Title: Diabetes in cats

{{Short description|Chronic disease of cats}}
{{About|diabetes in cats|general usage|Diabetes|other uses|Diabetes (disambiguation)}}
{{Use DMY dates|date=October 2023}}
'''Feline diabetes mellitus''' is a [[chronic disease]] in cats whereby either insufficient [[insulin]] response or [[insulin resistance]] leads to persistently high blood glucose concentrations. Diabetes affects up to 1 in 230 [[cat]]s,&lt;ref&gt;{{cite journal |last1=McCann |first1=T. M. |last2=Simpson |first2=K. E. |last3=Shaw |first3=D. J. |last4=Butt |first4=J. A. |last5=Gunn-Moore |first5=D. A. |title=Feline diabetes mellitus in the UK: The prevalence within an insured cat population and a questionnaire-based putative risk factor analysis |journal=Journal of Feline Medicine and Surgery |date=August 2007 |volume=9 |issue=4 |pages=289–299 |doi=10.1016/j.jfms.2007.02.001 |pmid=17392005 |s2cid=5832729|pmc=10822632 }}&lt;/ref&gt; and may be becoming increasingly common. Diabetes is less common in cats than in dogs. The condition is treatable, and if treated properly the cat can experience a normal life expectancy. In cats with type{{nbsp}}2 diabetes, prompt effective treatment may lead to [[#Remission|diabetic remission]], in which the cat no longer needs injected insulin. Untreated, the condition leads to increasingly weak legs in cats and eventually to [[malnutrition]], [[diabetic ketoacidosis|ketoacidosis]] and/or [[dehydration]], and death.

Diabetes in cats can be classified into the following:
* Type{{nbsp}}1 diabetes, in which the immune system attacks the pancreas, is &quot;extremely rare&quot; in cats, unlike in dogs and humans.&lt;ref name=pmid30050865&gt;{{cite journal |last1=Gottlieb |first1=S |last2=Rand |first2=J |title=Managing feline diabetes: current perspectives. |journal=  Veterinary Medicine: Research and Reports|date=2018 |volume=9 |pages=33–42 |doi=10.2147/VMRR.S125619 |pmid=30050865 |pmc=6053045 |doi-access=free }}&lt;/ref&gt;
* Type{{nbsp}}2 diabetes is responsible for 80&amp;ndash;95% of diabetic cases. They are generally severely insulin dependent by the time symptoms are diagnosed. [[Glipizide]] for T2DM are not known to be effective in cats, unlike in humans.&lt;ref name=pmid30050865/&gt;
* [[Gestational diabetes]], which occurs in humans and dogs, has never been found in cats.&lt;ref name=pmid30050865/&gt;
* Insulin resistance and diabetes in cats can also have a component of [[Hypersomatotropism (veterinary)|hypersomatotropism]] (an excess of [[growth hormone]], also leading to [[acromegaly]])&lt;ref name=&quot;pmid36637031&quot;&gt;{{cite journal |last1=Rothlin-Zachrisson |first1=N |last2=Öhlund |first2=M |last3=Röcklinsberg |first3=H |last4=Ström Holst |first4=B |title=Survival, remission, and quality of life in diabetic cats. |journal=Journal of Veterinary Internal Medicine |date=January 2023 |volume=37 |issue=1 |pages=58–69 |doi=10.1111/jvim.16625 |pmid=36637031 |pmc=9889602}}&lt;/ref&gt; and [[hyperadrenocorticism]].&lt;ref&gt;{{cite journal |last1=Niessen |first1=SJ |last2=Church |first2=DB |last3=Forcada |first3=Y |title=Hypersomatotropism, acromegaly, and hyperadrenocorticism and feline diabetes mellitus. |journal=The Veterinary Clinics of North America: Small Animal Practice |date=March 2013 |volume=43 |issue=2 |pages=319–50 |doi=10.1016/j.cvsm.2012.12.004 |pmid=23522175|url=http://researchonline.rvc.ac.uk/id/eprint/7110/ }}&lt;/ref&gt; In some cats, cancer causes the loss of pancreatic islets.&lt;ref name=&quot;pmid36637031&quot;/&gt;

==Symptoms==
Cats will generally show a gradual onset of the disease over a few weeks or months, and it may escape notice for even longer.&lt;ref&gt;{{Cite journal |last1=Rand |first1=Jaqueline S. |last2=Fleeman |first2=Linda M. |last3=Farrow |first3=Heidi A. |last4=Appleton |first4=Delisa J. |last5=Lederer |first5=Rose |date=2004 |title=Canine and Feline Diabetes Mellitus: Nature or Nurture? |journal=The Journal of Nutrition |volume=134 |issue=8 |pages=2072S–2080S |doi=10.1093/jn/134.8.2072S |pmid=15284406 |doi-access=free |title-link=doi}}&lt;/ref&gt;

