gum disease is one of the leading diseases of the mouth in felines, often leading to other medical problems such as tooth loss, sinus infections and even heart failure. With awareness of the problem and some precautions, you can help your cats avoid this very preventable ailment.

Identification

Feline periodontal disease, also known as feline gum disease, is inflammation of the tissues surrounding and supporting the teeth. Feline periodontal disease weakens cats' teeth and gums, often leading to other more serious medical conditions.

Symptoms

Look for the following signs and symptoms if feline periodontal disease is suspected. Look at the appearance of the teeth and gums. Yellow or brown spots on the teeth, receding gum lines, or reddened edges of gum lines are all symptoms of periodontal disease. Bad breath is another telling sign. Other symptoms include blood-tinged drool, mouth pain, and difficulty chewing food.

Causes

Over-crowded teeth and genetics are two contributors to feline periodontal disease, but there are many others. The older a cat grows, the more likely it is to suffer from gum disease. Certain breeds such as Persians, Himalayans and Siamese suffer from periodontal disease more often than other breeds. If the cat's diet consists of mainly soft food, it will be more at risk for periodontal disease than a cat that eats hard food. Also, cats that do not receive regular home or veterinary dental care will be more at risk of developing periodontal disease.

Treatment

A veterinarian will examine a cat's mouth to diagnose feline periodontal disease, looking for irritated gums or decayed teeth. The veterinarian may recommend oral radiographies (X-rays) to determine the severity of the disease. Most often, the cat will be anesthetized and the tooth debris, along with any infection, will be physically removed. In severe cases, badly decayed teeth will often be removed. Antibiotics may be required to help treat infection, and pain medication may be required to help treat pain from any dental procedures.

Prevention/Solution

Regular dental care and maintenance are the only ways to prevent feline periodontal disease. Ask your veterinarian to recommend a specially formulated toothpaste to use with a feline toothbrush , and brush your cat's teeth at home several times per week. Use brushing your cat's teeth as an opportunity to get a good look at his mouth, checking for any signs of problems. Also, take your cat to the veterinarian for a yearly dental exam to look for and prevent any upcoming dental problems.

Articles by Dr. Plotnick - Dentistry and Oral Disorders

"Dental Disease" 

"Tooth or Consequences" 

"Severe Gingivitis/Stomatitis" 

"When Cats Drool"

 

Feline Gum Disease

By Jamie Conrad, eHow Contributor

Dental disease is the most common disease in cats, affecting nearly every cat 5 years and older, according to Dr. Arnold Plotnick of Manhattan Cat Specialists. Gum disease is one of the leading diseases of the mouth in felines, often leading to other medical problems such as tooth loss, sinus infections and even heart failure. With awareness of the problem and some precautions, you can help your cats avoid this very preventable ailment.

Identification

Feline periodontal disease, also known as feline gum disease, is inflammation of the tissues surrounding and supporting the teeth. Feline periodontal disease weakens cats' teeth and gums, often leading to other more serious medical conditions.

Symptoms

Look for the following signs and symptoms if feline periodontal disease is suspected. Look at the appearance of the teeth and gums. Yellow or brown spots on the teeth, receding gum lines, or reddened edges of gum lines are all symptoms of periodontal disease. Bad breath is another telling sign. Other symptoms include blood-tinged drool, mouth pain, and difficulty chewing food.

Causes

Over-crowded teeth and genetics are two contributors to feline periodontal disease, but there are many others. The older a cat grows, the more likely it is to suffer from gum disease. Certain breeds such as Persians, Himalayans and Siamese suffer from periodontal disease more often than other breeds. If the cat's diet consists of mainly soft food, it will be more at risk for periodontal disease than a cat that eats hard food. Also, cats that do not receive regular home or veterinary dental care will be more at risk of developing periodontal disease.

Treatment

A veterinarian will examine a cat's mouth to diagnose feline periodontal disease, looking for irritated gums or decayed teeth. The veterinarian may recommend oral radiographies (X-rays) to determine the severity of the disease. Most often, the cat will be anesthetized and the tooth debris, along with any infection, will be physically removed. In severe cases, badly decayed teeth will often be removed. Antibiotics may be required to help treat infection, and pain medication may be required to help treat pain from any dental procedures.

