Diabetes is one of the most common diseases suffered by both humans and our pets. The proliferation of sugars, artificial carbohydrates, and fillers in food leads to an imbalance in insulin production and receptiveness, causing blood sugar problems.
Type II diabetes is the most common in cats. It's primarily an issue with insulin production. In simple terms, insulin is a key that unlocks a cell to let sugar in so the cell can use that sugar for fuel. Type II diabetes happens when those cells grow more resistant to that key; it takes more insulin to unlock the cell. Cells suffer without enough sugar, even if the sugar is there in the bloodstream and available to be used because the pancreas doesn't produce enough insulin to get it into those cells.
Increased blood sugar then cascades into other problems. When the body can't process sugar for energy, it starts to seek other nutrients and turns to protein, breaking down muscle and causing weight loss. Blood sugar also needs to be filtered out by the kidneys, which suffer from excess stress, leading to frequent urination, excessive thirst, water and electrolyte imbalances, dehydration, and kidney damage/failure over time. Extreme cases can also lead to nerve damage.
As much as 1% of cats will be diagnosed with diabetes in their lifetimes, making it a very common disease amongst household felines.
Traditional Diabetes Treatments in Cats
Diabetes is treatable but not curable. It can be controlled and managed to restore quality of life and extend the life of a cat, and if the disease is caught early enough and treatment is aggressive and consistent enough, the cat may even enter remission. It will likely return over time, particularly if dietary habits slip and as the cat ages and other systems go out of balance, but in the meantime, it can give years of life.
There are generally two traditional treatments for feline diabetes. These are dietary control and insulin therapy.
Prior to either therapy, the cat is generally examined for signs of other potential causes of high blood glucose levels. For example, corticosteroids used in the treatment of feline asthma and certain other conditions like skin infections can lead to hormonal imbalances, which in turn leads to temporary diabetes symptoms. In these cases, changing or removing the steroids can resolve the symptoms of diabetes.
In other cats, there may be hormone-altering tumors or other physiological problems that are impacting the pancreas, the hormonal system, or the processing of blood sugar in other ways. These can be signs of something worse, like feline cancer or even just a benign tumor in a bad area that causes problems. They may be resolvable without the need for diabetes treatments.
Dietary Therapy for Feline Diabetes
Dietary therapy is usually the first-line treatment. This is because one of the leading causes of diabetes in cats is obesity. This is because stored body fat increases insulin resistance and decreases beta-cell insulin production. It's a complex system and is still under study, particularly to identify differences between human diabetes and animal diabetes.
Since obesity is the leading cause of diabetes, dietary control has the potential to reverse or even cure diabetes if caught and addressed soon enough. Cats are obligate carnivores, but unfortunately, modern food sources often have an excess of filler material and carbohydrates. These are the ingredients specifically that cause both weight gain and diabetes.
Thus, the primary goal of dietary treatment for diabetes is addressing obesity through the reduction of carbohydrates in your cat's diet. This must be done in a slow and controlled manner to avoid shocking the system unduly and causing other problems. Dietary treatment is largely focused on controlling the ingredients in the cat's food – there's no evidence to suggest that varying timing or frequency of meals has a tangible impact. In large part it comes down to the cat's habits and whether or not they are fine with grazing or are prone to overeating if food is left available.
In some cats, particularly if diabetes is minor and new, losing weight and returning to a healthy weight will be broadly beneficial to the cat. It can "cure" them of diabetes entirely, though, for most cats, the disease will return over time or if their diet and weight slip back out of bounds.
Insulin Therapy for Feline Diabetes
By far, the most common treatment for feline diabetes (and for human Type II diabetes, for that matter) is insulin therapy.
Since type II diabetes is characterized by the body's natural production of insulin being insufficient to allow cells to take in sugar to use as energy, the simplest solution is to add more insulin to the system. This is most commonly done using injections. Several kinds of injections, such as Vetsulin or ProZinc, are common options. These are prescriptions with varying costs, concentrations, and duration of action (governing frequency of dosage), so knowing the level of insulin necessary to keep a cat healthy and prescribing the correct dosage is critical for vets.
Insulin injection therapy is typically a twice-daily injection under the skin. In cats, the easiest way to administer it is usually grabbing them by the scruff and pulling the skin back, injecting them under the skin in that location. Most vets are familiar with this procedure and can train pet owners to handle it themselves.
Insulin injections can be tricky. Modern technology allows for an implant that can actively monitor blood sugar, reducing the need to see and test the cat in person to dial in a dosage. However, insulin injections also need to be given using specific kinds of needles and even specific kinds of syringes, so it needs to be handled appropriately to avoid the risk of mistakes that either fail to properly control blood glucose or overshoot and lead to hypoglycemia.
