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DISEASE · CATS

Diabetes in cats: telling stress from diabetes, and the chance of remission

Diabetes in cats looks much like type 2 diabetes in people, and unlike dogs, some cats go into remission and no longer need insulin. The diagnosis needs care, because a stressed cat can have a very high blood sugar at the clinic without being diabetic.

Written by the AI DiagAnimals editorial teamReviewed by the AI DiagAnimals TeamUpdated Our editorial policy

The essentials

Diabetes affects roughly 1 in 100 to 1 in 500 cats, most often overweight, older, indoor, neutered males. It is diagnosed on a persistently high glucose with sugar in the urine and typical signs, after ruling out stress, which rarely pushes glucose above 288 mg/dL. Fructosamine helps confirm it and monitor control. Many cats go into remission with good early control and a low-carbohydrate diet.

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Which cats get diabetes

Diabetes is found in roughly 1 in 100 to 1 in 500 cats in general practice, and seems to be increasing, partly because of obesity. Most cats have a disease similar to human type 2 diabetes [1].

  • Overweight cats are up to 4 times more likely to become diabetic.
  • Cats over 7 years, indoor or inactive cats, males and neutered cats are at higher risk.
  • Burmese cats are predisposed in some countries; corticosteroids and progestagens can trigger diabetes [1].

Signs of diabetes in cats

  • Drinking and urinating more; a wet or heavy litter box.
  • A big appetite with weight loss, or lethargy.
  • Weakness of the back legs, walking flat on the hocks (plantigrade stance).

Loss of appetite, vomiting and depression suggest ketoacidosis, an emergency [1].

Stress or diabetes?

Cats produce marked stress hyperglycaemias at the clinic. Stress uncommonly pushes glucose above 16 mmol/L (288 mg/dL) and usually resolves within a few hours [1, 2]. Some stressed cats even have temporary sugar in the urine [2].

Fructosamine helps: it reflects the average glucose over the preceding weeks and is not raised by a short stress response. It may, however, be normal in recent or mild diabetes, and it is lower in hyperthyroid cats, which can mask diabetes [1, 3]. See blood sugar in cats.

How to read the fructosamine line

Here is an example line from a cat on insulin.

An annotated line from a lab report · Illustrative example
AbbreviationResultUnitLaboratory intervalFlag
FRUC Fructosamine420µmol/L< 350H
  1. Abbreviation Fructosamine, sometimes FRUC or FRU.
  2. Result 420 µmol/L in this illustrative line, in a treated cat.
  3. Unit µmol/L.
  4. Laboratory interval In treated cats, the ISFM guide reads below 350 µmol/L as excellent control (or too much insulin, or remission), 350–450 as good, 450–550 as moderate and above 550 as poor [1].
  5. Flag Here, good control; it is always read with the cat’s signs and glucose curves [1].

Monitoring and remission

  • Glucose curves: the ISFM guidelines aim for a highest glucose of about 144–252 mg/dL (10–14 mmol/L) and a lowest of about 80–144 mg/dL (4.5–8 mmol/L) over the day; curves done at home avoid the stress of the clinic [1].
  • Diary at home: water intake, urination, appetite, insulin given and weekly weight [1].
  • Remission: in 90 newly diagnosed cats, half went into remission, after a median of 48 days [4]. It is more likely with good early control and a low-carbohydrate diet; cats in remission are still monitored [1].

The two emergencies

  • Low blood sugar (hypoglycaemia): below about 54–63 mg/dL, with trembling, wobbling, weakness or seizures. Rub honey or glucose gel on the gums and call your vet [1].
  • Diabetic ketoacidosis: a cat that stops eating, vomits, is weak or collapses; it is diagnosed on high ketones, acidosis and high glucose [1].

Related articles

Hyperthyroidism in cats

Lowers fructosamine and can mask diabetes.

Read the article

En français : le chat diabétique.

The emergency complication: diabetic ketoacidosis.

Questions to ask your veterinarian

  1. Could stress explain this glucose, or is diabetes confirmed?
  2. Is there sugar or ketones in the urine?
  3. What is the fructosamine, and how will we use it to monitor?
  4. Could we do glucose curves at home?
  5. Is remission possible for my cat, and what diet do you recommend?
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Frequently asked questions

How do cats act when their sugar is high?

They drink and urinate more, may eat a lot yet lose weight, and some walk flat on their back legs [1].

Can diabetes in cats go into remission?

Yes. In one study, half of newly diagnosed cats no longer needed insulin after a median of 48 days, especially with good early control and a low-carbohydrate diet [1, 4].

Why is my diabetic cat always hungry?

Without enough insulin, the body cannot use glucose for energy, so cats stay hungry and lose weight. Hunger improves with control [1].

Why is my diabetic cat peeing outside the litter box?

Large volumes of urine can overwhelm the litter box, and urinary infections are more common in diabetic cats. Tell your vet.

How many times a day should a diabetic cat eat?

It depends on the insulin and the diet. Follow your vet’s plan, usually matched to the insulin injections.

Sources

  1. Sparkes AH et al. ISFM consensus guidelines on the practical management of diabetes mellitus in cats. J Feline Med Surg. 2015;17(3):235-250. doi.org/10.1177/1098612X15571880
  2. eClinPath, Cornell University College of Veterinary Medicine. Glucose. eclinpath.com/chemistry/energy-metabolism/glucose
  3. eClinPath, Cornell University College of Veterinary Medicine. Fructosamine. eclinpath.com/chemistry/energy-metabolism/fructosamine
  4. Zini E et al. Predictors of clinical remission in cats with diabetes mellitus. J Vet Intern Med. 2010;24(6):1314-1321. doi.org/10.1111/j.1939-1676.2010.0598.x

Laboratory methods and reference intervals vary. This article explains; it does not diagnose. For a decision about your pet, use the original report and talk to your veterinarian. Our editorial policy.

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