Prevention/Solution

Regular dental care and maintenance are the only ways to prevent feline periodontal disease. Ask your veterinarian to recommend a specially formulated toothpaste to use with a feline toothbrush , and brush your cat's teeth at home several times per week. Use brushing your cat's teeth as an opportunity to get a good look at his mouth, checking for any signs of problems. Also, take your cat to the veterinarian for a yearly dental exam to look for and prevent any upcoming dental problems.

Articles by Dr. Plotnick - Dentistry and Oral Disorders

"Dental Disease" 

"Tooth or Consequences" 

"Severe Gingivitis/Stomatitis" 

"When Cats Drool"

 

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Strangest Things Ever Found Inside of a Patient Contest

Yay! Dr. Plotnick received honorable mention for the 'Strangest Things Ever Found Inside of a Patient' contest brought to us by Clinician's Brief.

Subject: Clinician's Brief Strangest Thing Contest

Hello Dr. Plotnick,

Congratulations! You won honorable mention for our “Strangest Thing Ever Found Inside a Patient” contest! Attached is the layout featuring your photos and as your prize, we’re going to send you a free algorithm binder. Please reply with your mailing address so that we can send your prize. Thank you so much for your participation in our contest; we sincerely hope that you participate in future photo contests.

Best regards

---

Check out the full article with the winners as well as Dr. Plotnick's entry here (PDF).

Yay! Dr. Plotnick received honorable mention for the 'Strangest Things Ever Found Inside of a Patient' contest brought to us by Clinician's Brief.

Subject: Clinician's Brief Strangest Thing Contest

Hello Dr. Plotnick,

Congratulations! You won honorable mention for our “Strangest Thing Ever Found Inside a Patient” contest! Attached is the layout featuring your photos and as your prize, we’re going to send you a free algorithm binder. Please reply with your mailing address so that we can send your prize. Thank you so much for your participation in our contest; we sincerely hope that you participate in future photo contests.

Best regards

---

Check out the full article with the winners as well as Dr. Plotnick's entry here (PDF).

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Reader Question: How Can I Help My Cat With Chronic Renal Failure Feel Better?

How Can I Help My Cat With Chronic Renal Failure Feel Better? 

CatChannel veterinary expert Arnold Plotnick, DVM, examines ways that a cat with CRF can be comforted and treated.

Dr. Arnold Plotnick is one of CatChannel's feline health experts. Check out more of his CatChannel answers.

Q: Can my 17-year-old cat with probable kidney failure really be treated? My vet said to bring her in, but I have been down this road with my other geriatric cat. Can’t I do something besides bring her in, most likely, to die in his office? Can the traditional practice of veterinary medicine provide palliative care in for this kind of situation to make it easier for my cat and me?

A: Chronic renal failure (CRF) commonly causes illness in cats, especially in older cats.  While it may be difficult or impossible to improve kidney function in cats with chronic renal failure, you can delay the progression of renal failure, improve the cat’s quality of life and extend a cat’s survival time through a variety of diet and drug interventions. 

Bring your cat to the vet and at least do bloodwork, to assess the severity of the kidney disease to see if your cat requires hospitalization. Cats that are acutely ill with CRF require hospitalization, intravenous fluids and other supportive measures. I can’t tell from your letter how sick your cat is, so I cannot predict if your cat will respond to treatment.  Hospitalization and intravenous fluids may improve the cat’s condition, but it does not return it to normal.

If you cat’s condition improves and she is sent home, feed her a prescription diet designed for cats with CRF. It is proven that cats with CRF that eat these diets do better and live longer. If your cat has mild or moderate kidney failure, it may not need hospitalization, and may be managed at home. You can perform many treatments at home to make a cat with CRF more comfortable. For example, nausea is common in cats with CRF, contributing to the poor appetite and vomiting. Antacids like famotidine (Pepcid) have proven beneficial in some cats with CRF.

Some cats with CRF will develop low levels of potassium in their blood.  This can accelerate the progression of the CRF.  Potassium supplements can correct this problem.  Twenty percent of cats with CRF have high blood pressure. This, too, can accelerate the CRF as well as damage the eyes, heart and nervous system. Give cats with CRF and high blood pressure medication to control it. Some cats with CRF lose too much protein in their urine. These cats tend to have shorter survival times. Fortunately, you can correct this with proper medication.

Cats with CRF tend to develop anemia over time. You can treat severe anemia with injections of a hormone that causes the bone marrow to release more red blood cells.

As the kidneys continue to fail, the blood phosphorus level may begin to rise.  Elevated phosphorus levels can be detrimental to the kidneys. For cats with high phosphorus levels, mix a phosphate binder into the food. These supplements bind the phosphorus in the food to prevent the cat from absorbing it.

Encourage cats with CRF to drink as much water as possible. Do this by feeding canned food, adding water or broth to the food and using fountain-type water bowls.  Give cats with inadequate water intake fluids subcutaneously (under the skin) at home. Although this sounds daunting, cat owners can quickly master this skill, once shown the proper technique.

Many advances have been achieved regarding the treatment of chronic renal failure. Although CRF is not curable, cats can live for many years after diagnosis if treated appropriately.

More Feline Renal (Kidney) Disorder Articles by Dr. Plotnick:

"Long Term Management of Chronic Renal Failure in Cats"

"New Test for Renal Disease"

"High Blood Pressure"

"Polycystic Kidney Disease"

How Can I Help My Cat With Chronic Renal Failure Feel Better? 

CatChannel veterinary expert Arnold Plotnick, DVM, examines ways that a cat with CRF can be comforted and treated.

Dr. Arnold Plotnick is one of CatChannel's feline health experts. Check out more of his CatChannel answers.

Q: Can my 17-year-old cat with probable kidney failure really be treated? My vet said to bring her in, but I have been down this road with my other geriatric cat. Can’t I do something besides bring her in, most likely, to die in his office? Can the traditional practice of veterinary medicine provide palliative care in for this kind of situation to make it easier for my cat and me?

A: Chronic renal failure (CRF) commonly causes illness in cats, especially in older cats.  While it may be difficult or impossible to improve kidney function in cats with chronic renal failure, you can delay the progression of renal failure, improve the cat’s quality of life and extend a cat’s survival time through a variety of diet and drug interventions. 

Bring your cat to the vet and at least do bloodwork, to assess the severity of the kidney disease to see if your cat requires hospitalization. Cats that are acutely ill with CRF require hospitalization, intravenous fluids and other supportive measures. I can’t tell from your letter how sick your cat is, so I cannot predict if your cat will respond to treatment.  Hospitalization and intravenous fluids may improve the cat’s condition, but it does not return it to normal.

If you cat’s condition improves and she is sent home, feed her a prescription diet designed for cats with CRF. It is proven that cats with CRF that eat these diets do better and live longer. If your cat has mild or moderate kidney failure, it may not need hospitalization, and may be managed at home. You can perform many treatments at home to make a cat with CRF more comfortable. For example, nausea is common in cats with CRF, contributing to the poor appetite and vomiting. Antacids like famotidine (Pepcid) have proven beneficial in some cats with CRF.

Some cats with CRF will develop low levels of potassium in their blood.  This can accelerate the progression of the CRF.  Potassium supplements can correct this problem.  Twenty percent of cats with CRF have high blood pressure. This, too, can accelerate the CRF as well as damage the eyes, heart and nervous system. Give cats with CRF and high blood pressure medication to control it. Some cats with CRF lose too much protein in their urine. These cats tend to have shorter survival times. Fortunately, you can correct this with proper medication.

Cats with CRF tend to develop anemia over time. You can treat severe anemia with injections of a hormone that causes the bone marrow to release more red blood cells.

