DVA 326 Bridge Street * Dedham, MA 02026 * 781.326.2800

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Feline Diabetes Mellitus

Your cat has been diagnosed with Diabetes Mellitus. Diabetes occurs in cats when there is decreased or no production of insulin by the pancreas or the body has become resistant to the effects of insulin. Predisposing causes of this disease include obesity, pancreatic injury or disease, and use of certain pharmaceuticals. Insulin is critical to the body to allow the cell to use sugar (glucose) for energy. Diabetic cats have excess glucose in the blood that cannot be used by the body causing the body to be starved for sugar. Because there is so much unusable sugar in the blood some escapes through the kidneys, which are not able to handle such high levels of sugar. Some of the body’s water is also lost along with this sugar resulting in dehydration.

Signs of diabetes may include: Excessive thirst, excessive appetite, increased dilute urine output, weight loss and abnormal posture (“down in the hocks stance”). Because there is sugar in the urine of diabetic cats, bacteria love to live there. Many diabetic cats will also have a urinary tract infection. If diabetes goes untreated, an emergency situation can develop called ketoacidosis. This situation occurs when the body has starved for too long and begins breaking fat into simple energy particles which contribute to a metabolic acid/base imbalance. The cat will become too weak to eat or drink and develop a life-threatening dehydration. This condition can usually be avoided with careful treatment and regulation of diabetes and is a medical emergency.

The main treatment of diabetes is insulin injections. Many cats will need an injection twice daily but some can be regulated with a once daily injection. Many different types of insulin exist and not every cat can be regulated with the same type of insulin. Some cats can be regulated well with human insulins, common brands are Humulin and Novalin, which come in different formulas to last different lengths of time. Since the insulins are made for humans, the effect on each cat must be determined on an individual case basis. Most cats can be regulated on one of these types of insulin twice daily. Because this insulin was created for humans the structure of the insulin particle is slightly different than the cat insulin particle. Some cats will form antibodies to this insulin rendering it completely inactive requiring the type of insulin to be changed. Some cats are more successfully treated with a type of insulin called PZI. Because PZI Insulin is very long acting, so some cats will need it once daily and some twice daily.

In some cats, an anti-diabetic drug called Glipizide can help control diabetes. It is very rare that this drug can be used as the only treatment but is some cases it can aid in regulation in addition to insulin.

Regulation of diabetes can be very difficult if there is an underlying infection present. It is extremely important that all infections are discovered and treated while attempting to regulate your cat’s diabetes. Additionally, an underlying infection can predispose your cat to developing life threatening ketoacidosis. For this reason, a urine culture will be recommended to ensure that there is no urinary tract infection present. Many cats will have this condition. The culture allows us to determine which organism is growing in the urinary tract and which antibiotic will be the least expensive and most effective. Additionally, cats with severe dental disease, which is an infection of the teeth and gums, can be very difficult to regulate. If your cat has a severe mouth infection, we recommend cleaning the teeth and removing any diseased or infected teeth lest we end up being challenged to regulate your cat.

Diet, exercise and body fat are considered important to the control of diabetes. There are two theories about what the perfect diabetic food should consist. One theory states that a high fiber diet will aid in diabetic control by allowing a slow steady release of glucose from the intestines to the blood. The other theory states that a diet high in protein will decrease the dependence on dietary carbohydrates and that protein will be relied upon for energy instead. Both types of diets have helped in control of diabetes in both humans and cats. A recommendation will be made based on your cat’s personal medical history. Obese cats with diabetes will be more easily regulated and may have a less severe form of diabetes if they get down to a healthy weight. Since it is important for diabetics eat in order to utilize their insulin, a good way to help an obese diabetic cat to loose weight is through a moderate increase in exercise and moderate restrictions in food intake. Exercise also will help glucose get into cells. ALWAYS HAVE FRESH WATER AVAILABLE FOR YOUR DIABETIC CAT.

If diabetes is not treated, your cat will suffer and eventually die from ketoacidosis or a secondary infection that gets out of control. Diabetic cats have weakened immune systems. Cataracts will develop when the blood sugar stays very high for a long time. The goal for treatment of a diabetic cat is not to have a perfectly normal blood glucose at all times, but to have an acceptable blood glucose level at almost all times. It is important for a cat to have enough insulin in their body for most of the day to be able to use food for energy and maintain a healthy weight and most importantly avoid ketoacidosis. In a 24-hour period, diabetes is considered well managed if a cat can maintain a blood glucose level between 100 and 300. This is often not possible, since some cats will have a higher blood glucose level at around the time they are due for their next injection. A high blood glucose for a short period of time is not dangerous, however blood glucose that is too low can be very dangerous, if not life-threatening. It is extremely important never to give an overdose of insulin.

