TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 

 

 

DIABETES MELLITUS

 

ON THIS PAGE:


What is Diabetes?


Risk Factors


Symptoms


Diagnosis


Treatments


Monitoring


Possible Problems


Diabetes and CKD


Support


 

 

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Acute Kidney Injury


 

KEY ISSUES


Nausea, Vomiting, Appetite Loss and Excess Stomach Acid


Maintaining Hydration


The Importance of Phosphorus Control


All About Hypertension


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Potassium Imbalances


Metabolic Acidosis


Kidney Stones


 

SUPPORT


Coping with CKD


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Success Stories


 

SYMPTOMS


Alphabetical List of Symptoms and Treatments


Fluid and Urinary  Imbalances (Dehydration, Overhydration and Urinary Issues)


Waste Product Regulation Imbalances (Vomiting, Appetite Loss, Excess Stomach Acid, Gastro-intestinal Problems, Mouth Ulcers Etc.)


Phosphorus and Calcium Imbalances


Miscellaneous Symptoms (Pain, Hiding Etc.)


 

DIAGNOSIS: WHAT DO ALL THE TEST RESULTS MEAN?


Blood Chemistry: Kidney Function, Potassium, Other Tests (ALT, Amylase, (Cholesterol, Etc.)


Calcium, Phosphorus, Parathyroid Hormone (PTH) and Secondary Hyperparathyroidism


Complete Blood Count (CBC): Red and White Blood Cells: Anaemia and Infection


Urinalysis (Urine Tests)


Other Tests: Ultrasound, Biopsy, X-rays etc.


Renomegaly (Enlarged Kidneys)


Which Tests to Have and Frequency of Testing


Factors that Affect Test Results


Normal Ranges


International and US Measuring Systems


 

TREATMENTS


Which Treatments are Essential


Fluid and Urinary Issues (Fluid Retention, Infections, Incontinence, Proteinuria)


Waste Product Regulation (Mouth Ulcers, GI Bleeding, Antioxidants, Adsorbents, Azodyl, Astro's CRF Oil)


Phosphorus, Calcium and Secondary Hyperparathyroidism (Calcitriol)


Miscellaneous Treatments: Stem Cell Transplants, ACE Inhibitors - Fortekor, Steroids, Kidney Transplants)


Antibiotics and Painkillers


Holistic Treatments (Including Slippery Elm Bark)


ESAs (Aranesp, Epogen etc.) for Severe Anaemia


General Health Issues in a CKD Cat: Fleas, Arthritis, Dementia, Vaccinations


Tips on Medicating Your Cat


Obtaining Supplies Cheaply in the UK, USA and Canada


Working with Your Vet and Recordkeeping


 

DIET & NUTRITION


Nutritional Requirements of CKD Cats


The B Vitamins (Including Methylcobalamin)


What to Feed (and What to Avoid)


Persuading Your Cat to Eat


Food Data Tables


USA Canned Food Data


USA Dry Food Data


USA Cat Food Manufacturers


UK Canned Food Data


UK Dry Food Data


UK Cat Food Manufacturers


2007 Food Recall USA


 

FLUID THERAPY


Intravenous Fluids


Subcutaneous Fluids


Tips on Giving Subcutaneous Fluids


How to Give Subcutaneous Fluids with a Giving Set


How to Give Subcutaneous Fluids with a Syringe


Subcutaneous Fluids - Winning Your Vet's Support


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Home > Related Diseases > Diabetes

 


Overview


  • It is not uncommon for a CKD cat to also have or develop diabetes.

  • The dietary needs of a diabetic cat may seem incompatible with the needs of a CKD cat but the diabetes must take precedence.


What is Diabetes Mellitus?


 

Insulin is a hormone which enables the body to process food and to produce energy from it. Diabetes mellitus is a disease in which:

  • not enough insulin is produced by the pancreas; or

  • the cat’s body cells do not properly process insulin which the pancreas has produced.

