Feline Diabetes Mellitus
Diabetes Mellitus is a metabolic disease caused by a failure of the pancreas to produce enough insulin. Insulin allows cells in the body to absorb glucose (sugar) from the blood. Glucose is the cells’ main energy source and is critical to cellular function. Without insulin, the cells do not get the energy they need to function, and glucose levels in the blood rise. The body can use fats as an energy source; however this can occasionally lead to a life threatening condition called diabetic ketoacidosis which requires emergency treatment.
Symptoms of diabetes include the following:
1. Weight loss – as fats are mobilized for energy instead of glucose
2. Increased appetite – as the body tries to increase its energy supplies
3. Increased drinking and urination – the glucose in the blood overwhelms the kidneys and spills into the urine drawing excessive amounts of water with it
4. Untreated diabetics can develop diabetic ketoacidosis. If this happens, the cat will show signs of severe illness including loss of appetite, lethargy and vomiting.
Diagnosing diabetes is generally straightforward. Most diabetic patients have significantly elevated glucose levels in their blood as well as in their urine. In many cats we recommend a fructosamine test to confirm the diagnosis and make sure the elevated glucose was not due to stress.
Most diabetic cats do very well with treatment and can live for many years with the disease. In addition to treating the diabetes, it is important to closely monitor all aspects of your cat’s health, since diabetes can make cats more susceptible to other problems such as infections. Dental health is especially important!
Treating diabetes involves several steps:
1. Diet – Recent studies have shown that decreasing the intake of carbohydrates can dramatically improve diabetic control. We recommend a relatively high protein, high fat diet for our diabetic patients. Canned food is best. If your cat prefers dry food, Purina DM or Royal Canin Diabetic are two dry diets relatively low in carbohydrates. Overweight patients should be portioned for gradual weight reduction as this will also improve diabetic control. Dietary fiber can also be beneficial and your doctor may recommend a diet or supplement to increase fiber.
2. Insulin – Insulin injections are usually given twice daily. In almost all cases, this is the best and most important treatment for diabetic cats. Many people are uncomfortable with the idea at first, but find that the tiny needles are easy to give and that their cats don’t really mind too much. A cat under good diabetic regulation with insulin will stop losing weight, gain energy, and usually eats, drinks and urinates less. There are several different types of insulin; make sure you know which one your doctor prescribes for your cat.
3. Monitoring at home – Monitoring your cats appetite, thirst, urine production and urine glucose/ketones helps us figure out if his/her dose of insulin is appropriate. Many clients keep logs so that they can detect changes in their cat’s patterns that might indicate a need for a recheck. This also helps the doctor determine the best insulin dose. We can also teach you how to do at home blood glucose curves.
4. Monitoring in the hospital – After the initial diagnosis of diabetes has been made and insulin therapy initiated, your cat may need to visit the Cat Hospital weekly or biweekly for a month or two while your doctor figures out the proper dose of insulin. Once they are under good diabetic regulation, diabetic cats should be checked by a doctor every 3-6 months depending on their age and overall health. Your doctor may recommend blood glucose curves (which require cats to spend a day or two at the hospital) or a fructosamine test (which can be done in an appointment) or both.
How to give an insulin injection:
1. Gently roll the insulin bottle in your hands to resuspend the crystals. Make sure the solution is well mixed, but do not shake the bottle as this destroys the insulin molecules.
2. Insert needle into bottle, turn bottle upside down and pull back plunger to draw insulin into syringe. Draw up more insulin than you need.
3. With bottle and syringe upside down, tap syringe so air bubbles in syringe move to top of syringe. Depress plunger to push air bubbles back into bottle then continue to depress plunger until appropriate amount of insulin remains in syringe. Remove needle from bottle.
4. Make sure you have correct amount of insulin in syringe and that there are no bubbles.
5. Position cat so he/she cannot run away as you give the injection and lift a roll of skin from the back or shoulder.
6. Insert needle into roll of skin, keeping needle parallel to the cat’s back and making sure the roll is thick enough that the needle doesn’t come out the other side.
7. Make the injection and remove the needle.
8. Feel the area where you made the injection to make sure it doesn’t feel wet. If it does, you may not have gotten the injection under the skin or the needle may have gone through both layers of skin. Do not repeat the injection since your cat may have gotten some insulin and overdosage can be fatal. Try again next time focusing on what you may have done wrong.
