A: While almost all diabetic dogs require insulin, many cats can be managed without it.  Unlike dogs, most cats develop a type of diabetes that is similar to adult-onset diabetes in people.  These cats usually have a history of being overweight.   The key to successful treatment without injections is to catch the disease in its early stages.  Once a cat becomes clinically ill, insulin therapy is frequently required.

              All diabetic pets should be regulated under the careful supervision of a veterinarian.  Examinations and blood tests will be required every few weeks initially.  Diabetes can deteriorate rapidly and life-threatening complications can develop if regulation is inadequate.  You should never try to regulate a diabetic pet without a veterinarian’s oversight.

              If your veterinarian determines your cat’s diabetes is in the early stages, the first step in treatment involves a high protein, low carbohydrate prescription diet.  I have had the most success with using a canned formula exclusively for the first six weeks of therapy.  In well-regulated cats, a similar dry food can be added back later.  My preferred brand is ProPlan Veterinary Diets Diabetes Mellitus (DM) Formula.  Other manufacturers make similar products.  However, no over the counter formula that I have seen replicates the proper protein to carbohydrate ratio. 

              In formulating a feeding protocol, all overweight cats should be placed on a restricted calorie diet.  The restriction should be targeted at a 2% weekly weight loss.  Weight checks every 7-14 days will be important to track progress, adjust calories, and be sure the weight loss is not too aggressive.  Rapid weight loss in obese cats has been linked to a serious liver disorder – yet another reason to ask your veterinarian for help.

              A high protein diet, carbohydrate restriction, and weight loss will control diabetes in many cats.  If yours is not one of them, your veterinarian can prescribe an oral medication designed to lower blood sugar.  The pill is usually given twice daily, but some may get by with once daily administration

               If all of these steps are unsuccessful, insulin may be necessary.  The good news is that needles used for insulin are so extremely thin and sharp that they are nearly painless.   Different cats respond in different ways to various insulin formulations, so several tries may be necessary.  Frequently long-acting human insulin is used.  However, there is FDA approved veterinary insulin that may be more appropriate for your cat.  Either way, the goal should be to find insulin that has a long enough duration of activity in your particular cat that you can give the injections once daily. 

              I generally consider it a failure when we need to use twice daily insulin injections in a cat.  It means I failed to convince the owners to put the cat on a diet when I saw her for her regular examinations.  It means I failed to convince the owner about the importance of early detection using blood and urine tests every six to twelve months.  It also usually means I failed to get the cat on a prescription diet early enough.