As a result, the cat develops high blood sugar levels (hyperglycaemia), which eventually lead to high sugar levels in the urine (glucosuria).

 

Diabetes may present as:

  • uncomplicated; or

  • diabetes with ketoacidosis (DKA)

Cats with the former may only have mild symptoms, at least in the early stages, but cats with ketoacidosis are usually very ill, and may die if not treated promptly.

 

There is another, much rarer form of diabetes called diabetes insipidus which is beyond the scope of this website.

 

Cornell University College of Veterinary Medicine has a good general overview of diabetes in cats.

 

Feline diabetes mellitus: from diagnosis to therapy (2009) is a helpful article by Dr DL Zoran.

 

Feline Diabetes provides detailed answers to frequently asked questions.

 


Risk Factors


 

Increasing age is a factor (as it is for CKD cats). Steroid-induced diabetes in cats (2013) Peterson ME Veterinary Endocrinology says "The average age at diagnosis for feline diabetes is 10 years, with a peak incidence between 9 and 13 years."

 

Obesity in cats, as in humans, is a strong predisposing factor for diabetes.

 

For some reason, male cats and neutered cats are more at risk of diabetes.

 

Burmese cats in the UK and Australasia (but not the USA) appear to be more at risk.

 

Cats who are on corticosteroids may also develop diabetes. Steroid-induced diabetes in cats (2013) Peterson ME Veterinary Endocrinology has some information about this.

 

CKD, pancreatitis, hyperthyroidism and infections all cause insulin resistance in cats, making them more susceptible to diabetes, according to Feline diabetes mellitus (2012) Huang A NAVC Clinician's Brief Oct 2012 pp21-24.

 

The American Veterinary Dental College states "studies in humans have linked periodontal disease to a variety of health problems including poor control of diabetes mellitus and increased severity of diabetic complications. Additionally, it has been shown that diabetes is a risk factor for periodontal disease."

 

Cats who have had a kidney transplant are more at risk.

 


Symptoms


 

The increase in sugar in the urine causes polyuria (increased urination) and polydipsia (increased drinking).

 

Diabetic cats also tend to lose weight, so to some extent the symptoms of diabetes may resemble those of CKD, although there is one noticeable difference, namely that diabetic cats tend not to lose their appetites – they lose weight despite continuing to eat, and may in fact eat more (this can also be a symptom of hyperthyroidism).

 

However, more advanced diabetes may cause lack of appetite, plus poor coat quality, vomiting and dehydration and occasionally breathing problems. Bladder infections are also relatively common because of the sugar in the urine, and inappropriate elimination may occur.

 

You may also see a plantigrade posture (as demonstrated by Ollie to the left), where the cat walks on his/her hocks instead of his/her feet. In diabetic cats this is usually caused by diabetic neuropathy, where the nerves in the legs are damaged by the disease; but it may sometimes be seen in cats with high phosphorus levels, or with neurological problems from other causes. Ollie was never diabetic, he did this because of low potassium levels.

 

Long Beach Animal Hospital has a photograph of a cat with diabetic neuropathy doing this (click on Symptoms). Newman Veterinary has a good before and after photo of a diabetic cat with this problem, scroll down a little to Other Common Consequences, then click on Plantigrade Stance (in red font). The Mayo Clinic has some information about peripheral neuropathy, including that caused by diabetes.

 

The symptoms of diabetic ketoacidosis are discussed here.

 


Diagnosis


 

The vet will base the diagnosis on clinical signs and blood and urine tests, particularly high levels of sugar (glucose) in the blood and urine on an ongoing basis.

 

Glucose (Glu) in the Blood


Glucose is also known as blood sugar, and it will be elevated in diabetic cats.

 

Glucose levels may also be elevated in cats with hyperthyroidism or secondary hyperparathyroidism.

