Companion Animal Clinic
2626 N. Campbell Ave
520-327-5763
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DIABETES MELLITUS IN CATS
What is diabetes mellitus?
Diabetes mellitus-also known as "sugar" diabetes-is a complex but common
disease in which a cat's body either doesn't produce or doesn't properly use
insulin. During digestion, the fats, carbohydrates, and proteins that are
consumed in the diet are broken down into smaller components that can be
utilized by cells in the body. One component is glucose, a fuel that provides the
energy needed to sustain life.
Insulin is a hormone produced in the pancreas, is responsible for regulating the flow of glucose from the
bloodstream into the cells of the body. When insulin is deficient or ineffective, the cat's body starts
breaking down fat and protein stores to use as alternative energy sources. As a result, the cat eats more yet
loses weight. Additionally, the cat develops high levels of sugar in the bloodstream, which is eliminated
in the urine. In turn, sugar in the urine leads to excessive urination and thirst. Cat owners often notice
these four classical signs of diabetes mellitus: ravenous appetite, weight loss, increased urination, and
increased water consumption.
Diabetes mellitus is generally divided into two different types in cats: insulin-dependent diabetes mellitus
(IDDM)], and non-insulin-dependent diabetes mellitus (NIDDM)]. Approximately one-half to threequarters of diabetic cats have and thus require insulin injections as soon as the disease is diagnosed. The
rest have NIDDM; however, most ultimately require insulin injections to control their disease.
While diabetes mellitus can affect any cat, it most often occurs in older, obese cats. Male cats are more
commonly afflicted than females. The exact cause of the disease in cats is not known, although obesity
(the major predisposing condition), chronic pancreatitis, other hormonal diseases (e.g., hyperthyroidism,
Cushing's disease, and acromegaly), and certain medications (e.g., megestrol acetate and corticosteroids
like prednisolone) have all been linked to the disease.
How is diabetes diagnosed?
Diabetes mellitus is diagnosed based on the cat's signs, physical examination findings, laboratory test
results, and the persistent presence of abnormally high levels of sugar in the blood and urine. Once
diabetes has been diagnosed, immediate treatment is necessary.
Left untreated, diabetes will shorten a cat's lifespan. A dangerous, sometimes fatal condition called
ketoacidosis may develop, indicated by loss of appetite, vomiting, diarrhea, lethargy, weakness,
dehydration, and breathing abnormalities. Additionally, diabetes can lead to an unhealthy skin and coat,
liver disease, and secondary bacterial infections. A diabetes-related disorder called diabetic neuropathy
may cause cats to become progressively weaker, especially in the hind legs, impairing their ability to
jump and causing them to walk with their hocks touching the ground.
Diabetes treatment is based on the severity of the disease. Cats with ketoacidosis require prompt intensive
care, which usually includes fluid therapy and short-acting insulin injections. For cats that are not
severely ill, your veterinarian may recommend a treatment plan that includes insulin injections or oral
medications, along with dietary changes.
What is involved in treating a diabetic cat at home?
Each diabetic cat is an individual, and each responds differently to treatment. Some diabetic cats are easy
to regulate; others are not. Some can be treated with oral medications, while others require insulin
injections. Some cats' diabetes is transient-reversing course with the passage of time-while others will
require treatment for the remainder of their lives. Different cats respond best to different types of insulin.
Regardless of this variability, all diabetic cats do best with consistent medication, consistent feeding, and
a stable, stress-free lifestyle.
Insulin
Most diabetic cats require insulin injections administered under their skin twice daily. The injections can
be given at home, preferably at the same time each day. Your veterinarian will show you how to give
these injections, which are not painful-in fact, most cats are unaware that the injection is being given.
Because each is different, the proper type of insulin, dose, and frequency of administration needs to be
determined by your veterinarian. Ideally, this is based on an 18- to 24-hour blood glucose profile,
obtained through a veterinarian-administered insulin injection and subsequent testing of blood sugar
levels at regular intervals throughout the day. Insulin dosage may change with time and may need to be
adjusted based on new blood glucose profiles, the results of intermittent blood tests and urine sugar
measurements, and the cat's response to therapy.
