Unlock the Secret to Your Cat’s Health: Ultimate Guide to Feline Diabetic Diets That Work!

Diabetes mellitus is a metabolic disorder affecting a significant number of cats, characterized by the body's inability to regulate blood glucose levels effectively. Like humans, cats require glucose for energy, and insulin, a hormone produced by the pancreas, plays a crucial role in transporting glucose from the bloodstream into cells. When insulin production is insufficient (Type I diabetes) or when cells become resistant to insulin's effects (Type II diabetes), glucose accumulates in the blood, leading to hyperglycemia. Feline diabetes most commonly presents as Type II. Understanding the intricacies of feline diabetes, including its causes, symptoms, diagnosis, and treatment options, is essential for cat owners to provide the best possible care for their diabetic companions. Dietary management is a cornerstone of diabetes management in cats, playing a vital role in regulating blood glucose levels, achieving and maintaining a healthy weight, and minimizing the clinical signs of the disease.

Understanding Feline Diabetes

Diabetes mellitus in cats mirrors the human condition, disrupting the body's ability to produce or respond to insulin, leading to elevated blood glucose levels. To understand the disease fully, it is important to understand the role of insulin. Insulin acts like a key, unlocking cells to allow glucose to enter and provide energy. In diabetic cats, this process is impaired, resulting in glucose buildup in the bloodstream.

There are two main types of diabetes in cats:

Type I Diabetes: Characterized by a decrease in insulin production.
Type II Diabetes: Characterized by cells not responding appropriately to insulin.

In both types, cells are deprived of energy despite an abundance of glucose in the blood. It is estimated that between 1 in 100 and 1 in 500 cats will be diagnosed with diabetes during their lifetime.

Risk Factors

Several factors can increase a cat's risk of developing diabetes:

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Obesity: Obese cats are four times more likely to develop diabetes compared to cats with a healthy weight.
Age: The risk increases with age.
Physical Inactivity: Lack of exercise contributes to insulin resistance.
Gender: Male cats are more prone to diabetes.
Glucocorticoid Use: Steroids used to treat other conditions can increase the risk.
Breed: Burmese cats may have a higher risk in some countries.

Maintaining a healthy weight and encouraging physical activity are crucial steps in preventing diabetes in cats.

Recognizing the Signs

Early detection of diabetes is crucial for effective management. The most common signs include:

Weight Loss: Despite a good appetite, cats may lose weight as their bodies break down fats and proteins for energy.
Increased Thirst and Urination: High blood sugar levels overwhelm the kidneys, leading to excessive water loss through urine.
Plantigrade Stance: In rare cases, nerve damage in the hind limbs can cause cats to walk with their hocks on or close to the ground.

If you notice these signs, consult your veterinarian for diagnosis and treatment.

Diagnosis

Veterinarians diagnose diabetes mellitus by assessing clinical signs and demonstrating persistently elevated glucose levels in a cat’s blood and urine. A single blood glucose reading may not be sufficient, as stress can temporarily elevate glucose levels (stress hyperglycemia). A fructosamine concentration test can provide a rough average of blood glucose levels over the past two weeks, helping to differentiate stress-induced hyperglycemia from true diabetes. Further tests may be recommended to rule out other underlying conditions.

Treatment Options

The primary goals of feline diabetes treatment are to:

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Restore normal blood glucose concentrations.
Stop or control weight loss.
Minimize increased thirst and urination.
Avoid hypoglycemia (low blood sugar).

Treatment typically involves a combination of insulin therapy and dietary management, and in some cases, oral medications.

The cornerstone of treatment: Insulin Therapy

Insulin injections are a common treatment for feline diabetes. These injections are administered subcutaneously approximately every 12 hours. There are several types of insulin preparations available, including lente insulin (Vetsulin), ProZinc, and glargine insulin. Each type varies in cost, duration of action, and concentration. It is important for owners to discuss the pros and cons of each type with their veterinarian to determine the best option for their cat. It is also important to use the correct syringe size (U-100 or U-40) for the specific type of insulin being used.

