Diabetic Cat Management

Diabetes mellitus is a common condition of middle aged to older cats, especially if they are overweight. There are two kinds of diabetes mellitus. Type 1 is when the body does not make enough insulin; in people this is often known as juvenile diabetes. Type 2 is when the body makes insulin but is not able to use it (insulin resistance); in people this is called adult onset diabetes. One cause of type 2 diabetes is obesity. Common symptoms for either type include drinking excessively, urinating large quantities, and weight loss in spite of a good appetite. Diagnosis is based on symptoms and the presence of glucose (sugar) in the urine, and too high a level of glucose in the blood.

Diabetic Ketoacidosis is a complication of diabetes in which the animal becomes very ill. Symptoms of this condition, in addition to the symptoms observed with diabetes mellitus, include: dehydration, weakness, vomiting, rapid respiratory rate, and sometimes the breath takes on an odor of nail polish remover. This is an emergency and often requires many days of hospitalization to treat. This condition often requires another inciting cause in addition to diabetes. Examples of conditions that can cause diabetic ketoacidosis in a diabetic animal include: stress, infection, inflammation, estrus (heat), steroids, congestive heart failure and kidney failure.

Another complication of diabetes in cats is called diabetic polyneuropathy in which the cat’s hind legs get progressively weaker. It becomes difficult for them to jump and they walk on the flat part of their foot, not just on their toes like normally. This often resolves if the diabetes is well controlled. More rarely cats can get cataracts with diabetes. These will not resolve with treatment of diabetes.

Treatment of uncomplicated diabetes mellitus in cats involves weight loss, through special diets and exercise, and insulin therapy. Sometimes other drugs may be helpful. Treatment is life long and requires bloodwork monitoring and follow-up exams. Treatment also requires a lifestyle change in that feeding and medication must be done on a consistent schedule, and that water consumption, urine output and overall health must be closely monitored. Some pets are easily regulated; some are more difficult to find the right combinations of therapy to keep them happy and healthy.

There are several diets that are recommended for use with diabetic cats among them: Purina DM, Hill’s Science Diet w/d, Hill’s Science Diet m/d, IVD Weight Control, and Eukanuba Optimum Weight Control. Some diabetic cats may be completely maintained on diet therapy alone, although most will eventually require insulin therapy. It is best to feed at least two meals a day. Cats that tend to eat small amounts all day should be given a measured amount to nibble on throughout the day. Any necessary weight loss should be gradual.

Oral hypoglycemic drugs are available to try to lower the blood glucose without insulin injections. These drugs are effective approximately 20% of the time. The most common one to use is called glipizide. Potential side effects to this drug are vomiting, jaundice, liver changes, and hypoglycemia (too little blood sugar.)

Insulin therapy is often necessary to successfully treat diabetes in cats. There are several different types of insulin and it is very individual which one works best for each cat. Most cats require twice daily insulin injections to control their diabetes. A few can be well regulated on once daily injections. Establishing control of blood glucose is easier and problems with hypoglycemia (too low blood glucose) are less likely when twice-daily insulin therapy is initiated while the insulin dose is low. It takes about a week to equilibrate to changes in the insulin dose or to changes in insulin type.

To administer insulin: Feed your cat. Take the insulin out of the refrigerator and roll it between your palms to mix it. Draw up the correct amount of insulin, making sure there are no air bubbles. Gently pinch a small amount of skin over the cat’s shoulders and insert the needle under the skin. Depress the plunger and, after the entire dose is given, withdraw the needle. You may discard used insulin syringes in a coffee can or other hard sided container. We will also allow you to bring your used syringes back to us and we will dispose of them for you.

Important things to know about insulin therapy:

1. It is important that the cat eat before insulin is administered. If he/she does not eat administer
   only a half dose of the insulin to prevent hypoglycemia.
2. Insulin should always be refrigerated. If it is left out of the refrigerator for too long it will not be effective.
3. Never shake insulin; always roll it between your hands to mix it before administering it.
4. If giving insulin twice daily it is best to try and be consistent as far as time of administration.
5. Try to get on a regular schedule of feeding and insulin administration every 12 hours.

Insulin therapy is started at a low dose to monitor for extreme sensitivity to insulin causing hypoglycemia. Once an initial insulin dose is established a blood glucose curve is run once weekly and adjustments to therapy are made until an effective long-term dose of insulin is established. This process usually takes at least one month. If the cat has other diseases (infection, inflammation, hormonal problems, or cancer) present it will make regulating the diabetes more difficult.

A diabetic cat is considered well regulated when:

1. the owner is happy
2. the cat is relatively asymptomatic (decreased urine volume, decreased water drinking), interactive, and grooming
3. the body weight is stable
4. the average blood glucose is less than 250
5. the fructosamine is less than 450
6. There is no sugar in the urine (this can be detected by adding special crystals to the litter box.)

Once good control of the diabetes is attained the cat will need to be monitored every 2-4 months. This may involve a physical exam, glycolsolated hemoglobin and serum fructosamine. Glycosolated hemoglobin gives an idea of blood sugar control over the past 4-6 weeks. Fructosamine gives an idea of blood sugar control over the last 2-3 weeks. The presence of sugar in the cat’s urine can also be monitored at home with special crystals in the litterbox. If there are complications or symptoms return more frequent monitoring may be necessary.

Hypoglycemia (too little blood sugar) can be caused by too much insulin, strenuous exercise, or prolonged inappetance (not eating for a long time). Signs include lethargy, weakness, incoordination, seizures, head tilt and/or coma. In the short term this can be treated with giving the cat Karo syrup by mouth to raise its blood sugar, the pet then needs to go into see the veterinarian and try to determine the underlying cause.

Diabetes mellitus is a condition in cats that requires a lot of effort to treat. It is important that you understand what to monitor and what to expect. For many cats their diabetes can be well controlled and they can live long and happy lives

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