Cats develop diabetes due to a poor/species-inappropriate diet, it really is that simple to prevent diabetes. Anecdotally speaking, in almost 11 years of the list with thousands of cats having come through my cyber door, I have yet to see one cat develop diabetes on a raw diet or even a low-carb canned diet for that matter.

 

Kibble-fed cats on the other hand are far more prone to several ills including diabetes (and IBD, obesity, CRF, etc.). This makes sense based on cat physiology; it shouldn't surprise us that feeding an obligate carnivore a grain-based diet is going to hurt them at some point (usually the hens come home to roost around middle age).

As with humans, in cats, eating stimulates insulin production in the pancreas. Given cats' prey animals/birds contain mostly meat, moderate amounts of fat, and very low carbohydrate, cat pancreas are not built to pump out large amounts of insulin on a daily basis.

Unfortunately, most commercial diets especially kibble, contain 2-10X as much carb as that contained in a mouse. A cat's pancreas is not meant to deal with such a carbohydrate overload. Carbs elevate glucose levels which in turn is the pancreas' cue to produce more insulin. Over time, large amount of carbs leads to pancreas injury or overload, which can manifest in different ways e.g. pancreas inflammation (pancreatitis), the ultimate result is lowered ability to produce insulin.

Various drugs e.g. hormones such as Ovaban, and steroids e.g. Prednisone, can further complicate matters as they too have been known to cause diabetes. On my list (Holisticat), we've had numerous cases of diabetes following a single steroid injection. Yell

Bottom line - when a cat's pancreas does not produce (enough) insulin, s/he can develop diabetes. This can occur when the hypothalamus feedback loop is out of whack because the pancreas does not read the signal given by the body when it eats, and does not produce insulin.

Sometimes the pancreas does indeed produce insulin but this isn't absorbed by the cells in the body which usually take the glucose that is a by-product of digestion. So the insulin is in the bloodstream but not in the tissues/cells where it is needed for energy; glucose levels builds up in the blood. The high levels of "blood sugar", as it is sometimes called, spill over and are excreted in the cat's urine.

Diagnosis

A blood test can be used to detect diabetes based on the blood glucose value. Usually a blood glucose value higher than 80 - 120 mg/dl (adjusting upwards to account for stress at the vet's) indicates cause for concern. A vigilant human companion can also often detect the following signs:

  • frequent or excessive drinking - Polydipsia (PD)
  • frequent or excessive urination - Polyuria (PU)
  • weight loss in spite of the fact that kitty has a good appetite and eats well; conversely in some cats sudden and complete loss of appetite is the only sign something's wrong
  • sweet breath from high blood sugar levels
  • oily skin (not just spiky fur, but under it as well)

Another less common sign seen in some diabetic cats is a cat suddenly sleeping a lot more than usual with or without the above symptoms.

Diabetes and other body processes

Cats with diabetes are prone to damage to blood vessels. This can lead to eye problems such as retinal damage, cataract formation, or vision loss. Diabetic cats can develop heart disease and kidney failure. Get your vet to examine your cat's retinas at every visit, and monitor blood pressure if possible.

If a cat has had long-term elevated glucose levels, they can suffer nerve damage. Be vigilant for signs of weakness in your cat's hind legs. Sometimes it's more obvious as their hind legs slip out from under them with diabetic neuropathy. Diabetic cats with neuropathy walk down flatter on their hocks, meaning unlike other cats, they don't walk up on the toes.

There are pictures of this "plantigrade stance" here. Scroll 1/2 way down:
http://www.uspharmacist.com/index.asp?show=article&page=8_1000.htm#FIGURE2

Cats with diabetic neuropathy benefit from B12 supplementation. Make sure it's methylcobalamin form. B12 injections are only available with a prescription in the U.S. and are cyanocobalamin form, but sometimes that's the only way to reliably get B12 into a kitty cat.

For cats who do not have tummy issues (unlikely given the etiology of diabetes in cats), one can use oral B12 e.g. NOW brand. However, cats with IBD or pancreatitis or small intestinal disease have trouble absorbing B12 from pills. In their case, try sublingual methylcobalamin. Natural Factors brand is the only one without sugar, colorings, and other icky ingredients. You will have to pop in a pill or portion of one e.g. 1/4 tab = 250mcg, and hold your cat's mouth closed for several seconds till it dissolves. Get falconer's gloves or something first!

