Diabetes mellitus: How to manage cats without insulin

How to manage cats with diabetes mellitus without insulin. Managing a cat with diabetes mellitus is not easy.  Blood glucose monitoring and insulin injections are often not accepted by these naturally stubborn furballs.

This makes it all the more interesting that it is possible to reverse diabetes in cats, known as remission, simply by changing their diet. This means that your pet no longer needs insulin, there is no need to monitor blood sugar levels and you can enjoy a relaxed daily life. How does it work? We'll show you.

What is diabetes in cats?

Diabetes mellitus in cats is a condition in which the body has difficulty regulating blood glucose levels. As in humans, there are two main types of diabetes in cats: type 1 diabetes and type 2 diabetes. In type 1 diabetes, the cat's pancreas stops producing insulin; in type 2 diabetes, the body does not respond adequately to the insulin that is present.

Type 2 diabetes, also known as non-insulin-dependent diabetes mellitus, is almost exclusively found in cats. The disease has two characteristics: First, the body's cells become resistant to insulin. The hormone, which provides energy to cells by transporting sugar (glucose) from the blood into the cells, no longer responds. The energy supply is blocked and most of the sugar remains in the blood.

As a result, the cells that produce the hormone in the pancreas are damaged, leading to insulin deficiency and the need to take insulin. The daily administration of insulin is an important part of normalising blood glucose levels at the start of treatment and should always be done, even if it is difficult. To determine the correct amount of insulin, blood glucose must always be measured first, as too little and especially too much insulin can be harmful to the cat.

What causes diabetes in cats?

The exact causes of diabetes in cats are not fully understood, but there are some risk factors. Obesity plays an important role, as obesity increases insulin resistance. Genetic predisposition may also play a role and is suspected in Burmese, Maine Coon, Siamese and Norwegian Forest Cats. Pancreatitis, stress, certain medications and hormonal imbalances can also trigger diabetes mellitus in cats.

At what age do cats develop diabetes?

Diabetes can affect cats of any age, but is more common in older cats. More than 80% of cases occur in cats aged 7 years or older. Obese cats and cats with a genetic predisposition are particularly at risk. It is important to recognise the risk factors and make an early diagnosis to ensure optimal treatment.

Symptoms: How does a cat with diabetes behave?

A cat with diabetes mellitus can show a variety of symptoms. Elevated blood glucose levels stimulate urine production, leading to increased thirst. In addition, the cells that need glucose to function do not get enough energy and cannot function properly. As a result, cats with diabetes mellitus show the following symptoms:

• Increased thirst and urination: Diabetes leads to increased thirst in cats. They may drink more water and use the litter tray more often.

• Weight loss despite an increased appetite: Cats may have an increased appetite but lose weight. This is because the body is unable to use blood sugar properly due to a lack of insulin and therefore draws on its fat reserves.

• Increased fatigue and sleeping: Cats with diabetes mellitus may appear lethargic and tired. They may sleep more and be less active due to lack of energy.

• Weakness and decreased physical condition: Due to changes in metabolism and energy intake, cats with diabetes may be weaker and in poorer physical condition. They may be less active and lively.

• Litter box behaviour: Some cats with diabetes develop litter box problems as the increased thirst and urination may cause them to urinate outside the litter tray.

• Flattening of the foot: Cats with diabetes mellitus may develop what is known as a plantigrade gait. This means that they place the whole sole of their foot on the ground, rather than just the tips of their toes. A plantigrade gait is a clear sign that the cat has been living with diabetes for a long time and has advanced complications such as diabetic nerve damage or muscle damage.

It is important to realise that these symptoms are not specific to diabetes and can also occur with other conditions. If you notice one or more of these signs in your cat, it is important to visit a veterinary practice for a diagnosis. Diabetes mellitus can only be diagnosed with the help of blood tests.

Do cats with diabetes have pain?

No, cats with diabetes mellitus do not usually develop pain directly related to the disease. Diabetes itself does not cause pain as it is a metabolic disease that affects blood glucose levels and insulin balance. The symptoms associated with diabetes do not usually cause pain themselves.

However, untreated or poorly controlled diabetes complications, such as diabetic neuropathy, can cause pain. Diabetic neuropathy is damage to the peripheral nerves caused by sustained high blood sugar levels. In some cats, this nerve damage can cause tingling, numbness or pain in the affected areas. The hind legs are more likely to be affected, which can lead to reduced mobility and the aforementioned plantigrade gait.

There is no universal rule for recognising pain in cats. As almost all organs and body structures contain pain receptors, there are a variety of behavioural and physical signs that indicate pain. These signs are not always obvious, or may be classed as 'normal signs of ageing'.