Oral Hypoglycemic Medications
Healthy diabetic cats can sometimes be successfully treated with glipizide, an orally administered
hypoglycemic medication that lowers blood glucose. Adverse side effects, although uncommon, include
vomiting, loss of appetite, and liver damage. If you use glipizide, have your cat's glucose levels checked
regularly to verify medication's efficacy. Although glipizide works for some diabetic cats, most require
insulin injections to successfully control their disease. In addition, the administration of oral medication
on a long-term basis is difficult for many cats and their owners; insulin injections may be a better choice
for them.
Diet
In addition to medication, an important step in treating diabetes is to alter your cat's diet. Obesity is a
major factor in insulin sensitivity, so if your cat is overweight, you will need to help him lose weight
gradually. Your veterinarian can tailor a safe weight-loss program, in which your cat loses weight
gradually. A high-fiber, high-complex carbohydrate diet not only can achieve weight loss if necessary,
but is believed to help control blood sugar levels after eating. (Underweight cats should initially be fed a
high calorie diet until they reach their ideal body weight.) Other diabetic cats respond well to
carbohydrate-restricted diets. Although diabetic cats have been successfully managed with both types of
diets, some cats respond better to high-fiber diets and others to low-carbohydrate diets. Trial and error can
help determine the best diet for your cat.
Your cat's feeding routine is also important. While many cats are "free-choice" feeders (i.e., food is left
out for them to eat whenever they want), this may not be the ideal routine for a diabetic cat. Ideally, a cat
receiving insulin should be fed half its daily food requirement at the time of each injection, with the
unconsumed remainder available throughout the day. The timing of feedings is less critical for cats
receiving glipizide; nevertheless, food intake should be closely monitored.
What are the potential complications of treating a diabetic cat?
Hypoglycemia-low blood sugar-is a potentially dangerous complication, usually caused by a relative
overdose of insulin. Hypoglycemia signs include weakness, listlessness, lack of coordination,
convulsions, and coma. Left untreated, hypoglycemia can be fatal. If hypoglycemia develops, the cat
should immediately be offered its normal food. If the cat is unable to eat, rub some corn syrup onto the
gums or, if the cat can swallow, slowly administer it by syringe into the mouth. Never force fingers,
food, or fluids into the mouth of a convulsing or comatose cat. Contact your veterinarian immediately
for further instructions if your cat exhibits signs of hypoglycemia.
How do I monitor my diabetic pet?
Monitoring your diabetic cat is a joint effort between you and your veterinarian. Because your cat's
insulin requirements may change over time, periodic checking of blood glucose or serum fructosamine
levels is essential. Seek veterinary treatment at the first reappearance of diabetes signs (increased
thirst, increased weight loss, increased appetite, or increased urination).
Some cat owners are willing and able to take on the task of measuring their cat's blood glucose levels at
home rather than in a veterinary hospital-a potentially less expensive and more accurate monitoring
method. Ask your veterinarian whether home glucose testing might be suitable for you and your cat. More
information can be found online at www.sugarcats.net/sites/harry/bgtest.htm.
At home, you'll need to be constantly aware of your cat's appetite,
weight, water consumption, and urine output. It is important to feed
a consistent amount and type of food at the same times each day, so
that you can be aware of days that your cat either does not eat or is
unusually hungry after the feeding. You should develop a way to
measure water consumption. The average cat should drink no more
than 7 1/2 oz. (225 ml) of water per 10 pounds (4.5 kg) of body
weight per 24 hours. Since this is highly variable from one cat to
another, keeping a record of your cat’s water consumption for a few
weeks will allow you to establish what is normal for your cat.
Another way to measure water consumption is based on the number
of times it drinks each day. When properly regulated, it should drink no more than six times per day. If
this is exceeded, you should take steps to make an actual measurement.
Urine output can be roughly estimated by determining the amount of litter that is scooped out of the litter
box. This is less accurate if more than one cat uses the litter box, but changes can still be meaningful. Any
significant variation in your cat's food intake, weight, water intake, or urine output can be a sign that the
diabetes is recurring and immediate veterinary care is needed.
The second method of home monitoring is to determine the presence of glucose in the urine. If your cat is
properly regulated, there should be no glucose present in the urine.