The first outward symptoms are sudden weight loss (or occasionally gain) accompanied by [[polydipsia]] and [[polyuria]]. [[Polyphagia]] or [[anorexia (symptom)|anorexia]] may be observed. Neuropathy in the hind legs may cause the cat to develop a [[plantigrade]] stance, walking on its [[Hock (anatomy)|hocks]] rather than its toes. The front legs may develop a corresponding [[palmigrade]] stance, with the cat standing on its &quot;palms&quot; rather than its toes.&lt;ref name=&quot;endo&quot;&gt;{{cite book |author1-first=Reusch |author1-last=Claudia |editor1-last=Feldman | editor1-first=Edward C. | editor2-last=Nelson | editor2-first=Richard W. | editor3-last=Reusch | editor3-first=Claudia | editor4-last=Scott-Moncrieff | editor4-first=J. Catharine |title=Canine and feline endocrinology |date=2015 |publisher=Elsevier Saunders |location=St. Louis, Missouri |isbn=978-1-4557-4456-5 |edition=Fourth |url=http://www.sciencedirect.com/book/9781455744565/canine-and-feline-endocrinology |chapter=Feline Diabetes Mellitus| publication-place=St. Louis, Missouri | pages=258–312}}&lt;/ref&gt;

A fasting glucose blood test will normally be suggestive of diabetes at this point. The same home blood test monitors used in humans are also used on cats, usually by obtaining blood from the ear edges or paw pads. As the disease progresses, ketone bodies will be present in the urine, which can be detected with the same urine strips used for testing human urine.

In the final stages, the cat starts [[wasting]], with the body breaking down its own fat and muscle to survive. Lethargy/limpness and acetone-smelling breath are acute symptoms of [[ketoacidosis]] and/or [[dehydration]] and constitute a medical emergency.

Untreated, diabetes leads to coma and then death.

===Diabetic emergencies===
Too little insulin over time can cause tissue starvation, as glucose cannot reach the brain or body. In combination with dehydration, fasting, infection, or other body stresses, the condition may progress to [[diabetic ketoacidosis]], a medical emergency with a high fatality rate that cannot be treated at home. Symptoms include lethargy, a fruit-like smell of the breath or urine, shortness of breath, and an increase in thirst. Emergency care includes fluid therapy, insulin, management of presenting symptoms and 24-hour hospitalization.

===Complications===

The back legs may become weak and the gait may become stilted or wobbly owing to [[diabetic neuropathy]], which is caused by damage to the [[myelin sheath]] of the peripheral nerves due to glucose toxicity and cell starvation, which are in turn caused by chronic [[hyperglycemia]].&lt;ref&gt;{{cite conference |url= https://www.vin.com/apputil/content/defaultadv1.aspx?meta=Generic&amp;pId=11290&amp;id=4252759 |title=Logical Approach to Weakness and Seizures |first=David B. |last=Church |conference=24th World Congress Proceedings |location=São Paulo, Brazil |date=21–24 July 2009 |publisher=World Small Animal Veterinary Association}}&lt;/ref&gt; Most common in cats, the back legs become weaker until the cat displays a plantigrade stance, standing on its hocks instead of on its toes as normal. The cat may also have trouble walking and jumping and may need to sit down after a few steps. Neuropathy sometimes heals on its own within 6–10 weeks once blood sugar is regulated.

