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Diabetes in Cats, Part II

April 4, 2019

Last week we talked about what diabetes is and how it is diagnosed. This week we’ll have an overview of treatment options and monitoring diabetic cats. Because there are many individual factors to take into consideration, I won’t be doing a deep dive into details, but will cover the basics.

We typically treat DM with a combination of diet and insulin.

Diet: Diabetic cats should eat a low carbohydrate diet. Ideally carbohydrate content should be less than 7%; 8-10% is acceptable but not ideal. It is easiest to achieve these goals using canned rather than dry diets. Unfortunately, carbohydrate content is not listed on most pet food labels. There are prescription diets suitable for diabetic cats, and there is also a good list of commercial diets with their protein, fat, carbohydrate, and phosphorus levels as well as calorie content at this link.

Keep in mind, though, that the best diet is one your cat will eat. Cats are cats, and some simply won’t eat the diets we want them to. It can be very difficult and dangerous to try to “out stubborn” even a completely healthy cat over food, and can lead to life threatening complications in a diabetic cat. So at the end of the day, we have to cater somewhat to their preferences.

Insulin: There are a number of different specific kinds of insulin, and a discussion of all of them and their advantages and disadvantages for any individual cat is outside the scope of a blog post. The bottom line is that as discussed last week, even though many cats are considered non-insulin dependent we should start cats on insulin to increase the chances of diabetic remission unless there are specific reasons not to.

Insulin is usually given twice a day via a subcutaneous (under the skin) injection. If your cat is diagnosed with diabetes, a doctor will recommend a specific insulin and we will set up an appointment called an insulin demonstration with one of our veterinary technicians. At this appointment you will be shown exactly how to give the injections and given oral and written instructions for how much and how often to give insulin, as well as feeding recommendations and side effects/complications to watch out for.

Monitoring: There are two general approaches to treating diabetic cats depending on your goals and resources (not only financial resources, but mental and emotional resources as well as time). There is no objectively “better” approach to take. Being realistic about which approach will work for you, your cat, and your lifestyle (work, school, travel, and other scheduling concerns) will result in the best solution for you. For example, it is better to take the more relaxed approach to control if you can’t consistently keep up with the testing required for tight control.

For many people, the main goal of treatment is to control symptoms and keep their cat feeling well. In this case, we aren’t necessarily trying to keep blood glucose normal at all times but rather in a reasonable range that keeps symptoms in check. Insulin is still given every day, but we settle on a relatively set dose (though this may change over the long term) rather than checking or adjusting day to day.  For these cats, we will periodically check blood glucose and fructosamine levels (at an interval to be determined on a case by case basis) in the clinic and may occasionally test blood serial blood glucose levels at home, but also rely strongly on symptoms. The advantage to this approach is that it is less time and labor intensive, and therefore more practical for most people. The disadvantage is that there is less of a chance of diabetic remission compared to tight control. Also, because insulin  needs do vary day by day, there may be some daily variations in symptoms.

For other people, the goal is perfect control and maximum chance of diabetic remission. This involves monitoring blood glucose levels at home multiple times per day and adjusting insulin doses based on results. This is sometimes called “tight control.” The advantage to this approach is that there is a higher chance of achieving diabetic remission. The disadvantage is that it takes more time, labor, and resources.

Other Factors: It is also very important to control any other health problems that your cat is experiencing along with diabetes, as other health problems can interfere with regulation of diabetes. Dental disease and obesity are two common examples of health problems that need to be addressed.

Cats with IDDM secondary to acromegaly (discussed last week) are managed the same as any other diabetic cat. Ideally, we would treat the acromegaly itself, but the option to do so is relatively invasive and not widely available at this time. It is common for these cats to need high doses of insulin and we often have to accept less than perfect control.

A final note, about dogs: Dogs almost always have IDDM, and are also treated with insulin and diet. However, in dogs generally a high fiber diet is favored over the low carbohydrate model. Clinical signs, diagnosis and monitoring are otherwise very similar in dogs and cats.

It can be intimidating to hear a diagnosis of diabetes mellitus and think about giving insulin injections! If you find yourself in this position, we will be here to help and support you and your beloved pet.

Karen Christopherson DVM CVA

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