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Frequently asked questions

Diabetes mellitus in cats

  1. What is diabetes mellitus and what causes it?
  2. What signs do cats with diabetes typically show?
  3. What do the terms polyuria, polydipsia, and polyphagia mean?
  4. My cat is having problems holding its urine; does that mean it has diabetes?
  5. How is diabetes diagnosed?
  6. Are all cats susceptible to diabetes?
  7. What other problems can be associated with diabetes?
  8. What other diseases have the same signs as diabetes?
  9. Did I do something to cause the diabetes?
  10. What is the difference between type 1 and type 2 diabetes?
  11. What is the expected life span for a diabetic cat?
  12. My cat was recently diagnosed. What advice would you give me?
  13. Is diabetes in animals similar to that of humans?

Vetsulin® (porcine insulin zinc suspension)

  1. Where on my cat’s body should Vetsulin be injected?
  2. Can I still use a vial of Vetsulin if it freezes?
  3. Can I still use a vial of Vetsulin if it was forgotten outside the refrigerator between doses?
  4. What else should I know about Vetsulin?
  5. How do I dispose of insulin syringes?

Management of diabetes mellitus in cats

  1. What must I do if I know that I missed a full dose or part of an injection?
  2. What should I do if I have or think I've given too much insulin?
  3. What should I do if I think that my cat has very low blood sugar (hypoglycemia)?
  4. How much water should I let my cat drink?
  5. What is the importance of making sure my cat is regulated?
  6. How long does it take to regulate a diabetic animal?
  7. My cat is ill and not eating. Should I still give him/her an insulin injection?
  8. What can I give my cat as a treat?
  9. What does the typical diet consist of?
  10. What is a blood glucose curve?
  11. What are some problems with blood glucose curves?
  12. How often should a blood glucose curve be done?
  13. What is a stress hyperglycemia?
  14. What is fructosamine?

About VetPen®

  1. What makes VetPen unique?
  2. Is VetPen difficult to use?
  3. Is VetPen more accurate than using an insulin syringe?
  4. Can VetPen be used with different insulins?

Using VetPen

  1. How does selecting a dose with VetPen differ from drawing up a dose with a syringe?
  2. How do I know when the injection is complete?
  3. Why does the VetPen need to be tested before each injection?
  4. What should the insulin cartridge look like after mixing and priming?
  5. Is VetPen reusable?
  6. What type of needle is used with VetPen?
  7. Can VetPen needles be reused?
  8. Does VetPen need to be kept refrigerated when it contains an insulin cartridge?
  9. What is the proper care of VetPen?

Troubleshooting VetPen

When experiencing any issues using VetPen, the first step should always be to confirm that air was properly removed from the cartridge through priming. Air bubbles in the cartridge can create multiple issues that result in the pet receiving too much or too little insulin.

  1. What if insulin drips actively from the needle after injection?
  2. What if the dose selector does not return to the start line after testing VetPen?
  3. What if there is not enough insulin in the cartridge to complete an injection?
  4. What if a dose too large for the pet is selected?
  5. What if no insulin drips actively or squirts from the needle after priming or preparing for use?

General

  1. How often should my diabetic cat see the veterinarian?
  2. Should my diabetic cat still receive vaccinations?
  3. Is it safe for a cat with diabetes mellitus to receive a general anesthetic?

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Diabetes mellitus in cats

What is diabetes mellitus and what causes it?

Diabetes mellitus is caused by an absolute or relative deficiency of insulin. Animals with an absolute or relative deficiency of insulin are called diabetics.

Insulin deficiency can develop for different reasons:

  • Disorders of the pancreas—the pancreas is unable to secrete enough insulin.
  • Other diseases or the presence of other hormones may be antagonistic to insulin or cause resistance to insulin. This causes insulin to be unable to function normally in the body.

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What signs do cats with diabetes typically show?

