The Evils of Fructose

Toward the end of May we became concerned about the fact that Hamlet was starting to slow down his elimination of feces to about twice a week.  Previously we had needed to take him to have his anal glands cleaned out as they were preventing him from elimination regularity, (oh the perils of old age!).  We started him on a regular dose of Lactulose and he did fine as long as he was receiving this aid, but nothing else would work so he was getting it on a daily basis.

At the beginning of June I suddenly wished I had looked into the ingredients in Lactulose more closely as Hamlet's numbers went through the roof as you can see in his chart.  We clearly put too much of a load on his pancreas.

There are a few theories floating around about why this happened, but personally my education in glucose control and experience with Hamlet tells me that the reaction to Lactulose must have been very similar to the reaction caused by corn syrup when we give it to cats to pull them out of a hypoglycemic episode.  Fructose works where other carbohydrates don't with cats because fructose is absorbed through the membranes of the mouth into the blood stream, just as happens with sublingual meds given to a number of species including humans.

Luckily we have found a working alternative to the Lactulose for Hamlet and I highly recommend it to anyone with a diabetic cat so that you don't overload the demand on the pancreas.  We use EVOO, (olive oil), and it is working fine.  We are, in fact, managing to back off its use a little at this point, which I like as I hate making Hamlet take meds he doesn't have to have at his age.

At this point, we have Hamlet stabilized again, but back on his insulin, unfortunately.  As it is summer we may get him back off it for a period of time, but only time will give us that information.

HAMLET BACK OFF INSULIN AGAIN!

Our dear fellow is getting on.  The vet equates him with a human of about 100 years old.  We estimate, based upon the time we have known and experienced him, that he has to be 19 this year.  His formal birthday is July 31, which is the day we rescued him.  And, our prince is once again giving us a holiday from a tight schedule of insulin shots.  His glucose readings while on Lantus, and since, are recorded here.

Hamlet is still in need of a minor dose of phenobarbital to prevent a return of night time seizures that brought about the last regression back to insulin.  The previous time we stopped him completely after dropping his insulin but are taking this much more cautiously.  We don't want to lose our boy to anything other than very old age. (-;

We can feel Hamlet's spine quite prominently these days, which hurts as it reminds us he could be older than we think, and that our experience with him is not going to go on forever.  We still take him for daily walks.  Smaller walks happen indoors on rainy days, but those have not had to happen too frequently.  In spite of the consistent exercise Hamlet has developed arthritis, so is being given Sasha's Flexibites.  He has only been on them for a couple of weeks but I swear they are working as he is standing a little taller on his haunches and starting to venture out onto the deck on sunny days instead of staying in his bed.  He is also having constipation issues as his activity level reduces so we need to keep an eye on him and give him a boost of Lactulose once in a while to keep things moving.  We haven't found Metamucil to be of much use, although it was recommended to us.

Well, off I go to take Hamlet out to enjoy his garden with the birds, squirrels, and sundry wildlife he likes to sit and enjoy a bit before trudging back the 200 feet to his bed.

We wish all the geriatrics in our family were doing as well as our dear boy.

At right, when DH takes Hamlet for a walk they go way up the street.  Hamlet usually takes his walks with Harley, (dog), for safety as we have a healthy population of coyotes, large owls, bobcats, and bears.  Hamlet has been through enough lifetimes for two cats, so we don't need the added expenses of preditory attacks.

As the other cats are active enough not to need this extra exercise they stay in safety on the deck where they bellow at us,  or indoors with noses pressed to the windows.

Going into Remission so Soon?

Hamlet has only been on Lantus since the beginning of last December, and has already shown a very sharp decrease in his need for insulin.  We had to back off completely until consulting with our vet, and looking at his low point getting a little high.  Just one unit brought him back to being "within range", so we expect to have to keep a close eye on him for a while, to see if this trend continues.  Our experience with Lantus is outlined on his chart.  What we have been able to learn about Lantus and how it shoud be handled is now added to the Diabetic Cats Dietary Management FAQ called "tamingthecurve".

A Seizure Strikes Again.......

December 13, 2009

We have had Hamlet on a new insulin for him, (Lantus), for about two weeks now. It was rather an exciting experience as our vet was away, and we were just handed a prescription to take to the drug store. Needless to say, the insert in the Lantus was for human use!   I had to do a lot of scrambling online to figure out what was needed for our boy and was once again thankful to Jacquie Rand and her associate Rhett Marshall for devoting so much of their time to researching and writing on this subject. 

Today is the day I get to check Hamlet's nadir period in an attempt to be able to increase his insulin to the point of at least getting him out of the black numbers in his chart.

Hamlet hasn't had another seizure, and the veterinarian is hypothesizing that there is a possibility his pancreas may somehow have triggered the seizure when it once again failed.  We had started him on 7.5mg phenobarbitol bid, and as he showed no signs of repeating the seizure we again backed off his daytime dosage to half the 7.5mg tablet, or 3.75mg, when we can keep an eye on him.  The poor fellow does have such a time of it when trying to navigate around the house under the influence of the drugs, and it is harder to ensure he is still getting exercise.

November 29, 2009
We don't yet know whether Hamlet needs to go back to using insulin.  He had a seizure at his strange hour of the night when he has been known to forget to keep regular habits of eating and drinking.  It may possibly be that he was dehydrated as that was how he felt when I checked him.  I gave him fluids when he had recovered from the seizure, (lasted about 10 minutes), which he tolerated for about 50ml and then declared "that's enough" and refused to stay put.  His glucose reading, which we were previously assuming was low at that point in the night time due to lack of eating, was 28.8, (Canadian number), so this is why we are now waiting patiently to get to the vet to check his fructosamine levels.  He is still perky, purrs like no other cat I have experienced, and is doing his little walks indoors to make up for the fact that we can't walk him outdoors in the rain and cold.

Hamlet has also been showing a slight limp with the stairs and now that he is back on the phenobarbital, that is exagerated a bit, so he may have arthritic issues in his right rear leg.  At the ripe old age of 18 or so, I guess that is allowed.

At this point I am making it a daily routine to check Hamlet for hydration.  Since the other night there has been no indication of a repeat performance, so hydration may be the issue rather than glucose concerns.

As Hamlet is starting fresh on insulin and we had previously discussed the possibility of trying Lantus with the vet's encouragement, I am now being taken on a new adventure by Hamlet, which is being recorded on a spreadsheet at the attached URL.

Hamlet kicks the habit again!

Feline diabetes is once again a non issue in our house, after a nightmarish struggle when Hamlet spun out of control, as you may be able to see from postings below. He is now 18 years of age, at least, according to our knowledge of his history. He can't be too much older than that as he is in great shape for an old guy!

Hamlet has been off insulin again, now, for nearly two months. His fructosamines are improving with the amount of time he is in remission, so we are at the point of once again dispensing with his insulin to someone who might benefit more than we would. We have also managed to very slowly reduce his phenobarbital now that night time hypos are not a danger, and from the 45mgs of phenobarbital he was using when the insulin was causing night time hypos without it, we are down to 7.5 per day, and will be dropping to half that this coming week. Three weeks beyond that we hope to stop safely with no ill effects to his body.

Hamlet has also lost about 1/2 a pound since his last yearly checkup, done again recently, and his Geri-panel numbers are improved in spite of the fact that he had been on the phenobarbital for months -- I will be so glad to be safely off that as he basically only has one kidney to care for his body.

Our progress was greatly helped by the dry summer we have had, as I am always aware of the need for physical exercise being a component of defeating feline diabetes. Our boys are all basically indoor cats with a run they use to bask in the sun. Cats don't voluntarily exercise, especially as they age. As Hamlet is not an active enough fellow to escape our supervision, we were able to walk him daily in the yard, ensuring at least 200' of flat/vertical surface was covered. We obviously weren't overdoing his routine as in the more recent days he has bounded up the front stairs to the door at the end of our 'quality' time.

Of course each daily walk has finished with Hamlet being brushed with his favorite wire brush, and you can't stop until he is ready -- or at least 15 minutes have passed. It is wonderful to be seeing our boy back again, and such a happy cat!

On our walks we also included Harley as lookout because Big Burrtha with two new cubs has been checking our corn for ripeness on a daily basis. Needless to say, shovelling 'scat' off the lawn also became a pre-excursion exercise for us on a number of occasions. Now that the rainy season is upon us I will have to conform more to what other owners have available for indoor cat exercise..........I wonder if cats can use treadmills? I will let you know.

One other note is that the ultrasound done in February of this year showed up what we believe to be the scar tissue on Hamlet's pancreas that led the original rescuing veterinarian to predict that he would develop diabetes. One or two of the veterinarians have commented that our difficulty in stabilizing Hamlet when he is on insulin may partly be to do with this in that the lump may become inflamed if Hamlet is showing symptoms of diabetes. There are rumblings out there in new study results suggesting inflammation may be a part of diabetes in general, and studies are showing cats to be very much the same as humans when it comes to the characteristics of this disease.

The Mystery Deepens

After a wonderful couple of weeks with no insulin injections, and Hamlet looking so much better, it was quite a surprise to find that he had a high fructosamine again, when tested. This was very unexpected. His fructosamine was 563, and when his apex was tested it came in at 27.7 without insulin. We are now working our way back up to a suitable dose for him, and sincerely hope we haven't thrown him out by six months again as we did last year when dropping insulin for one day.

