DIABETES MELLITUS
What is diabetes mellitus?
Diabetes mellitus is a medical condition resulting in an excessive amount of sugar (glucose) in
the blood. This is caused by a deficiency of insulin, which is a hormone secreted by the pancreas.
The clinical signs seen in diabetes are largely related to the elevated concentrations of blood
glucose and the inability of the body to use glucose as an energy source due to the deficiency of
insulin.
Diabetes mellitus affects an estimated one in four hundred cats, and is seen more frequently in
middle age to old male cats.
What are the clinical signs of diabetes mellitus?
The most common clinical signs seen in diabetic patients are an increase in water consumption
and urination. Weight loss is also a common feature, and an increase in appetite may be noticed
in some cats. Recognition of these signs is
variable though, particularly because of the
life-style of some cats. If a cat spends a lot of
time outdoors, it may drink from ponds or
pools of water outside rather than appearing
to drink excessively from what is provided
indoors.
How is diabetes mellitus diagnosed?
The diagnosis of diabetes mellitus is made
based on clinical signs, persistently elevated blood glucose concentration and the presence of
glucose in the urine. However, a diagnosis of diabetes cannot be made on a single blood and urine
sample as other conditions such as stress may also cause a transient rise in glucose levels.
Confirmation of diabetes may therefore require more than one blood sample collected over a
period of one to five days.
How is diabetes mellitus treated?
Diabetes mellitus is a treatable condition. Although long-term treatment requires commitment, it
can be very rewarding to successfully manage this condition.
Initial steps in treating a diabetic cat may involve removal of any predisposing causes for the
diabetes. For example, the administration of some drugs predisposes cats to develop diabetes and
withdrawal of these drugs may lead to resolution of the condition. Obese cats are more prone to
develop diabetes and weight reduction can lead to resolution of the signs in some cats.
If there are no predisposing causes, or if correction of the predisposing causes does not lead to
resolution of the diabetes, specific treatment is required. Although a small proportion of cats will
respond to oral hypoglycemic medication, most cats will require insulin injections to control the
diabetes.
During the initial stages of treatment, your cat will require several hospital visits until an
appropriate insulin dosage is determined. Most cats will achieve initial stabilization within a few
days to a few weeks. Most cats will require once or twice daily injections of a small dose of
insulin. Very small needles are available which cause no pain to the cat, and within a short period
of time the procedure becomes very routine.
Do treated cats need to be monitored?
Yes, it is important to monitor treatment to make sure it is working properly, and to determine if
any insulin dosage adjustments are necessary.
Monitoring can be done in part through the collection of occasional blood samples by your
veterinarian, but it is particularly valuable to keep accurate records of the following information:
Daily records:
•
•
•
•
Time of insulin injection
Amount of insulin injected
Amount and time of food fed and eaten
Amount of water consumed
Weekly record:
• Weight of the cat
In addition to these records, it can be valuable to
monitor the quantity of glucose passed in the urine as a
guide to the effectiveness of the treatment. This is best
done on urine that is passed during the night or first thing in the morning. The urine collected can
either be tested by your veterinarian or they may supply you with a kit to test it yourself. If there
is any marked change in the amount of glucose in the urine, this may indicate the need to alter the
insulin dose, but you should never change the dose of insulin without first discussing it with your
veterinarian. Changes in the insulin dose are usually based on trends in appetite, water
consumption and amount of urination.
What happens if my cat receives too much insulin?
If a cat receives too much insulin, it is possible for the blood sugar level to drop dangerously low.
For this reason it is important to be very careful in ensuring the cat receives the correct dose of
insulin.
The typical signs displayed by a cat with a very low blood sugar level are severe weakness and
lethargy, shaking, unsteadiness and even convulsions. If a diabetic cat shows any of these signs it
is important to seek immediate veterinary attention. If more severe signs are displayed (ataxia or
unsteadiness during walking, and/or convulsions) a tablespoon of honey, corn syrup or sugar
solution should be given by mouth. Your veterinarian can advise you on specific emergency
treatment of low blood sugar in your cat.
The injection technique is as follows:
Insulin Information. 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. Most dogs receive U-100 insulin. Make sure that the insulin needles you
use are designed for your pet’s insulin.
Before using the insulin, mix the contents. Be sure to roll it gently between your hands, not shake
it. The reason for this is to prevent foam formation, which will make accurate measuring difficult.
Some types of insulin used in dogs have a strong tendency to settle out of suspension. If it is not
shaken properly, it will not mix well and dosing will be inaccurate. Therefore, the trick is to shake
it vigorously enough to mix it without creating foam. When you have finished mixing the insulin,
turn the bottle upside down to see if any white powder adheres to the bottom of the bottle. If so,
more shaking is needed.
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
question about your pet’s insulin and how it was stored, we recommend 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.
Drawing up the Insulin. Have the needle and syringe, insulin bottle, and cat ready. Then, follow
these steps:
1. Remove the guard from the needle, and draw back the
plunger to the appropriate dose level.
2. Carefully insert the needle into the insulin bottle.
3. Inject air into the bottle. This prevents a vacuum from
forming within the bottle.
4. Withdraw the correct amount of insulin into the syringe.
Before injecting your cat with the insulin, check that there are no air bubbles in the syringe. If you
get an air bubble, draw twice as much insulin into the syringe as you need. Then withdraw the
needle from the insulin bottle and tap the barrel of the syringe with your fingernail to make the air
bubble rise to the nozzle of the syringe. Gently and slowly expel the air bubble by moving the
plunger upward.
When this has been done, check that you have the correct amount of insulin in the syringe. The
correct dose of insulin can be assured if you measure from the needle end, or "0" on the syringe
barrel, to the end of the plunger nearest the needle.
Injecting the Insulin. The steps to follow for injecting insulin are:
1. Hold the syringe in your right hand (switch hands if you are left-handed).
2. Have someone hold your cat while you pick up a fold of skin from somewhere along your
cat's back in the “scruff” region with your free hand. Try to pick up a different spot each
day.
3. Quickly push the very sharp, very thin needle through your cat's skin. This should be easy
and painless. However, take care to push the needle through only one layer of skin and
not into your finger or through two layers of skin. The latter will result in injecting the
insulin onto your cat's haircoat or onto the floor. The needle should be directed parallel to
the backbone or angled slightly downward.
4. To inject the insulin, place your thumb on the plunger and push it all the way into the
syringe barrel.
5. Withdraw the needle from your cat's skin. Immediately place the needle guard over the
needle and discard the needle and syringe.
6. Stroke your cat to reward it for sitting quietly.
7. Be aware that some communities have strict rules about disposal of medical waste
material so don't throw the needle and syringe into the trash until you know if this is
permissible. If it is not, we can dispose of them for you.
It is neither necessary nor desirable to swab the skin with alcohol to "sterilize" it. There are four
reasons:
1. 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.
2. Because a small amount of alcohol can be carried through the skin by the needle, it may
actually carry bacteria with it into the skin.
3. The sting caused by the alcohol can make your cat dislike the injections.
4. 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 once or twice each day it has to sit still for a few minutes. In most cases, a reward of
stroking results in a fully cooperative cat that eventually may not even need to be held.
DISCHARGE