Dietary Modifications

  • Feed your cat small frequent meat-based meals; all cats need this but it's critical for diabetic cats.
  • Make sure his/her diet has no simple carbohydrates which are converted into sugar very quickly in the body. Be vigilant about so-called low-carb foods which may not have grains, but contain potatoes, fruits, and other such high-glycemic items.
  • Diabetic cats sometimes need a little bit more moderately fermentable soluble fiber in their diet than their non-diabetic counterparts. 1/8 teaspoon of either rice bran (NOW and EnerG brands) OR 1/8 teaspoon psyllium husk mixed with water are good choices. If your cat won't accept either of these, low-glycemic vegetables 5% or less of overall diet works well too.
  • Keep honey on hand if kitty becomes hypoglycemic or starts shaking. Rub some along gums to bring blood sugar levels up.

Treatments

Sometimes switching a cat (gradually, to be safe) to a raw or even grainless canned diet brings blood glucose levels back down enough to where the cat doesn't even need insulin. I have seen this personally and on the list many times. If blood glucose levels do not come down with proper diet, treatment consists primarily of insulin injections.

Other times, one can cut back on insulin injections (with guidance from a vet, of course) by monitoring blood glucose levels at home as well as keeping an eye on urine output, water intake, etc. If your cat needs insulin, you must test BG levels before giving a shot of insulin. Do not depend on urine dipsticks because by the time glucose spillage occurs in urine, the BG levels can be quite high. In cats, the renal threshold for glucose is 220 mg/dl, far too high for the usual diabetic cat treatment range of 100 – 200 mg/dl.
Insulin for pets is made from pork and beef with most list cats doing best on beef PZI insulin. There are strict guidelines on the storage, and administration of insulin injections; diabetic forums have excellent detailed information on blood glucose monitoring at home, as well on the best type of insulin and syringes to use.

Injection site

The injection site for insulin is extremely important, as it shouldn't get into the bloodstream too quickly (can cause death due to overdose), or get into a fatty area from where it will not be absorbed fast enough.

According to this paper by Greco,D.S., Broussard,J.D. & Peterson,M.E. "Insulin therapy". Vet Clin N Amer (Small Anim Pract) 25, 677-689 (1995), just like with humans, where the insulin injection is given is extremely important because different parts of the body absorb insulin differently. The full-text is not available online, so I'll quote from my hard copy.

In cats, people will often give shots in the scruff of the neck like with subcutaneous (SQ) fluids. According to these authors, this isn't ideal because of "low blood flow and increased fibrosis caused by repeated injections".

Instead they recommend insulin shots be given "along the lateral abdomen and thorax" and should be "rotated daily in order to prevent fibrosis at an injection site".

Thorax is the chest cavity and with lateral abdomen I believe they mean along the sides of the abdomen. IIUC, one shouldn't inject right in the navel itself but around and out to the sides a bit is fine. In some cats, one can lay them on their backs, and as long as one avoids the nipples and navel, stomach can be a good place. In humans, maximum and most reliably consistent absorption of insulin is from injections in the stomach.

Alternatively, if a cat will lie on his/her side, one can inject anywhere along the sides of the body including hip areas. Stay away from extremities because insulin is poorly absorbed from there due to movement.

And in that paper, they mentioned dorsal area (back), so if kitty is standing or sitting on his/her haunches, then moving out from the spine out to the sides like hips/flanks is a good place to give insulin too.

Choose different spots each day as recommended in the literature to prevent granuloma from forming. If your kitty is sore from a granuloma and/or from ear-testing for BG, apply pure emu oil alone or mixed with St. John's Wort/Hypericum herbal/homeopathic tincture.

Holistic treatment options

It's much easier to deal with pre-diabetes because herbs, supplements, and diet can keep a kitty from developing diabetes. But once a cat is on insulin, it all becomes trickier to manage. Do not give a diabetic cat any herb, supplement, or homeopathic remedy without keeping strict tabs on BG levels. Constitutional homeopathic treatment is the only truly effective treatment and dare I say "cure" for diabetes. If you want to go at it alone, I've outlined some ideas but these should be treated merely as a starting point.