 

This value may increase suddenly because of stress – it is not uncommon for this value to be high in cats who get stressed or frightened at the vet’s. Therefore a high level on one occasion should not be taken to indicate diabetes, urine testing is also required.

 

Overview of feline bloodwork (2008) Jensen A 2008 Zimmer Feline Foundation states "Glucose also has a tendency to show dramatic increases in a healthy cat under acute stress.  Normal blood glucose should be well below 150 mg/dl.  In most species, a glucose measurement of over 200 would strongly suggest diabetes.  In the feline, however, stress alone can cause glucose to spike as high as 250 mg/dl.  A value over 300 is unlikely to be due to stress alone."

 

Cornell University College of Veterinary Medicine has some information on blood glucose.

 

Glucosuria (Glucose in Urine)


If your cat has high blood glucose levels, your vet may wish to test for glucose in the urine. Normally cats do not have glucose in their urine, so increased levels may indicate diabetes. Overview of feline bloodwork (2008) Jensen A 2008 Zimmer Feline Foundation states "One way to differentiate between a glucose spike due to acute stress and high blood glucose due to diabetes is through urinalysis.  If there is no glucose in the urine in the face of high blood glucose, it may be due to the fact that the blood glucose has not been high long enough to overflow into the urine, suggesting an acute spike. This is not definitive, however. Presence of glucose in the urine is, however, highly suggestive of diabetes."

 

Glucose in the urine may also be elevated in cats with acute kidney injury.

 

Cats with renal tubular disease may have glucosuria, but in this case glucose levels are high because the kidneys are not able to filter the glucose out of the blood properly; however, this is extremely rare. Renal tubular defects in small animals (2016) Brown SA Merck Veterinary Manual explains more about this.

 

Cornell University College of Veterinary Medicine has some information on glucose in urine.

 

Fructosamine


Since high blood glucose levels may be caused by the stress of a vet visit, it is a good idea to check fructosamine. It is the ongoing nature of the increased glucose level that is important, and the fructosamine test measures concentrations of glucose molecules historically over a period of approximately 2-3 weeks.

 

Lab Tests Online has an overview of the fructosamine test.

 

Caninsulin explains more about fructosamine.

 

Vetsulin discusses fructosamine.

 

Glycosylated Haemoglobin (GHb)


Glycosylated haemoglobin is a similar test to fructosamine, but it measures concentrations of glucose molecules historically over a longer period of approximately 2-4 months.

 

Vetsulin discusses fructosamine and GHb.

 

Kidney Values


Cats with ketoacidosis may have elevated BUN and creatinine levels, which in this situation may not necessarily be a sign of CKD, particularly if phosphorus and potassium levels are normal. Once the diabetes is under control, the BUN and creatinine levels may improve.

 

Diabetic cats also often have dilute urine, and the resulting dehydration may also cause increased kidney values. 

 

Initially the bloodwork may also indicate liver damage, which should improve as the diabetes is brought under control.

 


Treatments


 

Cats with ketoacidotic diabetes normally require hospitalisation including IV fluids and insulin therapy, until they are stabilised; thereafter they will be treated as cats with uncomplicated diabetes.

 

Uncomplicated diabetes is usually managed by means of insulin injections given at home, though initially these may be given in hospital.

 

Controlling any infection that is present, such as a urinary tract infection, may make the diabetes easier to manage.

 

ISFM consensus guidelines on the practical management of diabetes mellitus in cats (2015) Sparkes AH, Cannon M, Church D, Fleeman L, Harvey A, Hoenig M, Peterson ME, Reusch CE, Taylor S, Rosenberg D Journal of Feline Medicine and Surgery 17 pp235-250 discusses the treatment of diabetes in cats.

 

New treatments for feline diabetes (2013) Mooney C Presentation to the World Small Animal Veterinary Association discusses diabetes treatments.


