Treatment for diabetes may include one or more of the following: Insulin injections are the mainstay of treatment. Many
cats with DM will require one or two daily injections of insulin to replace absent or ineffective naturally occurring insulin. Because insulin is a hormone that is easily inactivated, it must be given by injection. These injections are given just under the skin using a small needle and syringe. Most pets become readily accustomed to the treatments, and despite initial trepidation, most owners can easily learn to give the injections without much objection from the pet. Type I DM, due to destruction of the pancreatic cells that produce insulin, requires life-long insulin therapy.
On the other hand, Type II DM, in which the tissues are merely resistant to the effects of insulin, can sometimes be controlled through weight management, diet changes and/or pills to lower blood glucose. Some cats can be maintained well on a special diet such as Purina's DM. Patients with uncomplicated diabetes are generally managed on an outpatient basis, but those experiencing complications such as diabetic ketoacidosis will require initial in-hospital stabilization.
Insulin comes from several sources and in many formulations. The most commonly available source is recombinant insulin, produced by genetically engineered bacteria to mimic human insulin. Other sources are from processed beef or pork pancreas.
Insulin formulations vary in the time they require to reach peak action and duration of action. Commonly prescribed formulations include glargine insulin (brand name is Lantus), protamine zinc (PZI), humulin NPH and Humulin U. Many of these insulin come on and go off the market frequently. Currently, PZI and Humulin U are both off the market. Another formulation, "regular" insulin, is very short acting and is primarily used in the hospital setting for complicated diabetics.
Diet. Proper weight management can aid in control of DM. Obesity causes tissues to be resistant to the effects of insulin, while animals that are too thin do not have any energy reserves. Maintaining an optimum weight can help both type I and type II diabetics. For Type II diabetes, a prescription diet can significantly help some cats, even to the point of no longer requiring insulin as long as they stay on the diet.
A low carbohydrate and high protein diet and regular exercise can aid in control of DM. Ideally, 15% or less of metabolizable energy should be carbohydrates. Diets may include prescription diet DM or high quality kitten foods.
Ideally, meals should be divided into twice daily servings and offered prior to/with the insulin injections.
Ovariohysterectomy (spaying) is indicated in female diabetic animals. When animals come into heat (estrus), the hormonal changes alter insulin and glucose metabolism.
Drug therapy. Antibiotics may be prescribed to treat infectious complications, particularly urinary tract infections or oral (gum) infections. Certain drugs, including steroids, should be avoided in diabetics. Steroids are often used to treat skin conditions, but should be avoided in diabetics.
Animals with complications such as diabetic ketoacidosis will require in-hospital therapy, including insulin administration with frequent dose adjustment, intravenous fluids, administration of electrolytes (blood chemicals) and antibiotics.
Be prepared for frequent adjustments to therapy early in the course of treatment. Veterinarians prefer to start with a low dose of insulin initially and adjust upwards slowly to avoid overdose.
Too much insulin can be worse than not enough; insulin overdose can cause low blood glucose. When blood glucose is too low, the brain does not get adequate energy. The result can be disorientation, lethargy, seizures, coma or even death. If you notice disorientation in your alert diabetic cat, offer food immediately. If the cat is unconscious, you can apply a sugary solution like Karo® syrup to the gums. In either case, call your veterinarian immediately.
DM requires dedicated follow-up care on the part of the pet owner. With a commitment of time, education and careful observation, most diabetic cats can have a good, quality life. Monitor blood glucose concentrations with your regular veterinarian. Weekly monitoring may be needed until adequate control is attained. Serum fructosamine measurements are recommended every 3 to 6 months after diabetic control is attained.
Routine. You will need to stick with a routine in both insulin administration and feeding. While insulin does not have to be given at precisely the same time everyday, it is very helpful to stick with the same schedule as closely as possible both for drug administration and feeding.
Insulin. Familiarize yourself with the type and source of insulin your cat uses. Purchasing insulin can be confusing.
Familiarize yourself with insulin handling. This bottled hormone is not perfectly soluble or stable. It needs to be kept cool and out of direct light, and it must be gently mixed thoroughly before use (rolled in the hands), but not shaken hard.
Familiarize yourself with insulin syringes and administration. Insulin is given as "units" rather than as the standard cubic centimeter (cc) or milliliters (ml); special insulin syringes come in a variety of unit sizes. Insulin is usually administered just under the skin. Your veterinarian can spend time teaching you how to do this with a minimum of protest from your cat.
Carefully note changes in water consumption and urination. Increases in thirst or frequency of urination may indicate the need for adjustment in insulin therapy or that a complication, like a urinary tract infection, has developed. Ask your veterinarian what the expected water consumption for your cat is and periodically measure the actual consumption.
If your pet vomits or does not eat, call your veterinarian for insulin recommendations. Giving the regular dose of insulin in a pet that does not eat can cause hypoglycemia. Do not skip a dose of insulin unless recommended by your veterinarian.
Some veterinarians will ask you to catch urine samples periodically and test them at home for glucose, ketones or both. This information may help your veterinarian adjust therapy.
NOTE: A well-regulated diabetic pet should look and behave the same as a pet in good health.
The prognosis depends upon the overall heath of the pet, other diseases present, secondary complications from diabetes, and the pet owner's ability to treat and closely monitor their pets progress. Many pets live a happy health live for years with diabetes with few complications. A mean survival time of pets with diabetes is 3 years from time of diagnosis. For pets that do well after 6 months of treatment, many will have a good quality of life for more than 5 years.