Affects: Cats, Dogs
Feline diabetes mellitus is a chronic disease in cats whereby either insufficient insulin response or insulin resistance leads to persistently high blood glucose concentrations. Diabetes affects up to 1 in 230 cats, and may be becoming increasingly common. Diabetes is less common in cats than in dogs. The condition is treatable, and if treated properly the cat can experience a normal life expectancy. In cats with type 2 diabetes, prompt effective treatment may lead to diabetic remission, in which the cat no longer needs injected insulin. Untreated, the condition leads to increasingly weak legs in cats and eventually to malnutrition, ketoacidosis and/or dehydration, and death.
Diabetes in cats can be classified into the following:
Type 1 diabetes, in which the immune system attacks the pancreas, is "extremely rare" in cats, unlike in dogs and humans.
Symptoms: Cats will generally show a gradual onset of the disease over a few weeks or months, and it may escape notice for even longer.
The first outward symptoms are sudden weight loss (or occasionally gain) accompanied by polydipsia and polyuria. Polyphagia or anorexia may be observed. Neuropathy in the hind legs may cause the cat to develop a plantigrade stance, walking on its hocks rather than its toes. The front legs may develop a corresponding palmigrade stance, with the cat standing on its "palms" rather than its toes.
A fasting glucose blood test will normally be suggestive of diabetes at this point. The same home blood test monitors used in humans are also used on cats, usually by obtaining blood from the ear edges or paw pads. As the disease progresses, ketone bodies will be present in the urine, which can be detected with the same urine strips used for testing human urine.
In the final stages, the cat starts wasting, with the body breaking down its own fat and muscle to survive. Lethargy/limpness and acetone-smelling breath are acute symptoms of ketoacidosis and/or dehydration and constitute a medical emergency.
Untreated, diabetes leads to coma and then death.
Causes: The signs of diabetes are caused by a persistently high blood glucose concentration, which may be caused by either insufficient insulin or by a lack of response to insulin. Most cats have a type of diabetes similar to human type 2 diabetes, with β-cell dysfunction and insulin resistance. Factors which contribute to insulin resistance include obesity and endocrine diseases such as acromegaly. Acromegaly affects 20–30% of diabetic cats; it can be diagnosed by measuring the concentration of insulin-like growth factor-1 (IGF-1) in the blood.
Quite frequently, a cat which is under stress because it has been transported in a car and/ or brought to a veterinarian will experience an artificial temporary spike in blood glucose levels called "stress hyperglycemia" which will subside after a few hours. This spike, however, will not affect the cat's blood fructosamine levels, which are therefore often a better measure of overall blood sugar.
Management: Diabetes is a condition which can be treated, but it is invariably lethal if ignored. Early diagnosis and treatment by a qualified veterinarian can help in preventing nerve damage, and, in rare cases, may even lead to remission. Diabetic cats do best with long-lasting twice-daily injections of insulin such as glargine (which as of 2022 is available worldwide as a synthetic generic drug) combined with a low carbohydrate diet. Because diabetes is a disease of carbohydrate metabolism, a move to a primarily protein and fat diet reduces the occurrence and recurrence of hyperglycemia.