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Feature September 2018 Issue

Taking Care of a Diabetic Cat

Most cats with this condition can be successfully treated at home by their owners, but it's important to try to diagnose it in its earlier stages. Here's why.

@ sanddebeautheil/Getty Images

The earliest warning signs of diabetes mellitus include increased thirst and increased urination, along with excessive appetite and weight loss.

Diabetes mellitus is a frequently diagnosed disease of the feline pancreas, a relatively small, thin organ nestled in the front portion of a cat’s abdomen.

The pancreas plays two vital roles — exocrine and endocrine. In carrying out its exocrine function, a healthy pancreas generates a variety of enzymes that enable the digestion of nutrients in the intestinal tract. In performing its endocrine function, the pancreas manufactures the hormone insulin, which helps a sugar called glucose (also referred to as “blood sugar”) to enter the cells of the body. Glucose is a crucially necessary chemical compound that is the source of the energy needed to sustain an animal’s life.

In diabetes mellitus, the endocrine function is impaired and a cat’s pancreas is unable to produce sufficient insulin, which consequently diminishes a cat’s ability to utilize glucose. (Diabetes mellitus is not the same as diabetes insipidus, a far less common disease characterized by persistent thirst and excessive urine production.)

According to Michael Stone, DVM, a specialist in internal medicine at Tufts, “The earliest warning signs of feline diabetes mellitus include increased thirst — polydipsia — and increased urination — polyuria, along with excessive appetite and weight loss. These four signs, which generally occur in combination, are the hallmarks of diabetes mellitus.” However, some patients seem to skip past the early warning signs and head straight toward diabetic ketoacidosis, an advanced stage of diabetes mellitus marked by lethargy, vomiting and loss of appetite. “In such a case,” notes Dr. Stone, “we wonder if the pets owners simply missed the early warning signs of diabetes. Or has the cat moved directly into the disorder’s ketoacidotic stage?”

Two types of diabetes

Diabetes mellitus results from an insufficient production of insulin by the pancreas. There are two kinds of diabetes — Type I and Type II.

In Type I diabetes, the body produces little or no insulin due to an insufficient number of cells capable of producing the hormone. Treatment for the condition entails daily injections of the hormone. “The condition is irreversible, and insulin administration will be required for the rest of an affected animal’s life,” explains Dr. Stone.

In Type II diabetes, the pancreas may produce insulin but the body’s cells have difficulty making efficient use of it — a phenomenon called insulin resistance, the most common cause of which is obesity. Many cats diagnosed with diabetes mellitus are thought to have Type II; it is estimated that as many as one half of them may go into remission. That is, an affected cat will experience periods during which insulin therapy is not necessary.

In general, a combination of gradual weight loss, polydipsia and polyuria suggests the presence of diabetes. Cats of both genders are susceptible to diabetes, although some studies have suggested that males are more commonly affected than females. Obese cats are at elevated risk, and while diabetes can occur in cats of any breed, studies indicate that Burmese cats are especially predisposed.

And although diabetes can affect cats of any age, older cats — those over age 10 or so — are most susceptible. A cat’s lifestyle may also increase susceptibility to diabetes, because inactive indoor cats are more prone to obesity than those who spend most or all of their time outdoors.

Seek prompt veterinary care

Owners who notice the signs of diabetes in their cats should seek veterinary care as soon as possible because severe complications may emerge if the condition is allowed to progress. One such complication is peripheral neuropathy, which results from diabetes-related nerve damage affecting an animal’s feet and legs. A cat with this condition is likely to show signs of weakness in her limbs, may drag her backside low to the ground and may eventually be unable to stand on all fours.

A more perilous condition is diabetic ketoacidosis, which is caused by excessively high levels of blood sugar and the consequent buildup of certain acids in the blood. Signs of this condition include vomiting, loss of appetite and lethargy. Without the prompt infusion of fluids and insulin, an animal with this condition could die.

When diabetes is suspected, veterinary examination will aim to confirm the diagnosis and rule out other possible causes for the typical clinical signs. The diagnostic procedure will involve a thorough medical history and physical exam; a urinalysis to check for the presence of glucose and ketones in the urine; a search for signs of possible urinary infection; blood tests to determine the concentration of blood glucose; and various procedures to exclude other possible conditions, such as hyperthyroidism. In some cases, abdominal X-rays or ultrasound imaging will be done to evaluate the health of the pancreas and other internal organs.

MarkHatfield/Getty Images

It can be daunting when an owner is first told he should start giving insulin injections to his cat at home. But with instruction, most people can do it easily.