==Causes==
The signs of diabetes are caused by a persistently high blood glucose concentration, which may be caused by either insufficient insulin or by a lack of response to insulin.&lt;ref name=&quot;Rand 2013&quot;&gt;{{cite journal |last=Rand |first=Jaqueline S. |title=Pathogenesis of feline diabetes|journal=Veterinary Clinics of North America: Small Animal Practice |date=March 2013 |volume=43 |issue=2 |pages=221–231 |doi=10.1016/j.cvsm.2013.01.003 |pmid=23522168}}&lt;/ref&gt; Most cats have a type of diabetes similar to human [[type 2 diabetes]], with [[Beta cell|β-cell]] dysfunction and [[insulin resistance]].&lt;ref name=&quot;Sparkes 2015&quot;&gt;{{cite journal |last1=Sparkes |first1=A. H. |last2=Cannon |first2=M. |last3=Church |first3=D. |last4=Fleeman |first4=L. |last5=Harvey |first5=A. |last6=Hoenig |first6=M. |last7=Peterson |first7=M. E. |last8=Reusch |first8=C. E. |last9=Taylor |first9=S. |last10=Rosenberg |first10=D. |title=ISFM consensus guidelines on the practical management of diabetes mellitus in cats |journal=Journal of Feline Medicine and Surgery |date=March 2015 |volume=17 |issue=3 |pages=235–250 |doi=10.1177/1098612X15571880 |pmid=25701862 |doi-access=free |title-link=doi|pmc=11148891 }}&lt;/ref&gt; Factors which contribute to insulin resistance include obesity and endocrine diseases such as [[acromegaly]].&lt;ref name=&quot;Sparkes 2015&quot;/&gt; Acromegaly affects 20–30% of diabetic cats; it can be diagnosed by measuring the concentration of [[insulin-like growth factor-1]] (IGF-1) in the blood.&lt;ref&gt;{{citation |last1=Stijn |first1=J. M. Niessen |last2=Forcada |first2=Yalza |last3=Mantis |first3=Panagiotis |last4=Lamb |first4=Christopher R. |last5=Harrington |first5=Norelene  |last6=Fowkes |first6=Rob |last7=Korbonits |first7=Márta |last8=Smith |first8=Ken |last9=Church |first9=Dadid B. |title=Studying Cat (''Felis catus'') Diabetes: Beware of the Acromegalic Imposter |journal=PLOS ONE |date=May 2015 |volume=10 |issue=5 |article-number=e0127794 |doi=10.1371/journal.pone.0127794|pmid=26023776|pmc=4449218|bibcode=2015PLoSO..1027794N |doi-access=free |title-link=doi}}&lt;/ref&gt;

Quite frequently, a cat which is under stress because it has been transported in a car and/ or brought to a veterinarian will experience an artificial temporary spike in blood glucose levels called &quot;stress hyperglycemia&quot; which will subside after a few hours. This spike, however, will not affect the cat's blood [[fructosamine]] levels, which are therefore often a better measure of overall blood sugar.&lt;ref&gt;{{cite journal |title=Serum fructosamine concentration as an index of glycemia in cats with diabetes mellitus and stress hyperglycemia |date=1996 |pmid=8947867 |last1=Crenshaw |first1=K. L. |last2=Peterson |first2=M. E. |last3=Heeb |first3=L. A. |last4=Moroff |first4=S. D. |last5=Nichols |first5=R. |journal=Journal of Veterinary Internal Medicine |volume=10 |issue=6 |pages=360–364 |doi=10.1111/j.1939-1676.1996.tb02081.x}}&lt;/ref&gt;

==Management==
Diabetes is a condition which can be treated, but it is invariably lethal if ignored. Early diagnosis and treatment by a qualified veterinarian can help in preventing nerve damage, and, in rare cases, may even lead to remission.&lt;ref&gt;{{cite web |url= http://www.felinediabetes.com/glargine.htm |title=Insulin glargine and a high protein–low carbohydrate diet are associated with high remission rates in newly diagnosed diabetic cats |last1=Marshall |first1=R. D. |last2=Rand |first2=Jaqueline S. |work=ACVIM Web Abstracts |publisher=American College of Veterinary Internal Medicine |date=25 January 2005 |via=FelineDiabetes.com}}&lt;/ref&gt; Diabetic cats do best with long-lasting twice-daily injections of insulin such as [[glargine]] (which as of 2022 is available worldwide as a synthetic generic drug) combined with a low carbohydrate diet. Because diabetes is a disease of carbohydrate metabolism, a move to a primarily protein and fat diet reduces the occurrence and recurrence of [[hyperglycemia]].