There are several ways to detect glucose in urine. You may purchase urine glucose test strips in any
pharmacy. They are designed for use in humans with diabetes, but they also work in the cat. A fresh urine
sample should be collected and tested with the test strip. If glucose is detected, the test should be repeated
the next two days. If it is present each time, we should see your cat for a blood test.
There are also special cat litter and boxes available: http://felinediabetes.com/SCB/SCBindex.html;
http://www.katkor.com/english/indexe.html
As well as useful websites: http://www.sugarpet.net/urine.html;
http://www.felinediabetes.com/monitor.htm
Monitoring Blood Glucose
There are two blood tests that can be used to monitor your cat, the blood glucose test and the fructosamine
test. One of these should be performed every three to four months if your cat seems to be well regulated.
Testing should also be done at any time the clinical signs of diabetes are present or if glucose is
detected in the urine for two consecutive days.
Determining the level of glucose in the blood is the most commonly used blood test. Timing is important
when the blood glucose is determined. When testing the blood we check the highest and lowest glucose
readings for the day. The highest blood sugar reading should occur just before an injection of insulin is
given. The lowest should occur at the time of peak insulin effect. This is usually five to eight hours after
an insulin injection. The procedure is as follows:

Do not feed or give insulin injection to your cat.

Make an early morning drop-off and bring its food, insulin, and some syringes with you.

A blood sample will be taken immediately and then we will give insulin and feed your cat if it did
not eat at home.

A second blood sample will be taken at the time of peak insulin effect.
If your cat gets excited or very nervous being in the hospital, the glucose readings may be falsely
elevated. It may be best to admit your cat to the hospital the day before testing so it can settle down for
testing the next day. Otherwise, the tests give us limited information.
The alternative test is called a fructosamine test. This test is an average of the blood glucose levels for the
last two weeks. It is less influenced by stress and inconsistencies in diet and exercise. It does not require
fasting and can be performed at any time of the day.
What is the prognosis for a diabetic cat?
There is no cure for diabetes mellitus. However, some diabetic cats may lose the need for insulin, months
or years after diagnosis. If diabetes has resulted from obesity, it is likely to improve a great deal-or even
completely resolve-once the cat's weight is under control. If obesity or some other disorder is not a factor,
the diabetes probably will not go away; however, it can be successfully managed. The serious chronic
complications that afflict people with diabetes mellitus (such as kidney disease, blood vessel disease, and
coronary artery disease) are uncommon in diabetic cats. Once control is attained with proper treatment
and home care, a diabetic cat can live many healthy years. Nonetheless, successfully managing a diabetic
cat requires much dedication and communication between you and your veterinarian.
What are the implications for me and my cat?
For the diabetic cat, one reality exists: blood glucose cannot be normalized without treatment. Although
the cat can go a day or so without treatment and not have a crisis, treatment should be looked upon as part
of the cat's daily routine. Treatment almost always requires some dietary changes and administration of
insulin.
As for you, the owner, there are two implications: financial commitment and personal commitment.
When your cat is well regulated, the maintenance costs are minimal. However, the financial commitment
may be significant during the initial regulation process and if complications arise. At first, return visits are
required every three to seven days to monitor progress. It may take a month or more to achieve good
regulation.
The financial commitment may again be significant if complications arise. Your veterinarian will work
with you to try and achieve consistent regulation, but some cats are difficult to keep regulated. It is
important that you pay close attention to all instructions related to administration of medication, diet, and
home monitoring. Another complication that can arise is hypoglycemia, or low blood sugar, which can be
fatal. This may occur due to inconsistencies in treatment.
Your personal commitment to treating your cat is very important in maintaining
regulation and preventing crises. Most diabetic cats require insulin injections
twice daily. They must be fed the same food in the same amount on the same
schedule every day. If you are out of town, your cat must receive proper
treatment while you are gone.
What is involved in treatment?
Consistency is vital to proper management of the diabetic cat. Your cat needs
consistent administration of medication and food, and a stable, stress-free lifestyle. It is desirable that
your cat live indoors most of the time. Although that is not essential, indoor living removes many
uncontrollable variables that can disrupt regulation.
An important step is to alter your cat's diet and feeding routine is also important. Some cqts prefer to eat
several times per day. This means that food is left in the bowl at all times for free choice feeding.