As the kidneys continue to fail, the blood phosphorus level may begin to rise.  Elevated phosphorus levels can be detrimental to the kidneys. For cats with high phosphorus levels, mix a phosphate binder into the food. These supplements bind the phosphorus in the food to prevent the cat from absorbing it.

Encourage cats with CRF to drink as much water as possible. Do this by feeding canned food, adding water or broth to the food and using fountain-type water bowls.  Give cats with inadequate water intake fluids subcutaneously (under the skin) at home. Although this sounds daunting, cat owners can quickly master this skill, once shown the proper technique.

Many advances have been achieved regarding the treatment of chronic renal failure. Although CRF is not curable, cats can live for many years after diagnosis if treated appropriately.

More Feline Renal (Kidney) Disorder Articles by Dr. Plotnick:

"Long Term Management of Chronic Renal Failure in Cats"

"New Test for Renal Disease"

"High Blood Pressure"

"Polycystic Kidney Disease"

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Diabetes Emergency Preparedness as Important as Insulin

Diabetes Emergency Preparedness as Important as Insulin
via Veterinary Practice News


Owners often are shell-shocked when they hear their pet has diabetes. But a veterinarian’s optimistic attitude can help a client successfully manage the disease.

“It’s usually a traumatic piece of information for an owner when a veterinarian tells them their pet has diabetes,” says Randy Lynn, DVM, a technical service veterinarian with Intervet Schering-Plough Animal Health of Summit, N.J.

“If the owner is handling the news well, you can discuss the emergency situations that may occur in a diabetic animal. If you’re speaking to them and their eyes gloss over, you might want to send them home with written information, and then have the owner return in a day or two once they’ve processed everything.

“It’s a delicate balance that the veterinarian has to weigh. If you tell them too much on day one, you could tip them over the edge.”

Dr. Lynn says a diabetes diagnosis gives veterinarians a “chance to shine,” noting that owners will rely heavily on them for information on choosing insulin, injecting insulin and monitoring the animal.

Besides hearing the diabetes news, distressed clients also have to be warned about hypoglycemia, the No. 1 emergency concern of veterinarians who deal with diabetic patients. The likelihood of hypoglycemia occurring in an animal is greater in the early weeks after diagnosis.

“When veterinarians have the emergency talk with owners, they must tell them specific signs of hypoglycemia and not speak in generalities such as ‘If the animal is acting strange, do this.’ Give examples,” says Audrey K. Cook, BVMS, MRCVS, Dipl. ACVIM, Dipl. ECVIM (companion animals). “Tell them an animal may stare into space, have tremors, walk like it’s drunk, run into walls or lean into furniture or even become unconscious.”

What to Do

Though all the contents may never be utilized, Ruth MacPete, DVM, of Del Mar Heights Veterinary Hospital in Del Mar Heights, Calif., says owners should have a diabetes kit. The kit should contain glucose testing supplies, syringes, ketone test strips, Karo syrup and what Dr. Cook calls “a junky kind of food.”

“Tell owners to keep a junky, fun-to-eat food on the shelf just in case,” says Cook, a clinical associate professor at Texas A&M University. “Some corn syrups are better than others for this, so tell owners a specific type and brand. If the animal is able to eat, giving food would be the first step, but if not, reach for the Karo and get the animal to the veterinary office.”

Another option for initial hypoglycemia treatment and an item for the emergency kit is Glucose RapidSpray.

“Glucose RapidSpray is basically sugar water,” says Arnold Plotnick, DVM, Dipl. ACVIM, Dipl. ABVP (feline), the owner of Manhattan Cat Specialists in New York City. “Four or five pumps of the spray on the gums should do the trick, and then the owner needs to get the animal to the veterinarian.”

Clients should monitor a diabetic pet’s appetite, water intake and urine output, Dr. MacPete says.
“Owners should record this information in a log and bring it with them to veterinary visits. They should alert their veterinarian immediately if they notice any changes,” MacPete says.

Why Hypoglycemia Occurs

Hypoglycemia has several causes, but one of the most avoidable is giving the wrong insulin dose.

