This document provides an overview of feline diabetes mellitus, including common causes such as islet cell amyloidosis and obesity. It discusses pathogenesis involving islet amyloid polypeptide and amyloidosis. Type 2 diabetes in cats is characterized by abnormal insulin secretion and peripheral insulin resistance. Clinical signs include polyuria, polydipsia, weight loss and plantigrade stance. Treatment involves dietary management, weight control, and insulin therapy to control blood glucose and minimize symptoms while avoiding complications. Monitoring is important to assess treatment effectiveness and adjust insulin dosage as needed.

1. Diabetes Mellitus
Feline
by Gerard Derminasyan DVM

2. Definition
Persistent Hyperglycemia due to
absolute or relative insulin deficiency

3. Common Causes
Islet Cell Amyloidosis
Obesity
Chronic Pancreatitis

4. Type II Diabetes
Abnormal Insulin Secretion
Peripheral Insulin Resistance

5. Pathogenesis

6. Islet Amyloid Polypeptide

7. Amyloid

8. Amyloidosis

9. Islet Cell Amyloid

10. Amylin Overproduction leads to Diabetes
2
Amylin is secreted with insulin
Amylin is converted to Amyloid
Amyloid is toxic to B-Cells
Amylin further inhibits insulin
secretion

11. OBESITY
leads to
Insulin
Resistance

13. How Insulin Works

14. Key and Lock Mechanism

16. Insulin Resistance

24. Pancreatitis and Diabetes

27. SYMPTOMS
Polyuria / Polydypsia
Weight Loss
Increased Appetite
Plantigrade
Stance/Weakness/Difficulty
jumping

28. Polyuria /Polydypsia

29. Ravenous Appetite

30. Plantigrade Stance

31. Diabetic Neuropathy

32. Plantigrade Posture

33. Cataracts

34. Biochemistry

35. Fructosamine
Sugar molecules circulating in blood stick
to proteins ( amines )
These proteins circulate in the blood
stream for 14-21 days
Measuring them gives a picture of the
amount of sugar in the blood for that time
period

36. Glucose
Fructosamine

37. Stress Hyperglycemia

38. Subclinical Diabetes
Cats in early stage of
developing diabetes
Usually healthy cats , stable
weight
Identified when routine
laboratory tests performed for
other reasons

39. Stress Hyperlycemia vs Subclinical
Diabetes
Remember cats with
subclinical diabetes do not
show symptoms of diabetes
Fructosamine test will confirm
the diagnosis

40. Diabetic ? Subclinical Diabetic ? Stress
Hyperglycemia ?

41. Concurrent Diseases
Pancreatitis : Acute vs Chronic
Urinary Tract Infection
Renal disease
Hyperthyroidism
Oral disease

42. Corticosteroids : Risk factor for
Diabetes

43. Urinalysis and Urine
culture

44. Urinalysis

45. Culture & Sensitivity

46. What other condition can mimic
Diabetes ?
Hyperthyroid disease
Causes similar signs to Diabetes
Can occur concurrently

47. Treatment Goals
Minimize clinical signs
Avoid complications ( e.g. Diabetic Ketoacidosis ,
peripheral neuropathy)
Avoid hypoglycemia
Maintain owner compliance with treatment and follow up
Achieve quality of life
Achieve Diabetic Remission ( if possible )

48. AAHA Diabetes Management
Guidelines

49. Subclinical Diabetes Treatment
Goals
Prevent onset of Clinical Diabetes
Manage obesity and optimize Body
weight
Goal : To obtain normal Blood
Glucose concentration without need
for insulin

50. Subclinical Diabetes Treatment
Goals
Weight Loss in Obese cats
Goal : 1 - 2 % loss per week ( maximum 4-
8% per month
Weigh monthly and adjust intake of food to
reach optimal weight

51. Feed a High Protein Diet
> 45 % Protein metabolizable energy (
ME) to maximize metabolic rate ,
improve satiety and prevent lean musle-
mass loss
Protein normalizes fat metabolism and
provides consistent energy source
Arginine ( amino acid ) stimulates insulin
release

53. Limit Carbohydrate Intake
Dietary Carbohydrate may
contribute to hyperglycaemia and
glucose toxicity
Carbohydrate levels classified as
ultra low ( < 5 % ME ) , low ( 5 to
25 % ME ) , moderate ( 26 to 50 %
ME ) and high ( > 50% ME )

54. Control Portion via Meal
Feeding
Allows for appetite and intake monitoring
Essential to achieve weight loss in obese cats

55. Canned foods are
preferred
Lower Carbohydrate Levels
Easier to control portions
Lower Caloric Density : cat can eat a
higher volume of canned food for the
same caloric intake
Additional Water intake

56. Clinical Diabetes
Management
Minimal or no clinical signs
Owner perceives good quality of life
and is satisfied with treatment
Avoid complications ( DKA , peripheral
neuropathy
Avoid symptomatic hypoglycaemia

58. Feeding Management
Feeding meals 4 times daily is ideal to
prevent clinical hypoglycaemia for cats on
insulin
Time feeders are useful for cats that
require multiple meals per day to manage
weight and control calories
free choice is acceptable for underweight
cats on insulin therapy

59. ?

