By Sophie McMurrough

A diagnosis of diabetes can be overwhelming to begin with. The management of this disease requires teamwork from the veterinary team and you as an owner. The veterinary team are here to support you, every step of the way and can always be called upon if you have any questions. We are in this together!

What is Diabetes Mellitus?

  Diabetes mellitus is a common hormone disease in cats and it develops when the pancreas is unable to produce or utilise insulin to meet the needs of the body. This causes your pets blood sugar (known as glucose) to rise. Although we still don’t full understand what causes diabetes in cats, there are a few factors believed to be involved. These may include genetics, obesity, pets receiving long-term steroids or any disease that may interfere with insulin.

What happens in the body and why is insulin important?

·      When we eat food, our body breaks the food down and uses the carbohydrates and sugar as energy

·      Now that we have plenty of energy in our bloodstream, the pancreas then releases insulin

·      Insulin sends the sugar or glucose into the cells, so our body can use the energy to survive

·      Think of insulin as the “key to the cell” and without it, the sugar cannot enter the cell and therefore, cannot be used

·      This leaves a lot of sugar in the bloodstream, so our blood sugars remain high

·      When a pet is diabetic, you need to give your pet insulin by injection

·      This will help bring down the blood sugar level and allow the body to use it as energy

Signs and symptoms of Diabetes

·      Passing urine more often

·      Drinking more

·      Wanting to eat more than usual, an increased appetite

·      Weight loss in some cats

 
  The high blood sugar level is filtered by the kidneys. This draws more water out of the blood stream which creates more urine. In return, your pet will become very thirsty and will drink more. Glucose is the body’s main source of energy but without insulin, this cant be used. In order to maintain normal bodily functions, your cat will start to use fat and protein as energy instead. Your pet may eat more but also lose weight for this reason.

Diagnosing diabetes

Diagnosing diabetes is not always straight forward and may involve many tests. Cats produce glucose during times of stress (like car journeys, sickness or trips to the vets), which makes diabetes in cats a little more difficult to diagnose and monitor. Typically, a diagnosis is based upon the signs and symptoms shown by your cat, persistently high blood sugar (multiple readings) and the presence of sugar in the urine. In some cases, more tests are required.

  At the time of diagnosis, it is important to screen your cat for other diseases that may be caused by or causing the diabetes. This may include diseases of the kidneys, heart, liver or pancreas to name a few. Additional investigations may include further blood and urine tests, ultrasound, CT, x-rays. These investigations are very important, treating other conditions will help us treat the diabetes successfully. In some cases, it may even help us achieve remission (resolve the diabetes all together).

Possible complications of diabetes

Without treatment, diabetes can lead to some serious complications.

Diabetic ketoacidosis (DKA) – this is a serious complication of diabetes, and it may occur if the diabetes is untreated or unstable. Without adequate insulin, the body uses fat as energy. If large amounts of fat are broken down, they release something called ketones into the bloodstream. This can cause changes in your cat’s electrolytes and may cause severe dehydration. This can become a life-threatening emergency.

Low blood sugar (hypoglycaemia)

  It is very important to monitor your pet for signs of low blood sugar. Low blood sugar is much more dangerous than high blood sugar and can cause serious illness or death very quickly.

How do I know if my pets blood sugar is low?

Normal blood glucose level 3.2-8.5mmol/L

Your pet may show some of the following signs:

·      Appearing less energetic than usual

·      Very hungry and ravenous for food (more than usual)

·      Weak

·      Shaking or twitching

·      Collapsed or unresponsive

·      Coma

If you think your pet may have low blood sugar, is it very important to act quickly.

What do I do if I think my pet has low blood sugar?

·      If conscious, offer food (any food)

·      If they wont eat or they are unconscious, rub something sugary on their gums (honey, syrup, glucose gel)

·      Once you have done this, phone the vet straight away for advice. They may wish to alter the next insulin dose or time.

It is a good idea to keep a blood glucose monitor and some glucose gel at home. Examples of these are:

Blood glucose monitor: AlphaTRAK Blood Glucose Monitoring System (for veterinary use)

Glucose gel: Glucogel or Glucoboost (usually available at your vet clinic)

How do you treat diabetes mellitus in cats?

  The aim of treatment is to resolve the signs and symptoms, improve the cats (and yours) quality of life and to reduce the risk of diabetic complications.

Insulin injections

  All cats will need insulin to begin with, some will need it lifelong. Cats are similar to humans with type 2 diabetes, meaning remission may be possible.

  There are many different types of insulin available and they vary in strength and how long they last. Each cat responds to insulin differently so there is no “one dose fits all”. At the start of treatment, it can take months to find the appropriate insulin and dose that fits your cat. Your vet will typically start off with a lower dose and wean up over weeks or months. This is because it is safer to have a higher blood sugar then starting on higher dose and sending the blood sugar too low.

  Insulin for animals is different to insulin for humans. It is very important that you only use the insulin prescribed by your vet. The human syringes are also different, they must never be used on an animal.

  Your cat will typically need two injections of insulin a day, morning and evening, 12 hours apart. The insulin injections should given at the same time as food. It is a good idea to make sure your cat has eaten at least half of their meal before giving the injection. This should prevent the blood sugar from dropping too low. Food should be left out for your cat to graze of through the day.

