Thursday, June 8, 2017

Feline Diabetes

Mandy Cooper

Feline Diabetes

Insulin is produced by special cells in the pancreas (an organ close to the liver) and this hormone is critical in the control and utilisation of blood glucose (sugar). Insulin is produced and released into the blood in response to increasing levels of blood glucose, and this allows the glucose to be taken up by cells in the body (and used for energy) and helps to maintain normal levels of glucose in the blood.
Diabetes in cats appears to be very similar to type 2 diabetes in humans.


What is feline diabetes?

Diabetes mellitus (also known as sugar diabetes) is a complex but common disease in which a cat's body either doesn't produce or doesn't properly use insulin. During digestion, the fats, carbohydrates and proteins that are consumed in the diet are broken down into smaller components that can be used by cells in the body. One component is glucose, a fuel that provides the energy needed to sustain life.

Insulin is a hormone produced in the pancreas and is responsible for regulating the flow of glucose from the bloodstream into the cells of the body. When insulin is ineffective, the cat's body starts breaking down fat and protein stores to use as alternative energy sources. As a result, the cat eats more yet loses weight. On top of that, the cat develops high levels of sugar in the bloodstream which is disposed of in the urine. In turn, sugar in the urine leads to weeing more than usual and extreme thirst. 

Cat owners usually notice these classical signs of diabetes:
       Ravenous appetite
       Weight loss
       Increased need to wee
       Increased need to drink more

Diabetes mellitus is generally divided into two different types in cats. Insulin dependent diabetes (IDDM) and noninsulin dependent diabetes (NIDDM). Insulin dependent diabetic cats therefore require insulin injections as soon as the disease is diagnosed and non insulin dependent cats require insulin injections to control the condition.

While diabetes can affect any cat, it most often occurs in older, obese cats. Male cats are more commonly affected than females. The exact cause of the condition is not known, although obesity, chronic pancreatitis, hyperthyroidism, Cushing's disease and certain medications have all been linked to the condition

Treatment of diabetes in cats

Diabetes is usually a treatable condition but it is not a simple condition to manage and does require dedication and commitment from owners. It can be however, an extremely rewarding problem to manage when things go well.
Initially, it is important to identify any complicating factors like if the drugs that are being given are causing the diabetes. These should be gradually withdrawn.

Dietary management

There are two major considerations with dietary management of diabetic cats. Firstly, if the cat is overweight or obese, it is very important to regulate their body weight. This itself may result in the resolution of diabetes (obesity interferes with the action of insulin). Weight loss can be achieved through a combination of reduced calorie intake and increased exercise although the latter can be challenging in cats. If your cat is very overweight then your vet may suggest a special weight reduction diet to help.

As a routine, cats with diabetes appear to benefit a lot from a diet that is low in carbohydrates. Several studies have shown that cats with diabetes are easier to manage, have lower insulin requirements and in some cases, the diabetes actually resolves itself simply by changing them to a diet that is very low in carbohydrates. Some diets available from your vet are specifically made to meet the requirements of a diabetic cat but if these are not available, feeding a low carbohydrate kitten diet may be a suitable alternative. Speak to your vet about these options.

Some weight loss tips include:

       Have your cat's weight checked regularly by a vet nurse. Regular contact with a nurse can dramatically help with your cat's weight loss. Feeding quantities may need adjusting in order to find the correct amount for your cat.
       Weigh out the daily food allowance in the morning and place it in a container to divide between the allocated meals. This way you are less likely to overfeed your cat. You can take out a few kibbles and give as treats throughout the day.
       It is important that no “extras” are added to your cat's daily allowance which includes milk and cat milk.
       Increase your cat's exercise levels gently in line with the nurse who can help to design an exercise programme. Cats can exercise by use of toys, wheels, etc. Remember that “little and often” is generally more beneficial for weight loss.
       Place the food in different areas or hide kibbles around the house to encourage your cat to exercise more. A food dispenser is also ideal In these situations making the cat work a little to get its food.
       If you have more than one cat, it is important to feed them separately and to watch over them when they eat. If just one of the cats is obese, try feeding the others on a high surface that the obese cat cannot jump onto or perhaps feed them in a box with only a small entry hole that an obese cat cannot squeeze through.
       It can be wise to inform your neighbours too that your cat is going on a weight loss programme and not to feed them.
       For a weight loss programme to be successful, everyone involved in caring for the cat and who may feed the cat, needs to be on the same side.

Oral drugs to control diabetes

In humans with diabetes, a number of oral drugs (tablets) are available that can help control the condition. Many of these are either toxic to cats (so should not be used) or simply do not work in cats. Some tablets (that lower blood glucose) can work in a small proportion of diabetic cats but their long term use is a little disputed. This may be an option occasionally for cats that are very difficult to inject with insulin.

Using insulin injections

Most diabetic cats will need to have their diabetes managed with daily or twice daily injections of insulin just as is needed for many humans with diabetes. Although the prospect of having to inject your cat once or twice a day is very daunting for most owners, it can actually be very easy to do with practice and because insulin syringes and needles are small, the cat usually does not feel a thing. The injection is given under the skin, usually in the scruff of the neck.

