Practice Scenario

Get to know Tigger, a senior cat with polyuria, polydipsia and periuria.

Meet TIGGER

A 10-year-old, neutered male Domestic Shorthair cat

  • Tigger, a mostly indoor cat, is presented for evaluation of inappropriate urination that started possibly 2 days ago. The owner reports the cat normally urinates in one of two litter boxes but recently found he had urinated in a laundry basket of dirty clothes. The owner also had noticed more urine clumps in the litter boxes and had seen Tigger drinking from his water bowl more often. 
  • Tigger has ad libitum access to controlled amounts of dry kibble and is offered wet food twice daily. The owner noted that he has become more finicky about which foods he will eat and has vomited occasionally in the past month.
  • Physical exam revealed a bright, alert, and responsive cat with a body condition score of 5/9 and normal muscle mass. Abdominal palpation revealed a small left kidney (the right kidney could not be palpated) and a mildly distended bladder that was not painful. The rest of Tigger’s exam was unremarkable.
  • Initial evaluation of urine obtained via cystocentesis showed a urine specific gravity of 1.025, no proteinuria, quiet sediment and a pH of 6.4. Other results were within normal limits. Blood work (i.e., complete blood count, serum chemistry profile, total thyroxine) results were within normal limits, although the total thyroxine level was at the upper limit of the reference range.

Pancreatic Disorders

Diabetes Mellitus in Cats

Dietary modifications along with insulin are integral to the management of diabetic cats. Unlike dogs, which have type 1 diabetes and remain insulin dependent, most cats typically have type 2 diabetes and may achieve diabetic remission.1,2 Diabetic remission means blood glucose levels can be managed by diet alone without exogenous insulin or other glucose-regulating medications in cats that previously required treatment to control diabetic signs.1 

Obesity, indoor lifestyle, physical inactivity, advancing age, and male gender are significant risk factors for diabetes mellitus in cats.1,3,4 Obesity is recognized as the most important manageable risk factor, with overweight cats having a 4-times greater risk for diabetes than cats in ideal body condition.1,5 Each 1-kilogram increase in body weight in healthy cats leads to a 30% decrease in insulin sensitivity.6 

feline pancreas icon

The goals of dietary management are to:

  • help regulate glycemic control to manage clinical signs of diabetes, including polyuria, polydipsia, polyphagia, and weight loss 
  • achieve and/or maintain healthy body condition and muscle mass 

Key Messages

  • Nutritional management of diabetic cats is different than for diabetic dogs because of the underlying disease etiologies. 
    • In newly diagnosed cats, the first goal of management is to gain glycemic control through diet and medication, including insulin as needed.
    • The most important complication associated with insulin therapy is excessively low blood glucose level. Signs of hypoglycemia may occur suddenly and can include: 
      • weakness
      • lethargy
      • restlessness
      • disorientation
      • incoordination
      • changes in behavior
      • muscle twitching
      • seizures
      • coma
  • Nutritional recommendations include:4,8 
    • A high-protein diet (defined as dietary protein ≥ 40% of metabolizable energy [ME] calories) is preferred for diabetic cats because it can help stabilize glucose levels, maximize metabolic rate, avoid protein malnutrition, prevent muscle mass loss, and improve satiety.7 
    • Dietary carbohydrates should be restricted. A suggested target is ≤ 12% of ME calories or 3 grams (g) of carbohydrates/100 kilocalories (kcal).4,9,10 
      • Studies suggest the amount and type of dietary carbohydrate strongly influence postprandial insulin and glucose concentrations in cats.4
      • Multiple studies support the efficacy of high-protein, low-carbohydrate diets to improve insulin sensitivity, decrease insulin needs, and enhance glycemic control.9,11─14 
  • Once glycemic control is established, managed weight loss in obese cats can help decrease insulin resistance, improve insulin control, and increase chances for diabetic remission.
    • Overweight or obese cats who are regulated, have stable body weight, and still need to lose weight may benefit from a high-protein (> 40% ME calories, > 10 g protein/100 kcal), lower-calorie diet fed at 80% of resting energy requirement for ideal weight.8 
      • Target weight loss is 0.5% to 1% of body weight per week. Rapid weight loss should be avoided due to the risk for hepatic lipidosis and excessive loss of lean body mass.8
      • A high-protein, low-carbohydrate diet helps maintain insulin sensitivity, which can help increase fat loss and preserve lean body mass during weight loss.6 
      • A higher-fiber, high-protein weight management diet may be useful in some obese, diabetic cats to facilitate weight loss. Digestible carbohydrates should be limited to 12% to 26% of ME calories in these diets.4,8,15 
  • Feeding ad libitum or multiple small meals each day may optimize glucose management. 
    • Research shows diabetic cats can be allowed to follow a typical feline food ingestion pattern of many small meals since they tend to have small changes in blood glucose and minimal postprandial hyperglycemia. Consequently, insulin injections do not need to coincide with meal feeding in diabetic cats that are naturally eating many small meals daily.16
    • Overweight or obese diabetic cats will still benefit from a portion-controlled amount of food as part of a weight loss program.
  • Checking for clinical signs is important to effective diabetes monitoring. Useful, practical indicators of diabetes control in cats are water intake or urine output over a 24-hour period, as well as assessment of the cat’s activities, appetite, and demeanor.4 Other parameters owners can monitor at home include body weight and body condition.
    • Pet owners may want to buy a baby or small animal scale so they can monitor body weight at home. They can also learn how to perform body condition scoring at home.
    • Weight loss in obese patients often reduces the amount of insulin needed to maintain healthy blood glucose levels.
    • Rapid and/or unplanned weight loss is an indication of poorly controlled diabetes.
  • Adjust dietary recommendations, as needed, when concurrent diseases are present (e.g., pancreatitis, renal disease, or intestinal disease).
conversation starter

