Pet obesity is on the rise, with more than half the U.S. cat population classified as overweight or obese. Along with obesity comes an increased risk for many other health problems, including diabetes. Estimates claim that up to 1% of cats will develop diabetes, although some experts believe this number will climb. Prompt diagnosis and strict management give diabetic cats the best chance at a long, healthy life. The Just Cats Clinic team wants cat owners to be aware of diabetes signs, and to understand what a diabetes diagnosis means for them and their pet.

What is cat diabetes?

Diabetes is an endocrine disease that results from an insulin deficiency. Your cat’s body cells need glucose for energy, and insulin to transport glucose into the cells. In Type I diabetes, pancreatic beta cells stop making insulin. In Type II diabetes, which most cats acquire, insulin circulates but body cells become resistant to its effects. In either case, cells are starved for necessary energy.

Risk factors for developing cat diabetes

Obesity is the most important diabetes risk factor, with obese cats up to four times more likely to develop diabetes than their slim counterparts. Other risk factors include:

  • Steroid use
  • Older age
  • Physical inactivity
  • Male gender, neutered
  • Burmese breed

Cat diabetes signs

Diabetes results in relative starvation, despite adequate food intake, so cats appear ravenously hungry while they rapidly lose weight. Excess blood sugar spills over into the urine and brings along water molecules, which results in cats urinating excessively, becoming dehydrated, and drinking more water to compensate.

Cat diabetes emergencies and complications

Because cats are excellent at hiding their medical problems, diabetes can go unnoticed at home, which is dangerous, because a cat whose diabetes is untreated for too long, or who develops another illness, can suffer from a secondary condition called diabetic ketoacidosis (DKA). Cats in DKA break down fat for energy, which is converted into molecules called ketones. Excessive ketones, combined with excessive sugar, results in more acidic blood, and severe illness. DKA is a medical emergency and requires several days of hospitalization with IV fluids, medications, and diagnostic testing to determine the trigger. Signs may include:

  • Vomiting
  • Lethargy
  • Weakness
  • Increased or decreased respiratory rate
  • Dehydration
  • Sweet breath smell

Diabetes can also make cats more prone to additional medical conditions, including high blood pressure, pancreatitis, fatty liver, and urinary tract infections. Controlling diabetes helps to prevent complications.

Cat diabetes diagnosis

Some cats with diabetes are first diagnosed when they present to an emergency veterinary hospital, others are diagnosed on routine annual exams, and still others are diagnosed because their owners notice weight loss or urination changes. Blood and urine tests, combined with clinical signs, can diagnose diabetes. If these test results are unclear, a specialized fructosamine blood test can provide the blood sugar average from the previous few weeks rather than a single time point. Cats presenting with DKA may need extensive blood work, X-rays, and ultrasound.

Insulin and diet strategies for diabetic cats

Diabetes treatment depends on insulin therapy, diet change, and weight management. Several insulin types can be used in cats, but determining the right type and amount can take months. Insulin injections are given at home, under the skin, every 12 hours. The best diets are low in carbohydrates and high in protein to keep blood sugar consistent throughout the day. Cats may be meal-fed or free-fed, depending on veterinarian, client, and cat preference. 

Weight management can be extremely valuable for diabetic cats. Home exercise and a strict diet can result in weight loss that, along with appropriate insulin therapy, may result in diabetic remission. Cats in remission no longer require insulin as long as their diet and weight are maintained.

Long-term diabetic cat monitoring

Frequent monitoring ensures cats are receiving the right insulin type and dose. After starting initial treatment, your veterinarian will perform a glucose curve, taking measurements every one to two hours throughout the day, then make dose adjustments using the information and, finally, perform another curve a few weeks later. The process can be painstakingly slow, but small, incremental adjustments are necessary to ensure your cat’s blood sugar doesn’t dip dangerously low, which can cause seizures, coma, or death. 

Aside from monitoring glucose curves to make periodic insulin adjustments, additional diagnostic tests are required every six months to monitor for complications. Tests include:

  • CBC and chemistry —These evaluate overall health, with special attention to liver, kidney, and pancreatic values, as well as blood cholesterol levels.
  • Urinalysis — This test determines whether glucose or ketones are present in the urine, and helps evaluate kidney function
  • Urine culture — This culture checks for “silent” urinary tract infections, which occur frequently in diabetic cats.
  • Fructosamine level — This test roughly indicates overall glucose control over several weeks.

At home-monitoring options

If you and your cat are open to the idea, you may consider performing spot glucose checks or glucose curves at home, because these results can be more accurate than in-hospital curves, which may be falsely elevated because of stress. Your veterinarian will provide the equipment and training necessary. Another option is the newly available continuous Freestyle Libre monitor. The veterinary team attaches a sensor to your cat’s skin, which stays in place for about a week, continuously monitoring glucose levels and allowing your veterinarian to see real-time trends and determine whether insulin adjustments are needed. 

Never use at-home readings to change your cat’s insulin dose or diet plan on your own—only your veterinarian is qualified to interpret results and make safe adjustments. We take your cat’s safety seriously, and we will terminate your relationship as our client if you choose to adjust your cat’s treatment plan without first consulting our veterinary team. 

Costs involved with cat diabetes

Diabetes management involves several ongoing expenses that you should be prepared for, including:

  • Insulin (may be more than $100 per bottle or pen) and syringes
  • Prescription diet food
  • Frequent veterinary visits for blood work and monitoring
  • Freestyle Libre monitor attachment and interpretation
  • Internal medicine specialist consultation, if needed

Additionally, your cat may need hospitalization in a specialty facility for several days if they have a DKA emergency, and these visits can cost several thousand dollars. Cats who go into remission within their first six months of treatment may no longer need insulin, which can greatly reduce your expenses.

Diabetes signs can be confused with many other diseases, especially in aging cats, so annual or more frequent wellness visits are important to screen cats for changes and monitor blood work trends. If your cat is due for a wellness visit, or you have concerns about changes to your cat’s weight, appetite, drinking, or behavior, contact us to schedule a visit with our Just Cats Clinic team.