Hypoglycemia can be very dangerous to cats. It can cause weakness, lethargy, shaking, unsteadiness, convulsions, and the appearance of being sedated or "drunk." It's considered a medical emergency and needs to be treated to avoid long-term damage or even death.
There are also drawbacks to insulin injections. Some 20% of cat owners put down their diabetic cats within a year of treatment due to difficulties, expenses, and other issues. Some people fail to control diabetes due to the difficulty of giving their cats injections. Some people dislike needles, some worry about causing the cat pain (though pain-free needles are usually prescribed), and some simply don't have the freedom or flexibility in their schedules to administer injections appropriately.
Insulin therapy has been, until recently, the most viable way to control feline diabetes. Dietary control only works for very minor cases and is otherwise supplemental to insulin therapy, and insulin therapy is the only way to treat the disease once it has progressed or when it's there long-term.
New Ways to Handle Feline Diabetes in 2024 and Beyond
As we step into 2024, medical science continues to advance. One of the most exciting developments is a new treatment option for feline diabetes. Though this treatment came out almost a year ago, it is becoming more common and more readily available.
Called bexagliflozin, brand name Bexacat, this new treatment for diabetic cats is an inhibitor of sodium-glucose cotransporter 2 (SGLT2), and it was given FDA approval for use in cats. This treatment is exciting for one primary reason: it's a pill.
It's not only just a pill, but a pill that can be crushed up and added to food, rather than given as a whole pill, which, as many cat owners can attest, is not an easy process for many felines. Food-based administration also helps prevent the risk of dangerous hypoglycemia as well.
Unlike many novel medical developments, Bexacat is also broadly affordable. The cost to vets is around $50 for a month of doses, though, of course, vets will increase that price for their own margins. Even still, it's a rather affordable option for many cat owners. It has also been shown to be 80% or more effective at controlling feline diabetes.
Ease of administration, lower risks, no messing with needles or injections, less strict timing; are there downsides?
Unfortunately, yes. This treatment option isn't viable for all cats. In particular, the cat must have relatively mild diabetes and not be symptomatically sick. If a cat has more advanced diabetes or has ever had insulin treatments, they are at greater risk of developing diabetic ketoacidosis, a potentially fatal complication. This is primarily due to the withdrawal of insulin, leaving the cat unable to produce enough of their own insulin to handle it.
Before prescribing Bexacat, a vet should perform a thorough evaluation of the patient. In addition to having never been on insulin before, the cat's kidney, liver, and pancreas and their associated systems should be evaluated for other signs of disease. In general, cats over the age of 13 should not be given the drug either, for increased risk of comorbidity and complication.
In other words, this works great as an alternative treatment option for otherwise young and healthy cats who would be consigned to a long lifetime of continually adjusting shots and risk of complications. With enough proactive monitoring and regular checkups, you can catch diabetes early in your patients and recommend Bexacat as an option instead of insulin.
Administering Bexacat should also be done in conjunction with dietary treatment, as diet and exercise are complementary treatments, and keeping a cat at a healthy weight helps eliminate further risk of diabetes and its complications.
Along a similar line, in late 2023, the FDA also approved a second, similar treatment. Another SGLT2 inhibitor, velagliflozin, comes as an oral liquid and can be administered either in food or directly to the cat.
Potential Future Developments
As always, the steady march of progress continues, and medical science will push the envelope every year. It's impossible to predict now what will and won't take off in 2024, but there are some promising options.
One potential area of study is a new so-called "smart insulin." Though it's not "smart" in the stereotypical sense of the word, it's a responsive chemical that adapts to conditions in the body rather than operating on a more linear time-from-dosage schedule.
This form of insulin is currently being studied in minipigs and in mice, though studies are few and far between at the moment. Initial signs are a promising kind of insulin that only needs to be injected once a week rather than twice a day.
For the time being, this medication is still in very early study and is also aimed both at humans and at Type I diabetes. However, it's possible that the development process could expand and be found effective in other areas, like feline diabetes. Of course, it could also just as easily be proven ineffective or too dangerous, as so many possible treatments end up being, and shelved. No one knows what the future will hold.
With time, more development will be put into both the current slate of SGLT2 inhibitors and novel treatment options like smart insulin. It remains to be seen what new frontiers will be developed in the coming year, but we're always striving to pay attention to the cutting edge of veterinary treatment.
We know, however, that you don't always have that luxury. The life of the vet is one of constant pressures, and even continuing education in your own specialty may be almost too much to handle. That's why we offer our consulting services. At Hope Vet, we know your job isn't to have the solution to every problem; it's to know how to find those solutions. Sometimes, that means your own expertise. Sometimes, it means seeking out a second opinion. Sometimes, it means working with other specialists outside of your field. Whatever the case may be, we're here to help.
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