The injections can be given into the tented skin between the shoulder blades. This will be demonstrated by your veterinary team.

Diet

  Diet is an important part of diabetic control. A diabetic diet is usually lower in carbohydrates and higher in protein. A good diet will help prevent spikes in blood sugar and will help keep the level consistent throughout the day. Treats should not be given to diabetic animals as this will spike their glucose level and may make treatment ineffective.

  Wet food is often preferred due to the extra moisture content. This will help keep your pet hydrated throughout the day. Not all cats will eat wet food and the most important thing is that your cat is eating a suitable diet they enjoy. Meals should be weighed out to make sure the same amount is given each meal (important when giving insulin).

  Obesity can cause the insulin to be less effective so weight loss in overweight cats is key. This should be a gradual process and any new diets should be gradually introduced over 7-10 days. The old diet should be mixed with the new one, until the old one is weaned out. Please remember that eating is very important for a diabetic cat, so a diet which is not perfect, is more important than not eating at all.

  If your cat has other diseases alongside the diabetes, diet can be an important part of that treatment too. The diet to address the other condition should be chosen over a diabetic diet.

Exercise

  Exercise is important to help maintain good blood sugar levels and to control bodyweight. Exercise can be encouraged through play such as laser pens, wand toys and puzzle feeders. Puzzle feeders make them work for their food and should be introduced slowly. Food is important to diabetics and we need to make sure the cat knows how to use the feeder prior to switching to prevent low blood sugar.

Treating other conditions that may affect how well the insulin works

Common conditions such as obesity, infections, kidney, heart, pancreas, or thyroid diseases can all effect how insulin works in the body (this is not a full list). Treating them can help control or eradicate your pets diabetes.

If is vital that diabetic pets always have access to water. Diabetic pets will become dehydrated much quicker than normal. Severe dehydration can occur if water is not available, which can cause your pet to go into a coma or even die. Large water bowls and fountains a good way of keeping your cat hydrated.

Infections – diabetes can weaken your cats immune system which means they are more likely to get infections. Urinary tract infections are common in diabetics. Large volumes of sugar in the bladder, makes a perfect breeding ground for bacteria. Infections can occur anywhere in the body, they may cause the insulin to be less effective so treatment is key.

Long-term monitoring

  A cat whose diabetes is well controlled should have a good appetite, drink and urinate a normal amount, maintain a stable bodyweight and have no signs of low blood sugar.

  Getting to this point can sometimes take months and may not be possible In all cats (typically those with other diseases alongside). Achieving good diabetic control involved teamwork from you, your veterinary surgeon and veterinary nurse.

Glucose monitoring

  Your cat may be admitted to the vet clinic for blood glucose curves. This allows us to see what the blood sugar is doing throughout the day, and how it is responding to the insulin.

Glucose sensors

Recently, monitors are available which continually measure your cats glucose over several days. They are human sensors and the most common one used in veterinary medicine is the Freestyle Libre. This is a small disc shaped sensor which has a very thin needle. The sensor is placed on your cats skin and measures the glucose continually. This can then be read with an app on your mobile phone. You can also set alarms which will alert you if your cats blood sugar dips too low. The sensors only last a maximum of 2 weeks each time. They are useful during early diagnosis, during insulin dose changes and at periods where your pet may become unstable. The sensors are well tolerated by cats and can be placed by a veterinary nurse in the veterinary clinic.

Glucometer (stick readings)

  Glucometers are easy to use and can be purchased online or from some pharmacies. They are easy to use and most cats tolerate the ear prick very well. They are particularly useful when you think your cat may have low blood sugar. The device allows you to check your pets blood sugar level in real time.

Resolving the diabetes (diabetic remission)

  Remission may be possible is some cats but not all. Some cats can still produce insulin and typically in these cats, the cause of the diabetes is something stopping the insulin working properly. Treating the cause of this (such as obesity), may allow the cat to start controlling its own blood sugar levels.

  Remission can occur in around 30-50% of cats and typically this happens within the first 6 months of treatment. Cats that don’t go into remission are usually those which have a source of insulin resistance that can’t be stopped such as kidney disease. Some cats may also be unable to produce insulin for themselves.

  Cats that do go into remission, usually require progressively lower doses of insulin until insulin can be completely discontinued without causing high blood sugar. Owners that achieved remission are encouraged to continue to control the cat’s bodyweight, maintain a low carbohydrate diet and encourage the cat to exercise.

  The diabetes can return in some cases so your can will need to be monitored for the signs and symptoms of diabetes such as drinking, urinating and eating more.

What does this mean for my cats’ life?

  Diabetic cats can live a long and happy life. If the blood sugar is controlled and no other diseases are present, your cat can have an excellent quality of life. Life-long management is a team effort and the veterinary team is always there to help you. If in doubt or if you have any queries, a vet or vet nurse is always at the other end of the phone.

For further support, please visit contact your veterinary clinic, who will be happy to advise you further.

Veterinary Nurse – Medicine Geek

Registered Veterinary Nurse and Veterinary Technician Specialist in Small Animal Internal Medicine