“Your cat [cat’s name] has diabetes mellitus, which means [his/her] pancreas is not making enough insulin or the body tissues are not able to respond to insulin—or both. As a result, glucose builds up in the bloodstream which can cause weight loss and increased urination, drinking, and eating. I recommend we start [cat’s name] on insulin and change [his/her] food to a therapeutic diet that is high in protein and low in carbohydrates.”

Related Tools and Content:

Obesity in Dogs and Cats

Obesity has many adverse impacts on pet health. Dietary therapy is a cornerstone of weight management in dogs and cats.

View Brief 1 min to 5 min

The Purina Body Condition System

The Purina Body Condition System is an easy and practical tool for assessing a pet's body composition.​

View Brief 1 min to 5 min

Feline Body Condition System Sheet

A visual aid to the Purina Body Condition Score System for cats.​

View Tool 1 min to 5 min

How to Perform a Body Condition Assessment - Cat

Assess a cat's Body Condition Score in just 3 simple steps.​

View Video 1 min to 5 min

Use Muscle Condition Scoring to Detect Muscle Loss in Patients

Muscle condition scoring is a hands-on method for evaluating lean body mass that can be used as part of nutritional assessments.

View Brief 1 min to 5 min

Lean Body Mass & Protein

Discover the importance of Lean Body Mass (LBM) in overall health for dogs and cats, and the role a high-protein diet can play in slowing LBM loss.

View Research 11 min to 15 min

To Share With Pet Owner:

Evaluating Your Cat’s Body Condition

Assess your cat's Body Condition in just 3 simple steps.​

View Video 1 min to 5 min

The Role of Diet in Managing Excess Weight

A tailored nutritional approach can help overweight or obese pets lose weight.