===Diet===
Diet is a critical component of treatment and is in some cases effective on its own following treatment with insulin. For example, a recent mini-study&lt;ref name=&quot;Catkins&quot;&gt;{{cite press release |url= http://www.medicalnewstoday.com/medicalnews.php?newsid=16452 |archive-url= https://web.archive.org/web/20070609112441/http://www.medicalnewstoday.com/medicalnews.php?newsid=16452 |archive-date=9 June 2007 |title=Study Shows 'Catkins' Diet Helps Cats Beat Diabetes |date=16 November 2004 |first1=Deborah |last1=Greco |first2=Mark |last2=Peterson |first3=Heidi |last3=Jeter |publisher=Morris Animal Foundation |via=MedicalNewsToday.com}}&lt;/ref&gt; showed that many diabetic cats stopped needing insulin after changing to a low carbohydrate diet. The rationale is that a low-carbohydrate diet reduces the amount of insulin needed and keeps the variation in [[blood sugar]] low and easier to predict. Additionally, research indicates that feeding cats low-carbohydrate meals increases their chances of obtaining diabetic remission by four times.&lt;ref&gt;{{Cite journal |last=Michel |first=Kathryn E. |date=November 2006 |title=Unconventional Diets for Dogs and Cats |url=https://linkinghub.elsevier.com/retrieve/pii/S0195561606000805 |journal=Veterinary Clinics of North America: Small Animal Practice |language=en |volume=36 |issue=6 |pages=1269–1281 |doi=10.1016/j.cvsm.2006.08.003|url-access=subscription }}&lt;/ref&gt; Also, fats and proteins are metabolized slower than carbohydrates, reducing dangerous blood sugar peaks right after meals. Cats are [[obligate carnivores]] and must consume meat to survive, as their bodies are unable to produce certain [[Amino acid|amino acids]] such as [[taurine]] and [[arginine]], and cannot process many of the nutrients that meat has from other dietary sources.&lt;ref&gt;{{Cite web |last=Hitchcock |first=Kristin |date=2024-10-03 |title=Cats Are Obligate Carnivores: Vet-Approved Info &amp; Feline Diet Facts |url=https://www.catster.com/nutrition/cats-are-obligate-carnivores/ |access-date=2024-11-21 |website=Catster |language=en-US}}&lt;/ref&gt; It is recommended to see a veterinary professional to discuss the specific dietary needs a cat with diabetes needs to manage their diabetes while also ensuring they do not develop other health issues related to [[malnutrition]].&lt;ref&gt;{{Cite web |title=Nutrition for Cats With Diabetes |url=https://www.merck-animal-health-usa.com/vetsulin/cats/nutrition-for-cats-with-diabetes |access-date=2024-11-21 |website=Merck Animal Health USA |language=english}}&lt;/ref&gt;

===Medications===
Oral medications like [[Glipizide]] that stimulate the pancreas, promoting insulin release (or in some cases, reduce glucose production), are less and less used in cats,&lt;ref&gt;{{cite journal |url= http://www.veterinarypartner.com/Content.plx?P=A&amp;S=0&amp;C=0&amp;A=627 |title=Oral Diabetic Therapies |first=Wendy |last=Brooks |date=24 April 2023 |orig-date=2002 |website=Vin.com |publisher=Veterinary Information Network}}&lt;/ref&gt; and these drugs may be completely ineffective if the pancreas is not working. These drugs have also been shown in some studies&lt;ref name=&quot;Hoenig00&quot;&gt;{{cite journal |last1=Hoenig |first1=Margarethe |last2=Hall |first2=Gregory |last3=Ferguson |first3=Duncan |last4=Jordan |first4=Katharine |last5=Henson |first5=Michael |last6=Johnson |first6=Kenneth |last7=O'Brien |first7=Timothy |title=A feline model of experimentally induced islet amyloidosis |journal=The American Journal of Pathology |volume=157 |issue=6 |pages=2143–2150 |date=December 2000 |pmid=11106586 |pmc=1885761 |url= https://www.healthfitt.com/what-is-diabetes/ |doi=10.1016/s0002-9440(10)64852-3 |access-date=16 December 2019 |archive-date=16 December 2019 |archive-url= https://web.archive.org/web/20191216163856/https://www.healthfitt.com/what-is-diabetes/ }}&lt;/ref&gt; to damage the pancreas further or to cause liver damage. Some owners are reluctant to switch from pills to insulin injections, but the fear is unjustified; the difference in cost and convenience is minor (most cats are easier to inject than to pill), and injections are more effective at treating the disease.