Herbs

There are no studies that have looked specifically at herbs for feline diabetes.

Stevia, Chinese herb He Shou Wu a.k.a. Fo-Ti (Polygonum multiflorum), and Ayurvedic herbs Bitter Melon (Karela) and Gymnema Sylvestre (Gur Mar), Holy Basil Leaf, and Eclipta alba a.k.a Bhringaraja or Kesharaja have shown promise in the treatment of diabetes in humans.

Some cats on the list have been on one or more of these herbs. There are no established safe or therapeutic amounts for these herbs in cats. Any herbal regimen would need to be customized for each cat.

Cinnamon is the only herb that has been used on my list for at least 10 years. As with the other herbs and supplements, it is particularly helpful in the early stages.

Cautions:

  • Use only water-soluble extract (to avoid coumarin and oils)
  • Avoid cinnamomum cassia form

In other words, stick to Cinnamomum Verum/zeylanicum the latter is also known as true Ceylon cinnamon as found in this paper:

Taherm Muhammad, Fadzilah Adibah, Abdul Majid, and Mohamad Roji Sarmidi, "A proanthocyanidin from cinnamomum zeylanicum stimulates phosphorylation of insulin receptor in 3T3-L1 adipocytes", Jurnal Teknologi, 44(F) Jun 2006: 53–68

Be sure to monitor glucose levels very carefully because in human studies, the effect of insulin was greatly intensified with cinnamon supplementation. Although I've seen suggestions for therapeutic human dose ranges from 250 to 1000 mg/day, as per mouse studies 200mg seemed to be just as effective.

If 200mg is the dose for humans, extrapolating from there for a cat one doesn't presumably need all that much. Needless to say, one would need to check BG big time just as if on insulin. Note - it takes a given dose of cinnamon at least 2 weeks to provide a reliable baseline. So don't plan on it acting like giving an insulin shot. Use the right (water-extracted) product e.g. NOW brand, starting with only around 20 to 25mg at first, and monitor BG levels closely. It takes some trial-and-error e.g. in some cases, cats do well on as much as 200mg and in others just 50mg keeps their BG levels in check. In other words, cinnamon is best used when a cat is not in a condition where insulin is necessary.

Supplements

  • Vitamin E - in humans has been shown to help diabetics cut back on their need for insulin e.g. as reported here. One can give cats 50-100 IU daily.
  • Pancreatic enzymes – if there is diagnosed Exocrine Pancreatic Insufficiency (EPI) to help the pancreas do its job. .
  • Pancreas glandulars and/or adrenal glandulars. Glandulars are made from animal tissue. Look for a brand that uses organic, good quality glandular material.
  • Water-soluble vitamins such as Vitamin B-Complex and Vitamin C. Ascorbic acid is a little rough on the stomach, so calcium ascorbate might be a better idea. In this paper, they found ascorbic acid helps with blood pressure and cardiovascular risk. Cats produce their own Vit C, but who knows, in times of stress, it's possible Vit C can help?
  • Trace minerals can be useful as well as chromium, zinc and manganese help to balance blood sugar. This is safer than giving Chromium Picolinate, on which even for humans, the jury is still out as to its safety and efficacy.
  • CoQ10 - 10mg of CoQ10 per 3 lbs of kitty body weight
  • These two supposedly work by increasing sensitivity of tissues to insulin and decreasing glucose release from the liver: Vanadyl Sulfate 10mg and Chromium Picolinate 200mcg
  • Below are 2 references (same author/presenter) that talk about using chromium (200mcg dosage) and vanadyl sulfate for cats with diabetes:
    • Greco DS. "Treatment of non-insulin-dependent diabetes mellitus in cats using oral hypoglycemic agents". In: Bonajura JD, ed. Current Veterinary Therapy XIII. Philadephia, PA: W.B. Saunders; 1999:350.
    • Greco DS. "Treatment of feline diabetes mellitus (dm) with pzi and transition metals". American Association of Feline Practitioners Fall Meeting. Nashville, TN; October 16-19, 1999.

Caution: There are concerns regarding toxicity especially for Vanadyl Sulfate, so it should not be used for more than 3 weeks at a time with long breaks in between.

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