Diabetic stabilization in cats

Diabetes is a relatively common disease in people and is being recognized more frequently in pets. If untreated the disease has serious effects and will ultimately result in the death of your pet. The good news is that most diabetic animals can be successfully treated and many live normal, happy lives. However, caring for a diabetic pet takes a good deal of time and effort to make sure their disease is well controlled, and poorly controlled disease can lead to a variety of complications for your pet.

If diabetes is not well managed your cat will continue to show signs of disease and they are at a high risk of developing medical complications. In a well-controlled diabetic cat, there is a slow increase in blood sugar levels after eating and blood sugar is neither too high nor too low at all times of the day. If animals are well-controlled the signs of diabetes, such as excessive eating should resolve. Keeping blood sugar levels well-controlled is important to avoid complications such as nerve damage and more severe potential problems like ketosis and infections. This gives your pet the best possible outcome and chance to live a normal life-span.

Difficulty controlling diabetes usually boils down to either:

Problems with insulin

This can be due to problems with the way you are giving insulin, timing of injections or dose of insulin used; or to poor handling, or storage of insulin so that the insulin does not work properly. If your cat’s diabetes is not well controlled on their current regime your veterinarian may want to consider changing the dose of insulin or type of insulin and the timing of injections.

Always make sure that insulin injections are given at the same time each day. If you are having trouble with the injection, ask your veterinarian to show you again how to give it properly and to check your technique. Your veterinarian will probably also check that you are keeping the insulin stored in the fridge and that it is not out of date.

Problems with the body’s response to insulin

The term ‘insulin resistance’ is used when a patient fails to respond properly to an adequate dose of insulin. This can be due to an ongoing problem such as obesity, because obese animals respond less well to insulin than do thinner ones. However, infections, eg urinary tract infections or even gum disease in cats, and some drugs or hormones can also cause insulin resistance. In these cases resistance may develop suddenly and then resolve if the drug is stopped or the inflammation settles down. Many diabetic cats may also have inflammation of their pancreas. They may show no signs of the inflammation or infection but, if it is untreated, it can be very difficult to control the diabetes. If underlying diseases are treated, insulin requirements can change over time, so it is very important to keep monitoring how well your pet is controlled on a regular basis.

Most cats with unstable diabetes have periods when their blood sugar is too high. This means that the signs they initially had, such as excessive drinking, are likely to return. Although more serious problems are rare, cats with very high blood sugar levels can become quite unwell with vomiting and depression and can fall into a coma. Over the longer-term other effects may be noticed. If you are taking regular urine or blood samples, you will start to notice sugars appearing in the urine or blood sugar levels always being high.

Some cats with unstable disease have times when their blood sugar drops very low. In these periods they may become wobbly and confused and, if levels continue to drop, cats can start to have fits (seizures), fall into a coma and even die if not treated. This is sometimes called a ‘hypo’ attack. If you are monitoring blood samples at the time of the episode you would see that blood sugar is low and your cat may need a rapid sugary boost. Since cats do not enjoy sugary foods you may need to rub some corn syrup or a strong sugar solution onto their gums.

However, urine samples can be misleading as sometimes cats that are unstable have times when their blood sugar is very high and then very low in the same day. Since the urine can remain in the bladder for a long time the urine sampled at the time of a ‘hypo’ attack may have been made much earlier in the day when blood sugar was high. It is possible to have sugar in the urine of a cat that is collapsing due to low blood sugar.

If you have a diabetic cat it is very important to ask your veterinarian for advice if your pet is unwell in any way.

Cats with diabetes have problems regulating their blood sugar level. When they eat their blood sugar rises but they fail to bring this down to normal levels. These persistent high blood sugar levels start to cause problems throughout the body. Most diabetic cats are treated with the use of regular insulin injections which help reduce blood sugar levels. There are many factors that may affect how well this insulin may work in diabetic cats and many of these can be controlled at home.

Diet

Dietary control is used to improve body condition in cats and to help with stabilization of sugar levels. Diets that are low in carbohydrate have been shown to help diabetic control. Wet foods seem to be better than dry foods for diabetic cats. Cats naturally have a high blood sugar for a long time after eating so timing of meals, unlike in people, is not important in most diabetic cats.

Obesity

Obesity reduces the ability of the body tissues to take up and use sugars from the blood. It is more difficult to control blood sugar in obese diabetic cats and weight loss is encouraged to improve their response to insulin. Weight reduction must be slow and steady until the desired weight is achieved. High fiber diets can help with the management of obese patients as the fiber also helps to control glucose levels and the extra bulk of the diet helps make your pet feel full after eating. As obese cats start to lose weight, they require careful monitoring as the dose of insulin they need often reduces as they slim.

Poor body condition

Some diabetic cats are thin at the time of diagnosis. Your veterinarian will want to do some tests to make sure there is no other condition that is causing weight loss in your pet. In most cases diabetic cats are thin because they have not been able to take up the calories from their diet without the insulin injections. In these cases, the cat may need to be fed a special diet that will allow weight gain.

Exercise

Exercise is important for all cats, but it makes insulin work better and additionally promotes weight loss. In diabetic animals exercise should be consistent from day to day to minimize its effects on blood sugar levels, but it can be very hard to regulate how and when a cat takes exercise. When an animal exercises their muscles use up sugars from the blood and blood glucose levels drop so, if possible, try to limit your cat’s outdoor activity at the times of peak insulin activity. Strenuous exercise can potentially result in clinically significant low blood sugar in diabetic patients on treatment.

Oral hypoglycemic agents

Some diabetic people with so called Type 2 diabetes, can manage without the use of insulin injections. A number of tablets are available that can help reduce blood glucose levels when combined with an appropriate diet and exercise management. Some diabetic cats can also be managed by a weight loss program and tablets to reduce their insulin requirements, however most will still need insulin injections.

If your pet’s diabetes is poorly controlled your veterinarian will want to examine them and talk to you about what has been happening at home to try to understand if there could be any health problems or if there is some problem with the insulin administration. Further blood tests and X-rays or ultrasound may be needed for a complete health check.

If your pet is diabetic you will be familiar with checking urine samples for the presence of sugar and you or your veterinarian will regularly monitor blood sugar levels also. If your pet’s diabetes appears to be unstable your veterinarian may want to take them into the hospital for some more detailed monitoring which involves taking multiple blood samples 1-2 hours apart to see what is happening throughout the day. Alternatively, they may ask you to take more frequent samples at home. Home monitoring has been simplified recently through the use of continuous blood glucose monitoring systems which avoid the need to obtain multiple blood samples. Ask you veterinarian about this option.

With careful monitoring it is possible to identify an unstable diabetic before serious consequences arise. With rapid treatment of the problem, it should be possible to get your pet back on an even keel and hopefully avoid the long-term complications that can go along with unstable disease.