Sammy is a lovely, and much loved, 13 year old moggie who has always been the picture of health. Healthy appetite, healthy weight and body condition – and he seemed pretty happy too. But a few months ago his owner noticed him at the water bowl more than she used to. At first she didn’t think anything of it, but with the extra drinking came extra urination, and it also seemed to be associated with an increase in appetite. But still she assumed that this was normal as the weather was getting colder and he was spending more time inside. However, at his next annual check-up with me, we found out that he had actually lost almost a pound in the past year. I recommended a blood and urine test and his owner agreed, and when the results came back the answer was clear – Sammy was diabetic. His owner was in tears. How could she possibly cope with a diabetic cat? She works full time and has two small children, and besides, she has no medical training so how on earth would she be able to give an insulin injection twice a day? She even thought about having him put to sleep because she simply wasn’t going to be able to handle his condition. But we had a nice long chat about what it means to be diabetic and what the treatment would and wouldn’t entail, and by the end of the conversation she was willing to give it a try. What is diabetes? This gets a bit complicated, but I’ll do my best to explain it. Sugar in the blood (also called glucose) is a very important source of energy for the body and without it the body’s organs (particularly the brain) run out of fuel and start to shut down resulting in lethargy, confusion, fits, coma and even death. Too much of it however can also be harmful and diabetes is a condition that results in the cat’s blood sugar being too high. Most of the time this is because the body doesn’t produce enough insulin, the hormone responsible for lowering and stabilising blood sugar. High blood sugar in turn results in lots of very sugary urine which leads to more frequent urination, and the increased urination causes increased thirst and drinking. A lack of insulin also means that the body’s cells can’t use the glucose, even if there’s lots of it in the blood, so the body starts to break down other tissues such as fat and protein for energy. This then causes weight loss, but also an increase in appetite as the body tries to compensate. Therefore, the four most common symptoms of diabetes are: 1. Drinking more than normal 2. Urinating more than normal 3. Eating more than normal 4. Weight loss Diabetes is not the only disease that causes these symptoms, but if all four come together, it puts diabetes at the top of the list. How is diabetes diagnosed? Diagnosing diabetes sounds like it should be pretty easy – if a cat has high blood sugar, it has diabetes, right? Not quite. Cats can have high blood sugar for a couple of different reasons, the most common being stress. And what cat isn’t stressed by the time it gets to the vet, let alone has its blood taken for testing? It is therefore important for your vet to make sure that it isn’t just stress causing the high blood sugar. One of the easiest ways to do this is to test the urine for sugar as well – if there is sugar in the urine, chances are the cat is truly diabetic but this still isn’t a perfect test. If your vet suspects that your cat may have diabetes, a second blood test will typically be run. This could either be, depending on your vet’s personal preference, a single test called fructosamine, or a series of glucose measurements over several hours called a glucose curve. Fructosamine measures the average amount of glucose in the blood over the past 2 weeks (thus making it a more accurate test than a single glucose measurement) whilst a glucose curve measures both the highest and the lowest blood sugar levels on a curve over the course of a day. Both tests are used commonly and both can help the vet diagnose and treat diabetes. And now the scary bit – how is diabetes treated? Because diabetes usually means the body doesn’t make enough insulin, the best way to treat diabetes is to give the body more insulin. This may sound easy, but unfortunately insulin can only be given by injection with a needle under the skin. And it has to be given every day, usually twice a day, at about the same time each day so a regular routine is essential. The good news is that the needles are very very small, and so is the volume that needs to be injected. Therefore most of the time the cat doesn’t even seem to notice, especially once they get used to the process. The bigger concern for the cat is having to go into the vet periodically for check-ups and blood tests to see how their body is coping with the treatment, but even that isn’t too bad and once their condition is stabilised these checks can often be done less often. Another thing that may help is a change of diet to something that is high in protein and low in carbohydrates (the nutrient that gets broken down into glucose after digestion). It is important to monitor your cat’s diet when they are on insulin, as if they do not eat regularly, the insulin could actually hurt them. Similarly, weight loss can help the body better regulate its glucose metabolism so losing excess weight in a controlled manner could make a big difference to their treatment and in some cases may even result in the disease resolving completely. If your cat is diagnosed with diabetes treatment is essential. It is not generally acceptable to allow the disease to go untreated as it can cause significant discomfort and severe problems for the cat. With insulin therapy, a well-managed diabetic cat can go on to live many healthy, happy years. Insulin, however, is not without risks itself, as giving too much of it can result in a condition called hypoglycaemia, or blood sugar that is too low. As mentioned above, this is a life threatening condition that can result in lethargy, confusion, fits, coma and even death. You should speak with your vet about what symptoms to look out for and how best to manage them should they arise and it’s very important that you let your vet know immediately if you think your cat may be hypoglycaemic. I am happy to say that both Sammy and his owner are doing very well today. His owner gives him two injections a day, which she has fit into the family routine and no longer sees it as a bother, just something else that has to be done. She has even offered to speak with other owners of newly-diagnosed diabetic cats to give them the confidence they need to get through the initial diagnosis and first few weeks of treatment. So if you find yourself with a diabetic cat, don’t be discouraged, it’s not actually that scary and yes, you can do it! If you are worried that your cat is showing the symptoms described above, please talk to your vet or try our Interactive Cat Symptom Guide to help decide what to do next.