Frequently Asked Questions about Dietetic Treatment of Feline Diabetes Mellitus

Q

A

What is the most effective way to treat diabetic cats?

Experience over the last few years clearly favors intensive insulin therapy (mostly BID), combined with feeding a high protein diet, low carbohydrate diet.

Do diabetic cats have postprandial hyperglycemia?

This seems to depend largely on the composition of the diet. Cats fed high protein diets that are now recommended for diabetic cats show no or only a slight postprandial increase in glycemia. The higher the carbohydrate content of a diet, the stronger the postprandial hyperglycemia will be.

What is the effect of different diets on average blood glucose levels?

In general, it is much easier to maintain near-normal glycemia in insulin-treated, diabetic cats when they are fed a high-protein, low-carbohydrate diet. Postprandial hyperglycemia is almost absent, and the average blood glucose level is reduced.

How long before or after insulin injection should a diabetic cat be fed?

If meal-fed, diabetic cats can be injected just after feeding but no clear recommendation can be given. A study compared feeding immediately after injection or 45min after injection. No major differences on metabolic control were observed.

What feeding paradigm is best for diabetic cats?

If maintenance of body weight is not a problem, it appears possible to feed diabetic cats ad libitum. If obesity is of concern, restricted feeding requires that food is not available ad libitum. In this situation, two meals per day, just followed by insulin injection, may be most appropriate.

What do you do if a diabetic cat does not eat after the insulin injection?

In an emergency situation, when a diabetic cat has received its full dose of insulin and does not eat, the cat should be offered rapidly absorbable carbohydrates, e.g. honey, to prevent lifethreatening hypoglycemia. If a diabetic cat suddenly refuses to eat the diet, another formulation should be tested, preferably also with a high protein content. Such an emergency situation can be prevented if insulin is injected only after the cat has eaten the meal. Obviously, this may be difficult for some owners for practical or time reasons.

Can the diet for a diabetic cat be varied from day to day?

Ideally, diabetic cats should be fed with high protein diets throughout the remainder of their lives, even if diabetic remission occurs. Anecdotal reports indicate that hyperglycemia will reappear within a few days when switching a cat in diabetic remission to a high carbohydrate diet. Therefore, given the metabolic situation in cats and the specific benefit of high protein, low carbohydrate diets in diabetic cats, it appears safe to recommend the long term use of these diets, even after resolution of clinical signs.

Does physical activity play a role in therapy?

It may be very difficult to control physical activity in cats. However, it is recommended to keep physical activity at a relatively constant level so that energy intake and energy expenditure are well matched to the treatment regime with insulin and diet.

Should the diet for diabetic cats contain high levels of dietary fibers?

Traditionally, high fiber diets were recommended for diabetic cats. However, the high fiber content does not seem to be the most important factor. High protein low carbohydrate diets seem to be very effective. It is currently not completely clear if high protein high fiber diets would offer an additional benefit. In any case, however, the lower caloric density in high fiber diets will render the control of body weight easier.

What should be done to achieve ideal body weight in diabetic cats?

Most diabetic cats are obese. Therefore, treatment should also aim at reducing body weight to normal levels. A decrease of 1.5 % of body weight per week appears to be safe (see Obesity chapter).When fed high protein diets, cats loose mainly body fat and maintain lean body mass.

Can diabetes mellitus be prevented?

The risk for becoming diabetic increases dramatically in overweight cats. Therefore, preventing obesity seems to be the most important factor to lower the risk of developing the disease. This is true in particular for neutered cats, because neutered cats eat more and need less energy. Neutered cats are three to four times more likely to become obese, and obese cats are four times more likely to become diabetic.