However, this is not the best way to feed a diabetic cat. The preferred way is to feed twice daily, just
before each insulin injection. If your cat is currently eating on a free choice basis, it is important to try and
make the change. It is important to accurately measure the amount of food that is consumed.
The foundation for regulating blood glucose is the administration of insulin by injection. The injections
are given just under the skin. We will demonstrate the injection technique. You may be pleasantly
surprised at how easy it is and how well your cat tolerates the injections.
How is insulin provided?
Insulin comes in an airtight bottle that is labeled with the insulin type and the concentration. It is
important to make sure you match the insulin concentration with the proper insulin needles. Insulin
needles show their measurement in “units per ml”, which must correspond to the concentration of the
insulin you are using.
Before using the insulin, mix the contents. Be sure to roll it gently between your hands, not shake it.
Insulin that is shaken too vigorously may become ineffective and the amount drawn into the needle may
contain an inaccurate dose.
Insulin is a hormone that will lose its effectiveness if exposed to direct sunlight or high temperatures. It
should be kept in the refrigerator, but it should not be frozen. If you have any doubt about your pet’s
insulin and how it was stored, it is safer to replacing it instead of risking using ineffective insulin. Insulin
is safe as long as it is used as directed, but it should be kept out of the reach of children.
How do I inject the Insulin?
The steps to follow for injecting insulin are:
Hold the syringe in your right hand (switch hands if you are lefthanded).
Hold your cat while you pick up a fold of skin from somewhere along
the “scruff” region with your free hand. Try to pick up a slightly
different spot each day.
Quickly push the very sharp, very thin needle through your cat's skin.
This should be easy and painless. To inject the insulin, place your
thumb on the plunger and push it all the way into the syringe barrel. Withdraw the needle from your cat's
skin. Immediately place the needle guard over the needle and discard the needle and syringe.
Stroke and praise your cat to reward it for sitting quietly.
Don't throw the needle and syringe into the trash. It is usually preferable to take the used needles and
syringes to your veterinary clinic or local pharmacy for disposal.
It is not necessary to swab the skin with alcohol to "sterilize" it, because:

Due to the nature of the thick hair coat and the type of bacteria that live near the skin of cats, brief
swabbing with alcohol or any other antiseptic is not effective.

The sting caused by the alcohol can make your cat dislike the injections.

If you have accidentally injected the insulin on the surface of the skin, you will not know it. If
you do not use alcohol and the skin or hair is wet following an injection, the injection was not
done properly.
Although the above procedures may at first seem complicated and somewhat overwhelming, they will
very quickly become second nature. Your cat will soon learn that twice each day it has to sit still for the
injections.
Does hypoglycemia occur in cats?
Hypoglycemia means low blood sugar. If it is below 40 mg/dl, it can be life threatening.
If the insulin dose is too high. Although most cats will require the same dose of insulin for long periods
of time, it is possible for the cat’s insulin requirements to change. However, the most common causes for
change are a reduction in food intake and an increase in exercise or activity. The cat should eat before
giving the insulin injection, because once the insulin is administered it can’t be removed from the body.
If your cat does not eat, skip that dose of insulin. Always remember that it is better in the short term for
the blood sugar to be too high than too low.
If too much insulin is given. This can occur because the insulin was not properly measured in the syringe
or because two doses were given. You may forget that you gave it and repeat it, or two people in the
family may each give a dose. A chart to record insulin administration will help to prevent the cat being
treated twice.
The most likely time that a cat will become hypoglycemic is the time of peak insulin effect (5-8 hours
after an insulin injection). When the blood glucose is only mildly low, the cat will act very tired and
unresponsive. You may call it and get no response. Within a few hours, the blood glucose will rise, and
your cat will return to normal. Since many cats sleep a lot during the day, this important sign is easily
missed. Watch for any subtle signs of hypoglycemia. It is the first sign of impending problems. If you see
it, please bring your cat in for blood glucose testing.
If your cat is slow to recover from this period of lethargy, you should give it corn syrup (one teaspoon by
mouth). If there is no response within fifteen minutes, repeat administration of the corn syrup. If there is
still no response, contact your veterinarian immediately for further instructions.