At this point there seem to be a number of options as he is developing slight dehydration issues, while feeling as though he may have fluid buildup on the inside that has been just slightly there for a couple of months, now, where we have noticed. There is a possibility of pancreatitis, or other internal disease, and we are likely to need an ultrasound for further choices to be made. The option of using glargine has been put forward, although I am not sure that regression back to needing insulin after such a short hiatus will categorize Hamlet as "newly diagnosed", so no decision has yet been made.

February 9, 2009
The past couple of months have been a roller coaster of emotion for us as Hamlet started exhibiting signs of seizures in mid December, (2008). Right before Christmas they turned into tonic-clonic seizures. After a number of trips with consultation with a variety of veterinarians, there has been no explanation for these seizures. We suspect it is possible Hamlet's glucose readings are going lower at night, (I have observed this in action), to the point that he may have gone into hypoglycemic episodes. A progression of these may have triggered the seizure activity.
However, we also found an explanation for the unstable glucose readings as Hamlet has a benign growth on his pancreas that will probably be changing size, and possibly becoming inflamed at times, thereby changing the pressures on the pancreas and influencing glucose levels. It would explain the erratic readings, and we are just relieved that the growth is, so far, benign, as our poor dear fellow is aging enough without major surgery again.

To control his seizures, Hamlet is being given phenobarbital which, of course, has turned him into a very mellow fellow. We are being far more cautious about the amount of insulin he is receiving, and the latest fructosamine has come in at a low enough number, (518), that we have decided to leave him there for the time being. The nadir of Hamlet's curve can vary from 27.7, (very odd time), to 6.1 as the lowest I have captured lately. I find the high numbers, (27.7) unnerving as it appears to indicate the insulin is having no effect. We have changed bottles of insulin and I am hoping it is just a problem with the last bottle not mixing properly.*

*Just a note here that changing bottles did not make a difference. The eventual explanation is that the lump on Hamlet's pancreas was acting up, as he eventually settled down with time. I was so glad the ultrasound was done to confirm information and make choices so much easier.

Hamlet's History

Hamlet has the physical characteristics of a Classic "seal bicolor" Ragdoll but was either a runt of the litter with genetic flaws, or his mommy got around, if you know what I mean. His eyes are not the classic blue and his legs are shorter that those I have seen in photos of purebreds. Ragdolls are described in technical books as having a "plate of fat" on their bellies, so while Hamlet is only 13 pounds, 4 ounces where other male purebreds range from 12-20 pounds, he still tends to look like an old man with a belly at the same time we are feeling his ribs and vertebrae. He was fully grown when we first saw him 'patrolling' the open concept housing complex we lived in at the time, and according to his physical health after all the walking, he was judged to be about three years old. As he should have been less mature when we first saw him if the estimate was accurate, we are now believing, according to normal aging signs, that he is probably between 15 and 18 years old.


His diabetes means that we must take special care to keep him at his optimal weight for health, partly because he had been a stray scrounging for food for several years, and developed very bad eating habits. He came to us with the diabetes, a slight heart murmur, and he has a problem with asthma. The diabetes has been in remission for a major portion of his time with us, and only came out of remission when he was dealing with severe emotional stress. His heart murmur is not showing up in his very regular checkups, and we have managed to avoid any accumulation of steroids in his system by keeping his asthma under control with Moducare and 1/4 tablet of periactin when he gets a bit wheezy. We are assuming that because the neighbours, (and us too), had been leaving out cheap high carb dry foods to keep him from looking too thin, we probably brought on the diabetic state, and weakened the rest of his health because he had been starved for wholesome nutrition for full body health............and we have had to pay for this since rescuing him when he was near death.


While I am often attacked by fanatics for feeding dry food to Hamlet, we DO NOT feed high carb food. I can't repeat often enough that he is maintained on 119.5 calories per day of low carb/high protein dry food as that allows for frequent grazing that keeps his stomach, and appetite, small. This attention to nutrition for his whole body to have the tools to make up for our early mistakes has also ensured good, well rounded health to combat the threats caused by diabetes, which are the same as those found in the human world of diabetes.


For those who would like to be leaving comments on my diabetes related sites, I am sorry but the rude comments from fanatics who don't have the education in nutrition, (glycemic control, food safety, etc.) that I do, or the up to date technical books back by scientific study that I use as reference material, have caused me to feel a need to block comments from people who don't know what they are talking about.


Anyone else who has managed to keep a healthy diabetic going for ten years or longer, we would love to compare notes, and share information, (backed by scientific references like those on our website please). We can be reached at the email address that will show up with a little detective work in the information attached to the email icon.