9. Find a reward to give your cat so that he/she looks forward to his/her insulin injections (petting, treats, play time).
• If your cat is acting sick, vomiting or not eating, call the Cat Hospital before giving the usual dose of insulin. It is always safer to under-dose rather than over-dose with insulin.
• If you accidentally leave a bottle of insulin out overnight, it is not ruined. However, if a bottle is left out repeatedly, the insulin will gradually lose its effectiveness. Replace your insulin bottle every 3-4 months even if you are not finished with the bottle.
Ways to check urine for glucose and ketones:
1. Isolate the diabetic cat from other cats. Empty litter box and line it with a clean plastic garbage bag or clean and rinse it thoroughly and wipe dry. Sprinkle a shallow layer of litter – enough to make the cat interested in using the box, but not enough to absorb all the urine. When the cat urinates in the box, dip the test strip into the urine that is not absorbed by litter.
2. Use a non-absorbable substance such as fish tank gravel instead of litter. When cat urinates, tilt box and push gravel aside to dip test strip in urine.
3. Fill litter box as usual. If cat has an area in the box where he/she usually urinates, dig a shallow hole in this area. Place a sheet of plastic wrap on top of the litter in that area, pressing it into the hole so that urine collects in the depression when the cat urinates.
• Determine the urine glucose and ketone levels using the color key on the bottle of strips. Record glucose levels on a calendar or log.
• Ketones should always be negative. If they are trace or higher call the Cat Hospital immediately. You’re cat may be very sick.
• Glucose levels are ideally 1/10 – ¼ %. If glucose levels are negative do not give insulin and call the Cat Hospital. Your cat may need a lower dose of insulin. Overdosing insulin can be fatal.
Insulin lowers the sugar levels in the blood. Sometimes these levels can get too low and your cat may act sleepy, wobbly, uncoordinated and may even collapse or have a seizure. If your cat is conscious but shows these signs you should immediately feed him/her a tablespoon of Karo or corn syrup or Nutrical then cat food if he/she seems better. Call the Cat Hospital immediately to set up an appointment to come in that day if possible. If your cat is collapsed or having a seizure, bring him/her to the Cat Hospital or a veterinary emergency room immediately.
Insulin overdose can occur if a cat’s insulin requirements decrease, if a cat accidentally receives a double dose of insulin or if a cat eats less due to illness, stress or lack of access to food. If your cat isn’t eating do not give insulin until you can speak with your veterinarian. Some cats cease to require insulin after months or years of treatment and these cats are at risk for an overdose. Therefore, careful monitoring of urine glucose and behavior are critical for all diabetic patients.
Caring for your diabetic cat while you are away
It is important that your cat’s treatments are continued if you are away. There are several options to choose from. Many of our clients use professional cat sitters who have years of experience caring for diabetic patients. Some people prefer to use a friend or neighbor who is comfortable giving the injections. These options allow the cat to stay at home in a less stressful environment. If you choose one of these options, make sure the person can monitor food intake and will stay with the cat long enough to determine that the cat is doing well. Many cats eat less when their owners are away, and if you anticipate this, you might temporarily decrease your cat’s insulin dose by 1/3 to ½ to prevent overdosing. A third option is to board your cat at the Cat Hospital, where he/she will receive closer monitoring and will have his/her blood sugar checked routinely.
In Hospital Glucose Curves
One way your doctor determines your cat’s insulin dose is by monitoring your cat’s blood glucose levels throughout the day following an insulin injection. This requires your cat to spend the day (and sometimes overnight) at the Cat Hospital. During the day we will take tiny blood samples from a vein in the ear to test blood glucose levels. If your cat is coming in for a glucose curve, you should give him/her a regular breakfast and full dose of insulin at the normal time in the morning, and then drop him/her off at the Cat Hospital by 9 a.m. If your cat does not get insulin in the morning before 9 a.m., talk with your doctor about how to schedule the curve.
When to call the Cat Hospital:
1. You detect ketones in the urine.
2. The urine glucose reading is negative.
3. The urine glucose reading is consistently high.
4. Your cat’s symptoms worsen (increased drinking, appetite or urination).
5. Your cat is losing weight.
6. Your cat is acting sick (lethargic, wobbly, vomiting, diarrhea, decreased appetite, seizures). Do not give insulin until you have spoken to your veterinarian!
7. Any time you have questions or are uncertain what you should do.
8. If 6 months have passed since your cat’s last check-up.