The most common signs of diabetes mellitus in cats include:

  • Excessive drinking
  • Excessive urination
  • Excessive appetite
  • Weight loss despite good appetite
  • Lethargy
  • Failure to groom; dry, dull fur

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What do the terms polyuria, polydipsia, and polyphagia mean?

  • Polyuria is the production of large amounts of urine in a given period (eg, per day).
  • Polydipsia is chronic, excessive thirst.
  • Polyphagia is great hunger or increased appetite.

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My cat is having problems holding its urine; does that mean it has diabetes?

No, your cat could have a bladder or kidney infection or some other medical problem. If your cat is having problems holding its urine, you should schedule a trip to your veterinarian as soon as possible.

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How is diabetes diagnosed?

Your veterinarian will measure your cat’s blood glucose level and test your cat’s urine for the presence of glucose and ketones.

Persistently high blood glucose levels along with glucose in the urine usually means that your pet has diabetes mellitus.

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Are all cats susceptible to diabetes?

Cats of all ages can get diabetes. Diabetes typically occurs in middle- to older-aged cats and cats that are obese. Neutered male cats are more susceptible than females.

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What other problems can be associated with diabetes?

The most common chronic complication of diabetes in the cat is the development of peripheral neuropathy, which you’ll notice as weakness in the hind legs. Diligent control of hyperglycemia (high blood sugar) can potentially reverse the clinical signs of neuropathy. A common problem in both canine and feline diabetics is recurrent infections.

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What other diseases have the same signs as diabetes?

Cats with diabetes mellitus drink and urinate a lot. They may also have a good or increased appetite but usually lose rather than gain weight. Other cat diseases that may cause some or all of these signs include:

  • Hyperthyroidism
  • Exocrine pancreatic insufficiency
  • Pancreatitis
  • Kidney disease/renal failure

To reach a definitive diagnosis of diabetes mellitus, your veterinarian will test your cat’s blood glucose levels and its urine for the presence of glucose and ketones.

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Did I do something to cause the diabetes?

No. Diabetes mellitus is caused by a lack of insulin produced by the pancreas. It is not caused by a virus or infection.

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What is the difference between type 1 and type 2 diabetes?

Insulin is produced by the beta cells in the pancreas. Type 1 diabetes is due to the destruction of the beta cells with progressive and eventual complete loss of insulin secretion. This type always requires insulin therapy. Type 2 diabetes is characterized by dysfunctional beta cells (irregular insulin production) or the other cells of the body not responding to insulin properly. Type 2 diabetes may or may not require insulin therapy. In general, all diabetic dogs have type 1 diabetes and require insulin to control their disease. Unlike dogs, cats can fall under the type 1 or type 2 classifications.

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What is the expected life span for a diabetic cat?

It is only recently that cats were treated aggressively for diabetes. Sadly, not many years ago these animals would have automatically been euthanized. Today, studies suggest that, if a cat is kept well regulated and does not have any other health problems, he or she should be able to have a normal life expectancy. Cats may also go into remission with the proper therapy and a controlled diet.

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My cat was recently diagnosed. What advice would you give me?

Learn everything you can about diabetes—talk to your veterinarian. Your cat’s quality of life will depend on what you know and how well you manage its diabetes. You will need to work closely with your veterinarian, and offer your input. Do not be afraid to ask questions, or ask for training from your veterinarian on giving injections and monitoring blood glucose levels. Finally, stay positive. Unlike dogs, some cats may go into remission.

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Is diabetes in animals similar to that of humans?

Yes, it is very similar. Your cat will be using similar medications, equipment, and monitoring methods as human diabetics use.

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Vetsulin

Where on my cat’s body should Vetsulin be injected?

Injections should be given subcutaneously (under the skin) about 1 to 2 inches below the spine or backbone. Constantly vary the injection location from behind the shoulder blade to just in front of the hip bone, and alternate injections between the cat’s left and right sides. Your veterinarian can help guide you as to the recommended locations for injections. Download the Administration Sheet for instructions on how to administer Vetsulin to your cat.