Oral Medications


 

Sometimes diabetic cats can be treated with an oral medication called glipizide instead of injectable insulin. However, only about 30% of diabetic cats respond to glipizide, and cats taking it must be carefully monitored because the drug can damage the liver. In any event, most cats are far easier to inject than to pill.

 


Diet


 

if your cat is overweight (highly unlikely if your cat also has CKD), your vet will usually recommend a weight loss plan, which will aim to help your cat gradually lose the excess weight. Managing the obese diabetic cat (2007) Greco DS The 2007 Nestlé Purina Veterinary Symposium on Companion Animal Medicine discusses how to handle obesity in a diabetic cat.

 

If your cat is not overweight, your vet can advise you on diet. Cats have a low natural requirement for carbohydrates, and recent research indicates that higher protein, higher fat and lower carbohydrate diets may be most suitable for diabetic cats. Keys to management of diabetes in cats (2011) is a presentation by Dr S Little to the 36th World Small Animal Veterinary Association World Congress which states "Current recommendations support the use of a high protein (> 30% DM), low carbohydrate (< 40% DM) diet for management of feline diabetes. Several studies have demonstrated an improvement in blood glucose (BG) levels and a decreased need for insulin therapy on this type of diet. Canned food is preferred in diabetic cats to maintain hydration, lower carbohydrate content, and improve satiety."

 

There are a number of therapeutic diabetic foods available which may be suitable for this approach, such as Purina Pro Plan DM Dietetic Management Veterinary Diets.

 

Foods for diabetic cats are often considered in terms of what percentage of total daily calorie intake comes from carbohydrates (metabolisable energy or ME) rather than in terms of dry matter analysis. ISFM consensus guidelines on the practical management of diabetes mellitus in cats (2015) Sparkes AH, Cannon M, Church D, Fleeman L, Harvey A, Hoenig M, Peterson ME, Reusch CE, Taylor S, Rosenberg D Journal of Feline Medicine and Surgery 17 pp235-250 states "Although the optimal dietary CHo content has not been determined, diets with restricted CHo content (≤12% metabolisable energy [ME] or 3 g/100 kcal) was suggested by the majority of the Panel) are appropriate pending further studies."

 

Many people I hear from with diabetic cats seem to aim for tighter carbohydrate control, aiming for less than 10% of calorie intake from carbohydrate.  Feeding the diabetic cat (2014) Spector D Vetstreet explains more about this. Many kitten foods, which are usually high in protein and fat, are suitable for this approach. Fancy Feast Classic and Friskies pate varieties may be suitable, but are too high in phosphorus for cats who also have CKD.

 

Free feeding is not normally appropriate for diabetic cats. Cats receiving insulin twice a day are usually fed half their daily food ration each time. Cats receiving glipizide are normally fed several small meals a day.

 

There is some debate as to whether dry food is appropriate for diabetic cats. Indoor confinement and physical inactivity rather than the proportion of dry food are risk factors in the development of feline type 2 diabetes mellitus (2009) Singerland LI, Fazilova VV, Plantinga EA, Kooistra HS & Beynen AC Veterinary Journal 179(2) pp247-253 found no evidence that dry food diets in themselves cause diabetes in cats.

 

However, some diabetic cats are so sensitive to carbohydrate that they need less insulin, or in a few cases stop needing it altogether, if switched to a low carbohydrate diet. Comparison of a low carbohydrate-low fiber diet and a moderate carbohydrate-high fiber diet in the management of feline diabetes mellitus (2005) Bennett N, Greco DS, Peterson ME, Kirk C, Mathes M, Fettman MJ. Journal of Feline Medicine and Surgery Nov 3 found that the diabetic cats in this study who were fed the low carbohydrate-low fibre diet were significantly more likely to stop needing insulin than the cats fed the moderate carbohydrate-high fibre diet. Canned foods are usually much lower in carbohydrate than dry foods, so canned foods low in cereals and added sugars may be helpful in such cases, whereas dry foods, which tend to have a high carbohydrate content,  are usually avoided.

