What to feed patients with diabetes

Diabetes is a common disease in cats and dogs that results from a decline in insulin secreted by the pancreas and/or decreased sensitivity of the body’s tissue to insulin. The resulting hyperglycemia causes the initial symptoms noted by the owner, such as polyuria, polydipsia, and weight loss. Later in the disease, the patient may have lethargy, poor body condition, weakness, and potentially cataracts. Frequently, diabetes presents with other comorbidities such as obesity, pancreatitis, urinary tract infections, hyperadrenocorticism, or infections. Comorbidities may impact the response to therapy and should be evaluated and addressed.¹

Dietary modifications can help regulate diabetes in addition to insulin or the newer feline sodium-glucose cotransporter-2 inhibitors. All owners of newly diabetic animals should be aware of the signs of hypoglycemia and how to address them at home. Because glucosuria causes increased urination, lots of fresh water should be consistently available for the diabetic animal. The dietary recommendations for diabetic cats and dogs differ to achieve optimal patient outcomes.

Feline nutritional needs

Cats with diabetes often experience insulin resistance secondary to hyperglycemia and obesity.^2,3 With chronicity, the pancreatic beta cells that usually produce insulin start to produce less, worsening the endocrinopathy. Studies have shown that these obligate carnivores can have diabetes remission at varied reported rates when a low-carbohydrate/high-protein diet is combined with insulin therapy.^2,4 Prescription feline diabetes diets are lower in carbohydrates and higher in protein. Canned foods generally have lower carbohydrate content and higher moisture content than dry kibble based food. The lower carbohydrate profile improves glycemic control by reducing blood glucose spikes.

Most insulin therapies in cats require a dosing interval of 12 hours.¹ Feeding a lower-carbohydrate canned meal twice daily, shortly before administering insulin, can result in good glucose control in most diabetic cats.

Dividing the daily caloric requirement into meals is ideal if the cat will adjust or already eats twice daily. Free choice or timed feeding can be done if the cat’s eating routine cannot be adjusted without causing stress. The impact of insulin on hyperglycemia usually peaks at 4 to 8 hours after injection, and a snack can be offered then if desired. Some owners will play an activity game to encourage physical activity during snack time and encourage lean muscle mass development in indoor cats.

Obesity contributes to insulin resistance, and controlled weight loss in overly conditioned cats is part of good diabetes management.² Weight loss in obese cats should not exceed 2% of body weight per week.¹

Lower-carbohydrate foods impact glucose more than high-fiber foods, which are not recommended for cats with diabetes.

Canine nutritional needs

Dogs with diabetes lack adequate insulin production by the pancreatic beta cells and always require exogenous insulin administration.¹ A dog’s diet can impact postprandial hyperglycemia but is generally considered less important than the diet fed to cats with diabetes.¹ Food high in insoluble fiber is often used to promote ideal body condition and minimize postprandial hyperglycemia by slowing glucose absorption from the gastrointestinal tract. A balanced and palatable diet is essential so food can be fed consistently, along with insulin injections, for good glycemic control.^1,5

If an animal does not eat a single meal, an appetite stimulant can be used, or half the insulin given at regular mealtime can be used to prevent a diabetic ketoacidosis state. An evaluation should be done to check for other concurrent diseases in an animal that has continued poor appetite.¹

Because diet less impacts glucose control in dogs with diabetes, feeding for comorbid diseases or palatability takes precedence when dietary regulation is needed for other conditions such as food allergy, inflammatory bowel disease, renal disease, or urinary stones. Weight loss in dogs with obesity should not exceed 2% of body weight a week.¹

Evaluating response to therapy

To monitor the newly diagnosed patient with diabetes, the clinician should use a combination of symptoms noted at home, body weight trends, urinalysis, and blood glucose levels to determine what therapy adjustments are needed. Careful questions about feeding amounts, timing, palatability, and other snacks/treats should be considered for dietary evaluation. With planning, client education, and patience, dietary modifications can be integral to achieving diabetes control.

References

1. Behrend E, Holford A, Lathan P, Rucinsky R, Schulman R. 2018 AAHA diabetes management guidelines for dogs and cats. J Am Anim Hosp Assoc. 2018;54(1):1-21. doi:10.5326/JAAHA-MS-6822
2. Zoran DL, Rand JS. The role of diet in the prevention and management of feline diabetes. Vet Clin North Am Small Anim Pract. 2013;43(2):233-243. doi:10.1016/j.cvsm.2012.11.004
3. Öhlund M, Egenvall A, Fall T, Hansson-Hamlin H, Röcklinsberg H, Holst BS. Environmental risk factors for diabetes mellitus in cats. J Vet Intern Med. 2017;31(1):29-35. doi:10.1111/jvim.14618
4. Bennett N, Greco DS, Peterson ME, Kirk C, Mathes M, Fettman MJ. Comparison of a low carbohydrate-low fiber diet and a moderate carbohydrate-high fiber diet in the management of feline diabetes mellitus. J Feline Med Surg. 2006;8(2):73-84. doi:10.1016/j.jfms.2005.08.004
5. Heeley AM, O’Neill DG, Davison LJ, Church DB, Corless EK, Brodbelt DC. Diabetes mellitus in dogs attending UK primary-care practices: frequency, risk factors and survival. Canine Med Genet. 2020;7:6. doi:10.1186/s40575-020-00087-7

Kathryn Junkins Sarpong, DVM, DABVP (canine/feline), is a small animal veterinarian and business owner who loves to mentor and teach newly minted veterinarians and help her colleagues with challenging cases. Initially, she trained as a chemical engineer at the University of Virginia and worked for Merck as a technical operations engineer. Junkins Sarpong course corrected early in her career, and she obtained her doctorate in veterinary medicine from Texas A&M School of Veterinary Medicine and Biomedical Sciences in 2001. She completed an internship with Stephen Ettinger, DVM, DACVIM (SAIM, Cardiology), at California Animal Hospital Veterinary Specialty Group in 2002.

She enjoyed practicing emergency medicine for several years before opening a small animal practice with a former classmate in 2006. The practice grew to 3 locations with 16 doctors, and Junkins Sarpong mentored numerous new veterinarians. In 2011, she completed the requirements to become board certified by the American Board of Veterinary Practitioners in canine/feline practice. She served as treasurer and later president of Emergency Animal Clinic Inc., the largest and oldest Dallas emergency animal hospital before navigating its sale to MedVet.

Other activities include publications, serving as a key opinion leader, past president of the veterinary leadership group for Innovetive Petcare, and serving on the Companion Animal Parasite Council board since 2022.

In 2023, she became director of leadership and learning for Innovetive Petcare. She developed a curriculum to create local leaders at each clinic location and personally mentored more than 40 local medical directors. She enables local leaders to drive medical excellence and business success.