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Can I still use a vial of Vetsulin if it freezes?

No, freezing will damage the insulin molecules and reduce its effectiveness. If a vial of insulin accidentally freezes in the refrigerator, it should be discarded and a new vial should be used.

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Can I still use a vial of Vetsulin if it was forgotten outside the refrigerator between doses?

Ideally, Vetsulin should be stored upright, protected from light, and maintained between 2°C and 8°C (35°F–46°F). After the vial has been used, it can remain at room temperature, not to exceed 25°C (77°F), for up to 42 days.

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What else should I know about Vetsulin?

  • Always have a spare vial on hand.
  • Keep it in the box to protect it from light.
  • Keep it refrigerated.
  • If it has gotten too hot, or frozen, discard it immediately.
  • Discard contents after 42 days of the first vial puncture.

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How do I dispose of insulin syringes?

Check local guidelines in your own community. All syringes should be disposed of in an appropriate sharps/biohazard container.

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Management of diabetes mellitus in cats

What must I do if I know that I missed a full dose or part of an injection?

If you missed a dose or part of a dose, it’s best to wait until the next insulin dose is required and then continue as normal. A brief period of high blood sugar (hyperglycemia) due to a low insulin dose is not as dangerous as the possibility of causing low blood sugar (hypoglycemia) by administering too much insulin.

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What should I do if I have or think I have given too much insulin?

Contact your veterinarian and explain the situation.

Monitor your cat carefully for signs of low blood sugar (hypoglycemia):

  • Hunger
  • Restlessness
  • Shivering
  • Unsteadiness
  • Very quiet or sleepy

If you see any of these signs, encourage your cat to eat a small meal or if this fails, rub some corn syrup on your cat’s gums.

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What should I do if I think that my cat has very low blood sugar (hypoglycemia)?

The following signs may indicate hypoglycemia:

  • Restlessness
  • Trembling or shivering
  • Unusual movements or behavior
  • Unusual quietness or sleepiness
  • Loss of consciousness (coma)

If your cat is conscious, rub approximately 1 teaspoon of corn syrup on his or her gums. When your pet is able to swallow, feed its usual meal and contact your veterinarian.

If your cat is unconscious or having a seizure, this is a medical emergency. CONTACT YOUR VETERINARIAN. In the meantime, you should immediately treat your cat by pouring a small amount of a sugar solution (eg, corn syrup) onto your finger and then rub it into your cat’s gums. The sugar is absorbed very quickly and your cat should respond in 1 to 2 minutes.

The sugar solution should never be poured directly into your pet’s mouth, because there is a risk that the solution will be inhaled into the lungs. As soon as your cat responds to the sugar administration and is sitting up, you can feed it a small, high-protein meal. After the cat has stabilized, transport it to your veterinarian for evaluation.

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How much water should I let my cat drink?

If your diabetic cat is drinking excessive amounts of water, then let it have all it can drink. Your cat’s body is trying to combat the high blood glucose level by expelling excess sugar through the urine. Once your cat is regulated, this behavior will stop.

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What is the importance of making sure my cat is regulated?

If diabetes is left untreated or unregulated, it could cause many complications. The most common chronic complication of diabetes in the cat is the development of peripheral neuropathy, which is exhibited by weakness in the hind legs. Diligent control of hyperglycemia (high blood sugar) can potentially reverse the clinical signs of neuropathy. Recurrent infections are a common problem in both canine and feline diabetics.

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How long does it take to regulate a diabetic animal?

Each case is different. There is no way to put a specific time on it. Sometimes the regulation process will require you to try different dosages, diets, or injection frequencies. Regulation can be achieved sometimes within a month, and in some cases, over a year from the time therapy first started. It is very important to work closely with your veterinarian during this process to avoid complications. Even after your cat is regulated, frequent veterinarian visits for examinations and consultations will help maintain good health.

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My cat is ill and not eating. Should I still give him/her an insulin injection?