These signs may indicate that your cat is in pain:

• Pain face: A relatively reliable indication of the presence of pain is the so-called pain face. The eyes are either fixed and wide open or narrowed with a furrowed brow. The ears are strained or flat against the head. The face is generally tense, the mouth is pulled back and wrinkles form at the corners of the mouth.

• Behavioural changes: A cat in pain may be unusually withdrawn and less active. It may play, jump or frolic less. Increased irritability or aggression may also be signs of pain.

• Change in posture: A cat in pain may show a change in posture, such as a curved or extended spine, a hanging head or a limp posture.

• Changes in appetite: Pain can affect a cat's appetite. She may avoid the feeding area, eat less or not empty her bowl completely.

• Altered sleeping behaviour: A cat in pain may have difficulty finding a comfortable sleeping position. It may sleep restlessly, wake more often or sleep less than usual.

• Abnormal body reactions: Pain can cause conspicuous reactions such as purring, hissing or sizzling when certain parts of the body are touched. You may also try to hide or withdraw to relieve the pain.

• Changes in grooming: A cat in pain may groom less intensively or avoid certain painful areas of the body. This can lead to a messy or neglected appearance of the coat.

It is important to look out for signs of pain or discomfort in your cat and discuss these with your vet. He/she will be able to determine if it is diabetes-related pain and take appropriate steps to alleviate it. Appropriate pain management or treatment of underlying complications may improve your cat's well-being.

What is the treatment for cats with diabetes?

Diabetes in cats is usually treated with insulin injections. Your vet will assess your cat's insulin needs and tell you exactly how much, how and when to give the insulin. He or she will also show you the procedure. It is important that you follow the vet's instructions carefully and check your cat's blood glucose levels regularly. In addition to insulin therapy, your cat should be given a special diet to help regulate blood sugar levels and reduce the need for insulin.

Insulin therapy: How often should your cat be given insulin injections?

The frequency of insulin injections for cats with diabetes depends on several factors, including the type of insulin used, the severity of the disease and the individual cat's response to treatment. As a general rule, most cats are treated with insulin twice a day, with injections about 12 hours apart.

When should a cat be given insulin injections?

It is important that insulin injections are given at the same time each day to maintain stable insulin levels in the cat's body. A regular schedule is essential for good blood glucose control and effective treatment. Insulin should also always be given after meals to avoid dangerous hypoglycaemia if your cat does not eat its ration as expected.

How do you inject insulin into a cat and what should you be aware of when injecting?

Follow your vet's instructions exactly when giving insulin. Use an insulin syringe to dose the correct amount of insulin. Insulin is usually given subcutaneously (under the skin). The neck is often recommended as an injection site. Try to vary the injections in different parts of the neck to avoid irritation. Use a diabetes diary to note daily blood glucose readings, how much insulin your cat has received, and any abnormalities.

Preparing an insulin syringe for cats requires precision and hygiene. Here is a step-by-step guide to preparing an insulin syringe:

• Wash your hands thoroughly with soap and water to ensure a clean working environment.

• Have all the necessary utensils ready, including the insulin vial, an insulin syringe of the correct size and a new needle.

• Insulin should always be stored in a refrigerator. Only take it out to draw up the syringe and then put it back. If you don't need the syringe immediately, put it in the fridge too.

• Check that the insulin has not expired and that it is clear and free of contamination. Do not shake the insulin, but roll the vial gently between your hands to mix it.

• Remove the protective cap from the insulin vial and disinfect the rubber stopper with alcohol or a suitable disinfectant. Allow the alcohol to dry completely before removing the insulin.

• Draw up the required dose of insulin into the syringe. Hold the syringe vertically and insert the needle into the rubber stopper of the insulin vial. Slowly squeeze the plunger to remove any air bubbles. Then squeeze the insulin into the syringe beyond the desired mark.

• Check the insulin dose to make sure you have drawn out the correct amount. Hold the syringe at eye level so that you can easily read the scale.

• Check again that there are no air bubbles in the syringe. If there are, gently tap the syringe to bring the air bubbles to the top, then gently press the plunger to remove the air bubbles.

• Remove the needle from the insulin vial and replace the protective cap on the needle.

How high can a cat's blood glucose be?

Regular monitoring of blood glucose levels is important for adjusting insulin doses. Measuring blood glucose in cats takes some practice and is best taught by your vet. Usually a small drop of blood is needed from a tiny puncture on the ear or other suitable site. This drop of blood is applied to a test strip that is inserted into a blood glucose meter. The meter will then show your blood glucose level. It is important to use a meter that has been approved and tested for use in cats, otherwise readings will be inaccurate.