“Insulin comes in different strengths,” Dr. Plotnick says. “U40 and U100 must be used with their corresponding syringes. When a client runs out of syringes, they might go to a local pharmacy or get leftover syringes from a friend whose pet had diabetes. Make sure clients are aware that syringe substitutes will not work and they should always buy their diabetes supplies through the prescribing veterinarian.”

During the hypoglycemia discussion, veterinarians should tell clients that only one person in the household should give insulin injections, authorities agree. This avoids potentially deadly confusion over missed or additional injections.

“Give insulin at the same time every day,” Plotnick says. “Since insulin is usually given every 12 hours, tell the owner to choose two 12-hour time frames in which they know they’ll be home. One of my clients gives his cat an injection at 3 a.m. and one at 3 p.m.”

Veterinarians might be tempted to start a cat on two units twice a day, according to Plotnick. This can lead to hypoglycemia.

“We gradually make our way to finding a patient’s correct insulin level,” Plotnick says. “Start with one unit twice a day, increasing it by an additional unit twice a day, if needed, after two to three weeks at the initial rate.”

Watch the Food

Diet is an important component in regulating an animal’s diabetes and preventing hypoglycemia, experts say.

“Although veterinarians are aware of the importance of diet, they have to convey that to the client,” Cook says. “I think about it in my mind like a teeter-totter—balance food and exercise with insulin.”

Maintaining proper weight plays a large role in diabetes regulation, Intervet’s Lynn says. This means the obligate carnivore cat needs a high-protein, low-carbohydrate food. Dogs also can benefit from a special diet.

“Altering a cat’s diet can have a huge impact on its diabetes status,” Lynn says. “Thirty to 80 percent of diabetic cats can become non-diabetic through diet and insulin therapy. Dogs are more omnivores, and we attribute their diabetes status more to bad genetics rather than obesity level, which is often the case with cats.” And watch the treats.

“With diabetic dogs, the big diet upset is giving snacks,” Cook says. “Changing the habit of giving diabetic dogs extra treats is an immediate need.”

Diabetic Ketoacidosis

Another emergency situation for diabetic cats is diabetic ketoacidosis (DKA). Experts say this occurs less frequently in diabetic animals than hypoglycemia but needs to be part of the early discussion with owners.

“An animal being treated for diabetes will suffer from DKA most frequently because there is a concurrent disease that counteracts the insulin being given,” Plotnick says. “The animal will vomit, stop eating and show distinct signs of not feeling well. Increased thirst, increased urination, weight loss despite a good appetite and sudden blindness can also occur.

“In this scenario, owners need to know they should immediately take the animal to their veterinarian.”

Two factors cause DKA. If an animal is given the required amount of insulin, the inability of the B-cells to secrete sufficient insulin gives rise to an absolute deficiency. An increased insulin requirement may lead to an inability to produce sufficient extra insulin, which is called a relative deficiency. This is an important distinction.

“If an animal appears particularly difficult to regulate despite being on an appropriate treatment regimen and the client is being compliant, the veterinarian should evaluate for the presence of medical conditions that may be making the regulation of diabetes more challenging, like an occult infection or other medical conditions,” MacPete says.

Cook says concurrent Cushing’s disease or immune mediated anemia can make regulating insulin very complicated.

Non-Stop Monitoring

Cook says diabetic emergencies can be avoided when owners are educated, motivated to monitor their pet at home and know when to take action.

“There are devices to help with this process,” she says.

Charles Wiedmeyer, DVM, Ph.D., Dipl. ACVP, adapted the human MiniMed continuous glucose monitoring device to minimize the stress of drawing blood and avoid emergencies. Dr. Wiedmeyer, an assistant professor of clinical pathology at the University of Missouri, says the device can be used with dogs, cats, horses and cows.

“Cats especially can get stressed during blood draws,” Wiedmeyer says. “This monitoring device is only a couple of centimeters in diameter and is inserted under the skin with a 22-gauge needle. The probe stays in the animal for three days, sending real-time data to a laptop that will graph the animal’s glucose rate.