If your cat is not eating—do not administer Vetsulin! If your cat has a reduced appetite and eats only half of its meal or usual intake, reduce the daily dose of insulin by half. If the situation lasts more than 2 days (due to illness, for example), consult your veterinarian.

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What can I give my cat as a treat?

Your veterinarian will be the best person to determine your cat’s diet, as he or she best knows its needs. Ask about appropriate treats your pet could still enjoy!

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What does the typical diet consist of?

To keep your pet’s diet constant from day to day, it’s best to use commercially produced rather than homemade foods. Cats are natural meat eaters and in general need high-protein, low-carbohydrate diets. Canned foods are generally lower in carbohydrates and preferred over dry foods. Consult with your veterinarian for the best diet to meet your cat’s specific needs.

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What is a blood glucose curve?

Your veterinarian will use the blood glucose curve as a tool to either validate or adjust your pet’s insulin dose. The procedure is as follows: shortly after the animal has been given its first meal (preferably at home), the first blood sample is taken just prior to the insulin injection in the morning. Thereafter, blood samples are collected every 2 hours throughout the day for about 12 hours, if possible. These data are then plotted on a graph to generate a curve that is useful for veterinarians to determine how well the current insulin dose is working.

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What are some problems with blood glucose curves?

Blood glucose curves done at a veterinary clinic may only approximate how the diabetic pet responds to insulin at home. Feeding and exercise patterns are different, and stress (especially in cats) can alter the glycemic response. Therefore, your veterinarian will take clinical signs (or lack thereof) into account when contemplating any change in the insulin therapy. The ultimate goal in regulating your diabetic pet is to control the clinical signs rather than achieve an ideal glucose curve.

In addition, it is not uncommon for curves to vary from day to day, because many things such as appetite, digestion, metabolism, exercise, hormones, and stress, can affect blood glucose levels.

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How often should a blood glucose curve be done?

After your pet is regulated, blood glucose curves should be done a minimum of every 3 to 6 months, or more frequently if a problem is suspected. Your veterinarian will advise you on the frequency.

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What is stress hyperglycemia?

Stress hyperglycemia is caused when the pet is frightened or stressed. It’s caused by the release of epinephrine (adrenaline). Glycosuria (glucose in the urine) is usually absent with stress hyperglycemia, because the blood glucose does not stay high for a significant period and therefore does not spill into the urine. Stress hyperglycemia does not influence the diagnosis of diabetes, because the blood glucose level does not stay elevated long enough to cause glucose to spill into the urine.

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What is fructosamine?

Fructosamine is essentially glucose bound to proteins in the blood and can be used to measure glycemic (glucose) control over a longer period. Unlike blood glucose measurements, fructosamine is not affected by stress or the timing of the insulin injection. Your veterinarian may recommend periodic measurements of fructosamine to evaluate how well your cat’s blood glucose level has been controlled over the last few weeks.

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About VetPen

What makes VetPen unique?

As the first insulin pen for use in diabetic dogs and cats, VetPen:

  • Is more convenient and can be less intimidating to use than insulin syringes. The ergonomic design of VetPen makes it easier to give your cat insulin injections discreetly anywhere, without the hassle of dealing with vials and syringes.
  • Makes it easier to deliver an accurate dose consistently over time. By simply turning the dial, you can accurately select a dose. In a laboratory study, VetPen was found to be consistently more accurate than syringes for low doses.11
  • Helps enhance insulin delivery safety. The all-in-one construction of VetPen, double needle caps, and sharps remover reduce the risk of accidental needle stick injuries.
  • Takes fewer steps to prepare doses than using syringes. VetPen contains a multi-dose insulin cartridge that allows you to prepare doses easily once a new cartridge has been primed (air removed from cartridge) for use.

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Is VetPen difficult to use?

VetPen is ergonomically designed for easy handling and dosing. Additional adaptors are provided to further assist you if you have visual or manual dexterity issues.