Normal blood glucose levels in healthy cats vary depending on factors such as age, activity level and nutritional status. In a cat that has not eaten for at least eight hours, blood glucose levels should be between 55 and 125 mg/dl or 3.1 and 6.9 mmol/l. However, during times of excitement and stress, the level can rise to 200 mg/dl or 11 mmol/l without being pathological.

It is important to note that blood glucose levels in cats can fluctuate throughout the day and are influenced by various factors such as meals, stress or physical activity. It is therefore advisable to always measure the blood glucose level at the same time of day and under the same circumstances.

In cats with diabetes mellitus, blood glucose levels are often above normal. Your vet will give you specific target ranges for your cat's blood sugar. These values may vary from case to case, but the aim is usually to keep the blood sugar in a stable range between 100 and 250 mg/dl or 5.6 and 13.9 mmol/l.

What happens if the cat doesn't receive insulin?

If a cat with diabetes does not receive insulin, this can have serious consequences for its health. Without sufficient insulin, the blood sugar level remains high while the cells have no access to glucose. This can lead to life-threatening conditions such as diabetic ketoacidosis, where the body breaks down fat as an energy source and releases ketones. These ketones can change the pH value of the blood and lead to severe metabolic disorders. It is therefore important that insulin therapy is administered according to the vet's instructions.

When should you stop giving your cat insulin?

It is important to know that stopping insulin or changing the dose without consulting your vet can be dangerous. Insulin therapy should never be stopped or changed unilaterally, as this can lead to a worsening of the cat's condition. Always speak to your vet if you have any concerns or questions about insulin treatment.

However, there are certain situations where it may be necessary to temporarily suspend or adjust insulin administration in a cat with diabetes. Some possible situations where insulin should not be given are

• Loss of appetite: If your cat is not eating his food, you should not give him insulin. This could lead to life-threatening hypoglycaemia. Wait until she has eaten and then give her the usual dose.

• Hypoglycaemia (low blood sugar): If your cat shows signs of hypoglycaemia, such as tremors, disorientation or seizures, you should temporarily stop giving insulin. See your vet immediately as this is an emergency.

• Illness or stress: If the cat becomes acutely ill or is exposed to severe stress, the insulin dose may need to be adjusted. In some cases, insulin can be temporarily stopped until the cat has recovered or the stress has subsided. Discuss this with your vet.

Where can I get feline insulin and which is the best?

Insulin for cats is a prescription medicine that can only be obtained from a vet. There are several types of insulin available, including insulins specifically designed for animals, such as PZI (protamine zinc insulin) or glargine, and human insulin. Which insulin is best for a cat with diabetes depends on a number of factors, including the individual course of the disease, blood glucose control and the cat's individual response to the insulin.

Your vet will choose the most appropriate insulin for your cat. The decision will be based on your cat's specific needs, blood glucose response and other factors.

How much does feline insulin cost per month?

The cost of insulin for cats can vary depending on the type of insulin, the dosage and your cat's individual needs. Insulin for cats is generally not an expensive medication, but regular purchases can add up over time. In addition, the cost of insulin is only part of the total cost of managing diabetes in cats. Other costs include regular visits to the vet, blood tests and the purchase of blood glucose test strips, syringes and special diets.

It is therefore advisable to plan a budget for your diabetic cat's care, and talk to your vet if you have financial problems to find suitable solutions. It is also a good idea to take out pet health insurance. Depending on the plan, this will cover the cost of various treatments and surgeries for cats in the event of illness. 

How long can a cat with diabetes live without treatment?

If left untreated, diabetes in cats can lead to serious complications and significantly shorten life expectancy. An untreated cat with diabetes can lose weight and develop long-term damage to organs such as the kidneys and liver. It is therefore important to detect the disease early and start the right treatment.

How can you care for a cat with diabetes on holiday?

If you have a diabetic cat and want to go on holiday, you need to plan carefully. It is advisable to find a reliable person to administer insulin and give your cat the necessary food. You should write detailed instructions for your cat's care and have important contact details for the vet's practice in case any questions or problems arise while you are away.

Can a cat's diabetes be cured?

Yes, in some cases it is possible for cats with diabetes mellitus to go into remission. Diabetes remission occurs when a cat's pancreas is able to produce enough insulin to regulate blood glucose levels without external insulin supplementation. This is usually achieved through a combination of weight loss, dietary changes and regular exercise.

