While Cat’s TCM Notes is not a veterinary medicine site, I have nonetheless learned quite a lot about health and TCM from my pets. When my German shepherd was diagnosed with COPD a number of years ago I had just graduated from AOMA. I was totally sold on acupuncture and energetic medicine, but had a dubious relationship with herbal medicine. My dog changed all of that. Once she was diagnosed I decided to try Evergreen’s Circulation formula rather than the liver-killing pharmaceutical medicine that was recommended. The results were profound and gave her a very high quality of life, high degree of physical comfort, and put the spring back in her step for her final 4 years of life.
And now it’s happened again. My sweet elder stateswoman, Princess Peach Pie, recently lost so much strength in her legs that she had trouble getting around. She had also developed a high thirst drive and the ability to produce ridiculous amounts of urine at a time. We took her to the vet. After looking at her “dropped hocks” and with only one blood draw they diagnosed her with feline diabetes. The recommendation was 1 unit of insulin, injected BID. We asked about testing her blood glucose (BG) and were told not to bother – just give her the injections, bring her back in a few weeks or a month and they would put her through a full day of testing every 2 hours.
My response was exactly what you would expect of a well-trained medical professional: I panicked. Hey, she’s my ‘kid.’ What can I say? My partner and I ran to the pharmacy and filled the script for Lantus, an injectable form of insulin normally designed for people, and a half-ton of syringes.
Insulin is freakin’ expensive!
If you or someone you know/love is diabetic, you might already know this. The price of Lantus is ridiculous. $300 for a vial that is only rated to last 28 days. Oh. My. God. The vet said, ‘Oh, that’s just what they have to say. It will last 6 months.’ Insert my one raised eyebrow here. I’m skeptical at best about this. So is Pie. This is her skeptical “yeah right” face. It’s also her “screw you, stop poking my ear with that lancet” face. More on that later.
Bad advice about diabetes
It took me a hot minute after the diagnosis, getting her home, and calming myself down to realize my vet had just given me Very Bad Advice About Diabetes.
A brief blood glucose refresher:
Insulin is basically a key that unlocks the cell door to let the glucose into the cell, which is awesome, because cells use glucose for fuel. When the cells’ tanks are already topped off and the blood sugar is still too high, the kidneys have to get rid of the free floating glucose molecules. Glucose molecules are large. They are actually too large to fit gracefully through the filters in the kidneys, so it takes a tremendous amount of water to flush them through (hence the increased thirst and urination).
But what if blood sugar levels are too low? When blood glucose levels get too low – 50 mg/dl or lower – the body begins to shut down. Low blood sugar can make some people cranky when it drops, but when it really drops, the result is confusion, tremors, and even death if it drops low enough.
So. After researching our faces off at the kitchen table with our respective computers, my partner and I came to the conclusion that we needed ignore the vet and test her serum glucose levels. Unfortunately, it was just after midnight when we came to this conclusion. What’s open at midnight when you decide you have to test the blood glucose levels RIGHT NOW? Walmart. I hate Walmart. But that’s where we went, and I’m grateful they had what we needed.
For a little less than $30 we walked out with a Reli-on blood glucose/diabetes test device, super thin lancets, test strips, a control solution (which has a known glucose level and helps you verify that the test device is working properly), and just for the heck of it, ketone test strips for the urine.
The problem of food and diabetes
Unless one is born with type I diabetes (and my cat wasn’t) there’s a better than average chance that the devil that caused diabetes (type II) was the diet. My cat is a chubster. She loves to eat. I fed her Wellness, which I believed to be pretty good food, for a long time. A couple of years ago, her body started creating bladder crystals, resulting in what looked like a UTI. I took her to the vet, he diagnosed the crystals, and he prescribed Royal Canin Urinary S/O, a food that helps control the crystals. I gave it to her faithfully for 3 years, even though she didn’t really love it.
Seriously. That’s all she’s had to eat for 3 years. It’s not like I’ve been feeding her Dr. Pepper, Cinnabons, and Cheetos.
We all know that a food’s glycemic index – how much sugar is in the food and how quickly it metabolizes into glucose – is extremely important for diabetics. A human diagnosed with type II diabetes can modify their diet, eating proteins, vegetables, and limited complex carbohydrates to keep blood glucose as stable as possible.
