Dr. Coates is a veterinarian based in the other “Sunshine State” – that's Colorado to the rest of you – where she lives and plays with a varied range of animals. She shares her professional and personal experiences, Monday through Friday, here on petMD's blog, the Fully Vetted. Log in for your daily dose of her insight and wisdom. < Previous Post Oct 10, 2013 Why Diabetes is Not a Death Warrant for Cats by Dr. Jennifer Coates, DVM Share Save to mypetMDMaking a diagnosis of diabetes mellitus in a cat can be frustrating. On the one hand, cats generally respond very well to treatment. Some can even be weaned off of insulin injections and eventually be managed with diet alone. On the other hand, it takes a very dedicated owner to successfully treat a diabetic cat. Insulin injections almost always have to be given twice daily, ideally as close to 12 hours apart as possible, and cats with diabetes need to be monitored closely at home and rechecked frequently as their insulin needs often change over time.
Frankly, not every owner is up to this level of care. I would rather euthanize a diabetic cat than send it home to suffer from poor (or no) regulation. Whenever I make a new diagnosis of diabetes in a feline patient, I have a candid discussion with the owner about what treatment involves. One question that usually pops up is whether or not I can predict how easy to regulate the cat in question will be. In other words, if we initiate treatment, what are the chances that it will be successful? I recently read a study that will help me better answer that question in the future.
Researchers used the medical records of 114 diabetic cats to investigate a variety of factors that could affect the length of time a cat with diabetes might survive. They found that there was a 16.7% chance that the patient died within 10 days of diagnosis. The median survival time for all of the cats was 516 days (almost 1½ years). 59% of cats lived for longer than 1 year, and 46% lived for more than 2 years.
Two factors appear to be associated with shorter survival times: high serum creatinine levels (an indicator of kidney disease) and a diagnosis of another illness in addition to diabetes. It shouldn’t be too surprising that cats that have more than one diagnosis have a harder time being successfully treated for diabetes. If diabetic management is like walking a tight rope, adding another disease into the mix is akin to walking a tightrope in a snowstorm. The relationship between increasing creatinine levels and decreasing survivability was especially strong. For every 10 ug/dl increase in creatinine the risk of dying increased by 5%.
Interestingly, the presence of ketoacidosis (a complication of severe and uncontrolled diabetes mellitus that leads to dehydration, electrolyte disturbances, and sometimes death) was not associated with a poorer prognosis. In fact, 32% of the cats with ketoacidosis survived for more than three years. This finding has to go against what many veterinarians assume: The more ketoacidotic a cat is at the time of diagnosis, the worse its prognosis must be.
My take home message is this: No matter how bad newly diabetic cats look at the time of diagnosis, their chances of enjoying another good year or two is reasonable, so long as they are not suffering from a serious concurrent disease and they have an exceptionally dedicated caretaker.
Dr. Jennifer Coates
Survival time and prognostic factors in cats with newly diagnosed diabetes mellitus: 114 cases (2000-2009). Callegari C, Mercuriali E, Hafner M, Coppola LM, Guazzetti S, Lutz TA, Reusch CE, Zini E.
J Am Vet Med Assoc. 2013 Jul 1;243(1):91-5.
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Susan Seluga Diabetic Cat 10/10/2013 09:53am My lynx point Siamese was diabetic and hyperthyroid. I realized something was wrong one morning when he couldn't walk well on his hind legs. I made a vet appointment and discovered he had neuropathy due to diabetes. During the discussion about his disease, the vet did mention euthanasia and I was aghast; put my boy down because of this? No way.
It was a lot of work to take care of him, but I would do it all over again. Insulin shots twice a day in addition to his methimazole, changing his diet to high fiber and less carbs, the frequent trips to the vet for glucose monitoring, the dental surgeries that removed most of his teeth, the expense of his care and just general worry about him. He held up well through it all and 2.5 years after his diagnosis he was still alive. In the end it wasn't the diabetes that he succumbed to, but a tumor in his gut. I still miss him. Reply to this comment Report abuse 5 redkitty1 Redkitty1 10/10/2013 11:25am My cat was diagnosed shortly before he turned 15. Yes, it was a lot of work, but watching him regain his pep and attitude was well worth the effort. I learned a lot about giving insulin and checking blood glucose levels - I discovered that it didn't hurt me at all to give shots (except when I stuck the needle through his skin into mine) or to check his blood (always remember to use the cotton ball - it's there to keep you from stabbing yourself) - and did you know that when your cat's blood glucose goes too low that they don't really like you squirting corn syrup into their mouth?(my son still has the scars on his back). All in all, Shadow was a real trouper about the whole thing, quietly passing in his sleep when he was almost 19. Reply to this comment Report abuse 5 pvojtas Diabetes treatment option 10/10/2013 12:27pm I'd like to add that there is an even better way to address diabetes and that is a method called 'Tight Regulation". It is similar to how we measure and dose for diabetes in humans, rather than the old-fashioned method of blind dosing on a fixed 12 hour schedule and retesting only every few weeks (usually involving a day-long Vet visit to take a glucose curve). Tight Regulation means that the glucose levels are testing regularly at home with a simple ear prick and a teensy drop of blood using a human lancet and glucometer (available from Walmart or any pharmacy), and the dose and schedule is adjusted based on the reading. This way, you're always dosing EXACTLY the amount of insulin needed and at the right time to avoid spikes. It is a lot to handle initially, but the results are amazing. A few other notes: 1) STOP feeding ANY dry food or dry treats immediately. Only low-carb wet or raw from here on in. 2) Do not use human insulin. 3) Shoot for maintaining an ideal glucose level UNDER 100 (this is not what your Vet may tell you, by the way). 4) Keep a careful log of test results and dosage. 5) Visit http://www.yourdiabeticcat.com/protocol.html for more details and lots of help. Pam (and Spike you has been 'off the juice' (diabetes-free) for almost 2 years) Reply to this comment Report abuse 2 Venita 10/11/2013 03:17am Hi Pam. Thanks for discussing Tight Regulation.