It is important to note that not all cats with diabetes achieve remission. This depends on a number of factors, including the underlying cause of the diabetes, the stage of the disease and the cat's individual response to treatment.

Remission usually occurs if diabetes is detected and treated early. By consistently monitoring your blood glucose levels, using insulin, adjusting your diet and taking good care of yourself, you can increase the chances of remission.

However, it is important to remember that even after remission, there is a chance that diabetes will return. Regular monitoring of blood glucose levels and continued veterinary care are therefore necessary even during remission.

Diabetes remission in cats: How does it work?

Unlike dogs, cats are carnivores. While dogs cannot resist an apple, wild cats eat prey, usually whole. A combination of meat, fur, bones, blood and offal provides the cat with all the essential nutrients. Depending on the composition of the prey, the cat's main source of energy is protein and fat. Their bodies only need small amounts of carbohydrates, and hence sugar.

Insulin resistance in cats is therefore usually caused by an unbalanced, carbohydrate-rich diet that floods the body's cells with insulin. The body responds to the excess sugar with a massive release of insulin to lower the high blood sugar levels. This is where the measures that can lead to remission come in.

A low-carbohydrate diet reduces the need for insulin. The damaged insulin-producing cells can recover over time and your cat's sugar levels will return to normal. Studies on this subject¹ report success rates of up to 50%. This means that, if successful, half of cats with diabetes can be off insulin for several years. Feeding your cat less carbohydrate can normalise insulin production and eliminate the need for daily testing and injections. This can save you and your cat a lot of hassle, nerves and money! If the change of food is successful and your cat needs less insulin, your vet will be able to tell you at the regular check-ups.

What should a diabetic cat eat?

A first step towards the right diet for diabetes mellitus is to reduce the amount of carbohydrates in the diet. Studies have shown that a combination of high protein and low carbohydrate can lead to more remissions. Foods should be very low in carbohydrates, less than 12%, and high in protein, more than 40%, and preferably grain-free and sugar-free. The same goes for treats.

Ask your vet for advice on which diet is best for your cat. You can then buy special food for diabetics. Recommended diets include Hill's Prescription Diet r/d Feline if your cat is starting to lose weight, Hill's Prescription Diet w/d Feline and Purina Veterinary Diets OM Obesity Management for cats with diabetes. These brands offer both wet and dry food, depending on your cat's preferences. If you prefer to prepare the rations yourself, you can work with a vet who specialises in nutrition to create a diet plan for your cat.

But be careful: changing the diet of cats with diabetes can be a tricky business. It takes a lot of attention, sensitivity and time. Cats are very sensitive when it comes to food acceptance. That's why you should never change food on the spur of the moment, but always introduce new foods slowly.

Are there any home remedies for cats with diabetes?

No, there are no specific home remedies that can cure diabetes in cats. Treatment requires comprehensive care, including insulin therapy, dietary changes and regular veterinary check-ups. It is important that you follow your vet's instructions and do not rely on alternative or self-proclaimed remedies as these may be ineffective or even harmful.

What is the life expectancy for cats with diabetes?

The life expectancy of cats with diabetes depends on several factors, including the stage of the disease, the response to treatment and the overall health of the animal. With the right treatment and care, many cats with diabetes can live long and full lives. It is important to detect the disease early and start comprehensive treatment to improve the cat's quality of life.

End stage: When should a diabetic cat be put down?

In the advanced stages of diabetes, complications can arise that significantly affect the cat's quality of life. If, despite appropriate treatment and care, a cat has persistent diabetes-related problems and its well-being is severely compromised, in some cases it may be necessary to make the difficult decision to put it down.

However, this should always be done in consultation with your vet, who can assess your cat's health. It is important that your cat does not suffer unnecessarily and that you are aware of the various treatment options and choices so that you can make the best possible decision for your beloved pet.

The bottom line

Diabetes mellitus is a serious disease in cats that requires appropriate treatment. Management is based on three components: Blood glucose monitoring, insulin administration and nutrition. With an adapted, low-carbohydrate diet, you can ensure that your cat goes into remission and that the first two components are eliminated over time. This will save you time, money and nerves.

Early diagnosis, regular veterinary check-ups and careful management are crucial to maintaining your cat's quality of life. Always talk to your vet to find out the best treatment options for your cat and to make sure they get the best possible care.

The confidu magazine is written by our veterinarians according to current scientific standards. The articles do not replace a veterinary diagnosis, but are intended to provide you with initial information on many topics related to your animal. If you have specific questions about your pet, our vets will be happy to advise you via the confidu app.