In a 3-week study, close to 97% of pet owners reported that VetPen was easy to use overall.3 And more than 97% reported being able to learn how to use VetPen.12,13

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Is VetPen more accurate than using an insulin syringe?

Yes. In a laboratory study, VetPen was shown to be consistently more accurate than syringes for low doses. Even when drawn up by trained lab technicians, study results showed that syringes delivered at least 20%-25% more insulin than needed for a 1-unit dose.11 Unlike syringes, VetPen provides a precise and accurate dose every time, without relying on your capability to draw up an accurate dose.

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Can VetPen be used with other insulins?

No. VetPen must be used with specially designed 3 mL cartridges containing 2.7 mL of 40 IU/mL concentration of Vetsulin, the world’s most trusted veterinary insulin, proven safe and effective for more than 20 years in hundreds of thousands of diabetic pets.* To avoid damaging VetPen and dosing errors, cartridges containing other insulin should not be used with VetPen.

* Vetsulin is known as Caninsulin outside the US.

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Using VetPen

How does selecting a dose with VetPen differ from drawing up a dose with a syringe?

While the overall injection process is similar, VetPen allows you to select doses more accurately. With just the turn of a dial, you can select a customized dose of insulin down to 0.5 units for your cat. And, with a push of the release button, the VetPen’s internal mechanism works to deliver the precise dose each and every time.

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How do I know when the injection is complete?

To make sure your cat’s dose is injected precisely and accurately, you need to hold down the release button until the arrow () points to the start line (—) on the dose selector. Then, wait at least 5 seconds before removing the needle from the skin. This allows for VetPen’s internal mechanism to optimally deliver the selected dose.

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Why does the VetPen need to be tested before each injection?

It is important to confirm that the VetPen and the needle are working properly to ensure that your cat receives an accurate dose of insulin. To do so, measure a small dose and ensure that the insulin flows freely through the needle.

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What should the insulin cartridge look like after mixing and priming?

Each cartridge contains 2 glass beads to help with the mixing of the Vetsulin before use. The cartridge should be shaken thoroughly before inserting it into the VetPen. After shaking, the insulin should appear uniformly milky. Do not use the cartridge if clumps persist after shaking thoroughly. Do not mistake the glass mixing beads for air bubbles, which should be removed during priming.

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Is VetPen reusable?

Yes. VetPen contains an insulin cartridge that allows multiple doses to be provided with minimal preparation time, even when away from home. Just be sure that there is enough insulin in the cartridge for a full dose before leaving home. When all the insulin has been used, simply remove the empty cartridge and insert a new one. Please note that sterile needles are designed for single use only and should not be reused. Tests show that VetPen lasts for at least 3,000 uses.11

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What type of needle is used with VetPen?

VetPen is designed to work optimally with specific 29 gauge/12 mm needles, which are small, thin, triple-sharpened, and specially lubricated to lower penetration force and minimize discomfort for your cat. These are the only needles that should be used with VetPen. Always use a new needle for each injection to minimize your cat's discomfort and ensure the needle is sterile.

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Can VetPen needles be reused?

No. Sterile needles are designed for single use only. A new needle should be used for each injection. A needle may become blunt or bent after use, which may cause your cat discomfort. The needle should be removed with the needle remover and safely disposed of immediately after use.

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Does VetPen need to be kept refrigerated when it contains an insulin cartridge?

Yes, VetPen should be refrigerated after a cartridge has been loaded and the VetPen is in use. Vetsulin cartridges should also be refrigerated before use. At all times cartridges should be protected from light. Vetsulin cartridges should not be frozen.

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What is the proper care of VetPen?

To clean VetPen, simply wipe with a damp cloth. Do not immerse it in water.

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Troubleshooting VetPen

Whenever experiencing any issues using VetPen, the first step should always be to confirm that air was properly removed from the cartridge through priming. Air bubbles in the cartridge can create multiple issues that result in the pet receiving too much or too little insulin.