“This would be used most in newly diagnosed diabetic patients.”
Wiedmeyer says the reusable monitoring device, from Medtronic Inc., costs about $1,200. One-time-use probes cost $35.

The company is considering directly marketing to the veterinary industry.

“An important part of educating pet owners about diabetes is preparing them for possible diabetic emergencies,” MacPete says. “Complications can occur and they need to know how to recognize the signs and symptoms and how to treat them.

“The more educated a client is about potential diabetic emergencies, the better.”

Diabetes Emergency Preparedness as Important as Insulin
via Veterinary Practice News


Owners often are shell-shocked when they hear their pet has diabetes. But a veterinarian’s optimistic attitude can help a client successfully manage the disease.

“It’s usually a traumatic piece of information for an owner when a veterinarian tells them their pet has diabetes,” says Randy Lynn, DVM, a technical service veterinarian with Intervet Schering-Plough Animal Health of Summit, N.J.

“If the owner is handling the news well, you can discuss the emergency situations that may occur in a diabetic animal. If you’re speaking to them and their eyes gloss over, you might want to send them home with written information, and then have the owner return in a day or two once they’ve processed everything.

“It’s a delicate balance that the veterinarian has to weigh. If you tell them too much on day one, you could tip them over the edge.”

Dr. Lynn says a diabetes diagnosis gives veterinarians a “chance to shine,” noting that owners will rely heavily on them for information on choosing insulin, injecting insulin and monitoring the animal.

Besides hearing the diabetes news, distressed clients also have to be warned about hypoglycemia, the No. 1 emergency concern of veterinarians who deal with diabetic patients. The likelihood of hypoglycemia occurring in an animal is greater in the early weeks after diagnosis.

“When veterinarians have the emergency talk with owners, they must tell them specific signs of hypoglycemia and not speak in generalities such as ‘If the animal is acting strange, do this.’ Give examples,” says Audrey K. Cook, BVMS, MRCVS, Dipl. ACVIM, Dipl. ECVIM (companion animals). “Tell them an animal may stare into space, have tremors, walk like it’s drunk, run into walls or lean into furniture or even become unconscious.”

What to Do

Though all the contents may never be utilized, Ruth MacPete, DVM, of Del Mar Heights Veterinary Hospital in Del Mar Heights, Calif., says owners should have a diabetes kit. The kit should contain glucose testing supplies, syringes, ketone test strips, Karo syrup and what Dr. Cook calls “a junky kind of food.”

“Tell owners to keep a junky, fun-to-eat food on the shelf just in case,” says Cook, a clinical associate professor at Texas A&M University. “Some corn syrups are better than others for this, so tell owners a specific type and brand. If the animal is able to eat, giving food would be the first step, but if not, reach for the Karo and get the animal to the veterinary office.”

Another option for initial hypoglycemia treatment and an item for the emergency kit is Glucose RapidSpray.

“Glucose RapidSpray is basically sugar water,” says Arnold Plotnick, DVM, Dipl. ACVIM, Dipl. ABVP (feline), the owner of Manhattan Cat Specialists in New York City. “Four or five pumps of the spray on the gums should do the trick, and then the owner needs to get the animal to the veterinarian.”

Clients should monitor a diabetic pet’s appetite, water intake and urine output, Dr. MacPete says.
“Owners should record this information in a log and bring it with them to veterinary visits. They should alert their veterinarian immediately if they notice any changes,” MacPete says.

Why Hypoglycemia Occurs

Hypoglycemia has several causes, but one of the most avoidable is giving the wrong insulin dose.

“Insulin comes in different strengths,” Dr. Plotnick says. “U40 and U100 must be used with their corresponding syringes. When a client runs out of syringes, they might go to a local pharmacy or get leftover syringes from a friend whose pet had diabetes. Make sure clients are aware that syringe substitutes will not work and they should always buy their diabetes supplies through the prescribing veterinarian.”

During the hypoglycemia discussion, veterinarians should tell clients that only one person in the household should give insulin injections, authorities agree. This avoids potentially deadly confusion over missed or additional injections.