If severe hypoglycemia occurs, a cat may have seizures or lose consciousness. Ultimately, untreated
hypoglycemia will lead to coma and death. This is an emergency that can only be reversed with
intravenous administration of glucose. If it occurs during office hours, take your cat to the veterinarian’s
office immediately. If it occurs at night or on the weekend, call your veterinarian’s emergency phone
number for instructions.
SUMMARY OF INSTRUCTIONS
Read and reread this material so that you understand the specifics of proper regulation and how to
recognize and treat hypoglycemia.
Diabetes Mellitus is an endocrine disease that affects insulin metabolism and the body's ability to control
blood glucose (sugar). High glucose levels usually result in eating, drinking, and urinating more than
usual. It may also have a poor hair coat and decreased energy level. Diabetes can also result in kidney
disease and urinary tract infections.
Management consists primarily of insulin administration and diet control. Your cat will need periodic
serial glucose tests. This test is performed in the hospital over a full day, blood glucose is measured every
2 hours for 6-8 hours. After the blood glucose is regulated, response to therapy can be assessed by
monitoring blood fructosamine levels and signs at home, especially food and water intake. It is important
to keep in mind that even a well-regulated animal’s needs may change at any time, requiring another
serial glucose test in the hospital in order to adjust the insulin dose. Monitoring progress at home is key
to successfully managing this disease.
If your cat receives too much insulin, or doesn’t eat a meal but receives insulin, take it to the hospital or
emergency clinic right away. Signs of insulin overdose include acute collapse, shaking, weakness,
seizures, and severe vomiting and diarrhea. It is important to keep a source of glucose like Karo Syrup to
be rubbed on the gums or given orally to temporarily increase glucose levels.
You should feed a special diet in 2 small meals rather than one large meal. This results in slowing
digestion and a more gradual release of glucose into the blood. It is important to feed a meal before the
morning injection. Do not give insulin if your cat does not eat!
Important Notes
1. **Always make sure your pet eats before the time of the injections.**
2. Monitor water intake and urine output.
3. When rechecking blood glucose; make early morning appointments. *Do not feed morning meal,
but bring along food and insulin*
Give the first injection of 1.5 units insulin at about 7:00 AM.
Return for a glucose curve, no later than 8:00 a.m., July 30.
If you to use urine glucose tests strips, they should be purchased at a pharmacy.
Following regulation in the hospital, measure the urine glucose two consecutive days, then twice weekly
for the next two weeks. If glucose is not detected, measure the glucose two consecutive days every other
week.
If you are unable to test the urine for glucose, return to our hospital in two to four days for a blood
glucose test. This should be done about five to eight hours after an injection of insulin. If two injections
are given each day, be sure the test is done before the evening injection.
Return to our hospital for a blood glucose test in one month. Since this test is the fructosamine level, the
time of day is not important and fasting is not necessary.
Diabetes treatment plan:
1. 1.5 UNITS INSULIN AT 7 A.M. AND 7 P.M. EVERYDAY.
2. Feed every 12 hours. Always feed before injections. Be as consistent as possible with regard to
feeding times and type of food.
3. Feed only Diabetic diet. (10 cal/lb/day for wgt loss; 15 cal/lb/day mx)
4. Please schedule a recheck visit on Wednesday
5. Also schedule a glucose check: July 30. *Do not feed morning meal, but bring along food and
insulin*
Care of Insulin
1. Keep refrigerated
2. Gently rock bottle back and forth to mix.
3. Inject a little air into the bottle to keep from creating a vacuum.
4. Hold bottle vertically with diaphragm down
5. Draw out more insulin than you need, push air bubbles and insulin back into bottle until you have
the correct amount of insulin. You may need to tap syringe to dislodge bubbles.
6. Renew insulin prescription every 45 days.
Administering Insulin
1. Unsheathe needle.
2. Pinch skin where you will be injecting insulin.
3. Insert needle through skin. The hub of the needle should touch the skin. Visualize needle going
through the skin.
4. Withdraw plunger a little to check for blood in the hub of the needle. If you get blood, pull out
and insert needle somewhere else. Check for blood return again. If no blood in hub of syringe,
then inject entire contents.
5. Recap needle, carefully. Dispose of properly.
Please feel free to call us with any questions or concerns.
Thank you for trusting us with your pet’s care!
Dr. Valentine and the staff of Companion Animal Clinic