Although administering injections may seem intimidating, most owners can be taught to do so at home. Cats usually tolerate these injections well due to the small needle size. While ideally, injections should be spaced 12 hours apart, varying the timing by 1-2 hours when necessary should not adversely affect treatment.

Dietary Therapy: A Key Component of Feline Diabetes Management

Dietary management is a critical aspect of managing diabetes in cats. The goals of dietary therapy are to optimize body weight with appropriate protein and carbohydrate levels, fat restriction, and calorie and portion control. A diet low in carbohydrates and high in protein has been shown to improve blood sugar regulation in diabetic cats.

Key Principles of a Feline Diabetic Diet

High Protein: A high-protein diet (≥40% protein metabolizable energy) helps maximize metabolic rate, prevent lean muscle-mass loss, and improve satiety.
Low Carbohydrate: Limiting carbohydrate intake minimizes hyperglycemia and glucose toxicity.
Moderate Fat: Fat restriction contributes to weight management.
Calorie Control: Precise calorie control is essential for weight loss in obese cats and preventing further weight loss in underweight cats.

Food Choices for Diabetic Cats

Wet Food: Canned foods are generally preferred over dry foods due to their lower carbohydrate content.
Prescription Diets: Several prescription food options are available in both wet and dry forms, specifically formulated for diabetic cats. These diets can be particularly useful for weight loss. Examples include Purina DM and Purina OM.
Nonprescription Diets: Diabetes can be managed with a carefully controlled program using a cat's normal diet, ensuring it meets the principles of high protein, low carbohydrate, and moderate fat.

It is important to stay away from food with gravy, as they are high in carbohydrates.

Feeding Schedule

The ideal feeding schedule for most diabetic cats is the same measured amount of the same food every 12 hours, just before administering insulin. However, some cats prefer to graze throughout the day, which is acceptable as long as the diet is low in carbohydrates and a longer-acting insulin preparation is used. Cats do not need to eat before receiving insulin, provided they are feeling fine. If food must be withheld for any reason, such as an anesthetic procedure, it is generally recommended to give 50 percent of the usual dose of insulin, with careful follow-up monitoring to ensure good glycemic control.

If a cat refuses to eat, a half dose of insulin should be administered, and a veterinarian should be contacted.

Weight Management

Achieving and maintaining a healthy weight is crucial for diabetes management. Overweight cats can develop insulin resistance, requiring higher insulin doses. Weight loss can lead to lower insulin requirements. Slow, controlled weight loss under veterinary supervision is important for overweight cats diagnosed with diabetes.

The "Prescription Diet" Misconception

It's important to note that the term "prescription diet" can be misleading. Many of these diets do not contain ingredients that require a prescription. The sale of these diets is often restricted to veterinarians as a marketing strategy.

Oral Medications: A Newer Treatment Option

In 2023, a new class of medications known as SGLT2 (sodium-glucose cotransporter 2) inhibitors was approved for the treatment of feline diabetes. These medications are administered orally once daily and lower blood glucose by increasing the amount of glucose excreted through the kidneys. These medications help improve the clinical signs of diabetes by lowering insulin resistance and reducing damage to the pancreas, allowing the cat to produce more of its own insulin.

SGLT2 inhibitors are approved for treatment of newly-diagnosed diabetic cats who are otherwise healthy and have not been previously treated with any injectable insulin. Studies have shown these medications to be more than 80% effective at improving blood glucose control in appropriate patients. Because these treatments rely on the cat making at least some insulin on its own, it is not appropriate for every patient, and this treatment should be discussed with a veterinarian before starting.

Monitoring: A Vital Part of Diabetes Management

Close monitoring by both the owner and the veterinarian is an essential part of treatment for a diabetic cat. Regular monitoring will help determine the ideal insulin dose for each cat as well as help avoid complications, such as hypoglycemia or uncontrolled diabetes and diabetic ketoacidosis.