[[Bexagliflozin]] (Bexacat) was approved for medical use in the United States in December 2022.&lt;ref name=&quot;FDA Bexagliflozin&quot; /&gt;&lt;ref&gt;{{cite press release |title=Elanco Announces FDA Approval of Bexacat (bexagliflozin tablets) – the First-of-its-kind Oral Feline Diabetes Treatment Option |website=Elanco.com |date=9 December 2022 |url= https://www.elanco.com/en-us/news/elanco-announces-fda-approval-of-bexacat |access-date=11 December 2022}}&lt;/ref&gt; It is the first [[SGLT2 inhibitor|sodium-glucose cotransporter 2 (SGLT2) inhibitor]] new animal drug approved by the US [[Food and Drug Administration]] (FDA) in any animal species.&lt;ref name=&quot;FDA Bexagliflozin&quot;&gt;{{cite web |title=FDA Approves First Oral Treatment for Cats with Diabetes Mellitus |publisher=U.S. [[Food and Drug Administration]] (FDA) |date=8 December 2022 |url= https://www.fda.gov/animal-veterinary/cvm-updates/fda-approves-first-oral-treatment-cats-diabetes-mellitus |access-date=11 December 2022}}{{dead link|date=May 2025|bot=medic}}{{cbignore|bot=medic}} {{PD-notice}}&lt;/ref&gt; [[Velagliflozin]] (Senvelgo), another SGLT2 inhibitor, was approved for medical use in the United States in August 2023 by the FDA.&lt;ref&gt;{{PDF page link|file=https://animaldrugsatfda.fda.gov/adafda/app/search/public/document/downloadFoi/14320|page=1|text=FOI Summary for the Original Approval of NADA 141-568 Approved August 10, 2023}}&lt;/ref&gt; SGLT2 inhibitors are not insulin, nor do they help a diabetic cat's cells use glucose for energy. SGLT2 inhibitors lowers blood glucose levels by excreting glucose through the kidneys.&lt;ref name=&quot;:0&quot;&gt;{{Cite journal |last=Medicine |first=Center for Veterinary |date=2023-12-14 |title=Two New Drugs to Treat Diabetes in Cats—Is One Right for Your Cat? |url=https://www.fda.gov/animal-veterinary/animal-health-literacy/two-new-drugs-treat-diabetes-cats-one-right-your-cat |journal=FDA |language=en}}{{dead link|date=May 2025|bot=medic}}{{cbignore|bot=medic}}&lt;/ref&gt; Both medications are [[Prescription drug|prescription only]] and are given orally (by mouth) once daily. Cats that have been previously treated with long-term insulin therapy, are currently on long-term insulin therapy, or has other underlying health conditions should not take these medications.&lt;ref name=&quot;:0&quot; /&gt;

===Insulin===

The method usually employed is a dose of slow-acting insulin twice daily to keep the blood sugar within a recommended range for the entire day. With this method, it is important for the cat to avoid large meals or high-carbohydrate food. Meals may also be timed to coincide with peak insulin activity. Once-daily doses are not recommended,&lt;ref name=&quot;Wallace90&quot;&gt;{{cite journal |last1=Wallace |first1=M. S. |last2=Peterson |first2=M. E. |last3=Nichols |first3=C. E. |title=Absorption kinetics of regular, isophane, and protamine zinc insulin in normal cats |journal=Domestic Animal Endocrinology |volume=7 |issue=4 |pages=509–515 |date=October 1990 |pmid=2261761 |doi=10.1016/0739-7240(90)90008-N |title-link=doi|doi-access=free }}&lt;/ref&gt; since insulin usually metabolizes faster in cats than in humans or dogs.&lt;ref&gt;{{cite journal |last1=Goeders |first1=L. A. |last2=Esposito |first2=L. A. |last3=Peterson |first3=M. E. |title=Absorption kinetics of regular and isophane (NPH) insulin in the normal dog |journal=Domestic Animal Endocrinology |volume=4 |issue=1 |pages=43–50 |date=January 1987 |pmid=3333933 |doi=10.1016/0739-7240(87)90037-3}}&lt;/ref&gt; For example, an insulin brand that lasts 24 hours in people may only be effective for about 12 in a cat.&lt;ref name=&quot;Moise83&quot;&gt;{{cite journal |last1=Moise |first1=N. S. |last2=Reimers |first2=T. J. |title=Insulin therapy in cats with diabetes mellitus |journal=Journal of the American Veterinary Medical Association |volume=182 |issue=2 |pages=158–164 |date=January 1983 |pmid=6298164}}&lt;/ref&gt;

Cats may be treated with animal insulin (bovine-based insulin is most similar to cat insulin) or with human synthetic insulin. The best choice of insulin brand and type varies from animal to animal and may require some trial and error. The human synthetic insulin, Humulin N /Novolin N/ NPH, is usually a poor choice for cats,&lt;ref name=&quot;Moise83&quot; /&gt; since cats metabolize insulin about twice as fast. The Lente and Ultralente versions were popular for feline use until summer 2005, when they were discontinued.

