Preparing for TR The Detox Process
Your cat has been diagnosed FD, you have found DCH and now you are trying to figure out what to do next.
The very first thing you need to do is to learn how to test your cats BG, a non-negotiable requirement for TR. We do not support blind dosing (not knowing what your cats BG is before giving insulin). It is extremely dangerous to give insulin without knowing if your cat needs it or not. Information on testing can be found here. If you are having problems getting the testing process down comfortably, please post on the TTR forum so that we can help you. An experienced member will help you decide when to start the detox process, based on how comfortable you are with the testing process.
Because the high carbohydrate levels of most of today's cat foods literally put the cat's liver to sleep, causing it not to perform it's main job of protecting the cat from hypoglycemia, your cat's diet must be changed before beginning TR. This is the other non-negotiable requirement for TR. We refer to this transition as detoxing the cat's body from carbs. For help with transitioning from dry to low carb canned, please ask your dosing adviser or post your request on the Head to Tail forum - you will be given lots of help. Here are the steps that need to be taken before you can start TR, depending on your cats situation:
Your cat has just been diagnosed with FD, is being fed dry/high carb food but has not yet started insulin.
If there has to be an optimal stage to be in, this is it. Many cats go into diet controlled diabetic remission simply by switching them to a low carb, all wet, species appropriate diet. Even if it turns out that your cat needs insulin after making the diet switch, the BG will drop significantly by removing dry food and it is likely the insulin requirements will be much less. Change your cats diet immediately to a low carb all wet diet, and test the BG at least several times a day over about 2 or 3 days. If the BG is over 150, you will need to begin insulin treatment. Experienced members will help you get started with the proper scale, as well as recommending the best insulin.
Your cat has started insulin injections and is already on a low carb wet only diet.
If your cat has already started insulin and has already been on a low carb wet diet for longer than 24 hours, it is likely that the only adjustment that will need to be made will be to the amount of insulin and the timing of shots. You need to do a curve (BG tests every 2 or 3 hours) on your cat to provide the data to determine what if any adjustments to dosing are required. It is possible that an adjustment to your doses will be called for, but, until you have done a curve or two on your cat, you wont know. Experienced members will help you adjust your dosing and guide you through the process of tightening up your shots.
Your cat has already started insulin injections and is being fed dry or high carb foods.
When the carbs are removed from your cats diet, the BG will drop significantly, by as much as 100 points or more. The doses you are currently giving may be too high once the carbs leave the system. You need to perform a 24-hour detox to protect your cat from clinical hypo.
You MUST withhold insulin immediately at the time you change your cat over to an all wet, low carb diet. We cannot emphasize this enough. The only exception would be for cats with a history of ketones or DKA - please consult your dosing adviser for help with detoxing a cat with these problems.
Too many times we have seen owners continue to give vet prescribed doses of insulin when they remove the dry high carb food only to have their cats end up needing to be rushed to the ER vet due to clinical hypo. This is a very frightening, but avoidable experience.
During the detox period, all insulin will be withheld for 24 hours. During that time, you will test your cats BG every six hours or so. Of particular importance are the tests from the 18 hour mark and the 24 hour mark, during the detox period. Once the 24-hour detox period has passed, you will begin using one of the starting scales posted for your particular insulin (see the Insulin sticky) - an experienced member will help you to decide on the correct scale based on the BG results, and increases to the scale will be made as needed to get your cat's BG into normal range as quickly as possible. The Basic Starting Scales (BSS) are conservative doses and it is to be expected that increases will be necessary. Regular testing must be done in order to determine what adjustments to doses are necessary. It is imperative that you keep your test log up to date in order for experienced members to assist you to make dosing adjustment decisions.
If you are having problems getting your cat to move from dry food to low carb canned, please consult one of the experienced dosing advisers on the board by posting in the Talking TR forum, so that we can help you to know when to start insulin again and how much to give. Insulin should not be withheld for more than 24 hours, but great care also needs to be taken if the cat is not eating a completely low carb diet. DO NOT try to starve the cat into eating - this is dangerous (please see the transitioning info in the link above).
Updated Sept 2014