A cat with diabetes – nutrition comes to the rescue!

Diabetes is one of the most frequently diagnosed hormonal disorders in cats, predominantly diabetes mellitus type 2. The diagnosis often brings a lot of uncertainty and distress for the pet and the owner. Therefore, the task of the veterinarian is to quickly achieve glucose control using an appropriate dose of insulin. However, diabetes is often diagnosed in overweight or obese cats, making the management of the condition a challenging task.

Risk factors
It is well known that obesity promotes insulin resistance, which leads to increased insulin secretion by the pancreatic beta cells and consequently to beta cell destruction. Cats are known to develop glucose intolerance and hyperinsulinemia with weight gain. Studies have found that overweight cats are at a fourfold higher risk of becoming diabetic than normal- weight cats.

An additional risk factor for an obese diabetic cat is hepatic lipidosis – a condition that can be life- threatening and occurs when an obese cat stops eating. Anorexia can occur in the case of hyper or hypoglycemia, often seen just before diabetes diagnosis or in poor diabetes management.

Feeding management
Many of these issues can be resolved by achieving a healthy body weight, which is why one of the most important aspects of treating a diabetic cat is the diet: composition and feeding management. But cats are often not the most compliant patients, and a lot of work is needed to make alterations in their feeding habits. However, if changes are made gradually, there is a higher chance of success.

Optimal dietary management would include making the diet high in fiber and protein, low in soluble carbohydrates, and rich in antioxidants and omega-3 fatty acids. In the case of obesity, the energy density of the diet should be adjusted to ensure a gradual reduction of energy and a successful weight loss protocol. Such a diet aims to improve glucose control and provide enough bulk to satiate the cat. This is achieved by using an appropriate combination of both insoluble and soluble fibers.

Soluble fibers are known to form gels in aqueous solutions, thereby binding glucose and water and preventing their transfer to the enterocytes in the intestine. Insoluble fiber has a lower rate of water-holding capacity, decreases the gastrointestinal transit time, promotes slower absorption of soluble carbohydrates in the diet, and therefore reduces insulin peaks after meals.

Conserving muscle mass
High protein content will aid with the conservation of muscle mass throughout the weight loss protocol, as the aim is to decrease just the fat tissue without losing lean body mass. Additionally, diabetic cats may have increased amino acid losses through their urine, and patients that are not well controlled could experience consequent muscle wasting. L-carnitine is often used to increase the level of beta-oxidation of fatty acids in order to spare the protein reserves in the body.

Wet versus dry
The choice between a dry and a wet diet is ultimately related to the cat’s preference, but – as urolithiasis and cystitis are commonly comorbid with obesity and diabetes the preferred dietary management would be to provide at least one part of the diet in a wet form to ensure higher water intake. To achieve better control over the prescribed amounts, an automatic feeder can be used. This enables the cat to be fed multiple small meals throughout the day, which will mimic its natural feeding behavior.

In a diabetic cat, feeding should be tailored around a bigger meal of approximately 30% of the daily amount fed at 12-hour intervals, which is followed by an insulin injection each time, and the remainder in smaller portions throughout the day. Additionally, it is necessary to stimulate both mental and physical activity in the cat using toys or other forms of environmental enrichment.

Close monitoring
Weight loss should be achieved at a gradual rate of 1% (0.5%-2%) per week. A decrease in weight in cats with diabetes can result in better tissue sensitivity to insulin, leading to lower daily insulin requirements. Although this is a positive evolution in diagnosis, it nevertheless requires close monitoring and follow-up as insulin doses have to be carefully adjusted. The ultimate goal is to improve the quality of life of the diabetic cat and finally, even, to reach a full remission where no insulin injections are needed.