The treatment protocol

Treatment for a confirmed case of feline diabetes will rely largely on dietary therapy aimed toward maintaining a cat’s proper weight and minimizing the consumption of food that might increase blood glucose levels. “The treatment of diabetic cats who don’t eat is complicated,” says Dr. Stone. “It requires frequent monitoring of their blood sugar, so hospitalization is often recommended. But home monitoring can bring costs down significantly, and as long as the patient is eating, home care is appropriate.”

The same can be said of insulin injections: Most diabetic cats will require injections of insulin, administered twice a day — and owners can be taught how to properly administer an injection by a veterinarian or veterinary technician. “Although it may sound scary, administration of insulin is very easy — easier than giving a pill — and is completely painless for a cat. The needle is very thin, and most cats won’t even react to the injection at all. In most cases the insulin will be administered twice daily, and we recommend that the cat be fed at the same time.” Regarding diet, “Most veterinarians believe that a low-carbohydrate, high-protein regimen is most appropriate for diabetic cats,” says Dr. Stone.

A cat undergoing prompt treatment will typically begin to show improvement within a few days. It is estimated that between 10 percent and 50 percent of affected cats will do well enough to eventually stop receiving insulin shots, although they will be predisposed to relapse and must be carefully monitored for the rest of their lives. Overall, notes Dr. Stone, “With proper home care, most diabetic cats can live long and happy lives.”— Tom Ewing

Comments (6)

I have just discovered the continuous glucose monitoring systems used by humans can be used for cats! MY Stewie is not stable yet on a dosage,and with the cgm, I can see his glucose level as much as I want without pricking anything. It's WONDERFUL!! ask you vet!!!

Also, what role does acromegaly play in diabetes? I understand that pituitary tumors can be a cause of diabetes???

Posted by: cbm | December 18, 2019 10:57 AM    Report this comment

We have a diabetic male around 12 years old. We first noticed him losing weight, then the litter box started containing "syrupy" clumps. Our vet said it was from passing sugar in the urine. We started him out with two injections daily, 12 hours apart, of 9 units each of insulin. He immediately started gaining weight. After about 6 months, we reduced the insulin injections to 6 units, then 5 units, twice per day. He never flinches when he gets the injections. In fact, when he sees me get the insulin out of the refrigerator he comes to me. It's almost like he knows the injections make him feel better! It's much easier to give a cat an injection that a pill.

Posted by: bottsje | December 16, 2019 5:13 PM    Report this comment

My cat has been diabetic for 7 years. She has gone into remission several times, but, unfortunately, it only lasts a few days to up to 2 weeks. Then.... back to the insulin regime. If she were a human I would call her a fragile diabetic as her glucoses are all over the place. So, I always test her 2 hrs post-prandial and have her on a sliding scale dosing with Lantus and that works pretty well. She is the most tolerant kitty and lets me do glucoses twice a day and give her subcutaneous fluids twice a week. Yes, she is in the very early stages of CKD. She is definitely my 15 y/o trooper!

Posted by: Greentaisa | December 16, 2019 4:53 PM    Report this comment

There is a cure for FD type II. Dr Elizabeth Hodgekins tight regulation. FIRST: cats a Obligate carnivores! They cannot handle grains and fillers (some will remain OK), but a cat prone to diabetes will get it if fed dry food. Get the cat on wet food only w/o fillers or grains. Remember that all those fancy things like cranberries carrots and sweet potato are carbs and not good for cats.. If your cat is on insulin this will lower it's need , so be careful NOT to overdose it. Buy a glucometer and test by pricking your cats ear at the tip..Well just look on the internet for "my diabetic cat". I used insulin from BCP compounding pharmacy.They make PZI insulin which is more matched to the cats natural insulin (713)771-1144. It's not that expensive and lasts a long time. I cured my cat and then again when he got into dry food . It takes a lot of love and care, but you CAN have your cat back! Be sure you understand the full protocol before you start.I lost my favorite cat before anyone knew better..This felt like a blessing to find this knowledge. Most vets don't seem to know it. Dr Elizabeth Hodgekins has a book Your Cat. happysky

Posted by: happysky | December 16, 2019 1:55 PM    Report this comment

At what age do female kittens come into heat for the first time, generally?

Posted by: Loretta Scott | January 7, 2019 10:47 AM    Report this comment

We had a cat we treated with 2x a day injections for a number of months. It was easy and he got so he reminded us when we were slow or forgot. After a year or so: No more treatments! The hardest part was the timing and someone being there on time.

Posted by: MayaVT | September 4, 2018 3:05 PM    Report this comment

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