 

Diet changes should be made gradually if a cat is already taking insulin, and blood glucose levels should be carefully monitored, because sometimes there is a dramatic drop in blood glucose in response to reduced carbohydrate intake, with a possible risk of an overdose of insulin (see hypoglycaemia).

 

Diet in the prevention of diabetes and obesity in companion animals (2003) Rand JS, Farrow HA, Fleeman LM & Appleton DJ Proceedings of the Nutrition Society of Australia discusses how dietary changes may help with diabetes control.

 

Diet for Cats with Diabetes and CKD


If you are dealing with both diabetes and CKD, it is more important that the diabetes should be regulated, and in fact once this is achieved, you may find the CKD improves too.

 

With diabetes, the focus is on carbohydrate control (see above). This is not a problem for CKD cats but people dealing with both diabetes and CKD are sometimes anxious because it appears that the protein requirements of the two conditions are incompatible. In fact reduced protein is not necessarily essential in the treatment of CKD in the early stages, see Nutritional Requirements for more information.

 

Even if your cat's CKD is more advanced, Keys to management of diabetes in cats (2011) Little S Presentation to the 36th World Small Animal Veterinary Association World Congress states "Current recommendations support the use of a high protein (> 30% DM), low carbohydrate (< 40% DM) diet for management of feline diabetes." A protein level of 28-35% DMA is often recommended for CKD cats so I would aim for a protein level of around 35% DMA for a cat with both conditions if your vet agrees.

 

However, the need to moderate phosphorus intake for CKD cats still applies to cats with both CKD and diabetes, and if necessary, phosphorus binders will need to be used.

 

Methylcobalamin


Vitamin B12 in the form of methylcobalamin may be helpful for diabetic cats, particularly those with diabetic neuropathy. See Vitamin B for more information.

 

Feline diabetes - five principles breed success (2012) Norsworthy G Veterinary Practice News mentions the use of methylcobalamin for this purpose.

 

Jasper's Page has more information on this treatment.

 


Insulin


 

Insulin is a hormone which can be given via injection when the body is not producing enough insulin itself. Most cats with diabetes need to be given insulin to manage their diabetes properly, though some cats do enter a remission phase, during which insulin is not necessary.

 

Feline Diabetes has information about insulin.

 

Cornell University College of Veterinary Medicine has a series of videos covering all aspects of diabetic cat care, including how to give insulin, monitoring your cat, and recognising and treating hypoglycaemia. 

Insulin Choices


There are a number of different insulins available. ISFM consensus guidelines on the practical management of diabetes mellitus in cats (2015) Sparkes AH, Cannon M, Church D, Fleeman L, Harvey A, Hoenig M, Peterson ME, Reusch CE, Taylor S, Rosenberg D Journal of Feline Medicine and Surgery 17 pp235-250 has an overview of the various types of insulin available and states "the Panel recommends, whenever possible, the use of longer acting insulin preparations (eg, glargine, detemir or PZi), injected twice daily, for optimal diabetic control."

 

Trade names include:

  • ProZinc (protamine zinc insulin or PZI): FDA-approved for cats.

  • Lanctus (glargine)

  • Levemir (determir)

Caninsulin is the only insulin approved for use in cats in the UK, so it must be used first. This is because UK regulations require that a medication approved for a species in the UK must be used as the first choice, and alternatives can only be considered if the first choice medication does not work or causes too many side effects. This policy is known as the cascade and The British Small Animal Veterinary Association explains more about how it works.

 

Bovine insulin is most similar genetically to feline insulin, but is only available from compounding pharmacies in the USA. However, 2010 AAHA diabetes management guidelines for dogs and cats (2010) Rucinsky R, Cook A, Haley S, Nelson R, Zoran DL & Poundstone M Journal of the American Animal Hospital Association 46 pp215-224 state "Although bovine PZI is available from compounding pharmacies, its use is not recommended because of concerns about production methods, diluents, sterility, and the consistency of insulin concentration between lots."

