Diabetes Mellitus in Cats

Diabetes mellitus is a very common disease in cats. This can be a very stressful diagnosis for clients to receive, but with appropriate direction from your veterinary team it can be well-managed and you can continue to provide your feline friend with a great quality of life. The following article will discuss some aspects of the diagnosis and management of diabetes, but for more information please reach out to your veterinary team for guidance.
The pancreas is a very important organ which produces the hormone insulin. Insulin is what the body uses to transport glucose into the cells of the body in a way that can be used. Diabetes is when the pancreas either stops or decreases production of insulin to the extent that the body is unable to use the glucose that it has. When it is functioning properly, the pancreas is extremely good at keeping the level of glucose in the blood in a specific range and either utilizing or storing the remaining glucose for future use. This is why when the pancreas is not functioning appropriately, the blood glucose levels are very high.
Typically to confirm a diagnosis of diabetes we would see an abnormally high blood glucose level, the presence of glucose in the urine, and some common clinical signs that are reported by the owner. Some symptoms that may indicate that your cat could be diabetic are a significant increase in drinking and urination, as well as an increase in appetite. There is often also weight loss observed in spite of the increase in appetite. These can also be signs of other conditions, so make sure that you seek veterinary attention and testing to confirm any diagnosis. 
Once a diagnosis is achieved, there are several key aspects of treatment for your pet. We will always do a diabetic consult with owners in a newly diagnosed case of diabetes to go over treatment, injection techniques, and monitoring. Insulin injections are the most important aspect of diabetic treatment. Most likely your cat will require two injections of insulin daily, 12-hours apart. This may sound daunting, but most cats tolerate this very well and with coaching from the veterinary team anyone can become proficient in giving these injections. You will be shown how to give these injections and given a chance to do so with the veterinary staff to ensure you feel comfortable doing so at home. 

If you need another refresher, there are some great videos online — we recommend checking out the YouTube video below.

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In addition to insulin treatment, switching diets is often something that is recommended to more easily regulate your pet. Treatment will be individualized to each patient depending on what other concerns they may have or what lifestyle, but generally a diet that is high in protein and low in carbohydrates will be recommended. These diets help to regulate glucose levels throughout the day and will help to prevent muscle wasting. We generally recommend transitioning to a feeding schedule where your pet is fed twice daily rather than free feeding throughout the day, but we will work with you to decide what is best for your pet. 
When it comes to monitoring, regular communication with the veterinary team will be critical to ensure the best outcome for your pet. It is likely that during the first few months after diagnosis that you will need to bring your pet in for several blood glucose curves to make sure we determine the best dose of insulin to give. The first curve will be roughly 2 weeks after starting insulin administration. 
For a blood glucose curve you bring in your pet to the clinic after feeding and giving insulin as you normally would. We will check the blood glucose levels several times throughout the day to ensure that we are getting the levels to an acceptable level for the majority of the day without going too low. Additionally, it will be important for you to monitor how much your cat is drinking and urinating at home and report to the clinic with any major changes as this can indicate that the insulin dose may need to be adjusted. It is very important to never change the dose of insulin without first consulting with your veterinarian. 
Another important aspect of monitoring your diabetic cat is being aware of what the symptoms of hypoglycemia (low blood sugar) look like. While hypoglycemic episodes are uncommon, they are most likely to occur if your pet did not eat prior to giving insulin, was given an incorrect dose, or was accidentally given two doses if there is more than one person in the home who takes care of injections. If your pet becomes hypoglycemic you may notice that they are lethargic, drooling, nauseous, stumbling or uncoordinated, or in a comatose state. If you suspect your pet is hypoglycemic you should immediately offer food if they are able to eat. If they are unable to eat you can rub some corn syrup or maple syrup on the gums, and then contact your veterinarian immediately for advice.

One exciting fact about diabetes in cats is that, unlike other animals, cats can often go into diabetic remission with treatment. This is most likely to occur if insulin therapy and diet changes are implemented as soon as a diagnosis is made. In these cats, the pancreas begins to produce adequate insulin levels again and they can be taken off of their injections entirely.

We know that it can be a very stressful time when your pet is diagnosed with any illness. We want to be able to best guide you through these times with as little stress as possible, and will be there with you every step of the way during treatment. Please reach out to the veterinary team if you need guidance, support or ever have any questions and we would be happy to help. With proper care and management, diabetic cats can go on to live long, great quality lives 

Behrend, E., Holford, A., Lathan, P., et al. (2018) 2018 AAHA Diabetes Management for Dogs and Cats. J Am An Hosp Assoc 2018; 54: 1-21.