View Brief 1 min to 5 min

References

  1. Gottlieb, S., & Rand, J. (2018). Managing feline diabetes: Current perspectives. Veterinary Medicine: Research and Reports, 9, 33–42. doi: 10.2147/VMRR.S125619
  2. Hoenig, M., Reusch, C., & Peterson, M. E. (2000). Beta cell and insulin antibodies in treated and untreated diabetic cats. Veterinary Immunology and Immunopathology, 77(1-2), 93–102. doi: 10.1016/s0165-2427(00)00229-4
  3. Slingerland, L. I., Fazilova, V. V., Plantinga, E. A., Kooistra, H. S., & Beynen, A. C. (2009). Indoor confinement and physical inactivity rather than the proportion of dry food are risk factors in the development of feline type 2 diabetes mellitus. The Veterinary Journal, 179(2), 247–253. doi: 10.1016/j.tvjl.2007.08.035
  4. Sparkes, A. H., Cannon, M., Church, D., Fleeman, L., Harvey, A., Hoenig, M., Peterson, M. E., Reusch, C. E., Taylor, S., Rosenberg, D., & ISFM. (2015). ISFM consensus guidelines on the practical management of diabetes mellitus in cats. Journal of Feline Medicine and Surgery, 17(3), 235–250. doi: 10.1177/109812X15571880
  5. Scarlett, J. M., & Donoghue, S. (1998). Associations between body condition and disease in cats. Journal of the American Veterinary Medical Association, 212(11), 1725–1731.
  6. Hoenig, M., Thomaseth, K., Waldron, M., & Ferguson, D. C. (2007). Insulin sensitivity, fat distribution, and adipocytokine response to different diets in lean and obese cats before and after weight loss. American Journal of Physiology–Regulatory, Integrative and Comparative Physiology, 292(1), R227–R234. doi: 10.1152/ajpregu.00313.2006
  7. Behrend, E., Holford, A., Lathan, P., Rucinsky, R., & Schulman, R. (2018). 2018 AAHA diabetes management guidelines for dogs and cats. Journal of the American Animal Hospital Association, 54(1), 1–21. doi: 10.5326/JAAHA-MS-6822
  8. Clark, M., & Hoenig, M. (2021). Feline comorbidities: Pathophysiology and management of the obese diabetic cat. Journal of Feline Medicine and Surgery, 23(7), 639–648. doi: 10.1177/1098612X211021540
  9. Bennett, N., Greco, D. S., Peterson, M. E., Kirk, C., Mathes, M., & Fettman, M. J. (2006). Comparison of a low carbohydrate-low fiber diet and a moderate carbohydrate-high fiber diet in the management of feline diabetes mellitus. Journal of Feline Medicine and Surgery, 8(2), 73–84. doi: 10.1016/j.jfms.2005.08.004
  10. Zoran, D. L., & Rand, J. S. (2013). The role of diet in the prevention and management of feline diabetes. Veterinary Clinics of North America: Small Animal Practice, 43(2), 233–243. doi: 10.1016/j.cvsm.2012.11.004
  11. Boari, A., Aste, G., Rocconi, F., Dalessandri, A., & Vita, S. (2008). Glargine insulin and high-protein-low-carbohydrate diet in cats with diabetes mellitus. Veterinary Research Communications, 32(Suppl 1), S243–S245. doi: 10.1007/s11259-008-9119-x
  12. Frank, G., Anderson, W., Pazak, H., Hodgkins, E., Ballam, J., & Laflamme, D. P. (2001). Use of a high-protein diet in the management of feline diabetes mellitus. Veterinary Therapeutics, 2(3), 238–246.
  13. Marshall, R. D., Rand, J. S., & Morton, J. M. (2009). Treatment of newly diagnosed diabetic cats with glargine insulin improves glycaemic control and results in higher probability of remission than protamine zinc and lente insulins. Journal of Feline Medicine and Surgery, 11(8), 683–691. doi: 10.1016/j.jfms.2009.05.016
  14. Mazzaferro, E. M., Greco, D. S., Turner, A. S., & Fettman, M. J. (2003). Treatment of feline diabetes mellitus using an alpha-glucosidase inhibitor and a low-carbohydrate diet. Journal of Feline Medicine and Surgery, 5(3), 183–189. doi: 10.1016/S1098-612X(03)00006-8
  15. Laflamme, D. P. (2020). Understanding the nutritional needs of healthy cats and those with diet-sensitive conditions. Veterinary Clinics of North America: Small Animal Practice, 50(5), 905–924. doi: 10.1016/j.cvsm.2020.05.001
  16. Martin, G. J. W., & Rand, J. S. (1999). Food intake and blood glucose in normal and diabetic cats fed ad libitum. Journal of Feline Medicine and Surgery, 1(4), 241–251. doi: 10.1053/jfms.1999.0052