Caring for the cat with diabetes

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Diabetes is a common issue among cats. Between better recognition from veterinarians and more owners bringing their cats to the vet, it is being diagnosed more and more. Adam Christman, DVM, MBA, of dvm360® Live, spoke with Patty Lathan, VMD, MS, DACVIM, about the differences between canine and feline diabetes, what is happening within the body, and medications that are changing how diabetes is treated. 

Adam Christman, DVM, MBA: How common is diabetes in cats?

Patty Lathan, VMD, MS, DACVIM: It is between 1 and 2 out of every 400 cats. A veterinarian will likely diagnosis a cat with diabetes every month or so.

Feline diabetes is much different from canine diabetes. It is like type 2 diabetes in humans whereas canine diabetes is more like type 1 diabetes. Once a dog becomes diabetic, they invariably need insulin for life, whereas type 2 diabetes in people can often be managed with diet, exercise, and oral medications. They may eventually need insulin, but that isn’t always the case. However, cats have often been treated with insulin due to a lack of effectiveness with oral medications. Now there are options.

Christman: How do amyloid deposition and glucose toxicity play a role in cat pathophysiology?

Lathan: Whenever insulin is secreted, so is amyloid, which helps decrease blood glucose over time. When you have more insulin resistance, β cells make more insulin, and the more insulin that’s produced, the more amyloid there is. Unfortunately, excess amyloid can deposit on the islets of the pancreas and cause inflammation as well as the destruction of β cells. Amyloid deposition is linked to Alzheimer disease.

Glucose toxicity, on the other hand, happens when β cells can’t keep up with the rising glucose levels. Glucose is toxic to β cells. This toxicity makes it so the β cells can’t make insulin. However, if you catch it soon enough, we think glucose toxicity is reversible.

Christman: What are the goals of treating and managing feline diabetes?

Lathan: My primary goals are to decrease clinical signs—frequent drinking and urination, weight loss—and improve the quality of life of the cat and the owner. While doing that, I also want to help prevent some of the complications associated with diabetes like hypoglycemia, diabetic neuropathy, and decay.

Christman: Walk us through the traditional treatment options when diagnosing feline diabetes. What are some common objections?

Lathan: We’ve used either protamine zinc insulin (PZI) or glargine insulin. We typically start the cats on 1 to 2 units twice daily depending on how high the glucose is and how big the cat is.

The first common objection is we’re often working with people who have not given injections before. They may have a needle phobia or are afraid of hurting their cat. Secondly, these are twice-daily injections, 12 hours apart. It doesn’t have to be to the second, but it does have to be consistent. So, it can get to a point where these injections affect the quality of life of the pet owner. The other side of this, too, is you want to enjoy time with your pet. If a cat is running away because they don’t want the needle and the pet owner is stressed about the cat’s glucose level, that tampers with the human-animal bond.

Christman: Tell us about new treatment options. 

Lathan: The new class of drugs are sodium-glucose transporter-2 (SGLT2) inhibitors. Glucose is filtered through the glomerulus and reabsorbed from the renal tube. SGLT2 is responsible for 90% of the reabsorption in the renal tubes, so the idea is, if we inhibit SGLT2, then glucose is excreted rather than fully reabsorbed. It is through the excretion of glucose that blood glucose concentration decreases. This class of drugs has been used on people for about 10 years and they have shown improvements in cardiac and renal outcomes.

The great thing about these medications is they can be given orally: Senvelgo is a liquid whereas Bexacat is a pill. Regarding adverse effects, some cats can develop diarrhea at the beginning of this treatment regime. The main thing to keep an eye out for is diabetic ketoacidosis because as the medication is working, some cats who may not be able to make insulin anymore due to the destruction of β cells can’t inhibit ketone formation.