Monitoring Techniques

Regular Assessments: Weight, water intake, and appetite should be recorded to help determine if treatment goals are being met. Monitoring your cat at home requires careful attention to these factors. Cats with well-controlled diabetes should maintain a normal activity level and demeanor.
Blood Glucose Curves: Blood glucose curves are the ideal way to monitor blood sugar regulation during treatment. The cat’s blood sugar will be checked right before receiving an insulin injection, and then every 1-4 hours throughout the day. This helps make sure that the average blood glucose is within an acceptable range, and that the value does not drop dangerously low at any time throughout the day. These assessments may need to be performed every few weeks when a cat is first diagnosed with diabetes in order to determine the appropriate dose of insulin, but can be spaced out further once the diabetes is more well-regulated. Even in a stable cat, blood glucose curves should still be performed every 3-4 months, as insulin needs can change over time.
Home Monitoring: Many cat owners can learn to perform blood glucose curves at home, which helps avoid stress hyperglycemia and inappetence experienced by many cats in the veterinary clinic, and can therefore give more accurate results. Blood can be collected at home from an ear vein or paw pad, and should be read on a blood glucose monitor that has been tested in cats. The Walmart Relion Micro or the newer Relion Confirm are good options, as they use only a small amount of blood (0.3 uL) and utilize 'wicking' test strips.
Continuous Glucose Monitoring: Some veterinarians may utilize a continuous blood glucose monitoring system to help determine blood sugar concentrations at home. With this approach, a small monitor is implanted on the cat’s skin in the veterinary clinic, which stays in place and records blood glucose readings every few minutes for a few days up to two weeks. Though this can provide a lot of information without repeated needle pricks, not all cats will tolerate the monitor for long so it is not a viable option for all owners.
Fructosamine Concentration: If performing a blood glucose curve is not an option, a fructosamine concentration can be used to get a rough estimate of blood sugar control over the last two weeks with a single blood draw. However, this is not an ideal way of monitoring a diabetic cat as it only measures the average, rather than the blood sugar highs and lows throughout the day, which are often more important in determining the success of their treatment.

It is very important that owners who monitor blood glucose readings at home do NOT change their cat’s insulin dose without discussing first with their veterinarian.

Monitoring Cats on SGLT2 Inhibitors

For cats being treated with an SGLT2 inhibitor, close monitoring is also important, especially during the beginning of the treatment. Bloodwork, including ketone levels and blood glucose curves, will be regularly monitored, as well as physical examinations and weight measurements.

The Dangers of Urine Glucose Monitoring

Using urine sugar (glucose) levels to manage a diabetic cat is far from optimal.

Potential Complications

Despite careful management, complications can arise.

Hypoglycemia

Insulin therapy and SGLT2 medications lower blood glucose, possibly to dangerously low levels. Signs of low blood sugar (hypoglycemia) include weakness, lethargy, vomiting, lack of coordination, seizures, and coma. Hypoglycemia can be fatal if left untreated, so any diabetic cat that shows any of these signs should be offered its regular food immediately. If the cat does not eat voluntarily, it should be given oral glucose in the form of honey, corn syrup, or proprietary dextrose gels (available at most pharmacies) and brought to a veterinarian immediately. It is important, however, that owners not attempt to force fingers, food, or fluids into the mouth of a convulsing or comatose cat.

Diabetic Ketoacidosis

Diabetic cats with uncontrolled diabetes may develop a condition known as ketoacidosis. This occurs when cells starved for glucose begin to break down fats for energy, a process that creates chemicals called ketones, which make the blood more acidic. Ketoacidosis is considered a medical emergency, and cats diagnosed with this complication require hospitalization for ideal management.

Prognosis and Remission

While there is no cure for feline diabetes, the prognosis for a good quality of life is good with adequate management at home. With early, aggressive treatment of diabetes, many cats will enter a state of diabetic remission, meaning they are able to maintain normal blood sugar levels without insulin injections. Older cats, cats who have previously received steroid medications, and cats treated with glargine insulin have been shown to be more likely to go into diabetic remission, but the most important factor is starting insulin therapy early and monitoring closely. If a cat has not entered diabetic remission within the first six months after diagnosis, it will almost certainly require life-long insulin injections. Cats who have achieved diabetic remission should continue to be fed a low-carbohydrate diet and receive close monitoring, as some will eventually require insulin therapy again.

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