What if insulin drips actively from the needle after injection?

This may be a sign that the needle may have been removed before the injection was completed. If the VetPen needle is removed from the skin too early, the pet did not receive its full insulin dose.

To make sure the pet receives its full dose, be sure to press the release button down fully and hold it until the arrow () points to the start line (—) on the dose selector. Then, to allow the VetPen to deliver the full dose, wait at least 5 seconds before removing the needle from the skin.

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What if the dose selector does not return to the start line after testing VetPen?

There are 4 likely causes for this:

  1. If the release button is not fully pushed toward the needle, it sometimes prevents the dose from being released completely. Be sure to push the release button down fully during each injection so that the dose selector can rotate back to the start line. Then, wait at least 5 seconds before removing the needle.
  2. You may be closing your hand too tightly around the dose selector, which can prevent it from fully rotating back to the start line. Avoid this from happening by holding the VetPen like a pen so that the dose selector is able to rotate freely after the release button has been completely depressed.
  3. The needle could potentially be blocked. Replace the needle on VetPen with a new one. It is important to use a new needle for each injection for hygiene and safety reasons.
  4. The cartridge may not have contained enough insulin for the full dose. If the cartridge is empty, replace it with a new one and complete the priming process. For additional information, see the next question.

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What if there is not enough insulin in the cartridge to complete an injection?

If there is not enough insulin left in the cartridge to give the pet its full dose, you can tell how many units of the dose were not given by looking at the number where the dose selector stopped. You may need to give the remainder of the dose. If so, write that number down.

Put in a new cartridge and prime (remove air from cartridge) and prepare the VetPen for use. Then, turn the dose selector to the number you wrote down and inject the pet as usual.

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What if a dose too large for the pet is selected?

If too high a dose has been selected, it is very important not to try to turn the dose selector back to a lower dose. This can damage or break the VetPen. The dose selector is designed to move from low to high numbers, but cannot be moved back from high to low numbers. If too high a dose has been selected, release the insulin through the needle into a tissue or swab by pressing the release button. Then select the correct dose.

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What if no insulin drips actively or squirts from the needle after priming or preparing for use?

There are 2 likely causes for this:

  1. The needle is blocked.
    To fix, replace the needle on VetPen with a new one. Remember to use a new needle for each injection. The needle is designed for single use only.
  2. The cartridge plunger is stuck.
    Follow these steps to fix this:
    • Place the protective cap back onto the needle and unscrew the cartridge holder.
    • Slide the release button towards the internal plunger and hold it until the arrow points to the start line.
    • Dial 2 units without screwing the device back together.
    • Push and hold down the release button until the arrow points to the start line.
    • Without rewinding the internal plunger, screw the cartridge holder and the VetPen body back together. This should release the cartridge plunger and expel some of the insulin.

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General

How often should my diabetic cat see the veterinarian?

If your cat appears and acts healthy and is well regulated, most experts recommend every 3 months. Talk to your veterinarian to see how often they would like to see your cat.

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Should my diabetic cat still receive vaccinations?

It is perfectly safe and desirable for your diabetic cat to receive its vaccinations. In fact, this annual visit also gives your veterinarian a good opportunity to give your cat a complete examination. By keeping your diabetic cat healthy, there will be fewer fluctuations in its insulin requirements.

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Is it safe for a cat with diabetes mellitus to receive a general anesthetic?

Normally animals need to have an empty stomach before they are anesthetized. A diabetic cat that has not been fed needs far less insulin. Your veterinarian will advise you on how much insulin to give your cat before it is admitted, or he or she may wish to administer a reduced dose of insulin to your pet. Usually a diabetic cat is administered intravenous fluid therapy while under anesthesia. This hydrates the animal when it cannot drink on its own. Apart from needing a reduced amount of insulin and fluid therapy (which is also given to some non-diabetic animals undergoing anesthesia), your diabetic cat is not at any additional risk from anesthesia than any other cat of the same age.