Frequently asked questions

Diabetes mellitus in cats

Vetsulin® (porcine insulin zinc suspension)

Treatment of diabetes mellitus in cats

General


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.


I have heard about diabetes insipidus; is this the same as diabetes mellitus?

No. Diabetes insipidus, also known as water diabetes, is caused when large amounts of diluted urine are produced. It is a far less common condition than diabetes mellitus. Diabetes insipidus is caused by problems in part of the brain or in the kidneys. There is no glucose present in the urine of animals with diabetes insipidus.


What signs do cats with diabetes typically show?

The most common symptoms of diabetes mellitus in cats include:

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


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.


My cat is having problems holding its urine; does that mean it's diabetic?

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


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 mean that your pet has diabetes mellitus.


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.


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.


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.


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.


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 dogs have type 1 diabetes and require insulin to control their disease. Unlike dogs, cats can fall under the type 1 or type 2 classification.


What is the expected lifespan for a diabetic cat?

The prognosis for diabetic cats depends in part on owner commitment to treating the disease, as well as whether other diseases are present. Diabetic cats that survive the first 6 months can generally maintain a good quality of life for more than 5 years with the disease. Also, keep in mind that many cats are diagnosed later in life, so a 2 to 5-year life expectancy may not be that different from their average lifespan anyway. Recent data suggest that, if a cat is kept well regulated and does not have any other health problems, it should be able to have a normal life expectancy with a high quality of life.


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

Learn everything you can about diabetes. 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. Don’t be afraid to ask questions, or ask for training on giving injections and monitoring blood glucose levels.


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.


 

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 hipbone, and alternate injections between the cat’s left and right sides. Your veterinarian can help guide you as to the recommended locations for injections.


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.


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

Vetsulin should be stored upright, protected from light, and maintained between 2° and 8° C. If the Vetsulin vial has been accidentally stored outside the refrigerator, consult your veterinarian for advice on whether the Vetsulin can still be used or not.


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.


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.

 


Treatment of diabetes mellitus in cats

What must I do if I know that I missed part of an injection?

If you missed 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.


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, try to encourage your cat to eat a small meal or if this fails, rub some corn syrup or honey on your cat’s gums.


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 one teaspoon of corn syrup or honey 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 or honey) 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.


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.


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.


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 occasions, 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.


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.


Should I feed my cat before or after an injection?

It is very important that your cat eats before you administer Vetsulin—either a meal about 20 minutes before the injection or free-choice food throughout the day prior to the injection works well.


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!


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.


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.


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 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, hormones, and stress can affect blood glucose levels.


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.


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.


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.

 


General

How often should my diabetic cat see the veterinarian?

If your cat appears and acts healthy, most experts recommend every 3 months.


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 check-up 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.


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 healthy cat of the same age.