In order to determine the effect a specific type of insulin will have on a cat, frequent testing of the blood glucose level is required. This testing can be done in the hospital periodically with a blood glucose curve. This consists of blood glucose checks throughout the day after administration of insulin. Your cat will need to spend the day at our hospital in the care of our dedicated nursing staff to have the glucose curve measured. This allows the veterinarian to monitor your cat’s response to insulin through out the day to determine an appropriate dose and dosing schedule. Sometimes another test called a fructosamine level is performed to determine the cat’s average blood glucose over several weeks, which helps assess overall regulation. As a cat is being regulated, it is not uncommon to need insulin dose changes or even a change in the type of insulin. Many cats will need more or less insulin as their weight changes or the severity of their diabetes changes. In rare instances some cats will eventually not need insulin anymore. Illness of any type can interfere with diabetic regulation as well. Finally, we will monitor your cat’s urinary tract as we manage his or her diabetes, as diabetic cats are susceptible to urinary tract infections even after they are regulated.

Because regulation of a diabetic cat can involve many trips to the hospital, some owners of diabetic cats are willing to learn how to test blood glucose levels in their cats at home. This involves the purchase of a glucometer and test strips from a drugstore. This is an inexpensive device, which requires only a drop of blood to measure blood glucose. A small needle is used to prick a vein on the cat’s ear to get the drop of blood. Most cats are well behaved for this procedure. If you have interest in learning how to do this at home we would be happy to teach you. It is important that you keep a journal of insulin doses and blood glucose levels and carefully record the time of day. For the first few weeks of regulation at home, it is a good idea to speak with a doctor or technician daily to answer your questions about regulation and help you adjust the dose of insulin. Sometimes sugar in the urine can be monitored. There are special test strips for this; however, we would use this information in addition to blood sugar. Urine sugar can give us valuable information, but we cannot use it alone to manage diabetes.

Insulin must be stored in the refrigerator. It is normal for some particles to settle to the bottom of the bottle. It is important to have the insulin well mixed before drawing it up into the syringe. Insulin particles are delicate and can be destroyed by vigorous shaking; not to shake the bottle but to gently roll it instead. You will need a prescription for insulin syringes, but the insulin itself is not a prescription drug. It can be purchased from your pharmacist over the counter. The syringes come in a box of 100 single use syringes. You will be instructed on how to give insulin properly and are welcome to return to our hospital as many times as is necessary to review injection giving skills with our experienced nurses.

If you get into a struggle giving the insulin and you are not sure if your cat got his or her dose, don’t try to give more insulin, as you may risk a low blood glucose crisis. Wait until the next scheduled insulin dose. If your cat is not eating for any reason, hold off on giving the insulin and call your veterinarian for advice. If you know that your cat will not be able to eat because of travel or surgery, be sure to get advice from your veterinarian. Additionally, if you miss a scheduled dose by more than an hour, don’t try to give it, just skip it and wait for the next scheduled dose. It is very important to stick to regularly scheduled times for insulin administration.

It is important to be able to recognize a low blood glucose crisis. Signs include lethargy, listlessness, grogginess or a drunken appearance. Do not give insulin if this occurs. Offer food right away and if your cat will not eat have some Karo syrup handy to smear in your cat’s mouth. A very low glucose level can lead to seizures. Contact your veterinarian right away. We may need to treat this crisis and then determine the cause of the low blood sugar.

The following is what we recommend for your cat:

DIET:

INSULIN:

GLIPIZIDE:

ANTIBIOTICS:

EXERCISE:

OTHER MEDICATIONS OR SUPPLEMENTS:

Diabetes Mellitus is a serious metabolic disease not to be taken lightly. This disease requires a lot of veterinary care and attention from this point forward. The good news is that feline diabetes is very treatable and that most cats will do very well if you work closely with your veterinarian in managing the disease. It is normal to be overwhelmed with all of the above information. Expect it to take a few months to become familiar with the new normal for you and your cat. We will go through this with you one step at a time. Visit the feline diabetes website often. Call us as many times as you need to, and please ask as many questions as is necessary. We are as dedicated as you in making sure that your cat receives the best veterinary feline diabetes management available.

Do not hesitate to call Dedham Veterinary Associates if you have any questions or concerns.

(781)326-2800

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