60. Insulin Therapy
Approved for Cats

61. AAHA Recommends
U-100 U-40

62. Initial Insulin Therapy
Initial Dosage = 0,25 U /kg q12 hrs
based on an estimate of the cat’s lean
body weight ( AAHA panel )
This equals to 1 U q12hrs in an
average cat
Even in very large cat , starting dose
should not exceed 2 U per cat q 12 hrs

63. First Week of Treatment
Insulin
Start at 1 U per cat q 12 hrs
At this stage the goal of monitoring is to only
identify hypoglycaemia
The insulin dose should not be increased based on
1 st day BG evaluation
If monitoring is elected , measure BG every 2-3 hrs
for cats on PZI , and every 4 hrs for cats on
Glargine for 12 hrs following insulin administration

64. First Week Insulin Treatment
Ctd
Decrease insulin dose by 0,5 U if BG < 8,3
mmol/L , at any time during the day
Treat as outpatient and plan to reevaluate
in 7 days
Immediately reevaluate if clinical signs
worsen : if clinical signs suggest
hypoglycaemia: or if lethargy , anorexia or
vomiting is noted

65. Signs of Mild
Hypoglycemia
Cats do not show overt signs until the BG
is dangerously low ( < 4,4mmol/L)
Weakness , Lethargy
Sleepy
Reluctance to move
Slow to respond to owner

66. Hypoglycemia
link video

67. Glucose Curve

68. Ongoing Monitoring of the
Cat
The primary concern for the newly diagnosed and
treated cat is the development of hypoglycaemia in
individuals that may quickly go into remission
Home blood glucose monitoring offers the most efficient
and accurate diabetes monitoring
If BG monitoring is not available , monitor and document
changes in clinical signs
Urine glucose testing using glucose detecting crystals in
the litter can be used to detect diabetic remission

69. Diary At Home

70. Ongoing Home monitoring
Log food , water , and appetite daily
Log insulin dose daily
Note any signs suggestive of hypoglycaemia :
contact veterinarian if persistent
Periodically test urine , looking for negative
glycosuria ( suggestive of hypoglycaemia or
diabetic remission ) or positive ketonuria (
suggestive of substantial hyperglycaemia)

71. Urine Glucose Detection

72. Ketonuria

73. At 1 week after Insulin Treatment
If Clinical signs Improved
Continue Present Dose of Insulin
Introduce Home Monitoring if not done already
If a Spot Check on the BG is possible , assess
for hypoglycaemia at 6-8 hours following insulin
injection
If BG is < 8,3 mmol/L , decrease insulin dose to
0,5 Units q 12 hrs

74. If Clinical Signs Have Persisted or
Worsened
Evaluate Client compliance and Dosing
Technique
If Compliance good , increase dose to 2 Units
q 12hrs
If the cat is Ketonuric , has developed
peripheral neuropathy , or does not have good
appetite , Evaluate for DKA and Rule Out
Complicating Disease ( e.g. Pancreatitis)

75. During the First Month
Weekly : Spot Checks of BG at 6-8 hrs following
insulin injection ( more often if Hypoglycemia is
suspected )
Every 2 weeks : Perform Blood Glucose Curve
Utilize Urine dipstick or urine glucose detecting
crystals
Consider insulin overdose or possible diabetic
remission if 3 consecutive negative urine glucose
results are obtained

76. At 1 Month after Insulin
Treatment
In Clinic Examination recommended for all cats
Thourough History , Physical Exam , Weight and Urinalysis
Measure Fructosamine unless detailed home monitoring records
are available
Additional lab tests may be needed
Adjust insulin dose , insulin dose should not be increased more than
1 Unit at a time
The majority of cats on Glargine or PZI do not need > 3 Units of
Insulin q 12 hrs

77. Long Term Monitoring of Insulin
Treatment at Home
Daily : Clinical signs , Food/Water intake , Insulin
Dose
Weekly : Body Weight
Monthly : BG spot checks ( twice monthly better ); if
on Glargine , evaluate BG prior to insulin and 8 hrs
post insulin ; if on PZI evaluate BG prior to insulin and
3, 6, 9 hrs later
Twice Monthly: Urine Glucose and Ketones : If urine
is consistently negative DIABETIC
REMISSION

78. Long Term Monitoring in
Clinic
If the cat is doing well , don’t make changes based on
increased BG measurements alone , especially if
measured in the clinic (?)
Every 3 months : Examination and Weight
Every 3-6 months : Serum Fructosamine : If at the
lower end of the reference range or below the
reference range Consider Chronic
Hypoglycemia and Diabetic Remission : Decrease
insulin dose and recheck in 4 weeks

79. If BG consistently < 8,3 mmol/L or urine
persistently Negative for Glucose
Decrease Insulin Dose
Switch treatment to q 24 hrs
Stop Insulin and monitor response

80. Clinical Remission
Clinical Remission
Up to 60% of cats enter diabetic remission with
insulin and dietary therapy.
Remission may not be permanent . Approximately
30% of cats in remission will revert to diabetic state
and require reinstitution of insulin therapy
Remission rates increase in cases with good glycemic
control within 6 months of diagnosis

81. Causes of Insulin
Resistance
G Obesity
G Chronic pancreatitis G Bacterial infection
G Kidney disease
G Hyperthyroidism
G Heart disease
G Neoplasia
G Hyperadrenocorticism G Acromegaly
G Glucocorticoid or
progestogen administration

82. Home Blood Glucose monitoring

87. Somoygi effect
Nadir

91. To Give or
not To Give
Insulin :
That is The
Question
NO

95. M E R C I
Gerard
Derminasyan
DVM