 

Glargine (Lantus) is very expensive. One member of Tanya's CKD Support Group was paying US$265 for a vial, which would last 1-6 months. Some people source their insulin from Marks Marine Pharmacy in Canada, which apparently charges US$170 including shipping for about a year's supply (five pens).

 

Keys to management of diabetes in cats (2011) is a presentation by Dr S Little to the 36th World Small Animal Veterinary Association World Congress which compares the various brands of insulin available and advises on how to adjust insulin dosage.

 

Insulin: How to Give


There are a number of different protocols for managing diabetes. The Roomp and Rand protocol (2008) favours tight regulation. Your vet will probably use the one s/he feels most comfortable with.

 

Many vets choose to start with one unit of insulin, which is usually administered every twelve hours but occasionally once daily.

 

ISFM consensus guidelines on the practical management of diabetes mellitus in cats (2015) Sparkes AH, Cannon M, Church D, Fleeman L, Harvey A, Hoenig M, Peterson ME, Reusch CE, Taylor S, Rosenberg D Journal of Feline Medicine and Surgery 17 pp235-250 suggest:

  • "Starting dose: 0.25–0.5 U/kg q12h
  • The dose is rounded down to the nearest unit, and is generally ≤ 2 U/cat q12h
  • The higher dose of 0.5 U/kg may be appropriate if BG is >20 mmol/l (360 mg/dl).
  • Obese and underweight cats should be dosed according to their estimated ideal weight, and not their current weight."

Cats vary in their response, so the amount and the frequency are determined by checking blood glucose levels. This may need to be done every few hours at first, but gradually the frequency of checks can be reduced to once or twice a day (see monitoring). If the diabetes is properly controlled, the earlier symptoms should disappear.

 

Keys to management of diabetes in cats (2011) is a presentation by Dr S Little to the 36th World Small Animal Veterinary Association World Congress which compares the various brands of insulin available and advises on how to adjust insulin dosage.

 

Insulin: Goals


Generally speaking, a cat is considered regulated if his/her blood glucose consistently remains in the 5-14 mmol/l (US: 100-250 mg/dl) range.

 

ISFM consensus guidelines on the practical management of diabetes mellitus in cats (2015) Sparkes AH, Cannon M, Church D, Fleeman L, Harvey A, Hoenig M, Peterson ME, Reusch CE, Taylor S, Rosenberg D Journal of Feline Medicine and Surgery 17 pp235-250 says that the goal with insulin treatment is:

  • "To control BG to <14 mmol/l (252 mg/dl) for as much of a 24 h period as possible; and

  • To avoid clinically significant hypoglycaemia at all times."

They do also state that if closer monitoring is possible so that blood glucose can be maintained ≤11 mmol/l or 198 mg/dl, this reduces risks associated with diabetes and increases the chances of remission.

 

Monitoring: Blood Glucose Testing


It is important to monitor your cat's blood sugar levels each day, so the insulin dose can be adjusted as needed.

 

These days many people monitor their cat's glucose levels at home using a glucometer (available from pharmacies for use by human diabetics) because home monitoring is much cheaper and less stressful for the cat. Many UK vets are unfamiliar with this approach, but it is recommended in ISFM consensus guidelines on the practical management of diabetes mellitus in cats (2015) Sparkes AH, Cannon M, Church D, Fleeman L, Harvey A, Hoenig M, Peterson ME, Reusch CE, Taylor S, Rosenberg D Journal of Feline Medicine and Surgery 17 pp235-250 (many of the authors are UK specialists)..

 

Home testing appears to be both safe and effective. Intensive blood glucose control is safe and effective in diabetic cats using home monitoring and treatment with glargine (2009) Roomp K & Rand J Journal of Feline Medicine & Surgery 11(8) pp668-82 states "Only one mild clinical hypoglycaemic episode occurred observed despite tight blood glucose control. In conclusion, intensive blood glucose control is safe and effective in diabetic cats using home monitoring and treatment with glargine."