Until the early 1990s, the most recommended type for pets was bovine/porcine-derived PZI,&lt;ref&gt;{{Cite web |url= http://www.felinediabetes.com/pzi.htm |title=PZI Insulin Information for Cats}}&lt;/ref&gt; but that type was phased out over the 1990s and is now difficult to find in many countries. There are sources in the US and UK, and many vets are now starting to recommend them again for pets, but they have been discontinued by most manufacturers {{as of|2007|lc=y}}-2008. A new synthetic PZI analogue called ProZinc is now available.

Caninsulin (known in the US as Vetsulin) is a brand of porcine-based insulin approved for cats which is available with a veterinarian's prescription. According to the manufacturer's website, the insulin's action profile in cats was similar to that of NPH insulin, and it lowered blood sugar quickly, but for only about 6–8 hours. Vetsulin was recalled in the US in November 2009 due to inconsistent strength; it was available again {{as of|2013|April|lc=y}}.&lt;ref&gt;{{Cite web |url= http://www.vetsulin.com/vet/Product_Update.aspx |title=Vetsulin: Insulin for Diabetes in Dogs and Cats |access-date=28 February 2015 |archive-date=19 February 2015 |archive-url= https://web.archive.org/web/20150219012044/http://www.vetsulin.com/vet/Product_Update.aspx }}&lt;/ref&gt;

Two ultra-slow time-release synthetic human insulins became available in 2004 and 2005, generically known as [[insulin detemir]] (Levemir) and insulin glargine ([[Lantus]]). Studies have had good results with insulin glargine in cats.&lt;ref&gt;{{Cite web |url= http://www.felinediabetes.com/glargine.htm |title=Glargine (Lantus) insulin and feline diabetes remission}}&lt;/ref&gt; Follow-up research &lt;ref&gt;{{cite journal |last1=Roomp |first1=Kirsten |last2=Rand |first2=Jaqueline S. |date=22 April 2009 |orig-date=2008 |url= http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf |journal=Journal of Veterinary Internal Medicine |volume=22 |issue=3 |page=791 |doi=10.1111/j.1939-1676.2008.0103.x |access-date=14 November 2009 |archive-url= https://web.archive.org/web/20100215181737/http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf |archive-date=15 February 2010 |title=Research Abstract Program of the 26th Annual ACVIM Forum San Antonio, TX, June 4 – June 7, 2008 |pmc=7166787}}&lt;/ref&gt; shows that Levemir can be used with a similar protocol and that either insulin on this protocol can lead uncomplicated feline cases to remission, with the most success being in cats who start on these protocols as soon as possible after diagnosis.

====Dosage and regulation====

Cats may have their mealtimes strictly scheduled and planned to match with injection times, especially when on insulin with a pronounced peak action like Caninsulin/Vetsulin or Humulin N. If the cat free-feeds and normally eats little bits all day or night, it may be best to use a very slow-acting insulin to keep a constant level of blood glucose. Some veterinarians still use the outdated recommendation of using Humulin &quot;N&quot; or NPH insulin for cats, which is very fast-acting for most cats.&lt;ref name=&quot;Wallace90&quot; /&gt; The slower-acting Lente and Ultralente (Humulin L and Humulin U) insulins were discontinued in 2005), so most cats are treated with either the veterinary PZI insulins or the new full-day analogs glargine (Lantus) and detemir (Levemir).

The first goal is to regulate the cat's blood glucose by keeping the blood glucose values in a comfortable range for the cat during most of the day. This may take a few weeks to achieve.

The most successful documented method is tight regulation with Lantus or Levemir.&lt;ref&gt;{{cite journal |pmid=19592286 |doi=10.1016/j.jfms.2009.04.010 |volume=11 |issue=8 |title=Intensive blood glucose control is safe and effective in diabetic cats using home monitoring and treatment with glargine |last1=Roomp |first1=Kirsten |last2=Rand |first2=Jaqueline S. |journal=Journal of Feline Medicine and Surgery |pages=668–682 |date=2009 |hdl=11858/00-001M-0000-0019-FA20-B |s2cid=14537094 |hdl-access=free|pmc=11132583 }}&lt;/ref&gt;

Typical obstacles to regulation include:

* Chronic overdose masked by Somogyi: A dose that is too high may cause a Somogyi rebound, which can look like a need for more insulin. This condition can continue for days or weeks.
* High-carbohydrate cat food: Many commercial foods (especially &quot;light&quot; foods) are very high in carbohydrates. The extra carbohydrates keep the cat's blood sugar high. In general, canned foods are lower in carbohydrates than dry foods, and canned &quot;kitten&quot; foods lower still. Diabetes in cats can be better regulated and even sometimes reversed with a low-carbohydrate diet.&lt;ref&gt;{{Cite web |url= http://www.morrisanimalfoundation.org/learn/about/press/Catkins.asp |title=Morris Animal Foundation |access-date=15 March 2005 |archive-url= https://web.archive.org/web/20050313020052/http://www.morrisanimalfoundation.org/learn/about/press/Catkins.asp |archive-date=13 March 2005 }}&lt;/ref&gt;
* Inappropriate insulin: Different brands and types of insulin have idiosyncratic effects on different cats. With some dosages, the insulin may not last long enough for the cat. Testing blood sugar more frequently can determine if the insulin is controlling the blood sugar concentration throughout the day.

====Blood sugar guidelines====
[[File:Glucose-measurement-cat.jpg|thumb|Taking a blood sample from a cat's ear to measure blood glucose concentration on a glucometer.]]
Absolute numbers vary between pets, and with meter calibrations. [[Glucometer]]s made for humans are generally accurate using feline blood except when reading lower ranges of blood glucose (&lt;80&amp;nbsp;mg/dl–4.44&amp;nbsp;mmol/L). At this point the size difference in human and animal red blood cells can create inaccurate readings.&lt;ref&gt;{{Cite web |url= http://veterinarycalendar.dvm360.com/avhc/article/articleDetail.jsp?id=610978&amp;sk=&amp;date=&amp;%0A%09%09%09&amp;pageID=10 |title=Diabetes mellitus (Proceedings) |first=William A. |last=Schall |date=1 April 2009 |work=VeterinaryCalendar.DVM360.com |access-date=14 March 2010 |archive-date=10 July 2011 |archive-url= https://web.archive.org/web/20110710160219/http://veterinarycalendar.dvm360.com/avhc/article/articleDetail.jsp?id=610978&amp;sk=&amp;date=&amp;%0A%09%09%09&amp;pageID=10 }}&lt;/ref&gt;

====Somogyi rebound====
Too much insulin may result in a contradictory increase of blood glucose. This [[Chronic Somogyi rebound|&quot;Somogyi effect&quot;]] is often noted by cat owners who monitor their cat's blood glucose at home. Any time the blood glucose level drops too far to [[hypoglycemia]], the body may defensively dump glucose (converted from glycogen in the liver), as well as hormones epinephrine and cortisol, into the bloodstream. The glycogen raises the blood glucose, while the other hormones may make the cat insulin-resistant for a time. If the body has no glycogen reserves, there will be no rebound effect and the cat will just be [[hypoglycemic]].&lt;ref&gt;{{EMedicine|med|2098|Somogyi Phenomenon}}&lt;/ref&gt;

Rebound hyperglycemia occurs rarely in cats treated with glargine in a protocol aiming for tight control of blood glucose concentrations.&lt;ref&gt;{{cite journal |last1=Roomp |first1=Kirsten |last2=Rand |first2=Jaqueline S. |title=Rebound hyperglycaemia in diabetic cats |journal=Journal of Feline Medicine and Surgery |date=June 2015 |volume=18 |issue=8 |pages=587–596 |doi=10.1177/1098612X15588967 |pmid=26045481 |s2cid=37698449 |doi-access=free|pmc=10816392 }}&lt;/ref&gt;

====Hypoglycemia====
An acute hypoglycemic episode (very low blood sugar) can happen to even careful pet owners, since cats' insulin requirements sometimes change without warning. The symptoms include depression/lethargy, confusion/dizziness, loss of excretory/bladder control, vomiting, and then loss of consciousness and/or seizures. Immediate treatment includes administering honey or corn syrup by rubbing on the gums of the cat (even if unconscious, but not if in seizures). Symptomatic hypoglycemia in cats is a medical emergency and the cat will require professional medical attention. The honey/corn syrup should continue to be administered on the way to the vet, as every minute without blood sugar causes brain damage.

A cat with hypoglycemia according to a human-calibrated blood glucose meter (&lt;2.2&amp;nbsp;mmol/L or 40&amp;nbsp;mg/dL), but with no symptoms, should be fed as soon as possible. Hypoglycemic cats that refuse to eat can be force-fed honey or corn syrup until they stabilize, though this may not be done if the animal is unconscious or having a seizure, as the liquid is likely to enter the animal's lungs and cause choking and asphyxiation.

Mild hypoglycemic episodes can go unnoticed or leave evidence such as urine pools outside the litter box. In these cases the blood sugar will probably appear paradoxically ''high'' upon the next test hours later, since the cat's body will react to the low blood sugar by stimulating the liver to release stored [[glycogen]].