PLEASE CHECK A BLOOD SUGAR EACH MORNING BEFORE GIVING
INSULIN OR FOOD.

IF THE BLOOD SUGAR IS GREATER THAN 350, GIVE _____UNITS
AFTER FEEDING

IF THE BLOOD SUGAR IS BETWEEN 250 – 350 GIVE ______UNITS
AFTER FEEDING AND RECHECK THE SUGAR BEFORE THE NIGHTIME
DOSE

IF THE BLOOD SUGAR IS LOWER THAN 250 GIVE ______UNITS
BEFORE FEEDING AND RECHECK THE SUGAR BEFORE THE NIGHT
TIME DOSE.

IF THE BLOOD SUGAR IS LOWER THAN 150 OR IF ___________
REFUSES TO EAT, DO NOT GIVE INSULIN UNTIL SPEAKING WITH
YOUR VETERINARIAN

ONCE ________ IS WELL REGULATED, PLEASE CHECK A BLOOD
SUGAR IF YOU NOTICE:
1. A change in thirst or appetite
2. Any vomiting or diarrhea
3. Any odd behavior
4. At least once a week to ensure we avoid problems

PLEASE GIVE ______ UNITS OF _______INSULIN______DAILY WITH
MEALS

PLEASE FEED ______CUPS OF W/D OR GLUCOSE CONTROL ____DAILY

PLEASE KEEP A DAILY RECORD OF WATER INTAKE AND APPETITE
FOR AT LEAST THE FIRST FEW WEEKS.

WHEN YOU NOTICE A DECREASE IN URINATIONS AND WATER
CONSUMPTION, PLEASE CALL THE DOCTOR.

PLEASE MONITOR _________ WEIGHT WEEKLY

IF YOUR PET IS NOT DRINKING A LOT, AND STARTS TO ACT ILL,
OFFER FOOD, KARO SYRUP, AND CALL US IMMEDIATELY

DR. ___________WILL CALL TO CHECK ON ________ IN _____DAYS.
PLEASE CALL SOONER IF YOU HAVE ANY QUESTIONS OR
CONCERNS.

IF YOUR PET MISSES A MEAL, GIVE HALF THE DOSE OF THE
INSULIN. IF HE/SHE DOES NOT EAT THE NEXT MEAL, PLEASE
CONSULT WITH THE STAFF BEFORE PROCEEDING.