 

The blood can normally be taken from the ear (make sure it is warm) using a sterile lancet, and only a tiny amount is required. Some people take the blood from a paw pad instead.

 

You normally test before you give any insulin so you can adjust the dose accordingly. If you don't do this and your cat's blood sugar level is already quite low before giving the insulin, your cat is at risk of it falling too far following the insulin injection (hypoglycaemia).

 

Veterinary Partner has step by step instructions for home blood glucose testing with a slide show guide.

 

Sugar Cat Harry's Website has detailed information on home blood glucose testing.

 

Remission


Remission means that the cat no longer requires insulin injections. This is usually because the pancreas begins producing insulin on its own again.

 

Cats who develop diabetes because of corticosteroid use may go into remission once the steroids are stopped (which should always be done gradually).

 

Going into remission is relatively common in cats with well controlled diabetes, even if they are not on steroids. Predictors of clinical remission in cats with diabetes mellitus (2010) Zini E, Hafner M, Franchini M, Ackermann M, Lutz TA & Reusch CE Journal of Veterinary Internal Medicine 24(6) pp 1313-21 found that 50% of cats in the study went into remission and that this was more common in older cats.

 

Tight control of blood sugar levels increases the chances of remission. Intensive blood glucose control is safe and effective in diabetic cats using home monitoring and treatment with glargine (2009) Roomp K & Rand J Journal of Feline Medicine & Surgery 11(8) pp668-82 states "An overall remission rate of 64% was achieved in the cohort. Significantly higher remission rates were observed if good glycaemic control was achieved soon after diagnosis: 84% for cats started on the protocol within 6 months of diagnosis went into remission, and only 35% for cats that began more than 6 months after diagnosis."

 

However, around 25-30% of cats in remission may relapse, meaning they need to go back on insulin. Glycemic status and predictors of relapse for diabetic cats in remission (2015) Gottlieb S, Rand JS, Marshall R & Morton J Journal of Veterinary Internal Medicine 29(1) pp184-92 found that relapsing was more likely in cats with poor blood glucose control, in cats who had been given corticosteroids, or cats who had pancreatitis, hyperthyroidism or CKD. The study recommends low carbohydrate diets and the avoidance of corticosteroid use in diabetic cats.

 


Possible Problems


 

Although diabetes is a scary diagnosis, most people seem to get into a routine that enables them to manage it very well. Occasionally problems may arise, so it is worth being aware of them, just in case:

Diabetic Ketoacidosis


Diabetic ketoacidosis is a very serious condition that usually occurs in poorly regulated diabetic cats. If the cells in the cat's body cannot use the glucose produced by the body, they break down fat and protein in the body instead in an attempt to obtain energy. If body fat and proteins are broken down too much, ketones are released and can cause potentially life-threatening imbalances to electrolytes. 

 

Symptoms of ketoacidosis include:

  • a distinctive sweet smell to the breath

  • vomiting

  • fast or laboured breathing

  • dehydration

  • low blood pressure

Ketoacidosis is a medical emergency and you must seek veterinary help as soon as possible.

 

Urine glucose is only really useful for initial diagnosis – healthy cats do not have glucose in their urine – because it is too imprecise a measure to make proper decisions about insulin dosage. However, urine testing for ketone levels can help avoid ketoacidosis, and is easy to do at home using dipsticks such as Ketostix, available from pharmacies. Even if you are testing blood glucose at home, it is worth checking for ketones if your cat doesn't seem quite right. Even a trace of ketones is a cause for concern and warrants an immediate vet visit.

 

Pet MD has an overview of ketoacidosis.

 

Diabetic ketoacidosis (2015) Guma N is a detailed powerpoint presentation about ketoacidosis in cats.

