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Often, it starts subtly. The litterbox seems a little wetter. The water bowl needs to get filled a little more often. Then Kitty starts to seem a bit slimmer, but the food bowl is emptying faster. Her fur, usually gleaming, starts to look duller. She starts seeming a little weaker. Maybe you think she’s just getting older, or the new cat food you got isn’t agreeing with her. But eventually, it starts to become obvious: your cat is sick.
You take her to the vet, and that little bit of weight loss turns out to be more than you thought. She’s dehydrated, and your vet recommends checking some blood and urine. That’s when you learn: your cat has diabetes.
Diabetes—technically diabetes mellitus—occurs when a patient’s blood sugar is persistently high, either because that patient is not making enough insulin (Type 1, or Insulin-Dependent diabetes) or because their body has become desensitized to their insulin (Type 2, or Noninsulin-dependent diabetes). LIke people, cats can develop either type. Type 1 diabetes can develop in cats who are slim or overweight, who are on any diet, and who are any age. Type 2 diabetes is more common in cats who are overweight, eating dry and/or high-carbohydrate diets, and who are young to middle-aged adults. Cats on certain medications, especially steroids like Prednisolone or Depo-Medrol, are at a higher risk for Type 2 diabetes. Regardless, while they have different causes, the effects on the body are the same.
Insulin is responsible for helping glucose—sugar—get into the cells within the body that need it for energy. The brain, liver, muscles, and fat cells, all dependent on glucose, begin to starve. Fat and muscle breaks down, causing weight loss. The liver, thinking that there isn’t enough glucose in the body because it can’t access it, starts to produce yet more sugar. Ironically, the pancreas—responsible for producing insulin in response to an acute spike in blood sugar—starts to fail in the face of chronically increased blood sugar, resulting in even less insulin.
Eventually, if untreated, the body breaks down fat so rapidly that it produces an excess of ketones. This actually helps the body in the short term, as the brain, red blood cells, and other vital cells can use ketones as fuel. But using ketones takes a massive toll on the body, causing rapid dehydration along with pH and electrolyte imbalances. By this point, the poor cat is feeling pretty terrible. They usually won’t eat and are getting very weak, they often are vomiting, and if they still don’t receive treatment, they will die.
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The good news is, diabetes is treatable, and we continue to make breakthroughs in the treatment of diabetes in cats. Insulin injections, usually twice daily, are the only effective treatment for cats with Type 1 diabetes. However, for those cats with Type 2, insulin is no longer the only option: there are some new oral medications that can work well to help get the blood sugar back down to normal. And for both types of diabetes in cats, feeding a high-protein, low-carbohydrate diet can help tremendously with improving blood sugar control.
Case selection is important when determining if you’re going to treat with insulin versus oral medications. If the cats have ketones in their bloodstream at the time of diagnosis, they generally need insulin and will not respond well to the oral medications. For some people, giving an insulin injection is actually easier than trying to get an oral medication into their cat. The initial monitoring for the oral medications is just as intensive as with insulin, if not more so; this helps to ensure that it is working properly for them. Generally once cats start those medications they remain on them for life, unless they are switched to insulin. Oral medications are not typically any less expensive than insulin, either.
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Insulin injections are usually well-tolerated by cats. Most often, we start cats on long-acting insulins like Glargine, as they seem to regulate better with that. Initially, patients have to have their blood sugar checked often, either in the clinic or at home if their people are comfortable doing that, to ensure that the dose is adequate but not too high. Once they are well-regulated, we generally decrease the frequency of checks, though some cats benefit from more consistent monitoring.
There are two ways for people to track their cat’s blood sugar at home. One is to use a veterinary-specific blood sugar monitor, like the Alpha-Trak 3, using a stylet to get a drop of blood from an ear (preferred by most) or paw pad. Alternatively, we have used continuous monitors like the Freestyle Libre, which were developed for people but which can work well for our patients. These continuously monitor sugar in the fluid between cells, and are easily read using a cell phone app or a reader that communicates with a computer. We have seen cats sometimes scratch these off, but for hard to regulate patients they can be tremendously helpful.
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Managing diabetes is a commitment. Type 1 diabetic cats will require insulin for life. Some (not all) Type 2 diabetic cats who are started on insulin can eventually come off of it. This requires them to be on that high-protein, low-carb, high-moisture diet, and their blood sugar to be regulated long enough for the pancreas to start working again. Sticking with the diet is also important for both types of diabetics—we have seen Type 2 cats successfully come off insulin, only to backslide when a favored previous higher-carbohydrate food was reintroduced.
For some people, treating their diabetic cat is simply not possible. This may be due to the temperament of the cat, the financial commitment, needle phobia for insulin-dependent cats, or the rigid schedule that is required. For some of these patients, dietary management may be adequate to slow down progression and mitigate signs, but certainly that is not true for all. We understand and respect that every person’s and every cat’s needs are different. We will always do our best to maintain frank and open communication, and to assist in every way we can to do what is best for you and your kitty.
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Written by Alexis Soutter, DVM
Edited by The Pawsome Vet Care Team
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