==Remission==
Remission occurs when a cat no longer requires treatment for diabetes and has normal blood glucose concentrations for at least a month.&lt;ref name=&quot;Reusch 2015&quot;&gt;{{cite book |last1=Reusch |first1=E. C. |editor1-last=Feldman |editor1-first=E. C. |editor2-last=Nelson |editor2-first=R. W. |editor3-last=Reusch |editor3-first=C. |editor4-last=Scott-Moncrieff |editor4-first=J. C. |title=Canine and Feline Endocrinology |date=2015 |publisher=Elsevier |isbn=978-1-4557-4456-5 |pages=258–314 |edition=4th |chapter=Chapter 7: Feline diabetes mellitus}}&lt;/ref&gt;

Approximately one in four cats with type{{nbsp}}2-like diabetes achieves remission. Some studies have reported a higher remission rate than this, which may in part be due to intensive monitoring that is impractical outside of a research environment. Research studies have implicated a variety of factors in successful remission; in general, the following factors increase the likelihood of remission:&lt;ref name=&quot;Reusch 2015&quot; /&gt;&lt;!-- this whole paragraph and following list from this reference. --&gt;

* Diabetes was diagnosed a few months ago
* The cat has no other serious disease
* Treatment includes insulin glargine administered twice daily
* The cat is monitored frequently during the first few months of treatment
* The cat eats a diet low in carbohydrates and high in protein.

Cats may present with type{{nbsp}}2 (insulin-resistant) diabetes, at least at first, but hyperglycemia and amyloidosis, left untreated, will damage the pancreas over time and progress to insulin-dependent diabetes.{{cn|date=July 2021}}

Glipizide and similar oral diabetic medicines designed for type{{nbsp}}2 diabetic humans have been shown to increase amyloid production and amyloidosis and therefore may reduce likelihood of remission.&lt;ref name=&quot;Hoenig00&quot; /&gt;

Approximately one-third of cats who achieve remission will later relapse.&lt;ref name=&quot;Reusch 2015&quot; /&gt;

==Epidemiology==
Diabetes is rare in cats younger than five years old.&lt;ref name=&quot;Reusch 2009&quot;&gt;{{cite book |last1=Reusch |first1=C. |editor1-last=Ettinger |editor1-first=S. J. |editor2-last=Feldman |editor2-first=E. C. |title=Textbook of Veterinary Internal Medicine |date=2009 |publisher=Elsevier Health Sciences |isbn=978-1-4377-0282-8 |pages=1796–1816 |edition=7th |chapter=Chapter 291: Feline diabetes mellitus}}&lt;/ref&gt; Typically, affected cats are obese.&lt;ref name=&quot;Osto 2013&quot;&gt;{{cite journal |last1=Osto |first1=M. |last2=Zini |first2=E. |last3=Reusch |first3=C. E. |last4=Lutz |first4=T. A.  |title=Diabetes from humans to cats |journal=[[General and Comparative Endocrinology]] |date=1 February 2013 |volume=182 |pages=48–53 |doi=10.1016/j.ygcen.2012.11.019 |pmid=23247272|s2cid=22170416 |url= https://www.zora.uzh.ch/id/eprint/70631/1/Zini_GenComEndo_2012.pdf}}&lt;/ref&gt; [[Burmese cat]]s in Europe and Australia have increased risk of developing diabetes; American Burmese cats do not have this increased risk due to genetic differences between American Burmese and Burmese in other parts of the world.&lt;ref name=&quot;O'Neill 2016&quot;&gt;{{cite journal |last1=O'Neill |first1=D. G. |last2=Gostelow |first2=R. |last3=Orme |first3=C. |last4=Church |first4=D. B. |last5=Niessen |first5=S. J. |last6=Verheyen |first6=K. |last7=Brodbelt |first7=D. C. |title=Epidemiology of diabetes mellitus among 193,435 cats attending primary-care veterinary practices in England|journal=Journal of Veterinary Internal Medicine |date=July 2016 |volume=30 |issue=4 |pages=964–972 |doi=10.1111/jvim.14365 |pmid=27353396 |pmc=5094533}}&lt;/ref&gt;

==References==
{{Reflist}}

==External links==
{{commons-inline|Cat diseases}}

{{Domestic cat}}
{{Authority control}}

{{DEFAULTSORT:Diabetes In Cats}}
[[Category:Diabetes]]
[[Category:Cat diseases]]