 

Feline diabetic ketoacidosis (2008) Benigni C Zimmer Feline Foundation discusses ketoacidosis in cats.

 

The Somogyi Effect


Sometimes cats are started on too high a dose of insulin, which leads to a sudden drop in blood sugar levels, and the body reacts to this by releasing glucagons which raise blood sugar levels again. It thus appears, based on spot checks at the vet's, that the cat requires even more insulin, when in fact the opposite is the case. This is known as rebound hyperglycaemia or the Somogyi effect and Feline Diabetes has information about it.

 

Home blood glucose monitoring gives more accurate results and can help you to avoid such problems. Rebound hyperglycemia in diabetic cats (2016) Room K & Rand J Journal of Feline Medicine & Surgery 18(8) pp587-596 found that the Somogyi effect is rare in cats and concludes "despite the frequent occurrence of biochemical hypoglycaemia, rebound hyperglycaemia is rare in cats treated with glargine on a protocol aimed at tight glycaemic control. For glargine-treated cats, insulin dose should not be reduced when there is hyperglycaemia in the absence of biochemical or clinical evidence of hypoglycaemia."

 

Hypoglycaemia


As a general rule, too much insulin is far more dangerous for a diabetic cat than too little, and may cause low blood sugar (hypoglycaemia). Symptoms include:

  • weakness

  • lack of co-ordination

  • seizures

  • coma

The cat should be offered food immediately if still able to eat, or you may need to rub corn syrup or powdered glucose on the gums (in the UK you can also buy a human OTC diabetic product called Hypo-Stop); otherwise you should contact your vet urgently.

 

You will need to discuss your treatment programme with your vet following an incident of hypoglycaemia. 

 

Vetsulin explains more about hypoglycaemia.

 


Diabetes and CKD


See above for information on diet for cats with both diabetes and CKD.

 

A dehydrated cat may respond less well to insulin, and many people have found that once sub-Qs are begun, the insulin seems to work more effectively, sometimes with longer duration than was previously the case.

 

Anecdotal evidence suggests that diabetic cats with CKD may do less well on benazepril (Fortekor) than cats with CKD only.

 


Support


 

Feline Diabetes Message Board (FDMB) is a very busy message board.

 

Feline Diabetes Group is a group for people dealing with diabetes in cats, though I'm not sure how active it is these days.

 

Back to Page Index

This page last updated: 13 June 2017

Links on this page last checked: 13 June 2017

 

   

*****

 

TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE EXTREMELY DANGEROUS.

 

I have tried very hard to ensure that the information provided in this website is accurate, but I am NOT a vet, just an ordinary person who has lived through CKD with three cats. This website is for educational purposes only, and is not intended to be used to diagnose or treat any cat. Before trying any of the treatments described herein, you MUST consult a qualified veterinarian and obtain professional advice on the correct regimen for your cat and his or her particular requirements; and you should only use any treatments described here with the full knowledge and approval of your vet. No responsibility can be accepted.

 

If your cat appears to be in pain or distress, do not waste time on the internet, contact your vet immediately.

 

*****

Copyright © Tanya's Feline CKD Website 2000-2017. All rights reserved.

 

This site was created using Microsoft software, and therefore it is best viewed in Internet Explorer. I know it doesn't always display too well in other browsers, but I'm not an IT expert so I'm afraid I don't know how to change that. I would love it to display perfectly everywhere, but my focus is on making the information available. When I get time, I'll try to improve how it displays in other browsers.

 

You may print out one copy of each section of this site for your own information and/or one copy to give to your vet, but this site may not otherwise be reproduced or reprinted, on the internet or elsewhere, without the permission of the site owner, who can be contacted via the Contact Me page.

 

This site is a labour of love, from which I do not make a penny. Please do not steal from me by taking credit for my work.

If you wish to link to this site, please feel free to do so. Please make it clear that this is a link and not your own work. I would appreciate being informed of your link.