But cats are obligate carnivores, meaning they absolutely must eat meat. There’s no such thing as a vegetarian or vegan cat in the wild. Cats have absolutely zero need for carbohydrates. The only carbohydrate a cat gets in the wild is from whatever carbohydrates their prey happened to have from their “last supper.”
Why is this important? Because all dry cat foods and a significant number of wet foods – even the prescription diets – contain high carbohydrates. Dry foods contain 35-50% carbohydrates. Even the foods that say “grain free” are bulked with potatos and pea proteins – starchy carbohydrates. This is not only useless to cats, but is actively detrimental. Carbohydrates metabolize into sugars, which in turn spike insulin levels in the body’s attempt to do something with all those sugars. Over time that creates insulin resistance and/or pancreatic fatigue (the under production of insulin).
Because my cat is both blood glucose challenged and produces bladder crystals like a machine, she requires canned foods that are low in carbohydrates, low in phosphorous, and low in ash. That last number is easy – it’s listed on every cat food bag and can. But the other two are a beast to determine. Fortunately, Dr. Lisa Pierson, a DVM with a big clue, has put together an excellent list and a brief tutorial as to how to find out what foods have what. She also has a great chart, though a bit dated, with all of these numbers spelled out.
So What Happened?
It’s been several weeks now and the cat is doing well, but not because we mindlessly started giving insulin shots.
We tested every 2 hours for 12 hours that first day. Kitty was not pleased, but we got a great idea about when her BG levels fall and rise in relation to her fasting and feeding cycles. Her levels are highest 2-4 hours after eating, if you care. One night her levels were at 72 mg/dl, which is a really good number. Had we given her a mindless insulin injection they would have dropped to somewhere in the low 20’s, probably inducing a very serious hypoglycemic incident. Her fasting glucose numbers are around 95-105, which is pretty good. She rarely spikes over 160 even 2-4 hours after eating.
Giving insulin without knowing the BG levels is like driving a car with a box on your head. It’s irresponsible, it’s stupid, and eventually someone is going to crash.
We settled on four Weruva flavors which are low in carbs, in phosphorous, and in ash (La Isla Bonita, Mediterranean Feast, Chicken Frick-a-see, and Fowl Ball). Pie’s chipper demeanor is returning. Her back legs, which had lost so much muscle mass that she couldn’t stand long enough to use the bathroom or even drink water at the bowl, have regained strength. She’s running up and down the stairs now, pestering the other cat, and trying to eviscerate her catnip toys with her back feet.
She hasn’t had (nor needed) an insulin shot since the food changes.
Are my vets bad people?
No. They were right – she had a definite glucose impairment. Yes, they basically gave it to her with the food, but they just didn’t know. Western medicine doesn’t emphasize nutrition as a health solution and neither does western veterinary medicine. The emphasis is on pharmaceuticals and surgery. Do I intend to educate my vets? Hell, yes. I hope they are open to it.
I truly believe that western medical professionals want to get it right. Sure there are some obstinant people out there, but most of docs and vets are facing the same questions and problems we are: here’s a patient in my face, what can I do to best help them? We all learn from each other and get better as we continue to treat. That’s why we call it a “practice.”
Don’t blindly assume that an authority figure knows what’s best. Do what feels right. Follow your gut. Do your own testing. The upshot of this for you in your practice is: don’t take another practitioner’s word as gospel. Do your own research. Come to your own conclusions. Follow the treatment plan that feels right to you!
Food really is the best medicine
It’s not emphasized enough in Chinese medicine either. We had one nutrition class and there were a couple of mentions about diet and exercise changes being the first things that are prescribed in China. That was it. I took wrote pretty much everything down….hence this website.
Food is fuel for the body. It is the first and most important medicine. You can give it cheap junk from the local convenience store or you can give it high-grade fuel. The body only performs as well as the food you give it.
Effective TCM practitioners do more than just acupuncture and herbal prescriptions. Robert Chu, an amazing acupuncture practitioner in California, says we need to be lifestyle coaches and he is right. Not everyone will accept diet and lifestyle changes, but some will. Be gentle with your patients and meet them where they are. They will change when they are ready. Be that voice that is always there for them to teach them that in many cases they have the control if they are willing to take it.*
*Pie doesn’t, which is probably a good thing. She’d sit on the couch all day drinking Dr. Pepper and eating Cheetos and Cinnabons if I let her.