Pancreatitis and chronic kidney disease in feline patients with diabetes

Photo: Kristina Blokhin/Adobe Stock

Diabetes is most common in cats that are middle-aged or older, with many of these felines being geriatric. As a result, comorbidities in feline patients with diabetes are especially common. In their lecture Treatment Approach to the Diabetic Cat with Comorbidities, presented at the 2025 WVC Annual Conference in Las Vegas, Nevada, J. Catharine Scott-Moncrieff, Vet MB, DACVIM (SAIM), DECVIM; and Thomas Schermerhorn, VMD, DACVIM (SAIM), talked about the management of feline patients with diabetes, with a particular focus on patients with comorbidities. Some of the session’s highlights included treatment options for feline diabetic patients with pancreatitis and chronic kidney disease, among other common comorbidities.

According to Scott-Moncrieff and Schermerhorn, comorbidities cause insulin resistance, impairing insulin action in the tissues. “This [insulin resistance] is overcompensated for by additional production of insulin and also by additional production of [intestinal alkaline phosphatase] (IAP) or aniline, which then is deposited in the pancreatic beta cell and leads to continued beta cell dysfunction,” explained Scott-Moncrieff.¹ “So insulin resistance, lack of beta cell function can either cause…diabetes or worsen diabetic control in an established diabetic.”

Patients with pancreatitis

Recognizing pancreatitis in feline patients with diabetes is extremely important, as this condition is very common in cats. According to Scott-Moncrieff, studies have suggested that it is possible that up to approximately 67% of cats show some evidence of pancreatitis, with roughly 45% of apparently healthy cats also showing signs of the condition.¹

Subclinical pancreatitis

In the session, Scott-Moncrieff explained that most of the time, pancreatitis is subclinical in feline patients with diabetes. “If [the pancreatitis is] completely subclinical, I mean, even with their diabetic control, the problem is the clinical signs of pancreatitis can be super subtle. So sometimes we really don't know if there are low levels of clinical signs of their pancreatitis. Some studies have definitely shown that cats with evidence of subclinical pancreatitis have lower emission rates and poor glycemic control,” she said.

For these cases, patients should be monitored, including appetite and variations in glycemic control. If changes in glycemic control are observed, veterinarians should look for pancreatitis more thoroughly.

Scott-Moncrieff also emphasized the importance of monitoring for direct remission. “If cats have relapsing-remitting pancreatitis, if their pancreatitis subsides, they may go into diabetic remission and need to know about that… because we don’t want them presenting with hypoglycemia,” she stressed.

Clinical pancreatitis

In patients with clinical pancreatitis, acute or severe forms of the condition can cause inflammation of the pancreas, leading to reduced insulin secretion and potentially resulting in hyperglycemia. The inflammation also causes “waxing and waning” insulin resistance, explained Scott-Moncrieff.

Clinical pancreatitis in felines can also have the same “waxing and waning” effect on their appetites. “Most importantly, cats with clinical pancreatitis also have waxing and waning appetites…intermittent anorexia, and this can be hugely challenging,” said Scott-Moncrieff.

For these patients, Scott-Moncrieff explained, sodium-glucose cotransporter 2 (SGLT2) inhibitors are not a good treatment option. Instead, these felines need to be treated with insulin. Adding appetite stimulants, as well as nausea and pain relief medication is also recommended. Nutritional support may be needed. Additionally, Scott-Moncrieff recommends patients follow a diabetes-focused diet.

Patients with chronic kidney disease

As the leading cause of death in cats, chronic kidney disease (CKD) affects up to 40% of felines over the age of 10, and 80% over the age of 15.² Cats with diabetes and CKD at IRIS stage 1 or 2 may be good candidates for SGLT2 inhibitors but need to be systemically stable, explained Scott-Moncrieff. However, newly diagnosed cats with an IRIS stage of 3 and 4 should be treated with insulin.

The renal function of these patients should be regularly monitored, and the IRIS guidelines should be followed. Additionally, these patients’ diet should be focused on the CKD.

Takeaways

“In summary, most...diabetic cats have type 2 diabetes, but unlike humans, they’ve historically been treated with insulin,” concluded Scott-Moncrieff. SGLT2 inhibitors offer a new treatment option for feline patients with diabetes that do not have major comorbidities. However, not all patients are suitable candidates for this new treatment option, including those with IRIS stage 3 or 4 of CKD and those with clinical pancreatitis.

References

1. Scott-Moncrieff JC, Schermerhorn T. Treatment approach to the diabetic cat with comorbidities. Presented at: WVC; Las Vegas, NV. March 2-5, 2025.
2. Chronic kidney disease. Cornell University College of Veterinary Medicine. January 2025. Accessed March 5, 2025. https://www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/chronic-kidney-disease