The Skinny On Feline Diabetes
Cats and humans have quite a bit in common regarding diabetes: In both species, the incidence of the disease has sky-rocketed. Years ago, the wisdom was that diabetic cats “didn’t do well” and many cats did indeed have shortened lives of poor quality. Today, however, with a new understanding regarding the importance of diet, insulin selection and the proper use of at-home management, most diabetic cats not only do well, but many even achieve remission and are no longer diabetic.
Living By The Water Bowl
Clinical signs of diabetes in cats vary, but most diabetic cats will drink more water and urinate frequently. Clients often say that they must clean the cat box much more frequently and that often the cat box filler sticks to the pads of the kitty’s feet. Diabetic cats generally have a ravenous appetite – eating multiple cans of food daily – and still wanting more. At times, diabetic cats develop problems walking and have an unusual gait where they walk on their hocks (similar to the human ankle).These clinical signs typically stop once the kitty’s diabetes is regulated, although the neuropathy can take months to resolve.
Interestingly, diabetic cats – unlike dogs and humans – uncommonly form cataracts. Because the clinical signs of diabetes can mimic those of other diseases (like kidney disease and hyperthyroidism), a visit to the veterinarian as soon as the client becomes aware of them, is necessary in order to correctly diagnose the condition. Cats with uncontrolled diabetes are at risk for developing problems with sodium and potassium, often become dehydrated and can develop life-threatening diabetic ketoacidosis (DKA). Kitties with DKA are severely ill and typically require several days (sometimes more) of hospitalization, often in a veterinary referral hospital, to treat their multiple problems.
Type I and Type II Diabetes
The pancreas is the organ that makes insulin. Insulin lowers blood glucose (sugar) and helps to keep it appropriately normal. When the pancreas can no longer produce insulin, we say that the patient is a Type I diabetic. These cats are generally very thin and are dependent on life-long insulin injections. However, most diabetic cats are Type II diabetics. For these cats, their bodies can still produce insulin, but the insulin can’t get to the cells. Obesity is the most common cause of Type II diabetes in cats. Think of kitty’s extra fat as an “overcoat” that blocks insulin.
Why The Feline Diabetes Epidemic?
There are many theories as to why so many cats today are diabetic. Most veterinarians believe that the widespread obesity among cats is the primary cause of the feline diabetic epidemic. The typical feline diabetic is a neutered male cat over 15 pounds. However, obese female cats also are at risk for diabetes. Cats often gain weight when fed high-carbohydrate diets, especially when they are provided free choice. Additionally, indoor cats often don’t get the exercise necessary to burn excess calories. In my previous columns for Feline Pine, I have often discussed the benefits of feeding a canned diet with less than seven percent carbohydrates, providing an appropriate (but not an abundant) number of calories, and keeping our cats active and lean. These recommendations can help you ensure that your kitty won’t become obese and develop Type II diabetes.
Get into the habit of making sure that your kitty isn’t a “fat cat.” Can you easily palpate his or her ribs? When you look down on your cat, can you see a tuck behind the ribs? If you can answer “yes” to both of these questions, chances are your cat is of appropriate weight. If you have concerns, ask your veterinarian to estimate your cat’s Body Condition Score (BCS) and discuss whether a weight loss program is appropriate. The BCS is one indicator of an individual cat’s bodyweight. Generally, we want a cat to have a mid-range BCS (not too thin or overweight). Longhaired cats can be difficult to accurately assess, so ask your veterinarian for help in judging his or her BCS.
Clients often wonder how they can find appropriate low-carb canned diets for their cats. Cat food labels don’t readily provide that information. There are many over-the-counter foods that meet the less-than-seven-percent carbohydrate requirement. To find a list of foods, along with the percentages of carbohydrates, protein, fat and calories, I recommend that clients peruse Janet and Binky’s list (www. binkyspage.tripod.com/canfood.html).