I wish to observe that a human insulin—Lantus/Glargine—is probably the most-prescribed insulin for diabetic cats and many cats do very well on it. Lantus and Levemir/Detemir (another human insulin used with cats) are the only insulins with an academically studied protocol for cats. The remission rates on Lantus and Levemir are very good—said to be about 70% for newly diagnosed cats.
I also wish to observe that there are three other Internet groups for caregivers of diabetic cats that practice Tight Regulation (although the protocol details among the three differ somewhat). FelineDiabetes.com, DiabeticCatHelp.com, and Diabetic CatCare.com. FelineDiabetes.com also helps caregivers who are not practicing Tight Regulation.
Reply to this comment Report abuse 2 Westcoastsyrinx Longevity 10/10/2013 04:52pm We managed to keep our boy OFF insulin for well over 12 or so years and he eventually had to be put down due to a collapsed larynx that was basically old age. He was between 22 and 23 years old according to the history we managed to trace for him as the local 'mascot' stray. We originally took him in when he was attacked by a preditor, needing two surgeries to save his life. In the attack his pancreas was damaged, so it is amazing what our cats can accomplish if given good food and care. He developed his diabetes shortly after surgery and it took two years of finding a good high protein food back when the norm was to give diabetic cats "high fiber" diets. As a trained dietician, I knew this was not appropriate, so was happy to go along with finding the highest protein content food at the time, and we actually purchased timed feeders to ensure that this boy, who had previously been taking advantage of any food foraging he could while a stray, had a very stable demand on his pancreas with good nutrition. It worked, and of course we were much happier still when prescription diets were developed shortly after that, making it so easy to keep our boy off insulin for so long. I like seeing fiber in there as the secondary nutrient in feline diabetic foods because it was previously considered successful at maintaining diabetic cats before the high protein foods came out, and for good reason.
One problem we did encounter that wasn't mentioned here, was that our boy was one of those who liked to sleep through the night, and ate much less. That meant that he needed to be on a dose of insulin that was appropriate for his night time glucose lows, not his daytime numbers. Unfortunately we didn't figure this out, (didn't see middle of the night hypos), until he developed a need for seizure meds. I can't stress enough the need to find the low point in glucose levels that will occur while your family is sleeping, as well as when to watch your cat during the day -- when insulin influence in the body reaches its peak. That is the only control an owner has over what is happening inside their beloved pet. This happened as his body was getting very old, and it is likely that at some point your cat will also return to the need for insulin if good health keeps them alive long enough.
And also, it should be mentioned, that those who do make the commitment to their diabetic cats, the rewards are great as all the handling usually allows for a much greater bond with your companion animal.
Also, make sure the advice you take is that given by veterinarians who are respected by their peers enough to be either on sites like this, or accepted as speakers in workshops and conferences. Those who aren't, don't have good success rates behind their claims.
Reply to this comment Report abuse 4 TheOldBroad Diabetic Kitties 10/10/2013 06:35pm My first diabetic kitty was ketoacidotic and almost died, but the specialty clinic pulled her through. She was a completely uncontrolled diabetic and her insulin was adjusted accordingly each time. I learned a lot about home BG testing and the BG curves were a breeze.
My second was a steroid-induced diabetic (he also had cancer and wouldn't eat without the steroids) and was easily managed.
My third reverted (happy surprise!).
Even if a kitty is well managed/regulated, I still won't touch a cat with insulin until I've done a BG check - just in case.
As an aside, I'm so happy to see the other comments from people who didn't hesitate to care for their diabetic kitties. Reply to this comment Report abuse 2
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