Your vet will help by talking you through the whole procedure and letting you practice before ever having to give insulin to your own cat. Sometimes practicing by injecting water into something like an orange can help to get the feel of how to handle the syringe and needle and gain confidence. It is usually easiest to try and inject your cat when they are distracted with other things (when they are eating a tasty treat for example) and to begin with it may be better to have a second person who can help hold your cat although with practice, this will not be needed.

Several different types of insulin are available, some are specifically licensed for use in dogs and cats, others may be licensed for use in humans but still be suitable for dog and cat use. In general, insulins are divided into:

       Short acting preparations (soluble insulin)
       Intermediate acting preparations (lente insulin)
       Long acting preparations (protamine zinc insulin, insulin glargine and insulin detemir)

Individual cats may respond differently to different insulins but most cats will require twice daily injections of an intermediate or long acting type of insulin although some cats can be managed with once daily injections.

Storing and handling Insulin

It is important to store insulin properly so that it maintains its efficiency. Insulin should be kept in a fridge at all times and never frozen. Before drawing up insulin into a syringe, the contents of the bottle should be gently mixed so that an even suspension is obtained but you should not shake the bottle as this may damage the insulin.

       Always carefully follow the instructions from your vet when using the insulin
       Carefully draw up the correct amount of insulin in the syringe. Occasionally, insulin pens are used which help to make giving small amounts of insulin easier.
       If you are not sure whether an injection has been given successfully, never give a second injection. It is better to miss a dose rather than risk giving too much insulin

Stabilising a diabetic cat

Many vets will hospitalised diabetic cats undergoing initial stabilisation. Insulin is given and regular blood tests are used to monitor the effect on blood glucose. This allows adjustments to be made to the insulin dose (and if necessary, a change in the type of insulin or frequency of injection) to get good control of the diabetes.

In some cases, this may be done on an outpatient basis with regular trips to your vet to check blood glucose levels. In these cases, it may take a little longer to stabilise the cat as changes in the insulin dose will be made slowly to avoid causing problems.

Long term management of the diabetic cat

Day to day routines, feeding (type of food, frequency), activity and body weight should be kept as constant as possible as this will help minimise changes in insulin needs. Once a diabetic cat is stable, the dose of insulin may still need to be adjusted on an occasional basis. Only do this with the advice of your vet though.

Several things will help you and your vet monitor your diabetic cats. Your vet will, from time to time, want to:

       Check blood samples to look at blood glucose levels
       Check the weight of your cat
       Check urine samples (for glucose and ketones)
       Check the general health of your cat

To help you and your vet manage the diabetes, it is extremely helpful if you are able to keep a daily diary and record key things on a day to day basis. Looking and the changes over time can be extremely helpful in managing your cat.

Keep a daily not of:

       The time of injection and the amount of insulin given
       The cat's appetite and the amount of food eaten
       The overall demeanour of your cat, noting if they become lethargic or more sleepy than usual
       The presence of any vomiting or diarrhea
       If at all possible, measure the amount of water your cat drinks each day. Use a measuring jug to fill their bowl and at the end of the day, tip the water back into the jug to see how much they have drunk. Measuring the water intake is one of the most useful ways to monitor how well the diabetes is controlled. Even if you have more than one cat in your house, measuring how much they all drink my still be a useful guide.
       Weight. If possible, keep a weekly note of your cat's weight and record this in the diary as well. Take the diary with you whenever you go to the vet so that you and your vet can review what has been happening.
       Urine glucose. Your vet may suggest you collect a urine sample from your cat from time to time so that you (or your vet) can check for glucose in the urine with a very simple paper strip test. You can collect urine by replacing the normal litter with an non absorbent litter in the litter box. Special cat litters will be available from your vet.

Only change the dose of your cat's insulin after first talking with your vet. You should never give more insulin unless your vet has told you to. This is important as giving too much insulin can cause a condition called hypoglycemia, where the blood glucose level is too low.

The signs of hypoglycaemia are weakness, disorientation, the cat may appear as though they are intoxicated, they may collapse and this can progress to fits and/or a coma. This is a life threatening situation and requires immediate action. If your cat ever shows any of these signs, contact your vet immediately. In the meantime, it is helpful to give some glucose syrup or powder by mouth to your cat. As a precaution, it is always best to have a small bottle of glucose syrup (available from your vet or chemist) in the house when you have a diabetic cat.

What is the prognosis of a diabetic cat?

The long term outlook for cats with diabetes varies according to how old they are, how easy it is to stabilise their diabetes, whether they have any other conditions and how severe they are. Many diabetic cats have an excellent quality of life and may can live happily with their diabetes if they are well managed. These cats can be extremely rewarding to manage but not every cat responds well. Your vet will want to carry out regular examinations to evaluate the response with your cat and if your cat proves difficult to stabilise, becomes unstable or appears to need large doses of insulin, further tests may be needed to look for other underlying problems.

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*This article is just to help you understand more about Feline Diabetes. Always take your cat to the vet if you think something is not right with him/her.*