What if your cat is dry food addicted? While we want to transition cats to a low-carb canned diet, if at all possible, it is important that cats eat well everyday. Cats who do not eat well are at risk of developing fatty liver disease (hepatic lipidosis), which can be life-threatening. No dry diet is sufficiently low-carb, but some have fewer carbs than others.We want to avoid dry foods that are advertised as “reduced calorie,” “for indoor cats,” and “promote weight loss,” as these diets are generally high in carbohydrates. Many – if not most – kitty dry food addicts can be transitioned over time to a low-carb canned diet. Dr. Lisa Pierson’s website, http://www.catinfo.org, has a program for doing so that has been very successful for many kitties.
Dietary therapy can sometimes be used in lieu of insulin in recently diagnosed diabetic cats who have moderately high blood sugars. If used, the dietary therapy regimen requires strict adherence to diet (no cheating!), feeding the proper number of calories, and close home monitoring in conjunction with examinations by your cat’s veterinarian must be closely followed.
For many diabetic cats, insulin therapy is required in order to manage their blood sugars. Insulin therapy is not difficult for most clients, but does require that the family adhere to a dosing schedule. Insulin therapy should never be haphazard, as missing doses, giving improper doses and/or adjusting insulin without discussing concerns with your kitty’s veterinarian can have disastrous outcomes.
Lantus/glargine insulin, is a widely used insulin in human medicine that has been used successfully for several years in diabetic cats. Many veterinarians believe that Lantus, combined with a low-carb, canned diet, provides the best diabetic management for cats and the greatest chance for remission of the diabetes. Insulin, regardless of type (Lantus, PZI or NPH) is given twice-daily. Few cats can be well-regulated on once-daily insulin therapy, although some cats on Lantus can achieve about 18 hours of good glucose control.
Some clients want to avoid insulin injections for their cats and search for alternative therapies, including supplements (like chromium) that are touted to help human diabetics. Other clients want to use human medications that lower blood sugar. Unfortunately, these therapies do not work for diabetic cats and the oral hypoglycemic medications carry risks of liver problems and vomiting. Insulin and dietary therapy (or dietary therapy in selected patients) are the mainstays of diabetic management for cats.
Monitoring Diabetic Cats
Like human diabetics, feline diabetics need their blood glucoses monitored. While many clients initially think that they could never perform a blood glucose curve at home, the technique (which involves taking small blood samples from the ear of the kitty) is easy to learn and most cat guardians can perform these curves easily. Blood glucose curves provide the best information on how long the insulin lasts, what the lowest blood sugar for the patient is on a given dose and allows the veterinarian to make a thoughtful recommendation about changes in insulin doses, as necessary. You can learn more about in-home blood glucose testing at : http://www.veterinarypartner.com and searching “Home Glucose Testing Cats.”
In my practice, I have had single career women, elderly men, couples with children and college students all learn to do insulin injections and monitor their kitties’ blood glucoses. Most reasonable clients who love their cats and want them to have the best quality life possible, will be more than willing to meet the small challenge of at-home glucose testing.
Spot checks (bringing the kitty to the veterinary hospital at a certain time of day) are unreliable, as the readings can be affected by the stress of putting the cat into the carrier, the trip to the hospital, the visit and the blood sample collection. The same is true for in-hospital blood glucose curves which often provide incorrect information, because of the stress involved. Fructosamine tests also present problems, as they provide no information on how long the insulin lasts or what is the lowest blood glucose reading.
Living With Your Diabetic Cat
Once regulated on insulin, diabetic cats should be periodically checked by the veterinarian for weight gain or loss, urinary tract infections (common in diabetics, as bacteria grow well in a urine that contains sugar/glucose) and other health issues (kidney and dental disease, for example). Diabetic cats who have other health problems are often difficult to regulate. Appropriately treating the source of infection or inflammation (diseased gums or teeth, for example) often reduces the insulin requirement considerably.
In the 21st century, diabetic cats have the benefits of an increased understanding of the disease and can be treated with more effective therapies. Although clients are often dismayed by the diagnosis of diabetes in their beloved kitties, the good news is that the disease can be managed – even cured, in many cats – by following your veterinarian’s recommendations.