Historically, the only effective treatments for cats with diabetes have been regular insulin injections. While this can lead to excellent diabetic control, it is difficult for some pet guardians to achieve. As a result, there’s been a lot of interest in recent reports of a non-injectable medication. So can we now abandon the needles? Our vet blogger Sarah Hunter investigates…
Table of contents
What is diabetes?
Diabetes commonly occurs in middle-aged overweight male cats and is characterised by increased drinking, increased urination and weight loss, despite having a good appetite. Often a cat with diabetes will also be more likely to pick up urinary tract infections; so you may notice straining to urinate, passing small amounts of urine and blood in the urine.
In the cat, insulin is released by the pancreas into the bloodstream to help break down food so that it can be used for energy. However, when a cat has diabetes, either the pancreas doesn’t produce enough insulin or the body doesn’t respond appropriately to the insulin (insulin resistance).
What causes it?
Diabetes in cats can be compared to Type II diabetes in humans; which is more likely to be due to obesity. Whereas Type I diabetes is often due to an immune mediated destruction of the cells in the pancreas (Islets of Langerhans).
In overweight cats, fat becomes deposited in muscles, reducing the sensitivity of the tissue receptors. The pancreas then produces more insulin to counteract this which leads to an exhaustion of the Islets of Langerhans.
How is it diagnosed?
Often the clinical signs of drinking more and urinating more will make your vet suspicious of diabetes. Confirmation of the disease is then made by measuring glucose in the blood and urine. Often cats become stressed at the vets, which can increase the level of glucose in the blood. However, a test can be done to check what the level of blood glucose has been over the past 2-3 weeks. And as glucose should not be seen in the urine of a normal cat, seeing this result should confirm a diagnosis of diabetes.
How is it treated?
Usually diabetes in cats is treated with twice daily injections of insulin. Although most cats tolerate the injections well, sometimes it can be challenging due to the temperament of the cat, owners being nervous around injections and owners struggling to fit in giving injections with work or other commitments.
What about the new medication?
Recently, a new oral medication has been produced, this medication only needs to be given once a day and can be mixed with food or put directly into the cat’s mouth, making it much easier for owners. It works by allowing glucose to be lost in the urine, dropping the cat’s blood glucose levels. When treating diabetes with insulin injections, it can often take 3-6 months for the condition to stabilise, requiring several vet visits and blood samples to be taken often. Whereas with the oral medication, Velagliflozin, blood glucose levels can usually be controlled within one to two weeks, although blood samples will still be required for monitoring, it should be much less than if the cat is on injectable medication. In addition, cats on velagliflozin are unlikely to have dangerous hypoglycaemic episodes (“hypos”).
Supportive care
Alongside medication, diabetic cats should be fed an appropriate diet that is low in carbohydrates, contains high-quality, highly digestible protein and promotes a healthy body weight. The food should also be consistent each day so that there aren’t big changes in insulin requirements. As many cats with diabetes are overweight, weight loss is often needed, and in some cases, this can even result in remission of the disease due to improvement of peripheral insulin resistance. There are specially formulated prescription diets for patients with diabetes and these are recommended where possible.
How do I know that the treatment is working?
In most cases, there will be an improvement in the clinical signs, such as reduced thirst and urination, so monitoring this is important. However, blood samples and urine samples can give us more information about how the body is responding to the treatment.
So, the bottom line?
Yes, there is a new oral treatment, and it looks very promising. However, it is not without some side effects. In particular, it appears that it may increase the risk of cats developing diabetic ketoacidosis (DKA), a potentially life threatening complication of diabetes. In addition, about half of all treated cats will develop diarrhoea – and in about a quarter, this may be long-lasting. As a result, cats with gastrointestinal, cardiac, or liver issues would not normally be considered suitable for it, and it is contraindicated in cats at high risk of DKA.
So while this looks like it will be great for some cats, your vet will have to make a risk-benefit judgement to see if it’s suitable for yours.
Discussion