“Give insulin at the same time every day,” Plotnick says. “Since insulin is usually given every 12 hours, tell the owner to choose two 12-hour time frames in which they know they’ll be home. One of my clients gives his cat an injection at 3 a.m. and one at 3 p.m.”

Veterinarians might be tempted to start a cat on two units twice a day, according to Plotnick. This can lead to hypoglycemia.

“We gradually make our way to finding a patient’s correct insulin level,” Plotnick says. “Start with one unit twice a day, increasing it by an additional unit twice a day, if needed, after two to three weeks at the initial rate.”

Watch the Food

Diet is an important component in regulating an animal’s diabetes and preventing hypoglycemia, experts say.

“Although veterinarians are aware of the importance of diet, they have to convey that to the client,” Cook says. “I think about it in my mind like a teeter-totter—balance food and exercise with insulin.”

Maintaining proper weight plays a large role in diabetes regulation, Intervet’s Lynn says. This means the obligate carnivore cat needs a high-protein, low-carbohydrate food. Dogs also can benefit from a special diet.

“Altering a cat’s diet can have a huge impact on its diabetes status,” Lynn says. “Thirty to 80 percent of diabetic cats can become non-diabetic through diet and insulin therapy. Dogs are more omnivores, and we attribute their diabetes status more to bad genetics rather than obesity level, which is often the case with cats.” And watch the treats.

“With diabetic dogs, the big diet upset is giving snacks,” Cook says. “Changing the habit of giving diabetic dogs extra treats is an immediate need.”

Diabetic Ketoacidosis

Another emergency situation for diabetic cats is diabetic ketoacidosis (DKA). Experts say this occurs less frequently in diabetic animals than hypoglycemia but needs to be part of the early discussion with owners.

“An animal being treated for diabetes will suffer from DKA most frequently because there is a concurrent disease that counteracts the insulin being given,” Plotnick says. “The animal will vomit, stop eating and show distinct signs of not feeling well. Increased thirst, increased urination, weight loss despite a good appetite and sudden blindness can also occur.

“In this scenario, owners need to know they should immediately take the animal to their veterinarian.”

Two factors cause DKA. If an animal is given the required amount of insulin, the inability of the B-cells to secrete sufficient insulin gives rise to an absolute deficiency. An increased insulin requirement may lead to an inability to produce sufficient extra insulin, which is called a relative deficiency. This is an important distinction.

“If an animal appears particularly difficult to regulate despite being on an appropriate treatment regimen and the client is being compliant, the veterinarian should evaluate for the presence of medical conditions that may be making the regulation of diabetes more challenging, like an occult infection or other medical conditions,” MacPete says.

Cook says concurrent Cushing’s disease or immune mediated anemia can make regulating insulin very complicated.

Non-Stop Monitoring

Cook says diabetic emergencies can be avoided when owners are educated, motivated to monitor their pet at home and know when to take action.

“There are devices to help with this process,” she says.

Charles Wiedmeyer, DVM, Ph.D., Dipl. ACVP, adapted the human MiniMed continuous glucose monitoring device to minimize the stress of drawing blood and avoid emergencies. Dr. Wiedmeyer, an assistant professor of clinical pathology at the University of Missouri, says the device can be used with dogs, cats, horses and cows.

“Cats especially can get stressed during blood draws,” Wiedmeyer says. “This monitoring device is only a couple of centimeters in diameter and is inserted under the skin with a 22-gauge needle. The probe stays in the animal for three days, sending real-time data to a laptop that will graph the animal’s glucose rate.

“This would be used most in newly diagnosed diabetic patients.”
Wiedmeyer says the reusable monitoring device, from Medtronic Inc., costs about $1,200. One-time-use probes cost $35.

The company is considering directly marketing to the veterinary industry.

“An important part of educating pet owners about diabetes is preparing them for possible diabetic emergencies,” MacPete says. “Complications can occur and they need to know how to recognize the signs and symptoms and how to treat them.

“The more educated a client is about potential diabetic emergencies, the better.”

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