Unravelling Feline Diabetes

Diabetes in cats may come as a surprise, yet it is a reality. During my time in vet school, some of my relatives would enquire in Kashmiri, “Janwaran Chaa Gassa Sugar. “ Fortunately, I have since acquired the knowledge to address this question. The rise in cat ownership in Kashmir can be attributed to religious devotion and the distinct traits of cats leading to an increase in their popularity in recent years, a trend expected to persist. Cats are often referred to as ‘daytime dreamers’ and ‘night-time hard noses.’ In addition to a balanced diet and access to fresh water, cats necessitate regular medical care. Current research indicates that most cats experience underlying insulin resistance and subsequent β-cell dysfunction, making feline diabetes comparable to human type 2 diabetes mellitus. In the regions of Kashmir and Ladakh, approximately 8% of the population is affected by diabetes, with an additional 10% at risk of developing the condition. In observance of World Diabetes Day, the Sher-e-Kashmir Institute of Medical Sciences (SKIMS) in Srinagar shared these insights from the ICMR-INDIAB study on Thursday. Research conducted in Jammu and Kashmir has highlighted the role of a sedentary lifestyle and Western dietary practices as significant factors contributing to the prevalence of diabetes. It is anticipated that the incidence of feline diabetes will also rise in Kashmir in the coming years.

Feline diabetes

In Kashmir, ownership of cats and pet clinics is predominantly observed in urban areas, especially in Srinagar. Diabetes has evolved into a lifestyle-related health issue affecting a broader population. In the realm of human health, there exists a worldwide agreement on the diagnostic criteria for diabetes, as well as a shared understanding of what constitutes a cure. In feline practice, diabetes is diagnosed through the identification of symptoms such as increased thirst, urination, and appetite, along with weight loss and persistent hyperglycemia or glycosuria. Following diagnosis, treatment is promptly initiated. In rare instances of poorly managed diabetes, cats may suffer nerve damage in their hind limbs, leading to a “plantigrade” posture, where they walk or stand with their hocks near the ground. This condition is not painful and typically resolves with appropriate treatment. The primary approach for assessing impaired glucose tolerance in human medicine is the oral glucose tolerance test. In contrast, intravenous glucose is administered to cats, as oral glucose delivery requires careful handling to reduce stress and prevent hyperglycemia. To minimise diagnostic errors, a lab test measuring fructosamine concentration is employed for diagnosing feline diabetes. Since glucose is more frequently found in the urine of euglycemic cats, it is not a reliable marker for feline diabetes diagnosis. Vets may recommend additional tests to exclude other conditions that could be causing a cat’s clinical symptoms, such as urinary tract infections, chronic kidney disease, pancreatitis, or hyperthyroidism. Research has indicated a clear correlation between obesity and the development of diabetes in feline patients. However, it remains uncertain whether weight loss will universally improve the quality of life for all obese cats, as not all of them exhibit health issues. The incidence of feline diabetes is currently experiencing a notable increase in the West compared to India. The ownership of cats is anticipated to rise in the coming years, particularly in regions of India with a predominantly Muslim population, such as J&K. Cat owners should be aware that there is a correlation between the consumption of dry food and an elevated risk of diabetes in cats of normal weight. Feline obesity, advanced age, lack of physical activity, male sex, and the administration of steroids for conditions such as feline asthma are recognised as the primary risk factors contributing to the onset of diabetes. The field of veterinary medicine has aligned its terminology with that of human medicine, employing the classifications of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).

Management

Managing diabetes aims to relieve symptoms and improve quality of life for both the cat and its owner. Achieving these goals necessitates effective glycaemic control while simultaneously preventing hypoglycemia and other potential complications, such as diabetic ketoacidosis. Owner involvement in diabetes management is crucial, as factors like boarding challenges, leaving cats with friends or family, anxiety, hypoglycemia concerns, and financial burdens negatively impact their quality of life. It is important to address these concerns with owners on an individual basis and to make necessary adjustments to the treatment plan, such as modifying injection times to better fit the owner’s lifestyle. Access to vet support and guidance is vital for successful treatment outcomes. Traditionally, these objectives are met through a combination of insulin therapy and a diet low in carbohydrates. However, newer oral medications, such as sodium-glucose cotransporter 2 inhibitors (SGLT2), may represent a viable treatment alternative for certain cats. SGLT2 inhibitors received their initial approval for human use in 2013. Bexagliflozin tablets and velagliflozin oral solution are classified as SGLT-2 inhibitors utilised in the management of diabetes in felines. It is imperative that treatment options be tailored in consultation with a vet, taking into account the specific needs of each cat.

Continuous monitoring by both the pet owner and the vet is crucial in the management of diabetic felines. Such monitoring aids in determining the optimal insulin dosage for each individual cat. With prompt and vigorous treatment, many cats can achieve diabetic remission, allowing them to maintain normal blood sugar levels without the need for insulin injections.

Tail-piece

Diabetes is a serious condition in both humans and pets, but with prompt detection, treatment, and careful management, many patients can live well for many years after diagnosis. A more integrated interdisciplinary ‘One Health’ approach that bridges veterinary and human medicine is essential for enhancing research and clinical care in the context of diabetes.

Dr. Abrar Ul Haq Wani, Assistant Professor cum Scientist, Dept. of Medicine, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab.